I am a 23 year old female with thinning hair in the front of my head. My mother and grandmother had it also. What can I do about it? 

If the thinning is confined to the frontal part of your scalp and does not extend back to your crown, and if your donor area does not show significant miniaturization, and if you don’t have a scalp disease such as FFA or LLP, then I would consider you a reasonable transplant candidate as some women lose their hair in the front for genetic reasons. I would want to examine you first to make sure that you do not have other causes for the hair loss and that your donor area is healthy.

female thinning

This is an interesting question which required some reading on my part. I found an a scholarly article in the Journal of Urology which addresses this question and concludes: “Profound suppression of circulating serum dihydrotestosterone induced by 5?-reductase inhibitors during 1 year does not adversely impact bone, serum lipoproteins or hemoglobin, and has a minimal, reversible effect on serum prostate specific antigen and sexual function in normal men. Circulating dihydrotestosterone does not appear to have a clinically significant role in modulating bone mass, hematopoiesis or lipid metabolism in normal men.?”?

The clinical doses for these drugs is relatively low so I believe that the article is discussing these low doses

There are two forms of minoxidil available on the market, one is the topical which comes in many strengths, the second is the pills which was originally used for the treatment of high blood pressure. The pill, which is rarely used for hair loss in the US and can bring down the blood pressure of the person taking it but is more effective at treating hair loss than the topical application of the drug. In some countries, minoxidil pills are used as the primary treatment for genetic hair loss.

This woman reported hair loss in the frontal area (see pictures) about 2 months after she had a hairline lowering surgical procedure.  These procedures are common surgeries for women who can have their hairlines lowered about an inch directly by advancing the scalp forward and surgically removing the upper forehead. The good news about this surgery is that the results, which are often terrific, are immediate and this patient reported better initial results from this surgery than she thought she would have; however, after two months she began losing hair as shown in the pictures and this hair never came back.

Hair-loss from any forehead surgery, including brow lifts or even extended face lifts, have hair-loss as an infrequent complication. In women over 40, when this happens, the hair-loss rarely returns. There is probably some genetic predisposition to this problem in these women that might eventually show up when they pass menopause. Unfortunately, this woman not only had the hair-loss as shown, but a visible scar from where the hairline was sutured to the upper forehead.  The good news is that she does not have to live with this problem as a hair transplant can put the hair back and cover the scar so that she will eventually be normal with no visible scar. Somehow, this woman was not aware of this risk, and this is the tragedy. Every surgery runs a risk and we try to spell this out during our consultations and in the ‘informed consent’ that every patient signs before surgery.

Frontal loss after HLP Surgery

Justice was finally given out which should be an example to other doctors who think that their medical license allows them to extort money from patients by concocting diseases and then recommend treatment for profit.  Here is such an example:

“Ophthalmologist David Ming Pon, MD, MPH, was sentenced last week in a federal district court in Jacksonville, Florida, to 10 years in prison for bilking Medicare out of nearly $10 million.

One could call it a light sentence. Federal prosecutors had sought at least 40 years in prison for the 59-year-old Dr Pon, not just on account of the dollars at stake, but also on account of what they described as “evil” treatment of his elderly patients.

Dr Pon, after all, had told some 600 patients that they had wet age-related macular degeneration (AMD) when in fact they didn’t, and that they needed laser photocoagulation lest they go blind, according to prosecutors. To top off the fraud, he faked the treatments that he billed for”

The following was taken from the AMA news directly.

Majority Of Cancers Caused By Random Genetic Mistakes, Researchers Say

In “To Your Health,” the Washington Post (3/23, McGinley) reports research published in Science suggests “more than two-thirds of cancer-causing mutations are the result of random mistakes in DNA replication that occur when normal cells divide.”

Reuters (3/23, Steenhuysen) reports that the investigators “developed a mathematical model using DNA sequencing data from The Cancer Genome Atlas and disease data from the Cancer Research UK database, looking specifically at mutations that drive aberrant cell growth in 32 different cancer types.”

