Good morning doc. I’m a 26 year old male who is starting to go gray, pretty heavy on the sides & starting to in the front as well. Is this a good sign that said gray hair won’t fall out? Does this mean the gray hair has already passed a barrier to balding or is it just as likely to fall out as the other “youthful” (brown) colored hairs? Thanks for the great blog!
The graying of hairs is independent of balding (no relationship). Graying is genetic and not necessarily reflecting getting ‘old’, and you are not alone. I have seen many men and women who turn gray in their 20’s. The reason most people do not see them is that they hit the dying bottle and never show their secret.
Do all people follow the same pattern of hair loss, meaning they start from the temples and progress in a specific way as Norwood classification describes or there are unique variation for each person? People from the Balkans as Greeks, Bulgarians, Romanians are considered Caucasian or for them there are different hair loss patterns as Norwood describes?
Thank you in advance
Every male, from anywhere in the world, can have a balding pattern that has been defined by Norwood. The Norwood patterns are not showing a progression of balding that one goes through, but they show the end stage of a process as Dr. Norwood described it.
For example, to develop a Norwood class 6 pattern, you will not start with a 2, then go to a 3, then a 4, and then a 5 pattern. Most men with a Norwood class 6 pattern start losing their hair with thinning in that pattern that precedes the end stage of the balding (the hair begins to thin all over in that pattern).
Is female genetic hair loss/hair thinning more likely to start in early 20s if you’re of Asian (Korean) heritage? I’ve read that East Asian females have a greater chance of developing diffuse thinning than Caucasians.
No. I’m not aware of any good scientific studies that investigated women with hair loss by ethnic groups. We generally believe that hair loss does not discriminate race, sex, or ethnicity. In other words, it is mostly the same for all populations. You’re not at any greater risk than a Caucasian woman is if the genes are present.
I’ve studied a number of HT docs for hair loss info and I’d say you and Dr. Bernstein are at the top of my list as far as knowledge and being trustworthy. You say that shock loss or additional hair loss from a transplant is uncommon these day though Dr. Bernstein says that you will probably have some loss from the transplant itself. I think he said it would be unrealistic not to expect some loss. Obviously a confusing contradiction for me. Could you address this?
I also find your history with Dr. Bernstein interesting. How do you 2 originally connect? You were partners at one time?
Dr. Robert Bernstein and I do not disagree on much. Hair loss secondary to a transplant is what is commonly called shock loss (it is a matter of degree of loss) and I think that is where your problem is. Traditional shock loss has been satisfactorily treated with finasteride in young men, but hair transplants do damage some existing native hair. Hair that is miniaturized is what is lost first, so what you see may not be a radical change even if you lose some miniaturized hairs that did not contribute to the hair bulk you have.
As for the second part of your email — Dr. Bernstein worked at New Hair Institute with me for 10 years before he opened his own practice in New York. We are good friends and colleagues. We published many groundbreaking medical articles over the years.
I was curious if you know if any doctors track the survivability of the grafts? I know that there is quite a bit of information on transection rates for different surgeons but was wondering if anyone monitors this metric? If they do – how might the survivability be determined outside of just counting the grafts in the recipient area a few weeks/months after the surgery? Thanks
This is a great question. We track transection rates when we perform FUE surgeries. The transection can vary from 5% to 50%. I believe 5 to 10% is an acceptable number. If there is a high transection rate then we will abort or never recommend surgery. This is the reason why at NHI we always pre-test all potential FUE patients, but I realize other clinics and doctors may not do this.
The data for other clinics and doctors is not available or well published in studies. I believe mainly it is directly linked to business. No one would publish poor results or high transection rates, as it is not good for business. As unfortunate as it may be, the consumers and patients are left to do their own due diligence and trust their doctor, probably by contacting patients who had it done by that doctor. One way around this would be for patients to ask about seeing actual patients in person or seeing their own surgical records of how the grafts were tracked (if it is done at all). In theory, the transection rate should be documented on the day of surgery, but I realize not all doctors will keep this record (as it is not mandatory) and some may refuse to show it to their patients. I can say this because I have heard these issues come up in consultations with some patients that have had procedures done elsewhere previously.
I know of one doctor who promotes and reports 96% good FUE grafts (4% or less transection), yet I have see many of his patients and found a high degree of failures in those of his patients who came to me for a second opinion. This is a buyer beware business. Sometimes you can expose poor practices through reports by the chamber of commerce or the courts in the areas where the doctors practice. I’ve also been asked to post the names of doctors to be weary of, but if I were to speak up and identify those who may not be honest in their representation, I would become a target for slander. I have better things to do than take up residence in the court system.
Dear Doc,
I was just curious to how the levels of DHT change in the body over time. Do DHT levels rise to some sort of critical level before the onset of baldness? or do the follicles just become less resistant to DHT as one ages? Also is there a difference in DHT levels in bald and not-bald males?
thanks
Yes, DHT levels change as we age, but the level of DHT does not necessarily correlate with balding or androgenic alopecia (AGA). It is your genes that makes you susceptible to the DHT impact on hair that produces balding. In other words, you can have a high level of DHT and if you do not have the gene for AGA, you will not lose hair. Or you can have a very low level of DHT and have the gene for AGA and be bald. As DHT comes from testosterone, it is your testicles that are the supplier of the hormones that cause baldness. If you did not have testicles, then the balding process would stop, but your hair would not come back.
