Month: January 2010

In a recent question you write: “A 25 year old man already showing thinning in the Norwood Class 7 pattern will not benefit from Propecia unless it is caught early and still it may not do much more than stop the loss from occurring.”

Is there any difference between “thinning in the Norwood Class 7 pattern” and “diffuse pattern alopecia?”

And what’s a good way to determine if you are catching your thinning early? If you have hair all over your head, but your scalp is starting to be seen in the mirror, is that early? Or ?

Let me clarify things a bit. If you are 25 years old and already a Norwood class 7 (it does happen), you will not benefit from Propecia because there is no hair left to save. If you still have some hair, and show signs of Norwood 7 with significant miniaturization present in that pattern, then Propecia would help hold on to the hair longer. Norwood 7 has a definite pattern to thinning of hair loss. A diffuse pattern is just as it states — you are thinning all over (even in the sides and back of the scalp).

A good way to determine if you are thinning early is to have your scalp hair examined for signs of miniaturization. Get the scalp mapped, then have it done again in 6 months to compare the results.

Their is always so much talk about DHT being the root cause of Male Pattern Hair loss nearly everywhere one reads. I was just curious if their has been any other recent discoveries, excluding DHT, that may contribute or cause the condition?

For the genetic condition, it is the DHT that acts on the genetically sensitive hair follicle that causes hair loss. There are nother recent discoveries that I’m aware of relating to what you’re asking.

Hi Dr. Rassman,

my husband has thinning hair on two of his front corners of his head Norwood 2-3. And he went to a doctor for a consultation about the problem, they suggest dense packing the two corners. However my husband doesn’t want to have the corners densely packed in case the rest of his hair in the center thins out in the future, which will look odd (Having two thick corners and a thinned out center). He feels this approach is too aggressive and wants a little more hair there just enough so it doesn’t look like it is receding. Is this a realistic approach to restoring the two corners? Do doctors normally make special request such as this?

Regards

I can’t say much about this particular case, as I don’t know enough about it (the level of miniaturization throughout the scalp, the age of your husband, etc). Generally speaking, as a surgeon I don’t dictate what hair restoration design should be done on someone. I listen to the patient first, and then build a plan that makes sense for both the patient and the doctor. It’s a back and forth process so that everyone is happy with the outcome.

It sounds like the doctor your husband met with wants to dictate what he needs and I would personally run for the hills… or at the very least, get another opinion. The results of this surgery will last a lifetime, so your husband is smart to be cautious.

Just wondering about your opinion on SHBG (Sex Hormone Binding Globulin) and MPB. In short, I’ve read studies and theories stating SHBG binds to free testosterone reducing levels of DHT. I know exercise and low insulin have been shown to significantly increase SHBG. Perhaps exercise and a low-glycemic diet may be beneficial towards slowing or preventing hairloss.

The study below shows balding men had low levels of SHBG, unlike men without alopecia.

Sex hormone-binding globulin and saliva testosterone levels in men with androgenetic alopecia.

“Sex hormone binding globulin (SHBG), plasma testosterone and saliva testosterone were measured in sixty-four men with androgenetic alopecia and in forty males within the same age range without alopecia. There was a significant reduction in SHBG levels in bald men, compared with controls. Plasma testosterone levels were not raised in bald men, but their salivary testosterone levels were significantly higher than in controls.“

This is interesting stuff, but I do not know what value it brings for the balding man and woman. We will not exercise just to change SHBG levels. It makes for great academia.