The Los Angeles Times (3/23, Healy) reports that investigators “found that 5% of cancer-causing mutations can be linked to inherited genetic risk.” Meanwhile, “an additional 29% of malignancy-promoting mutations can be attributed to ‘modifiable’ factors…such as wearing sunscreen and vaccinating ourselves against cancer-causing viruses.” The other “66% of genetic mutations known to give cancer a foothold are random transcription errors in DNA.”

STAT (3/23, Begley) reports that the researchers “go to great pains to explain that this doesn’t mean that two-thirds of cancers are beyond the reach of prevention.” However, “understanding the role of these unforced errors ‘could provide comfort to the millions of patients who developed cancer but led near-perfect [healthy] lifestyles,’ said cancer biologist Dr. Bert Vogelstein,” the study’s senior author.

What this tells us is that many of the things we do (smoking, sun exposure as well as the use of sun screens, ,diet, even vaccinations could trigger mutations that lead to cancer.  By reducing as many of the causing factors, we can improve our chances of not getting cancer. Lung cancer and smoking is the best example of an effect induced by a know carcinogen, the tars in cigarette smoke. The causes of cancer wee well summarize in the magazine The Scientist as follows: “The researchers again found that random DNA replication errors play a major role in cancer: 29 percent of cancer-associated mutations were likely due to environmental factors, 5 percent due to heritable factors, and 66 percent due to DNA replication error mutations, the team reported.

I have seen some good results and some terrible results from Turkey. I have been told that there are almost 500 hair transplant clinics and only a few dozen that have actual doctors involved in the surgery which means that the vast majority of these clinics are illegal clinics by Turkish law (not enforced). Mass production surgeries in foreign countries are risky.

1- You can’t hold the doctor/clinic responsible if anything goes wrong. You can’t sue the doctor.

2- There is no follow-up to help you with any problems you might have or questions that might arise after the surgery.

3- If there are deaths from the anesthetics (it happens in some Western Countries where only doctors are allowed to perform the surgery) at the least if there is a doctor present, you have a fighting chance to survive.  With 80% of the clinics in Turkey, I suspect if you had a cardiac emergency there would be no one to make the diagnosis and act to help you. Cardiac emergencies are not totally uncommon in young men.

4- How do you manage complications after the surgery? Most people must see a hair transplant doctor in their home town and ‘beg’ to be seen. Many doctors will not want to deal with you. The scarring seen with these large sessions is fairly common, so the patients have to live with these problems. Few of these clinics warn the patients of scarring complications from large FUE sessions.

5- The testimony that I paraphrased yesterday had a man who was rightfully worried and not happy with the doctor’s service. The doctor told him that if he came back, he would be charged $1 million Euros (over $1 million dollars). The reason I believe that happened is because this man asked too many questions and the doctor did not like that.  For me, the patient interactions is what it is all about and I care for patients because that is why I became a doctor in the first place. One  of the complaints was that the patient did not get what he paid for or what the doctor promised.  I am not surprised as what he got was reasonably pushing the envelope.

I went to Turkey so what I am going to write about here is lengthy, I wanted to have the surgery performed by Dr. ‘X’ (I don’t want to use his name for legal reasons). The doctor’s team seems very well trained but clearly they were not well organized. They failed to discuss the procedure with me, despite promises over the phone telling me what I was going to get. In the US, they have an informed consent process, this was missing in my pre-surgical meetings, They treat me like McDonald’s serves its hamburgers, not as a patient.

I has my first surgery when I was 29. A local doctors promised me between 2500-3000 grafts, started losing my hair at an early age. When I was 31 I had a FUT surgery with a local doctor who promised 2500-3000 grafts. After the surgery I had a great deal of pain and only received about 600 grafts even though I paid for many more.  The experience was so bad, I started to weard a hair system.all of the time or if I took it off, I always had a hat on my head,

I first contacted Dr. X and told him of my terrible experience with my first surgery, I sent him pictures of me without the hair system system on so he could see what I looked like. He told me that I was a Class 7 patient and over the  phone, he told me that I was an excellent candidate for the surgery. I thought I had an excellent donor area and told him that it might take two sessions.He told me that he should be able to get 5000 grafts in the first surgery as I have an excellent donor area. I was very skeptical about the number of grafts as many other clinics were telling me that I would get only around 3000 or so grafts. I read other patient reports about Dr. X and they were good. Dr. X was one of the more expensive doctors so I felt that paying a little more would get me a great experience. He also promised me more grafts than any other doctor had promised me.

