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Lowered hair density. What could be the root cause? Is hair transplantation beneficial?

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Practicing since : 2006
Answered : 2015 Questions
Hi Doctor,
I am XXXXXXX XXXXXX.I had very density hair in 2007 in India and came to XXXXXXX in 2008 and also till 2010 march ,My hair density was very good..
From 2010 April my hairs from front sides and middle started to become very week and they start to fall slowly and i saw lot of hair had falled in 2013 maintly now in center area of head.
when I my put my head down in light some one could see my scalp at center of my head slightly via my hair.I am not sure why this sudden hair density decrease so bad with in 3 years.I Live in boston where climate changes regulary and i use to taken head shower most of the time.Some are mentioning not to use regular shampoo and use only Neutrogena T-Gel shampoo .
My father had good hair till age of 50 and i am only 32 now.My gradnfather lost his hair at 40's .My sugar,pressure,HDL,LDL ,everything is very good and i workout regularly.Please let me know what could be the reason for my hair loss.
I am planning to do a hair trasplant in india and i dont apply rogaine etc....
So please let me know
1.What could be the cause for my hair loss. it a good idea to perform hair transplantation

Posted Wed, 5 Jun 2013 in Skin Hair and Nails
Answered by Dr. Kalpana Pathak 2 hours later
Thanks for writing to us.
From the description provided, it seems you are having androgenetic alopecia or male pattern baldness.
The main cause for the same is hereditary factors and hormonal factors. Male contain a hormone testosterone which converts to its active metabolite 5 DHT. Testosterone is responsible for causing hoarse voice in males, all physical attributes of secondary sexual characteristics like growth of beard, moustache, increased hair over chest, axilla, forearms, back etc. So it causes increased hair growth at most places but the same hormone causes decreased hair growth over scalp in males. This is a paradox. Almost 80 percent males develop hair fall at sometime or the other but the severity may worry. This type of hair fall is characterised by fall from vertex, temporal and frontal areas and thinning or miniaturisation of hair strands as well.
Now coming to the treatment. Only two drugs are US FDA approved for the same
1) minoxidil 5 percent solution 1 ml twice in a day over scalp. It promotes hair growth by maintaining hair in growth phase and by causing vasodilation thus increasing oxygen and nutrient supply to hair.
2) finesteride 1 mg single tablet daily. It prevents conversion of testosterone to its more active form 5DHT.

Usually with hair loss from central scalp and hair fall of duration less than five years involving less than 10 cm square area responds well to above treatment.
So initially you may begin with the combination of above two drugs at least for four to six months. If response achieved is desirable, you may discontinue finesteride and continue with minoxidil solution only.

Also if planning for hair transplantation, for better hair harvesting it is advisable to use minoxidil few months prior to transplant. We resort to transplantation only when hair fall is advanced involving large area of scalp.

Hope that helped. Should there be a clarification required, please write back.
Dr kalpana
Above answer was peer-reviewed by
Follow-up: Lowered hair density. What could be the root cause? Is hair transplantation beneficial? 40 minutes later
Hi Doctor,

Thanks a lot for the same and providing lot of details on the same.I have used cialis and viagra even though i have good erection just for prolonged sexual activity with my partner.Can this would have casued the 5DHT to be more actiive which might cause the baldness.In that case should i stop using this medicines.
I would try both of the solutions you have provided .But i assume the above solutions would only prevent exsisting hair from falling and would not support regrowth of new hair ,Please correct me if i am wrong.
Can i use Neutrogena T-Gel shampoo while for washing my hair meanwhile i use the above 2 solutions.
Does taking daily head shower be another cause for hair loss .Is there any reason that hair trasplanation is not suitable when hair fall is not advanced and planting at areas where hair is thinking down.

some say taking finastride daily may decrease the testrone level and may impact sexual arousal.Is it true.

Thanks again for providing detailed responses.

Kind regards, XXXXXXX XXXXXX
Answered by Dr. Kalpana Pathak 26 hours later
Thanks for writing back.
Viagra is sildenafil, a phosphodiesteraae inhibitor. It has no role in hair loss.
Minoxidil and finesteride prevent hair fall and promote hair growth. These are prescription drugs and should be taken under a doctor's guidance.
T gel shampoo can be used with above prescription. It is basically meant to treat
Daily hair wash does not cause hair fall.
Hair transplantation can be done at early stages but it is usually indicated when the hair fall cannot be managed with medicines and is at advanced stage.
Finesteride use has been reported to cause decreased libido and erectile dysfunction though in very less number of patients. It is usually not seen with 1 mg dose. But as you already have a problem with erection, you may avoid taking it and just use minoxidil solution.

Hope that answered all your queries.
Above answer was peer-reviewed by
Follow-up: Lowered hair density. What could be the root cause? Is hair transplantation beneficial? 3 days later
Thanks Doctor.I started using the rogaine .As said i dont have a place in my head which is completely bald my hair is thinning now.I need to apply the medicine on the scalp but still there will be hair on on the top of the scalp and the solution would touch the hairs .
Will this can create problem to existing hair.I am not using finastride as you requested.I will update you on the same on outcome after 2 weeks on the occurence.I am also using TGEL Shampoo.

Do you also suggest any food items that are good for hair growth.
Is it also a good idea to apply vatica or coconut oil.Sometimes during winter times the coconut oils drys in scalp and causes dandruff So i want your suggestion on the same.

Answered by Dr. Kalpana Pathak 20 hours later
Apologies for the delayed response.
Try to apply Minoxidil solution over your scalp. While applying if the hair gets coated, there is nothing to worry. It is not going to affect or harm hair.You need to apply it at least for four to six months to notice desirable response.

You can use T gel shampoo. It is a medicated shampoo meant for dandruff. So if you have dandruff you can use it.

Food XXXXXXX in protein (like soy, dairy, lentils, sprouts, eggs,meat ), B complex like wheat germ, nuts like sunflower seeds, almonds, walnuts, green leafy vegetables, sardines salmon, mackerel, fruits and salads are good for hair.

Once in a week oiling is enough for good hair. Apply warm coconut or olive oil for two to three hours is enough or at maximum overnight. If having dandruff, oiling should be avoided.

Hope that answered your queries.
Above answer was peer-reviewed by
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