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I am a 17-year old boy and have been losing my hair for a year now. Im losing quite a lot of hair on top but thats not the thing, the thing is that im losing some hair on the sides and the back of my head and its really scary. There is no doubt that i have male pattern baldness but im wondering if lets say one becomes a 5 in the norwood class doesnt that person lose some(lose som density) hair on the sides and the back. Is it just the norwood 7 and beyond that lose their hair their there or what? Please answer there is no one that can answer my question!!

With a traditional balding pattern as outlined in the Norwood chart (see below), the sides and back are spared. All thinning is limited to the front, top, and crown in patients with genetic male pattern baldness (MPB). So if you do have thinning hair on the sides or back of your head, I might think about diffuse unpatterned alopecia (DUPA) — but this is all complete guess work without examining you myself. The questions you asked me via email should be asked of your caring doctor in person following an examination of your hair and scalp. I don’t know what you’re seeing, so I can’t provide much more than that.

You need to establish some measurements with mapping your scalp for miniaturization at a minimum in following your hair loss. You also need to have a good doctor establish a Master Plan for your potential progressive balding.

Hi Dr. Rassman,

I recently saw my dermatologist over concern about thinning hair. I started taking the anti-convulsant klonopin almost a year ago, a few months after I cut off about 15 inches of dense hair to nill, so I didn’t pay attention to thinning the whole past year. My dermatologist looked at my part line at noted that my part was defiitely bigger on the top than on the back of my head. I also notified her that the hair on my forearms and legs were thicker since starting the klonopin. She said that it could be one of three things:

1) a really stressful year,
2) androgenic alopecia emerging (I’m 30) independently, or
3) drug induced alopecia and hirsutism caused by the klonopin with the klonopin possibly unmasking androgenic alopecia early.

She said that if the cause was drug related, even in the case of unmasking AGA early, alopecia would be reversible once I stopped taking the drug, reversible that is until I reached menopause and then it would reemerge. My maternal grandmother has the thinning hair but she didn’t get it until she menopausal. Is my dermatologist incorrect in assuming if the klonopin unmasked AGA, the hair will automtically grow back for the next ten years or so, after I stop taking the drug? I don’t understand this as I’ve read several places on the web that “unmasking” of AGA implies that hair growth is not going to revive temporarily if you stop taking a drug. I got really excited when she said if that was the case my hair would grow back the way it was until I reached menopause. Her plan for me was to get me off klonopin and see what happens, it would take about 3 months to taper off this drug, and then several months after that to see if it grows back. that if it doesn’t grow back it’s classic AGA having nothing to do with the klonopin as an early trigger at all. IN the meantime if it is there something I should do as a preventive factor, like go out and purchase rogaine and see if it works? Your input would be very much appreciated.

It sounds like your dermatologist has it covered and you should follow her advice. If you’d like a true second opinion, you’ll have to find another dermatologist in your area. Klonopin, like other benzodiazepines, can cause hair loss in some people.

I realize it isn’t what you were hoping to get out of me, but I don’t have nearly as much experience with Klonopin (clonazepam) as it seems your dermatologist does to add any significant value to what you have discussed here… though I appreciate you sharing your experience and wish you luck.

I’m 22 year old male experiencing the early signs of Androgenic Alopecia. I have mild frontal thinning and crown thinning. I’ve been on propecia for nearly two months and generic minoxidil for just over three weeks. I’ve recently noticed more shedding than usual. I’ve lost as many as forty hairs while showering. This happened once during the first week of use, and has started up again this past four days. Is this something to be concerned about?

Also, the Rogaine website mentioned that shedding should start the first week and be over by the third. Is it unusually that I started really shedding on third week? Is it safe to use minoxidil on frontal areas of thinning?

Thanks

The connection between shedding and minoxidil (and even with finasteride) has been reported to me on this site many times. I don’t have any study results to say whether your response was unusual, and I can’t base my own patients’ experiences either, as I have not seen any direct patient reports on my patient population.

It is my opinion that Propecia (finasteride 1mg) is the best drug for young men, as it is proven safe and effective and I have seen the most drastic results with this simple daily pill. I feel less strongly on hair loss in the frontal area with minoxidil.

