This 50-year-old male presented with a Norwood Class 3A pattern of balding, which is easily transplanted with excellent results. This man would most likely undergo a hair transplant in the hands of too many hair transplant doctors. He had a diagnosis made by an experienced surgeon with trichoscopy that showed perifollicular erythema and hyperkeratosis, both observations diagnostic for Frontal Fibrosing Alopecia.  He had a scalp biopsy to confirm the diagnosis.  This is an autoimmune disease of the scalp, and if he had a hair transplant, the surgery would most likely fail and cost him a lot of money and an unnecessary surgery. He was placed on appropriate medication to control the disease.  Still, even with this disease under control, it often comes back, and if he had a hair transplant during the remission when it came back, the hair would again be lost. A hair transplant done during remission would likely exacerbate the disease and cause a loss of most of the transplants.  Conclusion:  Always find a good doctor who knows how to diagnose your balding problem appropriately.

[If you have any questions, you can reach me at williamrassman33@gmail.com] 

How bad do you think my hairline is? I know it’s thinning, and I’ve been losing a lot of hair lately, already on fin and min.

Hi, I’m a South Asian 17-year-old female. When I was younger, I had incredibly thick and healthy hair. However, over the past 1-2 years, l’ve noticed a significant amount of hair loss. My middle part has widened, and overall, my hair is much thinner now. I’ve attached pictures comparing my hair now versus a few years ago. Lately, it feels like I’m losing more hair than normal on a daily basis. I recently got a blood test done, and it showed that I’m very low on iron. As a result, l’ve started retaking my vitamins, including iron and biotin. A few days ago, I ordered castor oil and Mielle rosemary oil, and they arrived today. I heard that you’re supposed to dilute the Mielle rosemary oil, so I mixed it with castor oil. Before applying it, l massaged my hair with a silicone massager for about 5 minutes. However, after applying the oil mixture, I noticed a lot of my hair fell out. Is this normal when starting hair oiling, or am I doing something wrong? Also, if there’s anything else I should be using or doing to help grow back my hair, please let me know. Thank you.

You should be seeing a good hair doctor to diagnose you. You should look for deficiencies in Iron, Vitmin D, anemia, and other blood tests. Is there anyone in the female side of your mom’s or dad’s family that had hair thinning at any age, particularly at your age?  Your hair seems to have considerable miniaturization. You need a good microscopic examination by an expert as part of a doctor’s evaluation of your hair loss.  

[If you have any questions, you can reach me at williamrassman33@gmail.com] 

I (24M) have had hair loss for almost 3 years now. You can see the current state in the pictures. It’s uncomfortable for me to go out, and when I do, I only go out wearing a cap. I’m really not a big fan of medication, which means I would prefer to avoid finasteride. Would you advise me to have a hair transplant? How many grafts would be used? How long would it last until I have to get another one? If Finasteride is the only way out, would it fill my receding hairline with hair again? I don’t know what to do and it’s really stressing me out

You must recognize that hair loss is a progressive process until you reach your final genetic pattern of baldness. The single photo shows thinning in the frontal hairline with a possible forelock and balding around the forelock. I would need better photos to give you an opinion. There is also a suggestion that you have miniaturization throughout your scalp, which, if I am right, is a bad omen. Finasteride is the single best drug for reversing miniaturization and works best for men under 25. A hair transplant would be a disaster for you because if you have extensive miniaturization, you would likely develop hair transplant shock loss after a hair transplant.  See a good doctor or get a consultation from me at williamrassman33@gmail.com

[If you have any questions, you can reach me at williamrassman33@gmail.com] 

I don’t know your age, but from seeing these photos, I think you have far more miniaturization than this photo shows, possibly in the frontal hairline.  You need to be examined by a good doctor with a trichoscope.  Then you should go on ORAL finasteride first, as this is the best medication for most people who have extensive miniaturization.  

[If you have any questions, you can reach me at williamrassman33@gmail.com] 

Ive been noticing my hair thinning over the past year, but believe Ive caught it early. I used to have a very thick head of hair but it has started to thin roughly a year ago that I can see my scalp a lot when its wet. Feeling a bit concerned, Im considering finasteride daily. Will this help increase the density and thickness of my hair or should I opt for minoxidil?

You have clear frontal early thinning, which may lead to balding. You should not overthink this. Finasteride is the best drug if you are under 25 to reduce this frontal thinning. If that doesn’t work, oral minoxidil might be your next step. At any time, you can try microneedling with a Dr. Pan device with 36 needles and a depth of 1.25mm once a week but I hope that the finasteride will work for you.  

Merck manufactures both medications, and they are the same except for dosage. Finasteride also comes in generics for a fraction of the cost of Propecia. For example, Costco sells a year of finasteride (generic) for $30, while some other pharmacies charge hundreds of dollars for the same drug. Compare the 5mg Proscar to the 1 mg Costco generic and then talk money with us.