Category: Hair Loss Causes

A patient who had a surgery yesterday, told me about his experience as he was walking the two blocks to his hotel. His surgery was finished at about 4:00 pm and he was wearing a surgical cap (to cover his FUE and hair transplant surgery) and a doctor’s scrub top (given to all of our patients for surgery). He was approached by two beautiful women who seem to be tourist with Russian accents. They flirted with him and struck up a conversation eventually asking him what type of doctor he was. While he loved the attention and as a single eligible man on the dating scene, he just had a hair transplant procedure and it was not the time to flirt back. He thought “what would be the chance of meeting women like that after his hair grew out wearing a surgical garb?”. We both had a real good laugh.

I am 21 year old male suffering from moderate hair loss. The males from my mothers family are all bald and I share the same blood group hence the problem may be genetic. I have been prescribed anti DHT drugs by my doctor. The dosage will be 4mg per month for 6 months initially. Will the hairfall start again or even increase if I stop the medication after 6 months? Also what dosage causes side effects like difficulty in getting an erection and libido loss? My doctor said my dosage is very mild and wont cause any side effects.

The only oral medication for treatment of male pattern hair loss is Propecia which is finasteride 1mg. I do not know what DHT medication you were prescribed but you should ask your doctor and ask him these questions (directly to your doctor). The only other DHT reducing medication is Avodart (dutasteride) but 4mg is not a standard dose. Too many people think that they are getting a DHT treatment medication with something advertised on the internet or given by unethical doctors. This is a classic story of “Buyer Beware”!

As a physician (who reads medical journal articles regularly) and someone who received scalp micropigmentation (SMP) at your office, I thought your recently published article on SMP in the March issue of The Journal of Clinical and Aesthetic Dermatology was outstanding and very educational. As this article is freely available to the public (without cost) on either the journal web site or (below) through the National Library of Medicine, I thought it would be valuable to mention.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Rassman+pak+2015

After clicking this link, one should go to the button that says “Free PMC Full Text” on the right upper corner to access the full article.

Thank you for the mention. We have other medical journal publications HERE.

LeBron James is probably one of the most well-known athletes in the world. Articles have been written that he is perhaps self-conscious about his hair loss and wears a headband very high on his head in an atypical way to cover his receding temporal hairline. I was watching an NBA playoff game last week and even from my couch (via TV) I could plainly see a bald linear area on the back (right side) of his scalp. I looked at his postgame interview and he clearly has had some hair transplants to his temple areas. My question is: LeBron has worn his
hair in near crewcut fashion since high school. He makes millions of $ yearly and can go to the best surgeons in the world. Why would a strip FUE (as opposed to non-strip FUE) be desirable in someone like him who now has a very visible scar?

It does seem LeBron James had a hair transplant surgery looking at the photos. I cannot say why he would choose a Strip surgery over the FUE surgery. FUE surgery certainly would have spared him of the scar. I do know that curly African American hair is also very difficult for most doctors to perform FUE. Only a select few doctors can successfully perform FUE on curly hair. Even the ARTAS robot cannot predictably perform FUE on kinky hair. For whatever reason why LeBron had the strip surgery, only his doctor can tell you for certain.

Finally, I have found over the years, many celebrities often don’t do their own research or due diligence when choosing a cosmetic procedure. Often times, they are referred to a doctor from a close friend or find doctors via professional/ social connections. This does not mean the doctors are less qualified or not at the top of their profession. It is sometimes “who you know”, not “who is the best” in the decision making process. I find that in most cases the average “Joe” salary man does the best research when choosing the right doctor for their surgery and they have a better sense of the “value” the doctors provide. I am not saying LeBron’s surgeon was not the best, but it is one observation I had from past celebrities and other patients where money was not a factor.

Now, if LeBron ever wants to address his hair transplant scar, Scalp MicroPigmentation would be a great option for him.

I was reading about minoxidil and finasteride as I am wanting to start one or the other but am curious about something.

According to the wikipedia article for minoxidil, the reason minoxidil gains are lost when treatment is stopped is that DHT is then able to re-shrink the follicles unimpeded. But if finasteride inhibits or blocks DHT, shouldn’t one be able to keep minoxidil gains longer if they switch to finasteride with a, say, 6 month overlap of the two? Everything I’ve read indicates you lose everything from minoxidil if you ever stop it no matter what.

Wikipedia is not a substitute for a doctor or definitive information – especially when it comes to personal medical related topics that can impact your health. It is not a substitute for seeing a doctor.

Minoxidile does not have an impact on DHT. We really don’t know the exact mechanism why it works but did observe that new hair was grown on people who used the drug (1960s) when it was used as a treatment for high blood pressure. Once you stop using the medication, what you gained will be lost (despite being on Propecia) because the hair grown on the drug is directly from the drug effects on the skin. Propecia works by blocking the DHT at the hair level and unlike minoxidil will not grow new hair. Propecia may reverse the effect of miniaturization, the start of the balding process in men. If you stop using Propecia once you have been on the drug for awhile, what you gained will be most likely lost. These two medication work in different ways and it doesn’t always have the same efficacy or same effect on the hair. The best of both worlds would be to use both medications and stay on both medications for as long as you are concerned about your hair loss continuing.

