Maturing Hairline at Age 21

/by William Rassman, M.D./0 /,

Hi there. I’ve browsed around your site a little bit, and I’ve found some interesting information. However, to be honest, I am even MORE paranoid now about losing my hair! I am 21 years old, and I have always had a full head of thick hair. But within the past year I’ve noticed my forehead getting larger…or, as you’ve already deciphered, my hairline receeding. Nobody I know has noticed it because my hair is long, and its more on one side than the other. It is at the very beginning stages of receeding, but I wanted to see what kind of advice you had for me at THIS point. Should I already start taking propecia at 21? My dad and my grandfather on my mother’s side both have full heads of hair, but my mom’s brothers and my brother are balding. Are there any type of topical creams that are known to work at ALL??? or is it all just a waste of time and money?
Thanks for your time

Panic will not be productive. If you have a problem, you need to get a diagnosis in hand by a competent doctor and then you respond properly. A rising hairline does not mean that you are balding, as you may be transitioning to a mature hairline, which by its nature causes the hairline to rise about 1/2 to 3/4 inch from its childhood location. Whether you have genetic balding in your family or not, males develop a higher hairline between the ages of 17-29 (on average). This gives them that “distinguished” look that younger women talk about being attractive. This is normal (and actually desirable) and is not anything to be concerned about.

You should see a doctor and have a good microscopic evaluation of the scalp. If you only have a maturing hairline in transition, then there will be no miniaturization in the remaining parts of your scalp. Take charge, get a good doctor and find out if there is a problem before you jump to do something that you may regret.

Should I Be Proactive with Family History of Hair Loss?

/by William Rassman, M.D./0 /, ,

Hello Doctor,
Thank you for your blog !
I have a few questions. I am 24 yr old male with no history of hair loss/thinning. But my dad started balding at 34. I have a full set of hair as of now but the chances seem high that I will eventually start losing/thinning. My brother is only 21 and he is already thinning. I was wondering if I should be proactive and start on propecia/minoxidil so as to delay/avoid the hair loss? What are the downsides to this (if any)? Will the fact that I take minoxidil or propecia even though I have full set of hair affect my hair in any negative way or initiate the process of hair loss ? Even if any of those medications grow further hair .. will I lose all that hair or even my original hair if i discontinue taking them? Please advise. Thanks!

There is an old American saying “If it ain’t broke, don’t fix it”. That fully applies to you. You are correct to be slightly concerned at this time, so the best way to find out what will happen to you is to obtain a good hair doctor’s examination and get yourself followed yearly to detect the very first signs of miniaturization. You should not start treating it now, but if or when the process begins, then Propecia will probably be the best approach to preventing or slowing the process down, that is, unless another better drug comes on the market by then. It is not infrequent for generations to be skipped, so please do not obsess over the balding prospect.

High Forehead in Young Man

/by William Rassman, M.D./4 /,

Dear Dr Rassman,
I’m a 26 year old male who has experienced some frontal hair loss for the past 3 years. I used to where my hair slicked back in high school and some time after, but I noticed my forehead increased in length and I started to get a higher hairline. I guess being of English/French descent, I would have to deal with this soon enough. I never slicked my hair back ever again,because my forehead is just too long. I leave my hair natural and lay it foreward, but i have to have bangs just to keep the attention away from my forehead. It helps, but i don’t care to have long bangs. It sometimes makes my forehead breakout. I wish I had alot of money so I can take care of this, but i live on $8.00 per hour in the Bush era. Plus I need LASIK eye surgery because I look a lot better without glasses. My eyes are the only decent thing about me. The rest of me is 6’1 1/2″ of high foreheaded European human waste. Looks are almost number 1 on the priority list for me, but its difficult when u don’t have successful genes to help u in the long run.

