Category: Hair Loss Causes

I’ve been taking Finesteride over the last 7 years with good success at maintaining what I had until this past year. Over the past year I’ve experienced accelerated diffuse hair loss over my entire head especially in the front and midscalp to the point it is noticeable. I’m 40 years old now with a Norwood 2 along with diffuse hair loss. Even the donor area has thinned out dramatically. Could my situation be exacerbated by telogen effluvium even though I’m a Norwood 2? 6 months ago was a very stressful time for me.

I started to shave my entire head with a razor. Can shaving with a razor make your hair loss worse over time? I’ve heard that your hair follicles become more superficial on top of your head as you get old and lose hair. If that is true and the follicles are closer to the skin and not deeply rooted, can the razor unwantedly scrape out your follicles?

Shaving your head with a razor will not cause hair loss over time. No matter how sharp the razor you cannot “scrape” out the follicles. If you could “scrape” them out, a lot of women would be scraping out their bikini and armpit areas.

In the end, genetic predisposition (despite Propecia use) is the cause of male pattern hair loss. If you are concerned about your hair loss (genetic, diffuse, telogen effluvium, DUPA, etc), speak with your doctor.

You’ve mentioned a few times that stress can increase the rate of balding in those with the genetics for MPB. Is this scientifically proven?

By what mechanism does this happen or is this not known? (i.e does stress increase levels of DHT?)

thanks

Stress has been observed by many doctors as a cause contributing to the hair loss equation. Keep in mind that hair loss has other genetic factors that are influenced by environmental factors, and stress is one of the more obvious mechanisms. I do not believe stress increases DHT levels.

Doctor Rassman.

How are you. I love the website. My question surrounds the importance of finding an ethical doctor who is not just about the money. As a layman (like myself) I am not that experienced in hair transplants and what to do, I rely solely on the doctor. The only experience or knowledge I have is by coming on your website and reading things about hair loss on the internet.

So, How would I know who is a good doctor, what is the proper number of grafts I should receive, and if the doctor places grafts into my head is he placing them in the right spot so I won’t have shock loss etc etc.

I would mostly go with what the doctor says because I am putting my trust in him, unless he says something totally absurd then I know to back off.

I can read all day on the internet about hair loss and what to do, but how do we truly know whatever the doctor says is in a patients best interest and isn’t about the money, because every patient and situation is different.

Thanks

I put together a guide for patients, where I detailed the approach I would take if I selected any doctor for any reason. If you go for a consultation and end up meeting a salesman, then I would generally suggest that selling is the doctor’s priority. If you come to my open house events, you can meet many patients face-to-face and look at the quality you will get (as what you see is what you get). Photographs can be misleading and show what the photographer wants the viewer to see. Photos of a doctor’s work should be augmented by meeting real patients in person.

We all have instincts which we must rely on, so use your instincts to know if you met the greatest bullsh*tter of all time. Some of the worst doctors in this business have a style like a con man and the looks of Brad Pitt. Can you tell a con man when you meet one? The recommendation of the doctor, with regard to the work you will need, should match other opinions you should get from other doctors. If they do not match up, then you need to challenge both recommendations and see if they make sense.

Fortunately, I have written many books and articles which cover most everything that you need to know (see our Medical Publications, where everything is documented). Lastly, ask yourself if you like the doctor personally, and if you trust him/her to be there when you need him/her. I carry my cell phone 24/7 and every patient has 24/7 access to me. That is my way of telling the patient that I will always be there if he needs me at any time. Over the years, I have helped men who had heart problems, having nothing to do with the hair business, so that is my way of saying “trust me”.

Hi doc,

If you have very early bulk reductions in a certain area of the scalp, does this necessarily mean that you will be bald in those areas, or can someone’s final pattern only reflect thinning in certain areas? I am a NW2-3 with very early bulk reductions on the top and crown of my head, does this mean I am destined to be at least a NW6?

We all have some genetic pattern, but not all balding men will develop advanced balding patterns. These patterns are often final, so a class 3 may remain a class 3 pattern for life. This is why I’d want to perform a bulk assessment of the hair on your head, everywhere on your scalp. If the bulk is reduced, that may point to the final pattern you will develop. Also, by making these measurements, we can follow the success or failure in the treatment of hair loss with drugs like finasteride (Propecia).

Stop worrying and get yourself evaluated. We are often more frightened by what might happen than what will happen.

Dr Rassman,

Is hair bulk analysis a commonly performed test by dermatologists or hair transplant surgeons? I’m from the Uk and the dermatologists I’ve spoken to say ‘it’s easy to just tell with the human eye’.

