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Started suffering sudden and rapid hair loss, most noticeably on the sides and back of head.. Thought it was telogen effluvium at first but it appears the hairs are miniaturizing rather than just shedding (hairs are coming in thinner and scragglier and not growing as long). Can DUPA be caused by anything other than androgens? If caused by stress or hormonal imbalance or thyroid, if the issue is addressed can the miniaturization be reversed? Or can only shed hairs from TE be grown back to normal?

Most men who say that they have DUPA, don’t have it. As the doctor who first identified DUPA, I don’t believe that anyone knows what causes it. It may be uniquely genetic because it is similar to some women with diffuse alopecia which presents similarly to men with DUPA.

Ive been using 5% minox for about a month now along with dermarolling once a week and anti dandruff shampoo. My hairline hasnt improved much but i noticed lots and i mean LOTS of small hairs around the hairline after shower today. I heard hairs shrink before they fall out, the little hairs actually lay flat on my forehead so they mask my slightly receded temples nicely. Are those new hairs or are they about to fall out (i hope they dont because there really is a lot of them)

The best metric for measuring your progress of lack of progress with minoxidil or finasteride is the HAIRCHECK test (see here: https://baldingblog.com/haircheck-test-how-it-is-done-video/) . Hair is too important to take hair loss any way but serious. A man from Reddit came into my office today because he was very worried about the hair loss he saw in the shower. He also was worried about his hairline, so I did a HAIRCHECK test and told him he was not balding at all, and his hairline was just maturing. He smiled as he left the office because I took a weight off of his back.

The question I believe is just how many grafts you need, as that should determine what is done. There is often a limit as to how many grafts can be removed from a strip surgery and that reflects the donor laxity (redundancy of the scalp skin) and the donor density. If too much scalp is removed, problems could develop with the wound.

FUE scars can show on a shaved head, especially if you had (1) many FUEs and (2) a large punch used to create the FUEs. If you shave your head you will see the areas where the follicular units were removed. Longer hair can always grow out to cover it. For people who have significant scarring in their donor area, we often do Scalp Micropgimentation (https://scalpmicropigmentation.com/). The people with most detectable scars, when the surgery was performed with small punches, are those people who may have had a lower donor density so that the missing follicular units are more detectable. In people who have higher donor densities, there is enough hair not to notice the missing follicular units.

Drug side effects — Hair loss can be a side effect of certain medications, including lithium, beta-blockers, warfarin, heparin, amphetamines and levodopa (Atamet, Larodopa, Sinemet). In addition, many medications used in cancer chemotherapy — such as doxorubicin (Adriamycin) — commonly cause sudden hair loss affecting the entire head and some of these medications can actually trigger the genes for hair loss in men and women.

Symptom of a medical illness — Hair loss can be one of the symptoms of a medical illness, such as systemic lupus erythematosus (lupus), syphilis, a thyroid disorder (such as hypothyroidism or hyperthyroidism), a sex-hormone imbalance or a serious nutritional problem, especially a deficiency of protein, iron, zinc or biotin. These deficiencies are most common in people on restrictive diets and women who have very heavy menstrual flow.

I can’t write a book on it, and I am sure that there are MANY drugs that I have not mentioned in this group.

Doctor Rassman.

How are you. I love the website. My question surrounds the importance of finding an ethical doctor who is not just about the money. As a layman (like myself) I am not that experienced in hair transplants and what to do, I rely solely on the doctor. The only experience or knowledge I have is by coming on your website and reading things about hair loss on the internet.

So, How would I know who is a good doctor, what is the proper number of grafts I should receive, and if the doctor places grafts into my head is he placing them in the right spot so I won’t have shock loss etc etc.

I would mostly go with what the doctor says because I am putting my trust in him, unless he says something totally absurd then I know to back off.

I can read all day on the internet about hair loss and what to do, but how do we truly know whatever the doctor says is in a patients best interest and isn’t about the money, because every patient and situation is different.

Thanks

I put together a guide for patients, where I detailed the approach I would take if I selected any doctor for any reason. If you go for a consultation and end up meeting a salesman, then I would generally suggest that selling is the doctor’s priority. If you come to my open house events, you can meet many patients face-to-face and look at the quality you will get (as what you see is what you get). Photographs can be misleading and show what the photographer wants the viewer to see. Photos of a doctor’s work should be augmented by meeting real patients in person.

We all have instincts which we must rely on, so use your instincts to know if you met the greatest bullsh*tter of all time. Some of the worst doctors in this business have a style like a con man and the looks of Brad Pitt. Can you tell a con man when you meet one? The recommendation of the doctor, with regard to the work you will need, should match other opinions you should get from other doctors. If they do not match up, then you need to challenge both recommendations and see if they make sense.

Fortunately, I have written many books and articles which cover most everything that you need to know (see our Medical Publications, where everything is documented). Lastly, ask yourself if you like the doctor personally, and if you trust him/her to be there when you need him/her. I carry my cell phone 24/7 and every patient has 24/7 access to me. That is my way of telling the patient that I will always be there if he needs me at any time. Over the years, I have helped men who had heart problems, having nothing to do with the hair business, so that is my way of saying “trust me”.

IN 1911, Polish chemist Casimir Funk made one of the most influential biomedical discoveries of all time. He learned that a disease called beriberi affected those who ate a diet of mainly white rice, but not those who ate mostly brown rice. He isolated a chemical from rice bran, showed it could prevent beriberi, and called it “vitamine”.

We now call that compound vitamin B1. It is one of many essential nutrients that the human body cannot produce in sufficient quantities and that we must obtain from food. Casimir’s breakthrough led to similar discoveries, including the compounds that prevent scurvy and rickets. In 1920, the British chemist Jack Cecil Drummond proposed dropping the “e”

I’m sorry to disturb you with this message, but I’m really confused about something and I was out of options… I have been using Minoxidil for more than 9 months and finasteride for 8. I have read somewhere that I could never stop minoxidil because I started it before Finasteride and so that my hair was already dependent on its effect and that finasteride would not really work well too because of it. Is that true ?

I’m sorry if my question is stupid… Have a good day, Sir.

There is a lot of confusion out there. Minoxidil develops minoxidil dependent hairs when it works. Finasteride reverses miniaturization and possibly brings back the hairs when it is almost gone. These are independent so one can be used without the other although the two are complementary to each other.

Finasteride usually start quickly by reducing shedding and then stopping or slowing the hair loss in a few months. Reversal, if it is to occur, will happen between 4-18 months. Some men don’t ever see new growth and have to accept slowing the loss of stopping the hair loss. A few men will find increased shedding when they start taking finasteride. This is a sign that it is working so i tell these men not to worry, just be patient.