I do not want to rub your financial predicament with more salt to the wound of $8/hour wages. Sometimes, you have to figure a less expensive way out. The least expensive way for you is:

  1. Start taking Propecia to reduce the loss further. This will run you between $55-80/month, something you probably can afford to do.
  2. Change your combing style (forward to hide the long forehead). This will cost you a good 10 cents for a comb.

Be creative, and when your time comes for a hair transplant, reach out to us for our Standby Program where our prices are lower and more affordable for those that are more flexible with their schedule.

Too Young For Transplant at 23?

/by William Rassman, M.D./0 /,

Hello Dr. William Rassman,
I’m 23 and i have been seeing thinning of hair well in the past two years. i have been on propecia for two years, which did stop my hair loss to a certain level but lately im noticing more hair loss even on propecia. i had an appointment at a hair transplant doctor in the past week to go see if i can get a hair transplant. I saw a counselor, not a doctor who told me that no surgeon will perform a hair transplant on me because of my age. Me being too young, he said i have to wait till i go all bald. Can you help me or suggest me of any products, any new advances medications?

It is generally true that young men under 24 should not get a hair transplant, but it is a crazy thing to be told that you have to first go bald. Generally, I judge everyone differently, make few rules other than protect my patients from me, themselves and poor decisions. Because I am not a salesman, I make judgments all of the time about the maturity of the person I am talking with, their ability to understand what a Master Plan for their balding is going to be, and their response to drugs like Propecia. I find immature 50 year olds, and very mature 20 year olds. As I get to know the person, I would not say that someone of your age can not get a hair transplant. Medicine and surgery are a combination of art, science and compasion. You need all of the benefits of this with a caring doctor while making your Master Plan. Then and only then, can your candidacy be determined.

Losing Hair Rapidly at 15 Years Old

/by William Rassman, M.D./1 /,

Hi, i am 15 years old and im losing my hair rapidly. The only part of my hair im losing are the temple areas so my hairline looks like a big “M” also im noticing that the sides of my hair are thinning and receding also. Im not sure what to do i dont think its hereditary because my dad started losing his hair at 35 and all his younger brothers still have there hair and his one older brother started losing his hair at 40 so i dont think thats the cause of my hairloss. Im not sure what to do its getting really bad. It’s already receded about an inch and 1/4 on both sides. I do my best to cover it as much as i can but it still hurts my self esteem alot and i need a solution so can you please give me your opinion thanks

I am not sure we are talking about the same part of anatomy (temples or corners). Triangular Alopecia is a genetic condition that causes people to lose hair in the temples, while corner balding and recession reflects more of the typical male patterned genetic balding. You need to see a good doctor and have a proper diagnosis made. The doctor should make a good microscopic analysis of your entire scalp. Most doctors can project this evaluation on a TV monitor and show you how far the miniaturization extends. The amount and scope of the miniaturization will demonstrate the balding pattern as it may unfold. You are far too young for transplantation, but as you’ve noted that you are based in the Los Angeles area, if you’re interested you can have a parent/guardian call 800-NEW-HAIR to set up a free consultation in my Los Angeles office, so that I may properly evaluate you.

Hair Loss at Age 16

/by William Rassman, M.D./2 /,

Hello Doctor. I’m a 16 year old boy with a family history of MPB. My father (who is almost completely bald now) told me how he started balding in High School and was almost completely bald when he got out of college. I recently noticed my hair line receding. My hair is somewhat long so it’s easy to cover up, but I was wondering if any treatments can help stop, or delay my fate. I’ve been to my doctor to ask about Propecia, but she recommended against it, saying I’m too young, and opted for Rogaine or it’s generic counter-parts instead. Is there anything I can do?

In young men your age, it is unclear if an aggressive hair loss pattern will respond to Propecia as well as if the hair loss started later in your life. The data is not in. With that said, I do not believe that you are too young for Propecia. I feel strongly that Propecia is the only drug that can help you slow or stop the hair loss. If your doctor does not have a better solution, get another opinion. Minoxidil just will not stop the hair loss that you will have, assuming of course that you follow your father’s pattern (a likely scenario based on what you’ve told me here).

