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I asked a question about my hair loss a couple of months ago, and I said that I thought my hair loss was too aggressive to be male pattern baldness. I think my hair is following the general pattern of MPB (so i’m guessing it is MPB).

How much of an effect can stress have on people with MPB? My hairline is very thin, but I am not quite a NW2 yet on the scale. I still have a reasonable amount of hair on the top of my head, I believe it just might be miniaturized.

I found a picture of myself in February of this year, and I was still a NW2 (I think it’s just a mature hairline), but my hair was really thick. A full month later my hair on top was completely thin. Maybe I had very early miniaturization in the first picture, but it looked very thick. I don’t understand how my hair could get so thin so quickly. It hasn’t progressed much since then, but it is probably still thinning.

I have been struggling with bills and dealing with unemployment. I’ve been so depressed (thoughts of suicide, etc) because we have been struggling to keep the bills paid. We went a few months without running water, electricity. Without oxygen my father will die, and his oxygen machine runs on electricity. So this adds to the stress. Meanwhile my father’s health deteriorates and I’m only 19 so it’s very hard for me to step up and support our family. (And now on top of this my hair starts falling out)

Will this kind of stress accelerate MPB? And will hair loss from stress (even though I probably have MPB) grow back?

Last question, sorry for the long life story message:
There is no way I can see a doctor, I do not have health insurance, what can I do about my hair loss? It’s possible I could get finpecia or propecia. I’ve read that finasteride works best for people who are still in the miniaturized state. How well do you think propecia could work for someone my age with early hair loss (advanced miniaturization).

Hair loss from stress could shift your natural MPB timeline forward (basically kick starting hair loss that wouldn’t otherwise happen until later). Although each person will handle stress differently, your situation does sound extremely stressful and very well could accelerate your MPB.

I’d try to find a local hair transplant clinic with a free exam. Some offer a free 1st time consultation. I’m not suggesting to rush out for surgery, but these docs will know more about diagnosing hair loss than many other doctors will. Try to find one in your area by using the physician search at ISHRS.org — but find out pricing for the consultation beforehand, of course. Not all of them are free. If you can not find a local doctor offering a free consultation, send good digital pictures to me here along with a phone number to reach you and I will try to help you over the phone. My probable solution will be finasteride, but let me see those photos first… or let a doctor decide that after an in-person exam.

Hello. I recently visited a very well known transplant surgeon. He’s all over the internet and on many of the blogs etc. I think you may have referred to his practice in some of your recent postings. The photos and testimonials on his website are almost too good to be true, I mean the results are consistently the best I have seen anywhere internet. I am a forty year old white male, with receding hairline at the temples, I’m currently a NW3. I’m mainly just concerned with filling in the temples.

Here’s the issue. This doctor recommended 2500 FUE’s to fill in the hairline, this sounds a bit high to me, but he assured me that I wouldn’t be happy with any fewer. Is it wise in your opinion to do 2500 in the frontal zone based on what I’ve stated, I’m surely bound to keep loosing hair. And, can this doctor’s results be REAL? Even if he was cherry picking his best patients, he has probably 75 patients on his website, most with unbelievable results. I’m wondering if it’s marketing hype or is it real? Maybe he’s only doing very young patients with results that look great today, but not in the future? In addition, since this clinic only offers the FUE procedure, it is extremely expensive and would require a loan for me to complete the transplant. Thanks for your time.

Getting a second opinion is a reasonable next step. Some doctors produce a terrific marketing image showing what patients they want you to see. We offer our Open House events every month where you can see patients up close, ask them about their surgery, and get comfortable with the physicians and staff. For example, in our Los Angeles open houses, we often have a dozen patients to show off, and many just show up to help educate our prospective patients. Maybe you should listen to your instincts and get another opinion.

I can not comment on the 2500 graft recommendation with FUE (in one session? hmmmm) for a frontal hairline without at least seeing a photo of your hairline. Send me a good picture or three and point out the area where the surgeon said he would move the hair to. Reference this post when sending.

Dear Doctor,

I hope you are fine. I have a weird problem.

I am losing hair since last 4 years and I shave off my hair (completely bald) once in 4 months. Few years back, my dermatologist mentioned that I had Androgenetic Alopecia and I was thus placed on that medication for quite some time. After taking medication and doing relevant tests, it was found out that my DHT levels are low. But for some reason my hair still falls out!

