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How Much is Enough Hair?

This 26 year old man received 2200 grafts into the frontal hairline. He came into my office today asking me if he should do any more transplants. He trusts me and felt that I would give him the correct advice.

His results are remarkably good and he is very pleased with the results. Like most young men, he feels he might be happier with more hair, but he is not at all dissatisfied with the fullness he sees when looking in the mirror. I told him that considering his age and his overall satisfaction with the results, that additional hair transplants should be postponed, and we should watch for more hair loss over the next 5-10 years. If his balding does not progress and his present stage of fullness is maintained by continuing Propecia (he has been taking it for the last three years), then he can increase the fullness with more grafts into the frontal triangle. If, however, his balding pattern should progress to a more advanced pattern, the additional donor hair may be best placed elsewhere on his head, for the best results.

This is a call that could go either way. If he felt that a fuller forelock area was his focus, then I would have no hesitation to fill in the rest of this frontal triangle. Clearly, I am in no rush to take his money and he is in no rush to get more hair, so for the moment, we have decided to wait out the unfolding nature of his future.

Photo on the left is the “before”, from a few years ago. The photo on the right is the “after”, taken today.

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Why Does Minoxidil Packaging Say to Only Apply on the Vertex?

I recently received topical generic minoxidil solution and it says that it is only to be used on the vertex and is not for frontal hair loss. Is this true, will applying it to the front hairline be useless, if so, why?

Also, i would like to use a non-finasteride supplement in addition to the minoxidil, can you recommend one, or which ones are most popular??

The FDA only approved claims for crown benefits for minoxidil so the manufacturer complies with the FDA ruling. I don’t think it’ll be completely useless in the front, but the success rates are likely higher in the vertex than in the hairline.

There is no good substitute for finasteride in my opinion, but a popular natural supplement is saw palmetto. Popularity and reliability are too different things, however.


2008-12-18 14:45:27Why Does Minoxidil Packaging Say to Only Apply on the Vertex?

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How stem cells make hair, teeth, glands and other organs (Schematic Diagram)

It should be clear from this schematic that to make a single hair, requires the use of epithelial stem cells with a lot of coaxing (click to enlarge).

Functional ectodermal organ regeneration as the next generation of organ replacement therapy, Etsuko Ikeda, Miho Ogawa, Makoto Takeo, Takashi Tsuji Published:06 March 2019https://doi.org/10.1098/rsob.190010

Author’s Conclusion about Hair: “Because hair follicle stem cells are the only adult stem cells possessing organ-inductive potential that can be transplanted autogenously, the first human clinical trial of organ regenerative therapy will undoubtedly investigate hair follicle regeneration. The regeneration of hair follicles using our organ germ method is now being investigated in a pre-clinical study to cure patients suffering from androgenic alopecia, with an aim of conducting clinical trials in 2020. This hair follicle regenerative therapy will be a milestone in organ regenerative therapies and will lead to the development of material and responsive infrastructure to realize organ regenerative medicine. Applying knowledge of hair follicle regeneration and expertise obtained from clinical trials to other organ germs or organoids will enable the regeneration of other organs from pluripotent and tissue stem cells in combination with organoid technologies in the next few decades.”


2019-05-19 10:39:39How stem cells make hair, teeth, glands and other organs (Schematic Diagram)

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Why is hair loss irregular with age?

I just don’t understand why the earlier someone starts balding doesn’t always mean they bald extremely quickly. Like what explains a 30 year old balding almost completely in 2 years vs a 20 year old who starts balding at 20 but takes 15 years to show significant loss?

Again, it is tied to the genetics. Each hair in a region has a finite number of hair cycles to it. when the hairs go through its limited # of anagen growth cycles (a growth cycle in men is between 2-3 years), then the hair often dies. The death may be partial in the Folliclular groups (normally say a hair follicle has 3 hairs in a group, one of two my die off) making the hair look like its is thinning from above (it is thinning) and eventually that last hair will fall out sooner than later. So for an aggressive balding pattern (Norwood Class 7 pattern) the number of three year hair cycles for all of the hair from the front to the crown might be 8 cycles (pre-programmed at birth) of 3 years (3 times 8 = 24 years old to balding). Not a good scenario. Most Class 7 men will be bald by the time they are 26 years old. The same thing can occur in older men 30, 40 or even 50 and they may lose parts of each Follicular group of between 2-3 hairs each) and then eventually the rest falls out at its pre-programmed death. Drugs like finasteride, prolong these cycles making the hair last longer.

I hope I didn’t confuse you, but I got stimulated to give you a scientific view of the process that you are describing in different men of different ages.


2020-05-14 06:21:10Why is hair loss irregular with age?

