This patient had corner hair loss on one side of the hairline following a brow lift that she had done in 2003. We transplanted that weaker corner with 509 grafts in 2010. This is a unique case since we rarely just do the one corner, but the patient wanted to transplant just the left since the right corner did not show the same severe hair loss. We also treated the scar from the brow lift itself.

The corners of the female hairline often have slower growth than the middle of the hairline, so when one corner is transplanted with donor hair it will likely grow longer, thicker, and faster than the original corner hair. Why? Well, because her native hair in the hairline probably has a hair cycle measured in months rather than years. Now the hair that was transplanted at the left corner will most likely have to get cut frequently to maintain symmetry with the other side. We’re now planning another procedure to balance the sides out.

Anyway, this is a unique case and wanted to share. Click the photos below to enlarge.

AFTER – 9 months post-operation (509 grafts):

 

BEFORE:

 

Tags: hairline, female hair loss, brow lift, hair transplant, hair loss, hairloss

You have not made it clear why you would prefer to prescribe drugs for hairloss rather than a surgery. It is safer in every way to administer a hair transplant. Perhaps you realize that patients will opt out of treatment altogether since many men would never consider the very significant and costly method of pursuing a transplant?

I would use a non-surgical recommendation for a wide range of problems (e.g. many forms of heart disease, Parkinson’s disease, epilepsy, herniated lumbar disc). In some situations, I would recommend hair transplants as I get to know the patient if I am convinced that it is in his best interest. That puts the burden on the patient to convince me about his agenda.

I am not a plumber who is fixing a leaky pipe. I am a caring, responsible doctor who always does the best thing for his patient. Think about how strongly I must feel about this. I would rather offer a free consultation and then prescribe Propecia for a total fee to me of $85. My average surgical fee exceeds $5000… so I must really believe in the welfare of my patients to turn that down.

Tags: propecia, hair transplant, hairloss, hair loss

I’m a male who has been diagnosed with Iron-Deficiency at age 20. I also have been noticing hair miniaturization and hair fallout from the top of my head (nothing from sides and back).

My doctor said the reason for this is the Iron Deficiency and I should correct it by multivitamins and minerals and then see if the hair fallout continues, since hair loss is a symptom of Iron Deficiency.

My question(s) is this:
– Would my deficiency be accelerating my inevitable MPB?
– Wouldn’t my deficiency result in hairloss all over my head instead of classic MPB fashion?
– Would correcting my Iron levels result is less shed, maintenance, or regrowth at all?

Thanks!

I don’t know what tests your doctor conducted to completely eliminate genetic male pattern baldness as a possible cause for your hair loss. If you’re losing hair in a classic pattern, you could have a combination of genes and low iron.

So to answer your questions — Yes, iron deficiency could accelerate your genetic hair loss. It may also cause thinning elsewhere on your head. Correcting your iron levels is important, but it may not impact the genetic patterned hair loss.

Tags: iron deficiency, hairloss, hair loss

I’m a 20 year old with a question about balding and family genetics. I have a maternal grandfather who is is almost in his 80s who has a huge full head of hair, and a father who is bald. What are my chances of going bald?

There’s no telling. The balding gene can come from the maternal or paternal side and can skip generations. There’s no easy predictor just by looking at the family history, but with your father’s baldness, you do have some risk.

Tags: family history, hairloss, hair loss

Hello Doctor Rassman,
Does spironolactone cause more hair loss? I seen a lot of people on the internet that claims propecia make their hair worse and others says that this is reflex hyperandrogeincity and their argument was “when DHT lessened testosterone increased alot and cause more hair loss!” but what about Sprio? I heard it decreased testosterone itself and also block androgen receptor, so how it could cause more hair loss?

I’ve always said the Internet is a great source for information, but not everything you read on the web is factual and true. If you want to treat your hair loss with a medication, you need to speak with a doctor. Anecdotal statements or claims found online will mostly mislead or confuse people.

