Your hair loss questions, answered daily.


The use of JAK inhibitor drugs have been shown to be effective in the treatment of Alopecia Areata. Janus Kinase Inhibitors (JAK) are drugs which supress the functions of the JAK enzyme, a critical en\This is an inherited ‘autoimmune’ disease that causes the body to reject regional areas of hair in various parts of the body. It is usually found in the scalp, but face and other body parts can show this problem. Two drug have been tested effectively, they are (1) ruxolitinib, a medication used in the treatment of certain malignancies such as bone marrow cancers and (2) tofacitinib, a drug used in the treatment of Rheumatoid Arthritis. This is an early report from the Journal of Investimationo/Insights 2016.


This is a 33 year old male who I have been following for a year. His concern is that he is losing hair and he will consider a hair transplant once the hair loss is substantial enough. He is lucky because his hair is wavy, has salt and pepper color and it has a good weight. Because of these characteristics, the eye nor the camera shows the thinning that is certainly happening in his hair. From his HAIRCHECK measurements today, he has lost 50% of his hair in the front behind the hairline, 72% of the hair in the top of his head (imagine a line between the ears) and 50% of the hair in the crown. This is worse than it was a year ago. His frontal hairline shows some see-through as shown in the photos below.



The second patient is 18 years old, noticed that he was losing his hair when he was 16 but failed to see a doctor until today. HAIRCHECK measurements of his hair bulk show that he lost 78% of his frontal hair behind the hairline and 40% of his crown hair. Despite the huge amount of hair loss that was measured, the balding is barely detectable because of his sandy blonde hair which has a low contrast between his hair and skin color. Because he is 18, he has an excellent chance of reversing this hair loss (some or all of it) by using the drug finasteride. See his pictures below:



The University of Pennsylvania has been on the cutting edge of both (1) stem cell development for hair growth and (2) fat cell use in the treatment of acute scars producing reprogramming of cells in a wound. This is going to become a huge field with almost incalculable value. We have known for a long time that fat has stem cells has significant value when used in the treatment of various skin and scar problems. For example, the yellow fat next to the hair follicles seen in a hair transplant, has strong supportive characteristics that are important anatomical elements contributing to a successful hair transplant.

Various presentations on the use of such fat cells have been presented at medical meetings and in various medical publications. One in particular stands out was the use of hair grafts for the treatment of huge ulcers on the leg resulting from vascular disease. When these ulcers are transplanted with hair grafts that contain significant amounts of fat around them, these non-healing ulcers fully heal. As my background included the treatment of such non-healing ulcers, I was amazed to see the value of such grafts in such dire circumstances.

Read here:


All races of males have male pattern balding; however, the American Indians whose ancestors came out of the Alaskan Bridge, have no balding present. This is most unusual because their ancestors have balding. There has been a suggestion that the absence of balding in this group of American Indians may have reflected some cultural ethnic cleansing in the very early days when the immigration happened and the populations were very small. With this thesis, the male pattern balding genes would have been wiped out.

I wrote a post on many years ago where I discussed causes of balding from an evolutionary point of view and the discussion covers the theory of balding in men. See here:


Be honest and that shows you care. Men often deny early balding and by the time to stop denying it, the are past the point when they might have prevented or reversed it with medications. This goes to extremes and the denial can occur over a generation to the point where men can’t even see what happened to them such as those with the awful comb-overs whose wives and family never say a word. I know your question is really about early balding, but by being open and frank, you can show how much you really care and take a load off of his back.


“Long-term adverse symptoms of men who used oral finasteride against androgenic alopecia have been recently described as post-finasteride syndrome (PFS).” These men report that the sexual side effect after taking finasteride seem to hold for them for long periods of time. The frequency of this finding shows that it is not common as most men who develop the negative sexual side effects of finasteride, return to normal after stopping the medication. The following article recently appeared in the Journal of Sexual Medicine and is worth reading. What it suggests is that there may be differences in the genetic make-up of patients who experience PFS as compared to most others.


This is a momentary phenomenon and any hormones that are released in the male do not last long enough the impact the hair growth cycle. The following is interesting reading:


Skipping a dose of finasteride (e.g. one pill every other day) is as effective as taking 1/2 of a pill every day because even though the blood half life is under 6 hours, the tissue fixation life is about 1 week. That means that it sticks to the hair follicle growth center for 1 week after taking the medication.


For years, mainly because of the 4$ risk of sexual side effects from finasteride. man have asked for a topical form of finasteride. Now we are seeing many more examples of topical finasteride (liposomal topical finasteride formulation) which suggests that this works. Most doctors can order this through compounding pharmacies; however, the result of the effectiveness of this is not clearly define in the medical literature as of this time. I am sure we will hear more about it soon


How do you tell the difference between hairline recession and early balding? The first way to tell is to measure the distance of the hairline from the highest crease in the furrowed brow. In this 24 year old, the hairline is just starting to rise from the highest crease, a distance of not more than 3/4 inch is the point at which recession becomes the diagnosis. The corners rise more because the original hairline of the pre-adolescent male hugs the highest crease of the furrowed brow as the hairline takes on a ‘V’ shape.

The second way to tell is to measure the hair bulk in different parts of the head. I did this on this young man and found that there is no hair loss in any portion of the hair on his head. The bulk behind the frontal hairline and in the crown, was equal to the hair bulk in the back of his head. That tells me that there is not even the slightest amount of balding.

Between the location of the hairline and the normal hair bulk I measured, this patient does not have male pattern balding at least, at this time. He will come back yearly for rechecks if he is worried about his hair situation. Any surgeon who would suggest transplanting this patient would be guilty of malpractice.

The pictures below tell the story with appropriate labels. Click to enlarge.





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