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How Will The Doctor Know To Diagnose My Female Hair Loss?

well i have this thinning problem for the past 4 years. it was started when i conceiving my daughter 4 years back. i was prescribed chronostim for my hairloss and i used it for 2 months and my hairloss stop for a year (2005). the problem seems to show again about a few month ago roughtly on January 2006. the hair loss is diffuse and can be seen clearly on the crown. i started using minoxidil a month ago and my hair still falling.

To be honest i would like to have the hair transplant for the crown only so that it can look more dense.

my question is whether i am the right candidate for the hair transplant?. how will the doctor know that my donor area is not affected by AGA since females always have a diffuse thinning?

A doctor should look at your donor area with a hair densitometer to look for miniaturization. The greater the miniaturization, the worse the donor hair will be for hair transplants.

The important thing to understand is that women are generally not good candidates for hair transplantation, because the ‘donor hair’ is not healthy. If there is an area of good donor hair and the balding area is small enough to make a difference with a limited supply of your ‘good’ hair, then hair transplants MAY work, but you run risks that include the failure of the hair to grow enough to make a difference, and even experiencing hair loss with the transplants (this a real risk). You need to be able to trust that the doctor is not just taking your money for a quick sell, leaving you no better or even worse off once you empty your purse.

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Why Isn’t Minoxidil an Oral Medication?

Why isn’t minoxidil taken orally? I’ve always been under the impression that drugs taken orally (like Propecia) get to the root of the problem as opposed to ones topically. For instance, if caffeine theoretically helped hair loss, I would think consuming caffeine would work better than putting caffeine on one’s head.

Minoxidil was originally used as an oral anti-hypertensive medication for the treatment of high blood pressure. It was unpredictable in its use so it was abandoned, but people taking it (women) would notice face and body hair appearing from the oral pills. That is why it is not used orally today, as it has a tendency to drop blood pressure. That even occurs when you apply it topically, as some of the medication is absorbed into the body after a skin application.

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Hypertrichosis and minoxidil

Will the hypertrichosis caused by minoxidil stop at one time if I stop minoxidil, Or will the unwanted hair all over the body keep growing longer and darker if I keep taking minoxidil? Here in France, no doctor have knowledge about this issue….

If you are getting hypertrichosis with minoxidil, then as long as you take the drug, it will continue. When you stop it, the hypertrichosis should go away in a matter of months


2020-12-15 10:22:36Hypertrichosis and minoxidil

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Widow’s peak

Had a question about my hairline and widows peak. My mom has three brothers. Two have normal straight hairlines and one has a widows peak. My mom also has a widows peak. Her other sister does not. My moms mom does not have a widows peak but my moms dad does.

On the opposite side my dad or grandfather does not have a widows peak. My moms brother who has a widows peak has a good hairline for 60. Much like my moms father up until he passed away at 40. Is it safe to say im following there pattern for hair given my widows peak?

The widow’s peak is a remnant of the juvenile’s hairline which means that the hair around it (when you were a child) disappeared leaving the point called the Widow’s peak. I would suspect that you might follow this pattern as well

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I Am 25 Years Old And I Am Scared I Will Bald In 2 to 3 Years.

Am 25 yrs old. I am suffering from hair fall since 3 yrs. Am not bald but scared that i might get bald in next 2-3 yrs. wen i suffer more hair fall, shortening and regrowing hair gives me good result, but as the hair grows longer,again i suffer more hair fall..over these 2 yrs, i can say my hair has thinned and reduced in density .consulted dermatologist and i was suggested to use minoxidil topical solution(mx-10) + finasteride. I don’t have hereditary. As my dad and grand dad has good hair… so using minoxidil + finasteride is a good move?. after gaining hair back, can i stop using minoxidil as i don’t have hereditary?

Genetic male pattern balding is hereditary but it does not always follow a specific inheritance pattern. If you have the gene for male pattern balding there is no definite cure. There are medications such as Propecia and Rogain to help slow down and even reverse some hair loss but in the long term it is not a complete solution. The first thing you must do is establish a good diagnosis by your doctor and come up with a long term Master Plan and treatment plan. We have written many times that even those people who appear not to be balding but have balding in their families, can be balding and would not know it unless they lost more than 30% of their hair. We can detect that level of hairloss in our office with a special instrument that measures the hair bulk in various parts of your scalp and compares it to the back of the head where balding never really occurs. IF you should have clinically detectable hair loss with out instruments, then taking drugs like finasteride work great to slow it, stop it or reverse it.

If you don’t have genetic male pattern balding, Propecia will not help. This is why you need to talk with your doctor and have a good understanding of your long term goals and plans.
Rogaine and Propecia are long term medications. You don’t just take it to try it you come to a doctors’s office and get your hair bulk measured.