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Dr. Rassman,

I have been noticing a lot lately that most balding men also tend to lose hair on the back of the neck. The “receding neckline,” as I call it, is something that I never hear talked about on hair-loss forums, and it doesn’t appear to be represented on the Norwood scale.

Have you had any experience with patients who were concerned about this?

Yes, we occasionally see patients with neckline hair loss. It is not that common, but it does occur. In fact, a few years back a patient came to see me specifically requesting to have hair transplanted into his receding neck hairline.

The loss of neck hair is why harvesting donor hair from the correct (non-neck) area is very important for future hair loss planning. I have seen patients from other clinics who had their donor hair harvested from the neck area and I often worry that they may lose those hairs in the future if their neck hair was genetically determined to fall out, which would compromise the hair transplant.

Could you please indicate why the following approach doesn’t seem to be option as far as I can see on the market?

I’m wondering why there are no companies offering to attach single strands of hair (real or fake) directly to the scalp using some type of bonding adhesive. No mesh or anything like that but bonding the miniscule head of a strand to the scalp with adhesive. These strands would stay attached during showers, etc. until one could wash out the attached hairs with a special shampoo that can break the adhesive bonds. Or even better if the bonds can break down themselves over a reasonable duration of say a few weeks.

Then one would proceed to attach “fresh” strands as required. It would be like going to a hairstylist except one would go to add these strands. This would avoid the non-breathing aspect of hair pieces and possible traction alopecia. I’m sure the cost may be relatively high for the manual work but it may be the only option for some people who have limited options. I can envision a machine that might be able to do this efficiently as well.

Is there no such bonding material for the skin available in the medical community that would last for weeks at a time? Thank you for your informative blog.

Cyanoacrylate (more commonly known as Super Glue) is used in medical glues and can probably accomplish part of what you want. However, the skin does cycle and the top layer of skin often comes off, taking the glue with it. What you are describing would take a lot or work. Who do you imagine would do it if you couldn’t get your machine invented?

It’s fun to come up with new ideas, but this just doesn’t sound reasonable due to the time and effort to make it look natural. Hairs can’t just be dropped on the head randomly after smearing glue on your scalp.

(female)
I was on the men’s extra strength 5% rogaine foam for about a year, with spironolactone too. It has been beneficial for both my eyebrows and hair to some degree, but it has also caused a distressing amount of facial hair in almost every part of my face you could imagine, particularly my temples and jawline. I have never had facial hair before, and constantly trying to remove it just to look normal is both stressful and has had a negative effect on my once nearly perfectly smooth, flawless skin. So now I have decided to switch to the 2% liquid, in hopes that the facial hair will cease, and also because I’ve read that in females there’s no significant advantage recorded in using the 5% vs the 2%. However, in the last 2 weeks I’ve switched, my hair has been falling out like crazy. Is the 2% therefore really that much less effective?

Based on what you are saying, it would seem that the 2% is less effective for you. I don’t think I can add any more input. If everything you are doing is exactly the same and nothing has changed except changing the medication, it would be the next logical assumption.

I’m a 51 year old male…. There is no baldness running in my family. My twin brother has a full thick head of hair. About 5 years ago I noticed my hair thinning a bit around my hairline above my forehead. Didn’t really give it much thought. But over the past couple of years I’ve noticed an overall increase thinning of my hair especially around the crown and the hairline. I don’t have any bald spots. Just thinning to where my scalp is more visible now.

I was in a very stressful job when I began noticing my hair loss. Not sure if that had something to do with it. I do use hair products in my hair to keep it looking nice and shiny. Is there a way to tell if it’s just a temporary condition and that my hair will re-grow or something more permanent? Not sure if I should see a dermatologist or a general doctor. Any suggestions?

If you have an identical twin he will also lose hair like you, but if your twin is fraternal then your genetic make up is not the same. Thus, your fraternal twin may not lose hair like you. The great majority of the time men see hair loss is due to genetics, and this is called androgenic alopecia (AA) otherwise known as male pattern baldness (MPB). So while most hair loss for men is genetic, it can skip generations making it impossible to simply look at your father, brother, uncles, grandfather, etc to know if you will be bald.

Hair loss from stress is different than genetic balding and it does not occur in a “pattern”, thus the term male “pattern” balding. I’d suggest your next step is seeing a physician. Either your dermatologist or general physician should be fine.

I have been experiencing hair loss and notice during daily shedding, there are visibly different diameter hairs. Do the thin hairs represent minaturized hairs destined for baldness or can this be seen with the normal telogen phase? Thanks for your reply.

A non-balding person can lose 100 to 200 hairs a day. These hairs can be thick or thin, miniaturized or non-miniaturized. The good news is there are likely 100 to 200 new hairs growing at other areas of the scalp.

