Am I Balding — And If So, What is My Norwood? (with Photos)

Hi Dr. Rassman.

First of all thank you for taking the time to post here, it has been an invaluable source of information for me regarding hairloss, and is much appreciated.

Secondly, could you please take a look at my included photographs (you may publish these if you wish) and give me an approximation of my hairloss?

My hairline has definitely changed since I was a juvenile as I had a freckle on my original hairline which has moved higher since my childhood. In some photographs the hairline looks ok, but in others when I pull back the hair you can see some corner/temple recession.

I was just wondering if I was still in the bounds of Norwood 2/mature hairline category or if my hair exceeds this? The density is pretty good on top.

I am 32 years of age. Thanks

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Click the photos to enlarge:

 

People sure are sending in some blurry, poor quality photos lately. Regardless, thanks for letting me publish these.

You have early changes consistent with a mature hairline, or a Norwood class 2. If you are concerned, see a doctor who will be able to examine you in person, map your scalp for miniaturization, and provide hair bulk analysis to give you a better sense of your hair loss (or lack thereof).

At 32 years old with a strong hairline and good density on top, you probably don’t have much to be concerned about, though.

Tags: hairline, mature hairline, photos

I Think My Hairline Receded After 6 Months of Accutane Use

Hello,

I am a 22-year-old male, and last year I took small dosage of isotretinoin for around 6 months. My hairline seems to have receded some, but I am wondering whether I should go out of my way to go see a doctor about taking propecia as of right now. My father began balding in his late twenties, so I am worried I am following in his path.

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I took a look at the few photos you sent, and while they were poor quality photos, I didn’t see any hair loss. A maturing hairline could be what you’re worried about, but that is not considered treatable balding.

Isotretinoin (Accutane) is known to cause hair loss in some, but having your hairline mature is a normal occurrence for many men as they get older.

If you are concerned, see a doctor — but based on the photos, I don’t know that you have anything worth treating. Of course, a doctor will be able to examine you in person, map your scalp for miniaturization, and provide hair bulk analysis to give you a better sense of your hair loss (or lack thereof).

Tags: accutane, isotretinoin, hairloss, hair loss, mature hairline

If I Just Have a Maturing Hairline, Will Propecia Do Anything For it?

My hairline has been receding for the last 6 or so months. I’ve gone from a NW 1.2 to a NW 1.8 since then. I’m not sure if my hairline is just maturing or if it’s MPB. I’ve scheduled an appointment with my doctor, but if all I have is a maturing hairline, propecia won’t work on it right?

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I don’t know the answer to your question, as I have not prescribed Propecia to anyone with just a maturing hairline. I would doubt that Propecia will reverse you back to a juvenile hairline, if that is what you’re looking for it to do.

Tags: finasteride, propecia, mature hairline

I Have a Juvenile Center Hairline and Mature Corners

Dear Dr Rassman,

Probably like most males in their 20s, I’m concerned about my hairline recession. As you say, it seems as though most men will experience some form of recession in these years whether it be balding or not.

At the moment I think it is maturing only, but very unevenly. Now, I have read posts on your blog saying that one corner moving up quicker than the other is common. Well, that is indeed happening, but the middle doesn’t seem to be moving much at all.

I first noticed some recession when I was about 19/20. Up until that point, and for a fair while longer afterwards, my hairline was extremely low and straight and so fortunately caused me no concern at all. When I first observed some change at that age, it wasn’t so much recession as that the corners were a little less dense. The left side was also less dense than the right.

I remember at that time I had experienced some diffuse shedding (telogen effluvium) and was worried I was balding. I consulted a hair specialist who didn’t seem to be aware of the ‘mature hairline’ concept and said that any recession is balding, but said I didn’t appear to be balding.

Since then I’ve been keeping a close eye on my hairline. I’d say only in the past 6 months (and I’m 23 now) has there been more marked change. The left side seems to be thinning out more completely to establish what I think (or hope) is its NW2 mature shape. I’d say the recession will be about 1.3inch from the corners. However, the middle part is still basically juvenile. The right is perhaps a NW1.5 and still more dense than the left. Is this normal?

The problem is, the angle created by a ‘juvenile’ center and a mature corner makes it look weird, more like balding, even though I think the corners are still within mature parameters. Can I reasonably expect the middle to move up by a couple of centimeters to form a less sharp, more straight and rounded angle? The problem is, it seems as though a lot of men bald by receding up through the corners, while maintaining the middle. It’s possible this may be caused by styling, i.e. the left is maturing more rapidly as I tend to comb/style from that side (using products/dryers) so perhaps the miniaturizing hairs are falling out quicker.

