Dear Dr. Rassman,

I’m a 22 year old male. I’ve been thinning since the age of 17, to my knowledge (probably a little prior) and have maintained my hair, somewhat, it’s thinner as time goes by but i have used lexington’s lasercomb for 9 months and have not lost any more hair and my crown actually got thicker,
but the front has stayed the same (no complaints). I would classify myself as a NW2, but no bald spots, just much thinning in a NW5 pattern, you can clearly see the pattern if you look for it, but i am wanting to get an HT to give myself a natural look. I visited a clinic here and they say with 1500 to 2000 i would be okay, and i agree but only if i do not continue to thin.

I am just concerned that, although i am maintaining quite well right now, would under going a procedure induce loss? I would think without treatment, yes? But how many individuals are on a treatment and halted their loss, but still have shock loss? Ideally, I would like to get this done, and maintain the results, but my concern is that I’ll lose my natural standing hairs and the HT will look horrible and pluggy and i’ll need to play “catch up”. What do you think? I realize I’m young, but if it wasn’t for being able to control my loss, i’d not consider an HT, as that would be ridiculous if you can’t maintain your hair prior at this point.

Thanks for your time.

If you are a Norwood Class 2, then I find it a poor practice for a doctor to recommend transplants in someone at your age. You are correct to be concerned about hair loss and the things that might go wrong. Starting too early is just asking for trouble.

Shock loss following a hair transplant occurs more often in patients under 30 years old, more so if they are not on Propecia (probably 80% risk). You may not have a noticeable improvement from doing a hair transplant at your age and may only see the down side without seeing any short term benefits. Better to wait until you can determine your true pattern of hair loss.

With what you are telling me, I might think that the doctor is thinking more about his/her car payment rather than your hair and what is best for you. Once you start this process, you are committed for life on a hair transplant timeline without a Master Plan. I am not saying that your doctor is unethical, but I’ve heard about these types of situations before. Please read more about doctor ethics in past blog entries:

• Doctor Availability
• Marketing and Ethics
• The Truth About Cheap Hair Transplants

Hi Dr. Rassman,

I am a 49 year old man. I had a transplant of 1800 hairs about 4 years ago. One year after the transplant, I was very pleased with the result. In fact, it looked so good that I resisted the temptation to do a second “fill-in” procedure. Everyone commented on how great it looked.

But since then, I have been very slowly losing my transplanted hair. It watch it very closely and I see the individual hairs miniaturize and then finally disappear. I estimate that I have lost 25 to 30 percent of the transplant. I would like to get another transplant but feel like there is no point if the hair will eventually be lost.

I have an excellent diet and health and also take Propecia. I was led to believe that I would keep my transplanted hair forever…

Could you give me some advice?

Thank you!

Most men who report this are actually seeing the original hair population drop out, not the transplanted hair. Losing transplants over time is rare, but if it is really transplanted hair being lost, the miniaturization will be evident in your existing donor area. By mapping over the donor area for miniaturization, that diagnosis will be evident. See our article referring to Diffuse Unpatterned Alopecia, which states:

The diffuse androgenetic alopecias, that we will refer to simply as DA and which consist of Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA), can be further divided into various stages of progression with DA 0 representing the pre-balding state. The earliest stage of loss, in these diffuse alopecias, DA 1 , would be characterized clinically by a “slightly thinning” look in the front, top, and vertex, best visualized under strong lights or when the hair is wet. At other times it might not be noticeable. Almost all patients have subjective complaints of less fullness in the affected areas. Preliminary densitometry studies in the thinning area of these patients have revealed miniaturization to be in the range of 20-50%. DA 2 represents the stage when there is obvious thinning evident under normal lighting, but if the hair is styled properly, the degree of hair loss may be acceptable. Miniaturization for DA 2 is on the order of 50-75%. Patients with DA 3 have significant hair loss in the transplanted area, and the coverage it provides is no longer adequate. The frontal hairline, though still recognizable in it’s position as the mature hairline, does not have enough density to frame the face. Miniaturization in DA 3 is usually around 75-95%. The DA 4 patient has lost most of his terminal hair in the balding area (miniaturization > 95%), generally has involvement of the crown, and is similar in appearance to the typical Norwood Class VII.

We feel that the early identification of the diffuse alopecia patient is important in order to screen out those who will not be surgical candidates. In addition, because the diffuse alopecias are often associated with a rather rapid progression through the four stages described, the young patient is often not emotionally prepared for this degree of hair loss, especially with DUPA. Long-term planning and careful patient counseling is, therefore, critical before any restoration should be considered. We have not yet determined the exact incidence of the diffuse androgenetic alopecias in the general male population, but they appear to be significantly more common than are the Norwood Class A’s.

It is possible that in many instances diffuse, unpatterned alopecia is not a true “androgenetic” alopecia at all but actually represents a similar pathophysiology to what has been termed “senile alopecia,” 2 only occurring at a younger age. These authors evaluate the donor area for a miniaturization in every person consulted in our office for hair loss. We believe that some degree of clinically significant diffuse androgenetic alopecia occurs in a substantial number of men as they age. We have observed this in men as young as 17. Regardless of what the actual pathophysiology might prove to be, these authors believe that it is important to make a quantitative assessment of miniaturization , using densitometry, when evaluating each patient so that the physician can more accurately determine the total available supply of stable donor hair.