Had my first transplant (flap rotation) at age 19 in 1985 (big mistake). Continued to bald behind flap and put up with stares from strangers until 2005 when had 3000 fue put in front and behind flap. Grew out well, no stares, felt pretty normal, life was great.

Problem April 2010, nearly all 3000 fue fell out after 5 years of growing, all in about a 6 month period. Back to being stared at. September 2010 had another 3000 fue (2000 scalp 1000 beard) put in front and behind flap by same reputable FUE surgeon. Grew out well again, but now starting to fall out and started getting stared at again.

Had blood work done but all clear for thyroid, lupus, iron etc. Have used 2.5mg Proscar for many years and not changed regime. Not on any medications known to cause hair loss. Getting very desperate as no donor left for more transplants. Any ideas on what could be going on ? Any advice much appreciated. Thanks.

There is clearly something going on and you need to address your issues with your surgeon.

I sound like I’m a broken record, but body hair / beard hair does not follow the same growth cycle as scalp hair and it is not considered the standard in hair transplant surgery. I have seen many failures of body hair transplant patients performed by doctors all over the world.

Some surgeons use grafts from outside of the donor area, and FUE grafts taken from the non-permanent areas can fall out, as this may be genetically triggered and accelerated. For clarity, the permanent zone is 2 1/2 inches high and can be measured above the notch on the back of the skull and around the sides of the head.

Hi Doc,

Just wanted to know at what norwood class one should stop using a product like Toppik. I am a class 6 and have noticed that I need to put quite a lot of toppik on my head and it really just looks like a coating of coal dust! Does my hair have to be longer for it to look better? Or do you think I’m putting on too much!

I don’t know if you’re using too much or too little Toppik. I think the answer is really simple — just look at yourself in the mirror or ask someone if it looks too fake or if it looks normal. I really don’t know what to tell you beyond that, as there’s no way for me to tell based on an email if it looks like a “coating of coal dust” or if it blends well enough to be an effective camouflaging product.

Many early Norwood class 6 and 7 use Toppik with great results. The length of hair and hair loss matters, but it is on case by case basis.

I am a 45 year old male and have had a bald spot on the right hand side of my head for about 4 weeks. There is no itching or discomfort, and its about the size of a 50p piece. I am a smoker and probably drink more than I should, my job is also quite stressful.

could you give me any advice please? thanks.

I cannot diagnose a bald spot without seeing you. In addition to stress, there could be many causes, such as a fungal infection, alopecia areata, etc…

I recommend that you see a dermatologist to diagnose the scalp condition you have.

Results of dutasteride trials have been nothing less than impressive, particulary the study conducted by Olsen et al (2006) indicating that dutasteride at both 0.5mg and 2.5 mg/day generated a superior hair count to finasteride 5mg at 12 and 24 weeks. Anecdotal evidence has also suggested that dutasteride is an optimal hair loss treatment; www.twinhairloss.com is exemplary of its efficacy, in addition, the many thousands that are using it for hair loss purposes. I have also been in correspondence with one of the twins in this study. He has been on a daily dutasteride dose of 0.5mg since day one and the results are astounding.

Additionally, dutasteride has now been approved in Australia as a hair loss treatment since mid 2011. Despite not being FDA approved, is the current literature and anecdotal evidence still not enough to substantiate that dutasteride is a superior treatment to finasteride?

Thank you.

I haven’t heard of such dutasteride approval in Australia as a hair loss treatment. I can only find a public assessment report from Australia’s drug regulatory agency (Therapeutic Goods Administration) dating to January 2011 about the drug being approved for treating BPH, which is what the US FDA also has approved it for. Do you have a link handy so I can read more about the approval since mid 2011?

There is evidence that dutasteride is superior to finasteride for treating hair loss, but there are probably more complications, such as loss of libido, with dutasteride. And more importantly, the subject of sterility is still an open issue as far as I am concerned.

I generally prefer my patients to try finasteride first, and if it fails to achieve the desired goals and the patient is aware of the risks discussed above, then I have written prescriptions for dutasteride after I’ve developed a relationship with my patient. It is on a case by case basis, though.

Greasy scalp/itch and MPB. Are these all connected?

I went to see a trichologist recently who told me that she could see plenty of miniaturised hairs at my crown. She also commented on how greasy my scalp was and said that this was linked with my hair thinning and the itchiness which i’d reported was probably also to do with this grease.

Can you confirm if this is true? My hair is itching/greasier again this week and I notice that I do have more hair fall when it gets like this.

Male pattern balding is a genetic trait. Greasy scalp is just a greasy scalp (unless there is a genetic cause of excess sebum production from the hair follicles of the scalp). People who have a full head of hair can have a greasy scalp. Same goes for an itchy scalp. There can be numerous reasons for this, such as dryness, dandruff, hair products, lice, poor hygiene, etc.

