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I am 43 years of age and have been classified as Norwood 4. I started slowly losing hair in my mid thirties or so. Both my grandparents had a full head of hair, but my uncles on my Mothers side are Norwood 6’s. So, is it a high probability that I will progess to class 5 or 6 + in my later years?

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Norwood Class 4

Norwood Class 6

With treatment using the drug Propecia, I suspect that you can arrest your hair loss so that you do not become the Class 6 pattern of your mother’s side. If that is all you want, then no transplants are needed. If you want to reverse the hair loss, then hair transplants are the only real option.


I am 33 years old African American and am very concerned about my hairloss. I am probably between a Type 3 Vertex and Type 4 hair loss pattern. My crown is very thin and my hairline is getting thinner by the day. I tried Propecia for 10 months and did not see any substantial differences. I stopped using Propecia because of the uncertanity of future complications.

My hair on the sides and back are very strong, but I am concerned about how a transplant would look. I have seen some guys that have that pluggy look, which looks bad. Can you give me some advise on what the best step would be.

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A man of your age who is still at a Class 3 Vertex or Class 4 pattern, is usually not going to get very bald. In the African American, this is more typically the case, but it would be best to get a complete history of your family to be sure that your ancestors did not have advanced cases of hair loss. My concern would be that Class 4 patterns sometimes do lead to Class 5 or even to a Class 6 pattern. That is why I like trying to prevent progressive hair loss with a DHT blocker like Propecia which will probably stop or slow the progression. Stopping the progression is as important as fixing your problem correctly.

African Americans’ are the best candidates for transplant. The characteristics of very curly hair make the frontal work look awesome and the hair just covers better. It is always a pleasure to show off the results. Here are some examples from our website,


I am a 47 year old female, who has had thick, coarse hair all of my life. Last year, I had a few hot flashes, my gyn gave me some estradiol to take……..I felt better, discontinued it. *this was in April…I took it for a few months. I had a surgery in August…general anesthestic. In December my friend mentioned my hair looked thin. I got some Rogaine…..used for one month until my hair was falling out by the tons and I had noticable thinning in my temples/hairline. Hair looked much, much worse. Stopped using it Jan 21. Gyn gave me estradiol Feb 21st.,,after I saw him complaining of hair loss….he said I was periomenapausal. My hair shed slowed until two weeks ago and is now shedding again. I still have very thin hair in the bang area/temples….you can see my scalp in the sun or bright light. Blood work showed normal levels in all tests. I do have lots of new hair that can be seen over the back of my head…but I don’t see anything in my bang area. I am suffering anxiety and worrying constantly…which I know doesn’t help. How long does it take for hair to get back to normal if it is going to? Am I expecting results too soon? Have you ever heard of Rogaine making the problem worse and does it make it permanently worse?
I would like to consider a hair transplant if it can give me some density back. I am taking vitamins/EFA supplements….don’t smoke, ….also interestingly my once coarse hair is now soft/finer feeling which seems wierd.
thanks for any insight, help.

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Your email sounds desperate and you need to be sure that there is no underlying medical condition causing your problem. Assuming that you fully check out (see female hair loss Q&A), then it sounds like much of your process is reversing. The reversal time should be less than a year. You should be evaluated by a doctor like me, who can determine your base line today, the full extent of your miniaturization and then follow your progress. A transplant can solve the ‘bang’ problem, but first let’s clear you of a medical problem.


Can you transplant an eyebrow?

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Yes, eyebrow transplants work nicely. There are a series of problems that hair taken from the back of the head causes when it is moved to the eyebrow:

  1. It will grow long, so it must be cut on an angle a few times a week.
  2. It may take on the thickness of the hair behind the head. If the eyebrow has finer hair, than this might be a problem.
  3. There is always a risk of a change in character of the hair itself (unusual).

I love doing eyebrows on men, as most men want bushy or wider eyebrows. For women, we must be selective and sensitive to hair type. The photos below are of one of our male eyebrow patients who just came back a little over a year after his transplant. On the left is the “before” photo, on the right is the “after” photo.


I stopped using Propecia and over the next 3-5 months, the bald spot on my crown became large. This was 2 years ago. I have been sick about this and afraid to go back to my doctor and tell him what I did as I felt stupid. If I go back on the drug, will I get my hair back? Should I go to a different doctor?

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There are a number of issues here. First, stopping the drug and having lost the benefits with a return of balding is a common problem. Men frequently stop the medication after they have tried it for months or years and after seeing no benefit, they feel less committed to the drug. When they stop it, there is a period of what I call ‘catch-up hair loss’ where you will lose all of the hair that you would have lost without the drug in a short time period. That is what happened to the questioner. Some people may have progressed too far between stopping the drug and restarting it. Some people may have had slow progressive loss. Each will respond differently. All I can say is that restarting is better than doing nothing. You already know what nothing did and you are now sick over doing nothing.

As far as selecting a doctor for the second round, ask the basic question that I always like to ask – Is this a man that is caring, competent and ethical? If the answer is yet to all three, swallow your pride and take your lumps. Laugh when you tell him how foolish you were. If he is a cool dude, he will laugh with you.


