Category: Hair Loss Causes

Greetings Dr. Rassman,

I’m age 26, Male. I was diagnosed with MPB through a scalp biopsy. My hair loss is not evident to anyone who is looking at my head. I believe I have only lost a bit of density on the top. My hair loss started about 6-7 months ago. I first noticed a loss of density and then an increase in hair fall during normal activities. I was proscribed finasteride and am taking it.

My hair is relatively long (approx 3 inchs in length). Many of the hairs that I find while combing and shampooing appear to me to be thinner and are definitely less pigmented at one end than at the other. The “older” top inch of the hair is jet black while traveling down the shaft you will find it becomes brown in color at the “bulb” end. It also appears to be slightly thinner at the bulb end. I can tell this with the naked eye but comparing both ends of the individual hair on a white piece of paper.

Can miniaturization take place in one hair cycle or do hairs become less pigmented and smaller in shaft diameter as they enter the telogen phase?

In general, androgenic alopecia / male pattern baldness (MPB) is not diagnosed from a scalp biopsy. A scalp biopsy is usually only used to diagnose and confirm scarring types of alopecia (not MPB). MPB is diagnosed by looking for a pattern in one’s hair loss… which explains why it’s called male “pattern” baldness.

Individual hairs are never followed by tagging them so I really can’t answer your question. I believe that a single hair cycle can be miniaturized at a follicular unit level or die off at that level after telogen occurs. Pigment often is reduced in miniaturized hairs, but not as they enter the telogen phase if they were good, solid terminal hairs prior to that cycle.

I would stick with the finasteride, as per your doctor’s recommendation. I’ve seen many, many cases of this drug working very well for treating early hair loss at the top of the head, like you’ve described.

Snippet from the article:

[Ryan] Shazier overcame childhood taunts while growing up in South Florida, and he continues to have the last laugh over those who teased him when Alopecia, a condition in which the immune system attacks hair follicles, robbed him of his hair.

“I was probably the only little kid walking around with a bald head,” Shazier said. “It was tough because kids are mean. I just embraced it. I feel like if you didn’t like me for who I am, it’s a problem with you. I feel like it’s my signature now. I love having Alopecia. Having a bald head actually saves me a lot of money.”

Read the rest — Ryan Shazier continues to get the last laugh

Even though Ryan Shazier says that alopecia areata is his signature look, many people with this condition still desire the look of a closely clipped scalp that can be achieved with Scalp MicroPigmentation (SMP). See one such patient here.

Hello Sir and thank you for your blog.

I am an 18 year old male with thick dark hair and suffer from moderate hair loss with temple thinning. I have noticed not every hair on my head has the same diameter: they can vary quite dramatically with thick very dark strands and lighter thinner ones. Is this normal ?

Thank you very much for your answer

Yes, it’s normal. We all have varying diameters of hair as different hairs are in different phases of the hair growth cycle (anagen, catagen, and telogen).

If one area is much smaller in diameter (miniaturized) and it occurs in a specific pattern, we call it male pattern baldness.

Snippet from the article:

A longtime swimming buff, lawyer Robert Prignoli typically hits the pool for two hours at a time, four days a week.

But a swim earlier this year in “toxic pool water” at the LA Fitness in Travis cost him more than some wrinkled skin, Prignoli alleges in a $5 million lawsuit.

“Poisoned” by a ”hazardous and toxic stew” of chemicals, Prignoli suffered “severe” hair loss, skin rashes, eye irritation, headaches and loss of taste and smell, for a time, contends his civil complaint.

Read the rest — Swimmer burned, lost hair from ‘toxic stew’ of chemicals in LA Fitness pool, lawsuit alleges

I haven’t seen any studies that show high levels of chlorine in pool water cause hair loss, though there have been a couple previous cases (here, here) where that has been the suspected culprit.

Hi,
I was born with a permanent bald spot that will not regrow hair. I’m sorry that the photo is not high quality, it is near the back of my head to the side.

Click the photo to enlarge:

Was there a question for me? I don’t know why you have this bald spot, whether it was indeed from birth or perhaps a trauma to the scalp in your childhood that you don’t remember. But if there’s no hair that you remember growing there, I would agree that it is more than likely permanent.

