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My temples receded from my highest wrinkle brow to 1.75 inches. You said a mature hairline temples are up to 1.5 inches away from that wrinkle. So I’m slightly more which is fine by me. But around those corners there is a piece of short hairs, they seem to have the same thickness as a lot of my front hairs but they look like they will fall of since I assume they are miniaturized. After that my temples will be about 2-2.2 inches receded which will be too much. I just began Propecia and am almost 22 years old, can Propecia stop those hairs from falling out and even help them grow normal again? But I’m also taking Propecia because I have frontal and mid anterior probs as well but early stage.

Propecia will slow or stop the hair loss in most men of your age. Consider sending me photos (will be kept private) and I will give you an opinion, but you should consider getting your hair mapped out for miniaturization to determine if these hairs at that exact location are really miniaturizing.

Dear Doctor,

I am 19 years old and my hairline has receded a bit at the front and a bit more at the temples starting about a year ago. I am considering using rogaine to halt the loss but I read on the website that it could cause a significant increase in hair loss during the first stage of use. my questions are:

1. is it safe to assume that because I am relatively young, my hair wont fall out as much during this stage?
2. I read that rogaine does not work for everyone. If I experience the initial excessive hair loss, then stop using rogaine, will most of that hair grow back?

In addition, I would be more than happy to have your opinion on what path of treatment I should take

Shedding from minoxidil use does not occur for everyone and should be temporary, and there is no connection between this shedding and your age. See Hair Loss Worse After Rogaine for more.

You’re focused on Rogaine (minoxidil) and at 19 years old, your hair loss most certainly will be genetic. Propecia (finasteride) is the best choice for genetic hair loss in a 19 year old, without a doubt. Get your hair mapped out for miniaturization, have your doctor make a diagnosis, and then get him/her to think through a Master Plan with finasteride (Propecia) in it.

Hi Dr. Rassman,

i am following up on a previous message i sent. I am wondering if you know of anyone who after taking propecia(finasteride) found the following symtoms- tinnitus with an overall feeling of pressure in the head. I only took the drug for two weeks and then stopped after these symtoms appeared. I am still suffering with this six months later. I had these same symtoms five years ago, (but was not taking propecia at the time) which lasted for one year and am wondering if the propecia could have triggered this again as it is used as a blocker, or might it just be a coincidence.

Hope you can answer this for me, thanks!

I do not know what may be the cause of your problem. While many drugs can cause tinnitus, it is relatively rare. More importantly, tinnitus can potentially be a sign of serious medical problems and suggests to me that you have some medical issue which needs to be addressed by an expert in middle ear problems. I personally have not seen any patients in the last 10 years with tinnitus as a side effect of Propecia. I’ve been asked about this once before, a couple of years ago — Propecia Causing Tinnitus?

I have FUT surgery scheduled in late late July. I started taking propecia early July..so would have started about 3 weeks before surgery. Is this long enough before to help reduce chances of shock loss?

The longer the better, but 3-4 weeks should cover you. Stay on the medications until all of the results are achieved and then consider staying on the drug for life. Talk with your doctor about this.

Dear Dr. Rassman,

I’m 24 and I’ve been using Propecia since Dec 2006. It worked very well to slow down my hairloss but in the last 30 days I’ve been seeing more shedding. I work at my computer and I’m seeing more and more hairs on my keyboard and desk. I’ve been using Propecia for 2 years (almost) - is this the normal timeline for the hair cycle? Dormant for 2 years and then shedding for a couple of months? Is my shedding a sign of more balding to come?

Thanks!

If you had been my patient from the beginning, I would have a reference map of your hair and scalp for miniaturization and I would be able to look at the change over time. By starting from point zero and looking at the measurements two years into it, it will help show what occurs over the next two years, but will not help you now. This could be caused by a normal acceleration of the genetic process, or you can be misinterpreting what you are seeing. You should go back to the doctor who put you on the Propecia and ask him to examine you and give you an opinion.

Hi Dr. Rassman, can you explain why people with hypothyroidism and hyperthyroidism often suffer from hair loss? I was diagnosed with hypothyroidism last summer(TSH of a little over 8.8), and since then my endocrinologist has changed my dosage of thyroid medication twice, most recently in April. I have been experiencing a lot of hair loss since I have started the medication. Could propecia possibly be beneficial to my situation? Thanks for the great website.

Unfortunately, I do not know the exact mechanism of why people with low thyroid can experience hair loss from it. As the saying goes, it is the “practice” of medicine and not the “science” of medicine, and as such, medicine can be a descriptive and observational discipline.

Propecia will not be beneficial for hair loss associated with thyroid conditions unless there is an active genetic component to it. Propecia is a medication for androgenic alopecia.