Sudden Hair Loss in 21 Year Old

/by William Rassman, M.D./0 /,

Hi Dr. Rassman,
I was hoping you could help me with some suggestions or information on what is going on. I recently began losing a lot of hair suddenly. However, the really weird thing is that a lot of my hair (maybe 50 to 70%) of it has a white hard mucus type of substance that can be scraped off from the end of the hair(maybe its the actual skin from the scalp or the hair follicle or something?) Is this normal because i really feel like its not?!?!?! I’m freaking out here because im so young (21 years old) and it came on so sudden and i dont know if every hair that falls out with that stuff means that it will never grow back again, and maybe there is something i can do to stop it???? I’m really scared here, if you guys could help with any suggestion or what you think it is, i would forever be in debt to you. Thank you so much.

You are panicking and that is not a good way to evaluate something as serious as your hair loss seems to be. Clearly, a good doctor knowing hair and scalp problems will be able to diagnose your problem. I can only guess without having you in front of me and that would not be doing your any service. My suggestion is to see a good dermatologist in your area.

Lowest Donor Density?

/by William Rassman, M.D./0 /,

What is the lowest donor density a person can have in their late twenties, in order to have a successful transplant?

There is no simple answer to this question on donor density. First, I would want to make sure that the person should not have Diffuse Unpatterned Alopecia, which would reflect a depletee donor area in a young man (1-2% of the male population). Then, the size of the balding area (the area of the demand) and the eventual pattern of balding that would have to be maintained must be balanced in a well defined master plan with a worse case scenario put together. A good doctor can make a judgment on the value of the donor density.

Desperate for Hair that Looks Real

/by William Rassman, M.D./1 /, ,

I’ve been losing my hair since i was 19 and now i’m 23. I’m pretty much at a strong norwood 3. I tried alot of things, but nothing has helped. My mom’s dad was bald and the rest of his family too. Basically don’t know what to do. I’ve read that i’m too young to get a transplant and have not made a move on it. Im also afraid to get one cause of the scars. I really don’t know what to do. It has pretty much ruined my life. I use to have girlfriends all the time now have not had one since 20. Pretty much so desperate i would sell my mustang just to pay for a transplant but i don’t know if i should if results don’t look real and if there is scars involved.

First, be careful with statements like “I would sell my mustang just to pay for a transplant,” because many unscrupulous people will take your money and sell you hair. Realistic expectations, reasonable predictions based upon a good solid examination of your hair and hair loss distribution with good microscopic examination of the scalp, a good doctor with great integrity and lots of good experience, and some comparative shopping will tell you much about what you can do. Read my book, available online in PDF format here, or get one sent to you free. Visit my offices if you are in California. Natural results with a hair transplant are not difficult to obtain, but first you must know where you stand and what your long term ‘Master Plan’ should be before you jump to a hair transplant.

I know that if you do not feel good about yourself, if you do not have the self-esteem you want, then having a normal life becomes more difficult. A hair transplant may or may not solve these problems. The main reason we generally discourage men of your age in getting a hair transplant is that (1) you may not be able to determine when the hair loss will stop, (2) you may not be mature enough to understand both the financial and social remifications of the transplant process, and (3) you may not be able to get the realistic expectations that fit with your hair metrics (hair density, contrast in colors, character of the hair, laxity of the scalp, etc..). In effect, will you have enough hair supply to follow your hair loss to meet your expectations? Get a good doctor and develop a Master Plan with him/her. Then and only then, can you deal with the decision of “Should I or shouldn’t I?”

Predicting Hair Loss

/by William Rassman, M.D./6 /, ,

Hey Doc,
I got a question for you. Im 26 years old with no definitive loss yet although i do have the mature hairline. My question is has do with genetics. What is the likelyhood that a male will either take after their father or mothers father in terms of Male Baldness, is it almost 100% that you will take after one or both of them or could you concievably not follow either one’s baldness pattern and instead follow inherit MPB pattern as that to your cousins, uncles, great uncles, grandfathers.