I slowly worked out the days for the surgery.  Someone told me to avoid a Sunday as the clinic often understaffed or closed on Sundays.

My wife and I were met at the airport by a driver. He was very friendly and provided some information about the area and some places to visit before the surgery. He didn’t know what time I would be picked up the next day for surgery but said the the doctor’s office would contact me at the hotel in the morning. Even though they knew that my wife was visiting with me, they only provided me with a single bed. After a few minutes, they corrected that.

Things started to get disorganized on Monday. I wasn’t contacted by anyone from the clinic qme by 11:30, still no word about my surgery. They finally called me and told me that they would pick me up at 2:30. I was already getting nervous about the surgery because of my last surgery in the US. Now I had to wait until the afternoon and I did not know ehnen they would actually come for me. They did tell me that they were very, very busy. The driver came an hour earlier than they told me to be ready. The clinic was close to the hotel.


When I arrived, I was asked for immediate payment,  I wanted to have a consult with Dr. X first to review and make sure that everything was acceptable. I paid the fee and was then brought to see the doctor.

He told me that because some of his patients missed flight in, they were working hard to keep up with the surgery load that day. I was worried that the people performing the surgeries working for that many hours on so many patients in one day, might be too tired. Would I get their undivided attention? Should I move the surgery to another day when the staff was not so overworked? The doctor told me that his staff would be fine and that they do this many surgeries every day. He told that some patients were only getting smaller, 2000 graft procedures, and as mine would be a larger procedure, they would have more time to work on me. He then told me that my surgery would be for only 3000 grafts and would be very fast. When I reminded him that he said he should be able to do 5000 he said that my donor area wasn’t that good and that I had limits on the number of grafts. This is an exact opposite of what he said in emails to me. I pushed the point and he said he would have to see what he could do as I had short hair and it was hard to tell. “Don’t worry”, he said. most people require 2 surgeries anyway. He traced his standard hairline on my head and I did not like it. I wanted it narrower. I asked if it would not make more sense to narrow the hairline coming forward so we could provide thicker density and more coverage in the rear. He reassured me again that I would be ok, ignoring my ideas on my hairline. Dr. X seemed very rushed and didn’t seem interested in answering any more of my questions other than to say this is what he does. They put me into a gown that was too small for me (I take a large size) and I asked if they had something larger and was told that they didn’t. I was then instructed empty all my pockets into a bag that they gave me and that made me uncomfortable as it included my credit cards and Passport. They also focused in on my cell phone insisting that it must be given over. I said no as my wife was was there and I needed to keep in touch with her. Once I spoke to Dr. X he agreed to let me keep it as long as I didn’t use it during the donor extraction period. They next provided some drugs for me to take. I asked what they were for and they did not understand my question. A lady had to be called in to explain what the drugs were for. They then shaved my head and we moved to another room to see Dr. X. He looked atthe scar from my pervious surgery. When I asked what the story was or if there was any concerns, Dr. X said he was just consulting with his staff. I asked what about and I was told nothing to worry about. As the patient I felt very much like I was in a meat market just being moved from one room to another. I had no feedback to my questions and I felt like it was just going along for the ride.

The Surgery went well. The injections weren’t painful and the gentleman he who preforming them was very good at his job. The extraction team and the implant team (two different teams) were good at their job. Dr. X came near the end of the extractions he told me he was leaving my surgery room and that there wasn’t any issues I was in good hands.

I also had a cocern that there was a complete lack of privacy during the surgery. Even my driver came into the room looking over the results. I was bored through the entire procedure as the only thing I had was Turkish TV and even the position of my chair was such that I could barely see the TV

I didn’t sleep much that night because of the position I was told to stay in. I wasn’t in pain or any discomfort.