2007-09-05 13:33:282007-09-05 13:33:30Do DHT Levels Change Over Time?
Dementia tied to hormone-blocking prostate cancer treatment
July 5, 2019 by Lindsey Tanner
Micrograph showing prostatic acinar adenocarcinoma (the most common form of prostate cancer) Credit: Wikipedia
Alzheimer’s disease may be a risk for older prostate cancer patients given hormone-blocking treatment, a large, U.S. government-funded analysis found.
Previous evidence has been mixed on whether the treatment might be linked with mental decline. But experts say the new results stand out because they’re from a respected national cancer database and the men were tracked for a long time—eight years on average.
Among 154,000 older patients, 13% who received hormone-blocking treatment developed Alzheimer’s, compared with 9% who had other treatment or chose no therapy, the study found.
The risk for dementia from strokes or other causes was higher: It was diagnosed in 22% of those who got hormone-blocking treatment, versus 16% of the other patients.
The results, using perhaps one of the largest and most reliable databases, suggests there truly may be a connection, said Dr. Sumanta Pal, a prostate cancer expert with the American Society of Clinical Oncology. Pal was not involved in the study.
The analysis from University of Pennsylvania researchers was published Friday in JAMA Network Open.
The results aren’t proof but experts say they underscore the importance of discussing potential risks and benefits when choosing cancer treatment.
The researchers analyzed data from a National Cancer Institute database of cancer cases and treatment and covers almost 30% of the U.S. population. The study focused on men in their 70s, on average, with local or advanced prostate cancer diagnosed between 1996 and 2003. They were followed until 2013. Medicare records indicated dementia or Alzheimer’s diagnosis.
Hormone-blocking treatment can include testes removal to reduce levels of testosterone, which fuels prostate cancer growth. But it more typically involves periodic drug injections or implants that achieve the same result.
Most U.S. men who receive this treatment are in their 70s or older. It’s sometimes used in men who might not be healthy enough to tolerate other cancer treatments including surgery to remove the prostate and radiation.
It’s unclear how the treatment might be linked with mental decline. The researchers noted that it can lead to diabetes, which also has been linked with dementia—perhaps because blood vessel damage from diabetes can restrict blood flow to the brain. Hormone treatment also raises risks for heart diseaseand depression, which both have been linked with dementia.
Researcher Grace Lu-Yao of the Sidney Kimmel Cancer Center in Philadelphia, said the potential dementia risks from hormone-blocking treatment may outweigh any benefit for younger, healthier patients with longer expected life spans.
While the study doesn’t prove that the treatment causes dementia, she said, it is important to tell patients “because of the potential impact of Alzheimer’s disease or dementia on the quality of life of patients and their family.” She was not involved in the study.
More information: Ravishankar Jayadevappa et al. Association Between Androgen Deprivation Therapy Use and Diagnosis of Dementia in Men With Prostate Cancer, JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.6562
Cow licks (actually called widow’s peaks when they are central) are actually remnants of your juvenile hairline. Many women think that they are attractive in men and in women-over half of them actually have some for of widow’s peak present. I wrote an article on this here: https://newhair.com/wp-content/uploads/2018/11/phenotype-article-published.pdf. There are some good photos of widow’s peaks in men and women in the article.
I read all sorts of foods naturally raise testosterone levels, from garlic to oysters to chicken to lean beef to brussel sprouts to broccoli. So this must be normal and not contribute at all to hair loss right? These foods are considered healthy. Does eating chicken (which doesn’t have any external hormones added to it in the US) increase testosterone? And I read alcohol, sugar, caffeine lower testosterone and boost estrodiol. And that soybeans and tofu a phytoestrogens should be avoided by people wanting to increase natural testosterone. Similarly, working out and increased T levels with that should be normal.
I’ve also read that caffeine is both an in vitro cure for hair loss as well as something that boosts cortisol in the body and since cortisol is from the adrenal gland, that contributes to hair loss. What’s the deal here?
By the way, great episode on TLC Monday night.
Please do not focus too much on testosterone and hormones. If you are male and balding, it is most likely genetic. If you have the genes for hair loss, even normal or low levels of testosterone will cause balding. You may be trying to maximize everything by limiting hormones etc, but it doesn’t really work. If you are going to go bald, you will go bald. The best medical intervention we have thus far is finasteride (Propecia). However, even Propecia does not completely stop balding.
2008-06-23 11:32:402008-06-17 16:37:44Do Chicken, Oysters, Beef, Other Foods Increase Testosterone, Leading to Hair Loss?
Body hair transplants work, but the body hair has a short growth cycle. This means that for every 10 hairs that are transplanted, they will cycle about every 6-8 months meaning that only half of the hairs are growing at any one time as the sleep (telogen cycle) is also long. If you don’t have enough scalp hair, the beard is a better donor source, as its growth cycle is like scalp hair.
2020-01-07 04:00:342020-01-07 07:29:55Do Body Hair Transplants Work?
