Q: Hi Dr. Bernstein, I am a 30 year old man with a balding crown. I’m 99.9% sure its male pattern baldness (I’m currently on Propecia and Rogaine). I recently read about how people going bald are getting tested for LPP (lichen planopilaris). Do you perform this test?
A: Lichen Planopilaris (believed to be a type of autoimmune disease) occurs more frequently in women than in men and more commonly in African-Americans than in Caucasians. The variation that could be confused with androgenic alopecia in men is central centrifugal cicatricial alopecia (or CCCA). While definitive testing would involve a scalp biopsy, this is rarely necessary as the doctor can easily tell by just examining you with the naked eye using magnification (densitometry).
Q: How common is hair loss in adult men and women?
A: The incidence of androgenetic alopecia (common baldness) is quite high for both men and women. By age 50, 50% of men and 30% of women are affected. By age 70, that increases to 80% of men and 60% of women. Fortunately, in spite of significant thinning, women often preserve their hairline and have a diffuse pattern, so there hair loss can be camouflaged for many years.
Q: What is Lichen planopilaris?
A: Lichen planopilaris (LPP) is a distinct variant of cicatricial (scarring) alopecia, a group of uncommon disorders which destroy the hair follicles and replace them with scar tissue. LPP is considered to have an autoimmune cause. In this condition, the body’s immune system attacks the hair follicles causing scarring and permanent hair loss. Clinically, LPP is characterized by the increased spacing of full thickness terminal hairs (due to follicular destruction) with associated redness around the follicles, scaling and areas of scarred scalp. Read more ».
The terms DPA and DUPA were first described by O’tar Norwood in his seminal 1975 publication: Male Pattern Baldness: Classification and Incidence.
Q: What is Saw Palmetto? — R.P., White Plains, NY
A: Saw Palmetto is a dwarf palm plant native to North America. The active ingredients can be found in the plant’s brown-black berries. It is proposed that it blocks the enzyme 5-alpha-reductase that converts testosterone to dihydrotestosterone (DHT). There is little scientific evidence that Saw Palmetto is actually effective for hair loss.
Q: I have been on finasteride for about 7 months. After my latest haircut I can see that my scalp is shiny. I read that is from sebum buildup and it can cause a layer that clogs the growth of hair. I was wondering if this is true and, if so, how can it be treated? — T.C., Philadelphia, PA
A: It is not true. Hair loss is caused by the miniaturizing effects of DHT on the hair follicle, not by blocked pores.
Q: What happens to hair diameter when you age?
A: From infancy to puberty, hair gets progressively thicker. From adulthood to old age the hair becomes thinner again and this is exacerbated by the effects of DTH in susceptible persons. The later process is called androgenetic alopecia (common baldness) and is characterized by miniaturization – the progressive decrease in hair diameter and lengths as a result of DHT.
However, even without the effects of DHT, hair gradually thins over time in many people.
Q: It seems like my hair is thicker in the summer. Can this be true?
A: Hair will increase in diameter when there is more humidity, as it absorbs moisture, and will actually be thicker in the more humid summer environment.
Q: What color hair is the thickest? I thought it was brown, followed by red then blonde? But I am also reading that red is the thickest but redheads have the fewest hairs.
A: In very general terms, the darker the hair, the thicker it is and the lower the density (hairs per area). For example, Asians have the darkest hair, the highest hair diameter and the lowest density. Scandinavian blonds have very high hair density and the fine (diameter) hair. But there are many exceptions, African Americans have black hair, but it is usually very fine and of low density. I have seen red heads in all categories.
Q: I am a 47 year old woman with thinning on the top of my scalp for three years. I think I want to go for a comprehensive evaluation for hair loss and know that the doctor may want to take blood tests to help find out the cause of my hair loss. I am […]
Q: Why do some people have a full head of hair into their seventies or eighties and others start to go bald in their late teens or early twenties? A: The difference is genetic with the inheritance coming from either side of the family. Although a person will have the genes his/her whole life, a […]
Q: I have a quite a bit of hair on my chest, back and legs. Is that an indicator of future baldness? A: Although bald people joke around that they wish the hair on their body (and ears) was on their head, body hair is not an early sign of baldness.
