Balding Blog

so dr? i interpret from your blog that 5a reductase is responsible for MPB and sensitivity of the receptors have nothing much to do with such catastrophe?

Male pattern balding MPB is not a catastrophe. It is the cards that we are dealt when we are born just like the color of your eyes, shape of your nose, or the way you look. As stated in numerous posts, GENETIC inheritance is responsible for male pattern balding.

One of the mechanism of this genetic predisposition we know of is dihydrotestosterone (DHT). There may be other mechanisms other than DHT but it has not been discovered.

Scientists have found that if you block DHT, male pattern balding can be altered/ halted/ slowed/ temporarily reversed. Male pattern balding is not curable but it can be managed with drugs or surgery.

Blocking DHT is accomplished (as we know it) by slowing down the production of DHT. This is accomplished by inhibiting an enzyme called 5a reductase. 5a reductase is responsible for producing DHT from Testosterone. I suppose there may be another way to block DHT by blocking the receptors for DHT (not the enzyme that produce DHT). This will be new type of drug – yet to be discovered. Another drastic way to address MPB is castration to stop most of the testosterone production thus stopping most of DHT production but this will be drastic.

My point here is that it isn’t about DHT or 5a reductase. It is a genetic issue. So for those looking to completely block DHT with stronger medication such as Dutasteride (Avodart), it does not work as one may hope. Mainly because (I say again) it is a genetic issue. Another way to put it is that if you do not have the genes for MPB, you can have a very high DHT level and you will not be bald.

Pimples may reflect retained hair shafts from the hair transplant or they may reflect an infection. I would go back and see your surgeon to find out which of these is your situation

After a hair transplant, some people develop these yellow pustules as a reaction to the retained hair spicules in the scalp left over from the transplant. These spicules are a foreign body, so your immune system isolates them and pushes them out by draining them. If you only have a few once in a while as you said, it is best treated with warm soaks. This will cause the pustules to ‘pop’ open and drain spontaneously. This problem rarely occurs after the first 3 months following a hair transplant.

The pictures show that you were probably thinning in the area that is now devoid of hair, so the cause is likely due to the progression of the hair loss into the sides. Another hair transplant into this area will solve it; however, be careful that your doctor does not over-harvest your donor area or you will have a new problem – a see-through donor area with possible donor site depletion as shown many times in the RealSelf posts. Your donor density must be close to its harvested limit with an FUE procedure (assuming that you had an average donor density prior to your FUE transplant) so a strip surgery may be safer. You should make sure that your surgeon measures your donor density prior to making the recommendation for FUE or strip surgery.

These lumps may be caused by buried grafts that were pushed under the skin of the donor area at the time the FUE was done. These, if they get infected or are painful, should be excised surgically. Here is an example of buried grafts that was removed after an FUE was incorrectly performed. If you look carefully at each lump, there are hairs and grafts inside the lumps.

Scars like this are usually the result of an overly aggressive surgeon who removed a strip too wide, and the tension may have been too high when he closed the wound. Alternatively, a very elastic collagen is present in some people which can produce stretching of the wound. In this case, the wound reflects your genetic make-up with regard to the way you heal. The best treatment for this is Scalp Micropigmentation (see here:https://scalpmicropigmentation.com/scar-covering/). Sometimes, with scalp exercises, you can loosen up the scalp enough to try to get the scar removed. During that time, the surgeon would perform a trichophytic closure which will help obtain a better scar. If your scalp is not loose enough, a surgery will not work.

This bald stop, if only 2 weeks old, should be examined by a dermatologist. The dermatologist will look for Exclamation Mark Hairs, which might point to alopecia areata as a diagnosis. Maybe it is possible that you have had this for some time and just noticed it which then could be male pattern balding’s first presentation

Hi Dr. Rassman. I am 22 years old but have been experiencing hair loss since I was 13. I have already tried Minoxidil (1 year) and Propecia (1 year) when I was 14-16 without stopping or slowing hairloss. I haven’t really lost much confidence due to my hairloss but it is very notorious now and would definitely like to do something about it. From what I can tell baldness comes from my dad’s side of the family (grandfather and father plus many of my dad’s cousins went bald) but no one has gone bald as young as I have. I think I am a class 3A Norwood and have been thinking about getting hair transplant surgery but I am worried if I will have enough of a donor area to cover the bald spot once the balding process stops, especially if I bald like my grandfather but so far it doesn’t seem to be the case. I was just wondering if at this advanced stage it was possible for a doctor to determine how much hair I will have left.

You need to have a good doctor define what is going on with your hair. Hair loss at 13 is rare, but can occur. If genetic balding has started that early, it would have been good to get a base line on the degree of miniaturization and the change over time. You must have that done now, before you get worse, or you will not know where your hair loss is going. With your history, a densitometry examination with quantification of the miniaturization in each area of your head will point to the long term pattern of your genetic hair loss (assuming that this is the correct diagnosis). There are other conditions as well, so it would be of great value to you to have a consult with someone like me, who is familiar with the causes of hair loss.

Transplantation in a person with certain conditions could be contraindicated. You need to be evaluated by a professional and even sending photographs will not give me the detailed microscopic examination I need. Please do not become your own doctor. This is not a game, but your future look we are talking about.