Author: Dr. William Rassman

First off I would like to say thank you for answering people’s questions on this site. I’ve learned more here on the subject of hair loss than anywhere else. I have a few questions that I would appreciate some clarification on. I’m a 17 year old white male. My family tree doesn’t have much of a history of hair loss. My father is Norwood 2 at 50, and both of my grandfathers had full heads of hair, and so does my mom’s brother. The last bald person in the family was my maternal great grandfather. My hairline is probably identical to my fathers.

You spoke before of people having the balding gene but not expressing it – I’m wondering if that could be the case with any of these people and that I could have possibly inherited it. If it were, are there any triggers that could trigger it that I could avoid? For example, you said malnutrition can activate the gene. Specifically does that mean not getting enough calories, vitamins and minerals, or eating too much salt, fat, sugar, etc.

I’m also considering starting urine therapy for something completely unrelated to hair loss, but I read that male urine contains DHEA, which is supposedly another trigger of the gene. Do you think the amount of DHEA in urine would be sufficient to have any negative affect on hair loss?

I am assuming that you plan on ingesting the urine, as opposed to applying it on your scalp. I don’t think drinking it would be a negative on your hair (nor would applying it to the scalp — though I don’t know why you’d do that), but I have to admit that I don’t know a lot about urine therapy. Anyone with more experience in this area would be welcome to add a comment.

I do know that avoiding potential hair loss triggers really isn’t a great way to prevent hair loss, so long as you have functioning testicles. In other words, anything can potentially trigger it and there’s no perfect checklist to guarantee you’re safe from genetic hair loss.

If my balding is due to one of these: (braiding (dreadlocks), hypothyroidism, iron deficiency, malnutrition, stress, hormone imbalance) can I really be helped without having a hair transplant?

In your case, probably not — but you should correct the medical conditions. You seem to have a lot going on. See a doctor, because an in-person, face-to-face meeting would be miles ahead of internet advice.

Further FUE grafts harvested from the area shown where the previous grafts were removed will eventually make that area bald. The sides are reasonable additional donor source for FUE if this area was not harvested before. Strip surgery may also be possible for additional grafts. A careful discussion with an expert surgeons is critical to evaluate your residual donor hair supply and your Hair Mass Index.

I have psoriasis on my scalp. Do you think it is safe to microneedle? I don’t have psoriasis on my hairline, where i would do most of the microneedling (NW3 now). I’m very inclined to start microneedling, but afraid it might result in new psoriasis spots. Also, how about FUE? I read it might be problematic for psoriasis. Currently torn between the 2 options.

I wouldn’t recommend that you do it, considering the Psoriasis, because of the risks associated with repeated trauma for you can make your psoriasis worse. I have done hair transplant (FUE included) on people with psoriasis and provided that it was not in the recipient area- it was not a problem.

Can frequent, obssesive pulling back of the hair cause traction alopecia at the hairline? I’m a 20 year old male who cannot go past a mirror without pulling my hair up to look at my hairline. If there is a comb available, I use that as well. I do this to the point where the left side of my hairline in particular feels sore. Would you have any pictures to illustrate this sort of traction alopecia?

If you have an obsessive compulsive disorder to constantly pull on your hair, that may cause permanent hair loss to the area (depending on the severity and length of the offending habit)… but just looking at yourself in the mirror and combing your hair back will likely not cause traction alopecia.

It may seem like a chicken/egg conundrum (which came first…), but most men who have frontal recession are likely experiencing male pattern baldness. Particularly men around your age, which is when it wouldn’t be uncommon for genetic hair loss to begin.

If you are indeed worried about your possible hair loss or an obsessive compulsive disorder, you would establish a diagnosis with your doctor.

first of all i want to thank the doctor for a such great site, and also taking the time to answer some questions.My first question how is easy can a hair follicle be damaged, for example I cut my self shaving my head does that mean that the follicle is damaged? second question is that if you get slapped in the head is that gone make hair to fall out?

Unless it is very deep, cutting your skin while shaving will not cause hair damage. And no, slapping your head will not cause hair loss.

Your donor supply looks pushed. If you harvest more grafts in this areas where it was harvested before, you may deplete the donor area and become bald there. There is a limit to how many hairs can be supplied by the donor area. The safe area for harvesting I defined by the lines I drew (the safe area is between the lines) on the photo but as you can see, some of the grafts were taken from the non-permanent zone. I would not rush to get another hair transplant as the donor area will become more of a problem than the area where you are moving the grafts to fix. You might want to find a doctor who can do a strip surgery for more grafts as the depletion will be less in the areas shown.