Author: Dr. William Rassman

Dr. Rassman:

Upon reviewing your CV, I am extremely impressed with all that you have accomplished. It is an honor to be able to read your thoughts on your blog.

I am a medical student at a Philadelphia medical school, and I too am going into the armed forces via the Health Professions Scholarship Program. I see that you served in the Army MSC. How was your experience with that? I am excited to serve my country and have medical school paid for at the same time.

Finally, and as it pertains to the discussion at-hand, I have just begun a propecia 1mg/day regimen today. I also use topical minoxidil (MiN Agent 5%). Is there anything else I can be doing to halt/reverse my thinning hair? As a 23-y/o male how soon can I expect results? What is the advantage of adding nizoral or t-gel to my current regimen? My scalp sometimes itches, but I rarely get dandruff or redness as would be evidence of sebborheic dermatitis.

I recently saw a HT surgeon for my finasteride prescription. He didn’t do a miniaturization study, however he took before/after photos. Is this sufficient, or is a miniaturization study absolutely necessary? It is obvious that my hairs are miniaturized in the front and at the vertex, while there is no “bald spot”, the hair is losing pigment and is noticeably finer.

Finally, how do you feel about the current 1-yr standard training for HT surgeons? It is obvious that you have far more surgical training than that. Do you feel a one-year fellowship is adequate?

Thanks in advance, Dr. Rassman. I look forward to your response!

Thanks for your kind words. My military experience was long ago, but rewarding. I could write a book just about my experiences, but this isn’t really the place for that right now. I would like to thank you for your service and wish you the best of luck.

At 23 years old, your hair loss is likely in the early stages, so the minoxidil / finasteride combo you’re using is the best you can do for yourself. Nizoral’s active ingredient is ketoconazole, which some believe will help with hair growth (though that’s not been proven)… and Neutrogena T-Gel’s active ingredient is tar, which will offer no benefits for hair growth (yet it still is used by some as a hair loss treatment). Both are good dandruff shampoos, though.

Obviously, a miniaturization study puts numbers to the balding. When I see it reverse from the photographs, I expect that the degree of miniaturization should also be less. I never understood why doctors in this field are so reluctant to put numbers to the degree of miniaturization.

I have one of the few certified facilities that offer training for hair transplant surgeons. When I train them, the fellowship lasts a year. It is very difficult to train these doctors, as I have to volunteer my patients (with their permission) to allow the trainee to work on them. I am right at their side when that happens, so that the work being done is totally under my control. This is one of the many reasons that it takes a year to train. Even after that period, I have seen the difficulties the doctors have when they are completely on their own.