Chicknlittle- On Dutas, escalating

[chicknlittle]

Briefly, I have always had a high forehead. I had recession/thinning in college but functioned well enough and accepted it as a mature hairline (a bad one). I started finasteride at age 30 and at age 36 felt I had ongoing thinning. At that time I switched to dutasteride 1mg with some subtle improvement in density. Despite this, in recent years (age44) my hair has become less satisfying, and I am cutting it shorter and shorter to avoid weird hair... After an especially short buzz (#3) i am now more concerned that ever about thinning at crown and frontal area and temples. I am seeing scalp more than I ever have and notice that side hairs are very small, some white. When wet I see nothing but scalp : ( I believe that despite relative easy maintenence I am seeing ongoing miniaturization, diffuse thinning, and weakening of frontal hair near hairline and across crown/vertex, revealing scalp more often. I want to do more to reverse the underlying process; if possible to recover some density and increase hair thickness/length. And I want to stabilize better (in case there is in fact a better treatment coming in a few years... PGD2 inhibitor)



Current Treatment Dutasteride 1mg daily

New Treatment
Dutasteride 2mg daily (2x0.5 avodart, 2x0.5 dutas)
minoxidil foam bid (10/12 added oral minoxidil 5mg bid)
ketoconazole shampoo alt with piroctone Olamine shampoo (sachajuan scalp shampoo)
MSM, fish oil tabs, grape seed tabs, MVI

interested in reading/learning about other possible topicals, tricomin, other... hopefully with a shred of evidence behind them. interested in PGD2 pathway and inhibition.. awaiting new drugs.

I will update post in a few months....

 

[wareagle]

I don't have anything to offer along the lines of what you are looking for, but your story gives me hope, you've been able to fight it for a good number of years and I'll stay tuned to whatever you update us with.

 

[chicknlittle]

It might be worth looking into getting a small FUE hair transplant since meds can only do so much.

I have actually considered this for the first time this month.. The idea makes me nervous, and looks very disruptive (with the shaving and irritation... Hard to work into my schedule

.. I think I can do better cosmetically by not buzzing so close 2/8 is too short for me and revealed crown thinning I'd forgotten about. And I would like to see if I can get better density with minoxidil, which I haven't used recently. But I'm sure you are correct... I will not likely be satisfied without improved temples, which won't likely happen without a transplant.

I worry that I Have diffuse thinning/miniaturization to an extent that I would not have good donor areas, and suspect that I would be told to accept my current hairline/temples and focus on defending that with hair transplant if needed. I haven't heard this from a hair transplant doctor... Just guessing.

 

[chicknlittle]

2 months after the addition of minoxidil I may have had a little darkening of hair, and it may SEEM a little thicker on top, but this may just be wishful thinking... Too early to judge, in any case...

I did get a USB microscope (Dino-lite basic) out of curiosity, to get a better understanding of what was going on on my head. Really just confirmed what I knew, but the images are still interesting. Still experiencing very slow growth overall, and generally crappy thin hair that has inadequate density/strength/ coverage to wear at any length beyond buzzed.

Pic (below) of occipital area (should be the "safe zone)... not very dense, objectively. Hair is smaller in diameter than normal with some miniaturization (variable size) approaching translucent, but lots of multiple hairs out of single follicle area. Even this area is affected, I believe, but not terminally so, yet. When I go entirely bald it will be NW7 (will buzz : ). May not have good transplant donor site...

Pic from Vertex (below)... Similar.. Some variability in hair diameter... Occasional dying/translucent hair, but still reasonable spacing. Still, affected by male pattern baldness

Pic from Hairline (Below)(active receding)... Combination of thin/translucent minoxidil hairs, short and with little substance, many of which are new since minoxidil. Some have slight darkening at base, but most dont. Some are a little longer than others. Also long, thin, translucent hairs without pigment. I believe these are terminal hairs in the last stage of miniaturization prior to regressing to vellus/minoxidil hair size. Some (low percent) have a little more darkness at base, possibly minoxidil effect. As this is a snapshot it is hard to know if the long translucent hairs are coming or going, but since my hairline hasnt changed objectively I believe they are in the process of dying/miniaturization/ regression to vellus.