Hello

I’m fully aware of your position on Dutasteride as an unapproved hairloss treatment, however, I wanted to ask if you knew anything regarding Dutasteride increasing a recession of the hairline. I was prescribed Avodart off-label for a DHT-inhibitor for my hairloss (which is only at the hairline/temples) and have since seen no results other than a progression in my receding hairline.

I’ve read many hairloss forums/blogs where those taking Dutasteride have reported and increase in loss at the hairline. I’m aware that a 0.5 mg dose of Avodart decreses scalp DHT 16% more than a 1mg dose of Finasteride (54% versus 38%, respectively), yet increases scalp testosterone 104% while Finasteride only increases testosterone 24%.

Could Avodart’s dramatic increase in scalp testosterone be harming hairlines? Is there any reason why many people’s claims could hold true - that Dutasteride is bad for hairlines? Or, should one continue with Avodart for several months to hold out for the possibility of regrowing what is “shed” or lost from taking it?

Thank you for your food for thought. While it is interesting that you noted this, without data from the pending FDA study, there is no way to have real answers to your questions. You should take any claims made on the internet with a grain of salt, particularly when the information comes from various forums (where it unfortunately seems that many members like to play doctor).

have you had any positive results from silica complex vitamins?

There are herbal supplements which have various claims to stop hair loss, but when I research them (particularly on the internet), I can find no credible science. Your question was whether I’ve seen any positive results from silica complex vitamins — and assuming that you’re asking about this for treating hair loss, the answer is no. I can not seem to find any information about it actually treating hair loss in any way, aside from a single author on a weight loss site.

(female) I was put on Lorazepam, Topamax, and Wellbutrin. After over a year on Wellbutin, about3 months on Lorazepam, and about 2 months on Topamax my hair has begun to get very thin and frizzy. I thought it was falling out, I am not sure if it is that or breakage. I got a haircut, bought rogaine and am using Nioxin hair products. Which of these meds could have caused this and is there any way to pinpoint which one?

Pinpointing the one or two medications that are participating in your hair loss is very difficult. You need to go over this with your prescribing doctor. Have you been worked up for the various medical conditions that can cause female hair loss?

Dear sir,

I first of all thank you for taking your time out to answer this question. I’m sure you’re quite busy…I’ve seen more balding heads on the streets than ever.

I’ve been losing my hair since I was 17. I just turned 21.

I went through all the usual stages. Denial, loss of confidence, etc. I still have as much left as many men RECIEVE in their procedures, but it will only get worse. I had a solution in Spring 2006, while I still had enough that no one knew - Propecia. My (completely bald) doctor recommended it for me.

But I was an idiot.

In December 2006, I stopped taking it. I felt it hadn’t made any difference. No further thickening, no regrowth. Everything seemed fine until summer 2007, when it started becoming frighteningly apparent that it HAD kept some hairs in (I washed many long, luxurious strands of Marc Bolan-style hair down the shower drain). I didn’t know why this was happening all of the sudden - I did not know that stopping Propecia not only stopped the positive effects of Finaesteride on DHT, but also allowed the MPB held back to return with a vengeance.

Within six months, my hair loss had become worse and more apparent than it had since it began. It happened quite quickly.

I went to the barber’s in October 2007 and cut my long hair off. I could tell where the hair loss was hitting hard; the hair cut from the sides and back was thick and Roman, while the hair cut from the top and front was lighter and frizzy. Not enough hair was growing to create curls or waves, so it looked like it was damaged.

Immediately I began a plan of action. This time, I wasn’t going to hit MPB with just one drug. I was going to have an armory full.

In November, I began a treatment which gathered supplements, drugs, and shampoos over the course of those following months. It has come to finally include the following daily routine:

Propecia (1X)
Rogaine Foam (2X applications)
Saw Palmetto (supplement, 400 mg each; 2X)
Nioxin 3-part System (no.2; in the shower)
Neutrogena T-Gel (1X; shower)
Nizoral (1x; shower)

The anti-MPB effects of Propecia and Rogaine are known to you. Saw Palmetto is reputed to have anti-androgen effects, as is coal tar (1% found in the T-Gel) and ketoconazole (1% in the Nizoral). Nioxin is proven only to thicken the APPEARANCE of the hair, but claims to clean away “environmental residues like DHT” on the box. Reviews and hearsay seem to back this up, so I’ve been trying it.

Why go through all the bother, you ask? Simple.

