I am very interested in having the hairline lowering procedure. Do you know of any doctors in the OK area or anywhere close?
A hairline lowering procedure is done by plastic/cosmetic surgeons and a small number of doctors in the hair restoration business. You might check locally with those in this area of specialty. If you want to travel to California, I would be happy to consider doing this procedure, or I would recommend Dr. Sheldon Kabaker in Oakland, California.
Hi Doc,
2 questions. Still have good hair with balding at crown. Is propecia effective in your 50’s? Heard it wasn’t. Age 54.
Also, after a few days on Propecia noticed brain fog and anxiety attacks. Any experience with propecia causing anxiety?
Thanks
It works best when the hair loss is more recent. Men in their 50s generally have already passed the rapid hair loss phase, so the impact of this drug in the 50s is not as much as in the mid-20s. Anxiety is a known stress that makes genetic balding more rapid in many men, even 50 year olds.
I am peri-menopausal (50 years old) and was wondering if getting a perm would hold, as with all the hormonal changes I am and will be facing may affect this?
Having a ‘perm’ should add body to your hair and make it easier to style. The hormonal changes you are experiencing and will experience in the future should not be a factor in your stying decisions (to have or not have a perm).
Hey Doc, I have visited your site quite a bit over the last year reading various posts on MPB. I am a 21 year old male who has been noticing a receding hair line over the last year. I have been to many hair experts and one actual doctor regarding this issue. My doctor who I saw in December told me it was too early to tell if my hair was balding or just a maturing hairline. He told me to start using rogaine as a first step. However, I recently visited a Hair Club for Men just to see what they had to say about my situation. They mapped out my head for miniturization and it was very clear and apparent that my hair in the frontal area was miniturizing, aorund the temples and such. Moving backwards there was very little signs of miniturization on the top and none towards the back. They wanted me to start their extreme hair therapy which costs close to $2000 for six months. I obviously do not want to go that route and am very curious as to how you feel about my situation. My grandfather is bald and I have uncles who are bald and a 28 year old cousin who has already had hair transplants. How do you think my situation looks right now and what would you suggest as a plan. Thanks so much.
I could have helped you more if I knew precisely what Extreme Hair Therapy is. Just from looking at the Hair Club website, it appears to be some shampoo, conditioner, herbal pills, and topical minoxidil. Assuming that you have a high degree of miniaturization in the frontal area, the best treatment is finasteride 1mg daily which should slow down, halt, or possibly reverse hair loss. This is not “extreme therapy” and I charge $85 for an office visit and to write a prescription for the drug (if I find that you have genetic hair loss). The consultation is free, though. Miniaturization mapping at my office is also free. Anything else would not be good medical care in a 21 year old with miniaturization. Some of the essentials for establishing a long term plan that your doctor should comment include:
This does not cost $2,000.
Hi, i’ve been on Propecia for 10-12 months now, and I would say that it has slowed it down maybe 90-95%.
However there’s something that i’ve been wondering for a while now. If the rate of loss AFTER one has been on Propecia for this long was still quite fast *even though it would be a lot better than not being on it at all*, would this indicate:
1) That without Propecia, the hair loss would have been very aggressive?
2) That the person has not been very receptive to the drug.
3) Both.I’ve always wondered, what does a less than average reaction to the drug tell us?
The answer to your three questions is Yes, Yes, and Yes — all are possible.
There is no guarantee that Propecia will work. We see better results with the drug on young men with more relatively short term hair loss. This is a drug that is known to be effective at slowing down, stopping or reversing the hair loss, but what that means is clearly uncertain. Here’s stats from the official Propecia website’s FAQ:
A 5-year clinical study demonstrated the effectiveness of PROPECIA.
What’s more, in the first year of the study, 86% (587 out of 679) of men on PROPECIA maintained hair or increased the number of visible hairs vs 42% (282 out of 672) on placebo.
I’m a 38 yr old black female. My hair started thinning in the crown about 10 yrs ago. I started braiding it to keep out the chemicals. About 3 1/2 years ago I was diagnosed with traction alopecia. Had never heard of it before. I started wearing weaves and wigs to cover up the ugliness. I never realized that this would make my situation worse. Now the balding has spread to the top and front of my head. Is it too late for a hair transplant that would work. The hair on the sides and back is relatively thick, but it seems so unhealthy. At the rate I’m going I feel like I should just shave my head bald and call it a day. I feel so ugly. I did see a dermatogolist for the diagnosis, but I never got any advise on what I should do to help the situation. Can you recommend anyone to see on this side of the country??
