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My Grand-daughter has been told she has alopecia she’s only 4 years old. It started at her neck line in the back, it has now started coming out in the front. She has food allegies and she is on a medication for asthma. Can anything be done to get her hair to grow back?

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There are a series of genetic alopecias that show up in young children. IF she has one of these condition, she may go on to develop Alopecia Totalis, which in effect causes all of the hair to fall out. This would include eyebrows as well. She needs to be worked up by experts in this field. Your dermatologist should be able to point you to those experts, but if he can not, send me an email (found on the Contact page).


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 it mandatory that i may also lose hair as well as i grow old

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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.


As a writer focusing on men’s health issues I would be interested in your comments on two areas of my research.

  1. I have read a number of reports that suggest that hirsute men (those with a lot of body hair on chest, shoulders etc) are more prone to lose hair from their heads.
  2. I have also seen reports that the American Red Indian does not suffer from hair loss.

I do not believe these issues have been dealt with by you before.

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I too have seen claims that men with heavy populations of body hair have more balding than their hairless or less hairy counterparts. I can say that in my medical practice, the balding men routinely say: “I wish you can take it from my chest or back”. But then again, I do not have the type of interchange with non-balding men to probe the same issue. There is generally a belief that DHT (the evil hormone that ‘causes’ hair loss), also brings on the body hair, the nose hair and the ear hair along with the balding on those genetically inclined balding men. I believe that in the discovery of Finasteride, the people who ingested large amounts of this drug through their dietary intake of a food stock from the rain forest, did not bald, nor do the men born with a genetic defect where they can not make the enzyme that produces DHT. I recently probed a large number of doctors asking if anyone has found evidence of a reduction of body hair, nose or ear hair with Propecia. Everyone liked the question and told me that although they believed it might just do that, there is no evidence that Propecia or Proscar actually blocks or reverses these less than ideal hair locations.

With regard to the American Red Indian, I am fully aware of this observation. His ancestors came from the Alaskan bridge and they had the balding trait, so it is strange that this particular ‘race’ (the great grandchildren of the migrating Alaskan ancestors) is unique amongst all humans as they do not have balding. Of interest, I am not aware that these people are missing any enzymes for making DHT. Could it be that a primitive people actually wiped out balding genes in their brothers in a relatively short time frame of less than a couple of thousand years?


HI Dr. William Rassman. I read in many places that propecia can make the frontal hairline/temples recede. Is it true or is it a myth? Coincidently my temple was a NW 1.5 2 month before propecia. Now it’s diffusing in a strange way. thanks

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I am unaware of any reports that Propecia will accelerate temples recession. I am assuming that you are a young man (Norwood 1.5-2) and one of the things that you must recognize is that 95% of Caucasian young men (also true of other races but a smaller percentage) will change their hairlines as they mature. This maturation process certainly moves in the direction of a Norwood 2 – 2.5 range. This is not balding, but normal maturation which occurs between the ages of 18-29 in men. The other 5% or less of Caucasians are like Bill Clinton, where they keep their childhood hairline and remain as they were at 12 years old. Best to be sure that you understand the difference between normal maturation of the hairline as seen in your genetic family connections and the balding process itself.


I am considering getting a hair transplant, however, I read a comment you made that hair transplant can accelerate hair loss if the process of hair loss is active? what does that mean? So what’s the point to get hair transplant? Maybe I didn’t understand what you said.

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Every person who has genetic hair loss continues to have hair loss throughout their lifetime. Hair loss is accelerated as time moves forward and as we are stressed. A hair transplant is another stress. If you are a young man and in rapid hair loss, the added stress of a hair transplant may increase your genetic rate of loss for a few months. With women it is different. With drug protection (Propecia in men only) you can slow down the rate of loss that is programmed into your genetic clock. Those over 30 are less reactive to the stress of a hair transplant (less likely to get telogen effluvium, the medical term for stress loss) than are those under 25. The hair transplant (1) in the right patient performed (2) by a good doctor (3) with the proper modern procedure (4) placed in the right location (5) in the best distribution (6) adjusted to your hair color (7) hair character (8) hair shaft thickness (9) hair density (10) balding pattern (11) with a proper plan catered to your individual needs diagnosis, age and (12) adjusted to meet your financial situation may replace some of those already lost hairs. I could keep going on and on, but I hope that you understand that there is more to getting a world class hair transplant than just having a doctor put holes in you head and then plugging those holes with hair. All hair transplant doctors are not equal, nor is each hair transplant patient. The drug Propecia generally protects men from surgically induced hair loss, so we use that drug with great frequency.


My original blog entry (found here) detailed a reader’s thinning hair, possibly due to taking Accutane when he was a young man. The following is my response to him along with one of his photos, which I was given permission to post.

