Is Hair Transplantation the Answer?

Hair Loss is commonly thought of as something that occurs only in older men. But it happens in younger men, too—those who are not yet 21 years old. Because hair loss is generally unexpected before age 21 it can be a shock for a young man 15 to 20 years old to discover he is losing hair. The first hair sign likely to occur is thinning in the temporal area of the frontal hairline, above the eyebrows on either side of the “widow’s peak”. This can result in the appearance of a high forehead. The young man may also begin to notice excess shedding when he combs, brushes, showers or shampoos his hair.

If the young man’s father, mother, uncles or older brothers have pattern hair loss he may not be surprised to see that the family “baldness trait” has been passed along to him. Nevertheless, he most definitely will not be pleased to see the inherited trait appear so early. Hair loss before age 21 can be very disturbing for a young man, even if he expects to eventually undergo hair loss similar to other male members of his family. Loss of hair at this psychologically and emotionally vulnerable time in his life can leave him feeling disfigured, less attractive socially, and hindered in the job market. He can be an easy target for expensive but ineffective “miracle cures” advertised in print media, on TV and on the Internet.

What should a young man do if he begins to lose hair before age 21?

A good first step is consultation with a physician hair restoration specialist who is a member of the International Society of Hair Restoration Surgery (ISHRS). A physician member of ISHRS is skilled and experienced, and importantly, follows ethical guidelines that make the needs of the patient the physician’s primary concern. Ethical considerations are especially important when the patient is vulnerable, distressed, and not yet an adult. The minor with hair loss should not be “pushed” into any decisions regarding hair restoration, especially surgery, and should be educated and counseled against making any hasty decisions that may not be in his best interest.

The first advice a physician hair restoration specialist might give a minor with hair loss is: “Don’t panic. I understand. Male pattern hair loss is a common, inherited condition and it is normal to be bothered by it. We can almost certainly find a way to manage it by making decisions tailored to your individual needs.”

When the patient is a minor, the physician hair restoration specialist must insist that a parent or legal guardian be involved in the decision-making. Inclusion of a parent or legal guardian resolves questions of legal responsibility and gives the patient support in making informed decisions. Close parental support is important in the success of any treatment recommended to a minor. No recommendations for treatment will be made until the physician hair restoration specialist has determined the cause of hair loss. While male pattern hair loss is the most common reason for hair loss in men there are many other causes that need to be considered and ruled out. Hasty treatment before a diagnosis is established may be ineffective and could be counter-productive.

What treatment is a physician hair restoration specialist likely to recommend?

The physician’s first goal is to educate the patient with regard to the cause, progression and long-term ramifications of hair loss as well as any treatment for hair loss. Because hair transplantation has high public acceptance as a successful method of hair restoration, the young man may consider it his first option for treatment. However, most leading physician hair restoration specialists do not consider hair transplantation a good option for most men under age 21. Hair transplantation may rarely be an option for individual young men under age 21 when indicated by individual patient characteristics.

Hair transplantation may not be a good hair restoration option for young men because, among other reasons:

  • The pattern and progression of hair loss has usually not been fully revealed at this early age
  • Hair transplantation performed this early may be less than desirable later in life when the pattern and progression of hair loss has been more fully revealed
  • It is difficult to design a surgical procedure that will look natural and appropriate for the rest of the patient’s life
  • Once hair transplantation is begun, future surgeries are required to maintain a natural appearance
  • Unfortunate results of hair transplantation performed too early may have to be surgically corrected later
  • Even with parental guidance, it is difficult for a minor to make informed adult decisions regarding elective surgery.

Hair transplantation may eventually be the best approach to treatment of the patient’s hair loss. An interim option often recommended by leading physician hair restoration specialists is non-surgical treatment with minoxidil (Rogaine®) and finasteride (Propecia®)—the only hair restoration medications approved by the U.S. Food and Drug Administration and scientifically proven to successfully treat hair loss. Treatment with minoxidil and finasteride can slow hair loss and give the appearance of more hair by adding density to miniaturized hair follicles.. Slowing the progression of hair loss before and after age 21 improves the opportunity for successful hair transplantation later.

In selected cases a physician hair restoration specialist may perform a small “forelock” transplant to provide immediate improvement in the patient’s temporal frontal hairline. In only very rare cases would a physician hair restoration suggest aggressive treatment with hair transplantation. The cost of consulting a physician hair restoration specialist may be less than the cost of multiple ineffective “miracle cures” purchased from vendors advertising on the Internet, TV, radio, or in print media. The professional advice and support of a physician member of the ISHRS will be invaluable to a young man who feels devastated by the early loss of hair.