Hair Loss in Teenage Female

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

I am an active 17 year old high school cheerleader and my hair which used to be thick, is now falling out and becoming thin, like my mother, my grandmother and two of my aunts. They tell me it is in the family, but not when they were my age. What should I do? If I go to a doctor, how do I find one?

Genetic causes of hair loss in a 17 year old female, is unusual. You were correct to ask your female relatives at what age the condition first appeared with them. I would first have a good doctor see you and look for medical causes of hair loss (there are many). The following problems are amongst those that should be considered: anemia, thyroid disease, connective tissue disease, various gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone if you are taking any of these. Many other medications can also contribute to hair loss so if you are taking any drugs of any type, then that should be looked into as well. The following laboratory tests may be useful if underlying problems are suspected: CBC, Chem Screen, ANA, T4, TSH, STS, Androstenedione, DHEA-Sulfate, Total and Free Testosterone.

It is possible that a medical condition may be the cause of your hair loss, so before you jump to conclusions that you are following your female relatives’ fate, I would have you checked out for these conditions. Also, please read my previous blog entry, Female Hair Loss.

When Will I Go Bald?

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

i am 20 yrs old,and my dad is bald,although he started losing his hair only when he was 37 yrs old,i just have the fear that i may also get bald like my dad,so far now,my hair is ok,just that i have some dandruff .is there any specific age that i wil start balding,or how can i keep my hair healthy and ever long lasting.is it mandatory that i may also lose hair as well as i grow old

Balding almost never hits men under 18, so I have set up a model for the balding process to give some insights into men on the balding process. If you imagine that we are born with different types of baby hair that changes as we get into our first year. Then it changes again through childhood and then again around puberty (11-13). I suspect that these changes are influenced heavily by the hormone DHT. The hair undergoes another change between 18-29 years old.

The changes are two fold. The first part of the process is the advancement of the frontal hairline into the mature position. The typical juvenile hairline of the 12 year old boy is no different than the hairline of the 12 year old girl, but as men (typically 95% of Caucasians) move into a mature pattern with the central area rising about ½ – 3/4th inch above the central crease and the sides move up about 1-1½ inches, giving a slightly receded corner. A small percentage of men (Bill Clinton and Ronald Reagan) keep their 12 year old hairlines through life. Many young men mistake the mature changes in the Caucasian hairline for balding. Such changes are normal, but for the soap actors who must retain their baby face, such changes are devastating, so on rare occasions I have restored this juvenile hairline on famous actors.

Secondly, the balding process may start anytime after this change starts (about 18 years old). Since real balding starts at about 18 years old (caused by the impact of DHT on the susceptible genes associated with genetic hair loss) the faster the fall out occurs, the worse the prognosis. There is some protection against DHT that holds until 18, but when that protection is gone, the faster the fall out, the more is the indication that balding will be severe. On a visit to my office, I will put the hair of the patient on a TV, so that they can look at the hair shaft diameter variability. Normal (non-balding) hair has equal diameter while genetically impacted hair starts to become finer and finer, reducing the diameter to smaller and smaller sizes (miniaturization is the term that doctors use) until it becomes threadlike and just disappears. The drug Propecia blocks the impact of DHT on these impacted hairs, often slowing, stopping or reversing the process over time. The best way to change the course of this hair loss is to take Propecia which means that you must stay on the drug for life. Short of that medication, there is no effective proven medication or treatment. There is no doubt that the hair loss will still pick up again (even on the drug) but it will be a slower process.

Hair Transplants in Young Men

/by William Rassman, M.D./3 /

I just answered a question about transplanting in older men, so I’ll answer one on the other side of the age scale. “Youngtoo” asks…

Why exactly is 20 too young if the hair is taken from the permanent growth zone? I am 23 and a doctor also told me that I was too young without giving a real justifiable reason. thanks for your time.

There are many reasons why transplanting a very young man is not a good idea. I will list some of them:

  1. The final balding patterns start to become evident on a men in his mid-20s. Earlier than that, one may not be able to determine the final pattern so that surgical planning becomes difficult. If a 20 year old is destined to become very bald (e.g. the most extreme Class 7 pattern) then he may not have enough hair to tackle the balding pattern, so planning is critical. On the other hand, a man with only mild balding can be aggressively treated after the pattern is clear without putting him at significant risk for placing his limited donor supply in the wrong places.
  2. The ability to slow or halt the balding process with Propecia needs to be determined. For those men in their early 20s who do not respond to this drug and continue to bald, the future prognosis is far more bleak than for those who are drug controlled. I generally like to get a ‘feel’ for the aggressiveness of the balding process.
  3. This is a life-time decision, a decision that many people at age 20 are either not equipped for or do not have the financial follow-through capabilities to manage. Maturity on a 20 year old is different than a 30 year old.
  4. We change as we get older and along with that change, our priorities change. Once the decision to start a surgical hair restoration course has begun, there is no going back.

