Advanced Balding in Young Man

I am a 23 year old male with an extensive family history of balding. I am well on the way to follow my father and grandfather’s pattern. What can I do?

I just had a patient of the same age and with the same problem in my office, so I thought it might be worthwhile to read what I wrote to him. I send comprehensive letters like this to all of my prospective patients out of respect. It is always an honor to be able to play such an important role in the life of a patient.

Here’s the letter:

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You have an unusual problem found in less than 1% of balding men. Your donor hair density in the rim of ‘permanent’ hair around the side and back of your head is higher than average (300 hairs/cm2 while the average is 200 hairs/cm2) but 1/3rd of these hair show miniaturization. This is the same process that goes on in the balding area on the top of your head and it should not occur on the side and back. When it does, it reflects a condition we have defined in the medical literature which we call Diffuse Unpatterned Alopecia. In essence, you have a process going on throughout the hair on your head, even the ‘permanent’ zone. Now with that said, your effective donor density of 200 hairs/cm2 (which reflect the sum of your hair count less the miniaturized hairs) is from a practical point of view, normal. But the fact that you have this process going on in the permanent zone means that the future of your permanent hair is uncertain. In my fairly wide experience, people who have had Diffuse Unpatterned Alopecia, have not experienced progressive extensive balding in the ‘permanent’ zone, but there is not certainty in your future. In determining your predicament, I would like to call your attention to some of the other elements of the examination I performed on you. Your hair is more coarse than most people, which means that the value of each hair is much higher than a normal person. There is a slight wave to your hair which means that it grooms and covers well with its strong character. Your hair is black and your olive colored skin provides moderate contrast between your hair and skin color, and although your olive skin offsets the dark hair a bit, it still calls attention to a lighter background which might require more coverage to get a full look.

Your biggest problem is the extent of your balding, which appears well on the way to becoming a Class 7 balding pattern (the most advanced pattern) and one that runs in your family. At the age of 23, you have a typical early appearance of this advanced balding process, but that balding process although mild in the top and crown of your head at this time, may respond well to the drug Propecia. You indicated your objection to using this medication to slow down or arrest the hair loss in the top and crown area. Your objections are over the side effects of the drug (rare and unusual). Considering your age, you have a good chance to get some reversal of the balding process in the top and crown area. With the diagnosis of Diffuse Unpatterned Alopecia that we found our your examination, I see even more reason to use the drug. I have seen fully half of the men who take Propecia see some reversal of the diffuse hair loss process in the ‘permanent’ zone, giving you two reasons to reconsider your position against taking this drug.

When dealing with a young man, I tend to be conservative, leaning on the drug treatment to slow down the balding process and for the maturity of the patient to line up with the extent of the problem. By saying this, I do not mean to be offensive, but young men are driven for now answers and often do not see themselves through the entire balding process which may take years. Transplantation, although a wonderful solution when appropriate, is the wrong answer for those who have not worked out a Master Plan with a good doctor that accounts for the worst case scenario of the balding process as modified by a transplant program. That is the dilemma before you and I at this time. You have to convince me that you understand what I know about your hair loss and what can be and can not be done about it. I must understand your maturity in dealing with a transplant program that will be with you the rest of your life. A good doctor/patient relationship is what I am talking about, something that is not easy to obtain in an hour visit to my office.

I am not firm against a transplant solution for your balding but because of the Diffuse Unpatterned element of your Alopecia, I need some comfort that whatever we plan is going to be the right plan for you. I want to speak with you again about the Propecia option and dive more into depth on the various subjects we discussed. We spent a great deal of time discussing the safety issues with Propecia, hopefully giving you more comfort in considering this drug as part of the long term treatment of your progressive hair loss problem.