July 22 2010, 3:00 pm PT | Posted in: Drugs + Hair Loss Causes + Hairlines
I just got the results from a scalp biopsy. My doctor had some interesting conclusions. I was wondering if I could run them by you.
- She said that the results from the biopsy were able to differentiate between MPB and a maturing hairline. Is that possible? She said that the biopsy did indicate MPB. I find this confusing considering I have only lost hair at the corners of my hairline. I just assumed it was a mature hairline.
- She prescribed Propecia. She said that if you have very slow hair loss that Propecia will in fact completely arrest its development. From what I’ve read on this blog Propecia can only slow it down.
- She also said that Rogaine works on the hairline as well as the crown.
Your thoughts would be greatly appreciated.
In all my years, I really never relied on a biopsy to differentiate between male pattern baldness (MPB) and a maturing hairline. Actually, I do not know how one would see that on a biopsy and I would want to know exactly where the biopsy was placed. Plus, it would leave a scar if you were to biopsy the frontal hairline. Getting a biopsy to determine the cause of hair loss is generally performed to see if there is an inflammatory or a scarring type of balding from an autoimmune disease, for example. In my opinion, a maturing hairline or genetic male pattern baldness diagnosis does not require a biopsy.
There is nothing that completely stops hair loss. Propecia is a great medication, but it is not a cure for hair loss. It could slow the hair loss down to make it appear that its completely stopped, but there’s still minor loss going on.
Rogaine and Propecia have been tested and proven to work best on the crown area. Many patients use both Rogaine and Propecia for the frontal hairline and it does work for some men… but not as well as it does for the crown.
If you’re concerned that your doctor made the wrong diagnosis, feel free to get a second opinion. You don’t want to take medication if it is unnecessary… so if it turns out you only have a mature hairline, there would be no reason for you to take Propecia or use Rogaine.
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This article suggests that biopsies, while rarely performed in cases of suspected male pattern baldness, can identify the condition.
http://emedicine.medscape.com/article/1070167-diagnosis
Please, it is very easy to do a Google search to find articles. But if you read the article, it mentions nothing about juvenile hair line. In addition, no physician in practice should be doing dermal biopsies just to diagnose androgenic alopecia in young men. It is invasive and you should start with a microscopic exam (miniaturization study).
Dr. Rassman: It was not my intention to goad you on the subject of biopsies and I apologize. I am, however, interested in a diagnostic test that is more definitive than a microscopic exam. Consider my case. I went to a reputed hair transplant surgeon whom I, and you, respect; he prescribed Propecia and I was on my way in five minutes. No photos, no miniaturization map, nothing. He did say that at 37, I am still not a candidate for surgery and that crown balding is not a priority for someone who will go completely bald in time. The doctor’s prediction that I will go completely bald is based on my family history and his considerable experience in the field. After four months on Propecia I have experienced noticeable benefits-even my children comment on the shrinking hole-but without a miniaturization map there is no metric, no yardstick for systematic study. I am not even sure whether a miniaturization study is feasible after four months on Propecia and posed, without success, the same question on Balding Blog. It is in this frame of mine that I read the biopsy question and wondered whether it could give conclusive answers to people in different stages of treatment. Now that you have spoked out against the use of biopsies to diagnose male pattern baldness, I will cross it off my list.
Propecia does have a limited advantage. It can stop further hair loss but there is no indication that it will bring back life to a dead hair follicle.