Looking back at my history, my hair grows long for 3 months (and I dont lose much hair in these three months - 4-5 per day) and they start falling out rapidly in the fourth month (20-25 per day)! In the fourth month they become so weak that if one would gently smear on the head, my hair would come out on his hand!

My question is why does the hair keep falling out when it grows long, in spite of me being on the medication - dutasteride (0.5mg per day), rogaine foam (twice daily) and nizoral (thrice a week).

Doctor, my hair loss worries me quite a lot. In the last four years, you can actually notice that the density of hair on my head has reduced drastically!

I will be grateful for your advice and help.

Hair growth is unpredictable. Contrary to the cycle of hair loss and growth that you report, I am skeptical that you can see it in 4 month cycles. Measure it by mapping out your hair for miniaturization and then you can prove it either is happening or not.

Using all of the medications like a shotgun won’t get you more hair growth, and although not likely, it’s possible that your hair loss is from causes other than MPB and thus medication wouldn’t help anyway. Perhaps seeking out another dermatologist for a second opinion might be worthwhile. Also, it’s normal to lose around 100 hairs a day.

If I get a hair transplant do I need to take propecia to keep that transplanted hair from falling out or it will it be permanent?

The transplanted hair should be permanent if it is taken from the permanent zone (called the donor area)… and as long as you don’t have any underlying disease that causes hair loss in that area, such as alopecia areata. Propecia (finasteride) should be used by men to halt further loss in the non-transplanted area and to prevent shock loss from the surgery. But otherwise, the transplanted hair doesn’t need Propecia to stay in there.

Hi Dr. Rassman. Congratulations for your great blog!

I’m a 22-year-old male with early hair loss. I took 1/4 of proscar daily for five days before having to stop due to the side effects. Apart from low libido and diffculty in getting an erection, these included very dry skin (never thought rubbing the index and thumb could be so unpleasant!), some discomfort in the prostate area, apparently water retention (i.e. urinating little and darker while drinking the usual amounts) and somewhat of an overall bloating of my body, which I put down to the excess fluids but seemed to produce increased tenderness around the nipples, esp. the left one. Since gynecomastia is the one reaction I am by no means willing to put up with, I thought better safe than sorry and quit the medication right away. It has been a few weeks since, however, and everything seems back to normal. I am very concerned about the hair, so I was thinking about starting again with a much smaller dose of finasteride (something like 1/8 of proscar every third day), and increasing it every two weeks or so all the way up to at least half of what I tried initially. Then my question is whether you have tried this approach to successfully manage side effects such as mine in your practice.

Thank you very much for your valuable time.

You should work this out with your doctor. The internet is not the place. I haven’t started patients on a low dose and gone up from there, but I often suggest that lower doses of Propecia may have value for the few men that have sexual side effects from the drug.

You mentioned in this link that certain chemicals and dyes can seep into the hair follicles and damage them.

My question is regarding sodium hydroxide, the most popular permanent hair relaxer around. Can this damage the hair follicles? I didn’t realize it could actually seep through the skin!

Yes, it could seep into the skin and hair follicles. At high concentrations it could be dangerous.

Hello,
My question in in regards to potential long term side-effects of finasteride/propecia? I was perusing an article on the internet about the possibility of the long term side effect of it. Then a doctor commented in an article that he questioned the prolonged use of finasteride and said something to the effect of “remember phen, fen?” and we don’t know the potential long term side effects of finasteride yet.

So, did this doctor make a “blanket” statement or do we not yet know all we need to know about propecia?

I’m the kind of guy that doesn’t like to take medication unless there’s something “wrong with me”. So is this safe to start taking? I just didn’t like the reference made to phen fen. Thanks in advance.

Does anyone know everything about anything? The answer must be obvious, so even after 13 years on the market, there could still be surprises. They may not be all bad however, as there are always some good that comes out of such medications. In this case, we know that cancer of the prostate risks are reduced with steady use of the finasteride 5mg dose and many experts think that this will spill over with the 1mg dose. Cancer of the prostate and preventing hair loss (or slowing it) should be considered against the down side risks, of course.

We each need to make these judgments, but over and over again I hear men tell me that they WON’T take pills. Just the other day a 28 year old man demanded that I point him to an herbal for preventing hair loss with an emphasis on “certainty” motivating him. As he was demanding my herbal recommendations, I thought, “I am but a poor doctor giving advice, so please be reasonable with such questions.”

