Dr Lam's Hair Restoration Forum

Hi Dr Lam,

Thank-you for the informative website and for the chance to ask you questions directly.

I am a 27 year old male. I give the impression of being a strong Norwood 2 however, upon closer inspection I have some obvious thinning in the front of the hairline and some other initial thinning beginning in the vertex and the crown as well. My dermotologist told me I have DPA, but thankfully not DUPA as there was no sign of thinning in the permanant zone. I don't know how important it is, but my father and older brother are not bald, neither are either of my grandfathers and nor are any of my 6 Uncles from either side. That said somewhere along the line I inherited the gene and I have accepted that.

At 26 the second I visibly noticed my hair was thinning and was becoming see- through I booked an appointment with a dermotologist and he put me on Propecia. The first six months on the drug there was no change in my appearance so I believed that I would hold onto my hair rather than reverse the miniaturization. However, I read that it took 12 months to really see results so I decided I wouldn't look again for another few months. So at the 11 month mark after a haircut I had a close inspection and was thrilled with the results. The most obvious thinning in the centre of my hairline travelling up to the area just before the middle of the head was thicker as was the rest of the hairline. For the first time in 5 months I did not have to use Toppik in my hair. Propecia was a success, the dermotologist agreed it had worked and gave me hope that it may even get better still and I was basically in for the long haul.

However, upon hitting the 14 month mark and after another haircut I was dismayed to find the thinning in the centre of the hairline was present again. Though the thinning is still not as bad a when I began the treatment, the past two weeks since the haircut I'm back to using Toppik again. I visited the dermotologist and he agreed that the hair was thinner than a mere 3 months previous. He said it was extremely rare for someone to have such an excellent reaction to Propecia to dramatically reverse course and further, to do so within the time period that the drug should actually be peaking out its benefit (12-18-24 months). He said he could think of only one other patient who had dramatic shedding the first 4 months of treatment and had excellent results after a year, but who at the 13 month mark had another 2 month period of shedding. However, rather than reverse course this patient apparently had his hair come in even thicker again after the second shed. The dermotologist suggested that as I responded so well the re-emergence of thinning hair may mean the hair is preparing to come in thicker again and that I may be one of the few who has peak benefits at the 18-24 month mark. However, as I have never experienced any sheds as the other patient did he told me not to get my hopes up to high. He also did suggest that I just may have a very aggressive hairloss gene - though once again he thought the lack of balding men in my family tree and my initial good response to Propecia made it less likely to be so.

I was wondering if you had any experiences similar to this with your patients and even if you did not, if you had any speculation as to what the future may hold for me. Is it strange to have visible results at 12 months and then at 14 months to lose the benefit and reverse course? I have been more stressed and anxious with things of late and for 2 weeks took a course of the lowest dose of Xanax - could any of that have had an impact? I still take the Propecia daily (and haven't missed a dose in 14 1/2 months) and plan on continuing to do so even if I my hair worsens.

Thank-you so much for your time Dr.Lam

Scott

Wow, that is a pretty detailed synopsis of your situation and very helpful for me to use as information upon which to comment. I will say that I have seen reversals (albeit temporary) with Propecia, Rogaine, and even hair transplants after 14 months and for that matter at any time so don't worry about that. Unfortunately, hair loss is progressive and given your age group it sounds as if Propecia is going to be a critical way for you to hold on to what you have (minus some further loss nevertheless) as you age.

Have you considered adding Rogaine? It can work synergistically with Propecia and some think that even once a day can be effective so compliance is everything as you would surmise. Rogaine in the blood stream has a half life of 4 hours but might stay in your scalp for 22 hours plus (although there is no clear science for that now).

Thanks Dr. Lam I've started to use Rogaine on your advice. But, if I could ask some follow ups. When it comes to people suffering from diffused pattern alopecia are they easier in some aspects to transplant? More difficult perhaps? It's just that I see lots of elderly men more advanced than I with diffused hair loss and they always still appear to have a front hairline and coverage all over their scalp - albeit the hair is very thin. Is it restrictive to transplant around all that hair? Do they get better coverage than typical Norwood pattern balding individuals? And furthermore does it make it more challenging to have a hairline already in place - especially if it is lower than you would naturally put on a transplant patient?

And finally regarding propecia is it any more or less succesful in growing back or holding onto hair for people with diffused hair loss and at what point would an individual like this hit their peak benefit with the drug?

Thanks again

Generally speaking, someone who retains his/her frontal hairline with diffuse thinning CAN be harder to transplant only in the sense that the frontal hairline must be respected so when transplanting you may have to cover a wider terrain than otherwise desirable given the donor density. Fortunately, this is pretty rare in men and occasionally more prevalent in women. However, with good donor density and realistic expectations, you can get around this. Being able to distribute those hairs effectively and using the right sized grafts can make all the difference.

it is very hard for me to say that Propecia is less or more helpful in diffuse loss. At least I can say that when the head is slick bald like a Norwood VII, you will have almost no benefit with Propecia. If there is no miniaturization of hairs, there is less gain. Most peaks occur between 1 to 2 years but additional gains can be had thereafter. The key is not the peak but the decrease in progression of loss, especially when we are talking about someone like you who is 27 years old.
best,
sml