How to tell a Class 6 from a Class 7 pattern of balding

/by William Rassman, M.D./0 /

I’m not sure what Norwood level my uncle is as I believe I take after him.  If I describe his hair loss stage hopefully you can help me determine if he is a Norwood 6 or 7 please. So my uncle has quite a large donor area on the back and on the side. On both sides of his head he has high parietal ridges but he is completely bald on top on his head I did see he has like 10 hairs still on top but they were spread out. His crown is bald. And looking at his head from above it is a horse shoe. If my description doesn’t help I don’t mind sending pictures.

Here are three links with pictures of a Class 7 pattern of balding: https://baldingblog.com/class-6-7-pattern-balding-can-expect-hair-transplant-photo/ AND https://baldingblog.com/generation-gapphoto/ The back remaining hair sweeps low and the side fringe area is mostly absent. The picture on the right here: https://baldingblog.com/permanent-zone-hair-lasts-lifetime/ shows the classic way to determine the Class 7 pattern patient with arrows showing how I do it.

Do person to person hair transplants work?

/by William Rassman, M.D./0 /

Hello Doctor, what are your thoughts on person to person hair transplants?

Person to person hair transplants only works with identical twins because with non-identical twins or other person to person hair transplants, each hair follicular unit (a complete organ system) rejects as would a kidney or a liver. I have done one set of identical twins back in the mid-1990s. It worked out fine. The reason that there was a difference in hair loss between the twins (which should not be the case) was that one twin wore a Hair System which was attached with tape and glues which pulled out the hair at the point of attachment. The donor’s identical twin didn’t use a hair system and although he had only a little bit of recession, he had not lost his hair as his twin brother did.

My blood creatinine is above normal. Can it cause hair loss?

/by William Rassman, M.D./0 /

Can high Creatinine levels cause hair thinning? I had a regular blood test done and results showed that my Creatinine was above normal. I also noticed that my hair looks thinner than normal. Could it be the reason?

Creatinine is a byproduct of muscle breakdown and the more muscles you have, the more creatinine your body produces which must be cleared by your kidneys. The kidneys maintain the blood creatinine in a normal range but when it is elevated is often signifies impaired kidney function or kidney disease. Of course, any illness can contribute to hair loss. See a doctor

Sprayed before going on Airplane

/by William Rassman, M.D./0 /

1 day post op and I Had to take the plane to go back in my country,  problem is that before entering plane, I dad to enter a gate which sprayed some chlorine or hydroalcoholic anti covid solution on my head. Would that damage my hair transplant?

Within one day after a hair transplant, your recipient grafts should be sealed in position so I would doubt that any damage would have happened

18 month finasteride (photo)

/by William Rassman, M.D./0 /

These are my pictures after 18 months on finasteride. About 5 months ago, I added microneedling as well which made a significant difference

This is a wonderful example of how persistence and focus can get some men to impact their hair loss without a hair transplant.

Family destroyed my self-esteem

/by William Rassman, M.D./0 /

We just had a video call with my uncle, my family is italian but we live in Mexico so we always make videocalls with my family, this was the first video call with my uncle in months and the first thing my mom says is look at his hair, he is also losing it, and they all laugh, my mom knows how losing my hair has affected me and still she seems to take it as a joke, my uncle just laughed and said is a family thing, i know it wasn’t with bad intention but still felt bad, people doesn’t seem to acknowledge how much the balding can affect own self-esteem.

Today’s younger generation understand that balding is not an irreversible process. Unfortunately, the last generation needs to be educated not only on the advances in the treatment of balding, but that there is an emotional impact on many men going down the balding path.

Finasteride impacting beard growth

/by William Rassman, M.D./0 /

Here to ask a question I’ve never seen asked, or at least never answered on this subreddit or anywhere else on the internet despite my effortful and differently-worded google searches.

