I am 23 years old and I am an avid bodybuilder. I work out 6x per week, and the only supplements I take are whey protein and creatine ethyl ester. I still have some acne on my back and upper shoulders and occasionally on the chest and face. I used to have it worse on the shoulders but I started exfoliating and it’s def. 99% better, although I still get some here and there. I was wondering if b/c I am 24 and have acne if this is b/c I have more testosterone than normal. I should also say my sex drive is not very high at all, and I’m relatively unhairy on the chest, back, legs, arms, face.

I also drink a lot of milk, typically milk that says it’s from cows untreated with rbGH or any growth hormones. I read on Wikipedia that milk could cause IGF-1 levels to increase. Could this cause hair loss?

Regards.

It is not known why one young man develops acne and another of the same age does not. Clearly the presence of testosterone is important for it to be there as it reflects an over-secretion of sebum and cyst formation. To be sure, you should be under the care of a good dermatologist. Bodybuilding, milk, IGF-1, acne, sex drive, and testosterone are all extraneous factors that do not have a direct causational relationship and you are just complicating the matter. As an example, you can have a very high testosterone level and still have no hair on your body. You can have a high testosterone level and still have a low sex drive, because sex drive is a complex problem. You can have no hair on your body and have a full head of hair (or vice versa or any permutations) You can drink rBGH milk or any type of milk for that matter and still have hair loss… or no hair loss depending on your genes. Get the point?

I am curious to know, if I were to tell you that working out and bodybuilding were causing your hair loss, are you prepared to stop working out? I doubt the connection!

Hi Dr,

I’ve been losing my hair for approximately a year now, and I’ve noticed that when I started to lose my hair it went from being smooth and oily to “tangly” and dry. Is this normal for MPB or is this a sign of malnutrition? I’ve tried propecia and minoxidil and neither of these medications have helped. When I went and saw my Dr he immediately said MPB because my father is somewhat bald. Is there any specific blood work i can do that can help diagnose if malnutrition is playing a part?

Thank you!!

This is not a multiple choice test. You need to be evaluated by a doctor who knows the field and can diagnose genetic hair loss. Hopefully, the doctor will map out your scalp hair for miniaturization and lock in the diagnosis. Your physician (along with you) should then build a Master Plan for your hair loss and abide by it. Genetic causes are the most common among men, particularly as opposed to nutrition.

If you want to analyze your nutritional state, you can determine your nitrogen production in a 24 hour urine analysis and that will give you your nutritional state. A blood test won’t tell you definitively whether your hair loss is due to nutrition, though.

Hello Doctor,
At the end of summer, 2007 I began to notice some minor thinning. I briefly spoke to a dermatologist and was immediately given propecia. I began taking propecia and immediately had terrible increase in hair loss. I have read that this may happen. However, 5-6 months in, I was still losing hair. In addition, over that span it seems that my entire scalp diffused. I went to another dermatologist, who tested my iron and found out that I have very low ferritin levels and since I have Crohn’s, I started to get iron iv therapy. This dermatologist suggested strongly that I have TE. My question is, why after 6 months of being on Propecia would my hair loss be significantly worse and diffused, especially when there was no hair loss in those places. And additionally, why would it cause most of my hair to miniaturize?

Just an update: I stopped taking propecia due to the hair loss increase and breast tenderness. I have since been using Revivogen and Nizoral. What else would you recommend to get my hair growing again?

Thank you for your time

None of the other things you are taking to treat your hair loss actually have known benefits on hair loss. The presence of Crohn’s disease can induce hair loss as well as some of the medications to treat this disease (like steroids when they are used).

You need a doctor who you trust and will develop a Master Plan with to know what is happening. I always get a baseline measurement by mapping out the scalp for miniaturization before starting Propecia so I know what is happening over time, but I am not your doctor. Propecia users can go through an initial shedding phase, but it is not terribly common. Certainly, 6 months is well beyond any initial phase. Maybe you have something else wrong with you causing the hair loss? I would not want to treat you over the Internet, as that is not possible. Discuss this with your prescribing doctor.

Dear Dr Rassman,

I still have a lot of scabs/crusts 12 days post op - is it safe now for me to scrub on them without the danger of pulling the graft out? I have read your detailed article regarding this stating that your research show that after 9 days the grafts cannot be logged out with a scab, so my question is can I scrub on them hard now to get rid of them? Also even after 12 days my head of hair seems like it was pre op but I havn’t seen the transplanted hair in the bath?

Thank you for your help

Generally it should be safe to wash your hair, but I would not use a scrub brush on the scabs. I would soak the scabs and then rub them gently with your fingertips after soaking in shampoo for a few minutes and they’ve become softer. I do not know what or how your surgery was done, though. If you had follicular unit transplantation the way we do it here at New Hair Institute, it should be safe, and I would be shocked to see significant scabbing at 12 days. Otherwise I really cannot say what you are experiencing.

Quick preface: I’m not sure if I’m balding or not.