Angiotensin II Receptor Blockers don’t seem to list hair loss as a side effect, even rare. At least these two don’t….These don’t have the combination of a HTC which can, Diuretic. Here are two:

1. Micardis and Hair Loss
2. Avapro and Hair Loss

I know anything is possible and you will say you can still lose hair on it. Heck you can probably say that about every substance on earth. It is reassuring that these two don’t have it listed and I think it would be helpful for your worried readers to look into which medications statistically have the lowest reports. Maybe that is something you can research.

Over 4000 people in the trials and no reports. The problem I find with post-marketing data is there are too many variables like other medications, consumer stress ect ect. Also since 40% of those people who need HPB medication also fall into the 40% of the population who lose hair. So what came first right?? Might be good for your worried readers to talk to their doctors about. I have read a few blogs that claim hair loss in one or two people but those people seemed to be on more than these two drugs and even had been on a beta-blocker recently which clearly states hair loss.

I though I would share my research with you. Also, don’t you think having HIGH BP for an extended period of time can cause diffuse hair loss over the entire head?(not to mention the other serious problems). I have often wondered if my untreated high BP could have caused my diffused thinning over my entire head w/out any real pattern of MPB. That is until now when I have gotten treatment. I guess I will find out if it thickens up. Thanks

The association of hair loss with any medication could be a cover-your-ass approach by various drug companies who find it easier to mention hair loss than ignore a possible association from a medical/legal point of view. As a hair transplant surgeon, I am not in a position to form an opinion of my own about this. You are correct that the incidence of high blood pressure is as high in the general population as balding, but these two observations are not necessarily connected. I am afraid that I can not shed more light on this.

You said much and I appreciate your research. I agree with what you said about worried readers talking to their doctors about these issues. The internet is a great, great tool, but even better is a one-on-one with the physician that is already treating you and has specialized knowledge based on your medical history.

Dear Dr,
I’m a man 38 years year old, writing from italy. I had an HT 2 years ago with about 2000 graft implanted FUT. I take 1 mg Propecia for 2 years.

This is my problem:
I have very small pimples (less than 1mm) on each graft implanted there are very visible i.e. under the sun light.they don’t hurt me and seems like the hair is pulling up the skin. I don’t have any of them on non tranplanted hair… I searched on this site but almost all of the discussions I found are on bumps or normal pimples or pitting or scars. the most valid explanation I found is that it is due to the graft that was implanted too deep in the scalp.If it is true, what can I do for improve the situation? Dermabrasion or laser? may I start trying some remedy for folliculitis or is completely useless?pls give me some good hope on what I can do,I’m really desperate. the doctor who make me the surgery (in Mumbay while I was in a long trip for job…)after the first telcon, don’t reply to my calls or mails…however I don’t trust him anymore! I contacted another Dr who said that the only solution maybe is to make another transplant to hide the thin pimples, but I leave this as the last solution and I won’t make another bad transplant. pls tell me if there is something I can do for making less visible these pimples.Thanks in advance. sorry for my bad english. Best Regards

If what you’re describing is a cobblestone appearance (and not actual pimples), then please see this post. Without seeing you, it would be impossible for me to tell you what the problem is caused from.

Dermabrasion to the scalp causes visible scarring and only benefits the doctor’s pocket, not the patients who receive it. There are two types of lasers that can impact hair:

1. Low level light laser therapy (also known as LLLT), which I feel does not work at all
2. Higher powered lasers for hair removal, which do not work 100% on killing the hair

Neither offers much benefit to your situation. If you have bumps, some hair killed with the high powered lasers will just make what remains more visible and the laser itself can cause depigmentation (whitish areas) of the lasered skin. I would need to see you, but it is not an easy trip from Italy to my office in Los Angeles.

i had my second HT 25 days ago. my grafts are growing and i can see the hair. is this a good indicator of my surgery? i feel most grafts are growing. my question- does this growth indicate a successful surgery and if i lost my hair after a week or so, will it grow back after falling out depending on this growth i see now?

thank you

That is great news! Good for you. Hair growth occurs immediately in about 5% of patients. In some patients, some of it grows fast while other grafts grow slower over the 4-5 month time frame. I know when my patients grow immediately, they (and I) get excited. I only wish I knew how to make this happen more often, but it will always grow if the transplant was done correctly and if it does not grow, just be patient and it eventually will appear.