Will wearing a hat all day, (approx. 11 hours) every other day create thinning of the hair? Always have been curious. I wear hats…at least 3-4 times a week, all day. Wondering if the tight cap is bad for the head? Hmmmm. Thanks so much!
You do a fabulous job!
We have answered this many times and it is outlined as well as one of the many myths in our Hair Loss and Replacement for Dummies book.
The answer is NO. A hat doesn’t cause hair loss.
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In all of the studies trying to determine whether natural supplements like saw palmetto or green tea block DHT, they never refer to Type I DHT or Type II DHT — just DHT. Why is this? Good question, huh?
Good question. Propecia (finasteride 1mg) blocks mainly DHT type II, and Avodart (dutasteride) blocks both DHT type I & II. You would think if you block ALL the DHT it would be better against androgenic alopecia. Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. There are clinical observations that suggest that dutasteride is better than finasteride, but it is not approved for hair loss by the FDA and the long term safety on human reproduction for dutasteride (reports of sterility is a complication) have been suggested in some rare patients. We have received many reports by varying doctors who switch people from finasteride to dutasteride and get a better response. The next logical question should be: If we increase the finasteride dose to 5 mg or so, will it be better to treat hair loss? I don’t know if anyone really knows that answer for sure. Some of the original studies on finasteride suggested that the 1mg dose is the most universal dose, but it may be that a high dose in those who are refractory to finasteride may help. Some doctors are using a higher dose of finasteride on long term users. It’s a prescription drug, so I’m not suggesting you should take a higher dosage. The problems for either finasteride and dutasteride is that side effects rise when increasing dosages.
To get back to your question though — it’s been proven that type II is linked to male pattern baldness, but type I hasn’t been linked yet (though it’s possibly just not been proven yet). I couldn’t tell you why the studies out there don’t provide a breakdown by type, but I have not found scientific evidence that saw palmetto or even green tea actually block DHT anyway. And even if it did block some DHT, there is nothing in the literature that shows saw palmetto or green tea being effective for treating androgenic alopecia. I don’t mean to be a pessimist, but even Propecia does not completely stop androgenic alopecia.
The real quest should be finding other (non- DHT related) mechanism for androgenic alopecia. DHT is not the only solution out there… we just haven’t discovered the other yet.
Hi,
I would firstly like to thankyou for your blog, i have found it extremely helpful. Recently i have noticed elevated hair loss accompanying a receding hairline. I am 20 years of age and therefore a little startled. It currently does not surpass your definition of a ‘mature’ hairline and i am hoping it will arrest soon. However it seems to have occurred very rapidly. In what sort of time scale does the ‘mature’ hairline tend to develop? and does it stop at a similarly prompt fashion?
Thanks very much
The appearance of the mature hairline may occur over a year or two, or it may take up to 10 years to complete. The key for genetic hair loss is to look for miniaturization beyond the confines of the juvenile hairline.
Dr. Rassman,
Thank you for answering my last question. I have one more for you, if you do not mind.
I mapped my own scalp for miniaturization per your instructions, and found it a very useful tutorial, though I took a nod from a recent entry and snipped a few bits of hair from my head instead. I compared 5 locks of hair from all around my head (temples, forehead, crown, donor area) using my donor area as a control, and to be perfectly honest I could not see a difference in the hair shaft width between any of the samples. Unfortunately I do not have equipment to give hard numbers, but my hair does not seem any less pigmented or thinner in any of the areas compared to my donor zone. I examined it under a magnifying glass, but have access to a microscope if that is insufficient.
I’ve also visited a dermatologist. He did not have the equipment to map my scalp but he said I was a NW2 and was fine.
That said, how often do you suggest this process be repeated? Every three months? Six months? Yearly? Is there a certain age after which you can just stop as there is unlikely to be further progression?
I am 26 with no known male-pattern baldness in my family; both grandparents died with Norwood 2 patterns, and none of my uncles have any hints of balding.
Thanks!
I am assuming that the mapping showed no significant miniaturization. If that is the case, once a year mapping or more frequent mapping may have value if you think that the problem may be appearing or getting worse. The mapping exercise is best when comparing:
As for age, some men will lose hair in their teens, some in their 20s and 30s… it can even happen in the 40s and beyond (though it’s less likely). You might be one of the lucky ones and not have any hair loss problems, but I really have no way to tell at this point (and without at least an exam).
