Category: Hair Loss Causes

Dear Dr Rassman

I am a 31 year old male and around 5 years ago I realised that I had some hairline recession at the corners. I spent 2-3 years obsessing about this and worrying about whether I would be bald before I was 30 and I also worried about my crown too which looks a bit thinner than the centre of my scalp but remains covered with hair.

As I was so obsessed with this at the time, I tracked my hairloss pattern pretty closely and can safely say that it has not progressed much, if at all since then. The hairline is exactly the same (as is the crown). Maybe the corner areas which were thinning are a bit thinner but the actual area has not expanded. I do not take propecia and would prefer never to take it, for medical reasons.

Recently, for some reason, my hairline has started bothering me again, and feel like I would be more confident if I had it restored slightly so that I could spike my hair a bit rather than have the forelock fall flat over the receded areas. Actually what bothers me is not so much how it looks in the daytime, but first thing in the morning when I wake up. I guess the area which I would need transplanting is around 10-11cm squared in total…maybe 6 on one side and 4-5 on the other. This wouldn’t bring me to a straight juvenile hairline (which I don’t want anyway) but would be enough that I don’t look like I have a receded hairline.

My hair characteristics I am guessing are not great for a hair transplant. I have pretty good density in all other areas but my hair is brown and very fine. People are often surprised by how soft it is when they touch it – to give you an idea of how fine it is.

My question is, would having a small transplant (FUE) in these areas be a bad idea? Is it ever possible to perhaps transplant to these areas at a lowish density, just so that I look like I have a hairline rather than a forelock and so that if/when I lose hair elsewhere then I won’t be left with really dense temples and bald areas elsewhere. I would be happy with quite a conservative transplant which just gave the appearance of some hair in these areas, maybe just enough to style. I also think that one day, if I do lose a lot of hair elsewhere, I would shave my head down to a grade 3-4, but if I did this I would still want the appearance of a hairline to frame my face. With this in mind, maybe it wouldn’t be a terrible idea to get the corners transplanted? If it is not, roughly how many grafts might a 10-11cm squared area need?

Please let me know your thoughts. I have seen some very good FUE hair line transplant results online but I am guessing that a lot of these are very dense/’packed’ transplants.

There is a very simple answer to your question. If you are obsessed with your hair line then you need to make an appointment to see a doctor.

I recently filled a prescription for finasteride at Costco and noticed the manufacturing date was from a year ago (9/2014). The expiration date is 8/2016. Even though it hasn’t expired, should I be concerned that it might’ve been sitting around in a warehouse (either Costco’s or the manufacturer’s) for a year?

It’s Aug 2015 (not 2016) so your propecia has not expired yet. If you are concerned about the potency, just go back to the pharmacy for a new prescription. There is a reason why there is an expiration date and a manufacturing date. As long as you follow direction and use it before the expiration date, you should be fine.

Resveratrol, found in wine, actually in the grape skin, might help in the fight against Alzheimer’s Disease The skin of the grape is a potential treatment for a variety of age related disorders, reported from the Georgetown University Medical Center in Washington DC. In the disease, amyloid-beta protein is deposited in the brain and is associated with this disease, but in a study of 119 people with mild to moderate disease, taking 1 gm of resveratrol twice a day for a year, researchers did not see a significant accumulation of these amyloid-beta deposits. The study is small, so few conclusions can be drawn from this, but there seems to be no harm in taking this drug in these doses, so maybe it is worth a try in those who think that it might help their brain function, particularly if they or a member of their family may have this awful disease.

Hi Doctor, I have been taking 1 mg of finasteride 13 months my hair has become very weak and fine, and still losing hair every time it grows it’s more fine and weak also hair loss at the back of head and facial hair also weak and fine, should i stop this medication? your help would be greatly appreciated thank you.

First and foremost, I am not your doctor so I cannot advise you on your medical treatment. I can tell you that genetic male pattern balding (MPB) is a condition where there is no cure. Propecia is a medication that helps slow down the process. Everyone responds to medication differently. Follow up with your doctor for a recheck and come up with a Master Plan on your treatment goal.

