You might have pulled out your hair from the heavy scratching. If it was the first time in that area, it will grow back, just give it abut six months. If you constantly do it in that area, you can develop traction alopecia which would then be permanent hair loss.

I remember a former patient of mine who was mugged about one year after a very successful hair transplant. The mugger grabbed him by his transplanted hair, robbed him, beat him up holding on to his hair and when he was finished, they pulled out his hair. He came directly to my office, all bloody with a broken nose and broken ribs, crying about his precious lost hair. I told him not to worry about his hair and sent him to an emergency room. He came back to see me eight months later and all of the hair that was pulled out, was back as good as it was prior to his mugging.

The message here is “one episode of pulling out hair is never permanent!”

Dandruff scratching hair loss? from tressless

I’m a 38 year-old white male. I began taking Propecia in mid 2009 for what was becoming obvious thinning in my crown/vertex. A couple years later I added Minoxidil. My hairline never receded, that’s not an issue. Things are going well, no further loss happened that I can tell and I had some regrowth and thickening. From my photo, do you think it’s possible for me to have an FUE procedure that would add coverage to the top/crown to blend more with the sides? I like to wear my hair short, at a number one guard on the sides, so I’d like to avoid a strip scar. Do I have too much hair, would I just be making things worse with shock loss?  Your blog has been a great help in warning about the danger of over harvesting FUE grafts.  Also, I make about $60K/year so i would ask if a hair transplant realistically within my means?

From the pictures, I believe that the Finasteride and the Minoxidil have been holding on to your hair very nicely. I would continue with your current drug regimen. If you want to address the thinning appearance, then Scalp MicroPigmentation (SMP) works great. It is a non-surgical option that does not produce shock loss, which could happen with transplants, making your situation worse rather than better. Transplants might accelerate your balding process and you have been so successful in holding on to your hair (something that you probably don’t appreciate). I would think that SMP might be a better approach.

Here is a link to our website for this process: https://scalpmicropigmentation.com/bold-shaved-look/

Is it common for genetic male pattern baldness to start in the center of the forehead or does it usually start in the crown or nearer the temples?

Balding starts in a variety of locations in different individuals. Many people start either in the crown or develop frontal recession or both. I believe this is the most common occurrence.  However, one or the other may not be clearly apparent to the impacted individual. It is less common to start in mid head (between the ears). There is no particular age when it necessarily starts but it is more common in young men under 26,

This is an interesting post I saw on Reddit worth sharing with you. It was published on Aug 17, 2017.
Balding and hair graying are two conditions that causes distress among patients. A new medical research was finally able to find the mechanism of grey hair and balding. The research discovered two proteins, KROX20 and SCF, that are the major key factors for hair growth and hair pigmentation. The absence or deficiencies of those proteins will cause hair to fall and graying. We can expect a cure in the form of a topical application in the near future.

This man sent me an email asking this question:

How do you tell the difference between recession and mature hairline?

I asked him to send me a photo of his hairline with his eyebrows lifted high so that the creases show on his forehead. A mature hairline can be seen here because the hairline is about 1/2 inch above the highest crease of the furrowed brow.  The shape of a mature hairline is V-shaped which is a typical male hairline shape.  If you are concerned about a receding hairline, always do this test.

My hairline has been receding for a number of years, I am now 62 and recently had a heart attack. It seems to me that the hair loss has accelerated since that trauma. My hair now has sort of a trough down the middle that was not there before but it was thinning. My question is: Can a heart attack cause acceleration of hair loss and can hair replacement techniques be employed to reverse it? Thank You

A heart attack or any significant illness with its associated stress can accelerate hair loss. You can meet with a doctor who specializes in hair transplantation to see if there is something that can be done for this that meets your agenda.

If you get a hair system at the age of 20, the hair will all be lost due to the attachment mechanism and as a result will make you dependent upon the hair system for the rest of your life. With a Norwood Class 2.5, do you really have a problem that will cause you a decision now that will affect you for the rest of your life?  See a doctor like me and try to develop a Master Plan for your future hair loss and solutions that make sense.

Should I get a hair piece at the age of 20? from tressless