This is the reason i ask my father started to bald by the time he hit age 25 and was completely bald by around 35, my mothers father started balding in his late teens and was completely bald by 30 yet here i am at 26 with no apparent loss. With this family history i always figured i had no chance to keep my hair because both my father and mothers father have excessive MPB, so i assumed by the time i graduated High School, i would have some sort of loss.

Also the reason i ask is because generally many of the male family members on both sides (father and mother’s side) namely uncles and cousins have fairly good hair, is it possible i was fortunate enough to escape the MPB gene from 2 of the closest male members (dad, mothers father) and somehow instead inherited the hair of the more distant male relatives?

IN you encounters as a derm, do you think most males take after either their father or mothers father, or is it common for a male to not follow either one of their patterns and instead have a hairloss pattern that of a more distant relative.

Thanks for your response

Basically, we can take after either parent or neither parent. We can inherit genes and not have them expressed, yet pass the balding genes to our children or future grandchildren. I tell all of my patients that the best way to know, is to have a good microscopic examination of your scalp periodically. By the age of 27, you should have an idea of what your possible hair loss pattern is. In your particular situation, the appearance of a mature hair line has no significance for your balding pattern. It is possible that your pattern may have skipped generations or was inherited from others in the family that do not express the gene.

Thinning Hair Since Age 14

/by William Rassman, M.D./0 /,

Dr. Rassman,
I’m 20 yrs old and i have been losing my hair since i was 14. I’ve noticed my temples are receding quite rapidly and on top of that, my scalp is looking more thin. I have a brother whos 3 yrs older than me and hes been losing his hair as well since he was a teen except his temples aren’t receding as bad as mines. My Father is 45 and his hair looks natural for his age even tho hes its becoming more thin.

i have never tried any hair lost products and i’m at the point where i want to do something right now before its all gone. If you can please give me advice on what to do or recomend me doctors in the L.A. area that can help, it would be greatly appreciated. Thank You Very Much.

You need to be examined by a doctor who will look for a variety of conditions, including:

  1. Male pattern genetic hair loss (shows miniaturization in a defined pattern and sounds like what you may have)
  2. Alopecia, including a variety of other inherited forms that are not traditional male patterned balding

Only an expert doctor in this field can make the diagnosis. With the gravity of this in a young man, I would suggest that getting the best medical advice is what should drive you at this time. I can not make a diagnosis without examining you, but I would love to see you in one of my offices. There will be no charge for the examination.

Transplants in the Baldest Men

/by William Rassman, M.D./0 /,

I am very, very bald and 60 years old. I am having a hard time believing that you can really help me. Please let me know why I should believe that this enormous bald area on my head can really be covered with hair.

Some people with advanced balding, low hair densities and high contrast (black hair and white skin), can not get great coverage with a hair transplant. On the other hand, if you have lower contrast between your hair and skin color, higher densities, good character hair, and a loose scalp, you might be surprised at what you could achieve by the artful distribution of hair in the hands of a good hair transplant surgeon (see below for an example). There is real art in making less hair look like more hair and that is just one of the reasons why you need to shop around. Come to one of our open house events and you will be able to examine these patients yourself and make your own judgments. If you have a wife, female relative or friend whose judgment you trust, bring them too, as women have more discriminating views on what they see than men.

This patient is in his mid 60’s and had multiple procedures, totalling 6,036 follicular unit grafts transplanted. “Before” is on the left, “after” is on the right.



