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Dr. Rassman, thank you for your very imformative site!!

If after starting Propecia, one’s hair loss temporalally accelerates, would this be a sign that the drug is working and that regrowth is likely (i.e., would one be better off if they actually see accelearted loss versus not seeing it)?

When regrowth occurs with Propecia, is the initial hair very fine or does it grow back as normal hair?

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Sometimes it is thought that Propecia, when it is working, may accelerate the cycling of the hair. If this happens, there is a possibility that hair loss might worsen temporarily after starting Propecia. Most people who are responding to Propecia should be minimizing or preventing further male pattern hair loss and that is what most people tell me.

Tags: propecia, finasteride, hairloss, hair loss


I was wondering how to actually notice hair loss. When I was 25 I remember visibly seeing hairs in the shower and in my sink. Since then I have slightly receded but that is it. I am now 31 and I notice one or two hairs when I put gel in my hair and a few on the floor in my bathroom. I also notice I can slightly tug a few hairs out every once and a while. It just as easy to pull them from my sideburns as the top of my head. No one on either side (first and second generation) is bald in the back of the head. All related men do have recession and slight thinning (which I think is common). It looks like pattern 2. Is the fact that I notice the hair in my sink, tub and by pulling a sign of hair loss or MPB?
Thank you!!

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No, you cannot tell if you have male pattern balding (MPB) by simply pulling on your hair. It is normal to lose 100 hairs a day. You may be able to see MPB pattern under a hair densitometer, which is a special microscope for the hair, by demonstrating miniaturization of hair. To make the actual diagnosis, the patterns of thinning and miniaturization can be mapped out for predictive purposes.

Tags: hairloss, hair loss, male pattern balding


Hello Dr.Rassman,

I’m a 29yr old male who has recently become concerned/aware of recession at my temples, an undisputable norwood class 2. From my research, on this site and others, a norwood 2 can be indicative of a maturing hairline rather than male pattern baldness. Although the notion that what im experiencing is only the normal evolution of my hairline alieviates some of my stress I cant help but wonder when one is supposed to become concerned. I dont want to experience more recession before I take action, but on the other hand i dont want to start on expensive treatments prematurely. In your opinion, what norwood class should one reach before taking action?

A quick secondary question – Im a Canadian citizen spending most of my time between Montreal and Vancouver. Do you know of any reputable doctors in those cities that have the ability to map for miniturization?

Thanks for providing such a great resource for all of us out there with concerns! Blogs like this are few and far between.

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Norwood Class 2It seems you have done your research. You are correct in stating that a Norwood Class 2 may be indicative of a maturing hairline rather than male pattern baldness. If you are concerned about male pattern baldness, you may want to see a doctor who can view your scalp hair under a hair densitometer for miniaturization and quantitatively record if there is any pattern for thinning. There’s no rule as to what class should be reached before action is taken. I always tell patients: “If it ain’t broken, don’t fix it”

With respect to a reputable doctor, you need to follow the recommendations on researching your doctor. Check with the doctor search at as a point to start the search.

Tags: norwood, hairloss, hair loss, hairline


My brother has lost his entire body hair at the age of 6, due to medication. He had been suffering from typhoid and small pox at the same time then. Since then we had tried lot of medications, both homeopathic and allopathic. He had a patchy growth of hair during these medications at the age of 18+. Right now he is totally bald, no body hairs and no eyelashes and eyebrows. He is of 26 years of age now.
Can you please help me out.

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It seems your brother may be suffering from a condition known as alopecia universalis or alopecia totalis. There is really nothing much you can do in terms of regrowing or transplanting hair.

You may find more information on this topic at the following websites:

Tags: alopecia, hairloss, hair loss


Hi doctor, I started balding right around my 17th birthday. Both my grandparents and dad are bald, yet all of my 5 uncles have hair. I am almost 18 now, and i am on both propecia and rogaine. Exactly how long does it take to bald completely??? If it continues at this rate i will be completely bald in two years ( I had an absolutely enourmous amound of hair a year ago). I still have a lot of hair and none of my friends notice and think im crazy. I am just wondering how much time you think i have. I started taking propecia 1 1/2 months ago and rogaine this week. My hair loss rate has not decreased. I am very very anxious.

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For genetic balding, the baldest of men on the Norwood chart (see below) know that they will be bald by the time they are in their mid-20s (VI and VII). Those with lesser balding patterns take longer to evolve and may not complete the entire patterns show here.

Norwood Chart

Mapping out your scalp for miniaturization will tell you what is about to happen to you. Find out!

Tags: hairloss, hair loss, norwood


Can you please help me? I have a contact dermatitis and have been picking it- is the hair loss permanent or temporary?

Can you also recommend a good dermatolgist and endorcolgist in London? We have bupa but my gp is not good with hair problems.

Thank you . I am very impressed with the time you give others with this awful, life destroying conditon

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Contact dermatitis usually is not related to hair loss. However, you seem to describe a condition of compulsive hair-pulling (called trichotillomania) and it may be secondary to your contact dermatitis. Hair loss from pulling is often permanent if it goes on for any length of time. Fortunately if you stop pulling at it, your hair may still grow back. People who pull at their hair often have some obsessive/compulsive elements in their personalities and may require medications to stop the process.

