Your hair loss questions, answered daily.


All Hair Loss Causes related posts


Does smoking cause hair loss, will smoking affect the success of a transplant? Best Regards.

Block Quote

There are known effects on blood supply to the scalp and other areas of the body when one smokes. This may or may not contribute to hair loss. Many hair transplant surgeons warn patients that if they smoke, they run the risk of losing hair from a transplant or reducing the yield from a transplant. I have not found that to be the case, but from a good legal position, I must warn you of that possibility.


i am eighteen years of age and am loosing quite alot of hair. it has been a month since this has been happening to me. i dont really know if it is cos im using a hair strightener 2-3 times a week and m washin my hair at least twice in a week. i am loosing my hair particularly when i am in shower. i am really worried and m not using a hair straightner at all during this christmas hoildays. Do u think that i should use my hair straightener once a week and wash it once too? i will really appriciate it if you write back!
Thanks a million!

Block Quote

I am not 100% certain that a hair straightener can cause permanent hair loss, but if you are concerned, then you should stop its use and see if your problem goes away. That is the easiest and most logical thing to do. Sometime chemicals can cause your hair to become very brittle and break without actually destroying your root, therefore causing any hair loss to appear a lot worse than it actually is. It is normal to lose up to 100 hairs per day.


My 4 year old has developed an almost circular spot on the back portion of his head. It seems almost bald. What is it?

Block Quote

There are many causes of such balding, including genetic factors such as alopecia areata (or variations of this), fungal infections, etc. You need to take your 4 year old to see a dermatologist specializing in children and/or hair loss.


Hi doctor, I have been recently been encountering certain problems with my hair over the past 5 months, I am 16 years old (male) and currently starting my first year of college. First signs of change were with the texture and build of the hair, as it started to become much drier and thinner. Then the amount of hair that started to fall out naturally started to drastically increase, although I have naturally thick hair the changes that I am experiencing seem too unnatural, one example is the fact that I never really used to be able to see my scalp, now I am really feeling concious about it. I have great foundations of friendship in the school that I go to and the worry of acceptance isn’t preying on my mind too much. I have asked my best friend about it and she seems to see no difference in the appearance of my hair, but I still believe there is something wrong.

My grandfather had troubles with baldness as a teenager and was completely bald on the top of his head at age 20. Confident self image is something that I always like to pursue, I style my hair using straightening irons and using gel based products, which I have been widely recognised at school for, for the past two years. A balding head it something that is not really seen around my social groups, and I’m not quite sure how my friends would react. I haven’t consulted my doctor about it and I would really like some impartial, friendly advice on what to do next, whether I should consult my family or keep it quiet and hope it will go away. I would really appreciate your help in this matter as I have only spoken to one person about this and I haven’t been able to research it myself much. Thank you

Block Quote

Go get your head mapped out for miniaturization, which will show if you are in the early phases of genetic balding. Especially at your age, it is too important to guess or work the answer blindly through the internet.


Iam a 40 year old male that has only suffered from Psoriasis for the last 4 months. Previously I have very thick hair, but already my hair is thining down the front centre of my scalp. What causes this is hair loss? is it the thick crusts of skin or the red lesions ?

What course of action would you advise for me as this is now starting to really affect my day to day life ? Are there partucular shampoos or remedies you would suggest above others ?

Many thanks in anticipation

Block Quote

Psoriasis can cause hair loss due to stress, scratching and picking it, and from normal genetic process that run in parallel to it. The best person to treat your psoriasis is your dermatologist. I recommend that you learn more about Psoriasis at the National Psoriasis Foundation site. Also, please review previous blog entries regarding this.


Hello Dr. Rassman,
I am 40 years old, male. I have been on presription testosterone replacement therapy for about 1.5 years, due to chronically low levels of total and free testoserone. My doses are physiological (about 100mg/week). I have always had a very thick head of hair — and no MPB or baldness of any kind on either side of my family as far back as any generation can remember. I never experienced any hair loss or thinning until about 1 month ago, when I started noticing my hair suddenly started falling out in the shower and when I combed it, at the hairline, top of the head. It has become very visibly thinner in the past month. I have had every test my doctor could think of (blood, glands, brain scan, etc.), and he has ruled out pretty much everything he can think of. He started me on .5mg daily of Avodart (yes, I know – off label use, but he has seen great results with it over the last 3 years with his patients), but I have been on it for only a month. My doctor says that as long as I am on Avodart, even if the testosterone is causing the rapid hair thinning and loss, then this will stop it. He suggested that I do not stop TRT. My questions are:

  1. Do you think that these testosterone injections can cause hair loss to suddenly occur after almost 2 years with no previous problems; and
  2. Do you think that, assuming it is the testosterone that is causing the hair thinning/loss, that I can continue on TRT without further hair loss, provided I stay on Avodart?