I am a musician. A player, a writer, a performer. Not just a musician, either. A damn good one, with artistic vision and a damn good shot at making it.

But this is the one thing holding me back.

1: Toupee/Wig - Will not. Don’t want to be playing a windy outdoor show or find myself in the throes of lust with someone I fancy when the proverbial “rug” falls off.

2: Shave - The aesthetics of being a performer on stage in the rock/pop medium require a youthful, attractive appearance. This I know firsthand; people who knew me when I had a large rockabilly pompadour or a healthy tangle of curls suddenly looked at me with sad shock when my receding hairline and thinning temples were revealed. I have an odd-shaped head, and that doesn’t help either. So nix the Telly Savalas look for me.

3: Hair Transplant - This is the most promising option. I have read all sorts of “breaking news” regarding WNT proteins and new solutions for this age-old bastard curse, and they may eventually pan out. But not in the next five years, and certainly not soon enough to take advantage of my youth and hit the big time. But I do not have tens of thousands of dollars to spare (especially in the midst of the economic recession), and I know that (sparing a new cure) my situation is only going to get worse.

I have read on many forums that Propecia (or finaesteride at all) loses it’s effectiveness on most men after 5 years of use. This rumor is widespread and greatly troubling; if true, the backbone of my (and many other men’s) MPB treatments will be null and void in 5 years or less, leaving us to lose all the remaining hair in a fast, depressing way (as I did much of my hair last summer).

I am at ends. While one’s self-worth should not be based on looks alone, appearance is crucial to the formation of identity. And when that tool, that weapon of good looks is taken away from a hopeful star, what is there to do?

Again, your time is most sincerely appreciated and I truly thank you for reading this.

You are incorrect with regard to Propecia (finasteride). It continues to work for years and does not simply stop at the end of the 5th year. What usually happens is that hair loss continues to progress and eventually (around the 5th year), you may go back to your baseline hair loss pattern — but if you stop the Propecia altogether, you will be far worse.

You need to get a good doctor to build a Master Plan for you. It is said that the person who treats himself may have a fool for a doctor. You’re throwing everything at your hair loss, and while it may not be a bad thing (unless you count the expense of money and time involved), it might be excessive and unnecessary. Please, discuss this with a doctor — the physician that prescribed your Propecia is probably a good place to start. Thinning hair can be devastating to one’s self esteem, and many people will do whatever it takes to not let that happen.

I wish you good luck and thank you for sharing your story with us.

Will taking Nitric Oxide have adverse reaction on my thinning hair or the opposite?

We do know that nitric oxide is a vasodilator. Many of the claims that relate to increased blood flow that are reported from the low level laser therapy (LLLT) suggest that it is the nitric oxide that is causing the increased blood supply. Simply, LLLT has been claimed to increase blood flow to the hair follicles through nitric oxide production and release, thereby increasing hair growth. The evidence for this is scant and conjectural. Some people feel that if you take L-arginine supplements, this will help facilitate the process, but be careful as L-arginine is known in high doses to be a dangerous agent.

I hope I didn’t lose anyone. To sum all of that up — no, I do not believe it will have any effect on thinning hair.

Is it safe to use Apple Cider Vinegar on the scalp after Hair transplant. I had hair trasplant two months ago, and I love to use it because it makes my hair soft and eassy to manage. Does it damage my new hair follicles that were implanted? Hope to hear from you soon. Thanks

I tell patients that after a week or so following a hair transplant procedure, you can do whatever you like with your hair and your transplants. For those that are curious, apple cider vinegar is apparently used as a holistic “cure” for a wide variety of ailments, including allergies, acne, high cholesterol, flu, arthritis, and acid reflux.

It likely won’t benefit your hair transplants, but I doubt it will hurt them either. I certainly don’t subscribe to the idea that vinegar will cure all of your troubles, but you can read more about it here.

Dr. Rassman,
Thank you for taking your time to read this. I know that hair transplantation has improved greatly in the past decade. Do you think that the improvments have plateaued or can we expect even better results in the hair transplant community in the future.
Thank you for all you do.

I am hoping that the follicular unit extraction (FUE) technology will be improved from an instrument point of view. I personally believe that this technology has great room for improvement. With regard to strip harvesting, I think that we have only improved in our overall efficiency, not in a better technique. We are all waiting for breakthroughs in hair cloning, hair replication or stem cell work for creating new hair.