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.

Tags: hair transplant, fue, failure, hairloss, hair loss

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.

Tags: toppik, hairloss, hair loss

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.

Tags: hairloss, hair loss, bald spot

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.

Tags: dutasteride, finasteride, avodart, propecia, hairloss, hair loss

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.

Tags: hairloss, hair loss, greasy scalp, itch

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.

Tags: hair loss, hairloss, balding, prostate cancer

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.

Tags: hair transplant, post-operative, hairloss, hair loss

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.


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.

Tags: hairloss, hair loss, crown

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.

Tags: protein shakes, hairloss, hair loss


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.

Tags: hairline, hairloss, hair loss

I know what mpb and TE and CTE is but can there be other involvement with miniaturization of a follicle? Like toxins, emotional stress for a long period, extreme lack of nutrition etc.

Add to your list: aging (senile alopecia), a deficiency of various vitamins (vitamin A, vitamin B6, vitamin B12, beta-carotene, biotin, vitamin C, calcium, vitamin D, inositol, iodine, iron, magnesium, niacin, pantothenic acid, selenium, zinc), and a series of many autoimmune diseases.

The list goes on and on.

Tags: hairloss, hair loss, vitamins, aging, disease

Snippet from the article:

Andemariam Beyene sat by the hospital window, the low Arctic sun on his face, and talked about the time he thought he would die.

Two and a half years ago doctors in Iceland, where Mr. Beyene was studying to be an engineer, discovered a golf-ball-size tumor growing into his windpipe. Despite surgery and radiation, it kept growing. In the spring of 2011, when Mr. Beyene came to Sweden to see another doctor, he was practically out of options. “I was almost dead,” he said. “There was suffering. A lot of suffering.”

But the doctor, Paolo Macchiarini, at the Karolinska Institute here, had a radical idea. He wanted to make Mr. Beyene a new windpipe, out of plastic and his own cells.

Read the rest — A First: Organs Tailor-Made With Body’s Own Cells

I found this article and was blown away with excitement, so my first instinct was to share this with our readers. Imagine building organs with the help of the body’s own tools. That was done here and saved a life. One day, this will become common, for this I have little doubt.

Tags: cells, science, organs

I am wondering if I am beginning to undergo male pattern baldness. I am 29 years old and have never noticed any hair loss until recently. I have been shedding like crazy, and can see my scalp, mainly around the top of my head where the hair “swirls” around my part.

I saw a dermatologist and he said he didn’t think it was male pattern baldness (there is no significant recession around the front of my hairline…I have been looking at old pictures and feel like there has maybe been a minimal amount in the past year…hard to really say for sure). He did a pull test and said it was not telogen effluvium, unless it was the earliest stages. The increased shedding started a little over a week ago. I’m kind of depressed over this.

I have noticed that some of the hair that has come out is of the finer variety and I feel like my head as a whole has finer hair than it did say a year ago, but once again since I don’t have any hair samples from then to compare it to, I can’t say for sure. The hair around the swirl has taken on a more light colored tone than that on the rest of my head. I can send pictures if you would like.

A photo alone is not likely going to help me determine what your hair loss is, especially after a doctor you saw in person stated you likely do not have genetic balding. You are more than welcome to send us a photo for all the readers to comment, or visit our BaldingForum.com site and post photos there. You could also just get a second opinion from another local doctor.

Otherwise you can make an appointment to see me at my office in Los Angeles for an in-person, private consultation. At that consultation, I will look for miniaturization on your scalp hair and I will perform bulk analysis of your hair in various parts of your scalp.

When the thinning that precedes balding occurs, the bulk of the hair in the impacted area has hairs that are thinner than the hair from the back and sides of the head. The pattern of this thinning hair is measurable and that will point to the diagnosis of male pattern baldness. You need to have these tests, and have them done in the hands of an expert hair doctor.

Tags: balding, hairloss, hair loss, crown

Hey doc, I noticed your blog here presents us with numerous demonstrations of surgeries, where a receding hair line is being restored to a full-blown NW1. However, the impact of surgery on donor area (whether FUT or FUE) has drawn me to weigh the benefits of smaller improvements.

But I don’t remember seeing here any pictures of patients who could easily (graft-wise) afford a Norwood 1 transformation, but have chosen a minimalistic path (for example, going from a Norwood 3 to a 2 or simply increasing the width of the forelock a bit to eliminate the steepness of its shape). Such visual representations will surely educate us about our options with surgery.

I’m sure we’ve posted examples of patients that didn’t want a fully restored hairline on this site in the past, and I know there have been plenty of men who have had surgery for a “minimalistic” path. A patient must give us permission before publishing their pictures, so we’re only able to post those that have given their consent. Not every patient wants their photos shown to others.

There are comprehensive before / after pictures in our NHI photo galleries that will show various examples of hairline restoration.

Tags: hair transplant, hairloss, hair loss, photos

After using regaine foam extra strength for few years, am now told at over 49 years old i cant anymore. Any problems if carry on?

I do not know of any age limit for using Rogaine (minoxidil). The packaging may include information about studies being done on people aged 18-49, which just means that it wasn’t studied as a hair loss treatment for those 50+ (not that you necessarily have to stop at that age).

Tags: rogaine, regaine, minoxidil, age, hairloss, hair loss