Author: Dr. William Rassman

I’m 19 and play college football. My Dad experienced hair loss around my age and was a Norwood V by the time he was 30. His hairloss was gradual and then slowed way down.

I have a lot of stress right now because of playing football and tough academics and I broke up with my gf. It seems this is accelerating some of it. But, I try to calm myself down. What would you recommend me trying to take for now? I will get a transplant or something later after I play college. I just need to get through another 4 years!
Thanks in advance.

As you are finding out hair loss is genetic. In general many men who have the trait of Norwood 5/6/7 patterns will have the pattern show in their 20’s. It does slow down in their 30/40s.

If you want a medical treatment, you need to see a doctor to explore your options such as taking Propecia or Rogaine. It is the only two medication that work. Shampoos, vitamins, and products you may find on the Internet despite the great advertising persuasion, does not work to stop or regrow hair. At best it may be “good” for your hair in terms of keeping the hair’s shine and body.

Other options would be simply shaving! Bald is beautiful (or handsome)… as they say.

I am a 22 year old man.i underwent treatment for tuberculosis for2 year but now iam ok.the problem is now i have sudden hair loss with circular type.

Hair loss for men in general is caused by genetic factors. In other instances illness or medical conditions which cause stress to the body or adverse effects from medication can also be responsible for hair loss.

Treatment for tuberculosis (TB) sometimes can mean you tested positive and were once exposed to tuberculosis and doctors gave you a long course of antibiotic. It does not always mean you have an active tuberculosis infection. Either way, you were treated and it should not impact the hair especially after two years. Even the medication you took for TB should not be a factor after two years.

The best advice is for you to see a doctor for an examination. Circular type of hair loss (patchy circles) can also mean you may have a condition known as alopecia areata (AA). AA is not related to TB.

Hi, for the last ten months I’ve been having diffuse hair loss all over my scalp. Both top and sides of my head. My hair line has not receded. Within these ten months, I would say that I’ve lost about 60% or more of my total hair. All of the hairs have the small white bulb at the end. I’ve gone to a dermatologist and he suggested that it might be TE or MPB. I then went to an endocrinologist and had some blood work done. I came out having slight hyperthyroidism and I show many of the symptoms.

It seems that my hair loss has continued the same. I have slight hair regrowth but it tends to fall and my hairs still have the white bulb at the end. this problem began in june ’09 and I had been under a great stress two months prior. I am now 19. I have been on methimazole for about a month now and I am really anxious to try propecia. Do you believe this to be TE or MPB? Thank You.

I really don’t know what you’re seeing, so I can not recommend anything without checking out the hair loss for myself. My examination would include Miniaturiaton studies and bulk measurement with a HAIRCHECK instrument. I need to make a diagnosis and to see the distribution of your hair loss and knowing what you mean by hair loss over my entire scalp, does not mean anything to me from a diagnostic point of view.

The patient who wrote this some years ago was not too far from my Los Angeles office, so i suggested that he should come to our office for a free consultation. My office at 310-553-9113 (or 800-NEW-HAIR). If he had been from out-or town, I would have suggested that he see a local dermatologist to start, get his/her diagnosis and then if the diagnosis is not nailed down, try a telephone consultation with us by sending good pictures (which will be held confidential) and then get an opinion from us. This patient made a diagnosis on himself as diffuse alopecia, If this is the case, we could refine that diagnosis and determine if it was diffuse patterned alopecia or diffuse unpatterned alopecia. The former diagnosis is treatable while the latter diagnosis may not be treatable.

First of all thank you for what you do with this site it is a tremendous resource. I am twenty and began to recede at the hairline about a year ago. I started taking one fourth of a proscar daily in April without a prescription and got a prescription for it in June after seeing a dermatologist. I have since been taking the generic version daily. The medication does not seem to be working as I have continued to lose much hair from my crown to the point where my scalp is visible in harsh lighting.

