Author: Dr. William Rassman

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I don’t like my hairline. I’m 28. What can I do about it?

I have a lot of neck hair, can I use it for a hair transplant?

A hair transplant at this stage and at your age may bring you up to a full head of hair providing that you stay on the drug. Stick to the donor area if you have a hair transplant and do not use nape of the neck hair as it is a problem for two reasons: (1) taking it from there leaves scars and (2) this hair is not permanent in many men. At 28 you can have a hair transplant and reshape your hairline from the donor area alone. Results can be impressive, often in one surgery, if your hair is not fine.


2019-12-12 10:34:55I don’t like my hairline. I’m 28. What can I do about it?

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I Don’t Take Propecia Consistently, So What Would Happen If I Quit Taking It Completely?

Hello! I’m 27 years old. I’ve been taking Propecia on and off since I was 20 years of age. When I say on and off, I mean that it’s not always every day. I have had times where I was lazy and didn’t refill it for a week or two at a time. Sometimes I forget to take the pill every day. Sometimes I purposely take it every other day. I probably refill my 30 day pill bottle once every two months, on average. In October of 2009, I actually didn’t take it for about 4 weeks straight.

I know, I’m sure you’ll say it’s silly that I’m doing this (and I’d likely agree!). My question is this: If I were to stop taking it completely, is it likely I’d experience much loss as a direct result of stopping? I still have a good amount of hair (although a hairline that is back about 1 inch from when I was a teenager). I know that if people stop taking Propecia, they’ll lose any hair they have gained on the medicine…BUT since my usage is so spotty, and sometimes I only take it once every 2 or 3 days, is it likely that my hair loss might be minimal because my hair gain might also have been minimal thanks to my random usage of it?

If you don’t take medication (any medication) as directed, then it will not work as it is meant to work. If you are taking Propecia every 2 to 3 days a week when it is meant to be taken 7 days a week, it will not be much benefit. You might as well not take it. It probably isn’t doing much for your hair loss or hair gain. It probably is more of a psychological treatment.


2013-12-10 11:37:23I Don’t Take Propecia Consistently, So What Would Happen If I Quit Taking It Completely?

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I Don’t Know If My Hair Loss is Genetics or Chemical Burn from Relaxers

Dear Dr. Rassman,
I am 28 yrs old have been suffering from hair loss since I was about 22 years of age. I am about a norwood 3 right now. I had chemically relaxed my hair once when I was 18 and a second time when I was about 21, while suffering a minor burn from my second treatment. I have taken the hair DX test and I have been told that I have a moderate predisposition to male pattern baldness. Can my hair loss be due to a combination of both factors?

If it were solely due to the chemical relaxers, would I have lost my hair when the injury occurred and wouldn’t my hair loss be more diffuse? If it is due to the insult by chemical straightening, would the hair/hair follicles show the same progression of hair loss as if it were male pattern baldness? I can’t change the past, but I would just like to know if my chemical relaxer treatments have led to this.

Thank You

You have a complex story and it would likely require a complex examination. Without seeing you and examining you, I can not tell you the cause of your hair loss or what you can do about it. The HairDX test can tell you if you’ve got the genetic markers, but it won’t tell you if or when you’ll see those genes expressed.

See a good hair transplant doctor who cares about your welfare and then you will know more than you know now.


2011-12-22 11:39:38I Don’t Know If My Hair Loss is Genetics or Chemical Burn from Relaxers

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I Don’t Trust My Doctor After He Recommended Rogaine and the Laser Comb

Hi Doctor Rassman, first let me start off by thanking you for running the balding blog the way you do. Its the only real source for hair loss questions/answers that I trust in terms of reliability and i would be lost without it.

I am a 23 year old male who noticed a bit of a “wider part” and “larger cowlick” around 2 years ago. I’d wager I’ve thinned a bit since then, but i still have full coverage with no pure bald spots, thinning primarily noticable in the crown region. I took propecia for 8 months and then, like an idiot quit the medication out of fear it was doing nothing and i was throwing money away. approx. 4 months later I realized the thinning sped up so now I am taking the medicine again. I don’t really trust my prescribing doctor’s knowledge…he recommended using the laser comb and rogaine before I attempted propecia but I was persistent.

my questions:
1. Who can map my hair for miniaturization in my surrounding area?
2. assuming I will end up a norwood 6(like my father)what type of coverage could a transplant offer me if we assumed I had average scalp laxticity and average hair density?
3. Do you believe there will be breakthroughs in the next decade that will prevent most of my generation from being forced to live their lives as bald men?

