Month: January 2023

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“Catch-up Hair Loss”

If you used finasteride for a year and it slowed or stopped your hair loss and then you stopped the drug, you would play ‘catch-up’ hair loss and could lose all of the hair you would have lost while you were on the drug.

Yes, if you used finasteride for a year and it slowed or stopped your hair loss and then you stopped the drug, you would play ‘catch-up’ hair loss and could lose all of the hair you would have lost while you were on the drug.


2019-05-01 08:06:44“Catch-up Hair Loss”

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Catch-Up Hair Loss, Finasteride, and Hair Cell Suicide

Hi, Dr. Rassman.

You’ve written a number of times about the “catch-up” loss that happens when a patient discontinues finasteride/propecia. I know you didn’t design the drug, but I was wondering if you know how this catch-up process works.

What I have a hard time understanding is this: If androgenic alopecia is a gradual process of miniaturization, why doesn’t that process-when you stop the drug-just pick up where it left off at the start of therapy? It seems like something must be getting worse “behind the scenes” during the course of therapy. Is it known what that something is?

I hope that made sense. Thanks!

Propecia (finasteride 1mg) sustains scalp hairs that are genetically susceptible to falling out. It does this by a process of competitive inhibition. When the drug is no longer available, the DHT is manufactured by the body and it ‘attacks’ the hair follicle which is like turning off the ‘life’ switch of the dermal papilla cells (which manufactures the hair follicles).

Once you stop taking the medication, you will not lose all the hair at once, but the ‘attack’ will occur over a few months. The hairs that were being supported by finasteride will go back to its pre-destined state, which is something called apoptosis (these dermal papilla cells that generate the hair follicle commit suicide — just die off).

For more about apoptosis, see ResearchApoptosis.com and Wikipedia.


2008-06-25 09:32:23Catch-Up Hair Loss, Finasteride, and Hair Cell Suicide

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Castration and Hair Regrowth

From what I have read, castration stops hair loss however, castration will not regrow hair that has been lost. If this is true, why would Proscar grow any hair? It is my understanding Proscar blocks a percentage of DHT, which leads to the effectiveness of the product. If someone has been castrated there is o% DHT and still no hair regrowth? Also if DHT causes hair loss why is Propecia effective on the vertex of the scalp and not the temples.

There is a wide audience of young men (over a million) who have taken Propecia and we know that in the very young man with active miniaturization, the process may be reversed. This occurs mostly in young men in their 20s. I would guess that if we castrated 1 million men who are balding in their 20s, that the incidence of regrowth would be higher than those on Propecia alone, but I am not recommending castration as this is only an intellectual exercise.

When a hair is dying (miniaturized hairs fall in this category), like a dying person, they have a chance of being fixed or cured because they are not dead yet. When a hair has completely disappeared, it has gone through apoptosis, which means that the hair growth center is dead… and we all know that you can’t raise the dead. This applies to hair when the head is slick bald in any area impacted where there is no miniaturized hairs.


2009-11-19 16:17:51Castration and Hair Regrowth

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Carona Virus projects particles come out of our mouths

Just look at the distances. This is why it is important to keep away from other people if you want to avoid catching the Carona Virus. If you wear any protective mask and you have the virus, the mask will catch the projected droplets from your breath but the mask may not protect your from breathing it in when you are near someone who is projecting these droplets. The last photo shows microdroplets in a room 20 minutes after a cough by the person on the right. The entire room has circulating microdroplets exposing everyone in the room to potential infection. The last photo is from a video showing what happens in a super market where one shopper coughs and another is caught up in the droplets spread after a single cough in just seconds. In the stagnant air of an indoor market, virus particles spread very easily in the hair if someone is infected coughing.


2020-04-09 19:51:04Carona Virus projects particles come out of our mouths

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Why Can’t My Transplanted Frontal Area Have a Density Equal to What It Was Originally There in a Single Surgery?

The recipient area density is never equal to the original density, nor should it be because all of the donor hair would be used up. Also, there are mechanical limits on how closely a doctor can place the grafts to allow sufficient space and blood supply for good healing


2018-06-21 06:17:35Why Can’t My Transplanted Frontal Area Have a Density Equal to What It Was Originally There in a Single Surgery?

