possible hair loss

[Taiwanguy187]

Hello Doctor. I went to see a dermatologist today because I am afraid of losing my hair. Some background information about me. I am 28 years old. I have next to none history of baldness in my family history. My great-grandfather on my mother's side was bald. However, all my male and female relatives have never lost their hair. My hairline is what you could call a "mature" hairline. Meaning it is around a norwood 1.5 ish. The doctor took a look at my crown and could not notice any visible thinning. However, when he used a magnified camera he noticed a small amount of vellus hairs around my crown. I have major anxieties and stresses on a major basis and I also at the moment have a case of Seborhaic Dermatitis.
My question is. Are the vellus hairs a sure sign of future balding or could they be caused by stress or my dermatitis? The doctor told me that they could be caused by stress.
Basically at the beginning he told me the vellus hairs were a sign of male pattern balding but after i explained my stress problems he said he could not be sure whether or not I had male pattern baldness for sure. Oh he also used the camera to to look at the corners of my hairline and could not find any vellus hairs there.
Basically, am I suffering from early stages of MPB or could my stress and dermatitis be causing the small amount of vellus hairs?

[Bharat Chawda, MD]

Dear Taiwanguy187,

Thank you for writing back.

After going through your complete history again, I think that stress, hormones and your genes have a major role to play in causing hair thinning and hair loss.

As you said that your diet, sleeping habits and lifestyle are erratic. Also, the weight loss, that you been experiencing, further aggravates you hair loss. If you have experienced drastic weight loss, I would suggest that you get your thyroid hormones checked. You can get a serum thyroid stimulating hormone (TSH ) level and a free serum thyroxine level (FT4) level done.

As far as seborrheic dermatitis is concerned, a mild case does not lead to hair loss, but very severe dermatitis can lead to hair loss. So you should get this treated too if it is very severe. I would suggest the following:
• Use a good anti dandruff shampoo (medicated) like a shampoo which contains ketoconazole.
• Apply a steroid lotion at night. Since this is a prescription drug, I would suggest that you consult your dermatologist for the same.

I would again say that a multitude of reasons are responsible in your case and thus I suspect that you have an early case of male pattern baldness.

I can completely understand your condition and thus I would suggest the following:
• Tablets like finasteride, biotin & lotions like minoxidil should help you delay the process of baldness. As these are prescription drugs, please consult your dermatologist for the same.
• Plenty of green leafy vegetables, a high protein diet and good sleep for atleast 7-8 hours daily is also a must.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.

Best Regards,
Dr.Bharat chawda

[Taiwanguy187]

Thank you for your reply doctor. I am so stress right now it is not even funny. I can't think or even sleep. So are you saying that there is a possibility that stress and lifestyle is cause my hair to thin? Although it is not diffuse all over the head.
Basically you are saying I don't for sure have MPB. Is that correct?

[Bharat Chawda, MD]

Dear Taiwanguy187,

Thank you for posting the query,

You have provided a good description of your hair problem. I appreciate it.
Well let me tell you that there are various causes of hair loss in males (or in females).

Firstly, the genes for baldness usually come from mother’s side( X genes). As you said that your great grandfather from mother’s side was bald, so probably there seems to be a link. The most important cause of baldness in males is Androgenetic Alopecia, wherein hormones and genes both play a role in causing hair loss. Testosteron hormone works at the base of hair follicle where it gets attached to an enzyme called 5 alpha reductase, which  converts testosteron into DHT(dihydrotestosteron ), which is responsible for thinning of hair. This thin hair is ultimately called as vellus hair. This type of hair is either seen over  the frontal hair line or over the vertex, thus causing patterned hair loss.

Apart from hormones, stress, thyroid hormones, lack of sleep, crash dieting, zinc and copper deficiency etc can lead to hair loss. In such condition also there is conversion of terminal hair (thick hair) into vellus hair. But this is more diffuse i.e it is seen throughout the scalp rather than patterned. So there is a more diffuse hair loss in such a case. But then, in most cases, there is no single cause for hair loss, and two or more than two reasons could be responsible for hair loss in a person.

However, seborrheic dermatitis  doesn't lead to vellus hair formation and I won't consider seborrheic dermatitis as a cause of hair loss at all.

If one can do a trichogram for you, probably one can find if there is a chance of future baldness or not in your case. A trichogram is done by taking out good number of hair from different areas of the scalp and looking out for the ratio of telogen hair, anagen hair and vellus hair. But unfortunately it is difficult to find doctors with expertise in doing a trichogram. In case you want to go ahead with it I would advise you to check the doctor’s credentials and feedback.

Probably in your case, as you said, stress is an important factor. I would say that stress along with hormones and your genes are together playing a role in causing  hair loss in your case. And we cannot rule out the possibility that you may be at an early stage of MPB (Male pattern baldness).

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Bharat Chawda

[Taiwanguy187]

Also my diet and generally lifestyle are not good. I have lost around 10 pounds and my sleep schedule is highly erratic. I don't think the doctor saw it, but when i used to mirrors today i saw some noticeably thinning not on the crown but in front of the crown.
Why I am thinning at the top while my hairline isn't that bad?

[Taiwanguy187]

I read in an earlier post that Seborhaic Dermatitis does not cause hairloss. However, I have read a bunch of internet sites that claim it does cause hair loss. I have noticed that when my dermatitis is bad my hair seems to shed alot more and it just generally feels thinner.
I looked at my hair last year at this time and it doesn't seem much different to me at all. If I am losing my hair it seems to be at a very slow rate. I am being overly optimistic thinking that it could be years before I am noticeably balding? I have read before that balding is unpredictable and that it could start and then stop for a while. Sorry for all the questions but this is really killing me right now and worrying me beyond words