Am I Too Young to Lose Hair?

/by William Rassman, M.D./1 /,

Hello. I’m 23 yrs old and have been losing hair for about 2 years. I use to have thick, long, healty beautiful hair. My hair has thin out dramatically, has a lot of static, dry, and everytime I run my fingers through it, about 2-3 pieces of hair would come out. I loose a lot of hair in the shower as well. I have had my blood, hormones, tyroid tested and they all came back normal. I’m too young to lose hair. I don’t know what else I should do. My dermatologist suggested that I should use Rogaine, but I want to find the actual cause before I begin using Rogaine. Should I see a different doctor? If so, which one? I’m afraid that if I don’t get some kind of treatment, I would go bald very soon.
Thank You.

No one is too young or too old to lose hair.

I can not tell from the question if you are male or female; this is important, because the answers are different. I have answered this question many times for both men and women, so you’ll need to be more specific with your questions if you want a more specific answer. The Age category is a good place to start for someone of your age. Also, I would recommend that you use the search feature at the top of the page (next to the BaldingBlog logo) to help find answers. The ISHRS.org is the best website to find a doctor if you are not directly referred to one known to someone you respect.

Eyebrow Hair Loss

/by William Rassman, M.D./0 /

I’ve got male pattern baldness. Am 23. Lately i have been losing hair on eyebrows. My dad had lost his eyebrows in young age due to side effect of some thyroid medicine. My query is, is loss of eyebrows a part of male pattern baldness? What should one do in eyebrows loss. Thank You

The more common causes of eyebrows hair loss are genetic causes which run in families, or hypothyroidism. I recommended that you check with your primary doctor for blood work on thyroid level, TSH, & FT4. There are other causes of eyebrows hair loss, such as ezcema, imflammatory skin disease, plucking of the hair (trichotelomania), drugs, infection, and autoimmune disease. Like hair loss on the top of your head, eyebrows can be well addressed with a good modern hair transplant as well. I recommended that you may first do some blood work to rule out diseases causing the hair loss. Then, a trial of Propecia and Rogaine may help, but I doubt that these drugs will return eyebrow hair. After that, you may come to see me for free consultation and consider a hair transplant.

Here are two examples of eyebrow restoration:

Applying Rogaine to Head

/by William Rassman, M.D./2 /,

Doctor,
I am 23 years old and have noticed thinning on the front portion of my crown (not a receding hair line, but thinning right behind it). I have since been using rogaine twice a day for about 2 weeks. The hair in the affected area is roughly 2 inches. Do you recommend a shorter hair style in order to effectively apply rogaine to the area? I sometimes wonder if the 1 ml I apply is getting to the area.
Thank you

I don’t believe wearing your hair any certain length will make a difference, as long as Rogaine remains in contact with your scalp for a certain amount of time. You will not notice the effectiveness of Rogaine peak at about 6-8 months after using it religiously. Being compliant with Rogaine is very important (must use it twice a day). If you are a male patient, I recommended starting on Propecia for at least 1 year. There has been much data showing that Propecia is more effective than Rogaine for the balding male. In young men, starting Propecia should help prevent further hair loss and possibly even regrow some of the hair in the thinning area.

Heart Pain and Minoxidil

/by William Rassman, M.D./1 /

Hello Dr. William Rassman firstly thank you very much for all your helps for who fight with mpb. I am 26 year male and I ve been on finasteride and minoxidil about 1 and half year but 8 months after started minoxidil I started to have sides around my heart unfortunately I could not find a heart doctor experienced about minoxidil in my country turkey. minoxidil works the best for me it is wonderful but it gives me heart pain although I begun to apply less and less of solution. I do not want to stop using it. so could you please help me with these sides and with any alternatives. thank you so much for all your helps again. best wishes

One of the side effect of Minoxidil can be chest pain, though it is rare. Minoxidil is a hypotensive agent, which means it can drop blood pressure, and with that drop it can potentially cause chest pain. This is the sign/symptom of too much medicine being absorbed into the body in too short a time-frame and you might consider stopping or reducing the amount of Minixidil you are using. You must see a cardiologist or your doctor to rule out other causes of chest pain, like coronary vascular disease (a real issue for you to rule out), muscular/joint pain, pulmonic pain or gastric reflux or gastritis or peptic ulcer disease. I believe Propecia may have a better effect than Minoxidil, without the low blood pressure or other side effects that we discussed here.