I have long hair but i have noticed in the last week that I am losing the very short (terminal?) hairs again after not noticing them for the past few months. Could this be due to the switch to the generic version? The proscar pills were individually sealed while the generic are together in a pill bottle could this air contact affect their potency? As it has been seven months and I have lost noticeably more hair should I discontinue the medication?

Thank you, my dermatologist is pretty clueless when it comes to hair loss, so I appreciate your knowledge.

Generic finasteride 5mg is the same drug as Propecia, which is just finasteride in 1mg strength, so there should be no difference in efficacy. I don’t think bottle vs individually sealed has any bearing on the potency.

Finasteride does not work that well for frontal hairline, so what you may be experiencing is just your normal course of hair loss that the drug cannot address, particular in a man of your age who might have an aggressive pattern of hair loss in the family line. Many men like you report that their father or fathers father or mothers father had an extreme balding pattern at an early age. These men will not see the same effects as men who are not heading to an advanced hair loss pattern. I would ask if any of those balding men in your family had advanced balding and at what age did they lose their hair? That may shed light on your problem. Lighting will make the hair appear thinner. Do you have comparison photos to look at from before you started? You’ll need to discuss changes to your medication with your prescribing doctor but if you have your father’s pattern (of advanced balding) nothing may help. The best way to know this is to see a doctor who offers hair bulk assessment with the HAIRCHECK system. If you are heading for advanced balding, then this test will tell you that. If it were me, I would want to know!

I have lived With my nightmare Freaky hair transplant look too long, what can I do about it? Can you help me?

This patient would not allow me to show his pictures, but I will tell you in general what his “freaky” hair looked like. He had four scalp reductions (removal of bald scalp from the crown of the head) which left a scar down the middle of his head, and he had 4 partly failed transplants creating the old doll’s head look. Between all of these procedure, his entire donor area (except for one area high in the donor area that might still provide for hair for another hair transplant – perhaps not the best option). You can see through the hair on the back of his head and he looks like a cancer survivor despite his good health. This surgery was done over 20 years ago by a Los Angeles surgeon known to the professional community for this type of terrible work, but not known by his victims. The patient was in his early 20s back then and wanted to believe in the doctor and after many surgeries there was a progressive loss of trust. His hairline was placed an inch too far above its normal position, so he even looked worse.

My job was to assess his situation, communicate realistic (not idealistic) possibilities clearly to him and then recommend a possible treatment for him – if one was possible or agreeable to the patient. Many patients like this have few options and the 8 previous surgeries and all of the deformities that were created, left him mistrusting all doctors with few options. None of the options would bring him back to being completely normal without sacrificing certain styling options. Some of these options were:

1- Shaving his head and having Scalp Micropigmentation done, This is a reasonable option if he can put up with a shaved head and many people in his situation select this option. For an example of a result he might expect, go to scalpmicropigment.com and see patient 161 who has deformities in the back of his head similar to this patient. His after pictures show camouflage of these deformities but the deformities and scarring will still be there on close inspection.

2- Fortunately, I believe that he has enough hair that I can still harvest to recreate his frontal hairline with hair transplants. Then he can then have SMP done to cover the massive scars on the back of his head and cover the scars in the front, top and crown of the head. A good frontal hairline will allow him to let all of his hair grow out and style it once the new frontal hairline is created. SMP will help to minimize the look of thinning and scarring.

I have literally seen thousands of patients like this over the past 24 years, and helped many of them. By helping I do not mean making the deformities go away, but with good styling and some surgeries, at times, a much improved look is very feasible. Since Scalp Micropigmentation has been available in our practice, we have been able to create amazing improvements in patients like this. I think that we have done more of these types of repairs than any medical group in the world today.

