Hair Loss Information at Balding Blog

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I am down right angry about everyone targeting balding men as the butt of jokes. People do not understand that behind every bald man, is a feeling sensitive man and I wish that people will stop jabbing at us.

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In this week’s issue of The New Yorker magazine (January 9, 2006; pages 43-48), there is an excellent article about hair loss titled “The Power of Hair”, by Burkhard Bilger. There is a great quote in the article from an anonymous source that says, “The man who isn’t bald never thinks about baldness. The man who is losing hair never thinks about anything else.” It is full of wonderful stories about balding looking backward in time, and looking forward to genetic cures, cloning, and some of the recent work done on an experimental basis. The article is worth reading, concluding from a patient who had a hair transplant, “Having hair on your head, you feel like you’re still young. You feel like you’re alive. Nobody wants to look old, man. Nobody want to look old.”


Imagine, you go to buy a car, and you are clear as to what you want. A good car salesman is a professional who knows how to bond with you so that you can gain their trust to possibly have you buy the next model up with loads of options without appearing too pushy. You would think that in the noble medical profession, doctors should be better than a typical car salesman. Well, the following are a few scenarios that may surprise you.

Case 1:
You are a 18 year old young man who recently noticed some frontal corner hair line thinning. Seeing your bald father, uncle, grandfather, etc. is not a confidence booster for the future of where your hair line “may” be heading and in a panic you seek the help of the nearest hair transplant surgeon. Offering a surgery to this young man (who may not follow his father’s hair loss pattern) is tantamount to malpractice yet this happens when a doctor thinks about the money he will make more than the welfare of his patient. Rapidly balding at the age of 18 is one thing, but early sign of possible hair loss from the frontal corners does not mean that this man will go completely bald. Worse yet, if you only address the front corner at a young age without a clear diagnosis and the young 18 year old loses all his hair in the coming years, the hair transplant may leave him with a freakish hairline in the front. (I have seen this happen). He won’t even be able to shave it all off if he has the linear strip scar in the back of the head. For that matter FUE still leaves whitish scars from each FUE which show when the head is completely shaven. The key here, is that this young man is desperate not to look like his bald father and uncles, and may grab onto any hair transplant solution offered to him without much long term planning. I firmly believe that patient need to know what is happening to them and they need a Master Plan in their treatment process created with his doctor.

If you are young with early sign of male pattern balding, the doctor can offer medications (such as Propecia or Rogaine), not a hair transplant, especially if there is no clear evidence of the type of hair loss pattern and when the risk of shock hair loss is high. More doctors than I care to calculate, are quick to offer a hair transplant solution over a medical treatment that may slow down or reverse his hair loss. If medication alone buys the 18 year old even 3 to 5 years of stabilizing his hair loss and in that time a better prognosis can be made for his further hair loss pattern, it may be worth postponing a surgery, especially if the hair loss does not progress and they decide that they do not need surgery after all. If they do decide to have surgery, it would be an informed decision with plenty of background and education on the Master Plan of how to go about addressing their hair loss as they age. It is a decision based on education over scare tactics and insecurity. More over, the risk of shock loss is lower with with surgery in an older patient.

Case 2:
If you are a man over the age of 25 and you have early, but significant frontal and crown hair loss (Norwood Class 3 or 4), surgery is not out of the question. In my experience about half of these men do exactly the same as above (try the medication first and wait). Those who choose a hair transplant surgery but are told that their hair densities are low, may find that this diagnosis will limit the final hair transplant options as they bald. They might decide to transplant only the frontal area which may be a reasonable thing to do by skipping the crown area. This may be a better option for those with low donor density if they want to have a fully restored (dense) hair line. But if the surgeon offered an overly optimistic solution of covering the front and crown, the patient may run out of donor hair, unable to fully address both the front or the crown to their satisfaction as the hair loss progresses, leaving the work half finished (depleted of donor hair) before the hair transplant procedures are completed. The up-sale here means making more money (just like the car salesman) not thinking about the patient’s long term benefit.

Case 3:
You are a balding man or woman, and are offered PRP (Platlet Rich Plasma) to supplement your hair transplant. With no scientific evidence that is works, the doctor can draw a tube of blood from your arm, spin it down in a centrifuge and inject it into some part of your scalp. He charges you $1500 for this (costing him under $100) and make $1400 for this effort. Some doctors even offer this for an office visit to treat a balding man to regrow hair, but again, there is no evidence that it works.

Case 4:
You are a balding man or woman, and are offered minoxidil injections into the scalp and requested to come back every month for repeat needle injections saying that it will help grow your hair. The money is good for the doctor and may not harm you except in your pocketbook.