Transplanted Hair Characteristics

/by William Rassman, M.D./0 /

Hi Dr Rassman,
Does hair from the neck change structure when it gets on the top of the head? And how long will that take if it does ? I mean does hair fit in properly with your original hair in the front of your head or is there a permanent difference ? The micro “scars” you will get in recipient area will they ever heal 100 % ? If you later in life choose to shave your head can one notice something on the skin in recipient area ? Best regards

Scars are scars and they always show. Depending upon what type of scars and where they are placed, the scars may be less obvious. Scars in the neck always widen and are always visible. The neck hairs used for transplants are often lost with time as these hairs are not permanent like the hair above, in the back and sides of the head. Transplanted hairs usually follow what they looked like from where they were taken. On rare occasions, the hair becomes wavy or curly. I remember one case where a patient’s transplanted hair became kinky, and he loved it. It was what he wanted and that made me happy because I always want to please the patient (but I personally did not like the look). Clearly, the grown characteristics are not in the control of the doctor when a hair transplant is done. The good news is that changes beyond what the original characteristics of the hair are rare.

Hashimoto’s Thyroiditis and Hair Loss

/by William Rassman, M.D./0 /,

Dr. Rassman,
I am very concerned about my hair loss. I am 19 years old. I have been diagnosed with hashimoto’s thyroiditis; however, according to my most recent blood test a few weeks ago, my hormone levels are currently at a normal level (and have been for almost 6 months). The levels have been moving up and down over the past few years (hyper/hypo/normal). I am still experiencing a lot of hair loss to the point where there are some bald patches. The level/amount of hair loss actually has seemed to be increasing over the past few months. I am on no medication. Do you have any suggestions/advice? Would going on synthroid be a good choice? I am in college in Washington DC and am originally from Connecticut. Can you recommend a doctor or specialist for me either in DC or CT or a surrounding area? Thanks so much!

I would recommend Dr. Robert Bernstein in New York and New Jersey. You clearly need a good clinician to help you evaluate the various contributing factors associated with the fluctuating hormones and the patches of hair loss, which might point to other autoimmune causes of hair loss.

Is Chlorine in Water Causing Hair Loss?

/by William Rassman, M.D./36 /

Hi,
I came to Dubai 2 months back and from the beginning I am losing my hair very fast. When my hair is wet during the shower, it falls out even when I just touch them. I never had any problems with my hairs in my life. My hairs were very strong but dry without dandruff. After a month in Dubai I was feeling a little itching and I saw I was having dandruff, although I don’t have much dandruff now, but it has started. I heard Dubai water is not good for hair because it contains chlorine. I don’t want to lose my hairs and want to grow them big. I was using Vatika shampoo before Dubai and now here I have started using Sunsilk egg and also use oil to keep my hairs soft. My hairs are just falling, how to stop them and make them dark, strong & black. Which shampoo should I use. How is Head & Shoulders? Help me.

Again and again, I tell my patients that they need a diagnosis. You are grasping for straws until you get properly evaluated with a mapping of your scalp for miniaturization. Please see a good doctor first, get examined and have a proper diagnosis in hand, then look for causes if the hair loss results from other outside factors. This, a good doctor can tell you. Chlorine should do no more harm to your hair in normal therapeutic doses than water without the chlorine.

Revising Donor Scar

/by William Rassman, M.D./1 /,

I had a strip hair transplant done a couple of years ago, was unhappy with the results, and now shave my head. The scar on the back of my head is 5-6″ long. What are my best bets for revision?

Many thanks

A scar, which is present in 100% of all patients who have strip harvesting, is usually under 3mm in width and although noticable with a shaved scalp, they can be well covered with any reasonable hair length. With that said, if your scar width exceeds 3 mm, then you should consider seeing an expert to have the scar removed and the incision closed with a ‘fascial’ closure and without another hair transplant, minimizing the tension on the wound. If the scar is 3 mm or less, than an FUE procedure would be a good technique to use for your scar revision, which would transplant hair directly into the scar from the surrounding areas. The FUE technique, which has been defined by us, will eventually cover the scar, but it might take a few small procedures to get there.

Green Tea to Treat Hair Loss

/by William Rassman, M.D./1 /

Hi,
I am currently 24, I have been orphaned since 4 years old. so I have no idea if this problem of mine is linked to genetics. At about 16 years old I notice my hairline receeding, I was kind of ignorent then. About a year ago someone mentioned the (dreaded fact) since then I’ve been looking for alternatives to Medical drugs. I came across an article written about the 5-alpha Reductase inhibitors found in EGCG (green-tea)I was wondering if you know if and when there might be conclusive evidence with American Science, I do hope I don’t come off sounding like a (Jack-ass), but it really scares me to think that especially in (starting my own family )is lost due to the American Standard. Oh yeah on the Norwood Diagram, I am currently Type II.