Spironolactone does have theoretical anti-androgen factors, but clinically I have not seen or found credible evidence that it helps with androgenic alopecia. But I do understand that there are patients and doctors who use it as a treatment option. I do not.

Propecia (finasteride) does treat androgenic alopecia. It is not meant to cause hair loss. It is meant to grow hair. I understand there may be controversy on the Internet of Propecia’s side effects and some patients have strong feelings regarding those side effects. My opinion is that each and every individual talk with their doctor and discuss the side effects and understand the risks and benefits. In my practice, many patients use Propecia… and have been using it for over 10 years with no issues.

We can all sit on our ivory tower and debate the biochemical relevance of drugs and mechanisms, but in the end the results (hair growth) is what matters.

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

I have been on finisteride since 2004 which is working great. I was diagnosed with ulcerative colitis in 2009. Been UC free for two years but got it back in 2010. I still have it a year later, although only in MILD form. My hair did change in texture while a tad thinner. Now, although my vitamin levels have been fine, could the hair thinning be from the UC alone or the medication?

I took Asacol the first time I had it with no side effects. This time, I took it as well as the masalamine enemas. Since it has lasted a year this time around, could it be the meds or the UC alone? Also, any chance of my hair re-thickening? I was wondering how long I should wait until I visit Dr. Bernstein again. It will be greatly appreciated if all questions are answered!!

Asacol does list hair loss as an uncommon, but known, side effect. Maybe it’s the medication or a combination with MPB… or even the UC itself. I do not treat many patients with ulcerative colitis in my practice so perhaps your GI doctor can address your concerns as well.

Hair loss or hair thinning can certainly happen from major stress or illness on your body. This type of hair loss generally should reverse itself in about a year’s time. But often, I find that patients never quite regain their hair. Maybe you should call Dr. Bernstein for another consultation (I’m not sure when your last visit was).

Tags: ulcerative colitis, ulcer, hairloss, hair loss, asacol

Hello there,

I’ve been wondering if I was going to end up bald. My grandfather on my father’s side is bald, as is my own father. Nobody on my mother’s side is bald (though she had no siblings and her mother’s brothers had their hair).

My bald grandfather said he started to bald around 18. A picture of my dad when he was around 19 1/2, he looked like a NW3. I’ll turn 19 in four months and was wondering if I don’t see any symptoms by the time I turn 19 or 19 1/2, will I go bald?

Thank you again.

There is no way to easily tell if you’ll develop the balding pattern your male relatives showed around your same age. You can have the HairDX test done and get an idea if you have the genes for balding, or you can see us and get a hair bulk assessment yearly to show when and if the balding/thinning process kicks in.

Of course, you can also just watch and wait.

Tags: hairloss, hair loss, genetics

Hello doctor. I was wondering, are the genes for balding and hair ‘type’ independent? For example, if a bald person has straight hair as does their son, is their son at a higher risk of losing their hair since they have the same hair type. I guess this could be similar for curly hair too.

As far as I’m aware, hair characteristics and balding aren’t linked. For example, a son might have the same hair type as his father, but the son didn’t get the father’s balding pattern. There’s also nothing showing a link between hair color and baldness.

Tags: balding, hairloss, hair loss, genetics, hair type

For those of us with Alopecia Areata, – this study may be beneficial to you guys. The study is quite positive. Please read the link below:

Link: Local Study on Garlic for Alopecia Areata

GarlicNice find and thanks for sending. I don’t recall seeing too much about using garlic as an alopecia areata treatment.

This was a small study of 34 people presented last year at a conference in Australia. It does sound interesting, and I found another small alopecia areata study discussing the use of topical garlic gel in combination with betamethasone valerate, but I don’t know that the study mentioned in the link you sent was ever published in a peer reviewed journal. While the article is from the Philippine Dermatological Society site, it just mentions that the presentation was by one of their members…not that it was published in a medical journal.

