What Are These Fine Hairs at the Leading Edge of My Hairline Corners?

/by William Rassman, M.D./0 /

I have a real fine dirty blonde straight hair texture. I am also Caucasian with pretty fair skin and I am 26 years old. The question I’d like to know is it normal I guess when lifting my hairline under bathroom fixture lightning to be able to see scalp in the corners? I’ve read a lot of blog questions and even have come across a few that are similar to the question that I have prepossessed but would like to get some clarification.

My corners of my hairline look to have matured to a norwood 2 possibly a norwood 1.5. In the corners I see normal sized hair but they seem to be slightly finer. The zone of finer hairs is like .5 cm of the leading edge and seems only to be in the corners. Is this considered a transition zone or would this be miniaturization or is it even common to even see finer hairs located in the corners of the hairline?

Also one more question if I may can you also just explain a little what a transition zone is and is this for hair transplant patients or is there also a transition in none balding men and women hairline as well?

Good questions.

A transition zone is present in everyone… that is, unless there is recession associated with balding. Generally, the transition zone has from 0.5-1cm one-hair follicular units and behind this zone the appearance of two-haired follicular units start showing up. In the very front of the transition zone is a layer of vellus hairs. This layer of vellus hairs can be identified as they are short, often colorless, and they do not have the obvious scalp “hole” where the hair exits the skin. These vellus hairs are the first hairs to go when frontal balding occurs and it is these hairs that you are seeing in your hairline.

Everyone is different and those with finer hair have a different appearance than those with coarse hair. Seeing through the hairline is normal, up to a point. The normal hairline should not have many miniaturized hairs (can be seen under a microscopic vision of the scalp in the doctor’s office).

Tags: hairloss, hair loss, hairline, vellus hair

Was My Birth Control The Likely Cause of My Female Hair Loss?

/by William Rassman, M.D./0 /,

Hello, I’m a 26 year old female who recently experienced dramatic hairloss. I would say over the last 7 or 8 months I’ve lost nearly half my hair. All my blood tests came back normal including a hormonal panel. My DHEA sulfate was slightly elevated but not much. The loss is all over, diffuse. But more severe in areas like the hairline.

I went to two dermatologists who were fairly insensitive told me it would grow back and that was it. I was on two birth control pills this year which gave me bad side effects so I stopped taking them. My derm told me this is likely the cause.

If this is the case, will it really grow back? I see small sprouts, but not enough to fill in what I lost. Does growth happen gradually ?

Thank you for your help.

The questions you asked are reasonable, but I am not in a position to give you an answer to them. Massive hair loss, as you described, is not common. Telogen effluviums can occur that present this way, but these usually reverse in a year or so.

I don’t know which birth control pills you were taking, but I would go back to your dermatologist and ask if he/she thinks that a biopsy will give more information and is appropriate to get a specific diagnosis.

Tags: telogen effluvium, hairloss, hair loss, female hair loss

Cetirizine to Block PGD2?

/by William Rassman, M.D./3 /

Hi Doctor,

Some people started to use topical cetirizine to block PGD-2, they all say that they have re-growth from it and thickening up the vellus hairs and make them vellus in 3 months or so? it might be true?

I really do not know the answer. There is an association between cetirizine and prostaglandin D2 (PGD2), which is related to hair loss. There is no clear evidence that cetirizine, an antihistamine, can restore hair at this time. Just applying it to the skin makes no sense to me.

Tags: antihistamine, cetirizine, pgd2, prostaglandin, hairloss, hair loss

Should I Take Anabolic Steroids To Treat My Possible Alopecia Areata?

/by William Rassman, M.D./0 /, ,

Hi, I am 29 and recently noticed (about 2 months ago) some oval bald spots on the back of my head and in my beard. After doing a little bit of research, I am pretty sure that I have alopecia areata. As the spots are getting bigger I’m starring to worry that I might not lose not only my hair but my beard too.

This got me thinking that my brother had his facial hair greatly increased following an anabolic steroids cycle (for bodybuilding purpose). It got me wondering if taking anabolic steroids would help me regrow my beard even if I suffered from AA.

Thanks

So you diagnosed yourself with alopecia areata and then decided to ask me if anabolic steroids would help regrow your facial hair? First of all, you should get a physician’s diagnosis to see if perhaps it isn’t alopecia areata. Maybe you have an allergy or stress (both of which can also cause spots like that).

Secondly, while some people have reported faster facial hair growth while using anabolic steroids, the steroids are more likely to cause further hair loss if you have the genetics for male pattern baldness. You don’t want to end up doing harm to your scalp hair while chasing down a facial hair loss solution.

And most importantly, there is no cure for alopecia areata (if that is indeed what you have) but there are treatments that can reverse it… and I’m not going to suggest anabolic steroids is something you should try. See the National Alopecia Areata Foundation for more.

Tags: hairloss, hair loss, anabolic steroid, facial hair

I Got Generic Proscar from CVS, But Should I Trust It?

