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Doc, I really appreciate this blog which I consider, by the way, the funniest blog on the Internet about hairloss. My question is about maintainance. You have written many times that baldness will catch up all of us sooner or later but, on the other hand, some people, mostly in their early twenties are still maintaining after ten years, their benefits of Finasteride. According to these: you think that those who are taking Finasteride will lose most of their retained hair, maybe at their late thirties or fourties? Or perhaps these people could get to keep their hair until they reach their fifties or sixties?

I know very well that you don’t like the guessing game but I am sure your professional experience gives you a better perspective about these topic.

You’re right in that I don’t like to guess, so I’m not going to do so here. The data is just not there. Finasteride hasn’t been around long enough to say whether it’ll maintain hair loss treatment benefits 30 or 40 years after you start taking it. What I do know is that it does still provide benefits after the 10 year mark for some men, because the medication has been available for about that long. Finasteride was around in a larger dosage (5mg) since 1992 to treat the prostate, but I don’t have data about hair loss treatment benefits in those that took the drug back then for prostate health.

The drug company Merck shows a slow loss of effectiveness over the first 5 years, but there is no published data beyond 5 years. I have had many patients starting this drug in their early to mid-twenties and over the 10 or so years the drug has been on the market, many of the men who reversed the balding in the crown have maintained all of the benefits. Unfortunately, I can not project this out for the length of time you are asking about.

(male) Hi, i was wondering something and had a question. When i cut my hair real short and stand under direct light you can see my scalp, but if i am in just regular light like out in the car i can not see it. The strange thing is when i let it grow out i cant see through it at all. I dont understand whats goin on. People say my hair looks thin at the top but the lady that does my hair says i have good fine thin curly hair. Could you please give me some insight? thanks.

Imagine looking out your window when you’re in an airplane on a sunny day and seeing some thin, short trees. You’d probably be able to see the ground in between them. Now imagine looking out that same window on a gloomy day and seeing thick, tall redwoods. You probably won’t be able to see the ground between the trees. Now apply that logic to the hair on your head.

If that doesn’t make sense, how about this: Fine hair has less hair bulk than coarser hair, so the longer the fine hair is, the more significant will be the bulk. People with fine hair have difficulty looking full-headed, because the bulk of the hair shaft is small.

Thank you again for maintaining this blog. It’s very informative. I have two questions:

1. What does it generally mean when a man loses hair at the vertex first? I understand that every one is different, but do people who lose hair in the vertex and have little to no hair loss at the hair line tend to maintain their hair line? The Norwood scale suggests that hair loss usually begins with a receding hairline, with hair loss in the crown coming later. Also, I have noticed that men with receding hair lines generally state that they started to lose hair (in the front) in their early 20’s. Do men that make it to their late 20s with little to no recession tend to maintain strong hair lines, or have less recession?
2. I use minoxodil. However, I still have quite a bit of hair and don’t think it absorbs into my scalp very well. Even after 4 hours or so I can touch my head and my hands will be wet from the liquid sitting on my scalp. Should I use a scalp roller? I have read before that it may increase absorption. It seems relatively easy to use and inexpensive. So long as it does not cause any harm (or further hair loss) I would give it a shot. Thoughts?

Thanks again

1. Depending upon your genes, the balding may or may not start with thinning in the crown. If you keep your hairline into your 30s or so, you have a better chance that you will keep it — but some men do lose their hair later in life. I really can’t give you odds, as each case is unique. From your question, I am guessing that you’re losing hair in the crown and are worried about the hairline going, but I can’t provide you any clear comfort.
2. If you do not believe that regular minoxidil works well for you, try Rogaine Foam, which is reportedly easier to use and better on the absorption. I wouldn’t bother with the scalp roller until there have been some established trials that show it is worth using. Contributing author Dr. Bessam Farjo wrote about that recently.

Is it possible to lose hair in the crown even with a juvenile hairline or am I most likely seeing a cowlick or nothing at all?

I, Dr. Rassman, am an example of a person who has no hair loss in front, but had established a mature hairline before I lost crown hair with a wide 4 inch circle of hair loss. My transplants were only done in the crown (1600 grafts). I am a happy camper.

The frontal area and the crown area have independent tracks on the hair loss timeline. Each hair follicle is genetically coded for the number of cycles in its lifetime and usually the frontal area gets impacted faster and possibly earlier than the crown in some men. I am afraid that there are no general rules for your hair follicles to follow. So to answer your question, yes, it is possible to lose the crown while retaining a juvenile hairline.

Hi Dr. Rassman:

A number of years ago, I had some hairloss related to having my hair tied back too tight. At first I thought I was losing my hair, by over the years it’s become increasingly apparent that I’m suffering from damage from traction alopecia. The hair is back, but grows only an inch or two.

Is there anything short of a transplant I can do to treat it?

With traction alopecia in some cases there are elements of damage that still leave hair there, but the hair is not healthy anymore. Yes, hair transplants can increase the density there and the hair transplants will grow to full length. There’s really nothing else you can do to treat it, unfortunately.

Hello Doctors,

I just read an article from a writer for the local paper about her 100 pound weight loss following gastric bypass, which is something I’ve considered doing for myself. One thing that stuck out to me was that she says, “One common post-surgery side effect is hair loss. And I have been losing my hair. I knew about this before surgery, so I am dealing with it. I don’t like it, but it will grow back, and I have also lost most of my eyebrows, but that too will grow back.” See article here.