Thanks again for this site

We have written in the past about the LaserComb — basically, we don’t feel it works for treating hair loss. Rogaine, however, is an option if you are persistent enough to apply it twice a day, everyday. In my opinion, most men are horrible at keeping to a regimen and it is a factor you must consider when starting any daily routine like this.

Thank you for sharing your experience on Propecia. It seems that you experienced “catch up” hair loss after stopping the medication. While you will not gain what you lost, restarting the medication was probably a good idea.

Now to answer your questions —

  1. On the east coast, I would trust Dr. Bernstein in New York. He was with New Hair Institute until he branched off to start his own clinic and he’ll be able to map your scalp for miniaturization.
  2. Coverage really depends on your hair character + hair/skin color contrast. If you’ve got black hair, white skin, and a very fine hair character… you won’t have good coverage. If you’ve got thick blonde wavy hair, you’ll have better luck.
  3. Certainly there is work being done and there is a huge market for it, but what you’re asking about is essentially a cure for hair loss. While I do hope something happens within the next decade, I really have no way of knowing if the current work being done is the answer we’re all looking for. Keep your fingers crossed, but your expectations realistic.


2010-09-09 11:57:06I Don’t Trust My Doctor After He Recommended Rogaine and the Laser Comb

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I Drink a Lot of Alcohol and I Take Propecia

I’ve been taking Propecia for almost a year now and don’t think I’ve seen any more loss but I’m curious about taking Propecia whilst drinking heavily. I drink every night due to a stressful job and also entertain clients. I am looking into cutting down but due to the nature of my work, it’s not always possible.

If I am taking Propecia whilst drinking a lot, is there a better time of the day for me to take it? If I take it in the morning before work after a night of drinking, will my body process it like normal?

You know this already, but you should cut down or stop your excessive drinking. Taking Propecia is not related nor interferes with alcohol intake.

However, if you develop liver disease from the excessive alcohol, this could negatively impact the metabolism of Propecia. But if it got that far, hair loss shouldn’t be your number one priority anyway.

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I don’t trust my doctor actually took out 3000 grafts (photo)

If you have doubt about the grafts you received, go back and speak with your doctor and ask him for a copy of the count sheet which is part of the surgical record. Something must have happened that you lost trust with your doctor, so I would suggest that you speak directly with him to get to the root of the mistrust. The photos look about right for 3000 FUE grafts


2020-09-01 12:33:52I don’t trust my doctor actually took out 3000 grafts (photo)

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I Don’t Want to Take Propecia Until After I’m Married

i am a 24 yr old sikh male living in the uk. up until the age of 18 i had long uncut hair but then in 2003 i cut my hair. my hair has always been thin in texture from a young age. at first when i cut my hair it seemed to be quite thick on top and didnt seem to concern me too much. however after a few months of getting it cut i began to realise that a lot more of my scalp was visible, particularly in well lit areas.

so in following summer of 2004 i shaved my hair off completely in hope that it would grow back thicker which was really a waste of time. by summer 2005 i had realised that my scalp was a bit more visible than before so then i made the decision to start using rogaine. this seemed to work at good effect and by jan 2006 i had grown my hair a bit longer and had a new style cut. my hair appeared to be a lot better than before and a lot of people did notice. this however may have been due to the new style as well. but by summer 2007 i began to realise that my hair was appearing to be thinner again and i also noticed that at my crown the balding area had increased. the fact i have got a double crown does not help appearance either. so in late december 2007 i decided to switch rogaine for a private minoxidil 5% containing MPG. this too at first appeared to have made a slight improvement, and is a lot easier to apply than the rogaine. however by now in may 2008, i am still not to happy with the density of my hair. i went to a trichologist late last year, he advised me that i should not consider a hair transplant until i am least 25 and that i still have a bit too much hair for a HT. he advised me to take propecia, however i am scared of using the drug due to all the reported side effects. i would be willing to use the propecia, preferbly in a few years and after marriage! both my mother and fathers family have cases of hair loss, my father is bald apart from the hair on his back and sides. both my sisters have fine hair aswel, but they have a full head of hair.

i have seen pictures of hair transplants on patients who have diffused thinning and this would be my preferred method of sorting my hair out, however i am aware that i need to consider the long term instead of the short term. can you please give me some advice on what to do? thanks.