Q: My son, 25 years old, is seeing hair loss around the hairline. According to your website, he is probably a stage II. He may have a little hair loss at the vertex; right now it is hard to tell. He is very muscular and loves weight lifting, but no drug enhancement. Is there a […]
Q: Didn’t you do free consults in the past? A: Yes. It had been in response to the policy of the larger chains. Patients coming to our practice are evaluated by a board certified dermatologist, trained in diagnosing the causes of your hair loss with expertise in both medical and surgical management. Our consults are […]
Q: Why is the consult fee more for diffuse thinning than for a regular visit? A: Diffuse hair loss, more common in women, can be the result of a number of underlying medical conditions and therefore it usually requires an extended medical evaluation. If you are a male or female with obvious diffuse thinning from […]
Q: Do you use computer type imaging to create the best way to insure you (or any hair transplant surgeon) have the same goal or target “picture” of the particular patient’s restoration as that particular patient has as his “picture?” A: I prefer not to do imaging since it tends to oversell the hair restoration […]
Q: Can stress produce diffuse unpatterned hair loss (DUPA), or was it bound to happen anyway? A: Both DPA (diffuse patterned hair loss) and DUPA (diffuse unpatterned hair loss) are genetic conditions, unrelated to stress and would have happened anyway. These types of hair loss are characterized by a high percentage of mininiaturized hair in […]
Q: I’ve been dealing with daily mental stress for the past few months. I’ve notice that during that time, I’ve experience a lot of frontal hair loss and thinning. I thought stress was a myth for causing hair loss. A: Stress may cause temporary shedding, but it generally does not affect the long-term course of […]
Q: Dr. Bernstein, why have you not had a hair transplant? I’m sure this question gets asked a lot. Thanks. A: Yes, all the time. My donor area is very thin (so I am not a good candidate) and I have gotten used to being bald. It has been years.
Q: I have read that in the evaluation of a patient for hair restoration surgery some doctors use a densitometer to measure miniaturization – the decrease in size of hair diameters. I read that miniaturization is a sign of genetic hair loss, but when there is miniaturization of greater than 20% in the donor area, […]
Q: Dr. Bernstein, I saw you on TV where you explained why you haven’t had a hair transplant. If you had better donor hair and you could do the surgery on yourself, then would you consider having a hair transplant? A: Yes.
Q: Will cutting my hair short – skin level – adversely affect it? A: Hair shafts are not alive (only the follicle is) so cutting the hair will not affect its growth.
Q: I seem to be thinning, but I never shed hair as such in the shower. I cannot see my hair falling out. Can it be androgenetic hair loss? A: In androgenetic hair loss one rarely sees hair falling out in mass, but rather the thinning is due to the hair decreasing in diameter and […]
Q: I am suffering from Pseudopelade for four years now. I have lost a lot of hair & there are big bald patches on the top of my scalp that are difficult to hide. Is there any hair transplant surgery or follicle transplant surgery possible in my case, or anything else I can do? A: […]
Q: I am a Caucasian female that has experienced hair loss on the sides of my head from the height of the eyebrow to the ear due to traction. The hair loss has been present since my teen years. My job requires me to wear my hair up most of the time. Although I don’t […]
Q: I am a 45 year old women and I am beginning to thin on the top of my scalp. I don’t want to use medications and I don’t think that I am quite ready for surgery. Is there anything else I can do? A: There are a number of things that you can do […]
Q: I was at a party the other day and some women were talking about their boyfriend’s hair. I heard one refer to her ex-boyfriend as having a “bar code.” What is that? A: A “bar code” is slang term used in Japan for a comb over.
Can You Describe Your Hair Transplant Consultation and What Should One Expect from a Consultation at Bernstein Medical?
Q: I have been to a number of consults and each time I felt the doctor was rushed and had already in his head what he though I wanted even before I had a chance to speak. At another consult, the person was really attentive, but it turned out he wasn’t even the doctor. If […]
Q: I am 22 and losing my hair all across the top of my head. How can I thicken my hair to its level a few years previously? A: If medication, such as finasteride, is successful it can thicken hair by increasing the diameter of the existing hair shafts. Although the cosmetic benefits can be […]
Q: My hair loss resembles the grade I female hair loss scale, but none of the male hair loss patterns. It has been relatively stable for the past five years and only recently has it begun to progress further. I began both Propecia and regain two months ago, but the hair loss still continues at […]
Q: I underwent hair transplant surgery several years ago and was pleased with the results. However, over the last 2-3 years I’ve lost hair in the donor area with subsequent loss of hair in the transplanted area. Is this type of hair loss especially difficult to treat? What accounts for hair loss from the back of the head that is typically considered “permanent”?