The next day at breakfast I ran into several other patients. At 9:30am I was called to say the driver was there for me. I came down and there was 5 of us there. The driver brought us to a midsize car and wanted us all to get in. The driver noticed that it was going to be very tight and said he would be right back for me. I went back into the hotel and ran into another patient who was late getting down. Not sure how the driver planned to fit 6 grown men into a 5 seat midsize car. The driver was back and we were taken back to the clinic. All six of us were gathered in the reception area and this is where they took the dressings of us. We were then all huddled up to Dr. Maral’s office as a group and he provided instructions for post care. Several questions were asked of him and he quickly dismissed them with the statement “he hasn’t seen any need for it and that it was a waste of time”. Again it felt like we were just meat being processed instead of patients.

I asked about the timing for the transfer to the airport and I was told to speak with the driver as he would arrange everything. I spoke with him and he said I would be going with another gentleman as our flights were an hour apart. He was also traveling with his wife and I raised a concern about fitting 4 people plus driver and all their luggage into a midsize vehicle. I was told not to worry about it that it would all fit. I tried to explain that my wife and I had larger size baggage as we were going on to another destination from there. The other gentleman said his wife and him were in the same situation. We were told not to worry about it that it would all be taken care of. I did call the clinic back at the hotel and was told that I needed to send an email. I sent an email explaining my concern. Dr. Maral responded and told me he would arrange separate transfers for us and then went on to say “but please do me a favor and prefer another clinic if you go more sessions? or your price will be 1000000 euro”.

That night I spoke with several of the other patients and they all were promised more grafts then they received and were very unhappy with the communication. One of the gentleman said he was supposed to have his surgery on Saturday but they rescheduled it to Monday and they need to give their staff some time off. Of the 4 other patients I spoke with, all were promised above the 4000 and all received around 3000.

I’m not sure of the end results yet but I’m hoping for the best. I will be looking at a second session in the fall but I can guarantee I will be going with another clinic.

Maybe this was the perfect storm for the clinic and they were overwhelmed but I suspect this was not the case.

“I’ve had more sexual stamina via slightly reduced sensitivity but the libido and erections are still very strong if not stronger (on the drug finasteride). For instance, I’ve never been a good performer after a few drinks, but now drinking has no impact on my ability to produce an erection…”

This is good to hear because what I always hear about are the negative sexual side effects that people read about on the internet and their concerns that if they take finasteride that they will become impotent. My son has had your experience but I don’t hear many people volunteer the good side effects at all, only the bad. There always seems to be two sides of each coin.

Many young men want to accelerate their beard growth and ask about it. It takes age (genetic triggers which occur in family lines) so if you want to find out when your beard will grow out, you need to find out when your father or grandfather (either side of the family) started to grow their beards. Hormones should have kicked in nicely by the time a man reaches 18 but some people must wait out his genetics as hormones alone are not responsible for the onset of beard growth. Beard transplants can be done when the young man is a bit older (over 25) if the beard has not fully grown in yet. Minoxidil may help and if it works, then you are among the lucky few. It often produces very fine hair (called vellus hair).

You can generally expect that any benefit you get from finasteride will be lost when you stop the drug as well as any hair loss that may have happened during the time you started the drug to the time you stopped it. For people who have been on it for many years and have stability of their hair loss, the loss can be significant upon stopping the drug.

If you have real benefit from minoxidil, the hair is usually dependent upon it. When it is withdrawn, these dependent hairs often fall out in about 2-3 months. Stopping this drug will not impact hair that is not-dependent upon minoxidil.

The data from the original studies on finasteride suggested that 1/4 strength (0.25 mgs) is effective at about 50% of the full 1mg dose.  So if you find that you can not tolerate the 1mg dose because of sexual side effects and that the 0.25mg solves the sexual side effect problem, then it is reasonable to take the drug at the 1/4 dose.

No. The real impact from finasteride comes not from blood levels (relatively short in hours) but from tissue fixation at the hair follicle level (at least a week of holding effectiveness). So actually the daily dose is not as important as the summary of a weeks dosage.

We see this type of result when men have large FUE sessions.  There is little doubt that this is a vascular problem induced by the FUE technique. The good news is that we can treat this very successfully with scalp micropigmentation, but the hair will never come back so the patient must style his hair appropriate with the treatment (i.e. very short or very long hair). The scars will not show after the SMP is done.


moth eaten scars following FUE megasession