Hello Doctor, I wanted your opinion. I been of Finasteride for about 2 years and it worked very well for me the first year. But the past 6 months I been shedding a lot more than normal. Does Finasteride lose its effect after a while? I checked my blood work on everything and all good but my TSH levels were low 0.053. Can that be it as to why I am shedding so much? Also what is your take — should I switch to Dutasteride since Finasteride is not helping me anymore.

Thank you

I assume when you say that you’re on finasteride, that you’re taking the standard 1mg/daily dosage. The finasteride might be losing the hair loss battle to your genetics, but I have no way to know that for sure. Have you seen your doctor for a follow-up since the shedding began 6 months ago?

The switch to dutasteride may help, but the decision to use an off-label drug that is not approved by the FDA for treating hair loss (it is a prostate medication) is a decision for you and your doctor.

I don’t know if your low thyroid levels are related to the shedding, but that could be a possible reason. Are you having that treated?

Dr. Rassman
First of all I just wanted to say what a great blog you guys have!

I’m a 29 year old male with a thick head of hair and have been to the dermatologist recently and he said I have no signs of male pattern baldness but maybe going into a mature hair. I did the wrinkle brow test, but honestly my hairline even in old pictures when I was little was never really near my highest crease. How can you measure a mature hairline other than wrinkle brow? Because like I said my hairline never was like that even when I was seven years old.

I also notice that on top of my head I get hairs that are short and look thinner if I pull them out and the rest of my hairs are thick and coarse but all over my hairs seem to have different degrees and the dermatologist told me this was totally normal but I just wanted to ask you if it is? The lady that cuts my hair since I was twelve thought I was crazy when I ask her this, because she told me that she also has hairs that are thinner and thicker all over the hair and everyone does do to different hair cycles and its nothing to worry about. I do have a little OCD so I might be obsessing about something that’s totally normal.

I know the hair bulk test that you guys do is good and I told this to the lady that cuts my hair and she said if I really wanted to buy the Haircheck device that she would do it for me if I was worried and to ease my mind. I saw the video of the guy getting it done on my computer from the HairCheck website. In the video I notice they measured his hair in the middle and wanted to know if you can measure it at the hairline instead? Would the density in the front of the hairline be a little different than the back (donor area) even for a person with no signs of balding (MPB)? Do you always have to measure in the center or can you measure the left and right side head? Is measuring in the center the only way to do this bulk measurement test more accurately? Is there also a normal amount for a non balding person that the hair in front can be a little different than the hair in the back (donor hair) like percentage wise which would be consider normal?

Thanks for your time and hope to hear back from you soon! Sorry so long also You can publish this if you like too.

Movement of the hairline to the mature position is common by your age. Measuring the mature hairline using the wrinkled brow is really more of a loose “rule”. I’ve written about that here.

Hair cycling is normal as your follicles go through different phases of growth (anagen, catagen, and telogen), so yes, your dermatologist was correct that it is normal to have some hairs with different degrees of thickness depending on where it is in the growth process. If you want to know if you are balding just behind the frontal hairline, the HairCheck is good to give a number to compare one part of the scalp to the next. You can measure at the hairline, but you should make measurements in multiple parts of the scalp.

Snippet from the article:

Long-haul truck drivers already face an increased risk for left-side skin cancer because of the increased exposure to ultraviolet rays through their driver’s side window. But according to new research, the risks don’t stop there. Now, scientists say truck drivers have a greater chance of developing aggressive prostate cancer, and the latest theories point toward prolonged vibration as a possible suspect.

Presented at the American Association for Cancer Research, the findings also linked aggressive prostate cancer risks with men who worked in garden shops and in construction and finance. Conversely, they drew no link between cancer and men who worked as exterminators, landscapers, or animal caretakers. Those who were truck drivers faced an aggressive prostate cancer risk four times greater than educators — a profession the researchers used as a baseline, as they presumed educators faced none of the same “whole body vibrations” as truck drivers.

Read the rest — Truck Drivers At Risk For Aggressive Prostate Cancer: A Theory Of Vibrations

Hi, apologies if this question has already been answered. I’m a 22 yr old male with what I believe is mild recession and thinning at the temples, creating more of a widows peak. I started noticing the recession and thinning (really only on the right side) within the last year and it is slowly but I believe surely, getting worse and at a quick pace.

My question is, assuming what i believe it true, is it worth starting on propecia or do you think it won’t do anything?

Well, considering I haven’t examined you at all and have no medical history about you, I have no way to know if Propecia is worth starting. It’s a prescription medication, so you will need to see a doctor to find out if you should take it.

At 22 years old with early loss, it could be beneficial to halt the progression further. But if you don’t have genetic hair loss (let’s say you’re just seeing your mature hairline form), then Propecia probably isn’t worth starting. This is why you should see a doctor to help make that determination.