/by William Rassman, M.D./1 /

Hey Doc, I went to my dermatologist and asked if he could prescribe me proscar instead of propecia to save money (I was on propecia for a month), but wanted to change to proscar since it’s cheaper. He prescribed me the medicine. I went to CVS, and they gave me the medicine which only cost $10. Now the medicine was prescribed as 5mg Finasteride (generic for proscar). The manufacturer is Accord Healthcare; here’s a link to their website: accord-healthcare.com.

Now I wanted to know if I could trust this medication as I got it from CVS by a prescription? The reason why I am of suspect is due to personal reasons. You see I’m South Asian, and I know how fake things are sold at India just for money. I’ve been there a lot, so I know this from experience. But again I just wanted to know could I at least trust a reputable pharmacy like CVS where I got the medication from. And do these generics go through some kind of FDA approval before they are sold to Pharmacies in the US.

Thank You for reading, and could you let me know you opinion.

CVS is a very large pharmacy chain, and while I can’t say with 100% certainty that the medication you got is real, I’d think you’d have just as much assurance as anywhere else. I’d trust that prescription medications you get from CVS are fine, and I’d expect they would have quality assurance measures in place to prevent fakes from getting into their pipeline.

For info on the FDA’s generic approval process, check out Understanding Generic Drugs.

Tags: cvs, pharmacy, finasteride, fda, generic

Should I Stop Minoxidil If I Haven’t Seen Regrowth After a Year?

/by William Rassman, M.D./0 /

Dear Dr Rassman

I have been using Minoxidil once per day since February 2010 on the temples and hairline (as well as finasteride)

I haven’t ever experienced a noticeable shed, or any regrowth. My hair has continued to get slowly worse. I have continued using Minoxidil as I thought that maybe it could at least be contributing to help slow down the MPB process – but I am unsure if this is the case

The Rogaine website states that treatment should be stopped if no results (i.e. regrowth) are seen within one year. My questions are therefore

1) Is it best that I quit using minoxidil?
2) Is there a risk that healthy hair would have become dependent on minoxidil, and fall out if minoxidil is stopped?

I look forward to hearing from you.

Thanks

If you are sure that there was no benefit from the use of minoxidil, then stopping it should not make a difference; however, if there was some benefit, stopping it would cause loss in those hairs that benefited. So it really is important to be sure.

Tags: hairloss, hair loss, minoxidil, rogaine

I Just Found Out My Wife is Pregnant, So Should I Stop Taking Finasteride?

/by William Rassman, M.D./0 /

I am using a tablet called FINPECIA which is FINASTERIDE.

I just found out that my wife is pregnant, and now came across all the warnings that it is not safe for my unborn child.

Please give me more clarity on the matter, I am very worried for the baby.

Thank you !

For specific medical questions you should always consult with a doctor. I generally recommend to my patients who are trying to conceive and worrying about this issue, to stop taking Propecia for about one month as the medication has a short half life and is gone from your blood stream in a day and likely out of your body within a week.

There is no evidence that the drug finasteride is passed through the sperm into the uterus of a pregnant woman and then passed through to the baby. Thus, in general there is NO concern from research that states you need to stop taking Propecia. It does not cause any harm if you continue taking the medication before your partner conceived or even after your partner conceives. In fact after conception, it really should not matter at all.

The caution related to Propecia and conceiving is for the WOMAN. Men can continue taking Propecia without any issues to the woman or their unborn child.

Tags: propecia, finpecia, finasteride, hairloss, hair loss, pregnancy

My Donor Area is More Coarse and Curly Than the Rest of My Scalp

/by William Rassman, M.D./0 /

Doctor,

The hair in the back of my head is more coarse and curly than the front. How does that work with a frontal hairline transplant?

The hair on the sides is the same as the front.

Thanks

In most cases, if the donor hair is curly then the transplanted hair will be curly. Wherever the hair is harvested from should remain the character of the hair when it is transplanted to a new site.

Many men with large differences in the character of their hair in front when compared to the donor area have early cases of thinning. A good examination of your hair bulk will establish this one way or the other.

Tags: hair transplant, hair character, hairloss, hair loss

Are Certain Balding Patterns More Genetically Dominant or Recessive?

/by William Rassman, M.D./0 /

Hey docs, quick question.

Do certain balding patterns follow the dominant/recessive genetic patterns? For example, is a pattern 3 dominant over a pattern 6 when it comes to inheritance? Or is it just chosen by random?

Genetic male pattern baldness is not a dominant trait. It also does not follow a clear predictable pattern and can even skip generations. It may also be dependent on more than one particular gene. The genetics of balding are not as clear cut as the color of one’s eyes (for example).

Tags: genetics, hairloss, hair loss, mpb

Do I Have a Mature Hairline? (with Photos)

/by William Rassman, M.D./5 /,

Would this classify as a Mature Hairline? I have always had a fairly high hairline and am worried about the fact that the hairline is rounded more. I’m curious because I don’t see many pictures with this U shaped hairline. I am a 21 male. My vertex has no signs of thinning and depending on how I put my hair it looks worse than others. You can use these pictures on your site.

