Hi Dr Rassman,

Your blog is a gift so thank you for your efforts. After reading your blog and doing a bit of research I have decided to get some guts and visit my local doctor to start Propecia. I have been on it for two weeks so far with no major side effects – so any one reading scared off by all the internet hype out there - you will just have to suck it up and give it a go.

When reading your blog and looking at the Norword scale I am a little confused by my pattern, I am a 27 year old male and have progressed to the attached photo, its taken in high lighting conditions with a flash, in normal light it doesn’t look too bad and I can style it so its not very noticeable.

In January 2007 I had a full head of thick hair. I currently have many 1cm long thin miniaturised hair still left on the top of my head. I guess I was in denial for the last 2 years as I had a very difficult time plagued with family illnesses and stress. So my question is what balding do I have? Is it diffuse pattern which will end up as a Norwood 6 or 7? Or is it something else? I have a history of MPB in my family.

After much depression and why me’s!!! I have accepted the fact that I am going to be bald eventually.. On my course of Propecia what should I expect? Regards

[you have my permission to publish the photo]

I appreciate you allowing me to publish the photo (click to enlarge). Your hair is thinning in a Norwood Class 6 pattern, which means that you may lose all of the hair in the thinning area. So as a 27 year old man with what appears as miniaturization in the Class 6 pattern (this needs to be confirmed by microscopic assessment), you have a good chance at arresting the process or reversing it since it’s only been going on for 2 years. If you were over 35 years old, I would not be as optimistic. Diffuse unpatterned alopecia (DUPA) would have similar loss in the donor area, so a good mapping of your entire scalp would be warranted. Wait out the first full year on Propecia and then make a reassessment.

Get your scalp mapped out so that you can objectively put a number to the miniaturization and then compare those numbers after a year. What you see with your naked eye may be easily quantified with a good mapping of your scalp.

Have you seen this study? Japanese Nizoral study

Very small sample, but very interesting. Any comments?

Studies are great, but often difficult to dissect from a scientific perspective. Reading about the final results is one thing, but one must always have critical thinking. What I mean by this is that you must think of the motivation behind a study, and if the researchers will benefit from it (for example, by selling more product). Also, the methods used and the sample size are very important. The list goes on and on. Because of this, most studies are fairly weak.

The study in question about Nizoral is almost worthless with only 6 people enrolled. It reads more like someone’s homework assignment. One can not draw statistical significance to the data shown and without it, there is nothing worth believing.

Snippet from the article:

Hair extensions should be banned, according to one of the biggest hair science groups in the UK.

The Trichological Society says a growing number of salons are offering to do them at a cheap price and some hairdressers don’t have the qualifications to put them in properly.

The organisation says that’s leading to more young women suffering from hair problems such as bald patches and alopecia.

Read the full story at BBC News

While it is true that hair extensions can lead to traction alopecia, the idea of banning them likely won’t go very far. Groups like this issue a press release with some big proclamation (in this case, banning extensions), in hopes that a news organization picks up the story and gives them some notoriety. This follows a published report in the British Journal of Dermatology about the dangers of hair extensions. If anything, people should just be more aware of what possibly could happen if they decide to wear extensions in their hair.

I take propecia, which has halted my hair loss and re-grew some hair at the crown and top. If a better drug or a cell-based/cloning procedure comes along, would that mean I could get off propecia to start the new therapy, or will I always have to take it to keep what I got back?

Thank you

If another DHT blocker comes along with less side effects, you will be able to switch as long as it does block DHT. Dutasteride will retain benefits seen from finasteride (Propecia), but safety is still a concern of mine with dutasteride. Propecia is non-surgical (daily pill), and when hair cloning comes to be practical sometime in the future, it will almost be a surgical process of some sort. They’re entirely different processes, and if you stop the blocking of DHT from the drug, you’ll lose those benefits you saw.

Would an untreated ailment such as an exposed pilonidal cyst cause chronic telogen effluvium?

Anything is possible, but likely improbable. Sometimes people try to link one ailment with another. This may be valid in some cases, but often difficult to prove or correlate.

I would like to share my experience with latisse. I am 27. I am prone to balding as we have the genes in our family (father, uncle, and grandfather are bald!). However, I have not experienced any balding since I use propecia regularly (only a half a pill every day or every other day) and also use latisse on my scalp every other 2 days. My hair is thick, dark, youthful, and excellent. My hairline is still practically a juvenile hairline and rests at the upper crest of my brow. These combo of meds (propecia + latisse) seem to be protecting my juvenile hairline even into my late 20s.

