About     Contact     Archives     Videos     Events     Hair Transplant

Hi,

I recently went to a dermatologist to be diagnosed with AGA despite no family history (even 3 generations back). I am a 29 year old male, who has been overweight for a few years (~50-60 lbs)and generalized anxiety disorder. I was prescribed “Valium” and a beta blocker called “Propranolol” in December 2009. Sometime in 2011, my head began to itch, sometimes more, sometimes less. By February 2012, I noticed suddenly that there was a thinning patch on my crown and my scalp looked red and inflamed and itched more often.

The dermatologist also took two 4 mm punch biopsies from two sites on my vertex and pathology sent them back as AGA w/ active “Lichen Planopilaris”! I had never even heard of this before. My research just shows me it’s extremely rare, is incurable and for the most part will ruin my life unless I enjoy being bald. What am I supposed to do? Everyone else is calm about the situation, and my derm says he doesn’t yet “buy it” that it’s lichen due to my clinical presentation (Are transverse biopsies ever wrong?)

I’ve read you can’t even restore your hair with HT if Lichen is there because it will just destroy that hair too. How does this Lichen disease come about? I’ve read beta blockers can cause lichen planus, and i’ve been on a low dose for 4-5 years now. I’m not sure what to do, I don’t know why I’d have LPP or where it came into existence from. If its me reacting to the drug, would my hair restore itself if I came off of it after years?

Does LPP also cause miniaturization of hairs because that’s apparently happening as well. How statistically unlucky does one have to be to have both AGA with no famiily history + some rare LPP disease that will scar my head for life?

I’m lost and confused and so far no one has begun any treatments for anything. I know I can’t take propecia, and I know steroids won’t be tolerated well in my body if I have this lichen disease of unknown origin.

Have I received a death sentence for my scalp? The crown/vertex is thinning and a small thinning keeps developing down the parting of my hair. My hairline itself hasn’t receded at all since puberty… The top of my scalp is generally pink/reddish at all times with a little red itchy bump scattered sporadically around my whole scalp.

Thank you for reading my desperate post. I’ve gone from the extremely thick course hair I’ve had my entire life and model with, to losing what feels like 70% of it in the course of 15 months at age 28-29. It is imperative that I restore my hair to its previous glory. I do have pictures if you are interested.

Unfortunately, much of what you said is true. Transplanting hair into an area of active disease will kill the hair grafts. Most doctors will not do a surgery like a hair transplant where the odds are against the success of the procedure. I don’t know the specific statistics for those that have lichen planopilaris, as it is a rare scarring alopecia and difficult to treat.

There are some options: hair pieces, Scalp MicroPigmentation / SMP (which requires you to shave your head for best results), and topical concealers like Toppik.

I have really learned a lot reading your articles.

I am a 21 year old college student. About a year and a half ago I gained thirty pounds and in the last eight months lost 45 pounds, the bulk of which I lost the in the first four months through the Atkins Diet and intense working out. I also had a bad ankle sprain in the middle.

The past four months I have been experiencing shedding, rapid hair loss and a receding hairline. The front scalp has become very thin while the middle is still thick and grows normally. The right hairline has receded about one centimeter further than the left and I can also feel a bald spot, about the size of a nickel, on the right side of the back of my head. The scalp is very itchy and I find that after I itch that there is a white residue on my finger nails.

I feel like I am still young to have lost so much hair.

I still have relatively thick hair but it looks unnatural and frays to the left. Can this be tied to my weight loss, ankle injury or increased stress?

Acute weight loss can cause or accelerate hair loss. I would doubt your ankle injury had anything to do with your hair loss. It’s also possible that these things occurred coincidentally timed to your genetic predisposition.

As far as your nickle size bald spot at the back of your head, you need to see a doctor for this as there are many causes for such a problem. Without good pictures and an opportunity to examine you, there is little more I can say here.

I am now about five weeks into taking Propecia and think that it has affected my temperament. (It reminds me a bit of taking SSRI anti-depressants some time ago.) I little wish to lose my hair and will in a little while decide whether or not I continue with this medication which I gather takes about three months to have a noticeable effect.

What interests me is knowing whether or not this sex hormone pharmaceutical is more or less severe in its side-effects than the female contraceptive pill which it reminds me of (I am a medical layman) in its operation?

Hope that you do not mind a question from outside the United States!

