I Was Started on Finasteride, and in 5 Days, I Could Not Get an Erection.

After 5 days, a few patients have reported sexual side effects. When that happens, I often tell my patients to stop the medication for a few weeks until everything becomes normal again, and then retry it at one pill every 4 days for 3 weeks, and if that works, increase it to one pill every 3 days for 3 weeks. If that works, try one pill every two days, and stay on this dose, which is 80% as effective as the full dose.


2018-06-19 09:54:22I Was Started on Finasteride, and in 5 Days, I Could Not Get an Erection.

Started Finasteride 3 months ago (photo)

Started fin in January. If you zoom in, are those miniaturized hairs new? Are those hairs that will be growing in or are they hairs dying off

Too early to tell. Wait a full year and then you will know. With the balding you have, I would doubt significant growth from finasteride, except possibly in the middle of the balding area where I see existing pores present suggesting that the hair loss in this area was more recent. A hair transplant may be the only real solution for you. See some of our patients here: https://newhair.com/before-and-after/hair-transplants-men/#results


2020-04-20 08:41:30Started Finasteride 3 months ago (photo)

Have I Started to Develop a Receding Hairline? (Photo)

As your widow’s peak is showing very well, the tip of the widow’s peak is a good marker for where your hairline was when you were a child. This tells me that you have developed a mature hairline at this time. I can’t comment on the future. I wrote a medical article on this process (see here: https://newhair.com//pdf/2015/phenotype-article-published.pdf)

Standard of Care Consultation for Hair Transplantation

I just had my consultation at your office last week. I want to congratulate you with a professional way of managing your practice.

This blog entry is a little lengthy, but it is important to retell this man’s tale as he told it to me. For the purposes of privacy, I’ll refer to him as Joe.

Joe had received three opinions from different doctors over the past few months. The one with me was the last of the consultations. After receiving the nice note from him, I asked him for a competitive analysis. Joe had planned to get multiple opinions over a three month period and he had already attended one of our open house events prior to seeing me privately.

He had some comments about our practice, some of which were not flattering. He criticized the quality of our video as tired and out of date (it is 14 years old) and our brochure was not nearly as fancy as the ones that he had seen elsewhere. He might not have been aggressive at pursuing us if it were not for the generally less than professional presentation of the other two practices. With the two previous groups he had met, both were front-ended with a professional salesman who went through well-scripted processes, each recommending what the salesmen thought Joe might need to address his balding problem. Both of these groups applied considerable pressure to get him to schedule a hair transplant. At one of the two clinics, the doctor came into the office, but spent very little time with him, only confirming what the salesman told Joe about his needs. When he left each of the two previous groups, he was somewhat impressed, but skeptical of their sales process. Later, he did some internet research and found considerable legal problems with one of the groups and many generally negative comments on internet chats. Both groups were eventually crossed off his list.

Our office was his third stop. He came by an open house event and met with many patients that had been through the same thing he was now facing. Three patients came in without notice and they showed results that he felt were normal looking. He was impressed with the openness of the patients attending the open house. He met two patients with the exact balding pattern that he had, both in their 40s and they had Joe’s hair and skin color as well.

Joe went into the operating room and talked to the outgoing fellow who was having the hair transplant that day. When we eventually met, he was impressed that I had committed a full hour to the interview. The night of the consultation he went to the internet and found that every claim that NHI had made on its website (reflecting their authority as a pioneer in the field) was easily validated. This was quite different than the claims made by the other groups which he felt were over-hyped in their representations. The very next day, he got an email from me with what he said “was an amazing and thorough summary” of the conversation we had on his visit the day before. I had included a full fee schedule for the quoted estimate of work. None of the other transplant office took the time to produce such a document, not even the doctor who performed surgery on his broken nose a few years ago.

