Dear Dr. Rassman,

I am a 24 year old male medical student. I have had a very gradually receding hairline for the past 2-3, but just recently (past 6-8 months) I noticed the shedding of hair has increased and my hair is thinning in the front. This realization really is depressing because I didn’ think I would start REALLY balding until I was well in my 30s. At least thats been the pattern in my immediate family. I have an appointment with the dermatologist in a month to pinpoint it to male pattern baldness and not something else just to make sure. Anyways, my question to you is whether or not there is a correlation between weight lifting and hairloss?

Working out, especially with heavy weights, will increase your testosterone levels. So the natural assumption would be that increased testosterone levels = increased DHT production = more hair loss. I personally have been a big fan of whey protein supplements, glutamine, and creatine to boost my gains in the gym. My parents always warned me against taking these saying it was “unnatural” and would have consequences in the long run, and now I’m wondering if they might have been right after all. I’ve had a protein shake(30 grams whey protein) and maybe 5 grams of glutamine maybe 3-5 times a week for the past 4-5 years. This is very coincident with the time that my hairline started to gradually recede.

I’m starting to wonder now whether my dedication to weight training and diet actually hastened the hair loss process. For now, I am discontinuing all forms of supplements including protein drinks and glutamine. Doing this will obviously cut my gains in the gym, but as long as I can save my hair for now I don’t care what it takes. What is your opinion on this???

What you are suggesting is logical, but there is no proof to it. Since you are 24 years old and at the peak of the early balding process when genetics generally tend to kick in, it may be coincidental with your training process. Realistically, if you have genetic hair loss you should have a diagnosis made, then probably treat it with Propecia, which should stop the hair loss impact of DHT reasonably well. As a medical student you should approach this process the correct way.

Tags: propecia, finasteride, hairloss, hair loss, weight lifting, weight training

I’m thinking about a hair transplant procedure, but had some reservations about what happened if one continued to lose hair. The transplanted hair is supposed to permanent, so what happens to the rest of the hair on the crown if you get hair transplanted to the front hairline area? Does it stay and the rest of it go?

Assuming you are a male, have genetic hair loss, and you are taking Propecia (finasteride), then the hair loss should stabilize so that as you add transplanted hair you are gaining, not losing hair. Hair loss is a progressive process, arrested by finasteride in most men. Hair transplants in the front will frame your face and finasteride for the crown should stabilize or reverse the hair loss. Get you scalp mapped out for miniaturization to be sure of the diagnosis and then you can get a transplant if that is part of your Master Plan.

Tags: hairloss, hair loss, hair transplant, propecia, finasteride

I noticed hair loss from the age of 17 and am now 23. About 2 years back I started using Minoxidil 2% for 6 months and started Minoxidil 5% for another 6 months. There wasnt any improvement and started using propecia for the last 1 year and 6 months. Over all these years there hasnt been any sort of improvement. I can only see my hair getting thinner and thinner with time. I thought propecia is supposed to arrest hair loss. Do I still continue on propecia?

First, as I have said again and again, you need a good diagnosis with your hair mapped out for miniaturization. If you have genetic hair loss and stop the finasteride, you will almost certainly see the hair loss become worse. Just because you are not seeing benefits, it does not mean that you are not getting benefits. Put some science and medical diagnostic force in what is happening to you.

Tags: hairloss, hair loss, miniaturization, propecia, finasteride, minoxidil

Insurance companies generally exclude any hair treatment (wigs, transplants, drugs, etc) as a benefit of the insurance plan. For accidents, I have had insurance companies pick up the bills, but that is unusual. Read this interesting article about a woman fighting insurance companies on behalf of those with alopecia…

Tags: hairloss, hair loss, alopecia, insurance

Hi Dr. Rassman,

Thanks so much for your site.

I am a 26 year old male in Toronto, Canada, experiencing what seems to be a Norwood 3V hair loss pattern. When my hair is dry no scalp can be seen but when it is wet the scalp can be seen at the crown. I’ve noticed slow thinning/falling out of the crown hairs over the past 2 years or so. I don’t want the situation to get any worse, but before I get a miniaturization map done or start propecia etc., I wanted to know if a change in diet is likely to either stop the hair loss or even stimulate hair growth. An internet article I found at https://www.holistic-online.com/Remedies/Hair/hair_loss-nutrition.htm says taking high doses of Vitamins B, C, E, Zinc, Magnesium etc. and eliminating animal proteins from the diet has been proven to be effective in many cases in stopping hair loss or even stimulating hair growth. Are these claims true? If not, what are my options?

Also, do you know any good scalp dermatologists who could perform the miniaturization map in Toronto?

Many thanks for your time.

Holistic medicine has not been proven to reverse hair loss. I can not give you a doctor reference, but I would suggest using the physician search at ISHRS.org to find a doctor in your area. Be sure to do your research.

Tags: hairloss, hair loss, doctor, holistic

Hi Dr. Rassman,

At 21 I started losing my hair in the front of my head and on my crown. I ignored it for about a year and then at 22 I started taking finasteride this was about 8 months ago.

6 months into it I noticed no results but I believed my hair had stopped falling out; to try and maximize my results I started using minoxidil 5% on my scalp.

Suddenly about 2 weeks ago I noticed almost ALL of my hair had grown back and am experiancing almost zero hair loss. My question is do you think this is because the finasteride finally kicked in, or is it because I am using both finasteride and minoxidil?

(Just to clarify: I have been using finasteride for 8 months and minxodil for a little over 2 months)

I always tell people to go for a full 8-12 months on finasteride before drawing any conclusions. Likely, the impact of what you are reporting is the result of finasteride. Less chance it was minoxidil. If you have only been using the minoxidil for 2 months, you might try stopping it now, but if it should result in hair loss, then kick back in using it. You are a lucky and thoughtful man and you did the right thing.

