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Is their a Dr.in the Sacramento area who specializes in hair loss. My 18 year old daughter has been experiencing hair loss for about a year. I took her to the Dr. last year and was told it was probably due to stress. Her blood work showed no abnormalities. She has another appointment soon. I am thinking it could be heredity. My father stated losing his hair at 18. I have Kaiser Insurance and I don’t think they are going to do a whole lot to figure out what is going on with her hair loss. What would be the next step? Should she be referred to a Dermatologist? If you could give some assistance, that would be appreciated, thanks.

Women’s hair loss is very different from men’s hair loss. Finding the source of the female thinning isn’t as simple as looking to the history of hair loss from the male side of the family. You should take a look at the female hair loss category of this site and read the many posts on the subject. A doctor who specializes in hair transplantation and has the intellectual capacity to analyze it may be able to help. Usually this is an elimination process for known causes.

I would be happy to give you an opinion, but you would have to fly to Los Angeles to see me. Or Dr. Pak goes to our San Jose office and may be a first start to the process of analysis. It’s not quite Sacramento, but it’s closer than Los Angeles. If not, you can try the physician search at ISHRS.org.

I have had the strangest hair loss from about the age of 15 or 16. I am now 18 going on 19. There was hairloss on the crown which I thought was MPB but over the last 2 or 3 years I have had small but noticable regrowth at times which is uncommon with MPB as I took no minoxidil or propecia. One doctor told me I had folliculitis decalvans after some examination but I have read that this occurs after adolesence into adult hood where as my hairloss has been around since I was about 15 so I don’t know if this could be true. Also I have no pain, swelling or crusting often associated with the disease just some itching on and off or maybe a button or pustule on a rare ocassion. Please help.

If your hair is regrowing and you’re experiencing no pain and no crusting, how can I help? Let it grow! This is a good thing!

If you are not comfortable with what you were told about folliculitis decalvans, get a second opinion. It is a rare condition that is generally seen in adults, but it could occur in young men at your age.

My daughter is 7 years old and her hair his shedding alot. No bald spots. After her shower and when I brush her long hair. Many hairs fall onto the floor or into the brush. It seems like she has new hairs growing in or can this be breakage. She otherwise is healthy and not showing no sign of illness. Is it normal for a 7 year old girl to be shedding this much. When should I see a doctor. She has been shedding for about 3 weeks.

If you are worried about something that you are observing that is not normal, then go see a doctor now! After all, you know your daughter best.

Do keep in mind you can lose 100+ hairs a day. Sometimes we seem to lose more hair at times or notice more hair loss and that can also be normal. There is nothing wrong with getting a physical exam to make sure your daughter is healthy. Abnormal hair loss can be a sign of undiscovered health issues, but it is a very vague secondary symptom. It is a challenge to most doctors.

hi. i have fine hair but have always worn my hair long. so i first noticed it was going when i seen it wasnt growing as fast and what does grow is really stringy. i was wondering would propecia reverse this so that when it grows its thicker? im also 24 years old so hopefully i fall into the younger crowd that gets really good results!

Propecia does not grow hair any faster. It is a medication to treat androgenic alopecia. You need to see a doctor who can examine your hair for miniaturization and for signs of androgenic alopecia if you are to be a candidate for such medication. If you are actually losing some hair due to genetic causes and your doctor prescribes Propecia, I still wouldn’t know if you’d fall into that crowd that gets really good results. Each person is different. Some people get headache relief from one ibuprofen pill, some people will need to take a couple. But keep your fingers crossed!

Hello Doctor Rassman,
I have come to you as you are the first and final ray of hope for me to save my hair. I’m 17.5, male, and I play guitar, longing to become a rockstar some day. I started to lose hair one year ago, yet back then it was too subtle and I was able to successfully hide it…But now it’s different. My hair loss is becoming as visible as daylight and is becoming harder to hide as we speak.

As you can probably tell, I live in a place -heck, a country- where, for my seriously bad luck, no Proscar is available. I have explored various online pharmacy sites that supposedly sell genuine Proscar without prescriptions, yet I preferred not to risk such a thing. It is because of this that I come to you and ask of a genuine Proscar prescription that can permit me to purchase Proscar from a trusted online pharmacy.

I heard that taking Proscar at this age may disrupt the growth phase and turn me more “feminine”. Is this the case in every seventeen/eighteen-year old who decides to take Proscar? Plus, do the feminine side-effects instantly wear off as soon as I stop?

I’m really confused as to whether I should take Proscar or not.. I want to grow normally, lead a normal male life, but I’ll definitely be bald by a year from now. It’s a dilemma I really need your help and advice in to solve. Please, I swear to everything holy that you are the only person who can help me in overcoming this disaster.

You’ve referred to Proscar over and over, but I have to assume you mean Propecia since you’re talking about treating hair loss. Just to clarify, Proscar is 5mg finasteride and Propecia is 1mg of the same medication. The lesser dose is for treating hair loss, the higher dose is for treating prostate problems. If you get Proscar (or generic 5mg finasteride), it should be cut into smaller pieces if you’re treating hair loss. Now that that is out of the way…

I do not prescribe drugs without seeing a patient, as it is against California law. The risks for a 17 year old are minimal (it was studied in men as young as 18, however). I have prescribed the drug for men at your age, but you need to have a doctor involved and the dose should be 1mg of finasteride if it is indicated for you. I can’t tell you if finasteride is even right for you, as I’ve not seen you and I don’t know enough about your medical history, family history, etc. Please, please see a doctor. You’re 17 and likely in the early stages of losing your hair, which is when Propecia works best. I’m not sure which country you’re in, but I’d assume if you’re having a difficult time finding Propecia or Proscar name brand, you can find the generic name, finasteride.

