(female)
Every morning I wake up to see my pillow full of hair.. more hair than usual. Before I shower, I run my fingers through my hair and get some hair out. When I take out my hair band, strands of hair are stuck to it. It seems that lately more hair has been coming out, but I am only 14 years old and none of my parents or family members are bald. Is this normal? Why is it so sudden? Will it stop? What can I do to help it? Please help because I am worried.

We typically lose 100-150 hairs a day, but if you’re seeing excessive loss, there could be a variety of possible reasons. I don’t know what you consider excessive, though.

At 14 years old, you should get your parents involved and see a doctor to try to determine a cause for your thinning. Until we know why you’re losing hair, we can’t determine whether the loss is temporary or even what the treatment plan might be.

It’s quite possible that you are just seeing the effect of hair cycling, which is common in everybody. If you lose 100-150 hairs per day, you almost certainly are regrowing 100-150 new hairs per day.

I have been on testosterone replacement therapy for 6-12 months, dose recently increased about 4 months ago. I have not noticed any significant change in sex drive (which is low to medium, functioning OK, 44 years old). I have however been experiencing a lot of hair loss and thinning.

This adverse effect is not desirable to me and I plan to stop the testosterone. Will my hair grow back if this is cause? What about hair regrowth if this is also combined with heredity?

Thank You

Testosterone (an androgen) is a known cause of hair loss if you carry the hair loss gene (androgenic alopecia). Much of what you lost, if there is no hair in that portion of the scalp, will not grow back.

Without examining you I can not tell you where your hair loss is in the hair ‘death’ cycle (called apoptosis) that goes with male pattern balding.

This comes from prominent New York hair transplant surgeon, Dr. Michael Beehner:

With FUE, it is easy to fracture the neck of the base of the follicle when the bulb is “naked” and then grasped for placement, while in microscopic dissection with a strip harvest, there is good fat around the base of the follicle and fracture of the hair follicle almost never occurs during placement. When all of the people placing the grafts have to grasp the naked follicle, I think this causes a kink on the end of the exposed follicle and may be accompanied by poor growth.

Quite frankly, I wish that, instead of our always talking to the patient about the choice between FUE and “strip” harvesting, I would rather talk about FUE vs. “microscopic dissection of grafts”, because this is where the biggest difference is between the two procedures. Also, the FUE often strips the end of the graft as it is being pulled out, leaving less tissue and fat on the end. With strip harvest and microscopic dissection, the doctor’s staff have total control on how that graft will be produced and we never see stripped grafts. Also, the fact that in a strip surgery, we are always taking the strip from the absolute richest center of the scalp where the best hairs are, this makes the choice difference for me a “no-brainer”.

I have no trouble convincing 95% of my patients who walk in seeking FUE to go with strip when I present the FUE problems to them this way. I explain all of these things and reassure them that many patients have almost undetectable strip scars.

We wrote about Follicular Unit Extraction (FUE) vs Strip (FUT) nearly two years ago: FUE vs FUT — Which is Better?

When you look at a follicular unit, you will see all of the anatomical parts that are traditionally created from a strip harvesting technique. All of the critical anatomy is preserved as the grafts are dissected under a microscope from the strip harvest. Damage, providing that the grafts remain hydrated, is rare and growth is excellent.

When FUE’s are done, the follicular units are not-infrequently disrupted in some manner, and these grafts may not grow as well as a result of the disruption. This is shown in some grafts that we put aside for trimming when a patient had the type of collagen that resisted the extraction in the FUE process. This is viewed here. Once these second class grafts are trimmed, they must be grasped with a forceps at the bulb or just above the bulb, which can fracture the hair shaft (this is what Dr. Beehner was talking about above).

With good instrumentation and considerable experience, FUE can be done as successful as with a strip; however 100% of patients do not have a tissue anatomy that allows such a clean FUE. This was discussed in our pioneering article that introduced FUE to the medical profession.

Hi Dr. Rassman,

Firstly, thank you for your awesome blog, it’s a brilliant resource for hair loss sufferers.

About 2 months ago I started using liquid rogaine in the evening instead of foam (I still use foam in the mornings). I did this because my hair is relatively long and I felt that the foam was just going on my hair rather than my scalp. My hair has been shedding like crazy recently and I’m wondering if this could be due to the switch to liquid in the evenings?

I’m hoping that now more minoxidil is reaching my scalp it’s causing miniaturized hairs to fall out rather than the balding process accelerating. What do you think, could my theory have any credibility?

PS. I have been on proscar split in 1/4s for over a year.

Many thanks in advance.

I suppose it’s possible that you could have an allergy to something in the liquid that isn’t in the foam, but the active ingredient in both versions of Rogaine is 5% minoxidil. Some people notice increased shedding in the first couple of months, so continue using it and see what happens over time.

You should be managed by a competent, experienced hair doctor who uses the HairCheck device to accurately measure your hair bulk to see if you are losing hair. Once baseline measurements are made with this instrument, you can repeat it in a year to see what, if anything, changed.

Snippet from the article:

Scientists have found that regularly eating the brightly-coloured vegetables appears to reduce the risk of prostate cancer by almost a fifth. Men who included carrots as part of their regular diet, eating them at least three times a week, were 18 per cent less likely to develop a prostate tumour, according to findings published in the latest European Journal of Nutrition.

The study, by scientists at Zhejiang University in China, pulled together the results of ten smaller studies from different parts of the world looking at the anti-cancer effects of carrots. This type of research, called a meta-analysis, is performed when findings from lots of studies with small numbers of patients produce conflicting findings. Some research has suggested carrots do protect the prostate against disease, others have found little or no benefit.

Read the rest — They help you see in the dark – now carrots can reduce the risk of prostate cancer

Always remember to eat your vegetables.