I’m 20. I started balding at 14, and I started fin at 17. Switched to dut at 19. Now I’m 20, and I still don’t have beard growth despite having the genetics for insanely aggressive baldness and insane beard density. This makes total sense because I’m taking a DHT blocker but my question is- will I never be able to grow a beard if I continue with my DHT blocking regimen? Am I blocking myself from ever being able to grow a beard, or am I just blocking it for the time being while I’m taking the DHT blockers? The idea of never being able to grow a beard terrifies me and I think I’d rather go bald and have a beard than never ever have facial hair as an option, but if I can wait until I’m 25-30 and then grow a beard after ceasing dut/fin, I’d rather do that. Thanks for any and all responses this gets.

Dr. Robert Bernstein answered this question as follows:
As you suggest, it would be reasonable to assume that since DHT stimulates beard growth, blocking DHT (with finasteride) would tend to inhibit its growth. In practice, this does not seem to be the case, i.e. we don’t find that Propecia has any effect on facial hair. The reason is not clear.
It is interesting to note that testosterone stimulates growth of axillary and pubic hair, but not scalp hair. Scalp hair growth is not androgen dependent, only scalp hair loss is.
DHT stimulates terminal hair growth of the beard, trunk and limbs, external ears and nostrils. Of course, it also is responsible for the bitemporal reshaping of hairline as one passes into adulthood and causes male patterned baldness (androgenetic alopecia).

Class 4 pattern of hair loss in 18 year old (photo)

/by William Rassman, M.D./0 /

For 18 years of age, you already have an advanced Class 4 pattern of balding and based upon your family history, you may lose all of your hair. I would want to know who you take after in your family.  You appear blonde (that is good) but you are a person who needs to see a doctor and develop a Master Plan because it looks like you are likely to lose all of your hair other than the permanent rim of hair around the back and sides of your head. There is no substitute for a one-on-one with a good doctor who specializes in genetic hair loss in men.

Does a man become resistant to finasteride over time?

/by William Rassman, M.D./0 /

I am a 23 year old man who recently received a scalp miniaturization test at a hair loss clinic. I was told the hairs on the top of my head are about 85% the density they should be.  If I’ve learned anything from tressless, it’s that prevention is key. My only fear about starting FIN or DUT is that my body will build up a tolerance to them. I want to take these drugs my entire life, but I’m worried that if I start before I actually begin showing symptoms, they’ll lose effectiveness by the time I really need them.  I see a lot of posts about people thinking they’re building up a tolerance to FIN after 6 or 7 years, but that might just be that their hair follicles are becoming more sensitive to DHT.  Does the drug itself build a tolerance in your body? If so, should I start with FIN and switch to DUT when I need it? Or will a tolerance to FIN also give me a tolerance to DUT?

No concern. These drugs block the DHT at the hormone receptor and they continue to work for years. This is the critical time for you if you want to see benefit from finasteride as the older you get, the less the benefit you will see when it comes to reversal rather than just slowing or stopping the process.

Zinc and Argenine for AGA and TE

/by William Rassman, M.D./0 /

https://pubmed.ncbi.nlm.nih.gov/33878855/

Conclusions: Based on our results, the combination of arginine and zinc tested in our study could represent a good therapeutic option for the treatment of AGA and TE and it might represent a valid alternative to finasteride.

Is it safe or proper to get a hair transplant at 25?

/by William Rassman, M.D./0 /

I’m turning 23 next year april. I’m on treatment and aren’t shedding hair any more. However I absolutely hate my hairline and am definitely going to get a hair transplant. Is the age of 25 when it can actually be measured which NW you’re gonna end up at? Or how aggressive your hairloss is gonna be in the future?. I’ve been to several clinics and they all advised that I wait until I’m 25 to get a hair transplant

For me, 25 is the youngest I generally consider for a hair transplant but that depends upon the person and the consultation where I determine a Master Plan.  There is no simple answer, just get a good doctor. Read this post: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/