Dear Dr. Rassman,

I will try to keep this simple: Once a man with hairloss can make out his “horseshoe” pattern, is it possible or common for any of the “horseshoe” hair to bald at a later point?

I am 26 and, while I don’t have any bald spots, the hair on top of my head is thinner and more limp than the hair on the sides and back of my head. My “horseshoe” hair goes all the way up the sides of my head, and does not dip down low at the back of my head. Given that this hair has remained unaffected for the past 8 years since I’ve been thinning, is this indicative of hair that will remain unaffected for the remainder of my life?

The thinning in a young man at 26 years old which can produce an apparent horseshoe pattern, may be stable for years in the horseshoe itself. I have seen men that have a horseshoe pattern which is much more narrow than most Class 7 pattern patients. I often classify them as a Class 8 pattern to reflect the narrow band.

The normal height of the posterior part of the horseshoe is somewhere between 2 1/2 and 3 inches high (not counting neck hair). If this Class 8 patient was to have a hair transplant to cover his entire head (assuming the Class 7 pattern) he will likely have moved some of his non-permanent hair in the procedures. With the strip method of harvesting, the scars can be vary bad for cases this large. I have unfortunately seen this type of pattern with the scars produced by overly aggressive surgeons, and each one is a real challenge.

I couldn’t tell if it’ll dip down further as the years progress, but measuring the bulk of the remaining hair should be able to tell you if that area is continuing to thin.