Author: Dr. William Rassman

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Is the Alcohol in Rogaine Causing My Irritation?

Dear Mr. Rassman,

Thank you for all the help you are providing the public. I am 23 years old and suffering from thinning hair. Unfortunately, we have limited options in Dubai. We have only one product of minoxidil 5% which is regaine, however, I develop scalp irritation from using it. A dermatologist asked me to try ordering rogaine foam from the US. He believes that the irritation was caused because regaine 5% is an alcoholic solution.

1) Do you think rogaine foam does not have alcohol? If yes, can you recommend any other product that contains minoxidil 5% but is not an alcoholic solution. Minoxidil is my only option and it is very important for me to find a way to avoid irritation.

2) I used the total daily dosage of regaine 5% at once a day, not twice as recommended. Do you think that is the reason for irritation?

3) I want to study whether regaine is effective with a microscope and taking pictures. How can I be sure that I am comparing the same spot with the same amount of zoom. For example, I zoomed a little and found 10 hairs in area A in the first month. I am worried that I might zoom less and find 12 hair counts after six months. Moreover, I might take a snap of another spot (beside the original one) in area A.

Thank you very much in advance.

1. Rogaine Foam does contain alcohol, but it is the propylene glycol that is generally what causes skin irritation in some people. Rogaine Foam doesn’t contain propylene glycol. If it is the alcohol that’s causing your irritation, unfortunately I’m not aware of any particular minoxidil currently sold with zero alcohol content. I have no way to know exactly what is causing your skin irritation, though.

2. Using it only once a day might just not be as effective as the recommended twice daily application, but I doubt the lesser dosage is what is causing your irritation. The irritation is probably from the propylene glycol in the Rogaine liquid, or perhaps an allergy to one of the other ingredients.

3. I suppose you could have a permanent dot the size of a pen mark tattooed on your scalp to be sure you have the exact spot monitored each time, but I think that’s a little overkill. The better way to go about this is to have a professional check the overall hair bulk using the HairCheck instrument, then recheck it again in a year to see if the numbers changed (increased bulk means you’re having more hair growth).


2014-03-11 13:06:09Is the Alcohol in Rogaine Causing My Irritation?

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Is Telogen Phase the Same Length for Balding and Non-Balding Men?

Dear DR, hi,

I found your blog by searching about duration of telogen phase on Men with male pattern baldness. I’ve a pretty simple question: is the telogen phase the same for Baldness suffering peoples and “normal” peoples?

I’m asking you that because ive checked your blog, and i saw tons of guys complaining about masturbation/working out incidence on MPB. Alot said they saw some changes in the daily shedding (in good or worse) after 3-5 days only… How is that possible? I though a “dead” hair fell 100 days after the beginning of the telogen cycle. So how can they check the result of abstinence OR over masturbation only after a couple of days? Do i misunderstood something? As nobody never corrected them about this point, do that means the telogen phase for MPB men is equal to less than 2 weeks and not 2-3 months like for others men?

In advance, thank you. Regards.

The duration of the telogen phase varies in everyone. The cycle can be longer when there is miniaturization present . If a hair dies (apoptosis), it can die within a follicular unit or miniaturize within a follicular unit. The telogen cycle, I believe, is significantly longer than 2 weeks. So, for example, if you have a high density and many three-hair follicular units, one hair may go into miniaturization and at some point in the follicular unit’s cycle, that hair can die off.

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Is the Flap a “Cure for Baldness”?

There is a post out of the UK that says there is a cure for Baldness called the Fleming-Mayer Flap. Please see the link and give me back your comments. See “An end to baldness – for those who can stomach it“

The original procedure was actually ‘invented’ by Dr. Jose Juri in South America. It was widely performed around the world with, at times, terrible consequences. Dr. Juri has been quoted by doctors I know as believing that this invention was a terrible mistake and I believe he apologized for the damage his procedure did to the many victims that the radical surgery produced.

As there is no cure for baldness, certainly a radical scalp moving procedure has many opportunities for problems. Worse, it can not cover all of the balding area, for that would take God’s hands, and not this technique.

  • A banana-shaped piece of hair-bearing skin is marked out on the side of the head
  • Incisions are made and the flap is loosened, always remaining attached to the head in order to maintain the blood supply
  • The bald area is cut out of the patient’s scalp and removed
  • The flap is twisted, flipped over the top of the head and sewn into place where the bald patch was. Surrounding skin is stretched lower down to compensate

I would not recommend this procedure for many people with ordinary male pattern balding. Even if their balding pattern does not look too bad at the time they have the procedure, as they get older, the flap will make them look freakish and I have treated many patients for deformities resulting from this type of surgery as they continued with an advancing balding pattern. The article you sent is very misleading; the flap is not a cure for baldness.

For more information about the flap procedure, please visit:

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Is the Donor Hair Really Permanent?

