Author: Dr. William Rassman

I’m a 23 year old male experiencing male pattern hairloss around the crown. I’ve noticed it for 8 months and it’s been getting substantially worse recently- more hair loss in the shower, more strands on my pillow every morning, hair follicles on my hand as I run it through my hair. I’ve also been experiencing Dry Scalp recently which I think is related to the balding. I’m meeting my Primary Care Physican soon, I plan to ask him for a 5mg Proscar prescription and get a pill splitter with that. I do not want to use Rogaine, as I’m a medical student and expected to look professional all the time. I’m afraid it might mess with the oils on my skin. As for the shampoo, I’m thinking of ordering shampoo either nizoral or DR regenpure. Which one do you recommend using? Are there any additional tips you can provide? Could the hairloss be associated with medical school stress to any degress? Thank you for your time!

I believe that there is a 99% chance you have genetic hair loss in process and the best treatment is finasteride 1mg/day or as you said split a Proscar into 1/4 or 1/5th. You don’t have to be 100% accurate as long as you end up totallying 5mgs every 5 days. If you can find someone with a HAIRCHECK instrument (https://baldingblog.com/2017/01/10/value-haircheck-bulk-measurements-two-patients-seen-today/), get your hair bulk measured and then you can get a metric on the value of the drug over time. I don’t believe that the shampoo makes any difference, but for a douoble wammy, if you are having crown loss as well, I would consider adding minoxidil once daily to the crown.

I have performed a HAIRCHECK test on this now 24 year old male with a receding hairline last year and then again today. His hair has shown stability and very little loss as the drug finasteride seems to be helping him hold onto his hair. I told him to return in a year for another HAIRCHECK test and to see if his corner frontal recession bothers him. A hair transplant is a viable option.

If you have thinning along the sides and back of your head as well as elsewhere (thinning on front and top), there is a condition we published called Diffuse Unpatterned Alopecia (DUPA) which requires a doctor to make the diagnosis with a hand microscope showing miniaturization in the sides and back of the head hair.This is a difficult problem to treat and people like you who have DUPA are not candidates for hair transplantation.

He appears to be thinning in two areas and his forelock appears strong and he wants a hair transplant. Forelocks tend to last a lifetime if it remains strong until a man is over 35 and these tend to run in families. This man is not a candidate for a hair transplant yet at 23, but possibly when he get to be 25 or 26, he will see these areas bald more. If he takes the drug finasteride, it might not happen.

Should I get a HT ? Im 23 i used minoxidil for 2 years and did nothing just stopped the shedding so what you advice me to do ?

This is a failure of the transplant unless your surgeon placed far less than the 2200 grafts you reported. I would go back to have a frank discussion with your surgeon as you paid good money to have this done. The most frequent reasons for hair transplant failure, is some technical glitch or lack of experience by the surgeon and/or his team!

This is a common finding in some women, although it is more common as women get older. I have treated many of these women with a hair transplant to put back the rounded hairlines typical of the female hairline. You should be look at my an expert to make sure that you don’t have an autoimmune disease like Frontal Fibrosing Alopecia. a diagnosis that is easy to make when your doctor is skilled in the examination of a female hairline

I have a few questions about getting a hair transplant as a 26 year old. Before I get the “just go bald” comments, I’m not gonna do that, so save your breathe. Call me vain or whatever.

Anyway, I’m currently on finasteride, but I started after my temples had already receded and my hairline is just….a mess. I really, really want to get a transplant on my temples/hairline right now, while my looks actually matter to me. I know waiting till I’m in my 30’s makes more sense, since the balding will likely have completed by then and I can repair it all at once, but my looks are important to me now more than ever. It really hurts my self-esteem…

I guess what I’m wondering is, will it be okay to get a transplant on my hairline now and then just get another one when I’m older/in my 30’s to fix the rest once the balding has completed? The finasteride should keep the rest from falling out until then, right? (It’s been working for me thus far)

By this age, you can transplant the frontal hairline. What you need is a Personalized Master Plan for this process. I would do a HAIRCHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-video/ ) to determine your present balding pattern and try to predict your future hair loss pattern. Then I would quantify your donor supply to know just how many grafts you have in your lifetime so that good planning can start now. With this information, you can be intelligent about how many grafts that doctor is going to use up now, and how many grafts your doctor will leave behind. There is an interesting problem that most men don’t recognize. Too many doctors push graft numbers high because they charge by the graft so they profit from more grafts at the time of the surgery. I have seen many patients that had twice the number expended for a frontal hairline and then down the road they might run out of hair. Get a doctor who understands this process and cares more about his/her patient than their pocketbooks. If you stay on finastetride, you will prevent shock loss and hold on to your native hair.

This man used all of the approaches to regrow his hair including Finasteride, Minoxidil and a Dermaroller once a week with great results

I am 26 and I lost a lot of hair giving me a huge forehead. How many grafts will this take?

First, what I need is a frontal picture with your hair pulled back and your eyebrows lifted high so that your forehead creases. That shows me the anatomic point that allows me to determine the proper place of the hair line. Once I know this, I can give you a recommendation on the number of grafts you would need for a hair transplant. Keep in mind that fine hair takes more grafts than coarse hair. In addition to the picture, I would want to know the thickness of the hair in the back of your head.