You cannot say miniaturized hairs represent hairs that are destined for baldness. It may just be a normal part of the hair cycle. In every hair follicular unit there are one or two vellus hairs which are short and thin. They go through the hair cycle like their big brothers in that follicular unit.

Hello Doctors,

Most hair loss experienced by men is due to genetics and therefore there is really nothing that may be done to change one’s genetics. If a young man in his early twenties begins to lose hair with a Norwood 3 hair loss pattern does it mean the hair loss will be progressive and continuous (e.g., in early thirties be at NW4 and so forth)? I’m in my early twenties and heading to a NW3 hair loss pattern so in general does it mean my hair loss will get worse as I get older or will I keep that NW3 pattern up to my senior years? Also, is being at NW3 at early twenties a bad sign or greater probability that hair loss will get worse?

Thanks

You can’t just use the age you start losing hair to find a clear view of your final hair loss pattern. You could start losing hair at 40 years old and stop at a Norwood 4. You could start losing hair at 20 years old and proceed to a Norwood 6. Your hair loss might stop at a Norwood 3.

Mapping the scalp for miniaturization will help you see the progression over time so we can estimate the pattern you’ll get to. At this point, there’s no way to say whether your loss will get worse.

Hi Doctor,

Given the longer half life of Avodart would you expect catch up hair loss - due to stopping drug - to be delayed more than Propecia (i.e 3-6 months)?

Thank you for your time.

That’s an interesting question. I do not know for sure, but I suppose in theory the catch-up hair loss with Avodart (dutasteride) may take a bit longer considering the long half life.

Hello, my questions is about your terminology of “buyer beware”. That is you often say all these over the counter medicines are “buyer beware” does that indicate that you believe there are some non FDA approved supplements etc. that actually do work on an extremely small percentage of people. In essences have you ever seen someone benefit from any non FDA approved treatment?

The best example of an herbal that is popular for treating hair loss is saw palmetto. There is a suggestion that there are some positive hair effects, but without clinical studies you will not see me endorse it. I’d need to see the proof beyond isolated reports by anonymous people on the internet. I’ve yet to see a patient here that had positive hair loss treatment results from an over the counter supplement.

Expectations are everything and you don’t want to have your time wasted by trying new approaches over and over again with no value as you continue to lose your hair forever. Readers of this site and of course my own patients expect me to be straightforward and not point them in a direction that could be a waste of time when there are proven safe and effective medications. Hair loss is a progressive process and every man who has it and does not take proven medication is destined to be balder and balder over time. Safety is another issue and from time to time we see the FDA take a stand and get some product pulled from the market for safety reasons.

“Buyer beware” is just a reminder to be smart about what you’re buying. It’s a notice to folks to use common sense and be more cautious before wasting your money on some truly obvious scams. If some product claims 100% success in regrowing hair, don’t you think everyone would know about it? I’d have no reason for this site if just one of these garbage products had the 100% results that are claimed, because there would be your hair loss cure.

Hey Doc

Firstly huge thanks. When I finally realized I was balding scouring the internet was about the worst thing I could have done until finding your blog and information. I made the decision to get on propecia and take control. My question is about how fast balding can progress. What I mean is I know there is no specific timeline, but is it possible for someone who begins to notice their balding to progress extremely fast over a short period of time of say 6months - 1 year? Obviously the timeline varies but I just mean if you have seen cases that have progressed super fast in the form of MPB. If so what was the fastest you saw?

Again thanks for all your help here!

I think the fastest I’ve seen someone bald was in 4 months or so, when a 40 something year old man lost his young child. Hair loss from this absolutely terrible stress is well known. Some men may lose much of their hair in the period of one year when they are stressed (which accelerates the balding patterns in many men). Keep in mind I am sure the process started much earlier on, but the visible dramatic (socially visible) change can happen fast. Usually for those with the Norwood 6 or 7 destined gene, the balding process seems more dramatic as it happens earlier in life (often in a man’s 20s).

The Norwood scale is not necessarily a progression scale where one goes from a 3 to a 4 to a 5 to a 6 and to a 7 pattern. Most Class 7 pattern men will thin to that pattern without going through the other classes of balding.

Dr. Rassman,

In prior posts here, you have stated that 50% of men experience some degree of balding in their lifetime. Yet, when looking around at older men, that number seems much higher than that! Men like Ronald Reagan stand out precisely because so few men still have ALL their hair in old age. Reagan’s hair would not be so striking if he was just part of the 50% who never lose hair. I am just wondering what that 50% stat is based on.

I believe that 50% is loosely based on observations by doctors and is quoted widely (even by me). I am not aware of any specific studies that looked at men in a certain age group and categorized them on a hair loss scale. So I guess the percentage could be 42%, 51%, 69%, 71%, etc….

On a final note we generally consider 50% of men go through some degree of genetic, patterned balding. This does not account for age related general hair loss, where there is no pattern.