I’m a 20 year old with a question about balding and family genetics. I have a maternal grandfather who is is almost in his 80s who has a huge full head of hair, and a father who is bald. What are my chances of going bald?

There’s no telling. The balding gene can come from the maternal or paternal side and can skip generations. There’s no easy predictor just by looking at the family history, but with your father’s baldness, you do have some risk.

Hello Doctor Rassman,
Does spironolactone cause more hair loss? I seen a lot of people on the internet that claims propecia make their hair worse and others says that this is reflex hyperandrogeincity and their argument was “when DHT lessened testosterone increased alot and cause more hair loss!” but what about Sprio? I heard it decreased testosterone itself and also block androgen receptor, so how it could cause more hair loss?

I’ve always said the Internet is a great source for information, but not everything you read on the web is factual and true. If you want to treat your hair loss with a medication, you need to speak with a doctor. Anecdotal statements or claims found online will mostly mislead or confuse people.

Spironolactone does have theoretical anti-androgen factors, but clinically I have not seen or found credible evidence that it helps with androgenic alopecia. But I do understand that there are patients and doctors who use it as a treatment option. I do not.

Propecia (finasteride) does treat androgenic alopecia. It is not meant to cause hair loss. It is meant to grow hair. I understand there may be controversy on the Internet of Propecia’s side effects and some patients have strong feelings regarding those side effects. My opinion is that each and every individual talk with their doctor and discuss the side effects and understand the risks and benefits. In my practice, many patients use Propecia… and have been using it for over 10 years with no issues.

We can all sit on our ivory tower and debate the biochemical relevance of drugs and mechanisms, but in the end the results (hair growth) is what matters.

I have been on finisteride since 2004 which is working great. I was diagnosed with ulcerative colitis in 2009. Been UC free for two years but got it back in 2010. I still have it a year later, although only in MILD form. My hair did change in texture while a tad thinner. Now, although my vitamin levels have been fine, could the hair thinning be from the UC alone or the medication?

I took Asacol the first time I had it with no side effects. This time, I took it as well as the masalamine enemas. Since it has lasted a year this time around, could it be the meds or the UC alone? Also, any chance of my hair re-thickening? I was wondering how long I should wait until I visit Dr. Bernstein again. It will be greatly appreciated if all questions are answered!!

Asacol does list hair loss as an uncommon, but known, side effect. Maybe it’s the medication or a combination with MPB… or even the UC itself. I do not treat many patients with ulcerative colitis in my practice so perhaps your GI doctor can address your concerns as well.

Hair loss or hair thinning can certainly happen from major stress or illness on your body. This type of hair loss generally should reverse itself in about a year’s time. But often, I find that patients never quite regain their hair. Maybe you should call Dr. Bernstein for another consultation (I’m not sure when your last visit was).

Hello there,

I’ve been wondering if I was going to end up bald. My grandfather on my father’s side is bald, as is my own father. Nobody on my mother’s side is bald (though she had no siblings and her mother’s brothers had their hair).

My bald grandfather said he started to bald around 18. A picture of my dad when he was around 19 1/2, he looked like a NW3. I’ll turn 19 in four months and was wondering if I don’t see any symptoms by the time I turn 19 or 19 1/2, will I go bald?

Thank you again.

There is no way to easily tell if you’ll develop the balding pattern your male relatives showed around your same age. You can have the HairDX test done and get an idea if you have the genes for balding, or you can see us and get a hair bulk assessment yearly to show when and if the balding/thinning process kicks in.

Of course, you can also just watch and wait.

Hello doctor. I was wondering, are the genes for balding and hair ‘type’ independent? For example, if a bald person has straight hair as does their son, is their son at a higher risk of losing their hair since they have the same hair type. I guess this could be similar for curly hair too.

As far as I’m aware, hair characteristics and balding aren’t linked. For example, a son might have the same hair type as his father, but the son didn’t get the father’s balding pattern. There’s also nothing showing a link between hair color and baldness.

For those of us with Alopecia Areata, - this study may be beneficial to you guys. The study is quite positive. Please read the link below:

Link: Local Study on Garlic for Alopecia Areata

Nice find and thanks for sending. I don’t recall seeing too much about using garlic as an alopecia areata treatment.

This was a small study of 34 people presented last year at a conference in Australia. It does sound interesting, and I found another small alopecia areata study discussing the use of topical garlic gel in combination with betamethasone valerate, but I don’t know that the study mentioned in the link you sent was ever published in a peer reviewed journal. While the article is from the Philippine Dermatological Society site, it just mentions that the presentation was by one of their members…not that it was published in a medical journal.

I am glad there are new alopecia areata treatments being explored, regardless of how stinky they may be. And it’s worth noting that a few years ago the NY Times wrote about unlocking the secrets of garlic for use in medicine.

A week ago my grafts were exposed to the sun for approximately 10 mins. I didn’t burn but I did go slightly pink most noticeably on my right temple. To be honest I didn’t worry about it at all at first as from what I gathered from researching previous posts here your pretty much safe up to a first degree burn.

Over the last couple of days however I’ve lost a few newly sprouted transplanted hairs where the discolouration is on my scalp. In fact they emerged just before I was exposed to the sun so only 1 week old. I’m slightly concerned as I assume the only reason this would happen is if the follicles were going back into a resting phase or if they have died.

Is it possible sun exposure can cause follicles to shed but then regrow? I’m 9 weeks post op and had just experienced some early growth about week 7/8. Your opinion would be greatly valued.

I wouldn’t think you have anything to worry about regarding your sun exposure. I don’t know why your newly emerged grafts disappeared, but 10 minutes in the sun will not harm the follicles and I doubt it will affect your scar. The ultraviolet light is what you want to avoid, so in the future I’d recommend applying sunscreen to your scalp (SPF 45 or higher).

If you are still worried, follow up with your doctor.

Hi Dr. Rassman

I just watched a timelapse video of a man age for 17 years, which shows the balding process really nicely. I noticed that his hairline recedes very slowly and gradually. But his crown thins all of the sudden at age 44. Can you explain why this happened?

Thanks

This is a great video illustration! This man took multiple photos daily for nearly two decades. As to why he lost his hair in this way… it’s all in the genetics.

See the video below:

You mentioned one time in a post that it is common for on side of a balding hairline to recede faster than the other. Is this also common in a hairline that is just maturing? The right side of my hairline seems to have been stable for a while now, but the left side is catching up.

Yes, it is very common to have one side recede faster than the other when forming mature hairline. But rest assured (as you are starting to notice)… the other side usually catches up.

This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).

E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:

“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].

In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”

We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.

The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ’slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.

I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.