If people with MPB have hair follicles that are sensitive to DHT, then why is it that they don't
loose their hair right away in their twenties, but only much later in their life? I presume that DHT gradually lowers when we get old? So why do some people start getting bald in their thirties or even forties?

The truth is, hairloss is due to genetics, and DHT shortens the hair cycle, accelerating it - Quote from the new propecia leaflet. Genetics plays a massive role in hair loss, and truthfully we don't really understand it.

At this point, the only answer we can give is: it's because of your genes. And yeah, it sucks!!

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On Propecia since July 2008 and maintaining.

There are several reasons for that happen. But primary reason is genetic and habits. Everyone can reduce their loss hair by doing healthy habits.

get that link off of here

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My Hair Loss Website

I think what he's asking is what the physiological mechanism is by which a gene causes hair loss to start at age 20 or age 30.

I have no idea, by the way, and I'm not sure anybody does.

In men, except in unusual circumstances, hair loss is all genes and luck, or lack thereof.

I recall from some source or another, that male hairloss affects 10% of the population per decade...thus 40% of guys in their 40s have significant hairloss. My "eyeballing" of people walking around the mall or at a recent football game suggests that is probably reasonably accurate.

So then the issue is what do you do about it. My consultations always offer 4 choices.

1. do nothing. you won't die from hairloss.
2. wear a hairpiece when needed. we have done quite a few fellows who wore hairpieces and either were able to get rid of them, or wear a smaller hairpiece after surgical options.
3. medical therapy works for many folks but has its own pros and cons.
4. surgery.

Now, a patient and doctor need to be pretty frank about goals, and potential future hairloss before spending donor hair. For example, if a 20 year old whose entire family is class 6 rolls in with a bit of thinning up front, I'd have a significantly different suggestion than if he were 45 with a negative family history.

Make sure you include your family "potential" in your hair transplant decision equation, although every hair doc will tell you of the one "lucky" patient's brother who has a full head of hair in a bald family; or the 1 unlucky patient with a family full of class 1 hairlines. So at this point (2009) genes are still a guess, albeit an educated one.

Then, make sure you are willing to accept a hairline that will look good as you age. I had 3 23 year olds walk in yesterday, one in particular brought his high school picture and said "if I could just get back to this I'd be happy". Well gosh, I'd like to be in the same physical condition I was at age 17 too.

But once we talked about if he had that 17 year old hairline at my old age of 45, that he'd look like a goof-ball, I think he realized that if he proceeds at some point down the road, that a good doctor will suggest a more mature hairline than he'd like in the early 20s or maybe even 30s; but that he would avoid being a hairline "cripple" at age 45... And with proper styling, some fashion advice, and a grasp of the big picture, he could achieve an appearance that would "fit" him as he ages.

The fellow waiting after this guy, also 23, chimed in that he had a significant temporal recession as far back as he could remember, way more than the first patient, and the second guy just wanted to discuss medicine for his crown thinning. It was good to have 2 young guys discuss a couple of these issues and see that there is no "one stop fix" for hairloss.

So, use forums like this to get educated and make the best decision you can for the long term.

Dr. Lindsey McLean VA

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William H. Lindsey, MD, FACS
McLean, VA

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians