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Thanks in advance for taking time to answer my question. I am 18 years old and have been noticing hair loss on the back of my head (in the crown area) for about 10 months. I guess it has gotten worse with time, I am still getting the same comments/questions from friends, “Are you going bald?” It’s not the best question to be asked at 18 years old. I am having trouble accepting the fact that I am loosing my hair because I would venture to say that I am physical-look-conscious. haha. I have an appointment with the dermatologist in about 2 weeks. The hair I have lost isn’t all that great, but when looking specifically at the area you can tell 2 thinning patches, one on both sides of my head. Will I be able to grow my hair back to normal or will I be able to stop the hair loss? What can I do on my own to help myself either grow hair, reduce the loss, or make it look as though I am not loosing hair? I was under a lot of stress over the past year, but I don’t believe that hair loss would just happen in those areas if I lost my hair due to stress, or could it? Thanks again for reading and answering!

Stress can induce hair loss. The place where the hair loss occurs is usually the weakest hairs first, then the less weak hairs in the ‘patterned’ hair loss that men experience. Where it is lost is genetically programmed in each and every man. If you are losing hair in the front, then if you get stressed, the frontal hair may experience accelerated hair loss. If you are losing it in the crown and not the front, then the crown may experience accelerated hair loss before the front is impacted. What I just said reflects genetic balding, not some other condition causing hair loss. Women do not have patterned hair loss, so they can lose hair anywhere with stress.

I’m 34 with hair only thinning in the front. I first started noticing the thinning at around 21 years. My thinning has been really slow, but lately, in the front, I noticed more than usual. Is this slow, then fast pattern typical for hair loss? I read on some of your posts that loss typically plateaus around my age. Just wondering what I should expect in the future. Thanks for your help.

Many times a person may lose much of their hair without knowing that they have a problem. Blondes or curly hair people with light hair color or darker skin can lose 70-80% of their hair before they note the problem. What you have been calling thinning over the past 13 years, may be worse than you know. A Master Plan can be put together with a good doctor. Your call, of course, because you have control over it.

Dear Dr.Rassman,

Im trying to decide if I’m going to start taking propecia or not. On many places, including this blog, I have found similiar questions – is the positive effects of propecia time limited?

I think most people understands that this is very individual, however, if this product slowly losing it’s positive effects (4-6 years), why use it in the first place?

It feels like you are buying a couple of years of halted hairloss just to, 5 years later, wake up and face the reality – again.

Please advice, Im 24 years young with a Norwood II, I think it’s a good time to start fighting hairloss now but Im not to sure if I want to use propecia yet!

I am sure that Propecia keeps it effectiveness over many, many years. The issue is one of your progressive hair loss that comes with the genetic male hair loss process. The thing that we do not know is whether the loss stabilizes at a final pattern that will be better than had you never taken the drug. I suspect that the answer is that prolonging the hair loss process over many, many years buys you time and in this time frame, it is possible that better and more effective long term approaches to hair loss will materialize. Take the drug rather than lose the hair, and then when the new treatments become available (it is inevitable) you can move to the next generations of solutions for hair loss, whatever it be.

Dear Dr. Rassman,

My 17 yr old son started experiencing hair loss when he was just 12 years old. He was diagnosed with Ulcerative Colitis when he was 10 yrs. His hair loss was rapid and the Doctors diagnosed it as male pattern baldness, since his father began balding when he was 20 yrs. He currently shaves his hair. I was wondering if he would be a candidate for hair transplant? Also, he has a small scar caused by a cut while rumping around with friends. Can hair be transplanted on the scar?

Thanking you in advance,

His Mom

The Ulcerative Colitis is stressful, so I am sure that it is pushing his genetic cards with regard to hair loss. If he is taking steroids for his condition, that will also accelerate the genetic cards. He should be evaluated for miniaturization, get a diagnosis in hand, and understand what is happening to him. He could probably be put on a medication such as finasteride to arrest or possibly reverse the hair loss, and then build a Master Plan for his future hair loss management (which may or may not include hair transplants). Yes, hair transplants work nicely to cover up a scar.

I am seriously considering hair transplantation surgery and had a couple questions. Realistically, what is the average time it takes for any seriously noticeable signs of surgery (swelling, redness, etc..) to disappear? Also, I currently use Toppik to conceal my current hair loss and was wondering how long after the surgery I would have to wait until I could continue my use of the product. Thanks for your help.

Most signs of surgery should be gone in about a week or less provided that good aftercare is done, including careful but thorough washing of the scalp. Swelling has not been a problem anymore in most of my practice with better medications that I use, but it does happen in about 5% of patients and will almost certainly be gone in 6-7 days (worst case in less than 1% of patients, some black and blue may persist up to 2 weeks). The use of Toppik and other scalp coloring agents can be safely used once the crusts are gone from the recipient area (with good aftercare, that would be a week or so).

Redness is rare, but it occurs in people who are have what I call ‘Histamine Positive Skin’ which means that the body produces large amounts of histamine at the point of injury. You can tell if you are Histamine Positive by using your fingernail to scratch your forehead. Those who are Histamine Positive will develop a red streak at the point where the scratch was produced within a minute of producing the scratch and the redness from the scratch will last hours. Treatment in the after care for people who are Histamine Positive should be started with the transplant when the patients qualify for this treatment, although it may not reduce all of the redness, which might last a few weeks with a pink coloring to the skin. The whiter the skin, the more the pink color will show.

