Author: Dr. William Rassman

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Free Testosterone Declines with Propecia Use?

Dear Dr. Rassman,

I am a 31 year old male who has been on Propecia for 5 years. After getting bloodwork done, it was discovered that while my Total Testosterone was high, the percentage of Free Testosterone was proportionately low.

Then, I discovered an article from an Egyptian medical journal entitled “Effect of Oral Finasteride on Serum Androgen Levels and Androgenic Alopecia in Adult men”, which found that all men in the experimental group experienced a decline in free testosterone after taking Propecia relative to no change for those taking a placebo. Were you aware of this? Does this not add to the growing body of literature showing how dangerous Propecia really is?

The main point of why Propecia (finasteride 1mg) works is because it changes DHT hormone levels. DHT is the result of testosterone catabolism (it is a byproduct of testosterone metabolism). So to say Propecia affects testosterone in some way is valid, but I cannot say what this really means. The study you refer to included only 30 men and it does not go on to state what the implication is or what the significance is of the findings.

For those interested, the study can be found here (PDF file).

These are the type of articles that can cause confusion and add fuel to the never-ending debate on Propecia depending on how you parse the information presented. Anyone can quote articles and infer what they want, but the real meaning or significance is unclear. At least this is interesting reading. Let the debates begin… or rather, continue!

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Frequent emails from many of the same patients asking me about their surgical problems

I get emails every day from patients who had their surgeries from all over the world and couldn’t get their doctors to return their phone calls. One man today told me that his doctor always returned his phone calls when he had questions BEFORE the surgery, but will not now return his calls. Some doctors think that you, the patient, is here for them to make money from. They sell you their services, treat you well until you go forward with the surgery. Then it is the next patient, not you, then gets their attention. Immoral doctors behave like this!!!!!!!


2019-09-05 08:37:12Frequent emails from many of the same patients asking me about their surgical problems

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Frightened to take Finasteride

hey dr. wrassman, i know there’s probably no chance you respond, but i wanted to just look for advice.

i’m 19 years old, about to turn 20 in january. my hair has been thinning and i’ve been a diffuse thinner for years, so the thinning is making it slightly worse as time goes on. i want to take finasteride so badly but the side effects scare me. i know they’re present in about 4% of men, but the recent reveal about merck lying about their side effects claim freaked me out as well. would you mind helping me calm down and explaining everything to me?

Most of the guys who take finasteride think that they are just taking their daily vitamins. That is my experience as I take it now and my son’s experience as well. This is completely your decision. If you don’t talk yourself into side effects, then if you get them you can just stop taking it. I don’t believe that PFS ever appeared in a normal person taking finasteride for a short time and then stopping it.


2020-07-16 07:18:29Frightened to take Finasteride

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Freezing donor hair for future balding

For someone paranoid about balding, but currently too poor to do anything about it aside from fin/min (oral+top) and derma-stamping, is there any way to somehow save donor area hair for the future? I worry that if financial security ever comes, it’ll be too late as far as my donor area is concerned. Any cheap solution to this? Do I just scalp myself and toss it in the freezer? (Kidding).

The donor area remains intact in most men throughout their early years until 60. After 60, some men start losing their donor area hair. This is a normal process and nothing to worry about. Freezing hair for future use sounds extreme to me and not practical today.

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From a Reader — A Note to Teenagers About Hair Loss

Well doc, I’ve got to hand it to you. You’ve solved all my problems. I’m 20 years old, and had been losing hair for over 2 years now. I was worried,stressed,depressed.. dreaEverything you can imagine.

I also tried all the products on the market that claimed to stop hair loss- creams,oils,herbal ‘remedies’. I didn’t use propecia though,it required a prescription which would mean I’d have to tell someone I was losing hair. No product seemed to work. Suddenly,long after I stopped using these products, my hair loss stopped.

Finally, I realize that my hairline was just maturing. All thanks to your site. I never knew such a thing existed!

Anyways, the point I would like to put across is to teenagers, who seem to be flooding your site with questions. The point is, your hair will be there till you are in high school, and till you graduate from college(assuming you arent unusually old for school). These are the two places where girls would superficially judge you (and where you’re just looking for thrills). After high school and college, its a different world. Girls turn to women, and they’re looking for more than just arm candy then. Your hair would NOT matter as much as you’d think.

So don’t worry about your hair too much; even if it’s rapidly falling,it would take a while for you to bald completely. And by then,you’d be through the superficial stages of life. And remember, nothing really causes hair loss apart from your genetics, which you cant change. So don’t worry about things that are not in your control.

Otherwise,there’s always Dr.Rassman ;).

Thanks for the comments! For those that still don’t know what a maturing hairline is, you should certainly read Maturation of a Hairline — Moving From Juvenile to Mature.

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From an Irrational, Mad as Hell Doctor

As a doctor in the hair transplant field, I take affront to this blog, the general tone of it and your almighty view of ethics that you published last week. You are forgetting your roots. Your ego-centric sanctimonious approach gets me sick. I hope your readers can see your self-serving motives here and I sincerely hope that you become a victim of your words.

