We are clearly more informed today that previous generations have been so today’s young people think that balding should not happen today when in our father’s time, it was just an accepted fact. In reality, Dr. Otar Norwood published his balding patterns in in early 1980s. What he said is that men bald in patterns and these patterns of genetic patterns that we inherit. The few balding men who have very advanced balding patterns (Class 7 patterns), usually, but not always, have them by the time they are 26 years old. Many of the less advanced patterns take years to occur. The reality is that each hair follicle has a ingrained number of hair cycles in its life time. If you have a 3 year hair scalp cycle for example, and you have an advanced Class 7 pattern of balding, the number of hair cycles that are ingrained in the hair follicles are about 7-8 cycles, at which time the hair follicles die out (called medically Apoptosis). Drugs like finasteride (Propecia), alter the length of these hair cycles and that is why they have become very popular.

Stress does add to the causative factors for hair loss. We see this in stressed college students and/or people who have romantic relationships that fall apart so managing stress is important to hold on to your hair. I do not believe that today, we see more balding than 30 or 100 years ago. Balding is genetic.

I have published a post on baldingblog in the past which shows that Saw Palmetto has poor responses for people with BPH (Prostate problems) here: https://baldingblog.com/2012/01/26/2006-study-says-saw-palmetto-does not improve-bph-symptoms/

It is a known fact that hair has cycles between telogen (rest) and anagen (growth). The growth cycle of scalp hair is different than body hair. Scalp hair grows for between 2-4 years on average and rests about 6 months on average. Body hair grows 6 months on average and rests 6 months on average. Younger people have longer scalp growth cycles than older people so they can grow their hair very long. When Propecia works at its best (completely arresting the hair loss from genetic hair loss, not common but more common in young people), their hair loss from telogen returns to its normal cycle. Calculate that the average Caucasian has 100,000 hairs on their head (Asians 80,000 hairs). If they have a 3 year growth cycle, then they will cycle about 100 hairs per day which will fall out (most never seen as they come out through the day in the wind or in a shower, etc..) and they will regrow through out the day at a rate of about 100 hairs per day. These new hairs get buried in the forest of hair on your head so you never see them.

African American’s fall into two categories of hair types, somewhat related to where their ancestors came from. Those from East African (Ethiopia for example) have curly hair but not kinky hair while many from the Western part of African have a kinky hair. Kinky hair has the ‘kink’ extending below the skin so that unlike Asians and Caucasian hair which is straight below the skin. some of the African people with very kinky hair, when transplanted, create a challenge for the surgical team. For strip surgeries, when the follicles are dissected under a microscope, it is easy in skilled hands, to navigate the ‘cork screw’ appearance of the heavily kinky hair below the skin as the grafts are prepared under a high powered microscope; however, when FUE is performed, the procedure is somewhat of a blind procedure where the dissection occurs while the hair is in the scalp. As drills are most often the instrument of choice and as always they are very sharp, a ‘cork screw’ hair follicular group may get transected (cut) as attempts to core it out is done with a sharp drill. Some surgeons use special types of punches that do not use a sharp ‘drill’. We use, for example, a serrated punch without rotation as it is hand help. We FEEL the punch as we navigate the coring process. Others use dull rotating punches of different varieties that can often, but not always, manage successful coring without damaging the hair follicles while it is in the scalp. The ARTAS robot uses two punches, a sharp rotating drill for penetrating the skin and a dull rotating punch for the deeper dissection limiting the depth to avoid cutting the ends off of the hairs.

You have to deal with your mother and possibly bring her to a consultation with a doctor who has experience with this drug to discuss the difference of opinion between yourself and your mother. If I were your doctor, I would encourage her to join us in a consultation. Maybe she knows more about you that is relevant to her concern, maybe she does not understand the real risks. Only a one=on-one meeting between your doctor and your mother with you present, is the way to manage this problem.

Depending upon your bone maturation, it may not be unreasonable to use the drug finasteride, but first where you are on YOUR growth curve (e.g. bony maturation) plus other factors relating to your hair loss are critical to understand. I belong to a group of 60 doctors who share a common email and the subject of young boys 15 and up and the use of finasteride has come up. With proper doctoring, this can be an option. The HAIRCHECK test is a critical first step in evaluating the degree of hair loss that you have. Many doctors may not want to use this drug on you so it is a careful discussion with you, your parents and your doctors that is critical in making such decision.

William Rassman, M.D.

The use of JAK inhibitor drugs have been shown to be effective in the treatment of Alopecia Areata. Janus Kinase Inhibitors (JAK) are drugs which supress the functions of the JAK enzyme, a critical en\This is an inherited ‘autoimmune’ disease that causes the body to reject regional areas of hair in various parts of the body. It is usually found in the scalp, but face and other body parts can show this problem. Two drug have been tested effectively, they are (1) ruxolitinib, a medication used in the treatment of certain malignancies such as bone marrow cancers and (2) tofacitinib, a drug used in the treatment of Rheumatoid Arthritis. This is an early report from the Journal of Investimationo/Insights 2016.