Thanks you for your help on this one!

Block Quote

Yes, testosterone replacement therapy can cause hair loss. Some people have the gene for hair loss that has not been expressed for a few generations. Testosterone can precipitate the gene’s expression. Some people believe that testosterone itself can cause you to lose hair.

With regard to your second question, Avodart will help block the effect on DHT receptors, but there is clearly a direct effect of testosterone on the gene as well, particularly if higher levels are achieved. Time will tell you.

I would get immediate mapping of your scalp hair for miniaturization to put some measurement to the process that you are observing. There is no substitute for good measurements to find out what is actually going on.


Im a male, 23, with no family trends of hair loss at all. About 2.5 months ago i had my hair chemicaly straightened, by a professional, im sorry im not sure of the exact chemical name. For a week or so after i had a sore scalp, and a couple of small burns/scabs on my scalp. A couple of days after i had the treatment i noticed hair loss. I noticed at my desk and on my pillow, everytime i run my hands through my hair gently i lose several strands of hair. I also lose alot during washing. I do also heat straighten my hair, but am trying to limit this too, could this also cause it? I dont wear my hair in a style thats induces traction. As the hair comes out i can see a little follicle on the end, so i guess its not breaking but is coming out at the root. To this day it appears to be getting no better, and my scalp often feels tingly and itchy, although the sores have long since healed.

Im worried that im going to go bald, the hair is still falling out and i was basicaly wondering what i could do to help it, could this be related to the chemical treatment? And how long could it take for the hair loss to stop….or could it be perminent. I am now using Alphosyl 2 in 1 medicated shampoo as recommended by my doctor, but it doesnt seem to help, and my doctor doesnt seem to be of much help. Sorry for the lengthy email, i really appreciate any advice you can give me. Thanks in advance

Block Quote

Although there may be no obvious genetic patterned hair loss in the family, it sometimes can skip generations, so evaluation for miniaturization is always a good approach to put metrics to the problem (good clinical science). There is no doubt that you have precipitated a problem with your straightening and chemicals, but if you stop with these abuses, then the dry scalp and short term hair loss should reverse, provided that you do not have genetic hair loss.


I’m only 16 years old and i’ve noticed I’m losing alot of hair, more then the 100 hairs a day that is “normal”, probably about 400+ a day. My hair has been going gray since I was 14 years old and I’ve died it a few times using the same product each time so I don’t think thats the problem. Since it started (or maybe a day before?) it was VERY itchy, and has been since. Is there anyone you can recommend going to see? or anything I can do myself? As its obviously far from normal losing hair/graying at 14-16yrs old.

Block Quote

You have an interesting problem which is not common and so your first step (based on your symptoms) should be to go to a dermatologist. You should expect that they will want to get some blood tests and possibly do a scalp biopsy. The dermatologist will likely advise you to stop using the hair dye at least until a diagnosis is established since dye in itself can cause itching and hair loss in some cases.

Before you go, there is one thing you can do – perform a hair count. Here is how you do it:

  1. Clean your brush and shower drain of all hair and change your pillowcase.
  2. For one week, collect all the hair that falls out and place it into an individual baggy marked with the day of the week.
  3. At the end of the week, sit down and count EACH hair in EACH baggy — keep a tally.

If your hair loss is less than 100 hairs per day (and some experts say 150 hairs), this is considered a normal amount of loss. When you go to a doctor for this problem, this will also be useful information for them so you might consider making a copy of the tally or bringing the hairs in so that they can be examined under a microscope. Whatever you collect, the actual hair loss will be higher because hair falls out everyplace you go, so if you count 100 hairs/day, it is possible the actual loss might be double that number. You will want your scalp mapped out for miniaturization to determine if you have premature genetic balding.

Hope all goes well!