The thing is, I also have really OCD (particularly with my hair) and it would ease my mind to know exactly how things were progressing rather than just questioning myself in the mirror every morning for an hour on end.

I saw a trichologists who said she could see miniaturised hairs at the crown but I have no idea what that means in terms of when I will have a bald spot. I want to stay away from drugs for as long as I can really but if it’s the case that I will be noticeably bald in two years then I might consider it.

thanks

You can tell if someone’s hair is thinning just by looking at them under a bright light, but the process of quantifying it is very difficult. Not many doctors perform miniaturization tests or hair bulk tests using the HairCheck device, which is highly accurate at detecting hair loss in its earliest stage.

I don’t have a list of clinics that perform these tests, but I know I’m not the only one that uses them. Best to call around and ask. I perform these tests at my clinic, because it gives me and my patients a certain metric or a quantitative value of what the state of one’s hair is in. We use these tests as a baseline to compare over a one year time frame to see if the treatments we use (Rogaine or finasteride) are working.

To be blunt, patients with obsessive compulsive disorder (OCD), particularly those who have seen other doctors and were told they are not losing hair, usually do not need help with hair loss. Their main issue may be the OCD, and the best help might be finding a treatment plan for that.

I have a few questions about traction alopecia. Firstly, I understand that it comes from pulling on the hair.

However, my questions are:
1) In which cases can traction alopecia arise from wearing a hat/beanie? Suppose the beanie/hat isn’t tight, but it is placed on your head in a way that holds long hair back (sort of like in a pony tail without actually tying the hair back)? I am not sure if this causes pulling, I do not think it does, but the main concern is with the fact that the hair is being held back.

2) Sometimes when I wear a beanie for a long time, I feel that the area around the nape of my neck is getting a bit sore or irritated. I think this is because the hat begins to “ride up” and it causes my skin to get irritated. Is this cause for concern when it comes to hair loss?

Thanks.

A beanie can theoretically cause traction alopecia if you wear it all the time and the beanie is either too tight or fixed with a set of clips at the same location each time it is used. This is all within reasonable limits. If you notice the irritation then it isn’t a good sign. You don’t need me to tell you this, do you?

Hello, I am very curious about the hair loss I have been experiencing. I’m 22 years old with no family history of male pattern baldness. Over the last 4 months my hair has been falling out at an alarming rate. You can now see my scalp through my hair. It is not at the rear of my head like most men, but all over the top of my head. I also have swollen glands on the inside of my jaws, however, I have no idea if that means anything. Do you think it could be male pattern baldness, or am I dealing with something else. Thanks for your time.

This appears to be two separate problems. The swollen jaw and swollen glands need medical attention. If you are balding, then it is best to see an expert on that as well. Male pattern baldness might be something you’re experiencing, but the swollen glands are unrelated.

Hi Doctor,

I’ve sent a few blog questions through, so I do apologise for the influx of emails you’ve probably received from me.

I’m 21. I suffer from OCD, and I’ve recently been extremely worried about my hair. I’ve posted numerous pictures on various different forums to try and get an analysis of my hair, and I’ve been told my hair is fine. However, I’m still worried, but am unable to afford an appointment to go to a trichologist. So, I was wondering if you could take a look at my album of photo’s. There’s a fair few in here to get a decent look at my hair.

At first I was worried about my crown area/top of my hair, but was told that I’ve got a natural parting coming from my crown. Then I was, and am worried about my hairline, but was told I have a ‘mature’ hairline. Still, I was wondering if you could take a look for me and tell me how you think my hair and hairline is? What Norwood do you think I am. I also have seborrhoeic dermatitis so my scalp is quite inflamed/red.

Basically, do I need to worry, or is it just my OCD?

Oh, and feel free to post the picture album of my hair if this question get’s published. I don’t mind. Thanks.

Click the photos to enlarge:

 

Nothing I can say online is a substitute for a medical exam or seeing your doctor in person. As you state you suffer from obsessive compulsive disorder (OCD), I think you need to have that under control. Since you’ve posted these pictures on numerous forums and have gotten a reply that your hair is “fine”, I do not know how much more I can add. Your hair looks very good to me, but there’s only so much I can tell based on photos. Base don the pictures, the hairline looks strong and thick, as does the crown.

If you are still worried and your OCD is under control, make an appointment with a doctor you trust, especially one who can perform a HairCheck bulk analysis which gives a metric for the presence of hair loss. I’m not going to be able to assuage your OCD and hair loss paranoia, but I do thank you for letting us use your photos.