Category: Hair Loss Causes

Hi there. I have always had a low density of hair around the top part of my scalp since my early teens however I have recently become much more conscious about it. For example after a shower my scalp is quite visible on the top part of my scalp and also when i part my hair when it is dry i can see through it under bright light. I have not undergone any considerable amounts hairloss nor have undergone any noticeable thinning of my hair but simply just feel that my scalp is quite visible on all parts of my top scalp. At a closer look its quite easy to see that my individual hairs are quite equally spaced out and is the main reason why i can see my scalp under the light. I am wondering whether this could just be my natural hair density that i have inherited from my mum (who also has a similar issue) or an early sign of male pattern baldness from my father’s side. Your reply and advice would be much appreciated. Thank you very much 🙂

If your hair is wet it will obviously look thinner as your hairs are separated from each other to expose the scalp. When you’re under a bright light it also will look thinner as the light illuminates your scalp between the hairs. This should be common sense.

If you are wondering if you are going bald you will likely see a pattern of thinning (see: http://newhair.com/resources/assessing-hair-loss/).

If you are still not certain you can see a a doctor for an exam and bulk measurement. We offer this in our practice in a free consultation with specialized instruments that measure, with good accuracy, your present hair loss status. We can often use this information to predict your future direction of hair loss.

I have been taking Propecia for 2 years than stopped for roughly 1 year.

I recently started to taking the medicine again for the last four month, but it seems I am losing a lot of hair.

I am wondering if one experience initial shed again if one stops it for long time and take it again?

In general you should not have increased hair loss after starting Propecia. I have heard of Rogain causing initial hair loss / shedding but not Propecia. I also realize there may be information on the Internet that may say otherwise, but my opinions are based on what I have seen in my practice over the many years. In general male pattern hair loss is genetic and there is no drug or treatment that completely stops the balding process. The medications are there to slow the progression and this rate is different for each individual. When you stop taking Propecia (as you indicate), you experience a “catch up” hair loss over 6+ months where your hair loss state “catches up” to where it would have been without the medication. If you re-start the medication at this point, it will take a good 6+ month to slow the hair loss process down (which means you will continue to see the rate of hair loss despite being on the medication).

I’m intrigued by SMP but concerned about the long-term commitment.

As I understand it, SMP is permanent. I’m worried that as I age I may want a more fitting, “mature” hairline, as my hair grays the SMP will stay dark and appear unnatural, or an alternative hair loss solution I prefer might become available but conflict with the SMP.

Is SMP reversible/adjustable? Is there an option for shorter-term SMP that fades in time (say, 1, 3, 5, or 10 years)?

Scalp Micropigmentation (SMP) like a tattoo is considered permanent. There are lasers which can remove the pigment but the decision to have SMP (or tattoos) should be made with the expectation that it is a life time commitment. There are some that advertise temporary SMP but I have not seen the work or how it fades over time and much of the time, as it fade, it become a half or a quarter done job. Also. it may look great for a few days but as it starts to fade, it can look worse if it fades in a blotchy pattern or fades unevenly.

With respect to changing of hair color (graying), if you have the SMP over the entire scalp, the grey stubble of hairs would not really matter. The SMP will dominate over the grey hairs. Only exception may be if your hair turns completely white (like Santa Clause).

I am down right angry about everyone targeting balding men as the butt of jokes. People do not understand that behind every bald man, is a feeling sensitive man and I wish that people will stop jabbing at us.

In this week’s issue of The New Yorker magazine (January 9, 2006; pages 43-48), there is an excellent article about hair loss titled “The Power of Hair”, by Burkhard Bilger. There is a great quote in the article from an anonymous source that says, “The man who isn’t bald never thinks about baldness. The man who is losing hair never thinks about anything else.” It is full of wonderful stories about balding looking backward in time, and looking forward to genetic cures, cloning, and some of the recent work done on an experimental basis. The article is worth reading, concluding from a patient who had a hair transplant, “Having hair on your head, you feel like you’re still young. You feel like you’re alive. Nobody wants to look old, man. Nobody want to look old.”

Imagine, you go to buy a car, and you are clear as to what you want. A good car salesman is a professional who knows how to bond with you so that salesmen can gain their trust to possibly have you buy the next model up with loads of options without appearing too pushy. You would think that in the noble medical profession, doctors should be better than a typical car salesman. Well, the following are a few scenarios that may surprise you.