If you can live with it, let it be. If you want to address it, please give my office a call at 800-NEW-HAIR. We can fix it with a limited hair transplant or Scalp MicroPigmentation (SMP). As it is a smaller spot, SMP would likely work well to eliminate the contrast between skin and hair color (plus the results would be immediate, as it is not a surgical procedure).

Hello,

Just writing to get a professional opinion. I was prescribed a topical steroid, specifically mometasone ointment 0.1% for skin on my fingers that’s swollen/opened up from a skin infection I had. My question is: do you think that application of this could cause hair loss? Perhaps I am being irrational but with no medical background I don’t know what to think. Doing some of my own research, I cannot seem to find a link between the two, but I am just wondering what you think?

Thanks.

I recall a woman that consulted me for a scar on her knee. I told her that I’m a doctor who treats men and women dealing with hair loss, but I think she just came to my office because the consult was free. She didn’t like my honesty, so she posted a bad review online. To this day her irrationality baffles me.

In a similar way, I don’t understand why you would think a topical steroid applied to an infection on your finger would affect hair loss on your scalp. There is no connection here. Most hair loss in men is genetic and should be addressed with medications like finasteride (Propecia) or minoxidil (Rogaine). I don’t know anything about your hair loss pattern, age, medical history, family history, etc. If your hair loss continues to be a concern, you should see a doctor about possible treatments.

If the ointment’s potential side effects are a concern, you should follow up with the doctor who prescribed it to you, though perhaps you have already answered your own question when you wrote “I am being irrational…”

Dr. Rassman

I am a 22 year old male with no family history of MPB. About 2 months ago I saw a dermatologist that diagnosed me with MPB and wrote be a script for Propecia. His exam wasn’t as thorough as I would have liked (No Pull test or tests for minimization). So I decided to seek a second opinion from another dermatologist in town. She preformed a multitude of tests and determined that under my circumstances I most likely had Alopecia Areata, and then proceeded to give me a cortisone injection. Now I understand that Alopecia is an autoimmune disorder but my question to you is:

1) Can a blood test be used to accurately determine whether I have Alopecia?
2) Would the cortisone injection have a negative effect on my hair loss if I do in fact have MPB?
3) Can I still take propecia, while receiving the cortisone treatment?
4) If I was misdiagnosed, what would be the appropriate measures to take to find out the real cause of my hair loss?

Thanks

Aside from a good history and physical exam, one way to diagnose alopecia areata is a biopsy of the scalp. More importantly, I would need to know more of how you present and what your hair loss looks like.

1. Blood tests cannot diagnose alopecia areata (AA) or androgenic alopecia (also known as male pattern baldness/MPB). Note the word “alopecia” is just a scientific term for hair loss and is not a diagnosis.
2. Cortisone injections do not work for treating MPB or AA in all cases. I realize some doctors use cortisone injections for AA, but it is not a cure and doesn’t work to treat everyone with this condition.
3. Propecia is for treating MPB and you should not be taking it if you don’t have MPB.
4. You need to seek out a doctor who can explain these things to you in person, and give you a diagnosis and a treatment plan with your options laid out.

Taking Propecia (finasteride) without a confirmed diagnosis is not a good approach to your problem. I have written many times about having a microscopic exam of the hairs in different areas of the scalp (miniaturization study) and having your hair bulk analyzed. This system can determine if your hair on one part of your scalp has less fullness than another part of the scalp. In young men, this is the best way to make the diagnosis of male pattern baldness.

Hi,

I’m not sure if my crown is thinning or not…. but its a strange shape…around 2inches circle in diameter with a bit of hair in the middle. The hair around it is quite dense, especially when wet, although when dry because it parts in all different directions it looks thinner.

Is this a normal crown pattern (to have hair in the middle and a circular thinner area around it)? I’ve had it for at least the last 5 years and i dont think its changed. But i also do have a slightly thinned hairline…maybe nw2-3.

I have seen this type of “donuting” in men who have had transplants in the crown years ago, and then had to face balding around the transplanted hair. The progression of their hair loss causes the crown to continue thinning, besides the permanently transplanted hair in the middle.

I do not recall seeing it in a natural balding pattern, though.