i have noticed that on the side of my head my hair is very thin and i notice bald spots on the side. can you please tell me why? please tell me why?
I would want to see pictures of your sides to differentiate between various forms of balding and skin/hair diseases. Please send me digital pictures to the address on the Contact page and I will give you feedback on what I see. Best if you could come to see me either in Northern or Southern California, where I have offices.
Does wearing a baseball cap every day or using a wig increase a man’s chances of going bald?
No, balding comes from within the scalp, from the genes that initiate each hair to grow. Even wearing a baseball hat for years and never taking it off and all you will have is a scaling, dirty full head of hair if your genetics are not ‘balding genetics’.
I have a doubt. I am 20 and my hair was fine until now,but I feel that my hair is not that dense as it was when I was 10 or 12. Although my hairline is not receded, my dad is bald. Is this a sign of balding or it is natural for eveyone. Also I shampoo my hair once every 3 days with a mild shampoo. Does this have any effect?
A good thorough examination of your scalp with high magnification may show if the early signs of balding have begun. If they have, preventative treatment with Propecia may be indicated. There is no certainty that you will follow your father’s hair loss pattern, but it is a good idea to keep a close eye on it with a good doctor advising you. Shampooing once every three days, once a day, several times per day, or once a year will probably not impact your balding pattern.
Thanks again for your rapid reply. I have a question regarding “telogen effluvium” mentioned in an article authored by yourself and Dr. Bernstein, ‘Follicular Transplantation, Patient Evaluation and Surgical Planning’. (This was a very informative and helpful read) In the article you mention that existing hair in the recipient area could potentially be shed as a result of transplant surgery due to telogen effluvium. You conclude that “it is probably important to transplant enough hair to overwhelm any possible telogen effluvium that might occur so that the net effect of the transplant will be a positive one.”
My question is what exactly causes “telogen” effluvium? And whether there is anything one can do before, during or after the surgery to reduce this side effect and hence achieve better denser results. Since
this article was published in 1997, I was wondering if there has been more studies in this area and if anything can be done to prevent or reduce it.
The telogen effluvium that we have seen with what we used to call ‘Hair Transplant Shock Hair Loss’ can be largely prevented today with Propecia, with which we had little experience in 1997 when the articles were written. We have found that this drug will protect much of the hair that is impacted by genetic balding against the ‘shock hair loss’ we used to see. If the hair that falls out is the permanent hair (which happens rarely), it will usually come back. If “shock hair loss” occurs in women, I have never seen it not return. The cause of telogen effluvium is not known. Most of my views on it are empirical ones that, from a scientific viewpoint, are not proven but it allows me to explain the process to patients and to myself.
I just found an article on the subject of hair loss in children which may have interest to my readers. See yesterday’s question from the young girl with possible genetic hair loss. This article is a bit technical but it does address the problem.
Androgenetic Alopecia in Children: report of 20 cases by Tosti A, Iorizzo M, Piraccini BM.
Research performed at: Department of Dermatology, University of Bologna,
Via Massarenti 1, 40138 Bologna, Italy. tosti@med.unibo.it
SUMMARY: Androgenetic alopecia (AGA) is the most common type of hair loss in adults. Although there are differences in the age at onset, the disease starts after puberty when enough testosterone is available to be transformed into dihydrotestosterone. We report 20 prepubertal children with AGA, 12 girls and eight boys, age range 6-10 years, observed over the last 4 years. All had normal physical development. Clinical examination showed hair loss with thinning and widening of the central parting of the scalp, both in boys and girls. In eight cases frontal accentuation and breach of frontal hairline were also present. The clinical diagnosis was confirmed by pull test, trichogram and dermoscopy in all cases, and by scalp biopsy performed in six cases. There was a strong family history of AGA in all patients. The onset of AGA is not expected to be seen in prepubertal patients without abnormal androgen levels. A common feature observed in our series of children with AGA was a strong genetic predisposition to the disease. Although the pathogenesis remains speculative, endocrine evaluation and a strict follow-up are strongly recommended.