I don’t know what I can say that hasn’t already been said on this site —

I’m not sure I quite follow the logic about waiting until after marriage to start Propecia (finasteride 1mg). The side effects from Propecia occur in less than 2% of men and most claims you read about on the Internet are unsubstantiated. Without seeing your hair, I couldn’t tell you if you’re a transplant candidate, but if you’ve already seen a doctor and were told that surgery was not recommended, I’d listen to him. You could’ve very easily gone to someone that would’ve taken your money and performed a surgery on you just to appease you. I don’t know which doctor you went to, but by not doing surgery on you, he likely did you a favor. You are, of course, entitled to go to another doctor and I’m sure eventually you will find a surgeon that is more than willing to take your money.

See the following for more:

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I Don’t Want a Mature Hairline!

Im 23, and know I have lost hair. My hair used to be really thick, and I have lost hair diffusely, at crown, and temples. 2 Derms I went to said it was simply a mature hairline. I dont want a mature hairline, I will not feel stupid being 30 with a teenage hairline. The derm said that I can try propecia if I want to. My mom and uncle have both mentioned my hair looks thinner. Im unsure what to do.

There are men that do not ‘grow up’ from a hair line perspective, so you can get reconstructive hair transplant surgery to bring back that old child-like hairline. While it is respectable that you do not want a mature hair line, it is something most hair transplant doctors do not treat, but something that I would be willing to do in a 30 year old who met certain criteria. The criteria would be:

  1. that the predictable hair loss pattern will not be advanced
  2. that your supply of donor hair will be enough to meet your needs on a worst case scenario
  3. that the various elements of your hair characteristics meet my criteria
  4. that you understand what is the worst case scenario for progressive hair loss and have a plan worked out with me to deal with it
  5. that you are mature and of sound mind and body
  6. that you have the finances to follow a worst case scenario through if it happened
  7. that you can tolerate and are willing to take Propecia for the rest of your life

Currently there is no data that shows finasteride (Propecia) will stop the progression to a mature hair line. Propecia can only be prescribed by a medical doctor and it is important to establish a correct diagnosis before you start any medication.

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I Experienced Shock Loss After My 2nd Transplant

Please talk about shock loss to grafted hair as I lost a lot 10 days ago in my second operation. What can I expect generally in this situation?

Shock loss is the state of losing miniaturized hair as a result of stimulation from surgery or any other stress. It is most commonly seen after the first hair transplant in patients who have significant miniaturization in the area. Younger patients are more susceptible to this condition. Widespread use of finasteride has significantly minimized the occurrence of this condition within the last few years.

Grafted hair is considered permanent and is resistant to shock loss. If you lose any of your hair at all, it would be the native miniaturized hair in the recipient area, not the transplanted ones. In my 16 years of doing this, I saw transplanted hair lost due to shock loss about 5 times and each and every time the hair came back. This would not necessarily be the case if the hair was impacted and miniaturized, and that is why the risks are there for the first transplant, not the subsequent ones.

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I Don’t Want to Spend My 20s Bald

First off, I am a 20 year old male who has been concerned with balding since I was a kid. My dad is almost completely bald but the men on my mothers side all have full heads of hair. When I was about 16 I notice the corners of my hairline are higher then the rest of my hairline. I’ve worn my hair long since I was a kid so I can’t tell if this is my natural hair line or if it is in fact receding. I compulsively check my hair and haven’t noticed any recession since I began checking 4 years ago.

What I am desperately wondering is whether or not a hair transplant can restore a mans hair completely? I know that doctors recommend waiting until MPB has stabilized but my concern is (1) I don’t want to spend my 20’s bald, waiting for mpb to stabilize and (2) if i end up nearly completely bald there won’t be enough donor hair to help me achieve the results I want. I’ve always maintained good hair care and styled my hair so the idea of losing my hair is devastating.

On a side note, I’ve read a bit about stem cells possibly leading to a better solution to MPB. Is there any truth or likelihood to this ever becoming a reality?

In the pages of this blog, there are many examples of men being proactive about their hair loss. You need to get a Master Plan developed with a good, honest doctor who can help you through these traumatic years. Each case should be unique, so you and your doctor need to form a plan.

You might be a candidate for surgery or for medication. You might not even be going bald, but it’s just that your hairline is maturing. You might have nothing to worry about (as you said, your hairline hasn’t changed in years). Without an examination, I’m not sure what more I could say.

Stem cell research is ongoing, most recently mentioned here and here. I hope at some point new treatments become reality, but I’ve got no timeline for availability, nor can I promise that they will.


2012-09-15 11:33:17I Don’t Want to Spend My 20s Bald