Case 1:
You are a 18 year old young man who recently noticed some frontal corner hair line thinning. Seeing your bald father, uncle, grandfather, etc. is not a confidence booster for the future of where your hair line “may” be heading and in a panic you seek the help of the nearest hair transplant surgeon. Offering a surgery to this young man (who may not follow his father’s hair loss pattern) is tantamount to malpractice yet this happens when a doctor thinks about the money he will make more than the welfare of his patient. Rapidly balding at the age of 18 is one thing, but early sign of possible hair loss from the frontal corners does not mean that this man will go completely bald. Worse yet, if you only address the front corner at a young age without a clear diagnosis and the young 18 year old loses all his hair in the coming years, the hair transplant may leave him with a freakish hairline in the front. (I have seen this happen). He won’t even be able to shave it all off if he has the linear strip scar in the back of the head. For that matter FUE still leaves whitish scars from each FUE which show when the head is completely shaven. The key here, is that this young man is desperate not to look like his bald father and uncles, and may grab onto any hair transplant solution offered to him without much long term planning. I firmly believe that patient need to know what is happening to them and they need a Master Plan in their treatment process created with his doctor.

Case 2: If you are young with early sign of male pattern balding, the doctor can offer medications (such as Propecia or Rogaine), not a hair transplant, especially if there is no clear evidence of the type of hair loss pattern and when the risk of shock hair loss is high. More doctors than I care to calculate, are quick to offer a hair transplant solution over a medical treatment that may slow down or reverse his hair loss. If medication alone buys the 18 year old even 3 to 5 years of stabilizing his hair loss and in that time a better prognosis can be made for his further hair loss pattern, it may be worth postponing a surgery, especially if the hair loss does not progress and they decide that they do not need surgery after all. If they do decide to have surgery, it would be an informed decision with plenty of background and education on the Master Plan of how to go about addressing their hair loss as they age. It is a decision based on education over scare tactics and insecurity. More over, the risk of shock loss is lower with with surgery in an older patient.

Case 3:
If you are a man over the age of 25 and you have early, but significant frontal and crown hair loss (Norwood Class 3 or 4), surgery is not out of the question. In my experience about half of these men do exactly the same as above (try the medication first and wait). Those who choose a hair transplant surgery but are told that their hair densities are low, may find that this diagnosis will limit the final hair transplant options as they bald. They might decide to transplant only the frontal area which may be a reasonable thing to do by skipping the crown area. This may be a better option for those with low donor density if they want to have a fully restored (dense) hair line. But if the surgeon offered an overly optimistic solution of covering the front and crown, the patient may run out of donor hair, unable to fully address both the front or the crown to their satisfaction as the hair loss progresses, leaving the work half finished (depleted of donor hair) before the hair transplant procedures are completed. The up-sale here means making more money (just like the car salesman) not thinking about the patient’s long term benefit.

Case 4:
You are a balding man or woman, and are offered PRP (Platlet Rich Plasma) to supplement your hair transplant. With no scientific evidence that is works, the doctor can draw a tube of blood from your arm, spin it down in a centrifuge and inject it into some part of your scalp. He charges you $1500 for this (costing him under $100) and make $1400 for this effort. Some doctors even offer this for an office visit to treat a balding man to regrow hair, but again, there is no evidence that it works.

Case 5:
You are a balding man or woman, and are offered minoxidil injections into the scalp and requested to come back every month for repeat needle injections saying that it will help grow your hair. The money is good for the doctor and may not harm you except in your pocketbook.

Case 6: You are a 29 year old women with thinning hair just like your mother and your grandmother. There is no known disease present in the hair and the doctor believes that you have genetic female hairloss. In 90% of these women with generalized thinning, a hair transplant could be called malpractice. However some doctors will recommend a hair transplant surgery. After one year when there is no significant cosmetic result their solution is to do another surgery to add more hair. Adding hair to thinning area does not always mean you will get visible (worthwhile) cosmetic results.

Case 7:
You are a man or women wanting or needing a hair transplant in a small area and most doctors would say 1500 grafts should be enough. But another doctor tells you that you need 2500 grafts to really give you the best benefit saying more is better. But at $6/graft, that is $6,000 more dollars out of your pocket into his. Did you really need that extra kick of more grafts?

Doctors have clout and their words are more persuasive than those of a salesman who have to work harder to get the up-sale. You will believe a doctor more readily than a salesman, but some of these the doctors have bills to pay, mortgages for their mansion, fancy cars to drive and at times, mistresses who need more than their sexual magnetism to be happy. These are the dollars the doctor must get from you to make a better living to meet his financial needs so up-selling may become his routine.