First of all, thank you for the time you put into answering questions and posting them on your blog. I have found it a truly unique resource in the often troubling search for useful information on MPB and Hair Transplants. I am 27 years old and have been very slowly losing my hair since I was 20. All the loss has been in the form of a receding hairline and I am now probabaly only a norwood class 2 – 2.5. I have kept most of my hair most likely due to my use of propecia off and on for the past 5 years (2 years on and then 1 year off (like an idiot) and now 2 years back on). The outline of my hairline is now a normal mature hairline but it has slowly gotten thinner and thinner especially on one side while the other side has stayed relatively full. My question is two parts: Is it common to see significantly more miniaturization on one side of the hairline? Are there down sides to doing a hair transplant among those thin hairs to add density? Some might call me crazy for even considering such an option but the hair has gotten very thin and I would like to enjoy a full head of hair and not have to worry about covering up a balding area. I dont mind where my hairline stands but would really like to fill in the thinning area if there are not significant negative repercussions. My two biggest concerns are shock loss and what my hair might look like years down the road (will I have a small patch of transplanted hairs while everything else has thinned out or fallen out?). Thanks again for your time and this blog in general.

Block Quote

I am glad that you find my blog helpful. Thank you for your kind words.

It is not unusual for a person to show more hair loss on one side than the other. The reality is that the other side will catch up to the worse side eventually.

Transplantation may be an option, assuming that your hair loss extends beyond the class 2 pattern. If the miniaturization goes well into the existing hair, then a transplant AFTER you are on a course of Propecia, may be a reasonable option. Shock loss is rare if you are taking Propecia. Good planning with a good doctor will assure your best outcome concerning your final appearance and should prevent you from having islands of hair. This requires a master plan for your short and long term hair loss, because hair loss is a progressive process. Since you are in Los Angeles, you should call my office at 800-NEW-HAIR or visit the Request Additional Info page to setup a free consultation in our LA office, or better yet, come to one of our Open House events where you can see a patient surgery, meet many patients who had the transplants done by me and meet other patients who had surgery done by others so you can compare apples to apples.


I am nearly 23, and my hair has begun to thin out quite a bit (in my opinion). There doesn’t appear to be a pattern at all, so I believe this may be diffuse thinning. About six months I felt that the front of my scalp felt thinner, but the rest didn’t. When I got my hair cut two months after, I became alarmed at the thinness of my hair behind my hairline and decided to go on Rogaine in September. I spoke with a dermatologist, and he described it as “minor thinning” and after a blood test (nothing abnormal although I initially tested positive with the lupus test), he prescribed Propecia for me which I went on in the beginning of November. Since I initially have gone on Rogaine (about 3 months), I have noticed that the thinning has seemed to spread throughout my hair – in fact my hairline has thinned (not receded) significantly in my opinion. I know without a miniaturization test (I’m going to go back to my dermatologist in a month to do this), it is difficult to diagnose, I would like your opinion on my prognosis. Although the thinning only is noticable to me (my parents can’t tell in pictures and no one has commented on it to me) when I apply the Rogaine in the morning and at night, it looks quite thin in parts, particularly behind the hairline. I don’t know if I’m responding to the Rogaine yet (it has only been three months on it, and since its diffuse thinning, it would probably be difficult to see results at this point), although on my hairline, I do feel small hairs (which could either be new hair or old hairs being miniaturized).

My maternal uncle and grandfather both had receding hairlines and went bald at young ages, but my father still has an extremely thick head of hair. I have always had thick and coarse hair like him, but in the last six months I feel that I have lost half the density of my hair. The dermatologist described it as “minor thinning” and said usually when he sees hair loss in someone my age, it is usually stress (I moved to New York to begin a job in finance six months ago), but I don’t believe it’s TE as I don’t shed (either on my pillow or in the shower to the best of my knowledge), nor have I. I would appreciate your advice/opinion.

Thank you.

Block Quote

Nothing replaces a good exam, but it sounds as if you are experiencing (possibly accelerated) genetic hair loss, regardless of your Dad’s currently thick hair. Rogaine typically takes at least nine months for maximum results and the Propecia needs about that long to show a change as well. It will be difficult for anyone in your position to make an objective assessment because of the emotions involved with losing one’s hair. Before starting more medications, you will want your scalp mapped out for miniaturization to determine if you have premature genetic balding. I suggest the following:

  1. Stay on the Rogaine/Propecia for at least a year. Neither of these drugs are associated with hair loss unless you stop them. Be patient and 9/10 times you will see results.
  2. Each month, have a good friend take a photo of your head where you are concerned about the loss. I will warn you that hair loss often looks worse in photos (especially if you use the flash), but the benefit is that if you standardize the lighting and the pose in the photo, you will be able to compare them over time and make an objective assessment.
  3. Do follow up with your dermatologist or a good hair surgeon (since you are in New York, I recommend Dr. Bernstein) to both document any miniaturization and classify your hair loss according to the Norwood-Hamilton Scale. These people can take photos for long term documentation as well.


Valid CSS!

HTML 5 Validated