What should scare you more is letting the hair be lost while you, as an amateur, try to do what hair professionals do every day. You need a diagnosis (even more important for you, because your genetic family line is unknown) and you need your scalp mapped out for miniaturization to find out if you are balding from genetic causes.

As far as green tea is concerned, I frankly do not know. If it really worked, more and more people would be using it and telling me about it. Just something to think about. I am curious, does one drink it or pour it on their head? Ha!

Lateral Slits and Transplanted Hair Direction

/by William Rassman, M.D./0 /

Suppose a patient has had two non-lateral slit transplants by doctor A (who is reputable), and goes for a third operation with doctor A (who now advertises use of lateral slit)–should doctor A perform a lateral slit transplant on the same patient, or continue with the same method of the previous two surgeries? Also, does the lateral slit method deserve the positive “hype” it receives on hair transplant sites? Or, is the difference slight and subtle and even overrated? Finally, when a transplant has been completed and the required one year waiting period ends, if hairs appear to grow straight up from the scalp, would you deem this to be a poor transplant? In my case, it appears that the hairs come straight out of the scalp, but lean or lay down–perhaps because of the weight of the hairs and also because of how I comb the hairs.

Switching between lateral and vertical slits are not a problem, but the learning curve for staff is a problem and those with experience in vertical slits will not just simply become experts in lateral slits without some experience.

I like the idea of lateral slits because it forces a bend of the hair as it exits the scalp forward and downward. In addition, the concept of fencing (where hair within a follicular unit appear like a fence/wall) should enhance the value of the grafts. Now with that said and the great theory, the realities are that no one has really demonstrated the value of lateral vs vertical slits, side by side. I have massive experience transplanting with vertical slits beyond 4 years ago, however I do lateral slits because it makes sense and it is in vogue, not because I am convinced that the results are better than those of the vertical slits.

If transplanted hairs grow straight up or to the sides, it usually reflects the way the surgeon put them in. I have seen people who had radial placement of hair with straight, strong hair and the hairlines look like bicycle spokes — not a normal hairline. Last week, I saw a patient where the hair was put in pointing to the right. The patient wanted to comb his hair back but because of a strong hair character, it always pointed to the right creating an unnatural appearance. This is a problem of strong haired people, not soft haired people. Hair characteristics tend to dominate in some people, impacting the way hair can be groomed.

Chemical Induced Thinning

/by William Rassman, M.D./0 /

Hi I’m a 21 yr. old male who is experiencing a form of chemical induced thinning and breakage. In August I had colored my hair and it had come out very dark. I frequently washed it and damaged it further, thinking it would fade the color. Needless to say once I started to notice some breakage I did everything I could do to condition my hair. The thinning was a very rapid affair, only taking a week. Since then there was no unusual hair loss. I was prescribed a topical steroid for redness in my scalp and I had some bad dandruff for about a month. Now I notice some new hairs coming in around the hairline and I still feel a diffuse thinning on top of my head kind of near my crown. It is hard to tell the new hairs from broken off hairs. Also I don’t see any kind of scarring. What advice can you give me to help my condition? Also what can I expect?

If you truly have hair thinning, you need a complete evaluation of your scalp and hair to determine if there is a genetic component to this process. It may not be due exclusively to the impact of the chemicals you used. If it was, then the chance is very good that most of your hair will grow back as long as no significant damage to your hair follicles and surrounding skin (which is probable). To determine if you have an underlying male balding pattern which may have exacerbated further hair loss by the chemicals which you have used, it is best getting a scalp and hair examination for miniaturization by a doctor that specializes in hair.

Excess Sebum on Top of Scalp

/by William Rassman, M.D./4 /

Hi,
My scalp produces too much sebum and there is a wax like build up around the hair follicles. As a result I am losing hair. My hair roots are not nourished properly and then fall out very easily. Surprisingly there is no sebum or wax build up on the sides and rear of the head and the hair is perfectly healthy in that area. Its the vertex part that is effected. Nothing seems to help. I am writing with a lot of hope…please suggest me something. I have started taking zinc sulphate and B6 and sebum production have reduced a bit. Thank you.

Sebum does not cause hair loss, contrary to what many people say, but the things we do to keep it down, does often cause hair loss. Shampoo regularly, possibly twice a day to keep the sebum down. Have your scalp mapped out to determine if your have miniaturization and genetic hair loss. Let’s be smart about how this is approached. Get a good doctor and get a diagnosis in your hand so that you know what has to be done.