If you are diagnosed with traction alopecia, you need to keep your hair short with no weaves and wigs. After stopping the insult, you should wait for at least six months and see if your hair regrows. In many cases, traction alopecia may cause permanent damage to the hair follicle and may not reversible. Repeating the evaluation of your hair after this period of time will show the areas of permanent hair loss. At that point, a hair transplant specialist can evaluate you for further treatment options if the hair failed to grow back. Then, if you are using a wig, be sure that it is converted to clips to prevent the transplants from developing traction alopecia.
Is there a medical answer for why whenever men get older they loose the hair on thier head and thier eyebrows get bushier?
I believe that the explanation of this is related to the effects of DHT. Included are other “benefits” such as:
You can’t just select one of these secondary sex characteristics probably caused by DHT, but I have seen a couple of patients who took finasteride (Propecia) and found that they lost some or all of their chest hair. They did not report the impact on their nose or ear hair, however.
I have always had a high forehead, but I’ve had two comments in the last month saying I’m growing bald. My hairline has always definitely been higher by my temples, but I’m now unsure if it’s getting worse. When I lift my hair to show my hairline though, I don’t see any thinning. Shouldn’t this be a gradual process where I could actually see the hair receding or doesn’t it work that way? Also, my dad and all of his brothers are completely bald, but they all showed signs by the time they were 20. No one on my mom’s side is bald. Would that mean if I was balding, it would be in the same pattern as my dad and his family? I’m almost 26, should I be balding at the same age as then and same rate?
You need to determine if you are developing a maturing hairline. You should also get your hair mapped out for miniaturization to determine if you are really balding. Recession is different that maturing a hairline and you need to understand the difference. If you do not show miniaturization, the it would be safe to assume that you are not now presently balding.
Doctor Rassman –
I was surprised to read in an earlier blog concerning Procyanidin B-2, that you were “impressed” with this approach (given that it is not FDA approved). I do understand that the ingredients are natural and no side effects occurred during clinical studies. My question is this: Would taking the Procyanidin B-2 in conjunction with Propecia be harmful or cancel out any results of Propecia? Obviously, if the two combined act synergistically, then why not give it a shot? Lastly, do you think it is worthwile to try?
Thanks!
Any full understanding of Procyanidin B-2 and Propecia is not available in the literature. There is nothing to suggest that Procyanidin would not work with Propecia, so I would try it if you have the ‘adventure’ in you. The problem, of course, is that if it works you have no clue to which of the two is actually working.
Doc…what’s your lay person’s take on laser therapy?? Seems odd you can use a laser to remove hair and also try grow it…sorry to bug you, just emailed you not too long ago…anyhow, they’re advertising lasercomb on tv, thought I’d ask what you thought of it…
To be honest, I am having difficulty believing that the comb works. A few passes with a comb through your hair each day brings hair back? My brain tells me not to believe it. The lasers that kill hair are different so look at them as a totally different product with a commonality in name.
Hi doctor, i have a oily scalp. How do i deal with that. I excercise regularly and my fitness is very good.. But how come i cant get rid of the oily scalp. I even shampooed daily.
People with oily scalp should use shampoos that are promoted for oily scalps. You need a stronger detergent in the hair shampoo and that is what makes the difference in shampoos. Daily washing is a good idea to prevent buildup of sebum.
In this answer you stated; “it is normal to have some miniaturization or thinning in the very front edge of your hairline“.
and in this answer you stated: “The maturing hairline is as thick as the juvenile hairline, as long as there is no genetic hair loss in the actual hairline (no miniaturization). Sometimes, the mature hairline is thinner (at least it seems that way to me as I look at my mature hairline), but that is just a feeling.”
These two answers confuse me since it seems that you in your first answer suggests that it is normal with some thinning in the very front, but in the second answer, it is NOT normal with some thinning in the very front. If this is not a contradiction I suppose the juvenile hairline also have some normal thinning at the very front?