So my question is, how common is this loss? Scalp hair loss is a problem in itself, but to lose my eyebrows too would be devastating. How long could something like this take to regrow (or will it not regrow)? My husband visits this site quite frequently and when I mentioned the story, he suggested I write to you. Thanks for your help.

A gastric bypass surgery causes weight loss and in many cases can produce signs of malnutrition. Weight loss is often associated with hair loss, particularly in men who have genetic hair loss. For women who do not have genetic hair loss, the hair loss may reverse as nutrition gets better and the weight stabilizes, but for men with genetic hair loss, it often accelerates the genetic process. For men in this situation, it’s best to take finasteride prior to having the gastric bypass, and maintaining this drug for life. Even with the DHT block offered by the drug finasteride, hair loss may still occur.

The good news is that hair transplantation can be used to replace the lost hair in the same way as in a person with hair loss that didn’t have the gastric bypass. As far as eyebrow loss, it would be unusual, but again, hair transplants into the eyebrow easily can solve that problem as well.

hi, i want to ask, hypothetically could a NW7 get an FUE but instead of getting a natural hairline get his grafts redistributed to a Mohawk so he would have no hair growing out of the sides but instead have all his hair concentrated to a 1 inch thick line going from the front to back and if that could be done, how many grafts would that be?

I’ve never had that request before, but yes, it is distinctly possible. What I tell all my patients is that the good and bad news about hair transplants is that they are absolutely permanent. As a young man, a mohawk may be a great idea for your particular look, but at 60 years old, will it still be great? Depending upon how thick you want it, it might take between 2500-6000 grafts.

Note: The image to the right is of the iconic Mr. T — and as far as I know, he didn’t transplant the mohawk to his scalp. I’m just using the photo as an example of the hair style.

Dr. Rassman,

I was given a single dose of oral testosterone by my endocrinologist and I had not taken my daily Propecia. I’m afraid that the DHT surge did some damage by “tagging” follicles. Is there truth to the DHT “tagging” myth? In otherwords: does DHT “tag” hair follicles and activate within them some sequence of irreversible self-destruction? Or, does fresh DHT need to continually bind to receptors on a follicle to cause it to lose function? Or, is the DHT binding cumulative? Does a hair follice only begin to lose function once a certain number of DHT receptors have been bound with DHT?

Castration is rumored to halt balding. Therefore, wouldn’t this indicate that the effect of DHT stops once the DHT is gone? However, their hair does not regrow. So, is DHT “stuck” to the follicles, or are the follicles just not able to revive?

DHT does not stay in the hair follicle for a long time, as the body will metabolize it. If you were to stop taking your daily Propecia (finasteride 1mg) and took testosterone at about the same time, I expect that more hair loss will occur. Each genetically impacted hair follicle has a number of hair cycles which is usually less than genetically non-impacted hair follicles. That is why we lose hair in different parts of the scalp and different points in our lives. The DHT will not stick to the hair follicle beyond a week or two, so those hair follicles that are not due to undergo apoptosis (cell death) will most likely live until their time to die comes.

Hello,

Thank you for putting time into this website. It has proved helpful. I had a few questions about finasteride.

1. Does exercise have any effect on increasing or decreasing side effects?>
2. Does exercise have any effect on how well it would work?
3. What do you think of taking iron supplements to get finasteride to work better? (I am iron deficient, but I am not sure if it is enough to effect my hair. Going to a doctor soon to get my iron checked again.) Link
4. Since I am 21, I have the best chances of finasteride to work. Do you see it work with almost everyone my age, especially at the very beginning of MPB? What about how common the side effects are at my age?
5. I am going to see a hair transplant doctor soon. If miniaturization is found and the doctor is not willing to give me a prescription for generic proscar, can you? (Not sure of the legality of this. I hope I am not putting you in a bad position.)

Thank you for your time.

1. No. Exercise won’t increase or decrease side effects if you happen to get them.
2. No. Exercise won’t mess with the effectiveness of finasteride.
3. Get your iron checked and be under the care of a good doctor. I don’t see any value in trying to make finasteride work better, though.
4. Finasteride works well in young men, but a few who are destined to develop advanced balding may find it doesn’t work as well. Side effects are possible, but it is a very slim chance. There are reports on the internet that are overblown.
5. You should do a miniaturization study and take pictures of various parts of your scalp. The presence of significant miniaturization will indicate genetic causes of hair loss.
6. You aren’t putting me in a bad position by just asking, but let’s get a telephone consultation (call 800-NEW-HAIR) and see what’s happening. Any doctor can write the prescription so once you know the diagnosis (miniaturization pictures taken by you and sent to me), you can start finasteride if it is in your best interest. Your family physician will often prescribe it for you.

dr rassman
quick question regarding dht and hairloss. if dht was some how able to be 100 % blocked would that totally stop hairloss or is their more to it than that ?

We know that if the testicles were removed (as done in one of two identical twins in a study in the 1950s) that hair loss will not occur. We also know that once the hair has been exposed to dihydrotestosterone (DHT), the impact is dramatic in the speed of the hair loss. The twin that had his testicles removed for mental illness (a barbaric process) had a full head of hair, but was given testosterone and rapidly lost his hair. The other twin, with both testicles in tact, went fairly bald naturally.

With all that being said, the complete blocking of DHT might not be the only solution to eliminating hair loss. There could be other factors in play, such as various diseases… or even something else entirely that has yet to be discovered or proven.