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Hair Loss/20+ yrs of hair loss


Hi Michael, thanks 4 being available.  I'm now in my mid 40s, & have had thinning hair 4 yrs.  I work in an office, so I shampoo my hair every other day.  I don't know how long I've had this problem, but it's been awhile.  I can take my fingernail, scratch my scalp several times, & there'd be alot of white dead skin under my nail.  I never thought of it as much, but then 1 day I noticed alot of it near my hairline.  When I scratched it off, several hairs came out with it.  This really shocked me, so I got a soft dog grooming brush & have been brushing my scalp in the shower 2 get rid of that stuff.  It got rid of most of it, but some of my precious hair comes with it.  Is this a bad idea?  Any other advice?

Male pattern baldness is the most common type of hair loss in men and it appears you have this type of hair loss.

Male pattern baldness is related to your genes and male sex hormones. It usually follows a pattern of receding hairline and hair thinning on the crown, and is caused by hormones and genetic predisposition.

Each strand of hair you have sits in a tiny hole (cavity) in the skin called a follicle. Baldness in general occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow a new hair. However, the follicles remain alive, which suggest that it's possible to grow new hair.


The typical pattern of male baldness begins at the hairline. The hairline gradually moves backward (recedes) and forms an "M" shape. Eventually the hair becomes finer, shorter, and thinner, and creates a U-shaped (or horseshoe) pattern of hair around the sides of the head.

Signs and tests

Classic male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss.

It is important to note that hair loss may be due to other conditions. This may be true if your hair loss occurs in patches, you shed a lot of hair, your hair breaks, or you have hair loss along with redness, scaling, or pain.

A skin biopsy or other procedures may be needed to diagnose other disorders that cause hair loss.

Hair analysis is not accurate for diagnosing hair loss due to nutritional or similar disorders. However, it may reveal substances such as arsenic or lead.


Treatment is not necessary if you are comfortable with your appearance. Hair weaving, hairpieces, or change of hairstyle may disguise the hair loss. This is usually the least expensive and safest approach for male baldness.

Two medications are approved to treat male pattern baldness:

Minoxidil (Rogaine) is a solution that you apply directly to the scalp to stimulate the hair follicles. It slows hair loss for many men, and some men grow new hair. Hair loss returns when you stop using this medicine.
Finasteride (Propecia, Proscar) is a pill that interferes with the production of a certain male hormone linked to baldness. It slows hair loss. It works a bit better than minoxidil. Hair loss returns when you stop using this medicine.
Hair transplants consist of removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring and possibly, infection. The procedure usually requires multiple sessions and may be expensive. Results, however, are often excellent and permanent.

Suturing hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.

Expectations (prognosis)

Male pattern baldness does not indicate a medical disorder, but it may affect self-esteem or cause anxiety. The hair loss is usually permanent.


Psychological stress
Loss of self-esteem due to change in appearance
Calling your health care provider

Call your doctor if:

Your hair loss occurs in an atypical pattern, including rapid hair loss, widespread shedding, hair loss in patches, or hair breakage.
Your hair loss occurs with itching, skin irritation, redness, scaling, pain, or other symptoms.
Your hair loss begins after starting a medication.
You want to attempt to treat your hair loss.

You may also have a telogen effluvium which is where your hair goes into a shedding cycle and that is why your hair falls out so easily.

Hair Loss

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Michael S. Fisher, <B>Ph.D., M.D.</B>


published over 50 articles on the subject.

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