I have heard many times people say finasteride loses its efficacy over time. However, you have said its just the naturally balding process taking over. Does that mean then, finasteride never loses efficacy and its just the balding gene taking over?

Think about a tug of war — one side (finasteride) pulling against the other side (genetics). The genes will eventually win the tug of war in most people (using a multi-decade time scale). Remember, the balding pattern you are inheriting can be almost any pattern. The worst pattern, the Norwood Class 7, is only present in 7% of the population.

Balding is progressive, but the speed and the degree of the balding process varies. There is no doubt that finasteride works constantly against the balding process but sooner or later, the balding pattern you inherited MAY be achieved.

So, I’m getting a hair transplant over in India, which is about a 20-30 hour series of flights, and would like to know if it’s okay to wear a hat afterwards? Like even if it’s just a light bandana, would it be okay for it to touch the grafts lightly for the trip at 6 days post op?

Wearing a hat should be fine. Just make sure that the hat does not rub against the grafts. We give out standard trucker’s hats after the hair transplant procedures we do. You can also double check with your surgeon to find out what he/she recommends.

Dr. Rassman,

I had many strip procedures in the early 1990’s that left my hair looking very “pluggy”. People would immediately look and my forehead at first meeting and continue to stare as though I was not even present. I wore a baseball cap everyday to cover up my hair everyday for 9 years (all the way through college, graduate, and PHD school). Luckily, I took a chance and made an appointment with you. You completely changed my life and helped rebuild my self-esteem.

After many corrective surgeries and reaching an amazing result due to you experience and craftsmanship, I have one last question regarding “reducing donor scar left from the strip harvesting.” Are there any other new options out there that could eliminate the donor scar through Trichophytic closures coupled with FUE, laser surgery, or tissue expansion that would allow me to shave my head if needed?

Thank you for the kind words and I’m glad I was able to help.

With respect to the donor scar, there are scar revision surgeries and even Scalp MicroPigmentation (SMP) to disguise the scar. I don’t know that you’ll be able to completely eliminate the scarring, but masking it or revising it would possibly be doable. With that said, everybody’s situation and needs are different, and I cannot give you a detailed personal consultation over the Internet without an examination.

Please call my office at (800) NEW-HAIR or (310) 553-9113 and we can set up an appointment to discuss your options.

(female)
Recently i have been losing more and more hair so i decided to look at cause. I saw one was after surgery from the anesthetic. I had my appendix out recently. Is it possible my hair loss is from the anesthetic? Your help in this matter would be greatly appreciated. Thank you

What you are asking may be possible, but I do not know if that’s what is really going on. Trying to find personalized medical answers for a diagnosis on the Internet is common and I don’t blame you, but the best help I can give you is to recommend that you see a doctor (face to face) and ask them for a medical diagnosis after they examine you in person and take a detailed medical history.

Some patients (as you’ve seen online) report some hair loss after a general anesthesia, but there can be many other medical reasons for hair loss in women.

Snippet from the article:

By the age of 35, two-thirds of American men experience some degree of measurable hair loss, and by the age of 50, approximately 85 percent have significantly thinning hair, according to the American Hair Loss Association.

Given those numbers, finding a cure for baldness has become the holy grail among scientists everywhere.

Read the rest — Hats Off to These 4 Potential Baldness Cures

ABC News goes over 4 potential balding treatments, once again throwing the word “cure” around. The methods they explain (in slideshow form!) are still in the research phase.

Hello doctor,
I’m 23 years old, I started losing my hair at 22, became very depressed and immediately sought out a transplant. I’ve seen a dermatologist in my area who is qualified for transplants and tells me I’m too young and my hair thinning is not so bad to even consider surgery. I was prescribed Propecia 1mg daily, and like some of the previous questions I’ve read, I’ve experienced an increase in libido for a short period of time. Its now month 9 on propecia and I no longer have the ‘morning wood’ and am experiencing decreased sexual appetite and desire. I am going off of propecia immediately, is there anything you can recommend for my situation?

Propecia can cause sexual side effects in 1 to 2% of the men that take the drug. If you are one of them, you need to inform your doctor and consider your options (including stopping the medication, which I guess you already did). It’s interesting that you had an increase in libido followed by a completely opposite effect months later. Did you notice any hair regrowth while you were on the medication? Have you talked with your prescribing doctor for a follow-up lately?

Besides Propecia, the only other FDA approved medication I recommend is Rogaine (minoxidil), but I really cannot give you an specific recommendations since I do not know you and I have not examined you in person. I can only give you general factual information. Whether you’re a candidate for surgery is also something I can’t tell you without an examination and more information about your hair loss. At 23 years old with early loss, I would usually recommend trying medications before opting for a surgery.