There is balding in my family, as both my older brothers started balding early (but at different rates), and my father also started balding in his late 30s/early 40s. However I seem to have escaped the late teens balding pattern (which struck my brothers, and they never had a really strong teenage hairline like me), and my father actually seemed to maintain a juvenile/NW1.5 hairline and his balding pattern came mainly at the crown, not the corners. My progression thus far does not seem to fit any of these patterns.

Is this encouraging? Or is it simply a matter of not being able to tell if you’re balding until you actually ARE? My grandfather on my father’s side never lost his hair and had a full head of hair when he passed away in his 80s, and my uncle on that side also never experienced MPB (though appears to possibly be experiencing some thinning at 60, but at that age I’d say he doesn’t have standard MPB).

I think my father on my mother’s side experienced balding in the 40s, but I don’t know much about my family on that side.

To summarize, it’d be a lot easier if hairlines stayed put! For sure, a solid juvenile hairline can look odd on a grown man, but NW1.5 seems the perfect compromise. Any comments on this would be greatly appreciated !

Thank you

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The central part of the hairline has a different genetic code in many people. When it is small, I call it a persistent forelock, but when it is large, it takes on a different appearance, though it still has the genetic code of a persistent forelock. What you are describing is such a phenomenon. The corners mature, while the central portion of the hairline remains at the juvenile level. I just wrote an article on this topic for publication in the Journal of Facial Plastic Surgery, which is due out sometime this month.

What I think you should do is determine if you have balding on the top and/or crown of your head by getting a hair bulk analysis with the HairCheck instrument I have discussed previously on this site (see here). I suspect that your corners will continue to rise, at least, until the mature hairline areas are reached — assuming you do not have genetic balding.

Tags: hairloss, hair loss, hairline, mature hairline

Can a Man Have Hairline Lowering at 20 Years Old?

Hello Doctor,

I’m a 20 year-old male with what I consider to be a high hairline (7cms from brow ridge to hairline). I know it falls between the male average of 6-8cms, but I have rather effeminate features that cause it to look disproportionate.

I recently talked to a highly regarded hair transplant specialist in my area to inquire about lowering my hairline with a hair transplant. He told me that my hairline was fine, and if I did go through with a transplant it would look fake and I would be very unhappy with it. Is this true? Or is it just because of the risk of further balding later in life?

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Decisions like this are made between the doctor and the patient. As for whether any surgery would look fake, I suppose that depends on the skill of the surgeon. But if your doctor is recommending you not have a procedure, I’d defer to him. If you want a second opinion, I am unable to give you one over the internet.

I am generally averse to doing any hair transplant or hairline lowering process on someone who might be balding in their future. At 20 years old, it probably wouldn’t be in your best interest.

Tags: hairline, hairline lowering

Where Do the Temple Peaks Come From?

This is probably a stupid question but your blog popped up in Google when I search the subject and figured you probably would know the answer. Does every guy have those “triangle points” or whatever they are called kinda by the eyes? I have seen some guys with a full head of hair without them and some guys that are slick bald on top but have really full points. Even some guys with just one. I never really noticed this before until someone at work was “lined up” at the barber and had crazy designs put in his. I don’t have them nor do I think I ever did (I kinda have some on one side I guess).

I am not bald by no means even confirmed by my dermatologist. Id ask them this question but I don’t go back in there for months for my check up. Anyway I know its probably stupid but I was just curious as I dont think any of the guys in my family have them, but I see all kinds of combos throughout the day. Maybe its just genetic makeup like hair color or fine vs coarse hair. Thanks for your time.

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Actually, this is a good question. There are two areas where people have peaks in their hairline. Both men and women get them, because these peaks (temple peaks on the sides and widow’s peaks in the center of the hairline) evolve from a concave juvenile hairline that is present in all children of all races. By children, I am talking about those boys and girls ages 5-7. As these children age, there are changes that happen as the hairline recedes either upward (in the center) or back (on the sides). In many men and women, the temple peaks are often left behind as the hair from the juvenile hairlines recede.

Take a look at Ronald Reagan as a young man here. What you will see is an eroded central hairline with the mid-portion slightly lower than the sides of his hairline. Please note the temple peaks. Now if you take a look at a later photo of President Reagan, you will see that these prominent temple peaks are mostly gone. There are some men who retain their temple peaks no matter how bald they become. I have patients with a Norwood class 7 hair loss pattern who retained their temple peaks even after they lost the majority of their scalp hair.