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I began losing hair in the back of my scalp towards my neck when i was 18. My parents took me to a dermatologist and i received 2 rounds of shots. The balding subsided about 6 months after than and i almost even got all my hair back. I am now 24 and about two years ago i began loosing hair around my ear on the right side. Now i have a fist sized bald spot ( which until recently i was very good at concealing). I am also balding on the other side of my head. The sides of my scalp itch badly and i cant help but to run my hands though it because its all i can think about. This makes me very self conscious. I have an extremely busy work week and meet with customers constantly. I feel that in my industry image is everything and being so young it makes it that much more important. This disease is starting to effect every aspect of my life and i need a solution. Please tell me where i can go ( preferably in houston ) to get treatment by someone who will not waste my time and my money.
Thank You
You certainly need a diagnosis, but I do not know who you can see. Either check the physician search at ISHRS or you can consider sending me a set of photos from many angles so I can get an appreciation of what your problem is (email address is on the Contact page. The thing is, this is a most unusual problem and I’m not sure just randomly picking a local Houston doctor, even on the ISHRS site, will be the greatest solution. It’s worth a shot if you’re low on options. If you send photos and I’m still stumped, I can send them to other experts in the field (I’ll block out your face in the images).
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Hi dr. rassman, thanks for the great blog
I have extensive shockloss around the scar from a recent strip hair surgery.
Do you think minoxidil would be good to help reverse the problem, and help the shocked hair to “fully” come back around the scar?
Loss of hair from around the scar is often the result of a surgical closure which was too tight. Sometimes the hair returns on its own and sometimes it simply doesn’t. Minoxidil won’t hurt, but probably will not help.
This has the potential to cause a very wide scar. Speak with your transplant surgeon about this problem and ask him/her if the closure was tight.
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doc,
i have used steroids and few years ago in my 20s and started to lose hair for a while. i went to a doctor and he told me take propecia, so i did for 8 months but my sex drive dropped. stopped taking propecia and now in my 30s i feel i need to take steroids to get my testosterone level to go back up. plus i am about to hit the gym again. my question to you is should i take propecia and steroids together so my hair doesnt fall out again? what should i do about low level of testosterone to bring it back up?
I am not your doctor and messing around with the steroids and Propecia is not a place where I wish to go, particularly over the internet. There is no doubt that taking steroids causes hair loss and although Propecia may help a bit, I doubt that it will prevent you from going with your genetic hair loss path.
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Can a hair dx test point out causes for balding in DUPA diffuse unpatterned alopecia patients?
I don’t believe that the HairDX genetic tests can explain the causes for DUPA.
Hello, I was wondering if you could help me understand a little bit about what Im going thru. At the current moment, The only thing I know is that I have hyperthyroidism. I dont know whats causing it yet, but soon I will find out. It could very well be Graves Disease. Well, because I have this its making my hair real thin and fall out. I was wondering if propecia could help me keep my hair? Is it safe while having a thyroid problem? Also would I have to go to a dermatologist to find out if my hair is falling out for another reason besides my Thyroid or what kind of Doc should I seek? Do you know of any Docs in the Houston area that you would highly recommend I should go see. Perhaps one that has knowledge of propecia/proscar? Thank you so much for any help/advice you could give me. Oh yea Im 29 years old if that makes any difference. Less than a year ago I swear it seemed like I was in perfect health hair or not. Now…well. Sorry this was so long. Thanks again.
Thyroid problems can cause hair loss and hair texture changes (as well as many other medical problems). You need to see your doctor and ask him/her these questions. Thyroid might be the cause of your hair loss, or it could be something else entirely. I cannot give you medical advice this way… not because I do not want to help, but because I have not examined you and taken a good medical history with you. I do not even know if you are a male or female! If you are female you should not be taking Propecia, but with Graves’ disease, I would not expect Propecia to work regardless if you are male or female.
I don’t have any physician recommendations in the Houston area, but About.com has some tips here. For more on hyperthyroidism, see thyroid-info.com.
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Hello. I’ve had trichotillomania for about 6 years now. I’ve pulled non-stop because it is REALLY hard to quit, but I haven’t pulled any hair out in a week now. I have a large bald spot on the top of my skull and there are several others scattered elsewhere. I am seventeen years-old. I can’t even go to the hair dresser’s to get my hair done because I’m so ashamed and I always worry someone might say something. I’ve adopted the name ‘bald spots’. I was wondering if my hair was going to grow back if I let it and if not, if there were any options available for me. Thank you.
If the hair loss has been there for around 6 years, I doubt that the hair will come back. First, you must get control of the pulling (not just for a week) and you may seek help from your doctor for medications that will help you through this. Once you have gone a year or more with no further hair plucking, then you might consider hair transplantation, assuming that your donor supply is adequate. But if you should start pulling again, then any transplanted hair can be lost by the exact same mechanism.
There’s a great reference site you should visit to read more — Trichotillomania Learning Center.
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