Dear Dr. Rassman,

I will try to keep this simple: Once a man with hairloss can make out his “horseshoe” pattern, is it possible or common for any of the “horseshoe” hair to bald at a later point?

I am 26 and, while I don’t have any bald spots, the hair on top of my head is thinner and more limp than the hair on the sides and back of my head. My “horseshoe” hair goes all the way up the sides of my head, and does not dip down low at the back of my head. Given that this hair has remained unaffected for the past 8 years since I’ve been thinning, is this indicative of hair that will remain unaffected for the remainder of my life?

The thinning in a young man at 26 years old which can produce an apparent horseshoe pattern, may be stable for years in the horseshoe itself. I have seen men that have a horseshoe pattern which is much more narrow than most Class 7 pattern patients. I often classify them as a Class 8 pattern to reflect the narrow band.

The normal height of the posterior part of the horseshoe is somewhere between 2 1/2 and 3 inches high (not counting neck hair). If this Class 8 patient was to have a hair transplant to cover his entire head (assuming the Class 7 pattern) he will likely have moved some of his non-permanent hair in the procedures. With the strip method of harvesting, the scars can be vary bad for cases this large. I have unfortunately seen this type of pattern with the scars produced by overly aggressive surgeons, and each one is a real challenge.

I couldn’t tell if it’ll dip down further as the years progress, but measuring the bulk of the remaining hair should be able to tell you if that area is continuing to thin.

Doc..

I can’t take the PG in minoxidil formulas and the foam seems to get more on my hair than my scalp. I have been taking 5% non PG Formulas from Dr. Lee who is now out of business. How much hair can one expect to lose going from a 5% formula for years to 2%.. which I’m assuming has less PG. is that a correct assumption?

You can get 2% minoxidil from the drug store without propylene glycol (woman’s version of the product). I can not predict what the effect of reducing the dose would be, but I might suggest more frequent use than just twice a day as you ‘crank’ down the dose. As everyone is different in their response to minoxidil, I really can’t tell just will happen.

Although this isn’t a prescription medication, talk to your doctor about changing dosage, as there may be other effects that can occur based on your medical history.

Hi,

I have been advised by a doctor to begin taking Propecia, and have been researching it A LOT. I have read both horror stories and great success stories and agree that people should stop scaremongering. Just because you happen to have been taking Propecia does not mean all your ailments were caused by it! I bet 100% of those things happen to people who do not take it too.

My only concern is that the Propecia website has been all but closed down. Do you have any idea why this is? It is now the only thing stopping me from going ahead with the treatment. It just seems a bit strange? It makes me wonder, what if Merck were to go out of business and Propecia stops being made. What happens to all those people who have been taking it for years?

Thanks for all your great responses, this is a great place of understanding and comfort, when it seems nobody else does!

Your guess is as good as mine. Initially, I thought it may have to do with the Propecia patent expiring, but that doesn’t occur until November 2013. Once that happens, you wouldn’t have to worry about Merck going out of business (which I doubt would happen anytime soon, regardless).

Hair loss message boards have speculated about why the site was pulled down, but it’s just that — speculation. I really have no idea.

Dr. Rassman,

I was wondering if you could shine some light on this in effort to give hope to NW5+ men. I think a great option for high NW men would be to obtain a low density (30/cm) transplant and supplement it with SMP.

What do you think? Also, with this strategy, would it be possible to keep hair at a 2 guard without it looking funny/weird?

Thanks!

A low density hair transplant with SMP (Scalp MicroPigmentation) in the scalp may or may not be enough to achieve a fully normal appearance. There is certainly a threshold where where too few transplants will not be adequately augmented by SMP.

Hi Dr Rassman

I was just wondering if you could explain why grafts enter a dormant phase immediately after being transplanted, and only start recovering after 8-10 months?

I’d also be interested to know why they initially grow back much finer, and then thicken up later. Essentially the follicle itself hasn’t changed, so why does the hair diameter it produces fluctuate in this way?