Thanks for sending your pictures. I am using one of these for the Balding Blog to make good reading for our audience, showing only a top down view without anyone able to identify you. What I see in this photograph along with the other you sent, is that you seem to have miniaturization throughout the Norwood Class 6 pattern. The frontal hairline looks stronger than the area behind it (a good surprise), suggesting that the frontal line has different and stronger genetics than the hair behind it. I can not determine the amount of miniaturization that is there, but a good baseline is needed to determine change over time and any response to medications. Also, the donor area around the back and sides needs to be assessed to determine if you have a condition called Diffuse Patterned Alopecia, a diagnosis that is important to make prior to considering what to do about your problem.

With such an extensive area of thinning, your donor supply, skin laxity, and varying hair characteristics need to be determined before any treatment recommendation can be made. You may be a good candidate for Propecia and/or Rogaine. The pictures help, but I would think that you need to be managed by a competent doctor before going forward from here.


I was an NHI client. Considering all factors, I would rate the experience as “average”. I am very close to being back to the point where I will need either more surgery, or I will have to shave my head and call it a day. Some of this was genetically predisposed, but some of it may have stemmed from the fact that the grafts did not “take” as well on the crown of my head, the place where I would need them if I have the procedure done again.

My question to you is twofold: Is there any or a better chance of the grafts “taking” in this area a second time? If so, is there a way to schedule the surgery with you without offending the doctor who did it? I think he did a fine job, but it is my understanding that you are the best – and if I do this again, I want it to be for the last time regardless.

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Your question may be clear enough for you and I to understand, but for the average reader, the problem you are pointing to is the progressive nature of hair loss. The crown of the head always takes more hair per square inch than the frontal area, so as we tend to favor the front, the crown often gets less hair than it really needs. Add to this the large area the crown represents and that compounds the problem. The swirl and the absence of good layering because of the swirl, added to the very large area make the crown a ‘hair hungry’ area. If we do a hair transplant and any of it does not take, we will replace any hair that did not grow at no charge. However we sometimes find that it is not a failure to grow, but the progressive hair loss that one has. Most complaints, when they are given, are the results of further hair loss. In our medical group we have no pride that supercedes the interests of the patients, so the answer is yes, if you want me to personally look at you and we decide to do more transplants, then I would be honored to be your doctor. To deal with the progressive nature of hair loss and to hopefully put an end to recurrent surgeries, the drug Propecia would be an important additive to your treatment protocol, particularly for the crown in someone like you.

I’ve had crown surgery, having made the mistake of having three scalp reductions to reduce the size of the bald area. By bald spot was a 3 inch diameter circle before the scalp reductions and a 3 inch diameter scarred circle after the scalp reductions. I eventually had 1600 grafts put into my crown and now I am normal. When I am in bright sunlight and my hair is web, my crown appears thinner than I would like. My bald spot used to get a sun burn before the transplants were done, but since the transplants there have been no more sunburns.

I look forward to speaking with you.


I had a brain tumor when I was a child. I was cured but the radiation I received left me missing much of my hair on my left side. Can hair transplants help?

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Yes, hair transplants will grow nicely in radiated scalp skin most of the time. I recently had such a patient come in after about a year from his transplant session with us (post radiation from a childhood treatment of a malignant brain cancer). He was Korean with black straight hair, olive complexion skin and one side of his frontal area almost completely hairless. His results with about 1500 grafts was wonderful and that included his hairline. He may elect to do another session, but frankly the results were outstanding and I did not think that he would push for another session. Clearly, he was happy and his hair ‘greed’ was taking over. Hair transplants work well for many scars and scalp conditions beyond simple genetic balding.


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

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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 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.


Dr. Rassman,
Thanks for taking the time to review my circumstance. i am 35 yrs old and have been thinning for the last 5-6 years. I currently use minoxidil and the lost has seemed to stop. A dermatologist said it was MPb after a brief exam. There are a couple of reasons why i disagree with this. first there is not one case of any member of my family even thinning much less losing their hair. second my hair doesnt look like a typical MPB patient. i have a real good hairline and decent coverage all over the top its just thin, much thinner than the sides which are quiet full. i also visited a Hair center to discuss some options and the interviewer was agreed that it didnt fit the normal profile. I am wondering if it is a hormonal issue. I took accutane when i was younger if that has any bearing. Also around the time i started losing my hair i started to sweat a bit more than usual Any help would be greatly appreciated

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Genetic variations are wide and family patterns do not always show balding. Now with that said, I would want to see you to map out the miniaturization in the head and then determine if this is one of the variations we see in genetic hair loss. Accutane clearly does participate in the process and if you are genetically prone, it may contribute to the genetic hair loss.

Send me pictures as a start (my email address is on the Contact page). You clearly need a diagnosis. Let me know which city you are in and if you are not near one of our offices, I may be able to refer you to someone who can help make a diagnosis.


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