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I’m Mostly Bald In the Front — Am I Still at Risk of Shock Loss?

Dear Dr Rassman

Recently you replied to a young man who had a transplant with you that:

“More importantly, having surgery too early may actually accelerate hair loss and you may end up with negative (worse off) results”

Were you referring to shock loss? I am 26, and also considering FUE surgery, but in the front of my head where it is actually bald now. I was told that I am not in much risk of shock loss because of this, and that transplanted hairs will not be in between existing ones. Would you agree?

I dont want to make my hair loss worse, is there a chance of this even though I will not be going near my existing hair (which is actually quite full). Thank you for your time.

Any 26 year old is at risk for shock hair loss after transplantation. Propecia (finasteride 1mg) is your best protection against it. What you already lost may be permanent, but the remaining hairs and all of the miniaturized hairs that are still present could be lost. What did the mapping of your scalp for miniaturization show? That will define the hairs at risk. Even in areas where your ‘eye’ says it is full, there still might have 50% miniaturization in which these miniaturized hairs could fall out. You need to know the answer to mapping question for a fully informed patient.

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I’m Male to Female Transgender and Was Told a Hair Transplant Is Not an Option

I am transgender male to female, and have male pattern thinning. I have been on hrt and antiandrogens for 2 years and Proscar and Minoxodil for 8 months. I consulted a hair transplant surgeon about transplants on the crown and top of my head, and after a video microscope evaluation he said that he cannot do transplants as there is no room for grafts. He stated that I have not really lost any hair and have great density, just that the calibre of the hair had diminished. Do you think given more time on hrt, antiandrogens, proscar, and minoxodil, that the miniaturized follicles may recover to terminal thickness and if not what other options do I have?

If your hair is miniaturizing, then the hormones and complex medications you are taking may be the cause of your problem. Hair transplants, where there are normal densities of hair, may not help solve your problem. I couldn’t tell you if more time will for sure help your hair.

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I’m Losing Hair in My Donor Area

First of all I, among many other really appreciate your work in helping people out with hair loss questions.

My condition, starting at 18 (two years ago) began abruptly with hair falling out at all parts of the scalp. This includes the “donor area”, sideburns, the top, the crown, the sides…everything. I researched and thought it may have been telogen effluvium but it never stopped which led me to the unfortunate conclusion that i was losing ALL of my hair. Two years later it is still going strong with all parts of my scalp significantly thinned but no receding hair line at all. This past year alone I have been having constant, very serious dandruff ( to the point where I don’t even understand how my skin cells keep up with all the skin shedding) and toward my hairline it almost looks like a rash where the dandruff begins. I feel like either the dandruff is causing hair loss or the hair loss is causing dandruff.

Anyway, I am just wondering if you have any knowledge of this and if there is any sort of treatment just to at least give me some extra tie with my hair since I’m am not even 21 yet! My mother’s father lost all of his hair by 30 but since much time has passed there must be some sort of working treatment other than minoxidil and propecia. I am also 100% Italian if that helps at all. Any thoughts at all will be extremely helpful since I am too scared to tell my parents or anyone because I am so young!

Thank you

You need to see a good doctor. If you are losing hair in the donor area and the sides (as well as elsewhere on your head), you might have diffuse unpatterned alopecia (DUPA)… or there could be something else entirely (allergy? fungus?). It would be foolish to treat yourself and second guess what is going in.

You’re 20 years old, but you’re never too old to lean on your family for support if you need it. I’d start with a doctor to help determine what is causing your hair loss.

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I’m Losing Hair Before I Can Even Grow a Beard!

Hi Doc

I am a 22 male with fine blond hair, and ever since I can remember I have always had fine hair (used to be able to pull out chunks of my hair) however since the age of 16 I have become obsessed with my receding hairline. Don’t get me wrong, I accept the fact I’m going bald and just waiting for the day to come where it becomes TOO noticeable so I can get the clippers on them. What I don’t understand is …. why now? I cant even grow a beard.

Surely it cant be normal for my hair to be falling out and I cant even grow a proper beard? I got stumble on the chin and upper lip but nothing else….. I am starting to think maybe I have a underlying illness that I don’t know about. Could it be because I am a smoker and that why my hair is falling out? Is it normal for someone to be going bald that hasn’t properly finished puberty yet? or maybe I am just being paranoid? I don’t know.

Any advice would be greatly appreciated

Kind Regards

Sorry to hear of your hair loss. It seems you have accepted that inevitable. Unfortunately, if you are destined to go completely bald (Norwood 6 or 7) it usually starts very early, possibly as you described.

Growing a beard has nothing to do with scalp hair loss. It is in itself a genetic trait (like balding). Some men just never grow a beard. Also, smoking is bad for you (hey, I’m a doctor — what did you expect me to say?).


2010-02-03 19:34:09I’m Losing Hair Before I Can Even Grow a Beard!

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I’m Losing Hair at the Temples, Sides of the Head, and Nape of the Neck

I have dramatic hair loss these last three months. Also on sides and behind the head on the neck (not in donor area). Also having too much dandruff and also losing hair on the temple.

Can dupa cause so much dandruff? Can hair loss on sides be caused by aggressive MPB? Can any chemical or toxin cause DUPA by consuming it once? Thanks for answers!

Diffuse unpatterned alopecia (DUPA) is unrelated to dandruff. Male pattern baldness (MPB) does not include hair loss on the sides of the head. I don’t know that you even have DUPA. There is nothing I can tell you other than what you told me. You need to see a good doctor to give us an opportunity to make a diagnosis.

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I’m looking at getting hair transplanted to make the size of my forehead be reduced

I was wondering if anyone has any tips or things to look out for when searching for a surgeon?

