hair loss

[curiousAUWE]

I am a 20 year old male (almost 21), and I have a hair loss problem that I can't seem to understand. It all started about 2 years ago after I had just turned 19. I had great hair and after a hair cut I started to get a reddish inflammation on my scalp and then I started to loose hair at increasing rate, but I highly doubt the hair cut caused the problem because the redness problem is still there. My scalp was also really sore and there was pain at the roots of my hair when I messed around with it. I went to the dermatologist and he gave me a corticosteroid that has 70 % isopropyl alcohol. It worked in reducing the redness and even my hair loss went down a bit.  Not only was there hair loss but also thinning of my hair, and the volume of my hair is not what it used to be. Over the course of the next two years the redness was still there but not as severe as it once was. I still get the redness (though not as severe) especially when I don’t use Head & Shoulders shampoo. And the redness correlates directly with acute pain that comes from the hair roots or scalp, whenever there is redness there is pain, and no pain when there is no redness. Also the redness, root pain and hair loss seems to effect the front, the top, and upper back part of my scalp the most. But the perplexing thing is that a short while after my hair on the scalp started to fall and thin, my pubic hair also got thin and started falling out. The volume of my public hair is probably not even a third (1/3) of what it used to be (and its getting worse), and each hair follicle is noticeably thinner than what it used to be. I know this may seem strange but the one connection that I see with hair loss at both places (scalp and pubic area) is that the situation is made a lot worse with the loss of semen. So whenever I masturbate on a regular basis, say 5 or 6 times a week, there would be redness and pain at the roots as well as increased hair loss. The pain at the roots is especially true with the pubic hair which would fall at an excessive rate during this period. If I masturbate non-excessively, say after every 4 days or longer, I don’t have these problems. But if I do it for say 3 days straight, there is a 95% chance redness and pain will show up at the pubic area and scalp. I noticed this pattern for a long time now and this is NOT just a coincidence. The hair on my stomach is also sore at it roots sometimes, but not every time.  I think there is an effect of all this with hair elsewhere on my body like underarm hair, but I can’t be sure of that because I do not recall how thick my underarm hair was before all this started.  So I thought maybe the increased testosterone levels after loss of semen caused the loss of scalp hair, but that would contradict with pubic hair loss right? I went to two dermatologists since, but I did not tell them about the pubic hair loss or the correlation of hair loss with loss of semen. One of them prescibed HYDROXYZ HCL 25 MG which didn't have much effect.

[Alan Rockoff, MD]

First, some basic facts:

1.  Scaling of the scalp doesn not cause permanent hair loss.  At most a few hairs can come out from scratching, but they grow back because the roots are still there.

2.  Ejaculation of semen has nothing that I know of to do with hair loss.  Testosterone affects the scalp by direct action on the follicles, not through serum (or through ejaculation.)

3.   The only disease I know which can affect both scalp and pubic hair is alopecia areata.  This either causes bald patches (which you don't have) or generalized loss, which would have made you not thin but quite bald by now.

In my experience, pain at the roots of the hair shaft is a symptom of worrying about the hair, not about hair disease.  Apparently your last dermatologist thought so too, because he recommended hydroxyzine, which is an antihistamine and mild sedative.  It doesn't treat hair.

No doubt this dermatologist didn't spell out his feeling, because many patients do no approve of psychological explanations of what they are certain is a physical problem.  Nevertheless, in your case I can't think of any other way to explain your siutation, especially when you've already seen a few doctors, who clearly found nothing specifically wrong.

In other words, you are not going bald.  You ought to stop thinking about your hair, because thinking is making you unhappy and uncomfortable.  I hope you can bring yourself to do this.  If you can't, you should get the help you need to get there.

Best.

Dr. Rockoff

[curiousAUWE]

thank you doc for your explanation. Another point I want to make is that the last dermatologist I saw said it was some alopecia. I don't remember exactly what type, but I do remember it was a two word name that started with an A, but it wasn't androgenic alopecia. I think it might have been alopecia areata, because I do have some generalized thinning, which is what i told him (instead of specially pubic hair).  Is there any real medicine that is used to treat alopecia areata, unlike hydroxyzine.

[Alan Rockoff, MD]

Not really--there are medications, but they're complicated and have side-effects. And of course I think it's at least questionable that you have alopecia areata.

Dr. Rockoff