I never make absolute rules and each person is different. I have done transplants on some men around the age of 20, but when I have, I was able to get to know and become comfortable with them, their maturity and their decision process. I also ask men of that age to bring in a parent, a girlfriend or good friend to listen to the consultation and become involved in the decision process like a “brick wall” to bounce ideas off of.

I hope that this answers your question. With more time, I will add to this list of ‘reasons’ to slow down the transplant process for a 20 year old.

Age Limit for Hair Transplants?

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

My wife passed away early last year and I just started to date on the internet. There are a lot of ladies out there, but my bald head makes me look too old, more like someone’s great grandfather. I want to be a lover and to be that, I got to look like that. Is there an age limit to get a transplant? I am essentially totally bald (except for my sides and back and scattered hairs in the front that seem to be holding on for dear life). Can hair transplants work for me at 84 years old?

Your question brought a smile to my face. I have done hair transplants on many men in their 80s and they were driven to have a hair transplant after either divorce or the death of their spouse. Men of all ages want to look young and looking young makes you feel young, so why not get your hair back and get your youth back? I have done surgery on many people with the most advanced hair loss pattern. Clearly, we are not all equal and some balding men just don’t have the supply, while others do. I always start by suggesting that you come in to the office to be evaluated. Rather than overwhelm you with lots of text, I thought I would point you to two patients who allow me to use their photographs. The first is a very bald man in his late 60s (happily married), before and after a hair transplant and the second is a man now in his 80s, that had one transplant procedure and started dating in his late 70s. The photos show his hair loss progression since the 1940s.

Hair Loss in Young African American Man

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

Dr. Rassman;

As hard as this may seem to believe (especially for me), I am a 20 year old African American male who started losing my frontal hairline at the young age of 18. I am a sophmore in college and only started losing hair a few months after my first year. I am foolishly hoping that there is some other unknown cause to my early hairloss besides MPB (i.e.-I wore tight cornrow braids for a year, have heavy dandruff, and am also a heavy marijuana smoker) but I know this is unlikely. I have not had any tests done. I am wondering what my best options are considering that I am a college student with low income. I do not want to only stop hairloss, I really need to re-grow the hair I already lost. I am well into a Norwood class type III and have been for about a year now. I also cannot shave my head completely bald because of dark spots on my scalp and the weird shape of my dome. My situation is devastating due to my age and lack of money. I feel that NHI is really the most sincere and genuine hair transplant program and would be the most truthful and accurate with any advice they could offer. Thank you in advance for your time, patience, and assistance.

Robbed of Youth

Returning lost hair may be impractical for genetic hair loss. If you had your hair in tight braids when you were young, what you may be experiencing is some impact of traction alopecia modified by the genetic process. Whatever the cause, you do need to be examined by a competent doctor to make a diagnosis. The drug Propecia can return hair that has been lost, usually not as much in the front as elsewhere on the scalp. This is a prescription item, so again you need to be seen by a good doctor. A good Dermatologist should be able to do this. We have offices in California and and an affliated office in New York, so if you can get to one of our offices, we would be happy to examine you. Otherwise, look for a doctor in your area at ISHRS.org. You are too young for transplants, so be sure that no one does a hair transplant on you and stay away from anyone that pressures you to do surgery.

The Lion’s Mane

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

Sir, my age is about 23 years i am the student of information technology where hairs are the main part of human personality which make a man live and active every here. when ever i use to set with my friends and compare my hair i feel some shame. My hair are falling with a big speed what should i do.

I use the metaphor that hair to men is like the ‘lion’s mane’ is to a lion. It is what creates his majestic look. You are like the lion, and are confronting a real problem- that your age and your hair do not conform with the overall image that the world expects. At your age, I understand that confidence in your appearance does count for your ability to feel comfortable with others. The shame you feel is clearly not of your making but you feel it nevertheless. None of these feelings are abnormal behavior and I have seen it in many men of all ages-from all walks of life. No one wants to look old and our society has been less than fair to the balding men out there, many times cruel.