I developed my hair restoration practice as I did when I practiced a more traditional ‘general surgery’. I’ve always believed that a medical practice should be classy and that means to me that the doctor should take every effort to provide what he would want to see if he or a member of his family were a patient — and that would include an honest, open communication. Unfortunately, too many medical groups who are now dominating the field of hair transplantation, have applied heavy sales tactics (which I believe is either immoral or unethical). The patient can easily become a victim if critical information is held back. As a case in point, throughout this blog, I discuss the need for assessments with mapping of the scalp hair for loss looking for miniaturization, and even with multiple articles written by me on this subject, the metrics in this field have not been incorporated into the standard of care. I would never transfuse a unit of blood without knowing the hemoglobin of a patient who was bleeding, nor would I use potentially toxic medications without understanding the working efficiency of the liver or kidneys, yet many hair transplant doctors seem to constantly offer extensive hair restoration surgery without measurements of the patients existing hair status or in giving the patient some help in predicting his future hair loss.

We need a standard of diagnosis for the consultation process and we need to exclude the salesmen who dominate the process and make recommendations that should be in the exclusive domain of the doctor. We need to incorporate such processes as mapping of the scalp for miniaturization, in order to give the patient a fighting chance in understanding what he is agreeing to when he undergoes a hair transplant. We need to provide educational material about what the patient may experience, including all of the risks (not sugar coated) associated with a transplant process. If we don’t do these things, then I will continue to speak out about our standard, hoping that the consumer will press those in this industry to discard shoddy sales tactics.

What If I Stand on My Head One Hour a Day for a Month, Will That Increase the Blood Supply to My Hair?

I had a young man do this for more than a year. He still lost his hair. The problem with hair loss in young men is that it is genetic and not blood flow related. The reduction of blood supply occurs because the volume of hair gets reduced, and this requires less blood flow.


2018-07-18 13:12:00What If I Stand on My Head One Hour a Day for a Month, Will That Increase the Blood Supply to My Hair?

Stan Lee’s Unusual Hairline

What’s up with comic book legend Stan Lee’s hairline? I’ve been watching a show he hosts on History Channel and his hairline is bugging me. Is it a flap or something? It looks like there’s a white line right around the edge of it. It’s a very unusual shape, but if it was a flap wouldn’t the color on top be the same as on the sides? I guess he could dye it though. What do you think?

Stan LeeYears ago, there were a variety of surgeries that produced many deformities in people that wanted to get hair. They were courageous enough to “lead the pack” of people getting hair transplants, but the worst of the deformities were the old plugs (pencil size grouping of hairs put into corn rows that looked like doll’s hair).

Since I entered the hair restoration field 20 year ago, I have treated many men who had these procedures in the 1950s – 1990s. Most of these men sought a fix-it solution, with the two most effective being:

  1. Excision of the grafts where the hair in these big plugs was removed and then divided into follicular units and then re-transplanted
  2. Camouflage the plugs with natural hair placed in front to hide and bury the grafts if the plugs were high on the head

Fortunately, many of the old plugs did not have even a 50% survival of the hairs, so the impact was benefited from the poor techniques of those original transplants. Despite this, the skin from the transplanted grafts lived, creating a cobblestone effect on the scalp that added to the ‘dolls head’ deformities. These unfortunate pioneer recipients of hair transplants suffered ridicule by everyone — their friends talked behind their backs, and those who were in the public eye were tagged with not-so-pleasant names. One celebrity that comes to mind told me that comedians were very cruel with their jokes about his hair plugs. In the first 10 years of my practice in this business, I performed hair restoration repairs on many men, making great friends along the way, including this one particular celebrity whose nightmare ended after the transplants grew.

Based on some photos I’ve seen using Google Image Search, I believe that Stan Lee had some corrective surgery to fix what might have been the old type of plugs. There’s a high-resolution photo here. The scar in front on the left side and the imbalance between the two sides suggest this to me. If I were to see him and could find enough hair still present, I would excise the plugs that remain and rebuild a new hairline in the normal position. With his white hair, this should be relatively easy.

Stagnation in Baldness Research?

Why is it that, despite the astounding leaps in cosmetic surgery, and in stem-cell research, we still are nowhere near the ability to give me back a full head of hair? I have recently read that scientists can now change someones eye colour for cosmetic reasons, and re-grow teeth. It seems bizarre considering the amount of money that is put in, and yet almost no treatment exists, yet other fields are advancing brilliantly so.

