Our office is closed today and tomorrow to celebrate Thanksgiving with our families. We’ll be back on Monday!
My father (age 60) is pretty bald (Class 6 balding pattern) but he still had hair on the top of his head. I am also a Class 6 (age 40) person but more balding than my father as my scalp is clean of any hair on the top. I went to a hair transplant doctor and he recommended that I get 1500 grafts on the front and top of my head. I was curious as to how much hair that would be, so I asked my dad if I could count the hairs on the top of his head. He had lost his hairline over 20 years ago as I have. I counted about 3000 hairs on his head, so assuming that I get 1500 grafts averaging two hairs each per graft, I realized just how much hair I wold get from such a transplant. He looks sickly with his 3000 hair if it were not for his top shape and his workout routine. Did I do this right to see what I think that I would like with 3000 hairs in the 1500 grafts recommended for me?
Answer: The recommendation of 1500 grafts in a completely bald class 6 pattern, would not give a big impact for you. To cover the class 6 pattern, you would need closer to 5,000-7,000 grafts depending upon the thickness of your hair shafts (fine, medium or coarse). Spreading 1500 grafts around a Class 6 pattern will not give you much coverage unless your hair shafts were thicker than his and the grafts were focused on the front and forward top areas of your head. I found a 44 year old male with a Class 6 pattern on my website (https://newhair.com/photos/patient-xk/). He had 4178 grafts in two sessions. The redness in the front reflected a hair system (wig) he wore which was glued to his scalp. His hair was of medium weight. If you hair is of medium weight, then you could expect to look like this with about 4000 grafts. Look at his before picture and tell me if this is the type of hair that your father has? If so, it might be miniaturized (very fine) so it will not give much coverage, so 1500 grafts of non-miniaturized hair placed in the frontal area might look ok, but significant coverage will not be obtained and these grafts should not be placed in the top and crown area.
To take a look at two other patients, I offer: https://newhair.com/photos/patient-ba/ (patient BA) and https://newhair.com/photos/patient-cd/ (patient CD). Patient BA’s area of coverage with 2184 grafts of medium weight hair that is straight (no wave in it) combs over nicely to cover the bald area. Patient CD had 1349 grafts with good frontal coverage because his hair was coarse and very curly (kinky). Patient CDs hair attributes give more coverage than people with medium weight, straight hair as seen in patient BA. If the hair was fine in either of these men, the coverage would be thinner.
I hope that these comparisons will give you an ability to estimate what 1500 grafts might do. Compare your hair attributes to those of these men and then you might be able to see the value of the recommended 1500 grafts.
hello Doctors, about 2 years ago i was shaving my hair with a trimmer and it pulled a chunk of hair out at the widows peak, the hair has never grown back properly and when light hits that area it appears shiny and bald. But on closer inspection there are loads of tiny thin hairs… these hairs have remained for over a year and never grow any longer than half a millimeter. I would imagine this is miniaturization ? but from reading up usually miniaturized hairs fall out…. these hairs have been there for over a year and never shrunk or grown more ? any ideas what might be going on and if i could use something to make
them grow normal ?
Traumatic pull of hair and hair loss resulting from such trauma can take about a year to grow back. If it has not grown back in one year, then we generally assume the hair is lost. In most cases it does grow back if the pulling is not chronic over time.
However after 2 years, I suspect what you see is what you get. The small fine hairs you may be seeing is just vellus hairs that is present on our bodies that is not necessarily scalp hair. I cannot tell you exactly what you are seeing without an examination.
I really enjoy visiting the website and reading the wealth of information that is posted on here.
I know dr.rassman has mentioned a few times that if a person is genetically balding their hair has a certain lifetime (example 5 or 10 years) , with or without the use of finasteride, before it completely dies. If that is the case, what is the point of taking finasteride if the hair is going die anyways within 5 or 10 years? Could finasteride prolong the hair from falling out early?
Male pattern balding (MPB) also known as androgenic alopecia (AGA) is genetic. There is no cure. But there are two drugs: Propecia (finasteride) and Rogaine (topical minoxidil) that can SLOW the process down. In some men it can sometimes REVERSE and grow NEW HAIR! But eventually over time, you will continue to lose hair in the genetic pattern.
