Hi Dr. Rassman
I just watched a timelapse video of a man age for 17 years, which shows the balding process really nicely. I noticed that his hairline recedes very slowly and gradually. But his crown thins all of the sudden at age 44. Can you explain why this happened?
Thanks
This is a great video illustration! This man took multiple photos daily for nearly two decades. As to why he lost his hair in this way… it’s all in the genetics.
See the video below:
You mentioned one time in a post that it is common for on side of a balding hairline to recede faster than the other. Is this also common in a hairline that is just maturing? The right side of my hairline seems to have been stable for a while now, but the left side is catching up.
Yes, it is very common to have one side recede faster than the other when forming mature hairline. But rest assured (as you are starting to notice)… the other side usually catches up.
This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).
E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:
“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].
In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”
We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.
The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.
I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.
What is hair bonding? Can it give a natural look?
Any treatment available to people over 60 years of age, with long standing baldness?
You may be taking this term out of context. Glues that are used to attach hair systems (wigs) are said to be bonded to the scalp. These can cause damage to weak hair, leading to further loss. They may look natural, but they also could take a lot of work and money to maintain that natural appearance.
Hair loss treatments that I recommend include transplantation and medication. Your options depend on a variety of factors, but since I have no info about you (aside from age) I couldn’t begin to list what those options might be. But yes, generally there are treatments available even at 60 years old.
Hi Dr. Rassman,
First off, I would like to say you have an excellent site here and it has been the source of many of my answers while I suffered with my paranoia of hairloss.
I wanted to ask about a type of hairloss I noticed while talking to a person. The man exhibited diffuse baldness and was almost completely bald on top however all over the top of his head he had a few thick hairs that were buzzed down. All the hairs that I could see were all thick. Also, his hairline was completely unharmed. It was covered in thick hairs from left to right. I was wondering if this is normal MPB or not since from my understanding in the diffuse form of MPB, all the hairs slowly thin out on top of the head. I know it is normal to see some thick hairs among thin hairs in someone who’s going bald, but this guy had only thick hairs on top of his head.
Thank you for taking the time to read this.
Some men who bald can have a persistent frontal hairline. Some never go bald in the front. These are a few exceptions to the classic Norwood patterns. You can also have thick (non miniaturized) hairs on balding areas. It is just that the proportion of thick to thin are different.
I had a trichophytic closure performed on a scar just over a year ago. I think it is healing well but the area is still red not pink and some hairs have grown through accordingly but not nearly as much or what I was expecting especially after a year. Is it normal for the area to still be red? If the area is still pretty thin or still has bald areas can it still be improved? Thank you for your feedback.
Some patients have persistent redness at the donor scar area, even after one year. Follow up with your doctor and get a formal opinion. Sometimes the redness may subside over time (1-2 years).
Hi, I read your “Juvenile vs Mature Hairline” article I found it very informing. However, I am unable to wrinkle my forehead. Is there any other way to check if I’m getting a mature hairline or actually balding. I’m 19 by the way.
P. S. Is there a DIY way to identify miniturized hairs?
Yes, you can also measure the distance from the tip of your chin to the tip of your nose (#1). Knowing that distance, you can look between your eyes at the top of the nose (in the hollow between your eyes) and go up to the forehead using the measurement you got in #1. That usually points to the location of the mid-line lowest point for the mature hairline. Note in the image at right, the white and red lines are the same length.
When I look to determine the mature hairline in my male patients, I usually do both measurements. The wrinkled brow is 100%, while the alternative measurement method discussed above usually runs an accuracy of about 90%.
As for mapping your own scalp for miniaturization, we wrote a 3 part series about that.
I’ve been taking Propecia for 4 years and have been satisfied with the results. My new MD recently prescribed me to take generic Proscar and split the pills in 4ths as it would be cheaper with approx the same amount of finasteride. After a couple months i noticed more thinning and my hairline receding more. Can this be that generic proscar is less effective? Please offer your professional opinion on this matter, money is not an issue for me I’m willing to do whatever will produce the best results. Thank you
If the Proscar (or generic) is legitimate, it should be the same drug as Propecia even when it is quartered. Many people want the generic simply for cost-savings. You can always go back to name-brand Propecia if you are concerned. There are many counterfeit drugs on the market and some are even sold in legitimate pharmacies (though the risk is likely low), so you could also try a different pharmacy or different generic maker.
And for those readers that might be unfamiliar, Proscar is 5mg finasteride for treating the prostate; Propecia is 1mg finasteride for treating hair loss.
I know that they have now discovered why hairs go grey, but are there any breakthroughs coming about getting or keeping hair from going grey biologically? I know that a person can dye their hair, but is there anything being worked on to get your natural hair color back?
Link: Grey hair in old age: Hydrogen peroxide inhibits the synthesis of melanin
I’m not familiar with any proven solution to gray hair other than coloring the hair. There are products that claim to “cure” gray hair, but I’m not so sure they work as claimed.
The last thing I recall reading about anti-gray breakthroughs was a month or so ago when researchers announced they had isolated a protein. We wrote about it here.
There’s little I can do to make this question less vague, but if an average man, with an averagely sized head, and average hair density/ thickness, who has reached the worst class of male pattern baldness, ever be able to achieve a look of a full head of hair through transplants? I’m not yet there, but discovering hair transplants gave me hope. Discovering their limits kinda scared me a little.
By a ‘full’ head of hair, I am aware that the original density will never be achieved, but is it possible to perform a procedure giving the appearance of a full, even head of hair with no signs of balding? Thank you.
The appearance of a full head of hair (just what you said) is what this is about. If you look at this patient, you will see a fully advanced Class 7 pattern, which is about as bald as you can get. He had almost 10,000 grafts to get this coverage (about 25,000 hairs transplanted). Considering that the average man you discussed above has 100,000 birth hairs, that means that the patient in the link would have moved his entire donor area to cover his head, leaving him almost bald on the side and back of his head. Obviously, this did not happen here, because this patient had a very high density to start (probably born with 200,000 hairs). I know that because with his high density, he could have had another 5000 grafts transplanted if he needed it.
I did not present this man to confuse you, but rather to show you what the worst case balding could look like if the supply of donor hair has very high. Many of our patients with advanced balding may only have 7,000 grafts of donor supply, which then must be distributed artistically by a skillful, experienced surgeon to create the illusion of a full head of hair.
I would suggest that you look at our website and the hundreds of patient examples shown in our Patient Photo Galleries. If it is said that a picture is worth a 1000 words, here’s 1000 pictures that are clearly worth more than that.
