Category: Uncategorized

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My Doctor Suggested I Use Minoxidil for 1 Year, Then Gradually Stop Using It

Dear Dr. Rassman.

I wrote you before about my hair condition. I am male, 22, caucasian. I went to the trichologist last week and was prescribed to apply topical Minoxidil 5% +mpg 0.0125% together with some vitamin-enriched solution called “Biostim” (ingredients include: Aqua, Sabal Serrulata extract (biogen), mono propylene glycol, ceramide, panthenol, calcium pantothenate (vitamin b3), vitamin E, vitamin A, Vitamin H (biotin), vitamin H (P.A.B.A.), Inositol (vitamin B8).

The doctor I went to also told me the weirdest thing about the long-term treatment plan. he suggested that I follow the usual minoxidil regime for 12 to 14 months, then switch to less concentrated solution with less frequency of application until I’m in my late 30s. What he added to that,that it is possible to take me out the medication at that age, because (quote) my “hormone levels will settle up”… I don’t know what to think of it? It sounds like some sci-fi scenario for me…

another thing I want to ask you is that I’m currently quite happy with my hair – I have slight recessions at the temple area and that is my only problem. I always had quite high hairline, so recessions are quite visible (if I for some reason will go for shorter haircut). I have no history of baldness in my family (my father is 60 and he is on NW3, so are/were most of my family). So as far as I understand the idea of the treatment is not to let my hair loss progress…

I’m very confused abouth this whole situation. Should I trust my trichologist, or does he sound ridiculous? Should I consider undergoing Minoxidil treatment at this stage or not?

I look forward to your reply.

kindest regards

Hair loss is a progressive process and if you think about it, you can logically figure out if the Master Plan made by your trichologist makes common sense. Certainly, I approach the problem with a solution (Propecia and/or minoxidil) and continue treatments that are successful. The idea of starting minoxidil and withdrawing it if it is working, guarantees hair loss from that withdrawal. Propecia always works at least by slowing down the hair loss (to what degree though, is different per person), possibly stopping it altogether, or maybe reversing it.

As for the Biostim product, the only place I can find that references this is one trichologist in London, leading me to believe he is the exclusive marketer of this product. Perhaps it is a private label item and he is just looking to make some money? I don’t know. The ingredients you listed do not look like they’ll do much for your hair. It is your call, of course.

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My Eyebrows Grow and Then Fall Out

Hello Dr. Rassman,
I have been having eyebrow loss for over ten years now. It started after a period of overzealous plucking as a teen (I am now 29). The hair grows out and then after a few weeks to months it gets very weak and limp and falls out. This has been going on for years. My primary doc said it was age and possibly alopecia (though I have no problems on scalp and hair loss is diffuse not patchy). my dermatologist said seb derm but my symptoms are not that similar and the meds he prescribed didn’t help. Any ideas what it can be? And am I a candidate for transplant surgery? Please help! Thank you.

I really couldn’t make an attempt at an answer to what you are asking without examining you myself. So I’m not sure what it could be. If it is indeed seborrheic dermatitis, treatments are usually limited to antifungal shampoos. You didn’t mention which meds you were prescribed, so I’m kind of at a loss there, too.

As for whether you’re a surgical candidate, again, that’s not something that can be determined without an exam. A hair transplant into the eyebrow will reflect the thickness of the hair in the donor area where it is taken from (back of the head area).

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Can end-stage miniaturization be reversed?

Can “end stage” miniaturized hairs be salvaged with medication such as Finasteride/Dutasteride/Minoxidil. Or are those a lost cause once they reach that stage?

We tend to look at these hairs as lost causes; however, microneedling may have changed that perspective. We don’t really know as proper research has not been done. I have seen finasteride reverse miniaturization on a limited basis, possibly when it is early.

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My Hair Doctor Told Me To Wait For Transplant

Hi Dr. Rassman,

I’m a 22 year old male. In the last two years I’ve noticed more hair falling out in the shower and if I run my hands through my hair, as well as a decrease in volume and more visible scalp. Although others haven’t said the same, I feel like I know my hair pretty well. I have mild temporal and frontal recession, a widow’s peak that was never there before, but most worryingly I noticed that individual hairs falling out are much thinner.

I saw a transplant/hair loss doctor and he took global photographs, but told me I have to wait. He said my small recession is just called ‘sculpting’ and that looking at my head you can’t see any pattern of loss.

My question: Why do I have to wait until its clear I’m losing my hair visibly to take action? My father has lost some of his hair (class III?), my mother has pretty severe hair loss, and one of my uncles as well (father’s side).

