Author: Dr. William Rassman

If you disease is under control and you understand the risks associated with having a hair transplant, then the answer is yes. There could be an increased risk of hair rejection if the autoimmune disease impacts the skin which can happen anytime after the surgery, even years out

I have seen great initial growth with finasteride in some men 18-22. It works best when the hair loss is recent. See the photo collection from Dr. Robert Bernstein’s office here: https://baldingblog.com/dr-robert-bernsteins-library-of-finasteride-results/

Hi Doc. I have a few questions regarding male pattern balding and hormones.

1. I obviously have a lot of DHT as I am 22 and have hair on my shoulders, back and chest and had bad acne growing up. Does this mean that I will be more susceptible to MPB?
2. I have a widows peak that I inherited from my father. He is in his 50’s and the only extent of balding happened before his mid twenties that resulted in a pronounced widows peak. Does this mean That I will probably follow his pattern? if I have more DHT that he does is there a greater chance that I will have more balding…or is your pattern of balding predetermined…regardless of the amount of DHT you have.
3. I have noticed miniaturized hair falling out every once in a while, they are thin but still as long as the rest of the hair. Does this always mean MPB or does some hair naturally miniaturize. (could other scalp conditions cause this, such as dermatitis)

I appreciate any info you can offer regarding these questions. Excellent site, keep up the good work.

1. Having “lots” of DHT does not necessarily mean you will have MPB. You need to have the gene for MPB. Just having hairy shoulders, back, and chest does not necessarily mean you have “lots” of DHT either.
2. You may or may not follow your father’s hair pattern. There is no way to tell for certain.
3. Miniaturized hair does not necessarily mean you have MPB. Men with MPB have miniaturized hair in certain “patterns” — thus, the term male pattern baldness (MPB).

What is happening to me and why don’t I have hair there?

For those of you who don’t know what retrograde alopecia is, it is a loss of hair (or thinning of hair) at the nape of the neck or sometimes more rarely on the sides above the ears. I believe that this is genetic.

The first picture is with a buzz cut, the second picture is with longer hair. As you can see, as my doctor told me, I don’t have a lot of hair so I can’t let it grow out or it looks terrible.

If you like the buzz cut which solves the lack of hair, I would recommend Scalp Micropigmentation, see here: https://scalpmicropigmentation.com/bold-shaved-look/ This approach will give you the look of a full head of shaved hair and completely hide the limited densities of hair that you have.

How long did it take for others to see return to baseline hair?

If you progressed over a year with your balding, then you can assume that the drug finasteride, didn’t reverse it. The real question is did it slow down the loss process. Without stopping it, you won’t know but if you stop it and the lose hair from stopping it, the hair you will lose in the first 3 months may not return if you go back on it. Damn difficult problem. If you are old enough, hair transplants are the solution. Combining it with minoxidil often makes for a better outcome.

Hi Dr. Rassman,

I am 24 and I know I have MPB. However, I’ve been having a poor diet over the last 4-5 months, which I already stopped and started getting a proper diet. However, during those months I noticed my hair getting thinner.

My question is simple: with a proper diet will I have my hair as thick as it was before the poor diet began? I do not expect an exact answer of course but just an idea based on your experience.

Thanks

Will your hair get as thick as it was before your bad food habits? Likely not. If you are sure you have genetic male pattern baldness (diagnosed by a doctor?), the poor diet might’ve exacerbated the hair loss. It could regrow somewhat, but I don’t know enough about your hair loss pattern or history to really speculate too much more.

You need to be seen by an expert, and you should consider getting on Propecia to slow down the loss if you are indeed experiencing MPB.

Having bumps where you had an FUE in the donor area may be the result of burred grafts which form foreign body reactions. You need to go back and see your doctor. These look like they already healed with possibly small cysts below the skin. Without examining you, I can’t be sure.

Hello Dr.R. I am an 18 year old. I have been classified as a NW1 by a hairloss center online in London. I however observer minatuirzed thin hairs on the leading edge of the hairline and the leading edge of the hairline corners but the hairs beyond this very forward part of my hairline are very thick. Does this indicate Male Pattern Baldness or future hairloss? If not, till where should miniaturisation exist beyond the leading edge to say that MPB exists.

Other details- I have 12% vellus hair and 88% terminal hair (I checked) and good hair density in general.

I sincerely hope you clear my troubles like you have for several other people on this blog. Thank you for all the information Dr.R.

It didn’t know there was a NW 1 classification. Many non balding men and women have fine miniaturized or vellus hairs on the leading edge of the hair line. This does not mean you are balding. There is no way to determine if you are going bald based on these things. If you see a hair loss “pattern” that develops, then it may be male “pattern” balding.