Author: Dr. William Rassman

First of all I would like to thank all the contributors to this site which has been really informative and has helped me to understand baldness better. However, I am still unsure about my own balding. Firstly I am an 18 year old male and I have noticed that my hair has been thinning from the crown since I turned 17 or so. What perplexes me is that my hair line is quite consistent, the thinning is occurring in the crown area only.

So I have two questions. What Norwood pattern would this qualify as since the hair line is still consistent? And is it possible that perhaps this is unnatural balding? My barber suggested that my hair loss might be from excessive dandruff that has been present for quite a while but haven’t been able to quite cure despite my best efforts. I should also note that my father and paternal grand-father are both bald especially my father who at the age of 41 has very little hair left.

If you see a doctor, you can get a definitive diagnosis concerning if you are balding or not. Balding men will have miniaturization of hair and reduced bulk measurements, so the diagnosis is scientific as well as clinical. Crown balding with a strong hairline isn’t “unnatural”, and dandruff does not cause hair loss like your barber suggested.

The good news is that the drug Propecia (finasteride) works well in crown balding in young men, so if the diagnosis is made you will most likely reverse the hair loss process in the crown.

Hi Dr. Rassman,

So I have been using finasteride for 3 months now. Had two questions

1) Firstly I have had no side effects, compared to the horror stories on the net. So far so good. However I have noticed a slight alteration in mood maybe. Its not like I feel depressed or anything, but definitely a little more tired and groggy, and slight changes in sleep patterns. I am quite sure it is a side effect of finasteride since I am not going through any great stressful time or anything. I know people are quick to blame this drug for everything. Not my agenda here. But definitely have noticed something. Nothing too alarming though.

I have read many forums and quite some people have suggested to take a very small dose of PREGNENOLONE alongside finasteride. I was wondering if you know anything about this combination or if it could help with mood disturbances. I know you will ask me to consult my prescribing doctor which I will do so, but was wondering what your thoughts are on this combination.

2) Also I take 5MG cut into quarters (generic). Your website mentions not to do so, yet many patients have been advised to do so, am I missing something here. I have no problem cutting the pill either (use a pill cutter) .. but the quarter is very small…I usually do get equal parts..but am wondering if I am indeed obtaining between 1-1.25 daily?? Some say the compound is not equally distributed, some say it is homogenized?? so just confused regarding this matter as well, and would appreciate your thoughts

thanks.

Pregnenolone is a steroid and not recommended for balding men. Moreover, steroids can also drastically alter mood as a side effect. I don’t know about the combo specifically, but I wouldn’t recommend it particularly because pregnenolone could lead to more hair loss. If you are having side effects from finasteride, then you should go back to the doctor who prescribed it to you.

Cutting 5mg finasteride into quarters should be as effective as 1mg taken daily. People cut it into quarters for practicality since cutting it in five equal pieces would be difficult. The generic should be homogenized (see here).

Where does this site say to not cut the pill? There’s a lot of info on this site, but I don’t remember ever suggesting that a cut 5mg pill is something that should be avoided. For years now I’ve been recommending splitting the 5mg generic pill for those patients that wish to save some money. You just need to find a doctor that will prescribe the 5mg pill (prostate medication) with instructions to cut it.

Almost bald at aged 19.

Not only have I had serious thinning on the crown and the temple receding, the sides and the back also seem to be affected. I am down to a shaver #1 and unless I can quickly change things I could be completely bald very soon. Is help available? My scalp has been visible for almost 2 years. Everyone knows I am going bald because my hair is that thin allover the place.

I will not be able to have a hair transplant even if I could afford it. Is there a chance I could respond well to Minoxidil or Propecia or Proscar with my hair being so short? I seriously do not think my hair has much life left in it.

Short not by choice. Short because my hair growth follicles are really small and thin allover my head.

If you’re thinning all over the scalp, including the sides and back of your head, a hair transplant probably wouldn’t be an option even if you wanted it. If the donor area is thinning, you are likely not a surgical candidate.

You need to see a doctor to find out what you’re dealing with. You might have some form of alopecia areata, which does not respond to minoxidil or finasteride. I wouldn’t know what kind of help is available just based on your email, but an examination with a good doctor will be able to determine what is causing your loss (genetics, disease, etc). You need to know what you have before you can look into options to treat it.

Hello Doc,

in a former post you said that you saw several young men with mpb, who just had some temple recession and that was it.

As this early but limited loss could look similar to a mature hairline and assumed that the miniaturization would not go further than its supposed leading edge (let’s say of a v-shaped hairline that sits 1 inch at the sides and 1/2 inch at the center above the highest wrinkle) how would you distinguish between maturing and balding then?

It can’t be the presence of miniaturization alone, since some doctors claim that if it drops sharply after the first 1 or 2cm, it is likely to be part of maturation. Is that correct?

Thank you

Have you read our post about the mature hairline? A good doctor will tell you the answer to your question. Tests for miniaturization and bulk measurements will tell you if you have genetic male patterned baldness. These are done in the doctor’s office.