Case 5: You are a 29 year old women with thinning hair just like your mother and your grandmother. There is no known disease present in the hair and the doctor believes that you have genetic female hairloss. In 90% of these women with generalized thinning, a hair transplant could be called malpractice. However some doctors will recommend a hair transplant surgery. After one year when there is no significant cosmetic result their solution is to do another surgery to add more hair. Adding hair to thinning area does not always mean you will get visible (worthwhile) cosmetic results.

Case 6:
You are a man or women wanting or needing a hair transplant in a small area and most doctors would say 1500 grafts should be enough. But another doctor tells you that you need 2500 grafts to really give you the best benefit saying more is better. But at $6/graft, that is $6,000 more dollars out of your pocket into his. Did you really need that extra kick of more grafts?

Doctors have clout and their words are more persuasive than those of a salesman who have to work harder to get the up-sale. You will believe a doctor more readily than a salesman, but some of these the doctors have bills to pay, mortgages for their mansion, fancy cars to drive and at times, mistresses who need more than their sexual magnetism to be happy. These are the dollars the doctor must get from you to make a better living to meet his financial needs so up-selling may become his routine.

Case 7:
Plastic surgeons can also fall into these up-seling processes and sell many procedures to patients that they do not need. I met a 27 year old woman with hair complications (bald patches of scars) from a face lift. Now, what would drive a 27 year old women to get a face lift? Two things: (1) Body Dysmorphic Syndrome (see: HERE), and (2) an opportunistic doctor who prays on women with loss of self image.

Surgeons recommend a surgery for Gall Stones that show up on an X-ray without symptoms, do not need any surgery under ordinary situations (I am a board certified surgeon who has seen this surgery done just because there is a perceived need for the surgery by the surgeon which correlate to the paying ability of the patient). Cardiologist who offer complex tests to young healthy patients because they can charge more money, even without clear indications other than the status of their insurance. These are just a few of the situations that reflect the up-sale scenario in the medical field. We can digress into another topic of our overly litigious society and doctors ordering excessive unnecessary tests to “cover their ass” but that is another topic and another blog.

It goes without saying, that we all want a doctor who we can trust, who will tell us the truth about our medical or surgical needs without bias and secondary gain or interest. In our society doctors are placed in higher moral regards in the totem pole than used car salesman. However, this should not blind the consumer into complacency and you have a responsibility to yourself to do your research before tackling surgery.


i started to take finax(finasteride) 3 and the half year ago.after 6 months it showed wonderful result.but at 1 year mark i again started to shed doctor prescribed me dutas(dutasteride)after switching to dutasteride about 2 years ago my hair loss progression got slowdow(just within 5 months).then 8 months ago i again switched to finastride and now i am experiencing massive hair loss.shedding all of the time with vertex and frontal region getting ,my doctor again prescribed me dutasteride as well as finasteride both(1
pill of each daily ) in conjunction with minoxidil 5%. i want to know would it work or is he just trying different things on me hopelessly??????

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We’ve said this many times here on BaldingBlog. There is no cure for genetic male pattern balding -MPB (androgenic alopecia – AGA). Drugs such as Propecia and Rogain helps slow the hair loss down. For some it even reverses hair loss and slows down the hair loss dramatically. Overall everyone slowly loses their hair as it is pre-programmed in to their genetic make up. Finasteride and Dutasteride work in similar fashion by blocking the DHT hormone but it is not a complete solution. Some think Dutasteride may work better but it is not approved by the FDA and the negative side effects are usually higher than Propecia. The answer to the MPB does not reside solely on Propecia, Dutasteride, or Rogaine. You need to find a good doctor who can give you options and a better explanation on the Master Plan of how to go about addressing your MPB.


In a recent post by Dr. Bernard Nusbaum from a series of conversations with varying doctors, he noted that people who use Low Laser Light Therapy who use minoxidil may develop a residue on their hair that mimics hair graying.



A retrospective study examining data show an increased number of visit to the emergency room (from the US Healthcare Cost and Utilization Project). These visits to the Emergency Room grew 50.4% between 2007 and 2012 in Colorado, one of the first two states to legalize both medical and recreational use of marijuana. Also increasing were visits related to opioids (by 42%), hallucinogens (40.4%), sedatives (40%), and amphetamines (20.6%).


i’ll be turning 18 in February . when i was approx 2 years old my aunty accidentally dropped boiled water on my head resulting in completely burning my hair and scalp of forehead and half head. my skin was wiped off after burning causing no hair regrowth on the affected area. my parents consulted many doctors for my hairs regrowth as em a girl . but all the doctors used to say the only way is to do a hair transplant and em too young for it. and yeah i make a hair style which doesnt expose much of my burned area but still some people notice it anyway so now that i’ll be 18 em planning to have a hair transplant . so can you help and guide me with it. thanks.

