A Young Man’s Guide to Hair Loss

hairlossBy Sara Wasserbauer, MD

I see a lot of patients for hair loss – over ten thousand at last count – and I am surprised how everything that is old becomes new again.  Young men in particular are confused by the choices for restoring their hair that are hawked on the Internet.  I was asked by another doctor (a dermatologist) recently, “If you had three pieces of advice to give to a young guy who is starting to lose his hair, what would they be?”  I had to think about that question for a moment, but after some reflection, here are the three things I came up with:


Back when I started practicing hair medicine – over 10 years ago now – EVERYONE was using Propecia preferentially.  I spent a lot of time talking patients into using minoxidil as well.  There was no foam version at the time, so the liquid with the propylene glycol (the ingredient that gives you that “residue-y” feeling) and alcohol (the ingredient that dries and irritates your scalp causing itching) was the only option.

How times have changed!  Now it seems ALL my patients are using minoxidil (the 5% foam) and are happy to continue it – but wary of starting finasteride.  If you are a young man who wants to keep your hair – ignore Dr. Google and take an old hair doctor’s advice; finasteride is the number one best way to keep you hair, there is no mephistophelean choice between looking attractive and being interested in sex, and years from now when your friends all have lost their hair – you will have the hair advantage.  They will all wonder how you kept it.

2) Focus on RESULTS!

Another hint I give young patients is – concentrate on the final result.  And by that I mean – what does the area that is losing hair now look like AFTER the surgery has grown in?  If you were to ask 50 of the best hair doctors in the world to give you the best hair transplant in terms of growth, appearance, and final result, their answers would differ, but most would tell you that if you don’t care about cost or the presence of a scar – the linear technique is probably still the best for most patients. Transection rates for grafts are next to zero, because the grafts are all prepared under direct microscopic visualization.  Linear methods are more efficient and precise for larger numbers of grafts, and they preserve the overall density of the donor area for the future.

Heresy – right!  FUE is the best – all the websites talk about FUE being the greatest, completely scarless, non-surgical, and that no self-respecting patient would choose differently!  FUE doctors are on the cutting edge, and on and on, even though there is greater chance of damaging each graft (because it is a blind surgical punch and grasping with forceps is needed to get the graft out), and there IS actually a little scar for the surgical extraction of each one of those grafts so the overall scarred area is much larger.

The truth is that the BEST doctors are fluent in ALL the techniques, and can help you determine which is the right one for your particular case.  Find a good doctor, one whose judgement you can trust (interview at least 3!) and then leave at least part of the decision-making in their hands.

3) CAVEAT EMPTOR (i.e. “Let the Buyer Beware”)

You have typed “hair loss” into a search engine, and now all your pop-up notices have to do with the “latest hair loss remedy” that “millions of men are regrowing their hair” with or that “doctors don’t want you to know.”  I look at these and think “are you kidding?”  But without years of study, experience, and knowledge about the hair loss industry, it is easy to be convinced and to shell out cash in the hopes that you will get something (anything!) that works.

So be a savvy consumer.  Consider the source and the type of data you are looking at.  If it sounds too good to be true – it probably is false.  Is the study or the doctor sponsored by the sellers or the marketer?  Look closely at the small print.  No surgical procedure is scarless, and no medication/shampoo/or herbal remedy will regrow all your hair.  To the extent that you can, try to eliminate cost as a deciding factor between treatments.  And realize that ALL effective treatments take at least 6-12 months to work.  BE a PATIENT patient!!

Good sources for quality information are the NIH database (www.pubmed.gov), the ABHRS (www.abhrs.org) and the ISHRS (www.ishrs.org).  All of these organizations have educating the public as their mission, and do not make money off consumers or based on what you buy (or who you do surgery with!).  Their mission is to be as unbiased as possible.  And in a world where losing your hair can be emotionally wrenching, it pays to have some clear-headed advice.

So I hope this helps all those young men out there struggling with who and what to believe.  Note that if you are truly taking this all to heart, even I deserve some scrutiny!  That being said, I am always happy to back up my credentials and opinions, as any good hair surgeon will be.  Good luck and happy researching!