Most people in their late 20s are unable to retain a youthful hairline. I started using propecia at only 22, and have added bimatoprost in at 27 years of age. I also use the latisse on my eyebrows every once in a while for the heck of it and my eyebrows are thick and dark as well. I have had absolutely no side effects from the latisse other than my hair becoming darker. It may be a cure/preventative measure to gray hair possibly.

Thanks for sharing! It sounds like you started on Propecia as a preventive treatment not for obvious balding (which I don’t generally recommend) and then added Latisse just for kicks years later. Since there are two medications in use, it would be difficult to pinpoint which of them (or perhaps both) are keeping your hairline intact. It could be possible that the MPB gene skipped you altogether, as it can skip generations. I’m not sure why you’d think Latisse could cure of prevent gray hair, as you’re not likely to see a lot of gray hairs anyway at 27 years old…

But this is interesting, and I do appreciate your 2 cents. If these treatments are working for you and the costs can be afforded, it is tempting to ponder a more extensive study, which I hope is already underway. I am happy that you’re not seeing any side effects. I hope you’re meeting with your prescribing doctor to keep track of your progress, particularly with using Latisse on your scalp, which I’d classify as experimental at this point.

Hi Doctor,

I had a 1500 FUE session 7 days back. My donor and recipient sites has healed well. Everything looks normal. But since the 3rd day, I have been having a lot of pain in the donor area. Its a burning pain. For some reason it gets better at times and worse for no reason. The whole area, although well healed and looks normal from the outside, is sensitive to touch and a bit numb too. Is this normal? I talked to my doctor. He asked me to keep taking the pain killers and give it more time. Is this something to be worried about? Is it going to get better? How much time would it take? Can this be a nerve damage of some type? Is that a possibility? I would appreciate any info/help on this. I was told there is almost a zero chance of nerve damage in FUE.

Thanks.

Pain is subjective and it certainly is reasonable to have post-operative pain as many small nerve endings were traumatized. There is always some degree of nerve damage when you cut through the skin (that is why it hurts). The main issue could be major nerve damage that runs along the back side of your scalp. These are the greater occipital and lesser occipital nerves. My recommendation is to follow up with your doctor and have him/her examine you.

By the way, not all follicular unit extraction (FUE) is the same; each doctor can use a slightly different technique and different instruments. So I couldn’t say how slim your chances were of having a complication, because I don’t know how the procedure was done. You’re not alone though, as I had a similar question posed here.

Hello Doctor,

My hair loss pattern is probably a NW3 and I have little to no miniaturization. I am in my early twenties. I went for a consultation about 7 weeks ago and was told to hold on to take Propecia. My hair loss keeps getting worse. I keep losing hairs and are not growing back. Also, on the sides there does not seem to have the same fullness as years before. I would like to know if I should start taking Propecia even though I do not have miniaturization?

Thanks

I’m not sure how I can help you. A doctor who examined you did not recommend taking Propecia. If you want a second opinion, you need to see another doctor. I am sure if you look hard enough you will find a doctor who will prescribe you Propecia, but I don’t think that is the issue here.

You point out you have “little to no miniaturization“, but consider yourself a Norwood class 3. Some men will recede without noticeable miniaturization, so Propecia could bring value to you. I would disagree with your doctor if you, in fact, have recession beyond just a mature hairline. Without an exam though, I’d have no real way to know that.

(Male)
Why does finer/flatter hair tend to become greasier over a short period of time compared to more full hair? the third day after i wash my hair it becomes greasy. I have tried to limit the amount of times i wash it but it makes no difference

I will have to guess on the answer to this question. If a person with coarse hair and a person with fine hair put out the same amount of sebum from the glands of the hair follicle, then there would be more wax around the hair shaft simply because the fine hair shaft would be smaller. That might appear to be very greasy to you. More frequent washings and using a shampoo for greasy hair may be better for you in solving the problem.

First off, great site doc. Very helpful.

My question is about hair density and thickness. Say one buzzes their hair, should they expect the density and thickness of the hair to be the same over the whole head or are the backs and sides of the head thicker than the top of the scalp, generally?

Thanks, doc!

If you’re not balding, the density should be the same all over the head. If you are balding, density will vary with the pattern of genetic balding. Of course, there will be normal variations as well.