I Was Diagnosed with MPB After a Scalp Biopsy

Greetings Dr. Rassman,

I’m age 26, Male. I was diagnosed with MPB through a scalp biopsy. My hair loss is not evident to anyone who is looking at my head. I believe I have only lost a bit of density on the top. My hair loss started about 6-7 months ago. I first noticed a loss of density and then an increase in hair fall during normal activities. I was proscribed finasteride and am taking it.

My hair is relatively long (approx 3 inchs in length). Many of the hairs that I find while combing and shampooing appear to me to be thinner and are definitely less pigmented at one end than at the other. The “older” top inch of the hair is jet black while traveling down the shaft you will find it becomes brown in color at the “bulb” end. It also appears to be slightly thinner at the bulb end. I can tell this with the naked eye but comparing both ends of the individual hair on a white piece of paper.

Can miniaturization take place in one hair cycle or do hairs become less pigmented and smaller in shaft diameter as they enter the telogen phase?

In general, androgenic alopecia / male pattern baldness (MPB) is not diagnosed from a scalp biopsy. A scalp biopsy is usually only used to diagnose and confirm scarring types of alopecia (not MPB). MPB is diagnosed by looking for a pattern in one’s hair loss… which explains why it’s called male “pattern” baldness.

Individual hairs are never followed by tagging them so I really can’t answer your question. I believe that a single hair cycle can be miniaturized at a follicular unit level or die off at that level after telogen occurs. Pigment often is reduced in miniaturized hairs, but not as they enter the telogen phase if they were good, solid terminal hairs prior to that cycle.

I would stick with the finasteride, as per your doctor’s recommendation. I’ve seen many, many cases of this drug working very well for treating early hair loss at the top of the head, like you’ve described.