Are you familiar with the romantic spy movie that came out a few years ago called “Duplicity“, starring Julia Roberts and Clive Owen? The plot of the movie included an attempt to steal a secret formula, which is documented step by step. What is the secret formula, you might ask? What does this have to do with baldness research? The secret is — it’s a cure for balding.

I understand your frustration, but the movie does show the value business puts on a cure for baldness. There is a great deal of money to be made by any group that comes up with a successful treatment. Hair loss is not necessarily government backed research, as much of it is carried out or funded because the motivation is strictly for profit. There is a lot of research looking for the cure, and we must be patient and believe in the capitalistic model to see what I hope will be a truly effective treatment for balding sometime in our future.

Just don’t ask me when.

Stacking Propecia, Rogaine, and Saw Palmetto

I just started using Propecia. I’ve been using Rogaine for about 5 years, and Saw Palmeto for the last 6 months. Is it safe to use Propecia with Rogaine and Saw Palmeto? Please advise. Thanks

I just returned from the International Society of Hair Restoration Surgery conference in Coronado (near San Diego), California this past week. Your question was one of the topics discussed during the meeting.

Saw palmetto is a herb that has been implicated in alleviating urinary flow, which is sometimes associated with enlarged prostate. It has not been scientifically proven to work, but it is a natural herb and consumers take it for whatever benefits it may have. Many people make the link in their minds that saw palmetto could be used in alleviating male pattern hair loss with finasteride 5mg (Proscar) just because it is used for men with enlarged prostate problems. Again, saw palmetto has never been scientifically proven to help with male pattern hair loss and is absolutely not a DHT blocker.

To date, topical minoxidil (Rogaine) and oral finasteride 1mg (Propecia) are the only FDA approved medications for male pattern hair loss. There are some that believe that using the two medications in conjuction may have a synergistic effect, as they have different mechanisms of action. I believe that using minoxidil and Propecia in combination has useful value in some people, but I’d start with one at a time. If you start with both, you will not be sure which one is working best for you, and are committing yourself to a lifetime of multiple medications, when your answer may be just the one.


2006-10-25 09:28:13Stacking Propecia, Rogaine, and Saw Palmetto

St John’s Wort and Propecia

I see in a previous post that you believe that St. John’s Wort will not directly contribute to hair loss. My question is, will St. John’s Wort inhibit or decrease the effectiveness of Propecia? Since Propecia is absorbed in the liver, and St. John’s Wort has been shown to decrease absorbtion of certain drugs, could it also be affecting the level of DHT bockers in the blood stream, thereby reducing propecia’s potency? I currently only take 2 300 mg tablets of St. John’s Wort at bedtime (I take my Propecia at bed time as well). Thanks in advance for your reply.

St. John’s wort is an herbal product used for its flavor or potential therapeutic in treating mild to moderate depression. In my opinion, a healthy liver should not have a problem with both St. John’s wort and Propecia. Discuss this with your prescribing physician. Like many other herbal products, there is not enough research on long term treatment, safety, and effectiveness of this product.


2007-12-10 14:17:47St John’s Wort and Propecia

St John’s Wort and Propecia

Hello Dr Rassman.

Want to start by thanking you and all the others who helped and contributed to this awesome forum!

I have been depressed for a while now. But then I’m very critical of antidepressants. So i have decided to test ST. John’s wort, who according to studies can be just as effective as antidepressants while it has much less side effects than conventional antidepressants.

But St. John’s wort has a tendency to affect the metabolism of other drugs.

My question is, do you know if St. John´s wort will affect propecia

I am not much of a herbal expert, but I do know that some herbs can interact with medications. In particular, St. John’s Wort is listed as having interactions with Propecia (finasteride 1mg), though I do not know if this will have a clinically significant affect on the efficacy of Propecia. You may run the risk of increase side effects, however.

I would consult with your doctor.