There is good news for people with hair loss. The drug Propecia can slow, stop or possibly reverse hair loss in young men and it has been on the market for 8 years with good results reported by millions of men. I would advise you to seek out a competent doctor in this field (your dermatologist or family practitioner), then seek his advice. I am certain that this drug will help most young men with hair loss, but you need a diagnosis and you need a doctor to manage you. If you are in California or New York, you can make an appointment with me or one of my associates (see newhair.com) or if you are not near by, visit ISHRS.org where other doctors who focus on this field can be found in your area.

Most 23 year olds are not good candidates for hair transplants for it may be too early, but the future is bright. Good luck.

Transplant in Younger Person

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

Dr. Rassman,
I am considering hair transplant but have a question that I cannot find the answer to on any website. What are the long term cosmetic issues associated with a younger person (I am 26) who has hair transplant surgery?

In other words, my hair has begun to recede to an NW 3 (approx.). If I was to have transplants, and several years later my hair line continued to recede, wouldn’t that make an unnatural and strange looking hairline? I.e. there would be transplanted hair at the very front, then further up the scalp there would be a zone with thin or non-existent hair, then there would by my natural hairline.

I hope I have adequately explained myself. Any info you could provide would be great.

Thanks,
JX

This is a great subject, one that is important to everyone who undergoes a hair transplant. In essence, JX is asking, “How does the hair transplant fit into the changes that keep producing more hair loss?” Much of this material is covered in a book I wrote, The Patient’s Guide to Hair Restoration. You can get a free copy of it by calling my office at 800-NEW-HAIR, or visting our website.

Everyone will lose hair to whatever their genetic pattern will eventually be. Those with advanced balding, usually develop indications of their pattern by the mid-twenties. Most will have their pattern evident by the time they reach 30. It is rare that people will start with hair loss beyond their 30th birthday so a good examination by a competent doctor will show the signs of ‘miniaturization’ on microscopic examination of the hair throughout the head. JX reports a Class 3 pattern hair loss at 26 years of age. Assuming that the pattern will not progress much further (that there is no ‘miniaturization’ of the hair in the mid head or crown), it would be safe to assume that he will not develop an advanced hair loss pattern and that a hair transplant program will never make him abnormal as he progresses slightly from this pattern. If he wishes to get the hair transplanted in the front to return his hair to its normal mature position, he can do this easily. If he uses the drug Propecia, his ability to slow down or stop the hair loss is good. There is now 8 years of good data on Propecia’s ability to slow the hair loss down, but only time will tell us if the medication can continue to be effective in the long term.

I generally tell my patients to create a Worst Case Master Plan which assumes that progressive hair loss will occur. With that Master Plan, you can estimate what might happen and plan for it both economically and socially. The one evident thing to point out is that once a hair transplant process is started, it should be followed with more transplants until the loss stabilizes or it takes you to another hair loss pattern that is found normally in nature. Frontal hair loss only commits the patient to frontal work, not to crown work. Worst, worst case is that with transplants in the front, the balding in the back will reflect what many men have naturally: a full-haired frontal look and a balding or thinning crown. This last scenario is JX’s worst case. If he wishes to see his worst case, he can visit me and look at my before pictures. I had a normal full front of thick hair (naturally) and a bald crown (which I elected to transplant but could have left it alone as an alternative option).

Hair Loss in the Mature Man

/by William Rassman, M.D./5 /,

Reader Tom asks…

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

Hi Tom, thanks for writing.

There are generally four causes of hair loss in men. Genetic inheritance and male hormones are the two most important. Time and stress are the other two. Typically, genetic hair loss occurs well before 35 years of age, and in most people it slows down with time. There are some older men who start showing the hair loss over the age of 45, although this is more the exception to the rule. Don Ameche, a popular film actor in the 1930s and 40s, was a hairy sex idol even at the age of 50, but was bald at the age of 75 when he had a prominent role in the movie Cocoon. So, he had an ‘expression’ of his genetic balding late in life. Your heart attack certainly brought on ‘STRESS’ and with a delayed genetic expression, probably precipitated your hair loss. I have seen this in illness or even divorce, both of which are heavy stress induced initiators for hair loss in the genetically prone man.

As your hair loss is recent, I would probably recommend that you go on the drug Propecia, because continued hair loss is possible. This drug may slow or stop the progression of the hair loss and it might even reverse it. If it does not do the trick, then a hair transplant works wonderfully.

Hope this answers your question.