Author: Dr. William Rassman

Hi Dr. Rassman,

I’m writing you to ask whether significant hair loss over the course of a couple months can be due to just MPB? Last august, I had a nearly full head of hair, but I admit it was a little thin on top. THEN, I started medical school and my hair is now thin both in front (along the hairline) and even more so at the crown. Did the stress, lack of sleep and not-so-great diet I’ve been eating simply exacerbate the balding process, or could there be another problem?

I’ve actually already seen a dermatologist regarding my hair-loss, but he didn’t ask me about the time frame whatsoever, so I figure there’d be no harm in asking you for a second opinion. He recommended I start taking finasteride and using minidoxil daily, which I’ve been doing for about a month now. Excuse my complete lack of medical knowledge on this, but I’m just a first-year, so we haven’t touched upon it yet.

All the best

There was a story I remember learning when I was in medical school, that a few years before I attended one medical student practically lived off of Twinkies and junk food. He developed scurvy from malnutrition. That is an extreme form of poor diet and I will assume your diet is a bit healthier.

With respect to my recommendation, I really do not have one to give you other than to follow your doctor’s advice. You need a medical diagnosis and a treatment plan and someone to follow up with you to see if that treatment plan is working.

In general, stress may accelerate the genetic process, but it is not a direct cause and effect type of relationship. I don’t know how old you are, but it could be quite possible that the timing of your MPB starting is coincidental to the start of your schooling.

Doc, I am an active, healthy 37 year old. After taking Propecia for 6+ years with little side effects, I started to notice a decreased libido, difficulty maintaining an erection, no morning erections, a smaller penis in the flaccid state and a feeling of “disconnect” (mind from penis). I stopped taking it 6 weeks ago and have not noticed a change, other than my hair loss has increased again. I have read on other sites men complaining of similar symptoms and claiming they are permanent. I have considered getting a testosterone level, A DHT level, FSH/LH, E-2, and Prolactin levels. I haven’t mentioned any of my concerns to my (female) physician. Any suggestions (other than discussing them with her? -which I will).

Decreased libido and difficultly maintaining an erection are reported side effects that occur in 1 to 2% of men taking Propecia, but the same symptoms are prevalent in more than 2% of the men who are NOT taking Propecia. You may have other unrelated health issues (undiagnosed diabetes, blood pressure problems, etc) that can also contribute to this. That is why you are doing the right thing by seeing your primary care physician. See Propecia Gave Me Side Effects — How Can I Get My Sex Drive Back? for more.

As far as the DHT and testosterone or FSH/LH tests, I really don’t have an opinion, as your endocrinologist will be better suited to advise you on whether you need those tests. With respect to a smaller penis size, I highly doubt a drug is shrinking your penis… just as there is no drug that grows your penis size. With respect to a disconnect with your penis, you may want to see a counselor. I highly doubt this problem is from Propecia. I wonder what Sigmund Freud would say…

Never (for a man) get a hair transplant before the age of 25 because the balding pattern does not declare itself until at least this age. You should build a Master Plan with a great doctor so that your hair transplant plans are carefully considered and reflect your specific short and long term needs.

Balding, when you have the genes for it, can start in your mid-teens. There is never physical pain from the hair loss.

at what age do i start balding,and does balding hurt? from tressless

Hair loss classification was created to discuss the end stage of hair loss. Many people will thin their hair as they get to their end stage. Of interest, Class 7 pattern, the most advanced pattern, usually is present by the time a man reaches his late 20’s because the genes for hair loss are very strong. Young men who have a Class 3 pattern of hair loss, when checked with the HAIRCHECK instrument, often show thinning elsewhere on their scalp that they can’t see and may not see for years because it can be a slow process. A good doctor who sees a young man under 25 develops a MASTER PLAN for him that will follow the changes I just discussed above, offering transplants only after the man is 25 or 26 if it fits. Medications, like Finasteride, as well as topical or oral Minoxidil, work to stop or reverse the hair loss. Therefore, a good relationship with a doctor who has built a Master Plan for you is essential to your future well-being. The use of the HAIRCHECK instrument has great value in reporting the degree to which your hair loss exists that may not be obvious to the naked eye.

In my weekly MIT Review, the following statement was found: “Since the 1980’s, there have been few advancements in treatments for hair loss and thinning. Thanks to Revela’s proprietary new search engine, we now have a revolutionary new formulae. The Secret? The worlds first new molecule, discovered by AI, to help encourage follicle health regardless of the cause of hair loss. ProCenilyl ™, helps activate dormant hair follicles to stimulate growth. In clinical trials, 97% of users saw fuller hair and brows in as little as 6 weeks. Just message a few drops into your scalp, it is that simple.”

I never heard of this before, so I am a doubter as this was a sponsored advertisement.