Hi Dr. Rassman,

I have started losing my eyebrow, I am on both propecia and rogaine, they work fine on my hair, what can I do to stop eyebrow loss?

Can I use Rogaine on my eyebrow?

There are many causes of eyebrow hair loss such plucking, hypothyroidism, anemia, contraceptives, psoriasis, and any skin inflammatory process going on. Rogaine may help for some of these. Get yourself in the hands of a good doctor to make the diagnosis. If eyebrows are lost, a hair transplant can work to restore them, provided that there is no autoimmune cause of the hair loss and you are in good health.

Good Afternoon Doc,

This question is not for me, but rather my brother, who was recently diagnosed with testicular cancer and will undergo a fairly strenuous (and stressful) 9 week session of chemo, followed by a major surgery to take out some of his lymph nodes.

He’s 23, has a perfect hairline, and no signs of male pattern baldness or thinning (unlike myself) so far. His good looks are definitely an asset and he’s concerned that his hair may go for good because of the stress and trauma he will soon experience. He’s already buzzed his head in preparation.

Now granted his hair is minor relative to the rest of his health, but is there anything he can do to minimize negative effects to his hair from cancer and stress? Would propecia help at all or would it simply get killed off by the chemo (or maybe the two drugs don’t interact at all and propecia would help)? Any other advice?

Thanks for the help!

There are no offerings that are approved for people on chemotherapy to prevent the hair loss that is associated with the treatment. The reason that the hair falls out is because most chemotherapeutic agents try to ‘knock out’ cells that are growing fast (cancers are essentially cells that grow out of control and that is almost the only thing they do). The cells in the body that normally grow very fast are also impacted by these drugs and these normal cells include: certain blood cells, platelets, intestinal lining (causes nausea and vomiting), and hair cells (causing hair loss). The cancer cells could die (that is the hope) while the other cells that get impacted by such drugs also die, but as these normal cells have a source for new cells (like stem cells) the populations usually recover after they go through their natural recovery cycle. Blood cells are relatively short cycled (they grow from a kind of stem cell), but a person may need blood transfusions while the recovery cycle kicks in. Intestinal cells usually re-grow in a matter of days to a week or so (nausea and vomiting stops at about that time) and hair re-grows when it passes through its normal telogen cycle (3-6 months when it re-grows hair probably from some type of stem cells as well).

I have recently been made aware of two new drugs in clinical trials that will target the protection of hair during chemotherapy. That means we might see some new breakthroughs in the next few years, far too long for those on chemotherapy today, but maybe in time for others who go this path.

First off you give excellent advice! I recently had a hair transplant.

1) How long should one wait before engaging in:

• Running (2k)
• Chin ups / Push ups / sit ups
• Light weights

2) How long does it take for the shock loss around the donor area to grow again?. Is this normal?.

Thank you kindly.

Generally after a surgery with the small wounds we create, I tell the patient that they can engage in full aerobics within 5-7 days after the surgey and can even run a marathon at a week. Chin-ups, push ups, and sit-ups are out for about 6 weeks in order to avoid stress on the neck muscles for a strip harvesting procedure. For an FUE harvest, there are no restrictions after 5 days. For FUE, full weights are ok after a few days, but for a strip harvest, you will be restricted to light weights provided that no significant stress exists on the neck muscles. One of the keys to prevent scars from forming, is not to stress the suture line. For FUE, there is no suture line.

Shock loss is unusual in you are on Propecia. Men who lose hair from shock loss. lose it in the genetically miniaturized hair and when this happens it may not re-grow. If the hair is not miniaturized, it should return in 4-6 months. For the donor area, when hair loss happens near the suture line and the person does not have Diffuse Unpatterned Alopecia (in other words has a healthy donor area) and there is not unusual compression stress on the donor wound from the surgery (no significant tension in the wound), the hair loss will almost always return in the 4-6 month time period from the date of the surgery.

Dr. Rassman,
After stopping propecia for about one year I lost a fair amount of hair all over my head including the forelock and frontal scalp area. I have started taking propecia again and I am now about 1.5 months into treatment. If I look in the forelock, I can see a few hairs popping up. I would guess that for every square inch, five to ten hairs that are about .25 to .5 inches long (which is quite different looking than the rest of my hair which is currently about two or three inches long) have appeared. My question is this. How excited should I get. If I’m seeing new hair pop up after only 1.5 months should I keep praying and expect to see even more of these lost soldiers sprouting? Also, another question. I’ve been using Rogain as well, but only at night, for the past few weeks. Will my hair become rogain dependent? I can’t see continuing to use rogaine for much longer, but I was hoping to slow the hairline loss while waiting for the propecia to kick in.

Whatever you are doing, it sounds like it is working — so stick to it. Minoxidil (Rogaine) does require twice a day treatment for it to be effective and if there is dependence, it usually takes months on a twice a day routine to develop.

Please get excited, because that will keep you interested in staying with the treatment. You should get your hair mapped out for miniaturization so that there is some science and numbers for you to track so that you understand what is happening on your head. That is why the mapping is so important and why I mention it quite frequently here.

Stress comes in all flavors including work, school, growing up, relationships, divorce, death in the family, illness and so on. I even found this one thanks to Google News, which connects infidelity with hair loss:

• MP blames infidelity on hair loss