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Can’t Take Finasteride, Follow-Up

I want to reference: Can’t Take Finasteride, But Is a Hair Transplant Still an Option?

Dr Rassman,

Thank you for answering my original enquiry. Whilst i understand that one your goals is to protect patients from over enthusiasm for a HT. But is a HT something you would do on a 22yr old male who can’t take finestaride. I ask this before one fly’s across the globe to see you for a consultaion.

Thank You

I can not tell you for certain that I would do a hair transplant on you without knowing your donor density and doing a miniaturization study to determine (if possible) what your projected hair loss is. Knowing your supply and demand potential and your density and laxity, I would then make a decision on a hair transplant on you. So if you can’t or won’t take Propecia (finasteride 1mg), it does not 100% rule you out, but I first need to make that assessment.

We can arrange a call after I receive good photos of you and base some of this evaluation at the time of a telephone consultation. To setup the telephone consultation with my office, you can fill out our handy web form and you’ll be contacted via email to complete the setup.

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Can’t Take Finasteride, But Is a Hair Transplant Still an Option?

Dr Rassman,
If one has been evaluated by a urologist and undergone a variety of tests for problems and finasteride has been single out as the cause. Can one still undergo restoration work? Or should one simply forget it?

You are asking for a medical opinion without my ability to find out details about you, something that I do when I perform a consultation. Things like family history, age, miniaturization (where it is and how advanced it is) will tell me much. One can have a hair transplant without taking Propecia. I do this in older men and in men who I can predict what will happen to them over time. Everyone is different. My job is to protect you from over-enthusiasm, bring you down to reality, and then try to accomplish your goals (which may or may not be a hair transplant).

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Can’t Doctors Remove Old Hair Plugs One By One?

Hi Doctor. Thank you for having this great site!!

About 25years ago I had a HT using the hobby drill method. Now I have 3 rows of white plugs. I am like most of the others on this site and want to shave my head. I was wondering if you have ever considered a procedure to re-drill the plugs and suture them closed similar to the way you show it being done to patients for the top of their heads. I have spoken to other doctors and they want to cut the entire area out and suture it closed. They also state that it would take two or three procedures. Why can’t someone just re-drill and suture shut the area?

We have done what you described — taking each of the old style hair plugs out one-by-one and suturing each wound closed. We have also cut out the entire row and sutured it all closed. And we’ve even done a combination of both. Here’s a step-by-step story of the process one man took to repair his pluggy hairline. It took multiple surgeries to complete his repair, with the first procedure being a removal of a row of plugs, and the second procedure being individual removal of some of the remaining plugs.

My point is, everybody is different and every treatment plan for each individual is unique. In the end, find the doctor that you trust and ask to see some before after results of these repair procedures. You may even ask to speak to their former patients or meet them. Good luck.

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Can’t control my hair loss with medications

21 y/o M Currently been on fin 1mg ED for over a year and a half. Closing in on one year oral min 2.5 mg ED. Got some great results from the combination until about February time I’ve slowly started to get worse and worse. Im still above baseline but I’m starting to consider other options. What do y’all think. Not just my case in specific but in general would it be bad to get a transplant because of shock loss etc?

Male Patterned Balding is not a problem that stays fixed after you treat it with finasteride. It is a progressive problem and continues with age until you reach your final inherited balding pattern. Generally, that pattern can be estimated best when a man is over 26; however, in some cases, the final pattern can be determined with 80% accuracy) with an experienced hair surgeon. Circumstances do occur when I transplant someone of your age. Still, I require a relationship between the patient and me so I can determine factors like (1) examination elements to determine donor density and donor hair mass), (2) maturity, (3) stable mental state, (4) the finances to finish a worst case scenario if you start going that route and (5) worst case patterned balding that you might develop over the next 5 years. By worst case, I mean hair loss acceleration after a hair transplant (something I usually can predict before the transplant) and the use of medications like finasteride, or oral minoxidil, or topical liposomal finasteride (which mostly stays in the scalp.