If you are rapidly losing hair in your 20’s and 30’s and you can take a medication to slow or sometimes reverse the balding process down for about 10 years, that may be worth it to some people. It is an optional medication with a low side effect profile. The most significant side effect for finasteride (Propecia) is sexually related (erection issues) or reduced sexual drive and it occurs in 1 to 2% of men who take the medication. The side effects are reversible once you stop taking the medication. But there are a subset of men out there who claim that the side effects are permanent. It is very difficult to prove or disprove the permanence of the validity of long term sexual dysfunction, but this is a consideration you must weigh if you take this drug. The risks and benefits should be individually discussed with your doctor.
The following is a LINK of before and after photos of men who took Propecia with great results.
I just recently quit taking finasteride due to experiencing some sexual side effects that did not decrease when trying a smaller dose. My doctor advised me to stop finasteride for six months to see if my sexual symptoms improved. I took my last pill a month ago.
I was on finasteride from age 24 to 27, and, while not improving my hair loss, it at least kept further loss from occurring. I’m starting to feel anxious about the catch-up hair loss that could come within the next few months. Would minoxidil help prevent this catch-up loss from occurring, or is it more or less inevitable?
If you had unwanted side effects with a medication, you did the right thing by discussing your options (weighing out risks and benefits) and stopping the medication. The catch up hair loss can happen over the next 6 months after stopping Propecia and that is something that cannot be completely stopped.
Starting another type of medication such as topical minoxidile (Rogain) may help but since it works in different ways than Propecia you still may experience hair loss from the “catch up” phenomenon. Everyone is different and you won’t know until you try.
Do you ever increase density to an area in anticipation that there will be some shock loss?
Maybe I”m off but if technicians are doing most of the procedure I would think the rate of transection would be high. I don’t know what kind of training they’ve had. I assume just in house training. Obviously they’re needed considering the number of grafts but it’s a concern of mine.
No one can predict shock hair loss from surgery precisely. As a general rule the younger you are (early 20’s) with active (noticeable) hair loss in the preceding months would be very concerning for shock hair loss. If one is in their 30’s and 40’s with no significant change in their hair status in the last several years the chances of shock hair loss will be less. This is further improved by being on Propecia / finasteride.
If one were to go ahead with a hair transplant surgery, we take all the above in to account and balance out the risks (shock hair loss) versus the benefit of (new hair growth).
We do overlap the “risky” areas where there may be future hair loss with additional hair. This is not necessarily anticipating shock hair loss but rather anticipating further natural genetic hair loss. So that as you age the transplants would naturally blend in with natural thinning. This is basically part of the global MASTER PLAN that we always talk about at New Hair Institute.
With respect to the technicians who assist with surgery, they are the ones responsible for dissecting the grafts and inserting the grafts. This is their MAIN job. They do their work better than any surgeon – which is painstakingly dissecting and separating each individual hair follicles under a microscope. It is a very detail oriented work that require years of practice. The transection rate under a good technicians’ hands are very low. Most of the technicians at New Hair Institute have more than 10 to 15 years of experience trained personally by Dr. Rassman.
I’m 19 and play college football. My Dad experienced hair loss around my age and was a Norwood V by the time he was 30. His hairloss was gradual and then slowed way down.
I have a lot of stress right now because of playing football and tough academics and I broke up with my gf. It seems this is accelerating some of it. But, I try to calm myself down. What would you recommend me trying to take for now? I will get a transplant or something later after I play college. I just need to get through another 4 years!
Thanks in advance.
As you are finding out hair loss is genetic. In general many men who have the trait of Norwood 5/6/7 patterns will have the pattern show in their 20’s. It does slow down in their 30/40s.
If you want a medical treatment, you need to see a doctor to explore your options such as taking Propecia or Rogaine. It is the only two medication that work. Shampoos, vitamins, and products you may find on the Internet despite the great advertising persuasion, does not work to stop or regrow hair. At best it may be “good” for your hair in terms of keeping the hair’s shine and body.
