Author: Dr. William Rassman

I have a few follow up questions:

I am from Canada and am not sure if the local dermatologists will have this device. Are there any comparable alternatives?

If hair miniaturization and loss is caused by stress, even though I may have the hair loss gene, would decreasing stress stop or slow down the hair loss? (I am curious about this because through the observation of hair loss in my family, significant hair loss is nonexistent aside from one uncle on my dad’s side.)

Given my current description of hair loss, would you recommend medication such as finasteride and/or minoxidil or do you think a change in lifestyle should be the first line of defense?

Thank you in advance.

You do need to see a specialist to find out if you are losing hair. You have what appears to be a juvenile hairline in transition to a mature hairline. This is not balding. What I would do is perform a HAIRCHECK test to see if you are really losing hair. If you are, I would recommend finasteride and then follow your progress over a year to see if the hair loss was reversed by repeating the HAIRCHECK test. However, if you are not balding according to the HAIRCHECK test, then I would not recommend finasteride. Finasteride will not stop the movement from a juvenile to a mature hairline. (see: https://baldingblog.com/value-haircheck-bulk-measurements-two-patients-seen-today/)

A clear “cut out” patch of hair typically reflects a disease called Alopecia Areata. This is an inherited disease. You should see a dermatologist for treatment.

Some men are very sensitive to minoxidil.

Did my dermatologist prescribe Finasteride too liberally ? Context : 27 y/o. Father and his 4 brothers have full heads of hair. Mother’s side : 3 out of 4 bald uncles. They were bald in their early twenties. I went to the derm two weeks ago. He didn’t look closely at me or do a hair count. He was like “yep, looks like MPB alright” and gave me a prescription for Fin (1mg). First pic is Aug 2017. Rest of the pics are from the last 2-3 months.

I would have performed a HAIRCHECK and a miniaturization study before committing you to a lifetime of finasteride. Too many men go on the drug not knowing for sure if they are balding. I like to make the diagnosis with instruments first, then use these instruments to establish a ‘metric’ which I can follow yearly to see the effectiveness of the finasteride yearly. That is the value I believe doctors should add to this treatment process.

Congrats! Oral minoxidil had a fantastic result in your hair loss on the top of the head. Your results speak for this tremendous result.

“I’m seeing a few hundred hairs in the shower drain every day. I really don’t think I am balding, but I came to ses you because I wanted to be sure that if I was balding, you could transplant my hair and keep it looking good.”

This comment reflected the comments, one way or the other, of many men who visit me, but this particular day, this 26 year old actor who just finished his first role in a major movie came to me with the above comment. He looked like a typical hairy 26 year old male and I thought that after I measured his hair bulk, that I would reassure him that he was not balding. Much to my surprise, the numbers from the tests surprised me but shock him. The tests indicated that he already lost 50% of his hair bulk in the front of his head just behind his hairline, and 40% in the top (between his ears) and crown (back) of his head. He came apart emotionally. “This can’t happen to me”, he said. “I am going to hit it big time in Hollywood, I have an interview coming up for my second film, now a leading man, and I just can’t go bald”.

I tried to calm him down. At 26, he could go on the drug finasteride and probably stop most of his hair loss, so that was the ‘good news’ I told him. But despite my reassurance, he had difficulty letting go of the idea that his career was going to be ruined. “They won’t take me on if they knew”, he said. Again, I tried to reassure him that the drug might very well buy him years on keeping his hair, but he would not, could not focus on what I said. Over and over again he said “It over, my life is over”.

Hair loss is devastating for many young men and they don’t have to be heading to the top of the Hollywood scene to feel the way this man did. Although the drug often turns out to be effective in 26 year old men, the reality is that some day he will have to face balding. Although preventive hair transplants are a terrible and improper decision for him now, if and when he starts losing his hair, this may become an option. He left very unhappy and even unwilling to consider taking the drug finasteride. I asked him to return to see me, but he was from out-of-town and not easily accessible, but I called him a week later anyway and he promised to see me in 4 months on his return to Los Angeles. I wonder if he will deny what I told him or if he will think this matter through and make the logical decision to try to slow down the balding process and fill the prescription I gave him.

In my case, Ambien caused excessive hair loss with scalp irritation. I don’t believe my alarming hair loss and tingly, itchy scalp problems, which began precisely at the same time I started taking Ambien, is just a coincidence. The shedding slowed down dramatically after I stopped taking Ambien as did the scalp discomfort. If this is a generic drug issue versus brand we’ll never know, but I’m willing to bet it is not the latter given it’s unaffordable cost for most of us and the 0% coverage with even the priciest of insurance plans. Try stopping for a week. You have nothing to lose except your hair.

Yes, Ambien is known to cause hair loss. Since you stopped taking Ambien, it seems to prove the cause and effect.