Thanks for the forum Dr. Rassmun, it has been very informative. I do a lot of research on the internet and it seems that people are all for hair translplants or they are all against them with many failure and nightmare stories. I saw something you wrote saying hair grows for 99% of translpants, but gaging from other sites it seems like 50,50. I was wondering if you could give me a ballpark number in your experience of people who are happy with their transplant to people who are not.

Anyways I am 24 and have pretty accelerated hair loss, but the back and sides of my hair is pretty strong and thick. Does the regrowth of transplanted hair in the mid 20s have a better look than transplanted hair later in life? Its seems the pictures Ive seen have led me to believe this, thank you for your time and keep up the good work.

Generally, delaying hair transplants just increases the suffering time for those individuals who are bothered by the balding process. Why delay a hair transplant when the young man needs and wants the youthful impact of a full head of hair? If you wait until you are 60 years old, then you will look older until the day you decide to be transplanted. A 25 year old may look 40, a 40 year old may look 50 or 60, and a balding 60 year old may look 80. A hairy 25 year old will look 25 and that is what most 25 year old people want. I have transplanted many 40, 50, and 60 year old men who look 10-20 years younger with hair.

Satisfaction rates in my practice are very high, not just because we are good surgeons and know what we are doing, but because we set expectations correctly, do not employ salesmen who get a commission for selling you what you may not really want or afford, and we give all of our patients access to previously transplant patients at our monthly open house events. Patient education is at the foundation of satisfied patients.

hi dr. william rassman.

i am a 22 year man suffering from male baldness pattern near to stage 4. at this young age i have lost most of my front hair and from front i am almost completely bald. i want to have hair transplant surgery within next a year or two. what is your suggestion? thanks and waiting for your reply soon.

Without an examination, I can’t tell you whether you are a candidate for transplantation or not. You should have your scalp mapped for miniaturization, which will help determine how advanced your hair loss pattern will get. For example, you wouldn’t want to rush into a surgery at 22 years old only to lose more hair as the years pass, leaving you with an unnatural looking pattern. At your age with class 4 hair loss, your pattern may continue to recede further. You should meet with a doctor that can help you form a Master Plan (an outline of your surgical requirements and plans for the future). The use of Propecia (finasteride) should be an absolute in slowing or stopping the hair loss in its tracks. Don’t get me wrong, even at 22 years old you still might be a candidate for a hair transplant, but you need to have a good doctor focus on building your Master Plan that will protect you for years to come.

dr rassman
in your experience is it always evident that the earlier the balding process begins the more advanced the pattern will be? or can an individual simply be limited to losing only his crown at 20 years old then have the hairloss stabilize?

also when someone is diagnosed as having 50 % miniaturization does that refer to their entire scalp or a specific area (ie the crown is 50% miniturized)

It is possible that you could start losing hair early and have it stabilize. When Dr. Norwood did the original study for classifying hair loss, he did note that of those men who progressed to a Class 6, the hair loss started in their early 20s. But, your hair loss pattern is decided by your genetics. Or in other words, if you lose your crown hair at 20 years old it doesn’t necessarily mean you’re going to be a Norwood 7 by the time you’re 30.

But in your case with 50% miniaturization, I assume whoever did that test was talking about the entire scalp, not just the crown. I don’t know how the measurements were taken, though. If you have 50% miniaturization throughout the top of your head, you’re likely going to have a large balding area. I generally measure each area in the balding patterns so that I can predict where the patient might go as they lose their hair. From these numbers, i will re-look at the patient in a year and see if there were benefits from medication and assess what the value of the drug was in modifying the hair loss pattern and rate of appearance.

Hello Dr. Rassman,
In your opinion, would avodart as a substitute for propecia in my situation be ok to take & would the avodart dosage be more effective in stabilizing hair loss? I’m in my 60’s & the avodart sterility side effects don’t concern me. I have been taking propecia for approx. 8 years, & have been experiencing substantial hair loss in the last few years of even previously transplanted hairs from two HT’s as I was a Norwood 6-7, & had very thin, fine hair in my donor site, & quite bald on top.

I’m out of state now, but my surgeon is very well known & extremely skilled & I respect him & was enormously happy with my HT’s I had 7-8 years ago. I’m assuming my donor hair is one of the few cases where it wasn’t destined to last a lifetime. I still some have hairs on top, but quite thin & sparse.

I realize you won’t give specific suggestions concerning Avodart, but any direction would be appreciated. I don’ want to go back to wearing a hairpiece (over 30 years)! Thank you!

Taking Avodart (dutasteride) for a man over 55 years old and not concerned about fathering more children is a reasonable approach. I have heard from the transplant physician community that when hair loss is not stopped with Propecia, the use of Avodart may help.

I am curious about the loss of your transplanted hair, however. This should not typically occur and should be discussed with your surgeon. Don’t just assume! Talk to your doctor!

I’m thinking about an HT, and after reading all your topics I see my biggest concern is shock loss. I’m a 61 year old male and have a high degree of miniaturization in the proposed recipient area. In one of your responses, I believe you recommended not having an HT for thinning hair?

You often recommend Propecia for younger men and say it might prevent shock loss for possibly 90+ cases? You also recommend taking Propecia 2 weeks to a month in advance of the HT(but even the day before the HT is better than not at all?). Would this advice apply to an older guy like me? Or if I’m correct that you would not advise cases of older age onset thinning to not seek HT?

Propecia works at any age to prevent shock loss. It is best to use this medication in advance of the surgery (at least 2-4 weeks). Older men generally have less hair transplant shock loss than younger men. I would need to know more about your miniaturization and your last 1-2 year history of hair loss. At 61 years old, few men are actively losing hair.