Scarring After Hair Transplantation

/by William Rassman, M.D./0 /,

I had a transplant at your L.A. Clinic in November 97. I have been reasonably happy with the results & would consider another transplant but I’m concerned about the scarring. Could you tell me what the extent of a 2nd transplant might have on the existing scar.

Thanks

Scarring is becoming less of a problem with the new method of closure we instituted a year and a half ago. Even for those who usually develop heavy scarring, we now have ways to treat these scars.

The new technique for preventing scars is what I call a modified fascial closure to the area where the scar might be a problem. I now use this technique in all of our patients. If a scar should occur, although it is rare with this new technique, we will attempt a scar revision (as the sole surgery without a hair transplant) at no charge. With a scar revision of any existing scar, the chances of improvement are as follows: 60-80% of patients will show some improvement, 50% will show a moderate-good improvement, 10% will show no improvement, 5% run a ‘risk’ of making the scar worse and 1-2% run the risk of making the scar much worse (although I have not seen that occur over the past 18 months or so since I perfected this new technique). The key to minimizing risk is to be conservative with the surgery, yet radical with the repair.

These are my three approaches to scars:

  1. Scar revision with a modified fascial closures
  2. Transplants into the scar with the Follicular Unit Extraction (FUE) technique (this is applicable and can work well in almost all patients)
  3. A balloon reduction (a radical approach to severe scarring usually caused by burns, car accidents, and following brain surgery)

With all of that said, I would doubt that scarring is a significant risk, but you can do a FOX Procedure (also known as FUE) which is removing one follicular unit at a time. The scarring is punctuate (small round 1mm wounds) that can only be seen if you shaved your head, but not with a close crew cut.

For more information on FUE / FOX Procedure, please see:

Remaxx

/by William Rassman, M.D./0 /,

2 quick questions…
I am currently taking propecia but have been reading on the web about the effectiveness of avodart which seems to be substantially better than propecia. Would you advise taking it if I could get my hands on it?(it seems like I could get it from overseas UK pharmacy’s)

Also, have you ever heard Remaxx products? I went to a Dr. for a consult and he said post-op that they have a couple of products that would be beneficial. Basically, a shampoo, conditioner, and replenisher. Have you ever heard of this co.? Any help on these subjects would be great.
Thanks

Avodart is discussed heavily on this site. You can see all of the articles referencing Avodart here.

Remaxx products show an extreme and unrealistic / unbelievable before and after photo. When they look unbelievable, I generally take a dim view of the company and its products. These products are just another offering in a mass market of claims galore for hair regrowth.

Finer Hairs at Hairline

/by William Rassman, M.D./0 /

Hello Dr.Rassman,
I am a 29yr old caucasian male who has over the last few years been dealing with questions of hairloss. Thus far there is nothing dramatic to speak of – no noticably thinning or balding areas. There is however one thing that has led to a good deal of concern – it can best be described as light or whispy hair around the frontal hairline (from temple to temple). My hair has always been quite fine in nature and until a few years ago a light brown color rather than the dark brown it has become. In recent years I have grown my hair out quite long – opting for the ‘rocker’ look as friends call it. If I pull my hair back I dont notice any loss at all – it looks like a regular hairline – but the hairs that make up the first cm (rough estimate) are lighter in pigment and fine in composition compared with hairs deeper in the scalp. Aside from the minor difficulties this phenomenon creates when attempting to style my hair I’ve been wondering if this is an example of the ‘miniaturization’ process that you have described. I have no signs anywhere else of this phenomenon – just the fringe of the frontal hairline. No crown thinning, no overall diffuse thinning, no temple thinning – and that is what is driving me crazy! If it were more extreme I would be prone to take some action be it drugs, topicals or other treatments. With this said however the lack of action kills me just as much because I wonder if I’m not acting when I should be – nipping my possible hairloss in the bud so to speak. Please let me know if you feel this is an example of ‘miniaturization’ or not and any course of action I should consider taking. Thank-you.

To really answer your question directly, you should be examined and have your scalp mapping of your hair for miniaturization, which is best done under magnification with a visualizing high power microscopic tool, like our densitometer. Fine hairs often exist in the very front of the hairline, but in regards to what you refer to, I am not sure if you mean the mature hairline that has probably evolved from your child hairline (age 10 or so), which is often lower and thicker. I would want to see pictures and possibly meet with you in person to make such assessments. If you’d like to send photos, you can email them to the address on the Contact page.