I have been asked over and over again if I can you predict a balding future for the young man with a family history of balding. I have also been asked to explain how I would go about such a prediction. I have two tools: miniaturization analysis and bulk measurements. Below, I’ll discuss the difference between the miniaturization studies we have been preaching about in the past and the bulk measurements we are now also doing in our patient assessments.
I use miniaturization measurements to get a general idea if there is genetic balding present. It can not give us (without special software) a metric on what is going on. From a practical point of view, checking for miniaturization over the course of months could never truly be in the exact same areas unless we place a tiny dot tattoo as a reference point. Then months after the first exam, we could examine the exact area again by finding the tattoo and measuring the degree of miniaturization at a point anterior, posterior, or lateral to the dot. In those people with a measurement of miniaturization, it varies from place to place even within a defined area (without a tattoo). The area observed is often just over a square mm. In other words, it’s using educated guesses.
Hair bulk analysis:
On the other hand, bulk measurement using a tool like HairCheck can cover a relatively large area (square inch) and finding anything in that area as measured by distance from the nose is replicable. So from a value point of view, it can give the doctor an assessment of bulk comparison to a person’s normal hair bulk when compared with the donor area in the back of the scalp. If the measurement changes over time, it will allow the doctor to produce a metric (number) which reflects the status of our hair bulk. In everyone with genetic balding, some part of the scalp hair will lose bulk.
To identify areas that can not been seen grossly for bulk measurement, we can do a miniaturization analysis to identify the worst areas on the scalp and then do a bulk assessment in those areas. It can also distinguish the differences that we can not ascertain from the naked eye or a photograph. I have seen people who report balding, my eye says no, but the bulk measurement shows significant differences to the donor area, confirming the diagnosis of genetic balding. I am sure that over a year, these bulk measurements will be able to help us show change (positive or negative) with the treatments we are prescribing.
So… am I going to go bald?
I am asked over and over again by young men with a history of balding in the family, “Am I balding like my father?” There’s no way I could answer that over email, but with the ability to do miniaturization analysis and bulk analysis during examinations, we can now tell much more about the status of a balding young man and we may be able to refine a prediction as the young man matures. Diagnosis and measurement is the backbone of any Master Plan we come up with.