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All races of males have male pattern balding; however, the American Indians whose ancestors came out of the Alaskan Bridge, have no balding present. This is most unusual because their ancestors have balding. There has been a suggestion that the absence of balding in this group of American Indians may have reflected some cultural ethnic cleansing in the very early days when the immigration happened and the populations were very small. With this thesis, the male pattern balding genes would have been wiped out.

I wrote a post on many years ago where I discussed causes of balding from an evolutionary point of view and the discussion covers the theory of balding in men. See here:


Be honest and that shows you care. Men often deny early balding and by the time to stop denying it, the are past the point when they might have prevented or reversed it with medications. This goes to extremes and the denial can occur over a generation to the point where men can’t even see what happened to them such as those with the awful comb-overs whose wives and family never say a word. I know your question is really about early balding, but by being open and frank, you can show how much you really care and take a load off of his back.


“Long-term adverse symptoms of men who used oral finasteride against androgenic alopecia have been recently described as post-finasteride syndrome (PFS).” These men report that the sexual side effect after taking finasteride seem to hold for them for long periods of time. The frequency of this finding shows that it is not common as most men who develop the negative sexual side effects of finasteride, return to normal after stopping the medication. The following article recently appeared in the Journal of Sexual Medicine and is worth reading. What it suggests is that there may be differences in the genetic make-up of patients who experience PFS as compared to most others.


This is a momentary phenomenon and any hormones that are released in the male do not last long enough the impact the hair growth cycle. The following is interesting reading:


Skipping a dose of finasteride (e.g. one pill every other day) is as effective as taking 1/2 of a pill every day because even though the blood half life is under 6 hours, the tissue fixation life is about 1 week. That means that it sticks to the hair follicle growth center for 1 week after taking the medication.


For years, mainly because of the 4$ risk of sexual side effects from finasteride. man have asked for a topical form of finasteride. Now we are seeing many more examples of topical finasteride (liposomal topical finasteride formulation) which suggests that this works. Most doctors can order this through compounding pharmacies; however, the result of the effectiveness of this is not clearly define in the medical literature as of this time. I am sure we will hear more about it soon


How do you tell the difference between hairline recession and early balding? The first way to tell is to measure the distance of the hairline from the highest crease in the furrowed brow. In this 24 year old, the hairline is just starting to rise from the highest crease, a distance of not more than 3/4 inch is the point at which recession becomes the diagnosis. The corners rise more because the original hairline of the pre-adolescent male hugs the highest crease of the furrowed brow as the hairline takes on a ‘V’ shape.

The second way to tell is to measure the hair bulk in different parts of the head. I did this on this young man and found that there is no hair loss in any portion of the hair on his head. The bulk behind the frontal hairline and in the crown, was equal to the hair bulk in the back of his head. That tells me that there is not even the slightest amount of balding.

Between the location of the hairline and the normal hair bulk I measured, this patient does not have male pattern balding at least, at this time. He will come back yearly for rechecks if he is worried about his hair situation. Any surgeon who would suggest transplanting this patient would be guilty of malpractice.

The pictures below tell the story with appropriate labels. Click to enlarge.





This is a highly unusual complication of a hair transplant which I have seen posted on the web. I have seen necrosis in the mid-scalp (between the ears) when the patient was a smoker or when the surgeon made wounds that were too large and possibly too close together in combination. I have reported necrosis from internet posts here previously on I am perplexed about the cause of this problem and considering that we have performed well over 15,000 surgeries in the past 16 years and never seen this type of complication in the frontal portion of the scalp, I am wondering why more and more such problems are arising and being exhibited on the internet by worried patients. Surgical techniques certainly may have something to do with these problems and smoking may also be a contributing factor. I have written to this person and ask for more details.

I would be worth searching ‘necrosis’ in the search bar in the right upper hand corner of the screen to see more cases and some of my analysis in the past.

frontal necrosis.jpg

Amazing way to sell hair products announced by L’Oreal. The hair brush listens to the way it works its way through the hair to report dryness and other hair characteristics. “Built-in sensors then determine if someone is brushing hair when it’s dry or wet while a gyroscope and accelerometer count the average number of brush strokes and measure the force used to brush hair.”

Hair Brush


This young man (Joe) believed that he was starting the balding process that his dad had (a Class 7 pattern of balding). His father was with him today and he told me that he started balding when he was in his very late 30s. That was unusual for a man with a Class 7 pattern of balding (just a rim of hair around the head) as most men achieved that pattern in their 20s. Joe had early recession in the corners of his hairline.

This is what I told him and what I did: “You were concerned about the balding in the family with your father developing his advanced balding pattern in his late 30s (unusual). We performed bulk measurements on your hair today and much to my surprise, the balding you are experiencing is very mild and early with less than 9% hair loss behind the frontal hairline and in the top of your head. At the age of 24, you might be able to hold on to your hair for years if you use the drug finasteride. We discussed the potential side effects of this drug and I told you to call me if you should develop any of these.”

This shows the value of the HAIRCHECK test for hair bulk measurements. Although he thought that shaving his head was a good option and receiving Scalp Micropigmentation rather than face his fading hairline every year, month by month, I felt that he had a good chance to keep his hair and postpone any more thinking about his balding. This is very important for any young man. At his age, thinking too much about his hair replaces the real important things in life. Hair may not be important for him to worry about for years to come.


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