The microscope is a fun toy, and I think it did help me confirm what I already knew (frontal area is active, but with diffuse miniaturization,,, back active too, with miniaturization)... Would be interesting to see a dermatologist/hair transplant doctor to see how they read my scalp... But, I think for typical male pattern baldness the diagnosis is fairly obvious, and miniaturization speaks for itself, without a microscope... And, if i need a microscope to see the effect of minoxidil, its really not helping yet : )

 

[chicknlittle]

6 months into new regime I have noticed positive changes, and am happier with my hair. I have met many of my goals (subjectively thicker, more growth), and had some unexpected but welcomed changes (darker hair, longer eyelashes), and one minor side effect (body hair is some thicker). Despite these positive changes, and the fact that I find my hair looks better with the improved growth/length/impression of thickness I do not believe I have grown any new terminal hairs at my temples/frontal hairline, or if so, not enough to budge the hairline. I'm not counting the minoxidil/vellus hairs.

One of the main things I was noticing 6 months ago was that my hair felt fine/thin/fried (I kept cutting it short/shorter because as it grew out it looked frazzled and weak, and looked strange longer... also when I did trim it eventually/infrequently there was just very little to trim... no body/bulk to the strands). Hair length is longer in these followup 6 month pics (I don't really want to buzz to #3 again, enjoying faster growth and length)... Pics may not show my subjective experience of improvement from thin frazzled hair to thicker hair, and change from very slow growth to more normal growth rate...


These last few months my hair just feels thicker and more substantial than I did, and when I trim it there is actually some bulk to the trimmings. The faster growth is making styles that haven't been possible in recent years seem possible.

In addition to my ?subjective? impression of thickening (?of individual strands) and faster growth, darkening is a notable feature. My family commented that they had never seen my hair so dark (light brown has become dark brown). Additionally my eyelashes have grown in a remarkable way (some positive comments on this : ) in both length and thickness. They, along with my hair, had thinned very gradually in recent years.

My thoughts on my treatments

1) most of this is surely minoxidil effect. I went from no minoxidil to minoxidil 12.5mg oral twice a day. Without FDA approval and more studies, and with some reasons to believe this may not be safe for all people, I do not recommend this for others, and am not going to defend this choice. But, for the sake of documenting and common knowledge, I am posting my results. I do get some facial puffiness/bags under the eyes which is tolerable. No change in blood pressure or heart rate. I chose oral rather than topical because I like the convenience, hope for a better response, and hate how minoxidil foam fries my hair.

2) Increased dutasteride from 1mg/day to 2mg/day. Why? Studies may show further reduction in scalp DHT with higher doses, and I wanted to throw the kitchen sink. No real notable sides. Finasteride remains the treatment for most people, and .5mg the common dutasteride dose. With dutasteride's long half life and questions about (rare) impotence, reproductive questions, and now unknowns re: neurohormones, dutasteride really can't be recommended freely for most (do your own reading and weigh the risks and unknowns). For myself, I've tollerated it well to date, and reproduction isn't an issue at my age (45).

3) Added RU in KB solution, 100mg/day. No side effects. I dont know whether to attribute any of the above results to RU. Instead, I take it as part of my "throw the kitchen sink" approach, mainly hoping that with RU I will be able to continue to maintain what I have for decades (or until a good proven topical anti-androgen appears)

4) Added Vitamin D, B12 and Folate oral; some reason to think these might help some people, and easier to take than to test for deficiencies. Are they making a difference? I don't know. Still, they are easy to take...

5) Nizoral shampoo. Why not? Alternating with .5% hydrocortisone shampoo.