I am curious to know the importance of DHT, post puberty. Is it only significant for men to sexually develop during puberty? Also, is it important for cognitive activity in any way? I ask this second question due to ‘brain fog’ being a reported (although rare I believe) side effect of finasteride.

Thanks for the great site

Dihydrotestosterone (DHT) is one of the many hormones responsible for secondary male characteristics during puberty such as body hair (facial, pubic hair) growth and deepening of the voice. DHT is one of the contributing factors in prostate enlargement as men age. Thus, DHT blocking drugs (Proscar: finasteride 5mg) is sometimes used to treat certain prostate related conditions. DHT is also one of the contributing factors in Male Pattern Balding (MPB) for those who have the genes for MPB. Thus, DHT blocking drugs (Propecia: finasteride 1mg) is used to treat MBP. It is unclear how it may affect cognitive activity but you may read on the Internet that men taking DHT blockers have reported “brain fog” on rare occasions. It is also important to note all drugs have side effects and every patient need to understand the risks and benefits before starting treatment.

Doc, after years on propecia I reduced the dosage due to sides. Obviously you can’t predict my situation, but what has been your clinical observations in patients who after years of use reduced Propecia dosage due to sides. I’d expect 1mg to .5mg to be the usual reduction. Did your patients experience increasedd hair loss?

BTW after 2 to 3 weeks I chickened out and went back to my regular dosage. Any guess What a 2 to 3 week reduction might do?

It is always a good idea to keep your doctor informed about your side effects and changes to the medications you are taking. It has been reported that half dose of Propecia should be 70 to 80% as effective as the full dose.

Part 1:

I really enjoy the website and find it very informative. I have read on this website many times, that many individuals who are destined to be a norwood 6 or 7 and eventually do become either of those stages, are typically men under the age of 30. Moreover, the final balding pattern is established or completely stops typically between the ages of 40-50.

So, how come there is so much uncertainty regarding hair loss between the ages of 30-40 and what will happen and if further progression of hair loss will occur? I would think if an individual has reached their 30’s with a significant amount of hair, then balding should stop.

Part 2:

My situation is like this, I started balding at 19 and am currently 33. I have been on finasteride for the past the 14 years and have remained a norwood 2-2A. I don’t have much body hair or facial hair and have always felt I have low testosterone. What am I a destined to become then, any ideas?

Thank you for following BaldingBlog!

There is no firm rule on what age you will lose your hair. For most men, genetic male pattern hair loss occurs in their 20s and30s. But it can also happen in their 30s, 40s, and 50s. Hair loss does not completely stop. We don’t necessarily fit neatly into a box. This is why patients go to doctors for an examination.

If your hair loss is a Norwood 2 there would be questions of why you would have needed to be on Propecia in the first place. A Norwood 2 hair loss pattern do not progress to a Norwood 6. Norwood classification is not a chart for “progression” of hair loss. It is merely a pictorial description of your genetic hair loss trait. In the end only your doctor can tell you about your treatment plan. If you suspect a low testosterone level you should discuss your concerns with your doctor and have a test to confirm this (…if it is an issue). Testosterone levels have nothing to do with genetic male pattern balding. You can have a very high testosterone level and have no balding and no beard. You can have a very low testosterone level and be completely bald with a full beard. There is no correlation with facial hair and testosterone levels.

Hello Dr.R. I am an 18 year old. I have been classified as a NW1 by a hairloss center online in London. I however observer minatuirzed thin hairs on the leading edge of the hairline and the leading edge of the hairline corners but the hairs beyond this very forward part of my hairline are very thick. Does this indicate Male Pattern Baldness or future hairloss? If not, till where should miniaturisation exist beyond the leading edge to say that MPB exists.

Other details- I have 12% vellus hair and 88% terminal hair (I checked) and good hair density in general.

I sincerely hope you clear my troubles like you have for several other people on this blog. Thank you for all the information Dr.R.

It didn’t know there was a NW 1 classification. Many non balding men and women have fine miniaturized or vellus hairs on the leading edge of the hair line. This does not mean you are balding. There is no way to determine if you are going bald based on these things. If you see a hair loss “pattern” that develops, then it may be male “pattern” balding.