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A hair biopsy or rather a scalp biopsy takes a small piece of your scalp out with a knife or punch, and sends it off to pathology to view it under a high powered microscope after it has been prepared and stained. A HAIRCHECK instrument tests for the thickness of the hair in a defined area of the scalp. As this can be compared area by area, the differences always reflects loss of hair bulk or hair mass. The HAIRCHECK test is non-invasive while the biopsy is invasive

I am 23 years old. I would like to know if the shedding phase associated with Propecia is a real thing. I was on Propecia for 2 months when a shed began. I was losing about 3 times as much hair as usual. I read on some online forums that Propecia can have a “shedding phase” where you lose a bunch of hair but it then stops and grows back. So I stayed on Propecia for an additional 2 and half months after the shed began. During this time the shed never relinquished so I stopped Propecia. My hair loss returned to its baseline rate within a few days. When I talked to my dermatologist he had never had a patient experience this “shed.” Also, on the forums it appears that for many people the shed never actually stops. For these people it just continues to fall out. This led me to believe that maybe the Propecia is causing a chronic telogen effluvium that does not cease until the drug is discontinued, as can occur with other medicine. I was considering trying Propecia again. So my question is, have you ever actually seen someone go through this shedding phase and then it stopped and they experienced no more hairloss? I would like to know if I should have stayed on the drug longer or if I just simply did not respond to it appropriately.

There is no shedding of hair associated with Propecia. There is however, natural genetic hair loss that still persist even while taking Propecia. In other words, Propecia does not completely stop hair loss. Propecia does not cause more hair loss. Internet forums are a collection of opinions from its members. It does not necessarily mean it is a definitive source or the correct source of information. If you are seeking a personal medical information, please see a doctor.

I have a Class 3 balding pattern (just corner loss) and I went to a hair transplant doctor who offered to perform 2000 grafts in the front to address the balding area. It seemed to me that I was thinning outside of my frontal balding area. The doctor who offered me the surgery never looked at my hair under a microscope. I am a 24 year old male and I purchased a hand microscope as you suggested on Amazon. When I looked at my donor area, this is what I saw in different parts of the donor area. How would you interpret the hand microscope pictures I have attached here?

This is clearly Diffuse Unpatterned Alpopecia (DUPA) which I originally wrote about in 1997 (see here: https://baldingblog.com/wp-content/uploads/pdf/mp-1997-evaluation.pdf). The view of your donor area shows very significant miniaturization of the donor area which means you are not a candidate for a hair transplant because it will fail. The hairs that get transplanted will look like these hairs and not have much bulk to them. The doctor who recommended 2000 grafts just wanted your money and probably never read about DUPA. You seem too smart for that doctor. The drug finasteride sometimes helps.

I know that theres a small chance that your grafts don’t shed at all, but thats not what I am talking about. I had my surgery done 2 months ago, most of my transplanted grafts shed until the 1 month mark, since then i have kept around 30-40% of the others and they grew like my other hair. Is this normal that not all shed, or should i expect them to also fall out in the next weeks?

It is common to lose all or some of the transplanted grafts between weeks 2-5. Many of the grafts that stick around will grow, similar to your native hair. I transplanted my cousin, and in just 4 months, he had a full head of hair. He told me that he never shed any grafts. Then I did another transplant on him to thicken up the previous transplant because his hair was “fine”. He didn’t shed grafts the second time either. I find that one in 30-50 patients, will not shed their grafts.

Good morning doc. I’m a 26 year old male who is starting to go gray, pretty heavy on the sides & starting to in the front as well. Is this a good sign that said gray hair won’t fall out? Does this mean the gray hair has already passed a barrier to balding or is it just as likely to fall out as the other “youthful” (brown) colored hairs? Thanks for the great blog!

The graying of hairs is independent of balding (no relationship). Graying is genetic and not necessarily reflecting getting ‘old’, and you are not alone. I have seen many men and women who turn gray in their 20’s. The reason most people do not see them is that they hit the dying bottle and never show their secret.

You have what appears to be diffuse thinning from the view in the photo below, but to make the diagnosis, you need a microscopic examination of the donor area to quantify the degree of miniaturization that is present in the donor area directly at the bottom of the scalp in the back of your head. Drs. Rassman and Bernstein first defined DUPA (Diffuse Unpatterned Alopecia), a rare condition in men, common in women. The only treatment for this is finasteride; it works in less than 50% of men. This diagnosis must be made with a hand microscope measuring the degree of miniaturization in the donor area in the back of the head.

Now about your question. You have a very, very small, and limited donor area based on the photo you sent me. The harvestable hairs, even if you don’t have DUPA (I suspect that a good hand microscope will show DUPA), you wouldn’t have enough hair to signifier impact your appearance. Beware of any doctor, anywhere, who would offer you a hair transplant. The results of a hair transplant will be a disaster for you. A dishonest doctor or ignorant illegal technician who does surgeries at a discounted rate may feel you are a good candidate because of the money they will make from you.