Men who use muscle-building supplements (MBSs) that contain creatine or androstenedione may have up to 65% increased risk of developing testicular cancer, according to a case-control study published online March 31 in the British Journal of Cancer. So many of our readers are focus on body building and use these supplements as a way to enhance the benefits of working out. This is a disease that hits many who are just too young.

If and when Piloscopy becomes a thing, will you adopt it too?

I’m asking this because you are a very skillful surgeon and it would be a great thing if big surgeons such as you adopt it..

First, what is Piloscopy. A presentation of an endoscopic approach to follicular unit extraction was presented at the ISHRS conference last October by Wesley. The idea was to use an endoscope to enter the scalp from a 2 cm incision and extract follicular units from below the scalp near the skull side with a 1.2 mm punch under suction. At this point in time, it would compete against a well established FUE procedure which is well understood and used by surgeons world-wide. There is no evidence that his technique (which is mostly theoretical) can work efficiently used, if in fact, at all. There are clearly wounds that would be made at different parts of the scalp which would have to be sutured and these wounds would scar. Anyone who claims a ‘wound-less’ surgery is wrong. If the grafts were taken out from an approach below the scalp, there would be a small wound at every folliclar unit where the connection to the epidermis must be cut to get the follicular unit free of the epidermis. This write-up is based upon my memory of his talk before the hair society in October.

See the Consumer Alert in ISHRS website.

Hi Doctor, your blog is extremely useful. I am an 18 year old Indian who has a hairline like Taylor Lautner when he was 18 years old…

You said in that post that he lost immature hairline rounded corners but otherwise had a juvenile hairline. My question doc is that, is losing the corners a sign of a receded hairline that falls under the category of a maturing hairline or is it still a juvenile hairline. Also, I would also like to point out that few of my friends have also lost there rounded corners. Is this normal. By normal I mean, is it not MPB or is it MPB or is it a maturing hairline or is it a juvenile?

I really hope you answer this question and ward off my worries. Thank you so much! Hope you have a great day!

Actor Taylor Lautner does not have balding. His front corner hair line looks slightly higher now than it did when he was younger. Thus I call this maturing hairline or loss of his juvenile hair line. Not balding.

Finally there is no such thing as “abnormal” MPB. Some people have the genes for Male Pattern Balding and some do not. Everyone has a juvenile hair line when they are in their “juvenile” years. Almost everyone will lose their juvenile hair line as they mature (in age). Some will go on to lose more hair (in their 20s and 30s) if they have the gene for Male Pattern Balding.

what’s with all the horror stories being posted on this blog about side effects that are irreversible- or reversible over a long period of time?

I’d very much like to try minoxidil and would really appreciate a professional opinion on the matter.

These anecdotes about wrinkles, dark circles, etc.. are all over the internet. Yet no official info exists.

What gives?

It just shows that Internet can be a great source of information as well as mis-information. Thus I advocate seeing a doctor face to face to ask your medical questions. Please point me to the link on this BaldingBlog if you have found a conflicting information on side effects. You can easily do a search (upper right corner) for this topic on my Baldingblog.

What other readers write about their personal opinion and anecdotes are just that.

Propecia is reported to have sexual side effects in 1 to 2 percent of men. There are reports that it caused permanent side effects but how the study was verified is questionable.
There are reports of Rogain causing wrinkles and dark circles but they are also anecdotes. I have not personally seen this in my 23 years of practice.

Your website is a great and informative, objective source of information. Well done.

I’m 48 and been on fin for nearly 15 years under the care of a doctor. I started on 1 mg per day, but reduced to 0.25 mg per day mid last year in response to what I perceived as libido issues. These are now resolved.

I have also noticed a return of morning wood at the lower dose. My question is: do you know of any science to support a negative correlation between finasteride dosage and morning erections, and if so what is the mechanism?

Thank you for your efforts.

I am not aware of any studies and I would be guessing at the mechanism of how morning erections are correlated with finasteride dose. It could just be a perceived effect not related to the dose or it may be the dose change after all. It is not hard to imagine that less drug should cause less side effect. The other issue to consider is that would less drug produce less benefit for what the drug was treating. There is a delicate balance between these two statements.

The observation you pose is real (for yourself) but it is difficult to prove on an absolute basis unless you have hundreds (if not thousands) of patients who are willing to take the a pill that is randomized to different dose or just a placebo (“sugar pill”) and report their erection in the morning. Even the doctor overseeing the patient would not know if the pill was a placebo until the entire study was complete (double blind randomized control test).

My personal thought is that if you and your doctor are in agreement with what works for you, then so be it.