Case 8:
Plastic surgeons can also fall into these up-seling processes and sell many procedures to patients that they do not need. I met a 27 year old woman with hair complications (bald patches of scars) from a face lift. Now, what would drive a 27 year old women to get a face lift? Two things: (1) Body Dysmorphic Syndrome (see: HERE), and (2) an opportunistic doctor who prays on women with loss of self image.

Case 9:
A general surgeon recommend a surgery for Gall Stones that show up on an X-ray without symptoms, which do not need any surgery under ordinary situations (I am a board certified surgeon who has seen this surgery done just because there is a perceived need for the surgery by the surgeon which correlate to the paying ability of the patient or good insurance). Cardiologist who offer complex tests to young healthy patients, age 35, because they can make more money, even without clear indications other than the status of their insurance. These are just a few of the situations that reflect the up-sale scenario in the medical field. We can digress into another topic of our overly litigious society and doctors ordering excessive unnecessary tests to “cover their ass” but that is another topic and another blog post. Imagine that the risk of dying from a general anesthesia in the year following the surgery in a healthy person generally runs 1:20,000. If you are that ONE, it is 100% so this may not really be a money issue alone.

It goes without saying, that we all want a doctor who we can trust, who will tell us the truth about our medical or surgical needs without bias and secondary gain or interest. In our society doctors are placed in higher moral regards in the totem pole than used car salesman. However, this should not blind the consumer into complacency and you have a responsibility to yourself to do your research before tackling surgery.

i started to take finax(finasteride) 3 and the half year ago.after 6 months it showed wonderful result.but at 1 year mark i again started to shed hairs.my doctor prescribed me dutas(dutasteride)after switching to dutasteride about 2 years ago my hair loss progression got slowdow(just within 5 months).then 8 months ago i again switched to finastride and now i am experiencing massive hair loss.shedding all of the time with vertex and frontal region getting worse.now ,my doctor again prescribed me dutasteride as well as finasteride both(1
pill of each daily ) in conjunction with minoxidil 5%. i want to know would it work or is he just trying different things on me hopelessly??????

We’ve said this many times here on BaldingBlog. There is no cure for genetic male pattern balding -MPB (androgenic alopecia – AGA). Drugs such as Propecia and Rogain helps slow the hair loss down. For some it even reverses hair loss and slows down the hair loss dramatically. Overall everyone slowly loses their hair as it is pre-programmed in to their genetic make up. Finasteride and Dutasteride work in similar fashion by blocking the DHT hormone but it is not a complete solution. Some think Dutasteride may work better but it is not approved by the FDA and the negative side effects are usually higher than Propecia. The answer to the MPB does not reside solely on Propecia, Dutasteride, or Rogaine. You need to find a good doctor who can give you options and a better explanation on the Master Plan of how to go about addressing your MPB.

In a recent post by Dr. Bernard Nusbaum from a series of conversations with varying doctors, he noted that people who use Low Laser Light Therapy who use minoxidil may develop a residue on their hair that mimics hair graying.

A retrospective study examining data show an increased number of visit to the emergency room (from the US Healthcare Cost and Utilization Project). These visits to the Emergency Room grew 50.4% between 2007 and 2012 in Colorado, one of the first two states to legalize both medical and recreational use of marijuana. Also increasing were visits related to opioids (by 42%), hallucinogens (40.4%), sedatives (40%), and amphetamines (20.6%).

i’ll be turning 18 in February . when i was approx 2 years old my aunty accidentally dropped boiled water on my head resulting in completely burning my hair and scalp of forehead and half head. my skin was wiped off after burning causing no hair regrowth on the affected area. my parents consulted many doctors for my hairs regrowth as em a girl . but all the doctors used to say the only way is to do a hair transplant and em too young for it. and yeah i make a hair style which doesnt expose much of my burned area but still some people notice it anyway so now that i’ll be 18 em planning to have a hair transplant . so can you help and guide me with it. thanks.

We have treated several patients (some as young as 10 years old) who have had similar stories of burns to the scalp. Hair transplants will help with covering the bald area from burns and if the burn scars are large, there are other surgical treatments that can succssfully even these extreme cases. Each case is different and you need to first start by making an appointment with a hair transplant surgeon. You can always call my office (800) NEW-HAIR for a consultation with me.