Category: Hair Loss Causes

Hi Dr,
In school we studied how MPB is autosomal and sex influenced, not X-linked. I also read that balding is mixed penetrance. Does this mean there is a possibility that an individual can get a mixture of hair/balding, from various relatives? For example if ones father has no hair loss but his maternal grandfather does.

Thanks for your time.

You are correct. You can inherit balding from either family lines and the genes may not express in your father or mother, but it may express in one or both of their parents. You could be a victim of these genes when you are old enough.

Hi doc, I’m a big fan!!
I saw a post where you mentioned the importance of consulting a doctor before taking meds for hair loss but what is your take on people self diagnosing and self medicating? The doctors I go to don’t do miniaturization test or bulk analysis. Instead, they just glance at my hair and tell my hair is okay. But I am sure I’m having hair loss although my hair looks full.

I could find many miniaturized (thin and lifeless) hairs mostly among the MPB regions. They pull out easily. The density of hairs in the MPB regions is very less compared to the permanent zone. I could scratch my scalp and easily find fine unpigmented hairs with dandruff flakes. Also the MPB region alone is super oily.

I would classify myself as Norwood 1.5 with very minor crown loss. I have been researching online for more than five years. I already bought a strip of Proscar and am waiting to take it.

BTW I’m 25 years old from India. I wish I could come and consult at yours. Sorry for the boring post, but your opinion sure will mean world to me!

The ability to check for miniaturization is in an easily available electronic hand microscope. Place the microscope against a small pea size area of scalp, and look at it. Count the hairs that are thick and then those that are thin. Miniaturization is present when the percentage of thin hairs exceed 20% of the total.

An alternative would be to have one of your friends do it for you with a non-electronic hand microscope. There can be purchased in the US for about $7, but I am sure they are also available in India.

If you’re under a Norwood class 2, I wouldn’t consider that to be hair loss. That said, there could be a good reason for your doctors to not prescribe you the drug, and I would not suggest taking a finasteride (Propecia / Proscar cut into 4 pieces) without a prescription.

I have been on testosterone replacement therapy for 6-12 months, dose recently increased about 4 months ago. I have not noticed any significant change in sex drive (which is low to medium, functioning OK, 44 years old). I have however been experiencing a lot of hair loss and thinning.

This adverse effect is not desirable to me and I plan to stop the testosterone. Will my hair grow back if this is cause? What about hair regrowth if this is also combined with heredity?

Thank You

Testosterone (an androgen) is a known cause of hair loss if you carry the hair loss gene (androgenic alopecia). Much of what you lost, if there is no hair in that portion of the scalp, will not grow back.

Without examining you I can not tell you where your hair loss is in the hair ‘death’ cycle (called apoptosis) that goes with male pattern balding.

Hi there,

I live in Canada, and unfortunately no one here provides miniaturization tests or hair bulk analysis. I understand Dr Rassman has offices in California and NY? Would it be possible to have these done if I came to one of his offices? Also, how much would I be looking at in terms of charge to have this done? I really have been trying any way I can to get a professional opinion with my hair, if I am over reacting or if there is something more going on. I would just like to know for sure, so I can determine my best plan of action, or if I need to be concerned at all. Any help would be much appreciated.

Thanks for your time.

We do this as part of a free consultation in appropriate young men. Our office is in Los Angeles, California. If you’d like to travel from Canada to see me or Dr. Pak, you can request a consultation via our website here. You might wish to send photos in advance of making any travel plans so that we can have an idea of what your loss is prior to your appointment.

If you decide to go to someone more local, just make sure that any doctor you see has the HairCheck instrument to measure your hair bulk.

Snippet from the article:

When patients present with hair loss, dermatologists should focus most heavily on patient histories, according to an expert who spoke at the 72nd Annual Meeting of the American Academy of Dermatology.

Many dermatologists perform a cursory exam and order a battery of blood tests, says Leonard Sperling, M.D., chairman and professor of dermatology, Uniformed Services University of the Health Sciences, Bethesda, Md. Dermatologists often dread these encounters, he adds, because they can burn daylight and often reveal problems that can’t be treated successfully.

Read the rest — Patient history is key when assessing hair loss

Few dermatologists use the modern tools for assessing hair loss (hand microscope to map for miniaturization and the HairCheck device for measuring hair bulk). Most dermatologists don’t like to do hair assessments if they can not tell if a patient is balding or not.

A good example was in a 17 year old that came in to see me last week. I had seen him a year ago at the age of 16 where I did the HairCheck bulk analysis. His family history is significant as his father is a Norwood class 7 patient and two of his three brothers are also balding. One year ago, his bulk analysis showed 55% loss of hair in the front and 30% loss on the top. The crown showed no hair loss. On the visit last week, bulk measurements showed that his hair loss in the front increased to 75% and on the top it increased to 60%. Most significant was his hair loss in the crown, which was 50% of his bulk.

His hair was black, his skin was white, and the hair was medium-coarse, so that to the naked eye he showed only frontal hair loss. I already know that he will probably be a class 7 pattern balding patient like his dad. Without these instruments, I would not have seen any hair loss last year if I had not measured it, but even a year ago, it was evident that he was balding. Last week, we knew what pattern of balding he will probably be developing. He was placed on Propecia 1 year ago, but it did not stop his hair loss. He took the news well and we spent some time discussing a future Master Plan on what he might want to do as his hair loss becomes more evident. Shaving his head once he gets into college might be an option (with or without SMP).

I am a 30 year old male with some hair loss problems. I have been suffering from seborrheic dermatitis for about 2 years. My scalp is naturally quite oily due to this problem. I recently went to a trichologist and he suggested that oiling scalp is a must, no matter how oily the scalp is. My questions are

1. Is it good for me to oil my hair despite greasy scalp? Would it not aggravate seborrheic dermatitis?
2. Trichologist recommends washing scalp daily with a shampoo containing saw palmetto extracts. Do you recommend daily washing?
3. Can I resort to options like Finasteride? Minoxidil again would probably aggravate seborrheic dermatitis?

Thank you ..

I think that the trichologist should be the one to speak with for questions #1 and #2. I don’t know why those recommendations were made. Finasteride and/or minoxidil will not help your seborrheic dermatitis.

If you have hair loss issues and want and medical treatment or assessment, you should see a physician. From a medical point of view, oily hair or scalp does not cause genetic balding and shampoos (even with saw palmetto) do not treat genetic balding.

Hi Doc,
When I was 18, I started losing massive amounts of hair follicles. The funny thing was that the hair loss was uniform throughout the entire scalp, even the permanent zone. I probably lost 50% of my fullness in one year. Then mysteriously the hair just stopped falling out. I’m 30 now and my hair hasn’t changed since then at all. What was happening?

What you’ve described is highly unusual, particularly with the hair loss being uniform and in the permanent zone. Without examining you, I can not tell what happened to you. Since it happened a dozen years ago, I would say that the loss doesn’t seem to be telogen effluvium or some other temporary loss (though I suppose that is obvious by now).

If you are not alright with your hair fullness, then I would be happy to see you and provide an opinion about what your options might be. But at this point without an exam, I would just be doing you a disservice by guessing as to what happened.