I normally would not publish this type of statement, but it looks like it illustrates the points I made in my blog entry from just last week, The Truth About Cheap Hair Transplants. I think that this doctor is forgetting his roots, which lie in the Hippocratic Oath taken when he became a doctor. Maybe his Mercedes and mansion mortgage burdens are clouding his priorities.

I’ve been reminded that my blog posting from way back in June entitled Doctor Availability, may have also contributed to this doctor’s rage.


2005-12-05 19:39:01From an Irrational, Mad as Hell Doctor

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Frontal Fibrosing Alopecia – FFA (Commonly Found in Women) – (Photos)

This woman had hair loss and went to a surgeon a few years earlier who recommended surgery. Her condition is a clear diagnosis to a doctor with experience, a disease called Fibrosing Frontal Alopecia, which will cause any hair transplant to fail. Although this occurs more in women then men, it does occur in men and an astute doctor who is knowledgeable is critical before you get a hair transplant that will fail if you have this condition.


2020-01-11 07:37:05Frontal Fibrosing Alopecia – FFA (Commonly Found in Women) – (Photos)

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When Doing FUE, Can You Count the Number of Grafts During the Extraction Process?

We use a standard double accounting system when we perform an FUE. We count the number of attempts at FUE, then we count the number of grafts that come out. By subtracting the difference, this tells us how good we are at the process. Then, we recount them when they are examined, trimmed and placed into the recipient area. All of this activity is recorded on the patient’s surgical report which is available to any of our patients who want to see it.

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FUE Back into the Linear Scar vs Scar Revision

I’m thinking about getting a strip method hair transplant and then just filling in the scar with FUE. Is that an option thats worth pursuing? I don’t want the line scar but I want every graft transplanted. I understand FUE has problems with transection or something.

I get this question quite a bit from patients who have already had the hair transplant strip surgery and then inquire about having a follicular unit extraction (FUE) procedure to follow it up. It makes little sense for the person that already has a strip scar (no matter how wide it is) to have an FUE into the donor harvest. If it’s just about treating the linear scar, better solutions would be a scar revision or Scalp MicroPigmentation (SMP). FUE grafts used in linear scars are generally wasteful and an expensive way to treat the scar with less than ideal results.

My complaints about the way the FUE technique is used are:

  1. It’s generally more expensive than a scar revision for those with a troublesome linear scar.
  2. The grafts do not come out of the sweet spot in the middle of the donor area (where the grafts are easily taken by a strip).
  3. In my opinion, the overall survival of the FUE grafts are not as good as those harvested from a strip in most doctor’s hands (I do not believe that is a problem in our hands).

As the first to publish a paper on FUE (introducing it to the medical community), I can speak with authority on these issues. The ARTAS FUE robot has not really changed the process, except for leveling the playing field for those doctors not skilled in the extraction technique. The FUE technique, as done in most doctor’s hands without the robot, is not as good as the grafts produced by a strip surgery. If there was a formal study, I would expect that each doctor would show variable comparative results when comparing their FUE results with this strip results, making such a comparison between FUE and strip surgery essentially worthless.


The presence of a fine line scar will not be seen in most patients who had a strip procedure, because they generally leave their hair just long enough to cover a strip scar. If they were to cut the donor area hair very close to the scar, at some point (depending upon hair length) the scar will show. I had two hair transplants and although I have a scar, few people can see it even when I show it to patients who visit me in the office. The public does not understand that there is scarring in FUE procedures, even though some doctors and clinics promote it as “scar-less” surgery. In some patients we have had to treat these FUE scars with SMP to allow for a close haircut or shave. The SMP process is the only one that treats FUE scars today and we are seeing more and more patients with this problem as time goes on. I suspect that the strip scar issue is more of a problem with a person who has dark hair and white skin, than the person who has medium brown hair and an olive skin. Nevertheless, both techniques do have consequences.

Here is an example of scarring from a large FUE procedure with the hair cut short. While there is no linear scar, you can clearly see the white pinpoint dot scars all over the back of the scalp. We’ve treated this with SMP (photos to come in a follow-up post later). Click the photo to enlarge.

 

With all that being said, I am not denigrating FUE. It is an important technique and in certain situations it may be superior to a strip surgery. Examples of superior candidates include those without large balding areas, and athletes who want to be able to resume full exercises and swimming within a week of the surgery; however, in patients with large balding patterns, taking the required number of grafts through FUE is not efficient and is relatively more expensive. There is massive experience with strip harvesting (some good and some bad). I have seen in some patients that visit me, that many doctors are harvesting grafts with FUE from the non-permanent areas to reflect a large need for grafts in a single session. Grafts that are taken from the non-permanent zone, may not last.

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I Had an FUE of 3500 Grafts Less Than a Month Ago (Photo)

You have a terrible complication that caused you to lose a lot of your donor hair. Maybe with time, it will come back. Go back and speak with your doctor since your donor area is in trouble. You may have been donor area may have been over-harvested, or this could be shock loss since it is in the first month. If your hair comes back, you will see it return around the same time as the recipient area grafts start to grow. If the donor hair does not return, then Scalp Micropigmentation is the only solution available to you or to anyone in your situation (see: https://scalpmicropigmentation.com/).


2018-06-22 09:46:41I Had an FUE of 3500 Grafts Less Than a Month Ago (Photo)