Im a 20 year old male. At the beginning of the year, I had some pretty major peeling of my scalp along the left side of my hairline. The peeling caused the hair in that area to come out as well. I finally went to the doctor and he prescribed me some special shampoo and the peeling has been gone for approximately 4 or 5 months. However, there has been nearly no hair re-growth in the area the peeling occurred, just some small hairs that recently began growing. How long will it take this hair to re-grow or could this loss be permanent?

This sounds like a form of seborrheic dermatitis or possibly psoriasis, though I’m not entirely sure what you mean by “peeling”. Go back to your doctor and ask him/her about these conditions. Generally speaking (without reference to your “peeling”) either of these conditions should not cause hair loss unless you picked the skin and pulled out your hair. I would keep waiting to see if the hair will regrow.

Hello Dr.Rassman,

Is it true that during the second transplant, the physician can cover the first scar that was caused by the first transplant? I would like to do a second procedure but do not want to have multiple scars as well as one BIG scar. Also, is it true that a scar from the transplant will be visible as the person ages and the hair in the back of the head gets thinner? One last question, can shock loss (loss of hair due to transplant) occur for already transplanted hair when a person undergoes a second transplant.

Thank You for your time

The state of the art today is to limit transplanted scars to just one, even with multiple surgeries. If, for any reason, the scar gets wider (5-10% of people) then a single scar can often be corrected in a special surgery that addresses the need for a scar revision. Some surgeons go into untouched areas of scalp and intentionally produce a ‘step ladder’ set of scars which accomplishes two things: (1) a higher yield of hair, and (2) more dollars for the doctor’s pocket. I generally believe that step ladder scars produce a more unsightly look and can not be fixed easily while a single scar is easier to manage in the long term.

I personally had two hair transplant surgeries 16 years ago and you can barely see my scar and it has not changed (as typical) since the last surgery that had been done.

Your last question addressed shock loss in previously transplanted hair. It is very, very rare and if it should occur (less than .01% of cases) it always returns.

China’s Last Eunuch Was Bald?

Mar 9, 2009/by William Rassman, M.D./2 /Hair Loss Causes

I read this news story about the last eunuch in China, named Sun Yaoting. At only 8 years old he was castrated… and looking at photos of him before his death in 1996 shows he was clearly bald. I thought castration was the “cure” for hair loss, not that anyone should ever go that far of course. So what’s the deal?

Here’s the news story: LA Times
Here’s the photo of him from the cover of a book: Book cover

Assuming that the castration was complete, there at least two explanations that come to mind:

1. He had testosterone production from non-testicular sources. We known that women have testosterone and when they lose their estrogen support at menopause, they developing balding.
2. This may show the phenomenon called apoptosis (a cell that has reached the end of its lifetime) and that the hair in the “patterned” areas had reached the end of their life.

I haven’t read the book and don’t know if there are photos throughout, but I would love to know what he looked like at age 40, 50, 60. Was he that bald at 40, 50, and 60 years old? We only have scant facts here, and I tried finding other photos online but just came up with that same one used on the book cover.

Hair Loss and Replacement for Dummies in Stores Now!

Dec 2, 2008/by William Rassman, M.D./1 /Hair Loss Causes

I am very happy to announce that my new book is in stores now! Yes, I wrote an official “for Dummies” book with Dr. Jae Pak, Dr. Robert Bernstein, and Dr. Eric Schweiger… and not only does it cover a wide variety of hair loss topics, but its also a great addendum to the BaldingBlog! You can buy it online at Amazon or at all major book stores.

Dr Rassman

First of all i like many of your readers would like to thank you for the time you take in responding to many peoples worries concerning hairloss.

I am 23 years old and have been using propecia for 1 year now (Thanks to the advice i have recieved for this site), i have noticed that since using propecia that my hairloss has started to slow significantly almost to the point of no further notice of hairloss. I have considered looking into the possibility of a hair transplant possible the FUE procedure, however before taking this step i would be interested to hear your opinions about taking both Propecia and Regaine to tackle hairloss. Is it a worth-while option in taking Regaine along with propecia to furher enhance hair growth before a FUE or stip procedure is considered?

Thank you for you time.

I can’t hurt to add minoxidil to your daily Propecia. Many men do use both medications at the same time with good results. The downside is that hair impacted on the front of your head by the minoxidil may become dependent upon that drug. I generally do not recommend minoxidil prior to a hair transplant for frontal hair, but often in the crown.

I’m 22 years old and noticed my hair thinning out about 4 months ago. Back then it was just some one my left side. Now about over a month I noticed some thinning in my forelock and after examining my whole frontal area it seems over all less dense. How can I have such fast hair loss. Is it common to be caught by surprise so fast? If my hair loss is so fast I don’t think Propecia can even help me so fast. I had my hair mapped a few weeks ago and the doc said it’s significant for my age.

For the young man with short term hair loss from genetics, Propecia has the best chance of working in the front. There is of course, no guarantee, but what it does not reverse may just thicken and the best part is that it may very well stop the hair loss. If you go on it, it will take months to see any impact and once started you should stay on it for life. Going bald is the alternative.