Other options would be simply shaving! Bald is beautiful (or handsome)… as they say.
I share this because I think Im a pretty good example of aysmmetircal receding of the hairline. I am a 27 year old (half Italian half English caucasian male) and my right corner of my hairline began to slowly recede exactly two years ago.
The left is still more or less compltely in tact ( I know it will catch up in time)
My father is 49 and he has the same hairline as this guy
(but short hair not long)
No hair loss at the crown (or negligible) and heavily receded hairline, but overall a decent amount for a near 50 year old. It is thinning more the last few years though. I think he said he started balding at 27.
His father has slightly more hair than him, basically a near full head of hair at 75. My mother´s father has a Norwood at 75. There are no complete baldies in my family.
I guess I would like this to be a ‘mature’ hairline but Im not sure that exists anywhere other than in moviestars and this will continue to receded.
As I said, my left side is totally fine, my right side has receded an inch or so and in that space where the hairline was is some minituarisewd hair. Behind it the hair appears fine and not miniturarised. Very thick hair overall.
Thoughts?
It’s quite simple. We are all built differently! In fact we are not quite symmetrical as you may think. Some have uneven length arms, uneven shoe sizes, uneven smiles, etc. Hair line and recession is not immune to such asymmetry. On a positive note (if you want to call it positive) the other side will likely catch up with the receding side with time.
I am a 22 year old man.i underwent treatment for tuberculosis for2 year but now iam ok.the problem is now i have sudden hair loss with circular type.
Hair loss for men in general is caused by genetic factors. In other instances illness or medical conditions which cause stress to the body or adverse effects from medication can also be responsible for hair loss.
Treatment for tuberculosis (TB) sometimes can mean you tested positive and were once exposed to tuberculosis and doctors gave you a long course of antibiotic. It does not always mean you have an active tuberculosis infection. Either way, you were treated and it should not impact the hair especially after two years. Even the medication you took for TB should not be a factor after two years.
The best advice is for you to see a doctor for an examination. Circular type of hair loss (patchy circles) can also mean you may have a condition known as alopecia areata (AA). AA is not related to TB.
Hi, for the last ten months I’ve been having diffuse hair loss all over my scalp. Both top and sides of my head. My hair line has not receded. Within these ten months, I would say that I’ve lost about 60% or more of my total hair. All of the hairs have the small white bulb at the end. I’ve gone to a dermatologist and he suggested that it might be TE or MPB. I then went to an endocrinologist and had some blood work done. I came out having slight hyperthyroidism and I show many of the symptoms.
It seems that my hair loss has continued the same. I have slight hair regrowth but it tends to fall and my hairs still have the white bulb at the end. this problem began in june ’09 and I had been under a great stress two months prior. I am now 19. I have been on methimazole for about a month now and I am really anxious to try propecia. Do you believe this to be TE or MPB? Thank You.
I really don’t know what you’re seeing, so I can not recommend anything without checking out the hair loss for myself. My examination would include Miniaturiaton studies and bulk measurement with a HAIRCHECK instrument. I need to make a diagnosis and to see the distribution of your hair loss and knowing what you mean by hair loss over my entire scalp, does not mean anything to me from a diagnostic point of view.
The patient who wrote this some years ago was not too far from my Los Angeles office, so i suggested that he should come to our office for a free consultation. My office at 310-553-9113 (or 800-NEW-HAIR). If he had been from out-or town, I would have suggested that he see a local dermatologist to start, get his/her diagnosis and then if the diagnosis is not nailed down, try a telephone consultation with us by sending good pictures (which will be held confidential) and then get an opinion from us. This patient made a diagnosis on himself as diffuse alopecia, If this is the case, we could refine that diagnosis and determine if it was diffuse patterned alopecia or diffuse unpatterned alopecia. The former diagnosis is treatable while the latter diagnosis may not be treatable.
Hi doctor Rassman. you have an amazing blog and are so informative when it comes to hairloss.
I have been taking propecia (the brand version from merck frost) for 6 months and 3 days to be exact. (I started taking it on June 1 2011, and today is december 3 2011). I have seen no change in my hairloss at all. My hairloss has not gotten better, or it hasn’t gotten worse. It is at the same rate prior to taking propecia. So basically its like I have taken the propecia for nothing. They say you are suppose to see less hairloss by month 3. this is now month six and still nothing.