More photos of the above patient on the NHI site: Patient ZU

Balding in Young Man and Shampoos

/by William Rassman, M.D./0 /,

i am 21 yrs old, and am experiencing receding hairline. in no means am i bald, but i suspect i will be in a few yrs time. for now, i have been using propecia daily. i just wanted ur opinion on what products i should use for hair care-shampoo and gel. for shampoo, so far i have been using pantene pro v, and instead of gel i use coconut oil everyday. are these products ok to use, or is there something better u would suggest? also, is it ok to shampoo and style my hair daily, or is that bad for u hair? please let me know. thanks dr.

For MPB (Male Pattern Balding) Propecia is the best way to prevent or retard its progression. With regard to the various shampoos, none that I know of has proven to be a greater value than others, when it comes to hair loss. I generally tell patients to use what they like, what works for them, to experiment with many until you find the right match and to follow the recommendations of the product manufacturers for dry or oily hair. Frequent shampooing does not hurt, but aggressive massaging during shampooing and rough brushing will cause fragile hair to break easily. I personally like the smell of coconut shampoos and use them often!

Balding By Age and Race

/by William Rassman, M.D./0 /

I have seen documented incidences of pattern baldness, they suggest 20% suffer in their 20’s, 30% in their 30’s, 40% in 40’s, and 50% in their 50’s and so on usually with age. But it seems these calculations are taken including all races such as asians, black american indian, hispanic specifically mexican man all of which have much lower incidents of male baldness.

I am a white man and it seems to me many white man experience some loss when they hit age 40, do you have any idea what the numbers would be if it was strictly white males and not other race.

These would be my guesses if just taking into account white males :

30% suffer in their 20’s, 40% suffer in 30’s, 60% suffer in their 40’s, 65-70% suffer by they reach their 50’s. And if a man doesnt experience any male baldness when they are in their mid 50’s near 60, in most cases these are the males that die with most of their hair.

Maybe my projections are inaccurate but i rarely see a white man with a full head of hair in their 60’s, 70’s. On average, i would say by age 70 8 out of 10 men suffer MPB. WIth the remaining 20% after age 70 escaping the god awful disease we know as MPB.

What do you think?

Breakdown of racial variations by age and degree of hair loss is not well documented. There are suggestions that Caucasians may have more hair loss than non-Caucasians. As a person ages, the first appearance of hair loss lessens in severity. If you reach 40 without any evidence of hair loss, chances are you are not going to bald. With that said, actor Don Ameche had a full head of hair at 50, but he had a nearly complete Norwood Class 6 pattern balding pattern by the time he appeared in the movie “Cocoon” in his mid-70s. So, there are no hard and fast rules when it comes to balding by race. There has been interest recently in obtaining better documentation of this by geography (i.e. race) and studies may be coming in the future. Of interest, the American Indian (those that came from the Alaska migration) do not have balding at all. This makes the American Indian unique for racial groups. There is no explanation of this.

My Son Is Balding at 19

/by William Rassman, M.D./1 /,

I am the mother of an 19 year old son, who is now experiencing the effects of heritary male pattern baldness. My father was bald, and my son’s biological father is bald. In fact baldness on both sides of the family goes back for several generations. Poor kid; he is really distressed about this. I tried to explain to my son that just because he is loosing some hair on the frontal area does not mean that girls will not be interested in him. Of course he always says, “That is such a MOM answer!” My new husband and I live in Utah and our communication with my son is mostly over the phone to California where he lives attending college. We told him to go see a Pharmacist but I am sure they will just recommend some over-the-counter cream like Rogaine. Also he likes to work out and has been drinking these shakes to help him bulk up. Are those bad adding to premature baldness as well? What do you recommend? Should he contact is primary care physician? Should he see someone in the Santa Clara, CA area? Please help.

Sometimes these ‘shakes’ have steroids in them and they can accelerate balding in people who use them. He needs to be seen by a specialist. I have an office in San Jose so ask him to make an appointment with me personally, and I will try to diagnose him and address the problem. The longer he waits to get to the root of the problem, the more hair he will lose. To set up a free consultation, please call 800-NEW-HAIR or fill out our online info request form and we’ll contact him to setup an appointment.