Anyway, I notice when I shed hair, which I don’t do excessively, a lot of the hairs are random sizes. Some are equal length to the rest of my hair, others are smaller but still as wide,
others are longer but thinner, some are shorter and thinner etc.. Is this ever the case in normal shedding or is it always an instance of MPB causing miniaturizing?

Normal shedding at the end of the anagen phase should push out a normal width hair in over 90% of the hairs that you see. If the hair are largely miniaturized, then maybe you do have male pattern baldness (MPB). Most men lose their hair from balding without noticing it, because the hairs die at the end of an anagen cycle and do not grow back.

For more on hair growth cycles, see Hair Follicle Cells Growth Stages.

I am 21 years old and seem to be thinning on my temples. There is always this slight constant itch that comes and goes and I resolve it by gently tapping and rubbing the same spot. I dont scratch my scalp at all for fear of losing it. Sometimes I feel little hair follicle bulbs that sometimes have a thin hair attached to it. Am I accelerating the death and thinning of my hair by gently rubbing the same spot?

Rubbing your scalp in the same spot over and over can cause traction alopecia, but tapping on it should be fine. You really should see a physician for a MPB diagnosis and a possible prescription for Propecia (or you can try minoxidil, which has no prescription required), rather than spending your time worrying about tapping on your scalp every time you get an itch.

I don’t know if you would have any insider information, but i figured this would be about the best place to direct my question:

Since the inception of companies like Follica and Intercytex, they’ve been remarkably silent about any progress they’ve made or are making. why do you think this is? Even attempts at
contacting them have been generally futile. Do you think it was alot of fluff when it comes to what these companies were purporting to do? just wanted your opinion?

I have no particular information on this, but silence usually means that they have nothing new to report.

Dr. Rassman,

I had a transplant procedure 7 or so years ago. Since then, my hair has continued to thin and even though the hairline was done well, one can discern that they are transplants. If I was to have the donor scar repaired and buzz my head to a # 1 clipper, would the transplant sites be very discernable (on top of my head?) If I was to pluck them out, would the recipient sites have scars? I am not really sure what to do. If I hadn’t gotten the procedure done I would probably shave my head close. I would also like to know if I had additional procedures done, would I be able to go with a buzz (#1) cut? Thank You

A hair transplant is forever, which means you shouldn’t do it unless you fully understand what is going to happen to you, even in the worst case scenario. I don’t know how to answer your question without seeing you. If the transplants were follicular unit transplants (FUTs), there is a good possibility you could shave the hairline, but based upon the what you describe, I suspect that the grafts were not follicular units. When there is any significant amount of skin in the transplanted graft, the skin will have some deformities associated with it. The larger the amounts of skin (which comes with procedures like minigrafts, micrografts, larger plugs, follicular families, double follicular units, etc), the harder it would be to get away with shaving the frontal scalp. Most people like you are easy to fix with more transplants, but it has to be done with FUTs and in enough numbers to fill in the problem area, but again I can not say this for sure without seeing you or your photos.

As you indicated that you’re in New Jersey, Dr. Robert Bernstein has offices in your area, so I would suggest that you see him for a straight answer, or you can send me photos to the address on the Contact page (reference this post, please).

Hi Dr. Rassman
Browsing the NHI site i found this 25 year-old man, Patient QE. Very good job. My question is that if this man becomes a type 4a in a few years, can you give him the density he has now?

This is an important question, because the doctor is putting hair where it has disappeared, but the process of losing hair is not static. With progressive hair loss that comes with genetic alopecia, you need to have a Master Plan and a good doctor. The doctor should lay out the worst case scenario for you and the remaining hair after the hair reconstruction should be present in adequate reserves to make up for any progressive hair loss that should occur.

Your particular question is good, because the patient you are referring to could eventually develop a Class 4A pattern and almost everyone with a reasonable hair density can follow hair loss to the Norwood Class 4A or even a 5A pattern with another transplant procedure. If the patient stays on Propecia, then it is likely that the hair loss process will be slowed.

Dr Rassman!!! Hope you are keeping well…….

Just wanted to say what a wounderful job you are doing! To the question: i know the Trials for Dutasteride for hair loss has been completed. But any idea on how long before we will know if it is FDA approved, or usually how long does this process take. Are we looking at months or years? The reason i’m so keen is because, i’m a 23 year old male and i’ve been on 1mg Propecia and Regaine 5% for over a year now and havent seen any results.. Please help with some advice..

Once again many thanks

I do not know the answer to this. I was asked a similar question a couple weeks ago here.

The data is likely being analyzed after completing the phase 3 clinical trials in January of this year, and if the drug company (GlaxoSmithKline) feels that they are ready for the drug to go to the FDA, they will take it there. I don’t even know how long it will take for them to complete the analysis, as this is not my expertise. There’s a timeline for FDA approvals on Drugs.com that outlines things nicely. Avodart (dutasteride 0.5mg) was approved by the FDA years ago for treating prostate issues, but must go through a different approval process to be evaluated for the treatment of hair loss.