So to answer your question, temple peaks evolve in many men from the young 5 year old hairline and they may keep it their entire lives, or lose part of it or even all of it as you age. I just wrote a paper on this very subject, which will be published this week in the Journal of Facial Plastic Surgery.

Tags: hairloss, hair loss, hairline, temple peaks

If DHT Is Blocked By Propecia, Why Wouldn’t It Work in the Front?

If DHT is responsible for hair loss and Propecia blocks it I don’t see why it wouldn’t work for the front. Yes, regrowth it may be useless but halting the front from thinning it may work just as good as in the crown.

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It does occasionally work in the front. One of my sons had a great impact with the return of much of his frontal hairline while on Propecia. When we report that it may not work in the front, it is because statistically we see much better results in the top and crown. It is just the way things are! We can also ponder why hair loss in men affects the crown and the front in the classic “male pattern”.

While DHT is a factor in genetic male pattern baldness, it is not the only factor. There are still many factors not yet discovered. We still do not know why DHT only affects the crown area in some patients.

Tags: propecia, finasteride, dht, hairloss, hair loss

After 5 Years on Propecia, I Noticed One Corner of My Hairline Was Slightly Thinner

I been on Propecia for 5 years. I’m almost 27 years old. I have early front hair loss especially thin corners. Up until a few days ago my hair looked just the same like 5 years but now I noticed my left corner got slightly thinner it’s easy to tell there. I know Propecia can’t hold hair forever and since I noticed this slight loss will it continue again and fast or may it be a slow process? I read a lot of guys used Propecia for years and once the effects weaned off they would lose hair super fast. I don’t want that to happen so I’m strongly considering to switching to Avodart and try to save what I have because I still have a full head of hair.

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I realize many men take Propecia to treat the front hairline thinning, but it generally rarely works for that area. Propecia works mainly for the thinning on the top/crown area.

Please speak with your doctor regarding stopping or starting any medication. Stopping Propecia abruptly can potentially cause “catch up” hair loss. Almost every week, I see a patient who told me that they tried stopping the drug or ran out of supplies of it for a few months. In every case the patient lost hair, and most of the time it did not come back upon restarting the medication.

Finally, Avodart (dutasteride) does not work any better than Propecia at the hairline since the mechanism of action is similar. At some point you may have to face that hair loss is genetic and there is no simple answer.

Tags: propecia, finasteride, avodart, dutasteride, hairloss, hair loss

Widow’s Peak and a Mature Hairline

Hi Dr R.
We seem to be reading posts describing the concept of a mature hairline frequently enough for each of us to form many conclusions about his own hairline. However, the great size of my widow’s peak is causing me much confusion, especially when considering placement of the leading edge of the hairline in a possible hair transplant scenario.

If a typical male person with a typical mature hairline shaves away his widow’s peak, will he still have a normal mature hairline, or will the hairline be higher than the average person without the widow’s peak? Or should we actually be asking, is a widow’s peak a result of a person having more hair or less hair than the average male person without a widow’s peak?

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Maybe we have the definition of a widow’s peak confused. A widow’s peak is the small triangular point on the front middle of the hairline that extends downward as low as the highest wrinkle of the furrowed brow. I am about to publish an article on the evolution of the hairline, and in that article I point out that the widow’s peak is actually a genetic remnant in the middle of your childhood hairline. Yep, the widow’s peak is just a genetic hold-over of the juvenile hairline.

The widow’s peak has nothing to do with balding, and I can simply point to the actor Andy Garcia as a good example of this. He has a strong hairline and pronounced widow’s peak. In women, some erosion of the hairline occurs as they mature and 81% of women have a widow’s peak, which reflects a phenotype of their genes in that location.

With respect to a hair transplant, some ask to create the triangle widow’s peak, though some may not want it. It is merely a personal cosmetic decision / point of view.

Tags: widows peak, hairline, hairloss, hair loss

Can I See Dr Rassman’s Mature Hairline? (with Photo)

Dr. Rassman,
You have mentioned before that you have the classic mature hairline. Would it be possible for you to post a good size photo of yourself to get a better example of how deep the mature hairline is?

Thanks

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There is no secret to a mature hairline. If your hairline seems too high for you, then it is too high for you (mature or not). The real issue is whether you are balding (getting a higher hairline over the months and years) and if you want to do anything about it. Keep in mind that a mature hairline is usually about one finger width above your highest forehead wrinkle. This isn’t necessarily a hard rule, but it generally works out that way.

Upon your request, here is a photo of myself (click to enlarge):

 

Tags: mature hairline, hairline, hair loss, hairloss, rassman