I know Propecia won’t work to regrow a hairline but can it help regrow hair behind a hairline like 1cm behind it? Since my hairline is still intact but behind it is where the drama lies.

It can, but each person will react slightly different to medication, so regrowing hair there might be rare. It has a better chance of maintaining hair that is left, though regrowth isn’t completely out of the question. The younger you are and the shorter time since the hair is showing the impact of balding and thinning, the better the chance of reversal.

Dr. Rassman, if more Finasteride blocks more conversion of testosterone to DHT in the 5-alpha-reductase Type II, then why would it not be better for preventing more hairloss? I heard of people who up their dosage if it starts to lose effectiveness and it works for a period of time. Also, what would happen if 100% of DHT is blocked and you had no side effects, in theory could you never have hairloss? Lastly, why cannot Saw Palmetto be used in conjunction with Propecia to block more DHT?

Regards

To make DHT, your body must have the enzyme 5-alpha-reductase. We know this because some people are born with this enzyme missing and when that happens:

1. They do not develop sexual differentiation and become hermaphrodites
2. They do not become bald
3. They do not develop prostate cancer

That suggests that DHT is the cause of hair loss when interacting with a person’s genetics. I can not be sure that DHT and 5-alpha-reductase type I or II are totally responsible for genetic male pattern balding, but it is highly suggestive. It may not be as simple as blocking one hormone, so we may not really be sure of the science.

Lastly, I do not believe there is good scientific evidence of saw palmetto blocking DHT the same way Propecia does. I reviewed this subject fairly completely and could find conflicting discussions from good scientific sources that show evidence that saw palmetto may work on blocking DHT… or it may not. Saw palmetto is a herbal medicine that has been traditionally used for prostate (not balding) problems in men, so studies on balding are not very complete or scientifically studied with good double blind clinical research projects. Finasteride is a medication that has been used in high doses (5mg) to treat prostate enlargement in men with a unexpected side effect of growing scalp hair in balding men. The value of both Propecia and saw palmetto will probably give more side effects, particularly the negative impact on libido.

I been reading about the shedding that may happen with Propecia in the beginning of treatment in the blogs and on the Propecia site. If it’s gonna happen, will the shedding be noticeable or I’ll just lose a little more hair a day then I should? Also is it a rare or common thing to shed with Propecia? Right now my thinning ain’t visible to people but I know it’s there I would really be upset if Propecia will make my hair thinner in the beginning.

In the many years in practice and being one of the largest Propecia prescribers (according to Merck) in California, I do not remember one case of shedding reported by my patients. I do believe it does happen because of the large number of people who report it to me on this blog, but I suspect it is far less common than the reports you can find on the Internet seems to suggest it is. As I have not seen it in my patients, I really do not know the answer to your question, but I suspect it may vary all over the place from minimal to substantial.

Hi Doc!

I have been losing my hair for about 4 years now. I have used a number of products already including Avacore, Rogaine and most recently Kevis. I have been using Kevis now for about 6 months with no results. I have been losing more hair then I have ever lost on the other products though the people at Kevis had told me that I would not lose any hair and that the success rate is over 90%. They also said that I will see results within 2-3 months and when I told them that I dont see anything they said that I will have to wait 6-9 months before seeing any results and that I will have to double the dose. I am now completely bald at the sides- in the front and the middle is thinning terribly. I really want to stop using Kevis but I’d like to know if there is anything you recommend doing as an alternative hair loss program.

Thank you so much for your help.

What you are telling me is that you believed what you were told by salesmen who profited by giving you advice. Bad advice that ended up putting more money in their pockets. That is a shame. The ingredient in Kevis that the company promotes as HUCP is hyaluronan (hyaluronic acid), which is a supplement commonly used to treat joint pain — not hair loss. That is just one of a handful of ingredients listed, including water, alcohol, sorbic acid (a food preservative), and biotin (which is also known as vitamin B7). Although the product packaging and website certainly look slick, there is no science here. I can’t even find any before / after photos on their website, which should tell you something about the product right off the bat. All I see there are stock photos of happy people with full heads of hair.

Although I don’t know your age, I’m going to assume you are in your early to mid 20s. You should have seen a doctor and instead of wasting your money and the precious hair that you may have lost forever because of the delays, you should have been put on Propecia (finasteride 1mg). Propecia is the only oral FDA approved treatment for hair loss and it would’ve almost certainly halted the loss a 20 year old (again, just guessing on your age). It’s still not too late to do it right, so see a good doctor (dermatologist or hair transplant surgeon who is ethical) and get on the track to the correct treatment. The other treatments you mentioned (Avacor and Rogaine) are minoxidil, which apparently does not work on you.