Category: Hair Loss Causes

doctor Rassman, How come there are people who have BPH or even prostate cancer and still have a full head of hair? We know DHT is a cause of an enlarged prostate and prostate cancer, and DHT causes hair loss as well. There are so many people with a full head of hair that get BPH and prostate cancer and then there are bald people who don’t have prostate problems at all. What is the connection there? I am kinda confused. So some people don’t have the genes for hairloss and have the genes for BPH and then DHT does its work?

Let’s make it simple —

Genetics cause male pattern hair loss. If you have the genes for male pattern hair loss, DHT is what ultimately causes the hair loss. If you do not have the genes for male patten hair loss, then you can have all the DHT in the world and you will not have hair loss.

Prostate cancer and benign prostatic hyperplasia (BPH or enlarged prostate) has nothing to do with genetic hair loss.

Is staying at a norwood 3 rare?

Dear Dr Rassman,
My father (70) and brother (48) are both pretty advanced norwood 3’s, yet they have no hair loss on top or at the crown at all. I am 28 and it looks like I am starting to head the same way. Is it rare for men to reach norwood 3 and have no further hair loss on other parts of the scalp? I ask as I rarely see other men with this same hair loss pattern in everyday life. Just about always there is some crown thinning too it seems. If you are a norwood 3 does that make you a good transplant candidate as the hair loss is limited to a smaller area?

Thank you

I think the answer to your question is all around you — they’re shopping at the mall, walking out on the street, sitting at a restaurant… or as you note, take a look at your family! Many men are Norwood class 3 and that is their final hair loss pattern. These men make great hair transplant candidates. Of note, only about 7 to 8% of men in the world are Norwood 6 or 7.

It’s very important to note that the Norwood classification chart is not meant to be used as way to chart the progression of hair loss. It is meant to be a description of all types of hair loss patterned men. I would think more men are Norwood 3 than Norwood 7 by a long shot.

So no, I wouldn’t say a Norwood class 3 is rare at all. It’s possible you don’t see men with similar patterns because they’re treating this loss.

This post comes from Dr. Richard Shiell:
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Dr Masumi Inaba, who wrote a book on Androgenetic Alopecia (Springer 1996), was firmly convinced that the increase in Western style animal fats was causing an increase in baldness in young Japanese males. I am not sure that his statistical method would stand rigid scrutiny however.

The same lack of good statistics applies to all the popularly believed “causes” of baldness. Forty years ago when I was a young HT surgeon, the patients all blamed the wearing of hats in the Army or Police Force as the cause of their baldness, when I am sure that it was just that they entered these institutions at the precise age that severe AGA usually kicks in (19-21 years old).

I certainly believed throughout my career that “gym-jocks” lost hair more quickly than their “lay-about” brothers and cousins. The problem is that many were taking steroids and other “dietary supplements” so it was a very confusing issue to ascertain causality.

I had one of a pair of 25 year old “identical” twins who had lost significantly more hair than the other. When I spoke to the more hirsute twin about it he laughed and said it was because his brother was married with a child and mortgage, and had more stress. So there you have undeniable evidence from a large series of ONE case!!

Hair loss is the results of many complex things. For example, dietary supplements like whey and a variety of branched amino acids including creatine, push up men’s testosterone levels (and their DHT levels), which in turn accelerate hair loss. We are what we eat, I just wish I understood all of the complexities of diet as it impacts the hair loss we see.

I have been taking propecia for almost 6 years and its worked perfectly. However, recently, I started to have an itchy rash all over my chest. I wanted to know if you have seen this before and if I do have an allergic reaction to Propecia, what options are available to me as I really do rely on it. Thanks

I have never seen an allergic reaction to Propecia that caused a rash on the chest. I suppose anything is possible, but it does not seem probable based on your brief description alone. I would follow up with your doctor.

Snippet from the article:

It sounds more like an explanation that would be used by nursery children than respected scientists, but researchers have found that rather than losing their hair altogether, people who are going bald are suffering from “sleeping” hair follicles.

Trichologists have discovered that hair follicles on the scalp can become trapped in a resting state where they do not grow new hair, leading to thinning.

They now claim to have identified a way of waking the follicles up again to help restore a fuller head of hair to people who are going bald.

Read the rest — Balding men offered hope of waking their ‘sleeping’ hair

We have long believed that the stem cells that eventually grow into hair are probably still present in many people. Are they really dead in the balding man or can they be restarted by finding some defect in the pathway to the creation of an anagen hair? We really do not know this, so is it reasonable to call this sleeping hair?

L’Oreal in Paris carried out the research, and they’re reportedly working on a shampoo or cream to be a used as a new hair loss treatment. No time frame has been announced so far on this treatment, though.

Hello Doc,
I have recently been diagnosed with low testosterone levels and my doctor recommended that I start testosterone replacement therapy. Is it possible that once my testosterone levels reach “normal” or average levels that I will experience hair loss?

This is something you need to discuss with your doctor and express your concern to him/her. If you carry the genes for genetic androgenic alopecia (AGA) then testosterone replacement therapy can potentially cause hair loss.

I am 40 years old. I have bald areas corresponding to Norwood 3 Vertex but thin (but stable) hair corresponding to NW6 according to two doctors. I am not taking Propecia for 18 months.

1. Can I still progress to a NW6?
2. If you (Dr. Rassman) were to transplant me, would you fix the NW3 regions or the NW6 regions or both?

Generally, when doctors assess patients with a Norwood scale, it is meant to categorize your eventual balding pattern. You may not look like a Norwood class 6 right now, but it seems two doctors that have examined you think you are going to eventually be a Norwood 6. This likely means you are not a Norwood 3V, but you have a pattern leading to a class 6.

Many men on finasteride may never lose all of the hair in the end pattern, but no one really knows. Best to get good baselines with bulk measurements along with some good pictures, and then repeat them serially year after year to know where you are actually going.

So a good doctor should recognize this and transplant the hair with both a short term focus to address your immediate needs and a long term focus leaving enough donor hair available to address the evolving situation as it unfolds. In short, this is what I always stress about on this blog and in my private practice. This must be a Master Plan for each patient before going forward with the first hair transplant in what may become a course you will follow over your lifetime.