Dr. Rassman,
First, let me thank you for the valuable resource your blog provides. I understand that it is in men’s nature to become concerned about hair loss as we age. I also understand that you have answered this question, or at least very similar questions many times. I’ll ask anyway, because you seem like a good guy.
I am a 27 year old white man. I have severe depression and OCD. I recently (past couple of months) started obsessing about my hair. I’ve always been overly concerned about the way I look, and I’ve always been severely lacking in self confidence. When I tilt my head back and look up at the front of my hair line in under direct light from a couple inches away, I can see scalp going back about two inches. When I tilt my head forward, I see no scalp and my hair looks the same as it always has. There are a few long hairs growing below my hairline. I dont notice a change in my hairline when compared with photos taken when I was in my early 20’s. If I pull hard on my hair around my hairline, nothing comes out. Same with the crown. My mom’s dad died with a full head of hair in his 90’s. My dad thinned over the course of his life, but didn’t really go “bald” until he was in his early 50’s. He’s now maybe a norwood 3v or 4. His dad had the same pattern, except it didn’t kick in until later in life. My mom’s brother went bald young. My maternal great grandfather had Homer Simpson’s hair by the time he was 30 or so. My dad’s brother still has a good head of hair in his 50’s. What do you think (and I know you can’t really tell without a miniaturization study)… which leads me to my next question.
Is a miniaturization mapping something that is common among dermatologists? Do most of them (in your experience) properly perform and understand the procedure? Is this something that has been written about in peer-reviewed publications? Will a dermatologist that does not specialize in hair loss be able to correctly diagnose what is going on with my hair (if anything)? Thank you very much for your time.
If you know you have OCD and are starting to obsess about your hair, I think you answered your own question about what my thoughts are. You’re seeing possible thinning when your head is tilted and you’re under direct light. The hair will generally appear thinner under harsh lighting.
I wrote about this when I applied for a US patent in 1992. I published it in various articles, not suggesting mapping the head, but showing the connection between balding patterns and miniaturization. The rest is not rocket science. It is not exciting to map out the scalp for miniaturization and actually if the doctor is knowledgeable, then a good sweep of the scalp will give the needed information for a well trained physician.
Many doctors now have video imaging systems in their office, like slightly more expensive versions of the USB video microscope mentioned in the Mapping Your Own Scalp series. For around $100, you can buy this microscope for yourself and get the mapping started. One of the biggest reasons that I created BaldingForum.com was because of comments like yours — that forum gives site visitors the chance to empower themselves by mapping their own hair and making their own diagnosis, following the process over time with aging, drugs, etc. You can share your results with others and get feedback from other site members, not just from me (time is always a problem for me, because I can’t just get to everyone). I believe that the real power will be in the hands of people like you — those who just want to know what is happening to them.
I practice good medicine and always give the best, safest, and least invasive solutions for hair loss. If medication can solve the problem, I’d rather a patient go that route. Surgery should never be the first resort.