I have been picking my hair for years. I would like to think that I stopped, but I know that I keep picking at it. I now have a series of bald areas where the picking has taken out some hair. Is this permanent? Will it come back if I stop picking at it? Can it be transplanted if it does not grow back?
The medical condition is called trichotillomania. Children or adults sometimes twist or pull their hair, brows, or lashes until they come out. This hair pulling is sometimes a coping response to unpleasant stress and occasionally is a sign of a serious problem of an obsessive disorder. If the picking stops early enough, then the traction alopecia that results will reverse. However, this is not what usually happens as most of the people with this disorder continue to pick on the hair until it eventually becomes lost permanently. The best way to determine permanence is to look at the area with a high-powered microscope. Active areas of trichotillomania show blunted, short hairs which are signs of recent regrowth of plucked hair. When these short hairs do not show up under microscopic examination, the traction alopecia is probably permanent.
Yes, hair transplants can put the hair back in the area of alopecia produced by trichotillomania, but the problem with doing it is that the person will just pluck out the same hair again and again and produce the bald spot. What is the point of transplanting the area of alopecia only to have it returned? The key is to address the trichotillomania from a medical/psychiatric medication or therapy approach and solve the underlying problem. Once the patient knows that the cause of the trichotillomania has been fully addressed, then the reward can be a hair transplant to put their hair back.
Dr. Rassman,
Does blow-drying your hair accelerate hair loss? If so, is it worse if you use a brush attachment? Can you blow-dry transplanted hair?
If the plan is to transplant, say, 1200 follicles, how does the patient know that many were actually transplanted? Thanks, Doctor.
Blow drying does not accelerate the hair loss, but as the hair becomes miniaturized, the hair is more fragile and if one pulls too much or handles the hair roughly, then the hair may break off, giving the illusion that the hair loss is accelerating.
I really do not believe that you need to worry about the number of grafts you are paying for in our office. My finance office reconciles the patient accounting daily and routinely refunds money to patients who did not receive the targeted number of grafts. One of my patients, a well known actor, paid for 2500 grafts at my personal rate of $10/graft. When the accounting was finalized that day, he only got 1400 grafts, so we sent him a refund check for $11,000. After he got the check, he called me and argued with me, telling me that he did not care about the money and that I should keep the money. I refused to do so, saying that if he did not care about the money, he should give it to a charity, but that I had not earned it, so it was not mine to keep. He did make a donation of $11,000 to his favorite charity with my name on the donation. Integrity is either in a person or it is not and I was raised to believe that you can often tell the integrity of a man by his business dealings.
Does a history of scalp psoriasis (assuming it is under control with treatment) rule out using minoxidil or transplants to offset hair loss?
Psoriasis is an autoimmune disease that has a genetic preference in its victim selection. It comes in all degrees of activity. Simple dandruff may be a very low active state of psoriasis and as it becomes more severe, it takes on more of the characteristics of the disease state, where scaling of the skin and red areas in the affected area can become painful. Flaking of the skin can be easily seen when psoriasis affects the scalp. Baldness is also a genetic process but it is unrelated to psoriasis. Both processes can co-exist in the same person and both can be treated independently at the same time.
People with psoriasis often ask about transplanting the disease from one area of the scalp to another. Can, for example, skin taken from the area where psoriasis is active, move the disease to areas in the recipient area that are not showing signs of the disease? The answer here is no, as the disease seems to be localized in the area where the scaling exist and moving the hair from the scaling area does not impact the normal recipient area, assuming the recipient area is normal. Psoriasis can be aggravated in the area where the disease is active by any trauma and surgery is a trauma. Some people who tend to pick at their skin and hair can develop traction alopecia (hair loss) if they persist on picking over a prolonged period of time.
I generally tell my patients to use a topical treatment (steroids) on any active area of psoriasis prior to a hair transplant so that the scaling that occurs will be less bothersome during the transplant process. I try to get good control of any scalp psoriasis prior to a hair transplant.
