Balding Blog

I’m an 18 year old male and was recently told by my dermatologist that I am starting to bald. My dermatologist told me that I should just take Rogaine, since I was able to catch the balding early. However, the thinning is happening in spots just behind the hairline, and I know that Rogaine has not been proven to work in that spot. Should I go back and ask for Propecia?

If your only concern is hair loss at the hairline and the immediate area behind it, you should be aware that most of the studies, which documented positive effects of Propecia, were done on crown and vertex area. This is also true about Rogaine. With that said, Propecia is the best medical treatment for genetic balding, but you need a diagnosis by mapping out your scalp for miniaturization to determine if this is indeed genetic balding or just the maturation of your frontal hairline. One reason I usually recommend finasteride (Propecia) to my male patients, because of its ease of use (one pill a day rather than applying Rogaine solution to the bald area twice a day).

In the office yesterday, I saw a young man who was started on Propecia a year ago. He responded well in the frontal area, reducing the miniaturization from 70% to 30% and he had more hair in the frontal area from picture comparisons we had of him and his own assessment. What this means is that just because the official line is that Propecia may not work in the frontal area, clearly we all respond differently. He was smiling (certainly not complaining) about all of that new hair in the frontal area.

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Hi. i been using rogaine four months now. i had a hair transplant a year ago and i have shedding in the areas that were transplanted from rogaine and get irritation from it only when wearing a hat. Could it be my hat causing the the shedding at four month. And will transplanted hair grow back even if it been a year ?

It is difficult to know what is truly going on.

1. Rogaine can cause irritation. If it is causing irritation, it should probably be stopped. I doubt that the irritation is causing hair loss unless you are scratching it.
2. Wearing a hat can cause irritation. If it is causing irritation, you should stop wearing it. I doubt that the use of a hat is causing hair loss.
3. Hair transplants should not fall out, since they are considered permanent. If hair transplants were to fall out (and never grow back) no one would be doing it. I doubt that the falling hair is the transplanted hair unless you are traumatizing it. It may be the hair that was originally there (native hair). If the transplanted hair falls out for whatever reason, it should grow back.

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Hi, thanks for this service. While I am somewhat suspicious of your constant hawking of propecia to the exclusion of topical solutions (pun intended) such as minoxidil in your earlier entries, I would still love any insights you have on that topic. I am a 25 year old man. At age 18 or 19 my internist noted some frontal hair thinning/loss, evident to me retrospectively when I examined pictures (esp. if flash was used). I was immediately placed on minoxidil, which seems to have not only arrested the loss but perhaps, over the last 6 or 7 years, even allowed some regrowth toward the front. Finally, now, at age 25, I am noticing some thinning and folicle miniaturization in the center and back of my head for the first time, though I am still at the point that only other balding men notice—my female friends and loved ones think I’m neurotic and that even my minoxidil use is unnecessary. What I wonder is whether I should expect acceleration of the loss or merely loss at the same rate; if the loss rate itself is constant then I think I’ll try to hold on by using topical minoxidil.

Second, if I were to switch to a dht blocker, would you recommend avodart or propecia, and would you recommend cessation of minoxidil? I worry that after 6+ years my hair could do unpredictable things without the minoxidil. Lastly, I don’t think I yet qualify on any of those charts as balding, though I myself notice some thinning and, of course, many hairs in my hands when using hair products.
Thanks.

A DHT blocker impacts the cause of male patterned hair loss, so it is the best approach to use a drug that is known to be effective and safe. Avodart is not proven to be effective or safe (no scientific study for hair loss victims) for treating hair loss, but I believe that it is effective. Notice I did not say I believed it to be safe, because long term use of this drug has been on older men with prostate problems, not young men with hair loss problems. Is there a long term Vioxx type problem hiding in the closet? I don’t know, nor does anyone really know.

I tell everyone who is on minoxidil that when it is working to stay on the topical medication, for stopping it often causes ‘catch up hair loss’. Frontal hair loss and early crown hair loss indicate you may be a Norwood Class 3V pattern. You need to have your hair and scalp mapped out for miniaturization to make the diagnosis, otherwise you are flying blind.

I have no connection to Merck (producers of Propecia) and I am not ever paid by them for my opinions on this drug. I do not now, nor have I ever owned stock of this company (as I’ve stated before), so I am clean in expressing my opinions on this drug, because it has had wonderful results that I have seen in many of my patients.