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We have treated several patients (some as young as 10 years old) who have had similar stories of burns to the scalp. Hair transplants will help with covering the bald area from burns and if the burn scars are large, there are other surgical treatments that can succssfully even these extreme cases. Each case is different and you need to first start by making an appointment with a hair transplant surgeon. You can always call my office (800) NEW-HAIR for a consultation with me.


I am part of a group of doctors who discussed the value of long term finasteride. There is a general consensus that this drug has good long term effects, even if it just in slowing hair loss ‘progression’ however, a few patients pop up periodically who actual start losing hair while on the drug long-term. Some patients switch from Propecia to Proscar 5mgs tablets cut in quarters, or genetic 5mg tablets cut in quarters. These people, as a general rule, do not see changes in their hair loss from these switches. On the other hand, some doctors are reporting that a switch to the 1mg finasteride is causing more shedding within a month of that switch, suggesting that either the 1mg is counterfeit or not pure finasteride. So if you see shedding after switching your routine finasteride, then think seriously about going back to your doctor and going back on the real finasteride Either Propecia of Proscar in quarter tablets).

Suggestions for those who are really experiencing hair loss after long term use of finasteride, include combining minoxidil with the finasteride (Propecia) as there are different effects when the drugs are worked in combination. This is worth a try if you are disappointed in the results of the finasteride or if it is losing effectiveness over time. On rare occasion, a few doctors may prescribe dutasteride (Avodart) but must doctors are reluctant to do so, as I am since there is no clear evidence that it is better drug for hair loss.


Six years ago, when I was 24, my doctor prescribed Propecia. I had some early loss in my crown and I could see through it and my frontal corners were thinning. Within a year, I saw an increased amount of hair in my crown, but still had a see through look and my frontal corners continued to disappear leaving me today with a full Frontal Class 3 pattern in the front. Should I continue with the drug or can I assume that it has done its job?

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Have you considered that maybe if you did not take the drug, you would have even less hair now with a completely bald crown area? The original studies by Merck (drug company) showed that the drug may peak at 5 years showing a stabilization of hair loss. In men not on the drug (placebo group), the visible effects of progressive hair loss showed and they were more bald than those on the drug. The fact that the value of the drug over the 5 year study showed that some men actually benefited more, the more time they were on the drug. Unfortunately, the study was stopped at 5 years. From my clinical experience of prescribing the drug since it was introduced in the mid-1990s, my sense was that if men stopped it, at any time even after the 5 year period, they would develop what we have coined “catch-up hair loss” so as a result of that, we advise all of our patients to stay on the drug. The official study in the 5 year term showed that those not on the drug, became progressively more bald each and every year, suggesting that those that were treated, even if they had some progressive balding during the follow-up treated period, that it was less than if they never took the drug. We do see some men who lose hair while on the drug and I am convinced that if they were not on the drug, or stopped it after some number of years, the hair loss will eventually reflect the progressive nature of the genetic balding pattern. I am convinced that those who stay on the drug will have more hair than those who stop it. OF interest, that may not apply to all men of all ages, as men over 50, probably have less progressive hair loss than men under 30, but my general advice to most of our patients is: If you are not having symptoms or side effects from the drug and you sexual function is acceptable to you, to stay on the drug no matter what age you are. Even if you are losing hair and are on the drug, stopping it may make ‘catch-up hair loss’ a reality that you may not want to face. Also, long term use of finesteride may have a preventive impact on prostate cancer especially if you are over 50. Hopefully, you will eventually get to 50, so stick to the plan, stay on the drug.


This is exciting as it identifies stem cell heretofore not understood. Read the links HERE and HERE


Dr. Stuart Gitlow of the American Society of Addiction Medicine says “we’ve known that people who use marijuana when they are younger tend to have cognitive abnormalities”. He studied were people in their 40s who smoked about 6 joints a week when they were 18-20. Brain scans were done which showed volume, shape and density changes in two key regions of the brain. These areas deal with emotion, motivation and decision-making…. “This is the part of the brain you don’t want to mess with”. says Northeastern University psychiatrist Hans Breiter……” The more marijuana that users smoked, the more their brains differed from normal brains…..

As we move to more and more legalization of this drug, we should ask ourselves what is the price we will pay? This will obviously impact schooling, and everyday life. Can you afford to take this risk?

Tags: brain function, Marijuana, emotion, motivation, decision-making


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