With regard to minoxidil, if this medication does not produce skin side-effects, then one can use it with psoriasis. If side effects should appear or the psoriasis should become worse with minoxidil, then the medication may not be a good choice.
i am 20 yrs old,and my dad is bald,although he started losing his hair only when he was 37 yrs old,i just have the fear that i may also get bald like my dad,so far now,my hair is ok,just that i have some dandruff .is there any specific age that i wil start balding,or how can i keep my hair healthy and ever long lasting.is it mandatory that i may also lose hair as well as i grow old
Balding almost never hits men under 18, so I have set up a model for the balding process to give some insights into men on the balding process. If you imagine that we are born with different types of baby hair that changes as we get into our first year. Then it changes again through childhood and then again around puberty (11-13). I suspect that these changes are influenced heavily by the hormone DHT. The hair undergoes another change between 18-29 years old.
The changes are two fold. The first part of the process is the advancement of the frontal hairline into the mature position. The typical juvenile hairline of the 12 year old boy is no different than the hairline of the 12 year old girl, but as men (typically 95% of Caucasians) move into a mature pattern with the central area rising about ½ – 3/4th inch above the central crease and the sides move up about 1-1½ inches, giving a slightly receded corner. A small percentage of men (Bill Clinton and Ronald Reagan) keep their 12 year old hairlines through life. Many young men mistake the mature changes in the Caucasian hairline for balding. Such changes are normal, but for the soap actors who must retain their baby face, such changes are devastating, so on rare occasions I have restored this juvenile hairline on famous actors.
Secondly, the balding process may start anytime after this change starts (about 18 years old). Since real balding starts at about 18 years old (caused by the impact of DHT on the susceptible genes associated with genetic hair loss) the faster the fall out occurs, the worse the prognosis. There is some protection against DHT that holds until 18, but when that protection is gone, the faster the fall out, the more is the indication that balding will be severe. On a visit to my office, I will put the hair of the patient on a TV, so that they can look at the hair shaft diameter variability. Normal (non-balding) hair has equal diameter while genetically impacted hair starts to become finer and finer, reducing the diameter to smaller and smaller sizes (miniaturization is the term that doctors use) until it becomes threadlike and just disappears. The drug Propecia blocks the impact of DHT on these impacted hairs, often slowing, stopping or reversing the process over time. The best way to change the course of this hair loss is to take Propecia which means that you must stay on the drug for life. Short of that medication, there is no effective proven medication or treatment. There is no doubt that the hair loss will still pick up again (even on the drug) but it will be a slower process.
As a writer focusing on men’s health issues I would be interested in your comments on two areas of my research.
- I have read a number of reports that suggest that hirsute men (those with a lot of body hair on chest, shoulders etc) are more prone to lose hair from their heads.
- I have also seen reports that the American Red Indian does not suffer from hair loss.
I do not believe these issues have been dealt with by you before.
I too have seen claims that men with heavy populations of body hair have more balding than their hairless or less hairy counterparts. I can say that in my medical practice, the balding men routinely say: “I wish you can take it from my chest or back”. But then again, I do not have the type of interchange with non-balding men to probe the same issue. There is generally a belief that DHT (the evil hormone that ‘causes’ hair loss), also brings on the body hair, the nose hair and the ear hair along with the balding on those genetically inclined balding men. I believe that in the discovery of Finasteride, the people who ingested large amounts of this drug through their dietary intake of a food stock from the rain forest, did not bald, nor do the men born with a genetic defect where they can not make the enzyme that produces DHT. I recently probed a large number of doctors asking if anyone has found evidence of a reduction of body hair, nose or ear hair with Propecia. Everyone liked the question and told me that although they believed it might just do that, there is no evidence that Propecia or Proscar actually blocks or reverses these less than ideal hair locations.
With regard to the American Red Indian, I am fully aware of this observation. His ancestors came from the Alaskan bridge and they had the balding trait, so it is strange that this particular ‘race’ (the great grandchildren of the migrating Alaskan ancestors) is unique amongst all humans as they do not have balding. Of interest, I am not aware that these people are missing any enzymes for making DHT. Could it be that a primitive people actually wiped out balding genes in their brothers in a relatively short time frame of less than a couple of thousand years?