There are mental side effects reported in a small group of individuals, much as you described. I’ve written about this many times before, including here, here, and here.

In one study, finasteride has been found to inhibit hippocampal neurogenesis in mice, which is related to emotional behavior. There are reports in humans with the higher dose (5mg) used to treat the prostate, and Wikipedia lists a few very tiny studies from at least 6-10 years ago that might point to a link between depression and finasteride in humans. This preliminary study from nearly 7 years ago suggests that patients with a high risk of depression should be prescribed finasteride with caution.

Hi,

I’ve noticed that a few of the hairs at my hairline have become ‘wavy’ where as most of my hairs stand straight. Is it the case that these hairs are miniaturising?

They don’t appear to be thinner in diameter than the hairs next to them…but also don’t seem to grow as strong (i.e. they ‘fall down’ rather than grow straight up).

Thanks in advance.

The weaker hairs you’re seeing could be miniaturizing, or it could just be that you’re seeing hairs in different parts of the hair cycle. Without seeing you, I have no way to know.

If you want to know if you have started the balding process, looking at one hair at a time is not the way to go. See a doctor who will measure your hair bulk in different parts of the scalp. Balding people (even in the early part of the process where you can not see any thinning) will always show a reduction in hair bulk.

Hello,

I am 25 and have been gradually losing my hair for a couple for years now. In addition to what I would confidently call MPB, I also suffer from seborrhoeic dermatitis and chronic telogen effluvium.

1. Is the chronic TE linked to MPB or seb derm? I’ve suffered from TE for over a year and a half now and always assumed that losing hairs in this way was part of MPB. It constantly gets me down as I am constantly shedding hairs. A small pinch from anywhere from the top of my scalp can produce up to 20 plus hairs. It’s as if 50% of my hair isn’t even attached to my scalp. Several websites state that chronic TE is due to illness, whilst others say that it is the early stages of MPB.

2. Will the seb derm cause any hair loss if left untreated? Even though the seb derm is quite bad (thick yellow, oily scales all over my scalp), the condition is not yet visible to others and causes me no discomfort. I am worried about washing my hair every day with the recommended treatments because I lose so many hairs due to the TE.

Please help me! I’ve seen two doctors regarding my MPB and both told me that nothing could be done. I only discovered propecia etc. through google. I have been taking it for nearly 4 months now.

Many thanks for an enlightening website

We are not, I suspect, one of the two doctors you have seen. I have no real experience in doing transplants on someone who has a pull test like you reported as evidence of chronic telogen effluvium. I am actually surprised that this has not come before me at an earlier time.

The seborrhea will not produce hair loss as long as you do not scratch or pick in involved areas. Transplants may be contra-indicated with a chronic telogen effluvium.

First, I can’t thank you enough for maintaining this resource–it’s alleviated a lot of my anxiety about hair loss simply by giving my a place to find answers to my questions.

I recently had a consultation with a surgeon about reshaping my temples. I’m 29, and probably a NW2-3. (I’ve had relatively high temples since high school, though the spaces have expanded slowly since though then.) He ultimately recommended 1100 grafts to fill in my temples and create a relatively straight hairline.

I have two questions:

1. He told me that diet has a significant impact on hair loss, second to genetics. He advised a vitamin regimen of L-Lysine, Vitamin E, Saw Palmetto, MSM, Glucosamine, Chondroitin Sulfate, and Ester-C. In addition, he recommended that I stop consuming creatine, and eat a sulphite/nitrite-free diet that’s rich in antioxidants and low in refined sugar and bleached flour. I realize that much of this might be good health advice generally, but does it have any non-negligible connection to hair loss? I appreciate interest in my general welfare, but this had me a tad skeptical.

2. After examining the entirety of my hair, he told me that I’m “programmed” for hair loss not beyond a NW3. He did not conduct a miniaturization study; this was a “naked eyeball” examination. Because he didn’t think I’m “programmed” for any crown-area loss, he said Propecia wouldn’t be necessary. Should I take this pronouncement with a grain of salt, or could he accurately reach that conclusion via the type of examination he made?

Many thanks, and all the best. If it’s at all relevant, he did not recommend any type of hairline lowering, but simply filling in the temples and leaving the forelock as is.

While it is possible that you won’t advance beyond a Norwood class 3 hairline, I don’t trust doctors who give eyeball opinions for predicting hair loss. There are some good tests (miniaturization mapping and better yet, bulk analysis) that will tell you with some certainty if you are balding.

