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I’m going bald! Are hair growth treatments at 25 a good idea?

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The question

I'm a 25-year-old male who used to have a very full head of thick, curly hair. But I've noticed the hair on the top of my head is thinning. My dad never lost his hair but my maternal grandfather did. Should I start Rogaine or some other hair growth treatment now if I want to keep my curly locks?

The answer

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When hair thins, especially at a young age, it can lead to significant change in self-esteem, anxiety and decreased satisfaction with personal appearance.

Hair loss can happen for a number of reasons, but given that yours is thinning specifically from the top of your head, it is likely from androgenic alopecia, which is more commonly known as male pattern baldness. This is the most common type of hair loss in men and is related to genetic predisposition and male sex hormones. Male pattern baldness is characterized by the thinning of hair from the crown or top of the head with a regression of the hairline around the temples.

To understand why hair thins, let's think about the way hair grows. Each strand sits in its own small hole in the skin called a follicle. Thinning or baldness occurs when hair follicles shrink over time, resulting in finer and shorter hair. Eventually, the follicle just stops producing hair altogether.

Men suffering from this kind of baldness tend to have increased levels of testosterone, which causes these follicles to narrow earlier than expected, resulting in thinning and decreased growth of hair.

That's the bad news.

But there is good news. These follicles do remain alive for some time, which is where hair growth medications work to make it possible to slow hair loss or grow new hair.

Given your age, consider visiting your doctor to discuss what options may be best for you. While male pattern baldness seems to be the likely cause, it is important to rule out other causes of hair loss, such as hormonal abnormalities or nutritional deficiencies. A clue to different causes of hair loss can be if the balding is occurring in large amounts or in patches, if hair is breaking (instead of just falling out) or if you have redness, scaling or pain. A few simples tests should be able to determine the cause if these are the symptoms you're experiencing.

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Currently, there are two medications, minoxidil (Rogaine) and finasteride (Proscar, Propecia), that are used to treat male pattern baldness. They are both considered safe for use at your age.

Minoxidil is a topical treatment that is applied directly to the scalp and works by promoting hair growth and thickness. It needs to be used twice daily for at least three to six months before you'll notice anything. However, hair begins to shed less within a couple of months of treatment and by four to eight months, new hair growth should be apparent.

This treatment seems to work best in certain circumstances: when hair loss has been present for less than five years, when the hair loss is mostly from the crown of the head and when the area that lost hair is less than 10 centimetres in diameter. The main side effect of minoxidil is possible irritation to the scalp. If you have a history of heart disease, check with your doctor prior to starting this medication. You can buy it over the counter in lower concentration formulas, but a doctor can prescribe higher concentrations that may be more effective.

Finasteride is a medication that was discovered while researching a treatment for enlarged prostate glands. As a positive "side effect," researchers found the drug not only helped to decrease prostate size but also increased hair growth.

It works by decreasing testosterone levels, which in turn promotes hair growth and thickness. It can only be prescribed by your doctor and is taken as a once-daily pill. While considered safe, there are a number of side effects, including potential decrease in sex drive, difficulties with ejaculating and, in some rare cases, changes in mood.

It is important to note that regardless of treatment with either minoxidil or finasteride, if the medications are discontinued, hair growth reverses in six to 12 months.

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Send family doctor Sheila Wijayasingheyour questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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