Tags: trichotillomania, hairloss, hair loss, dermatitis


(female) I have been on Topamax 200mg twice a day for over a year now, I have also been taking Ritalin 20mg twice a day for the same lenght of time, and taking Xanax 2mg three times a day and Baclofen 20mg three times a day for about six months. I have also had a problem with anorexia and Bulimia for quite a number of years now and been up and down on my weight from about 72 pounds to around 145 to being stable at around 90 pounds for quite awhile now. I am a strick vegetarian and am now taking 65mg of iron twice a day and drinking a protien drink every morning. But for about the last four months my hair has been falling out all over the place, it falls out when I shower,in my sleep, when I run my fingers through it, blow dry it, brush it, on my clothes, ect..I am taking all the vitimans I can think to take but it just keeps falling out…and I had stopped taking my medications to see if that was the problem but it hasn’t helped. Could you please advise any helpful information on what I can do to stop the hair loss and get it to regrow, your help would be greatly appreciated.

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You have “been there and done that” with things that are known to cause hair loss, including the medications, severe changes in diet with weight loss, and dietary problems that could lead to a variety of vitamin deficiencies (too many to list here). These stem from your weight problems. Looking over your list, I would not know where to start. I think that you should find a good doctor that you trust and can form a bond with, and then tackle your hair loss problem as a matter of focused attention. This is not something for internet medicine. I wish I could offer more, but I’m limited to what I can do through text on a screen.

Tags: hairloss, hair loss, weight, bulimia, anorexia


Hi Dr. Rassman,

I’m a 20 yr old white male and I’ve seen my beautiful dense hair reduce it’s volume to about 40% over a 7 months period. It all started about a month after I relocated to another city. 2 months ago I went to a dermatologist. She gave me this treatment: Hairgrow 2% Minoxidil, Ducray Sabal shampoo and some vitamins. I don’t think it’s working because I’ve analyzed my scalp and I have less hair than 2 months ago. The thing is, I don’t have MPB but rather a diffuse alopecia. I honestly have no idea what the cause is because I have a healthy life style with balanced meals and workout. My father has MPB so in the worse case I should have developed MPB as well.
I would be forever grateful if you could shed some light on my problem. Thanks in advance.

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When you describe a diffuse alopecia, I really do not know what you are seeing. When I describe a diffuse alopecia, I expect to see miniaturization of hair throughout the scalp, including the rim of hair around the sides and back (we call this the permanent hair zone). When miniaturization occurs in the permanent zone in a man, this is a very bad omen for long term deteriorating hair loss, something that is not easily managed with drugs and certainly not transplants. Rather than go into the complex area of the real diffuse alopecias, their diagnosis and management, I would suggest that you get your scalp mapped for miniaturization to find out what is really going on. Is this real? Is this a disease that you are manifesting?

Tags: hairloss, hair loss, diffuse, alopecia


Dear Dr. Rassman,

I am a 17-year-old male that is experiencing moderate hairloss. I’ve had this problem since I was a pre-teen have gone throughout highschool with this embarrassing feature, as it has increasingly gotten more and more noticeable. The problem is I don’t know why or how this happen as the hair loss take on no typical male pattern hair loss pattern and is thin throughout my entire scalp. I’ve been to a doctor and a dermatologist and all they did was prescribe rogaine and propecia. I’ve tried rogaine for a series of months with no results and propecia’s outside of my budget. Can you please give any clue as to why this is happening to me at such a young age and how i can treat it. I have no medical conditions.

thankyou for your time.

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There are many causes of thinning. These can include changes in your hair character itself, something that happens as a person matures. I have seen young men with a coarse hair character change to a finer hair. If this is your situation, then this is the new you. Of course, the first thing you must do is get a diagnosis. Genetic balding, the most common cause of hair loss in men, can easily be diagnosed with a process I call mapping our your hair for miniaturization (which most regular readers know that I mention quite a bit). Even without patterns of hair loss, miniaturization does occur in a variety of medical conditions. I never tell people to go at this blindly. Get your diagnosis first, then go from there figuring out how you might deal with the problem, that is, if there is really a problem there.

Tags: hairloss, hair loss, teen


I am a 22 year old who has experience fairly severe diffuse thinning over a period of just four months. I first noticed the problem in March eventually going to see my doctor in April. He said he could see nothing wrong with my hair but noted that I have two patches of Alopecia Areata and some form of dermatitis on my scalp. My hair continued to thin and in June visited a dermatologist who was similarly distracted by the patches of alopecia and inflamed scalp and also said he could see no sign of MPB. However I feel my hair has continued to thin rapidly since then so I have booked another dermatologists appointment for two weeks on Wednesday but fear I will have little hair left by then.

Is four months considered rapid progression?
I have had an extremely stressful year so far but feel I can rule out T.E because I read you can not have A.A in conjunction with it.
My diet is admittedly poor but a blood test in April turned out to be fine.

Do you have any thoughts?


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I am assuming that you are a male. Men with genetic hair loss do, at times, develop alopecia areata. There is no connection between the two. With that said, if your hair thinning is diffuse and reflective of some other form of hair loss like diffuse telogen effluvium or diffuse unpatterned alopecia, you should have your scalp mapped out for miniaturization to find out if you have an early subtle patterned genetic hair loss. A hair pull test would also have value for you. Has your doctor done both of these things? Have you had blood tests for endocrine abnormalities such a thyroid disease? The stress you are having can accelerate genetic hair loss or diffuse unpatterned alopecia. If you get the idea, you need a doctor to make the differential diagnosis here.

Tags: hairloss, hair loss, telogen, effluvium, alopecia


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