My grandfather’s has what you call a Class 7 pattern and the hair around the back and sides is very thin. I asked him if his hair was always that thin and he replied that when he was my age, his rim hair was much thicker. He became bald in his later 20s. Is the donor hair really permanent?

The donor hair around the sides and the back of the head in some men is not permanent.

I have seen men like your grandfather in my office and their donor density is very low, but as they are usually coming for a hair transplant assessment, I, of course, turn them down. There is some miniaturization in the donor hair in these men and I suspect that the miniaturization process that impacted their original frontal hair extends to the donor region. These men are clearly not surgical candidates.

On very rare occasions (about once every few years) I see someone who lost hair bulk in the transplanted hair. These men have a drop in donor density as well, so I must assume that these men are losing this sacred donor hair. This introduces two more risk for patients who have transplants: (a) the loss of some of the transplants over time as the donor hair dies off, or (b) the hair becomes finer with age (a common finding). The few who I have seen that reported transplanted hair loss to me, fortunately did not lose all of their transplanted hair, but it is a risk. I have only been doing hair transplants for 20 years, a relatively short period of time in the life of my patients.

Amongst those men I have transplanted above the age of 70, they never showed miniaturization in the donor area and they behaved like the young men I transplanted. One of my most unusual patients who came to my office frequently during our Open House events, was a Class 7 patient who received 9900 grafts over 9 years and he maintained his donor density through the entire process without miniaturization. He was 74 years old.

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Is the Hair Transplant Industry Getting Oversaturated?

Hello Dr. Rassman,

I’m a pre-medical student, applying to medical school next year, and ever since discovering sites like ‘hair transplant network’ and doing independent research, I’ve decided I have a great interest in entering the hair transplant field. However, I recently read an abstract you published in 2003 regarding the status of the transplant market for both the consumer and the physician, and it lead me to believe that by the time I get out of medical school and residency, hair transplants may be an over saturated commodity? I may have interpreted the results of your work a tad harshly, but I was wondering if you had any advice for someone in my situation? Do you think there will still be potential for a successful, innovative private practice, or would it be akin to opening a laser clinic on Rodeo in 2009 -aka you’ve missed the cusp of the wave and it’s too late to break in now? I realize that you can’t predict the future, but I’d appreciate any advice or insight you can give me. Thank you very much.

I think that the issue is classic capitalism (supply and demand). With today’s economics, hair transplantation is not a necessity so there are clearly more providers than patients, but who knows 10 years down the road. The miracles I see daily in my practice will be better understood by the balding population and will, almost certainly, cause an upswing in patients seeking this service, but who know if the physicians skilled in the art will multiply faster than the demand for services. Ask our economists, who seem to know the answers to everything in our present economic climate.

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Is the number of harvestable grafts a lot higher if the patient caught MPB early and immediately started taking action (anti-androgens)?

No, the number of harvestable grafts are fixed for your lifetime and depend upon your original donor density which the doctor can measure. That is why we are careful about what we take from the donor area when we do a hair transplant. As the limit for a typical Caucasian is about 7,500 grafts, then as this number is drawn down, it can’t be replaced and eventually there is no donor hair left. This is my concern in Turkey where they will take out 6000 grafts in a single session, leaving almost nothing left for future balding (which is almost a certainty) and they do it all with FUE, but most people can’t handle more than 3,750 FUE grafts before they start looking bald in the back of their head (see: https://baldingblog.com/collection-victim-photos-internet-harvested-depleted-donor-areas/.

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Is there a connection between DUPA and DHT?

Nobody knows if there is a connection between Diffuse Unpatterened Alopecia (DUPA) and the action of DHT on the hair receptors. but I doubt that it fits the classic model for male pattern genetic loss; nevertheless, because finasteride is the only drug that we can use to block DHT and we know that sometimes it works, finasteride is the drug of choice for DUPA. People with DUPA can also develop patterned balding which shows that there is not a direct connection between the two.


2019-09-25 08:39:53Is there a connection between DUPA and DHT?

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Is there a gene for balding?

On these sending DNA Sites you can see what your likelihood is of going bald. Is there a specific gene that causes this?

The genes (many genes) have not been fully identified. the company 23 & me is not reliable for predicting hair loss because even if you have the genes, these genes may not express themselves.


2021-02-13 12:19:08Is there a gene for balding?

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Is There a Good Way to Stop Taking Finasteride?

What is the best way to stop finasteride ? all of a sudden or gradually ? , can sudden withdrawal cause rebound effect and more worsening (speaking of side effects not hairloss) ? and if gradual withdrawal is the best then how can i do so ?

thanks

The half-life of the drug in your body is somewhere between 4-6 hours. That means essentially that most of the drug that you take today will be gone tomorrow. Once the drug levels drop below a certain level, you will lose the effectiveness of the drug and it may take 1-3 months for the impact of the loss to be seen in your hair falling out. Tissue levels may maintain the effect of the drug for a couple of weeks or so.

The answer to your question — there’s no “best” way to stop the medication.