November 11, 2014, Los Angeles Times: REGULAR POT SMOKERS HAVE SHRUNKEN BRAINS, STUDY SAYS: “Experimental mice have been telling us this for years, but pot-smoking humans didn’t want to believe it could happen to them: Compared with a person who never smoked marijuana, someone who uses marijuana regularly has, on average, less gray matter in his orbital frontal cortex, a region that is a key node in the brain’s reward, motivation, decision-making and addictive behaviors network. More ambiguously, in regular pot smokers, that region is better connected than it is in non-users: the flow of signal traffic is speedier to other parts of that motivation and decision-making network, including across the superhighway of “white matter” that connects the brain’s hemispheres.”

There has been much speculation on this fundamental issue but it is not surprising to me because we seem to easily forget the impact of chronic alcohol intake on brain function (se:http://en.wikipedia.org/wiki/Wernicke%27s_encephalopathy). Excess has its costs, so how do we determine just the right amount of alcohol or pot that is safe. I suspect that it is different between people, some get these problems with lesser dosages.

I know there is often a lot of talk about celebrity hairlines, but one celebrity whose hair I’ve never seen on any blog is John O’Hurley, who is in fact known for his thick head of hair. I take particular interest because my hairline is very similar to his. It forms a stark v-shape and leaves his top brow ridge, but as far as I can tell has not receded over the decades. Is this representative of the “mature hairline,” or has he possibly had this hairline since birth? Any insight would be most appreciated.

Mature hair line is basically a hair line that develops from childhood to adult transition. Many young men think it is a sign of balding and toil over the definition or seek a diagnosis of this phenomenon to assuage the insecurity of hair loss.

John Hurley is not bald or balding. He still has a great head of hair as he had in his earlier years. The shape of his hair line is just his trait. I do not know what his hair line looked like in his childhood. Maybe his hair line changed a bit as he aged, but he is clearly not bald or balding.

Dr, what do you think about the new paper published by Dr. Irwing for Post Finasteride Syndrome: Androgen Levels and Semen Parameters Among Former Users of Finasteride With Persistent Sexual Adverse Effects. Are you still not convinced that PFS is not real?

Let’s put things in to perspective. Just because a study or paper is published does not make things a fact. Many people use the Internet and find their “truth” or “proof” based on simple statements without really looking at what has been done or studied. Few ever think about the study parameters and the limitations of the findings.

The study was conducted on only 24 participants. Participants were recruited from a website forum called propeciahelp.com It is a website that advocates class action lawsuits for people with side effects from Propecia. I don’t know what the readers may think of this, but wouldn’t you think there is a self selection bias here?

The study found low serum androgen levels but the study also admits to no baseline levels to compare this with. This means there is no way to determine if Propecia was a cause.

The paper is not a research paper, but just a letter that was submitted to a journal.

The “Limitations” mentioned on the paper was that it was a “Retrospective study design, small sample size, recall bias”

I believe there are patients out there who are suffering from sexual issues and that they believe it may be from Propecia. They can also be suffering from the same sexual issues irrelevant to Propecia and this is very hard to negotiate with the individual who is convinced that their symptom can only be from the Propecia use. These type of papers only further confuses the issue with no solution or clear explanation of the cause of the problem further propagating the conspiracy theories and frustrations of the people who are suffering from a problem.

I do agree that further research should be done with better methods and sample size.

I am losing hair at the top of my hair and now my scalp is becoming visible. I have tried strategically placing my hair pieces but its becoming very consuming. Please help me.

If your hair loss is an issue and you want medical or surgical options, you can always contact my office for a consultation. (800) NEW-HAIR

I’m 23 and I just started taking propecia for the first time in a year. Here is my 10 week before and after and the results are incredible so far. Frontal hairline is regrowing. Please blank out face if you are to use them.

Propecia usually do not work for the front areas and it takes several months to see results. But once in a while some do see great improvement.

Dr. Bernstein, my former NHI colleague, has many before after photos of men who only took Propecia and got phenomenal results. see: http://www.bernsteinmedical.com/medical-treatment/medications/propecia-finasteride/

BEFORE

AFTER

AFTER