Check out the doctor on various websites such as Yelp, Realself and look for places where the doctor got a bad reputation. When you meet your possible surgeon, make sure that you are meeting the surgeon not a salesman or saleswomen. Check out if he/she does the surgery or delegates it to technicians (including the actual cutting, FUE, anesthesia) as it should be done by only the surgeon. Ask to meet his/her patients one-on-one so that you know for real, what the scoop is. See if you like the surgeon (if he is an Ass, skip him, if he loves himself or herself, skip that doctor). The good doctors can be found by researching them.


2019-10-28 13:56:44I’m looking at getting hair transplanted to make the size of my forehead be reduced

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I’m Just Taking Medication Until Cloning is Ready

I have been losing my hair since i was about 17 and a half and i have found it deeply depressing and i am sick of the smell of hairspray! I was just wanting some helpful advice …

I have been taking Propecia for about 4 months and i am yet to notice any results and i am beginning to consider but as i am only 18 i will probably be denied such treatment. I just want something to tide me over until hair cloning is made public. Do you have any idea when this may be?

Any Advice you have i would be very grateful to receive.

Yours sincerely

I just got back from the annual ISHRS hair doctor convention (this year was in Amersterdam), and that very same question about cloning was asked to the experts who where on a panel that I chaired. The answer is that there is no cloning in the near future. I’ll write more about the ISHRS meeting in a future post this week.

My honest opinion is that cloning is still a decade away from being available to the public. They’re making progress, but even the clinical trials seem not to be working as hoped. If you follow message boards, some believers will tell you to give it another year or two… but that’s a moving timeline. I’ve been reading it’ll be available in “5-10 years” for at least the past decade. If you believe that someone has the answer, please let me know as it might just be good marketing hype.

You won’t see results in just 4 months of Propecia use, but stick with it. The most common question I get from 18 year olds on Propecia is about hair loss in the hairline. I don’t know what your hair loss is like, but keep in mind that full regrowth isn’t a benefit of the medication that you should be expecting. Just stopping the hair loss where it’s at is benefit enough. The peak benefits of Propecia takes 2 years and the gain in the second year slowly appears.

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I’m Intrigued By Your Attitude on Shock Loss

Dear Balding Blog Contributors, I mean no offense by this post-I am genuinely just intrigued.

After reading 32 pages of baldingblog.com blog posts which mentioned shock loss, I was intrigued by the attitude that was expressed, which seemed to be ‘shock loss happens, deal with it-propecia may help’.

What intrigues me is that this attitude seems to be contrary to your role as pioneering doctors in this field. After seeing shock loss affect and no doubt traumatize patients paying large sums of money to GAIN hair, should you not be investigating treatments which may help to reduce it? I’m no expert, but off the top of my head I can think of drugs to reduce the immune system’s rejection of hairs, drugs to calm inflammation or stress in the body, topical drugs for the same end, dietary supplements etc.

Am I missing something, or is the attitude I have interpreted you as expressing a little negligent of the well being of hair transplant patients?

Maybe you are missing the point. We (at least here at NHI) do not recommend hair transplants to patients who are at risk for significant shock loss, but some hair loss will occur that is inevitable with or without any medication. There will also be some form of nerve damage with surgery (both strip and FUE) in the small cutaneous nerves that are all over the scalp. This will make the scalp feel numb for several weeks to months, more in some areas than others. There will also be some pain while we’re at it, which may persist after the procedure (minor pain to some and rarely severe to others). These are just a few of the risks associated with surgery. We do not take this lightly. It is an educational and informed process that all surgery candidates go through. You don’t just show up to have surgery and get great hair. There are always these risks that need to be considered for the benefit of looking better (more hair). If any of the risks are unacceptable to both the patient and the surgeon we do not go ahead with the surgery.

Some patients are rightfully concerned about shock loss with hair transplant surgery, but they should not be obsessed with it. Reality is that even without surgery, hair loss will happen if you have the balding gene (pattern). That is the reason why people have surgery, right? And the timing of surgery is highly variable for each individual who comes for a consultation. If the risk of shock hair loss is too great then we will hold off on surgery with medication until the benefits will outweigh the risks. An example of this would be someone in their early 20’s who is rapidly losing hair and is not on medications (like finasteride), but still has a decent amount of existing hair to cover their thinning. These are things that cannot be conveyed completely on a blog, as each case is different.

To be clear, there have been no medications that completely stop genetic hair loss or shock hair loss. At best what we have seen in our 20+ years in practice is that Propecia helps with shock loss. If you can point out the drugs you are referring to which “reduce the immune systems rejection of hairs”, please let us know. Immune suppression is a dangerous process. Take note, however, anti-rejection types of drugs you may be referring to have many unfavorable and sometimes dangerous or deadly side effects. One minor side side effect is… hair loss. Not so simple, eh?

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I’m In My 50s and My Hair Started Thinning After I Took HBP Medication

I am 56 years old. i have been taking medicine for high blood pressure for 10+ years – Lisinopril10/12.5 and Ziac 2.5. My hair has been receding since i have been on this medicine like male pattern baldness but within the last 6 months it had thinned all over.

Do you think it could be the medicine i take, vitamin deficiencies, or poor circulation? I have been using hairloss shampoo Curetage and Nizoral and it seems to be worse. I can see lots of little tiny hairs about an inch long in my scalp. Is this MPB or something else.

Lisinopril and Ziac are both known to cause hair loss. Of course, the treatment of high blood pressure is important to your health. Speak with your doctor and ask him to consider switching your medication routine.

If you are in Los Angeles, consider paying me a visit so I can make an assessment of your hair, your hair bulk and the degree of miniaturization.