You always refer to miniturization, and I understand this process, but the doctor made no mention of mapping it in my case. Does every good hair doctor map for miniaturization? Is it right to pursue in my case?

What should I do?

Please respond, my hair is my confidence!

Thanks and all the best

Good measurements are the heart and soul of good science. That is why I map out the scalp in all of my patients. I generally do not like to transplant a 22 year old, but if you are in the early balding process you do need your scalp mapped out for miniaturization to understand what is happening to you. The science of measurement (metrics) is the back bone to diagnosis in your case. Where are you now with regard to miniaturization and where will you be in a year? If your hair is miniaturizing, why are not not taking Propecia? You need to have some good solid measurements to define where you are and where you are going. Then, with those good measurements over time, it will be easy to answer your questions. Please remember that what you do now will impact you for the rest of your life, so timing is critical.


2006-04-04 13:23:04My Hair Doctor Told Me To Wait For Transplant

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Can finasteride hold your hair forever? (from Reddit)

I have thousands of patients on finasteride and it is clearly holding on to their hair. When and if they stop it, the lose huge amounts of hair and then we have quite a conversation. Most want to get back on finasteride but some don’t fully go back to their hair status from before they stopped it. I have seen this effect in young men in there 20 and 30s and in men in their 60s and 70s as well.

Can fin work by itself ? from tressless


2018-12-11 15:21:57Can finasteride hold your hair forever? (from Reddit)

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My Hair Knots Up and Pulls Out When Applying Minoxidil

Hello Doctor

I’m a 27yo male with a full head of hair yet. I comb my hair a couple of times a day after my minoxidil application with a wide tooth comb. As I have medium length hair sometimes knots are formed and even if I’m gentle sometimes I feel little painful pulls.

Should I be worried about those? I doubt any hairs are being pulled out by the root because I try to be gentle, but if some hair does, will it grow back?

Thank you very much.

If you’re being gentle, I don’t know what to tell you. You could try switching to the foam instead of the liquid solution and see if it helps.

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Can grafts fail to grow and if so, why?

The three most common causes of graft failures includes (1) exposure to air for more than 15 seconds when placing the grafts or when preparing the grafts, (2) rough handling of the grafts during placement, (3) a recipient site that is too tight. These problems most frequently arise when the surgical team is sloppy, inexperience, poorly supervised, has no quality control systems in place implemented by the surgeon.


2019-01-21 14:57:33Can grafts fail to grow and if so, why?

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My Hair Loss Stops and Regrows Whenever I’m Pregnant

I am a 48 year-old mother of four who has all-over gradual hair thinning that began when I began menstruating at 12. I recently went through menopause, and although I have not experienced any chance in thinning since then, I do remember that when I was pregnant, I did not have hair loss, and my hair grew in again to a normal thickness. Each time, over the course of the pregnancy, the hair would grow thicker, until about three months after the baby was born, at which time it would fall out rapidly (over a few weeks). Is it possible that that regrowth during pregnancy indicates that I have some underlying hormonal issue?

I do not have hursitism, and twice in my life I have been checked for low iron and for thyroid problems, neither of which showed any problem. My periods were severe early in life but became easier over time and were roughly regular. The hairs that do grow are very soft and somewhat easily damaged but not severely.

I would be interested to know if you think some underlying hormonal problem could be the cause, given the regrowth during pregnancy.

Thank you.

Many women lose hair with child birth/pregnancy, menopause, etc. It is well described and known and you are not alone! But the hair growth during pregnancy, isn’t something I’m familiar with. I can only assume along with you that it is hormonally related, as there are a number of hormone increases during pregnancy.

Here are a couple of links I found via Google that might explain more — Pregnancy-Info.net and PregnancyEtc.com.


2010-01-26 08:38:37My Hair Loss Stops and Regrows Whenever I’m Pregnant

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Can Half of My Hairline Be Juvenile and Half Be Mature?

First I’ll like to say, I really enjoy your blog. I found your blog about a year ago and love it.

I have a question about hairlines. I have an asymmetrical hairline. I think its mature on the right and juvenile on the left. So could it be that my right side is juvenile and my left side is normal? I know you said they eventually even out, but are there any cases you know of where they DON’T even out?

You can have both the appearance of a juvenile hairline and genetic male pattern balding occurring at the same time. Unless you have an examination and also followed over a course of a year, it is likely difficult to tell. Other factors, such as your age, family history, degree/pattern of miniaturization, and even bulk measurements can aid in a more objective diagnosis.

Unfortunately, I don’t know enough about your case to give you a decent idea of what is happening to your hairline. Having an asymmetrical hairline isn’t impossible, but I wouldn’t be surprised if in time you see the other side catch up.