The decision to take drugs like finasteride should be based upon clinical evidence of balding. You might want to consider getting a second opinion, hopefully from a doctor that can give you a more thorough analysis of your hair. If you aren’t balding, Propecia isn’t necessary (though you should consider it to prevent shock loss from any hair transplant you may have). If you do have early balding, now would be the best time to start the medication.

As for the recommended vitamins, I am not a nutritionist, so your doctor’s suggestions may be good ones for your overall health. I wouldn’t expect to see lush hair growth upon taking them, though. None of those have satisfactory evidence linking them to treating genetic hair loss.

Hi Doctor,

When I was young, I was born with an amazing volume of hair. However, I am unsure of what reasons, I started having hair thinning when I was 18. Now I am 32 and my hair volume is only 1/4 of what I was. I am not taking any medication and my family does not have a history of thinning hair.

Can I check what are the possible reasons and what are the steps I can take to quickly regain all my hair?

Thank you.

There is nothing you can do to “quickly” regain your hair. If it was that easy, I doubt we’d see people with balding and this site would be a single post explaining how to regrow all your hair. Unfortunately, the magic you’re seeking isn’t a reality.

You should see a doctor to go over your options. If you have male pattern (genetic) hair loss, finasteride could be a possible treatment for you. Genes are the most common reason for hair loss in men.

Hi, I am a big fan of this blog.

I am a male of 24 years from India and have been losing hair since I was 18. Here is the condition of my hair:
-I think I am Norwood 1.5 and my hair seems full to others
-I lost much of bulk on my balding zones, non balding zones are okay.
-I lose hair which are so thin. Most hair strands that I lose are thick at the tip, but gets so thin towards the root (the bulb portion). The root portion is also whitish in colour.
-My scalp is so freakishly oily and have dandruff only on the balding zone. Whenever I scratch I find hairs that are almost invisible.
-Some long hairs can be pulled out easily. They move in the slightest of wind while holding at the root. Those strands are medium thick but very lifeless.
-My crown is feeling very thinner. The scalp can be seen at bright lights

I think I am in early stages of balding. I want to do something to treat early before it is too late. I am a bit scared of fin but I wont mind giving it a try. What do you say about my hair condition? is it mpb? Can i take fin without seeing a derm? or should i wait for histogen?

If you’re seeing a Norwood class 1 or 2, that isn’t really considered balding. It is normal to lose hair daily, as new hair grows in (hair cycling). It is also normal for your hair to appear thinner under bright, direct lighting. All in all, what you’re describing sounds pretty… normal.

If you are concerned that you’re in the early stages of male pattern baldness (MPB), you should see a doctor. Do not just take finasteride without a prescription. It is a prescribed medication for a reason, and you must see a doctor (dermatologist or otherwise) that can tell you if what you’re seeing is even MPB.

I couldn’t tell you if Histogen or other future treatments will become a reality, or how effective they will even be, or when they will even be public. There are still a lot of questions about future treatments, but we’re all waiting to know.

I am a 28 year old male and I have quite thin hair. Around three years ago someone mentioned it was thinning around the crown. At the time I had quite bad eczema on my head. I assumed this was the source of the problem and have since managed to get it under control with the help of a dermatologists.

However, the hair around my crown does not seem to have grown back. I keep quite a close eye on my crown and I don’t think it has got much worse over the last few years, although it is hard to tell.

Could the hair loss around my crown be due to the eczema? Should I assume it won’t grow back?

I suppose anything is possible, but your guess is as good as mine in this case. It is relatively unusual to just have crown hair loss from eczema. In general, crown hair loss for men is genetic in nature. It’s possible that you have genetic balding in addition to the eczema.

Are there any trends or differences for mixed race people vs Caucasians, Black etc? I mean, do you notice any more or less cases of hair loss in mixed race guys compared to those that you see in your office that are one race? I’m just curious.

There are always variations in ethnicity, but the variation is also individual in nature. One ethnic hair characteristic does not always dominate over another. You can have a half black / half white baby and they can either have white skin curly hair or black skin and straight hair (or vice versa).

We know that the donor densities are different in different races, with Caucasian the highest (100,000 hairs on the scalp) and African the lowest (60,000 hairs on the scalp). Asians are mid-way between the two.

But to answer your question — no, I don’t necessarily see more (or less) cases of mixed race men with balding in my office.