I am 17 years old almost 18 in 5 months. I am starting to thin in the back of my head but no signs of thinning in the front. So in order for this to stop, can I start on propecia or should I seek a doctor first? Also my dad is bald and my grandpa is somewhat bald. But my uncle (dad’s brother) is not bald. On my mothers side, my grandpa has a full head of hair.

So does propecia really help in this situation or what should I do? Because I am really considering taking this medicine. So please help me because I don’t want to be bald at all.

Many men don’t want to be balding, but genetic hair loss can happen as early as 16 years old. Propecia (finasteride) is a treatment for genetic hair loss in men, but it is by no means a cure (there is no cure). It is a prescription medication, so you must see a doctor to find out if you should be taking it. By seeing a doctor who can measure your hair bulk, you will know for sure if you are starting the balding process. If so, then Propecia would be the best approach to slowing it down or halting it.

Propecia isn’t a guarantee to stop all of your loss, but it should at the very least slow down the process. You could even see some regrowth, especially if the loss is early and limited to the crown (I assume that is what you mean by the back of your head). Each person responds differently, so without an examination I couldn’t give you any real indication of what benefits the drug will provide. That is why a good examination of your hair by an expert hair doctor will get to the bottom of what you are fearing.

Hi there,

I live in Canada, and unfortunately no one here provides miniaturization tests or hair bulk analysis. I understand Dr Rassman has offices in California and NY? Would it be possible to have these done if I came to one of his offices? Also, how much would I be looking at in terms of charge to have this done? I really have been trying any way I can to get a professional opinion with my hair, if I am over reacting or if there is something more going on. I would just like to know for sure, so I can determine my best plan of action, or if I need to be concerned at all. Any help would be much appreciated.

Thanks for your time.

We do this as part of a free consultation in appropriate young men. Our office is in Los Angeles, California. If you’d like to travel from Canada to see me or Dr. Pak, you can request a consultation via our website here. You might wish to send photos in advance of making any travel plans so that we can have an idea of what your loss is prior to your appointment.

If you decide to go to someone more local, just make sure that any doctor you see has the HairCheck instrument to measure your hair bulk.

Snippet from the article:

A Colorado child’s act of compassion got her kicked out of school. But she was allowed back in Tuesday after stories about her dismissal appeared around the country.

Kamryn Renfro, a 9-year-old whose dear friend is battling a rare childhood cancer, wanted to show support by shaving her own head to match her pal’s bald pate.

Renfro’s parents gave their approval and the young girl headed proudly to school Monday to show her classmates what she’d done. But once there, she was told she was in violation of the Caprock Academy dress code and that she would not be allowed in class.

Read the rest — Colo. girl banned from school after shaving head to support cancer-suffering pal allowed back in class

Wow, so this 9 year old girl tried to support her friend and the adults at her public charter school miss the point completely by enforcing their dress code that prevents a shaved head to be seen in school. Amazingly disappointing.

Snippet from the article:

When patients present with hair loss, dermatologists should focus most heavily on patient histories, according to an expert who spoke at the 72nd Annual Meeting of the American Academy of Dermatology.

Many dermatologists perform a cursory exam and order a battery of blood tests, says Leonard Sperling, M.D., chairman and professor of dermatology, Uniformed Services University of the Health Sciences, Bethesda, Md. Dermatologists often dread these encounters, he adds, because they can burn daylight and often reveal problems that can’t be treated successfully.

Read the rest — Patient history is key when assessing hair loss

Few dermatologists use the modern tools for assessing hair loss (hand microscope to map for miniaturization and the HairCheck device for measuring hair bulk). Most dermatologists don’t like to do hair assessments if they can not tell if a patient is balding or not.

A good example was in a 17 year old that came in to see me last week. I had seen him a year ago at the age of 16 where I did the HairCheck bulk analysis. His family history is significant as his father is a Norwood class 7 patient and two of his three brothers are also balding. One year ago, his bulk analysis showed 55% loss of hair in the front and 30% loss on the top. The crown showed no hair loss. On the visit last week, bulk measurements showed that his hair loss in the front increased to 75% and on the top it increased to 60%. Most significant was his hair loss in the crown, which was 50% of his bulk.

His hair was black, his skin was white, and the hair was medium-coarse, so that to the naked eye he showed only frontal hair loss. I already know that he will probably be a class 7 pattern balding patient like his dad. Without these instruments, I would not have seen any hair loss last year if I had not measured it, but even a year ago, it was evident that he was balding. Last week, we knew what pattern of balding he will probably be developing. He was placed on Propecia 1 year ago, but it did not stop his hair loss. He took the news well and we spent some time discussing a future Master Plan on what he might want to do as his hair loss becomes more evident. Shaving his head once he gets into college might be an option (with or without SMP).

I am a 30 year old male with some hair loss problems. I have been suffering from seborrheic dermatitis for about 2 years. My scalp is naturally quite oily due to this problem. I recently went to a trichologist and he suggested that oiling scalp is a must, no matter how oily the scalp is. My questions are

1. Is it good for me to oil my hair despite greasy scalp? Would it not aggravate seborrheic dermatitis?
2. Trichologist recommends washing scalp daily with a shampoo containing saw palmetto extracts. Do you recommend daily washing?
3. Can I resort to options like Finasteride? Minoxidil again would probably aggravate seborrheic dermatitis?

Thank you ..

I think that the trichologist should be the one to speak with for questions #1 and #2. I don’t know why those recommendations were made. Finasteride and/or minoxidil will not help your seborrheic dermatitis.

If you have hair loss issues and want and medical treatment or assessment, you should see a physician. From a medical point of view, oily hair or scalp does not cause genetic balding and shampoos (even with saw palmetto) do not treat genetic balding.