On an unrelated note, this is the post #2,000 on BaldingBlog. Wow!

Tags: hairloss, hair loss, minoxidil, propecia, finasteride

How can you reduce tension in the donor area after a procedure. In other words, what can the patient do to ensure proper healing of the donor area scar?

Good judgments in determining the size of the donor area is the best determinant of the size of a donor scar. When the incision is too tight because the piece of excised scalp is too large, then the enemy is tension. The use of special closure techniques minimize the scars and the tension, but a bad judgment at the time of surgery can not be offset with a repair process.

Tags: hair transplant, donor scar, tension, surgery

I have been told thet i have a hypothyroid condition. I take synthroid. Since I have been on this medication my hair has had severe breakage at the top and middle of my head. I have been using olux foam and selseb shampoo. I still continue to have sore spots in my head and several bumps to come in these spots. I am a 59 year old afro american female. I have also had injections in my head. My hair still does not seem to be starting to grow back. Do you think I am on the right track or should I talk to my doctor about some other type of treatment.

Unfortunately, it is impossible for me to really know what is happening to you just by reading an email. Hypothyroidism can produce hair loss and changes in the character of your hair. Apparently you are under the management of someone who is injecting something into your scalp. I can guess what that is, but rather than do that, I would suggest that you ask the doctor who is treating you the question you asked me. Any good doctor will discuss the treatment plan and his/her expectations with regard to that treatment plan. These bumps you are getting need a professional opinion, not something I can do competently over the internet.

Tags: hypothyroid, hairloss, hair loss

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.

Tags: hair transplant, hairloss, hair loss

This man wore a hat as often as he could. He has some pre-malignant skin changes on his bald scalp and the hat provided cover for it. His comb-over was as good as he could get for non-hat coverage and he didn’t like the way it looked. What did he do for a living? He is a make-up artist with a 30 year career working in many big budget movies and TV programs. Because of his career, he was self-conscious about his balding look and his comb-over. He knows almost every actor in Hollywood so he feels for those who are balding. Now, he proudly tells those people that he had a hair transplant, trying to help them find a similar solution (when appropriate). He received 1496 grafts in a single session just one year ago. Now, wanting to be slightly greedy, he will probably do it one more time to thicken the front so that in a bright light it will look thicker. His willingness to come forward and let me tell his story shows the character of a self-confident man.

Before:


After:


Tags: hair transplant, hairloss, hair loss, photos, combover

This blog is very informative. I have had transplants in the past, which look very natural (in my opinion). My concern is with the donor patches in the back. I would like to get more transplants, but the patches become noticable when my hair is short and any more bare spots would be obvious. Is there a surgical method/technique to minimize these blank spots? Thanks for the information.

I have addressed this question many times. This is a problem more of the past than of the present. See: Techniques to Minimize Donor Area Scarring and Trichophytic Closure Photos.

You need a Master Plan developed to deal with scars and the need for hair in maximizing the value of the remaining donor hair. Scars can be dealt with in most people using the techniques described in the referenced blog entries above. After you read them, call me at 800-NEW-HAIR or write to me again if there are unanswered questions (be sure to reference this blog posting).

Tags: hair transplant, scar, donor, trichophytic, surgery

Hello, I am a 49year old female and experienced hair loss on my scalp for about a year but much more noticeable in the last 6 months. I have been on Effexor for about 4 years and have been up and down in dosage as high as 225mg and as low as 75mg. I also started taking soriatane for my psoriasis about a year ago. My dermatologists thinks that it is the soriatane that is causing the hair loss, not the Effexor. Can you tell me what the more likely medication would be?

Many medications have the potential for hair loss as its side effect. Before changing any medication regimen you should consult your doctor. There is no way to tell which medication may be the cause of your hair loss, and in fact, it may not even be the medication. You may also consider if there are any medical causes of hair loss. These are the things that you should be discussing with your doctor (see the Female Hair Loss category for more).

Tags: hairloss, hair loss, soriatane, effexor

Having too much fun so the Docs here prescribed me lithium at 600 mg daily…of course my question to you is does lithium have any potential side effects regarding hair loss???

Simply put, yes… Lithium and other antidepressants and antipsychotic drugs are known to contribute or to cause hair loss.

Tags: hairloss, hair loss, lithium

What information did you learn about Avodart’s effectiveness in treating androgenic alopecia at the Sept. ’05 conference in Sydney, Aust.? Any hope for female pattern hair loss?

Avodart (dutasteride) may have value in those men where Propecia (finasteride) fails to work, but as it is not FDA approved for treating hair loss I can not in good conscience wholeheartedly endorse it. It does not show value in women.

Tags: hairloss, hair loss, avodart, women, female, woman, dutasteride

How soon into a three week period of Oxymetholone therapy will androgenic alopecia become aggravated?

If Oxymetholone does worsen pre-existing MPB, are the effects reversible upon discontinuation of the drug or possibly improved by other means?

Thank you.

Why are you undergoing Oxymetholone therapy? Do you have a major health problem? If so, you might look to that problem as a cause of your hair loss. I am sorry but there is no magic number and no way to tell, but this steroid is known to cause hair loss and once it kicks in, it may not be reversible. In determining if it might reverse, you may want to know if you have genetic balding and determine the degree of miniaturization you have.

Hair loss and the degree of hair loss can be a very subjective observation until one day you notice you are bald, since you can lose up to half your hair density and still look normal.

Tags: oxymetholone, alopecia, hairloss, hair loss