Category: Hair Loss Causes

About 3 months ago I found one little spot on my chin which was bald. I asked my dermatologist about it and he told me that hair will grow there by 2 to 3 months. But the spot is now increasing its area and it looks very odd. Also I don’t have any sign of fungal/bacterial growth in that area. Can you give me some idea of what it could be? Disease? Allergy?

Without seeing you, it would be a complete guess. Alopecia areata is a possibility if there is no fungal infection present, such as ring worm. If your dermatologist was dismissive, you can try seeing another dermatologist.

Dear DR.

I’ve been following your blog for a while now and finally worked up the courage to email in. I approached my doctor a short while ago about hair thinning and a red and itchy scalp but was brushed off with some anti-dandruff shampoo and told it was “just the weather”. I have a history of psoriasis and eczema, plus some dandruff but don’t recall my scalp ever being so itchy.

Following the itchiness, I began using the shampoo recommended but still no real benefit, to make matters better I decided to go for a buzz cut and get a number two over. It has since grown out a little, but I noticed afterwards some red patches on my scalp particularly around the crown and itchiness, the hair also looks like it’s begun to thin but I’m unsure if this is just the crown and way the hair grows or the start of balding. I was wondering if the itch could mean the onset of thinning? I’ve also fairly light hair and skin so was unsure if that makes a difference to the appearance plus the fact this is the shortest my hairs been in a long time as it used to be quite long and is still thick.

Any help regarding the possible thinning and or itch would be most appreciated.

Yours faithfully

The itch you’ve experienced could be related to the hair loss you’re seeing, but it’s not a common thing to have an itchy scalp because of genetic hair loss. I haven’t been able to pinpoint a link, but some people have told me they’ve experienced itchiness during thinning.

You should try seeing another doctor, perhaps someone that specializes in skin disorders (like a dermatologist), if you felt that the doctor you saw was too passive. You could have an allergy, a fungal infection, or something else entirely. It could even be scalp psoriasis or eczema, which you do have a history of.

Scratching the itchy scalp would produce the redness, and if you are aggressive you could end up causing traction alopecia, where the hair falls out due to the constant scratching.

Dear Sir,

I have some questions about the nature of hair. I am a 23-year old Asian (male).

I notice that hair at my back and sides are usually thicker and denser than the top. Moreover, when I style or pull my hair I feel that the hair on top feels some pain more easily than the back and sides. It gives me a sense like hair (or scalp) on the top is not as healthy as the rest and easier to fall out.

I don’t know whether this is normal and it’s the same for other people. Can these be signs for male pattern baldness?

Thank you for your help.

Best Regard

This is an unusual question. The best way for you to determine if you have male pattern baldness in its early stages is to see your doctor and possibly have a miniaturization study (microscopic exam) and/or have a bulk assessment of the hair and compare the hair throughout the scalp. Decreases in miniaturization or hair bulk in a pattern (thus the term “male pattern” balding) is a way to determine if your hair loss is genetic (male pattern) balding.

With regard to your pain, although on rare occasions people have reported pain with male pattern baldness, I have never had an explanation for it and it is not a sign of balding that I know of.

Hi Dr. Rassman;

Thank you for this blog and the excellent information you and your team provide. I have one quick question – does the temperature at which Finasteride is stored change its effectiveness?

I’m a 23 year old male, and I’ve been taking 1mg Finasteride for 2 years and 9 months (when I first noticed my hairloss), and my hairline has remained fairly stable until recently. But over the last few months I’ve noticed it move noticeably from about Norwood II to Norwood III, and my upper scalp has begun to thin. I assume this is the result of my genetics gradually beating out the drug’s effects. But as I’m a Peace Corps volunteer living in a southern, tropical country without access to air conditioning, I was wondering if the heat and humidity could have somehow broken down the Finasteride?

What do you recommend for storing Finasteride? Would it be better to store it in a refrigerator or to risk the sometimes 100+ degree heat? Or would you say that the temperature probably doesn’t make a difference, and that my genetics are slowly winning over the drug?

Thanks for your response!

We are told not to let the medication heat up, and you should realize that humidity could negatively effect its potency. The balance between the drug and the normal course of the hair loss process is very difficult to analyze; however, effective drugs of all types do depend upon low humidity and no increase in temperature over 100 degrees F.

As for storing in it a refrigerator, I’ve answered that before here.

If you say DHT is produced in all men, then how is it genetic? And why some get bald and some have a full head of hair even if they also produce DHT?

Dihydrotestosterone (DHT) is produced by all men and women. Testosterone made in the bodies of men and women is metabolized by the liver, and DHT is a byproduct of this process. When a person inherits the genes for balding, this hormone causes the hair to be lost in a pattern that is genetically determined. There are a number of balding patterns that were charted, and Dr. O’Tar Norwood standardized these patterns found in men back in the 1970s.

The treatment for balding is to try to block the action of the DHT at the hair level. Fortunately, the hair follicle is very sensitive to this hormone, which is easily blocked. Propecia (finasteride 1mg) is not a complete block of the actions of DHT on the hair follicle, but about 70% of it is blocked and this reduces the impact of the DHT on the balding process.

So everyone makes DHT, but only the genetic markers in some people will result in the DHT causing hair loss.

I believe I am suffering from diffuse patterned alopecia aka DPA. I was born with an undescended testicle causing a hormonal imbalance in my body. I am now 24 and have been experiencing diffusing hair loss for over 5 years. Ive been scared to take the next step and obtain treatment until now.

There is no connection between the testicle that did not descend and your hair loss. I hope you had the testicle addressed by now with a good doctor, as these testicles that are kept in the abdomen have a higher risk of testicular cancer.

The hair loss sounds like it’s probably typical genetic male pattern balding, for which you should be evaluated by a competent doctor.

We just spoke with a patient who had a full Norwood class 7 balding pattern with an approximate 2 1/2 inch height to the posterior rim. His donor density was very low from the pictures he sent prior to our phone consultation.

He had been making rounds with various doctors showing his picture and wanting a full head of hair. One doctor he spoke with quoted a certain dollar figure and told him that he could get a full head of hair from transplantation. I think he wanted to believe what he was told by this other doctor, and he was basically price checking with us. We told him that what he wanted was impossible, though. His goal was unrealistic and another doctor was about to take advantage of him.

Again and again, I hear of promises about bringing back hair from a hair transplant with goals that are not possible to attain. The promises from doctors who need the income seem to never stop. So as we always say — “Let the Buyer Beware”.