I went to see my dermatologist and he told me that since I haven’t seen any results within these 6 months that I should stop taking it if I want and further treatment with it will make no sense since it has done nothing in the first six months.. he basically left the decision up to me. These were his exact words, “If I were you, I would stop taking it because since it has done nothing, i don’t think it will be of any benefit, but its up to you. you can keep taking it for another 6 months and see where that goes”.
Now this is my question to you doctor rassman. I know you can’t give medical advice and such, and I completely understand. I just want your opinion on the matter. Since you are a hair restoration specialist, I feel that your opinion is far greater than any dermatologist.
do you think 6 months is to soon to give up? should I continue in your opinion? Have you had any patients who started seeing the benefits after 6 months and such. what do you think? I just want your opinion. I really appreciate it. thank you
Without an examination or documentation of how your hair loss has progressed in the last 6 months, I really would not know what to advise. I can’t tell you whether you should or shouldn’t take a medication I didn’t prescribe to you, but it could be worth sticking with it for a little while longer before making a decision either way. Your doctor gave you the same advice.
We advocate miniaturization studies, bulk measurement studies, and even take photographs under consistent lighting. These tests, while not perfect, are an attempt to quantify and scientifically track hair loss. Hopefully one day we can accurately measure and document hair loss more accurately. As a matter of fact, we have just been granted a U.S. Patent on such method a method (see here).
If you want an evaluation of hair loss and options, I would seek a hair transplant surgeon in your area. Your situation may not be hopeless as finasteride almost always works to some degree, even if it is just slowing the process down. I generally tell my patients that they need to take Propecia for 6 to 12 months before the effectiveness can be assessed but that same advice should extend to a few years with Bulk measurements taken yearly. I also make it a point to tell those patients that while they may not notice any difference (or even notice more hair loss), that could mean the genetic predisposition to hair loss is winning out over what the drug can offer. It’s possible that the medication has slowed the rate of your loss, and had you not taken it for these past 6 months you’d have even more hair loss than you have now. Really though, I don’t have any way to know unless you get two measurements for hair bulk over a 12 month period.
First of all thank you for what you do with this site it is a tremendous resource. I am twenty and began to recede at the hairline about a year ago. I started taking one fourth of a proscar daily in April without a prescription and got a prescription for it in June after seeing a dermatologist. I have since been taking the generic version daily. The medication does not seem to be working as I have continued to lose much hair from my crown to the point where my scalp is visible in harsh lighting.
I have long hair but i have noticed in the last week that I am losing the very short (terminal?) hairs again after not noticing them for the past few months. Could this be due to the switch to the generic version? The proscar pills were individually sealed while the generic are together in a pill bottle could this air contact affect their potency? As it has been seven months and I have lost noticeably more hair should I discontinue the medication?
Thank you, my dermatologist is pretty clueless when it comes to hair loss, so I appreciate your knowledge.
Generic finasteride 5mg is the same drug as Propecia, which is just finasteride in 1mg strength, so there should be no difference in efficacy. I don’t think bottle vs individually sealed has any bearing on the potency.
Finasteride does not work that well for frontal hairline, so what you may be experiencing is just your normal course of hair loss that the drug cannot address, particular in a man of your age who might have an aggressive pattern of hair loss in the family line. Many men like you report that their father or fathers father or mothers father had an extreme balding pattern at an early age. These men will not see the same effects as men who are not heading to an advanced hair loss pattern. I would ask if any of those balding men in your family had advanced balding and at what age did they lose their hair? That may shed light on your problem. Lighting will make the hair appear thinner. Do you have comparison photos to look at from before you started? You’ll need to discuss changes to your medication with your prescribing doctor but if you have your father’s pattern (of advanced balding) nothing may help. The best way to know this is to see a doctor who offers hair bulk assessment with the HAIRCHECK system. If you are heading for advanced balding, then this test will tell you that. If it were me, I would want to know!