I do not believe genetic hair loss, greasy scalp, and itchy scalp are connected. In my opinion, it is a old wives’ tale. If you’re scratching your head and pulling your hair out because of it, that might explain the thinning. Otherwise, I don’t know of a proven correlation.

Snippet from the article:

Men who go bald by the time they reach 40 may be at increased of getting prostate cancer at an early age, according to new research.

Scientists who studied hair loss patterns in nearly 10,000 men found those who experienced receding hair lines early in life were more likely to suffer a tumour later on. The findings, by a team of researchers in Australia, support earlier studies suggesting baldness could be linked with prostate cancer.

The reasons why are not clear but previous studies indicate it may be due to higher levels of testosterone, the hormone which can trigger the development of cancerous cells but also inhibit hair growth. In baldness, it’s thought high testosterone levels have an adverse affect on the hair follicles, acting on a hormone receptor to slow down hair production.

Read the rest — Men who go bald by the age of 40 are more likely to get prostate cancer

There are relationships between crown balding and coronary artery disease that have been reported as well.

My question is regarding post operative transplant shedding. For a little background, I’m a 26 year old male on Propecia for 2 years and exactly 8 months out of a 2000 graft hair transplant all in the frontal part of the scalp. At 5 months, my results were excellent, a very dense, even result with a natural looking appearance and texture. Since that time, however, I have noticed an increased thinning in my hairline; leaving a more see-through appearance. This has been coupled with a more “pluggy” texture. Furthermore, at 6 months, I noticed an increase in shedding but it has slowed down in the last 6 weeks.

My 8 month result is still great but there’s a visible difference in the last three months. Is this merely a part of the natural process for some patients and can’t be judge too quickly in my first year growth? Any help would be greatly appreciated! Also, let me know if you need extra information to answer my question.

Why don’t you follow up with your doctor with these issues? A pluggy texture is not good. Thinning may be related to continued (normal) genetic hair loss that may have happened without surgery. Shock loss is generally seen in the first month or two after the surgery.

In general, results of a hair transplant surgery can be seen in as early as the 2nd month all the way up to 12 months. Most see results in about 6-8 months. I couldn’t tell you why your results looked better at 5 months than they do at 8 months, though.

I am a 58 year old male who is generally in good health. I do have controlled blood pressure, on 5 mg of Bystolic, and type 2 diabetes, controlled on metformin, and I also take 10 mg of Crestor for lipid control.

My hair loss problem started around 20 years ago but now it is at the point where the hair loss is just past the crown on the top of my head. I have a thick head of hair on the sides and back but just scraggly hairs on top. What treatment options would you suggest to try and either grown some hair on top of my head or keep what I have now. I have looked at Minoxidil, Rogaine to name a couple but never actually used anything. I asked my personal doctor but since he is bald as well did not have any suggestions.

I would appreciate any help you could offer.

Thanks.

There is not much I can suggest based on a few lines of description alone. Many men have hair transplants for crown loss with good results, but each patient is different. You need an examination, discussion with a doctor addressing your goals, and a meeting of the minds addressing expectations and limitations.

Rogaine and minoxidil are the same medication, available over the counter. I don’t know of any interactions between minoxidil and the medications you listed, but talk to your doctor before adding any medication to your routine. Bald or not, your doctor should be able to tell you more since he knows your medical history.

With all of the questions being asked about protein shakes, are there any that you would recommend? Is there any kind of “regular” whey out there. I try to take protein shakes everyday, but I don’t want them is they have steroids in them. I don’t want them if they are similar to steroids. Regular protein is supposed to by good for the hair not hell on the hair.

While I don’t endorse any particular protein shake, I don’t know that they’ve been proven to make hair fall out. Your genetic predisposition makes your hair fall out. Protein shakes are not anabolic steroids.

Hello,

I’m 25 years old. Writing to determine if this appears to be MPB or a maturing hairline. Pictures with green walls are current.

I have also attached an image from April 2012, 2009 (black button down shirt) & 2005 (light blue shirt) in an attempt to show if there is or is not any progression since juvenile hair line.

My haircut is now more razor edged, not sure if this is contributing to my concerns. I believe I’m in pretty good shape hair line wise at 25, but will further pursue this if you feel MPB could be the case.

If you would like me to take clearer pictures for the use on the website let me know. I realize it is hard to tell without properly examining, any advice is appreciated.

Thank you

Click the photos to enlarge:

The photos are a little blurry, but it appears that your hairline is just maturing. I didn’t post the photos from 2005 or 2009, because they were way too small for the site… but from 2005 to 2009, there did appear to be some hairline maturation. And now in 2013, your hairline appears to have continued to mature. If it is just maturation, that is normal.

There’s no way for me to know just by the photos if your hair is miniaturizing elsewhere on your scalp, though. You would need to have an in-person examination to determine that. But overall, your hairline appears strong and based on the photos (see above), I don’t see a concern.