A: Less than 5% of patients have unstable donor areas, i.e. where the back and sides thin along with the front and top. We call this condition Diffuse Unpatterned Alopecia or DUPA. It is best to identify this condition before hair transplant surgery is contemplated as people with DUPA are not good candidates for hair transplantation. The diagnosis is made using densitometry by noting high degrees of miniaturized hair in the donor area.
At this point, I would use medications such as finasteride. I would not do further hair restoration surgery.
Q: I am a 36 year old female who has been diagnosed with Chronic Telogen Effluvium. Although I do not have any bald spots yet my hair is much thinner on both of my temples as well as in the back of my head. Is a hair transplant an option for me or am I just going to shed the new hair as I am shedding my current hair?
A: Since Chronic Telogen Effluvium is a generalized condition, it is not amenable to correction by a hair transplant. The reason is that there is no stable area to take donor hair from. Chronic TE is generally self-limited, so try to be patient.
Q: Can stress accelerate hair loss? I am 25 and there is balding on my dad’s side of the family. I never had any thinning or hair loss till this year. I guess you can say I’ve been under a lot of stress. When I did notice shortly after my 25th birthday I started stressing […]
Q: Over the past three months, my hair seems to be thinning more on one side. Is it common in male pattern hair loss for it to be more on one side? I had a lot of stress about three months ago and have heard that this could be the cause. Is this possible? Should […]
Q: I am a 34 year woman with a patch of hair loss by my temple. I went to the salon to have my hair done and to my surprise my hairdresser told me that I have Alopecia? First time I heard of it, my G.P is not very concerned about it but having read […]
Q: I was told that if men have a lot of testosterone that that’s when they lose hair. Is this true? A: Although androgenetic hair loss is dependent upon normal levels of testosterone, it is not due to increased testosterone. It is caused by a sensitivity of the follicles to normal levels of testosterone. So […]
Q: Dr. Bernstein, I was reading about a densitometer on your website. What is it and what is it actually used for? A: The hair densitometer was introduced to hair restoration surgeons by Dr. Rassman in 1993. It is a small, portable, instrument that has a magnifying lens and an opening of 10mm2. To use […]
Can Hair Loss be Caused by Thyroid Problems or Fluctuations in Levels of Hormones Produced by Thyroid?
Q: One of the things that I have noticed as a person who has needed to take thyroid medication for a long, long time, is that when my thyroid gets a little bit out of balance – when I’m not getting quite enough, I begin to notice is that my hair starts falling out. What […]
Q: I know that I am going to be bald because my father is bald and I am losing my hair just like him. What actually causes this kind of hair loss? A: Although there are many different causes, the overwhelming number of people that have hair loss have what is referred to as “patterned […]
Q: I am 19 years old and seem to be thinning all over, including the sides. My father has all of his hair but my grandfather is totally bald. Should I have a hair transplant now or wait until I am older? A: Most likely you have a type of androgenetic alopecia called Diffuse Unpatterned […]
Q: I am 27 years old and have a Class 3 degree of hair loss. Should I do a hair transplant or consider non-surgical methods of hair restoration? A: At age 27 with early hair loss, you should consider non-surgical options first. Propecia is the most important medication, but you need to be on it […]
Q: Over the years, I have worn my hair in braids and extensions. My hair is not growing at my hairline and temples. Can the braids be the cause and can this be treated with a hair transplant? A: The name for hair loss is this area is called alopecia marginalis. It is almost invariably […]
Q: I’m currently 24 years old. Ever since turning 20, my hair on top began to thin little by little. I have noticeable thinning on the top part of my scalp and on my crown, but have no recession at the temples. My hairline looks amazingly young and hair on the donor areas seems quite […]
Q: What are “Senior Medical Consultants”? A: These are non-medical personnel who wear white coats to give the impression that they have formal medical training. They are actually salespersons and they should immediately identify themselves as such. Although non-medical personnel can help to answer general questions, they should not be examining you and making specific […]
Q: Can a hair transplant into bald areas caused by alopecia areata ever be successful? A: Alopecia areata is an autoimmune disease in which the body attacks its own hair follicles. It generally appears as round patches of smooth bald areas scattered in the scalp or beard. Less commonly, it can involve the entire scalp […]
Q: I am twenty and think that I am starting to thin. I am also experiencing a slight tingling in my scalp. Are these related? A: Most likely. Early androgenetic alopecia can be associated with a slight tingling or slight tenderness of the scalp. You should see a dermatologist for evaluation and, if you have […]