Medscape November 17, 2014
The fact is that each year we lose over 400 doctors to suicide—that’s like an entire medical school gone. I lost both men I dated in med school to suicide. In my town, in just over a year, we lost three doctors to suicide. One doc in town lost seven colleagues to suicide! In what other profession can you lose seven colleagues to suicide?!
This is an interesting quote from a female doctor about a problem that is not uncommon. My son, a practicing surgeon, lost a colleague to suicide this year and that was not the first suicide at his hospital. Everyone was shocked. The suicidal doctor clearly did not communicate what must have been depression. Doctors are just like everyone else. They carry their baggage, their disappointments, their problems (both emotional and financial) with what they feel can’t be communicated to others, possibly some defect in themselves. They may not reach out for help, like so many ordinary people. In a conversation with my surgeon son, he said that all too often, the doctors who commit suicide, just don’t reach out and that some system needs to be created to address their somewhat unique status.
I have lived With my nightmare Freaky hair transplant look too long, what can I do about it? Can you help me?
This patient would not allow me to show his pictures, but I will tell you in general what his “freaky” hair looked like. He had four scalp reductions (removal of bald scalp from the crown of the head) which left a scar down the middle of his head, and he had 4 partly failed transplants creating the old doll’s head look. Between all of these procedure, his entire donor area (except for one area high in the donor area that might still provide for hair for another hair transplant – perhaps not the best option). You can see through the hair on the back of his head and he looks like a cancer survivor despite his good health. This surgery was done over 20 years ago by a Los Angeles surgeon known to the professional community for this type of terrible work, but not known by his victims. The patient was in his early 20s back then and wanted to believe in the doctor and after many surgeries there was a progressive loss of trust. His hairline was placed an inch too far above its normal position, so he even looked worse.
My job was to assess his situation, communicate realistic (not idealistic) possibilities clearly to him and then recommend a possible treatment for him – if one was possible or agreeable to the patient. Many patients like this have few options and the 8 previous surgeries and all of the deformities that were created, left him mistrusting all doctors with few options. None of the options would bring him back to being completely normal without sacrificing certain styling options. Some of these options were:
1- Shaving his head and having Scalp Micropigmentation done, This is a reasonable option if he can put up with a shaved head and many people in his situation select this option. For an example of a result he might expect, go to scalpmicropigmentation.com and see patient 161 who has deformities in the back of his head similar to this patient. His after pictures show camouflage of these deformities but the deformities and scarring will still be there on close inspection.
2- Fortunately, I believe that he has enough hair that I can still harvest to recreate his frontal hairline with hair transplants. Then he can then have SMP done to cover the massive scars on the back of his head and cover the scars in the front, top and crown of the head. A good frontal hairline will allow him to let all of his hair grow out and style it once the new frontal hairline is created. SMP will help to minimize the look of thinning and scarring.
I have literally seen thousands of patients like this over the past 24 years, and helped many of them. By helping I do not mean making the deformities go away, but with good styling and some surgeries, at times, a much improved look is very feasible. Since Scalp Micropigmentation has been available in our practice, we have been able to create amazing improvements in patients like this. I think that we have done more of these types of repairs than any medical group in the world today.
Long-term use of both mobile and cordless phones is associated with an increased risk for the brain tumor called glioma which is the most common type of brain tumor. The study was published online October 28 in Pathophysiology.
The Glioma risk tripled for people who used any wireless phone for more than 25 years. The risk was increased in those individuals who started using the phones before the age of 20 reported Lennart Hardell, MD, PhD, professor, Department of Oncology, University Hospital, Örebro, Sweden. He suggested that doctors speak with their patients about this risk. In this phone based society, we can protect ourselves by using hands-free phones with load speakers, text messaging and blue tooth technology in our cars.
Rassman Comment: We have seen this concern raised many years ago but there was no proof that the risks of brain cancer with phone use was so high. This article may be a game changer requiring all of us to keep the hand units away from our brain. When I walk in public places or pass by schools, young people can be seen with phones looking like they are ‘glued to their ears’. As parents and grandparents, we should be cognoscente of this risk and get our young people to use text or hands-free instead of long term phoning.