I would be really greatful if you could clear these things up…
Best Regards
Miniaturized hair means that the hair shaft is smaller than a normal (terminal hair) shaft. If you look at a follicular unit, you will see some vellus hairs (shorter and finer) and occasional thinner hair shafts, which when they are not present in substantial quantity, may be normal. As these smaller hair shafts are found all over the head, one must draw the line as to what may constitute a ‘medical condition’ that reflects genetic balding or other forms of alopecia. I have arbitrarily determined that any miniaturized count out of a population of normal hair shaft ‘terminal’ hairs, should be under 20%. When the thin (miniaturized) hair counts exceed 20%, I assume that this is a medical condition. In the frontal line, many people have thinner hairs, sometime exceeding 20% (in the first 1/2cm). If there is no miniaturization above 20% behind this first 1/2cm, then I would call this the soft look that God gave us to produce a transition from bare forehead to thick hair.
All hair shafts are not equal. In people with coarse hair, thicker hair shafts must be offset by finer frontal hair shafts and we actually see finer hair at the edge of a frontal hairline (first 1/2cm or so). The same is true for everyone, but the phenomenon I am talking about is most evident in the coarse hair person.
I hope this helps.
Dr. Rassman, my son had a medulloblastoma at age 10. He underwent whole brain radiation with a posterior fossa boost. This left him with very little frontal hair and no hair in his inferior occiput. The hair he does have is somewhat thin. Could your type of transplant help? Is there benefit with your method for him over other, standard methods?
Hair loss is one of the most common side effects of brain radiation therapy. It usually occur about two weeks after you have the brain radiation. Hair loss is usually limited to the area of treatment, but patients may occasionally lose all of their scalp hair. Hair loss after radiation could be temporary and it may grow back within weeks to months following radiation. Higher doses of radiation and frequent radiations may damage hair follicles permanently and leave patient with baldness.
In some patients, the hair grows back with a different character. Hair color or character may also change, becoming thinner and more fragile.
If your son did not grow hair one year after radiation therapy, he needs to be evaluated by a hair specialist. If his hair loss is limited to a particular area and he has preserved good quality hair in other areas, he may be a candidate for hair transplant. What I want to know is whether there are any areas where the hair is normal. If the answer is yes, maybe there are things that might be offered.
Hi Doctor,
I have been taking Dutasteride to reduce hair loss in the past 3 years. I just got married recently and planning to have children. Could you please tell me will I have problems with having children or my baby may become defect because of my sperm containing dutasteride. Should I stop taking dutasteride for a period of time before starting to have children?
Thanks
Dutasteride (Avodart), as mentioned on this site many times before, is not FDA approved for treating male pattern baldness. However, if you are on dutasteride for any other reason and are planning to have children, you can do so by discontinuing the medication for at least 6 weeks before that. I say 6 weeks, but Dutasteride has been reported to have a long half life (5-6 weeks) which might mean that the drug is in your system far longer than the 6 weeks estimate I just gave you. We really do not know the answer.
Although not studied on humans, animal studies show reduction in both ejaculate volume and sperm count using high doses of dutasteride. After stopping this medication on rats, its fertility effect is reversed in all animals, while sperm count needed 14 weeks for full recovery.
Just be aware that pregnant women should not handle the medication. It can be absorbed through skin and may affect the baby. If the drug stays in the sperm, in theory, it could impact sexual development of the baby.
Hi Dr.,
(male) I have a couple questions. The first one is I had a hair transplant (strip) in March of ’05 and I was wondering if the scar is fully healed by now. Im wondering this because sometimes when i lift weights the back of my head will hurt or feel strained and I do not know if it is due to the scar or if the strain feeling might just be on the muscles around that region. I lifted some amount before 8 months passed on my surgery and at that 8 month mark, the doctor said that I had a 1mm scar. So is it safe to say that it will stay 1mm since it has been so long and since it was that size at 8 months?
Also, I am heading over to california for vacation and would like to meet you in your san jose office so you can look and access everything going on on my head because I trust you will be able to make the best assessment on everything from hair loss to my transplant. Thanks so much.
Best to evaluate your scar and be sure that you have not developed a small neuroma that might be causing the pain. At 8 months, you should be completely healed. Tapping the scar will replicate the symptoms if it is a neuroma and we would be happy to evaluate that for you.
If you’d like to setup a free consultation, you can call my office at 800-NEW-HAIR or fill out our Info Request form and someone from my staff will get back to you to schedule.