I am glad there are new alopecia areata treatments being explored, regardless of how stinky they may be. And it’s worth noting that a few years ago the NY Times wrote about unlocking the secrets of garlic for use in medicine.

Tags: garlic gel, alopecia areata, hairloss, hair loss

A week ago my grafts were exposed to the sun for approximately 10 mins. I didn’t burn but I did go slightly pink most noticeably on my right temple. To be honest I didn’t worry about it at all at first as from what I gathered from researching previous posts here your pretty much safe up to a first degree burn.

Over the last couple of days however I’ve lost a few newly sprouted transplanted hairs where the discolouration is on my scalp. In fact they emerged just before I was exposed to the sun so only 1 week old. I’m slightly concerned as I assume the only reason this would happen is if the follicles were going back into a resting phase or if they have died.

Is it possible sun exposure can cause follicles to shed but then regrow? I’m 9 weeks post op and had just experienced some early growth about week 7/8. Your opinion would be greatly valued.

SunnyI wouldn’t think you have anything to worry about regarding your sun exposure. I don’t know why your newly emerged grafts disappeared, but 10 minutes in the sun will not harm the follicles and I doubt it will affect your scar. The ultraviolet light is what you want to avoid, so in the future I’d recommend applying sunscreen to your scalp (SPF 45 or higher).

If you are still worried, follow up with your doctor.

Tags: hair transplant, sun exposure, hairloss, hair loss

Hi Dr. Rassman

I just watched a timelapse video of a man age for 17 years, which shows the balding process really nicely. I noticed that his hairline recedes very slowly and gradually. But his crown thins all of the sudden at age 44. Can you explain why this happened?

Thanks

This is a great video illustration! This man took multiple photos daily for nearly two decades. As to why he lost his hair in this way… it’s all in the genetics.

See the video below:

Tags: hairloss, hair loss, hair loss progression, video

You mentioned one time in a post that it is common for on side of a balding hairline to recede faster than the other. Is this also common in a hairline that is just maturing? The right side of my hairline seems to have been stable for a while now, but the left side is catching up.

Yes, it is very common to have one side recede faster than the other when forming mature hairline. But rest assured (as you are starting to notice)… the other side usually catches up.

Tags: hairline, hairloss, hair loss

This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).

E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:

“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].

In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”

We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.

The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.

I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.

Tags: hair loss, hairloss, finasteride, cancer, tumor

What is hair bonding? Can it give a natural look?

Any treatment available to people over 60 years of age, with long standing baldness?

You may be taking this term out of context. Glues that are used to attach hair systems (wigs) are said to be bonded to the scalp. These can cause damage to weak hair, leading to further loss. They may look natural, but they also could take a lot of work and money to maintain that natural appearance.

Hair loss treatments that I recommend include transplantation and medication. Your options depend on a variety of factors, but since I have no info about you (aside from age) I couldn’t begin to list what those options might be. But yes, generally there are treatments available even at 60 years old.

Tags: hair bonding, adhesive, glue, wig, hairpiece, hairloss, hair loss

Hi Dr. Rassman,

First off, I would like to say you have an excellent site here and it has been the source of many of my answers while I suffered with my paranoia of hairloss.

I wanted to ask about a type of hairloss I noticed while talking to a person. The man exhibited diffuse baldness and was almost completely bald on top however all over the top of his head he had a few thick hairs that were buzzed down. All the hairs that I could see were all thick. Also, his hairline was completely unharmed. It was covered in thick hairs from left to right. I was wondering if this is normal MPB or not since from my understanding in the diffuse form of MPB, all the hairs slowly thin out on top of the head. I know it is normal to see some thick hairs among thin hairs in someone who’s going bald, but this guy had only thick hairs on top of his head.

Thank you for taking the time to read this.

Some men who bald can have a persistent frontal hairline. Some never go bald in the front. These are a few exceptions to the classic Norwood patterns. You can also have thick (non miniaturized) hairs on balding areas. It is just that the proportion of thick to thin are different.

Tags: hairloss, hair loss, diffuse