Hi, I am interested in possibly obtaining your services. In particular, I am interested in the FOX procedure. My problem areas are in the temple region. I live in MD so I have included some attatchments of the temple region. The ones that look like I have less hair is what I kind of look like in the morning. The ones that look like I have more hair is after I have brushed my hair. As my hair grows longer the hair around the temple region doesnt look as thick as the rest of my hair. I am currently taking propecia which seems to have stop the hair loss but I believe I started it a little to late to help my temple region. So my primary go is to thicken the areas of the temporal region. I may also be interested in some small things such as thickening some of my facial hair. If more pictures are needed I would be happy to get them to you. I am not sure what the next step is so I’ll be looking forward to hearing back from you. Thanks.

P.S. I am 27 years old.

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Nice to talk to you today. You reported that you have been on Propecia for 9 months. In addition, you saw a doctor from another clinic who suggested that you visit me and get an FUE (FOX) procedure into the temples.

I have reviewed your pictures. At 27 years old, I am generally very cautious. Before I would even consider adding hair density to the temple region, I would want to assess your overall future balding possibilities, looking for miniaturization throughout the head. I would also want to see what your temple densities are. As you are on the East Coast, I would recommend that you visit Dr. Robert Bernstein in New York where he can make such an assessment. He is an excellent doctor whose opinion should have great value. No one wants you to take unnecessary risks, particularly me, so a good opinion from Dr. Bernstein will determine the best approach. His website is


I heard from somebody that the average person loses 100 hairs a day. This seemed really high to me, is it true?

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Yes, this is true. It is believed that the average person has about 100,000 hairs on their head and the life cycle for a hair (before going into its cycle shut down and regrowth) is 3 years. Wtih that said, that means 35,000 hairs lost per year or about 100 (rounded) hairs per day for 3 years will equal the total number of hairs on the head of an average Caucasian Male.


Barring any sort of glaring injury like a burn, how easy is it for a dermatologist to tell if someone has scarring alopecia and their hair follicles have been permanently damaged?

I’m a female in my twenties and have had scalp dermatitis for several years. I tend to scratch it pretty badly in my sleep, resulting in small open spots that then scab over. Just within the last five months or so, I have developed bald patches as well as diffuse hair loss. There are other things it could be, but is scarring alopecia a possibility? Also, could the hair loss be from the dermatitis itself?

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The best way to determine which alopecia condition you have, is to get a dermatologist with considerable experience in diagnosing the various alopecias to give you an opinion. You may then need to get a biopsy of the area of alopecia and get a dermatopathologist to read the biopsy if there is any doubt on cause. Most good dermatologists do this in tandem, although your history seems to suggest that your constant scratching has produced traction alopecia with possibly some scarring. Sometimes, the alopecia will reverse (Alopecia Areata for example) if you completely stop scratching it.

Clearly, the picking of your hair at night can produce trichotelomania, which is a condition where constant picking or scratching causes hair loss. The diagnosis is always clear on microscopic examination of the scalp. If it only happens in your sleep, put on mittens and sleep with them on. Get a good doctor to examine you before you startsleeping with the mittens and after a few months. If the mittens works, then the changes that we can see under magnification will demonstrate that you are on the right path. Ordinary dermatitis without picking or scratching should not cause hair loss, unless is is associated with the genetic forms of hair loss.


I am a 33 year old female who visited a dermatologist that specializes in hair loss because of a receding hair line, (frontal hairline thinning). Very much the same why men start receding in the front. I was diagnosed with female patterned baldness and told to take Rogaine. In the past I was told the 2% was not very effective to use the 5% but the nurse has informed me to use the 2% and it will take up to 12 months to see any results. I have used the 5% in the past and have not had any side affects though I am not completely happy with the results. Is there any other medications or options I can take other then the Rogaine? I am feeling a tightness in my chest and shortness of breath which I think is from using Rogaine, but I am not 100% sure. I have had blood work done and everything has come up normal. I take no medications other then the Rogaine. It is just so frustrating to be told to use Rogaine when there has been so many medical advancements for men.

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Bells go off for me when I hear about tightness in the chest. Women with heart disease is far more common than most people realize. You must remember that Rogaine is a hypotensive medication and could induce (under certain conditions) a drop in blood pressure and chest pain from Angina. Please, see a good doctor. If you want an opinion on what to do about hair loss, please take a read through the many Female Hair Loss posts on this blog. If you are on the west coast, please come and see us.


The interest last week on our piece addressing hair cloning was very high. I would like to call your attention to a recent breakthrough that has just been reported on gene therapy. Scientists hope that by getting at the genetic roots of hair loss, they will eventually spawn better baldness treatments or a cure. This is a distinctly different approach than cloning a hair and more in line to the approach being used to cure cancer, Alzheimer’s disease and the like. The focus of such work is to identify the defect that causes the problem we wish to fix and then to develop a drug, enzyme blocker, or another approach to address the problem. There are many baby steps taking us to that cure and Dr. Markus M Nothen of the University of Bonn in Germany identified an androgen receptor gene on the ‘X’ Chromosome which is contributed by the mother in setting a person up for balding. The androgen receptor gene helps govern the workings of male sex hormones (androgens), such as testosterone.

Though these hormones promote the growth of body and facial hair, on the scalp excess androgens may cause hair loss. Dr. Nothen believes that this is only one of possibly many genes that trigger the balding process.



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