Thanks for allowing us to post these. Click the photos to enlarge.

 

Based on the photos, it looks like your corner recession is deeper than just a mature hairline. At 21 years old it’s possible that this is early hair loss, but I have no way to track the progression of your loss just by looking at some grainy photos taken under poor lighting. It’s also entirely possible that this is where your hair loss ends, or it could progress further. That’s where getting a doctor involved would make sense, so that you can quantify what you’re seeing.

So if you’re concerned, see a doctor for an in-person examination and get some baseline numbers in the form of hair bulk analysis.

Tags: hairloss, hair loss, hairline, photos

What Type of Doctor Do I See When I Have Early Hair Loss?

/by William Rassman, M.D./0 /

Hi Dr. Rassman,

I really appreciate your blog and the information you provide. My question is what type of doctor should a person see regarding initial hair loss? I do not have a PCP, but I’ve been told to see a dermatologist, endocrinologist, and cosmetic physician.

Ideally, I would like to visit your practice some day but work makes the trek difficult.

Thank you

You indicated that you live about an hour drive from my office in Los Angeles during non-rush hours. If you are serious about this examination you have to be willing to put in some effort. On Saturday, December 8th we have an Open House (11am-2pm) here in our office where you can meet us, get a consultation, and see a surgery. If you do not want to drive the hour here, you can find a doctor in your city by using the ISHRS site’s physician search.

Hair transplant surgeons generally screen patients for hair loss and should perform miniaturization assessment and bulk measurement analysis which picks up early balding in young men. We establish a Master Plan with every man we meet with and examine.

Tags: doctor, hairloss, hair loss

A Liberal Dose of Minoxidil Once a Day is as Effective as Twice Daily?

/by William Rassman, M.D./0 /

Hi Doc

Your colleague Dr. Bernstein believes a liberal dose of minoxidil once a day is about as effective as twice a day, due to the fact that topical last about 22 hours. Sounds reasonable. I had one doc tell me most of his patients only use it once a day, because they found twice a day too difficult and not cosmetically appealing.

What do you think? notice any clinical difference from patients who use it once as opposed to twice a day?

Thanks

The directions on the label say twice a day application of the medication is optimal. If your doctor says to use it once a day, then that is his/her opinion. If you want to use it once a day, that is your choice to make.

I do not know what the clinical difference would be and I generally recommend twice a day use. Perhaps you can try and let us know.

Tags: minoxidil, rogaine, dosing, hairloss, hair loss

Where Does the Hairline Belong?

/by William Rassman, M.D./2 /, ,

There is an art and a science for placing hairlines. The normal midpoint of a mature male hairline lies 1.5-2cm above the highest crease of the furrowed brow. If you go to a mirror and lift your brow, you will see two things:

  1. Where the hairline was when you were 8 years old (it hugs the crease)
  2. By moving up 1.5-2cm above the crease, you will see where the central point of your hairline belongs

Some people do not raise their hairline to the 2cm point with a transplant, as they may go upward only 1cm as their hairline matures. But placing the hairline in the proper position is critical when the transplant is done and it is critical in your understanding of what constitutes balding versus the changes associated with a maturing hairline (which is not balding).

Here’s a patient’s hairline at 17 years old (left), and the same man at age 30 (right). Click the photos to enlarge:

 

My challenge was to help him select the proper location for his new hairline. I used the 1.5-2cm rule, and he was happy with what we drew. The photo here is just used to point out the change in his hairline over 13 years (an almost juvenile hairline to a balding Norwood Class 3 pattern). The actual hairline he chose was between the two lines (juvenile hairline and the highest receding point of his leading frontal edge). I could not help but wonder if he had taken Propecia when his hair loss began, would he have lost this much hair?

Read more

Is My Hairline Normal for an 18 Year Old (With Photos)

/by William Rassman, M.D./6 /,

I am a 18 year old male. My dad is 50 with somewhere between a Norwood III and IV. My grandpa is probably a IV, but I doubt V because he has a fair amount of hair. I am wondering if my hairline is normal for my age? What about the corners? I’m sorry if the pictures aren’t decent enough.

You may publish my photos.

 

I guess we can let the readers comment. If you want to setup a consultation in our office, please call us at (800) NEW-HAIR. In a consultation (one-on-one with a physician), you can have your hair evaluated for  early signs of hair loss with miniaturization(examination with a trichoscope) ,and bulk measurements (with the HAIRCHECK instrument: https://baldingblog.com/haircheck-test-how-it-is-done-video/). The key is to find out if you are in the beginning of the balding process. From these photos, there is no way to tell and we need objective tests to find out. Doctors who specialize in this field have these instruments and can get these tests done on you.

Tags: hairline, hairloss, hair loss, photos