Author: Dr. William Rassman

Hi,

I just wanted to know if there were any solid statistics on what percentage of men are norwood II, III etc. in middle age?

Thanks

There are two studies that I know of that were published on the subject. Drs. O’Tar Norwood and James Hamilton both did studies and each came up with different numbers.

Although there’s no general agreement on the statistics for the frequency of balding, it’s believed that advanced balding (defined as a Norwood Class 5, 6, or 7 pattern) occurs in about 35% of balding men. Balding itself is present in approximately half of all men over the age of 45. For those that fall into the 35% of Class 5, 6, or 7 pattern balding, this doesn’t mean that there’s a complete absence of hair in the balding area, as some hair may remain. Norwood Class 2 and 3 patterns appear in about 42% of middle aged men, however, I do not look at Class 2 patterns as much more than men with a mature male hairline.

Update: I removed the statistical breakdown from Dr. Hamilton’s study that I initially posted, because they’re unclear and they are widely different than other published statistics.

Hello,

I had a brief question about the miniaturization or actual process of hair loss:

When one has a hair fall out (sheds), is that the last hair that particular follicle will produce? Or, does another hair replace the shedded hair, but in a slightly minaturized form, starting the process over again as the hair gradually gets thinner (diameter)until it’s no longer cosmetically viable?

Thanks in advance.

Genetic hair loss causes progressive miniaturization of the hair shaft. Eventually, when the hair goes into telogen (sleep phase) it just will not grow back, because it has died (apoptosis is the term for a cell that has reached the end of its lifetime).

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So it isnt true that hair is more susceptible to fall out when its longer? I ask you this because i am from a pretty bald family, and i grew my hair out pretty long when i was 17, and three years later my hair has never been the same density wise as it was before i had long hair. I was only wondering if growing ones hair out longer could kick start the genetic balding trait, if youve ever heard of that happening.
thanks!

That is a myth. The length of your hair has nothing to do with genetic balding, unless of course you are pulling on your long hair or getting it caught in things and having it ripped out… but that is another story.

Remember that as you age, if you do have male pattern baldness (genetic hair loss), your hair will thin until your final pattern is achieved. Get yourself checked out for miniaturization if you think that you may have genetic hair loss.

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I’m a Korean male 34 yrs old and began noticing 2 years ago that my hair was beginning to thin out. By thin out I mean that it was falling out and many of the hairs were now thinner. I’ve always had a very thick head of hair and never thought that baldness would ever be something I’d have to worry about. Concerned I went to a dermatologist who seemed to think I was a bit crazy with this concern but suggested that I begin using propecia and rogaine as they have a synergistic effect. At first there seemed to be a slow down of loss but recently it seems to have accelerated. The hairs that fell out in the past seemed to all be rather thin or thinner at the root end now the hairs falling out seem to be thicker otherwise healthy looking. My routine and diet have not changed except for an increase in alcohol intake. I wonder why I’m seeing an increase in loss all of a sudden and why thicker hairs are now coming out in greater volume. It seems that medications are doing little to maintain my hair and certainly are not resulting in any new growth. Is it possible that I’m seeing an increase in loss due to a natural shedding rhythm? I’d estimate that in the last 2 years I’ve lost 25-35% of my hair. My hairline is still in tact and to someone not looking for the loss it would not appear that I have anything to worry about, but I notice. It’s especiallly noticable when wet. My scalp is expossed all over whereas it used to be even with a wet head you would not be able to see much scalp. Furthermore I’m adopted so I have no genetic history available. One last thing regarding the increase in alcohol; could this contribute to the loss or lack of result from the medication?

Thanks for your time.

I very much doubt that alcohol is related to your hair loss… unless your diet is compromised, which could then make it an offending cause of hair loss. Even alcoholics can have full heads of hair, though.

I am a bit confused what you are saying about the dermatologist who thought you were “crazy” and prescribed you Propecia. Is there a definite diagnosis of male pattern baldness or are you just taking these medications without a diagnosis? What are you really treating? It sounds like you need a good miniaturization study to find what pattern of hair loss you have and how you are losing hair. It may be just a cycle, but I really cannot say. Unless you have male patten baldness (MPB), Propecia will not help.

Quick preface: I’m not sure if I’m balding or not.

Anyway, I notice when I shed hair, which I don’t do excessively, a lot of the hairs are random sizes. Some are equal length to the rest of my hair, others are smaller but still as wide,
others are longer but thinner, some are shorter and thinner etc.. Is this ever the case in normal shedding or is it always an instance of MPB causing miniaturizing?

Normal shedding at the end of the anagen phase should push out a normal width hair in over 90% of the hairs that you see. If the hair are largely miniaturized, then maybe you do have male pattern baldness (MPB). Most men lose their hair from balding without noticing it, because the hairs die at the end of an anagen cycle and do not grow back.

For more on hair growth cycles, see Hair Follicle Cells Growth Stages.

Hi Dr,

I’ve been losing my hair for approximately a year now, and I’ve noticed that when I started to lose my hair it went from being smooth and oily to “tangly” and dry. Is this normal for MPB or is this a sign of malnutrition? I’ve tried propecia and minoxidil and neither of these medications have helped. When I went and saw my Dr he immediately said MPB because my father is somewhat bald. Is there any specific blood work i can do that can help diagnose if malnutrition is playing a part?

Thank you!!

This is not a multiple choice test. You need to be evaluated by a doctor who knows the field and can diagnose genetic hair loss. Hopefully, the doctor will map out your scalp hair for miniaturization and lock in the diagnosis. Your physician (along with you) should then build a Master Plan for your hair loss and abide by it. Genetic causes are the most common among men, particularly as opposed to nutrition.

If you want to analyze your nutritional state, you can determine your nitrogen production in a 24 hour urine analysis and that will give you your nutritional state. A blood test won’t tell you definitively whether your hair loss is due to nutrition, though.

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