Many thanks

I do not know why there is a dormant phase after a hair transplant. To put it simply, when you have hair transplant surgery, your follicle was removed from your body, handled, cut, manipulated, put in solutions, manipulated some more, and put back into another new location on your body. If I was that follicle and I survived all of that, I’d be traumatized and go dormant for awhile. In all seriousness though, I do not have a professorial explanation.

The simple fact is that most follicles go dormant (telogen) and start to regrow in a period of 3 to 12 months. Most patients see results starting on the 6th month to 12th month. Some lucky minority of patients (< 5%) see results within a month! This is what we have observed over the last 20 years in thousands of patients.

Hello Dr. Rassman,

Is it possible to start balding in the vertex area and scalp area while still maintaining a juvenile hairline? I noticed that I still have hair under my furrowed brow, but the overall thickness of my scalp hair has dramatically decreased. I am 22 years of age.
Thank you.

Yes! You can start balding from the vertex (crown) area while maintaining a juvenile hairline. Those patients are a subset of the normal Norwood hair loss patterns with a persistent frontal hairline.

In rare instances, someone with this type of hair loss may even continue to have his juvenile hairline for the rest of his life, even though his crown has become bald.

Is it possible to permanently damage the Sebaceous gland to where it is not secreting any sebum? Two yrs ago i used a re moist intensive hair treatment and left it in my hair for several hours and every since then my hair has been brittle and dry.

I know that sounds crazy but my hair just hasn’t been the same. While i might be wrong about the product that i left in my hair causing my brittle, dry hair, one thing i do know is that (all of)the hair on my head is very unhealthy. Im debating to see a doctor about it but im afraid to waste my money to just be told to use a deep conditioner, which i have been.

Is there any thing that a doctor could do about very brittle, dry hair? Or is there any way to get the body to produce more sebum?

Maybe it is probable, but I do not really know. Some people just have dry and brittle hair, and it can change during one’s life. I do not know of any way to increase sebum production aside from perhaps washing it regularly.

Just wanted to send you a link to this silly article. One of the claims is that petroleum-based waxes can block hair follicles.

Link: Worried you’re going bald? Eat nuts and have a fried breakfast

Thanks for the find. Yes, it is a silly article. Journalism isn’t what it used to be. Even the title of that article suggests eating a fried breakfast will somehow stop your hair loss. That’s ridiculous.

Hello dr Rassman,

I think you are 68-69 years old.Does that mean that you are going to retire soon?If yes what will become of baldingblog?I hope you are going to be with us for another 5-10 years.

My grandparents lived well past their 90’s and longevity runs in the family… and since I love what I do, I suspect I will be doing this for a very long time. In fact, I am very involved with Dr. Pak in the engineering process of new hair transplant instruments and we will be testing a new FUE extractor and implanter in the next month!

Besides, even if I do eventually retire, I only need a computer and Internet for BaldingBlog, right? With respect to what you read on this site, Dr. Pak and I equally share contributing to the posts without the reader knowing who answered what. So even if I am gone for a long vacation, BaldingBlog will continue on. But in general, before any content is posted, both Dr Pak and I cross check and edit each other’s answers.

But just to make it clear, I am not planning on retiring yet.

Hello Doctor

How bad does a scalp wound has to be in order to mean permanent hair loss in the area ? I bleeding or crusting afterwards na indication for bye bye hair ?

Any cut on the skin will produce a scar, and on the scalp no hair will grow on that scar. Even with follicular unit extraction / FUE (advertised as “scarless” surgery by some) will produce a round punctuate scar.

In general, if the injury or wound is significant there will be permanent hair loss. Even a scratch could cause bleeding, but that doesn’t necessarily mean permanent hair loss will result. Only time will tell if your hair will grow back. This time frame is around one year. If you see no hair growth after one year, then it would be safe to bet it is permanent hair loss.