Hello Doctor,

I’d like to first thank you for such an informative blog, it has answered many of my questions. I am a 24 year old male and first started noticing hair loss exactly a year ago after moving from California to Maryland (Not sure if the climate change has anything to do with it). I have always had a lot (almost too much) hair, and other than my dad, all the men in my family have a lot of hair including both grandfathers that are well into their eighties. So I never considered hair loss as a possiblity and have been in denial for the past year. I finally felt like too much hair was falling out in the shower, and wanted to make sure if it was normal or due to mpb.

I visited a doctor, who to my disappointment merely glanced at my hair, and said that it is mpb (Which I found hard to believe as I didn’t think my hair loss was something noticable to the naked eye). He prescribed propecia, and told me to use it with rogaine or alone. Either way, I figured he was my Doctor, a dermotologist, and probably new better than me. It has now been 6 weeks that I am on propecia, and have been experiencing anxiety, aggitation, increased libido, and a great deal of shedding all over my head. The shedding is bothering me a great deal as I feel I am losing more hair than I ever was before, and as a result my hair density is becoming greatly reduced with my scalp slowly becoming visible. More importantly, now that I have been reading through your blogs about all the preliminary tests, mapping, and precautions you take before prescribing propecia to your patients, i’m wondering if I ever should have been put on propecia, or if I was just going through natural hair cycles.

I now have no idea what to do, i’m worried about continued use of the propecia if I don’t really need it and due to the side effects i’m feeling. And i’m scared to discontinue, not knowing if the hair i’ve shed will come back or not, and I really don’t want to cause anymore hair loss by stopping it’s use. At this point I would really appreciate any advice you might have for me as to what to do with the propecia. Also, if you recommend any doctors in the maryland area that I could see i’d appreciate it. Thank you very much for your time.

Kindest regards.

You really need to discuss these issues with your doctor, as there may be other medical problems unrelated to Propecia (finasteride 1mg) or balding. Generally speaking, increased libido is a very real side effect of Propecia (some people think that there is about 10% of men taking Propecia who report this, but I don’t have great statistics available). In contrast, 1% of men may experience a decrease in libido. I can’t tell you whether you should be stopping any medication that I didn’t prescribe to you.

It is true that you should start off taking any medication with a full understanding of what you are treating and what your realistic goals are. A miniaturization study is what I recommend at NHI before I’ll start a patient on Propecia. I do realize most doctors do not perform miniaturization studies, but I would advocate it. At the least you should have good photographs of your head with a short hair cut or wet hair so that the degree of hair loss is more visible.

Some reports available today indicate that even a quarter of a pill of Propecia (0.25 mg rather than 1mg) may have value for hair loss without libido problems. This approach works for those few patients who have experienced a negative impact on their libido. I generally feel that some finasteride is better than none, but that is my opinion and is nessarily not backed by others in the field.

I don’t recommend doctors as a rule, but you can use the physician search at ISHRS to find a doctor in your area and this list is narrowed to the doctors who do this ‘almost’ full time.

How Do I Stop Picking At My Scalp?

Oct 31, 2007/by William Rassman, M.D./14 /Other

I was wondering if there is a way I can treat my impulse in picking out my scabs from my scalp. I am starting to develop bald spots in the front area of my hair. Other than that, I have lots of hair, and don’t think that my hair will ever thin. Also, if I stop picking at my scabs, will the hair ever grow again at the aformentioned bald spots? Or will I have to use aids like propecia, if they would be of any help?

Thank you

You describe a condition known as trichotillomania. It is a sort of obsessive-compulsive disorder and there may be help. But first, you need to see a doctor who can diagnose you and manage your obsessive behavior, one step at a time.

If you are a male and have been diagnosed with female pattern hair loss would a DHT blocker like propecia or avodart still be effective? or is it caused by factors other than DHT?

Men with diffuse hair loss do not have the female version of the process. It is possible that you might have DUPA (diffuse unpatterned alopecia) and some doctors may call this “female pattern hair loss” because it is diffuse and does not follow the typical Norwood classification chart for male hair loss. Before going into the use of drugs, you should try to find out for sure what is wrong with you. If you have DUPA, then Avodart or Propecia may or may not be effective (it is not clearly known). In any case, you need to have this discussion with your doctor. Of course, you need to get a good diagnosis with mapping out your head for miniaturization.

I just did a hair transplant procedure and I have been asked to sleep at a 45 degree angle with 3 pillows in order to prevent swelling. This is supposed to help the fluids drain. However, I find that this causes me to sleep with my head tilted forward. Will this cause stretching of the scar?

I know that I am not supposed to play sports or lift weights for several weeks (by the way how long before I can lift again?) because this can stretch the scar also. But wouldnt sleeping with my head tilted back be better? I am just concerned that sleeping with my head tilted forward would put additional strain on the donor scar.

You should be asking this question to your doctor. The instructions given to you post-op are relatively standard instructions. With respect to the stretching of your donor wound, some stretch is unavoidable. Head positioning after a hair transplant is less important after 3 days, as swelling is less of a problem.