Medication-induced Alopecia?! Lost My Hair In A Month?! Devastated...

[snooze]

Dear All,

I am sharing probably one of the most depressing stories on this forum... I have been losing my hair since my early 20s, and I have been on minoxidil ever since. Around the age of 27 I have had my first FUE hair transplant, 3200 grafts, that unfortunately did not produce satisfactory results, my crown and my top were still thin. March this year I had another FUE hair transplant 3600 grafts, and my donor became quite depleted by now, but I didnt mind much as I started having great results. I stopped using minoxidil after the 2nd hair transplant but then freaked out at 4th month that I might lose additional hair, and then continued using it again after stopping for 4 months. Nevertheless, my results were fantastic, and I was very happy.

Unfortunately, on the 7th post-op mark, due to potential HIV exposure, I was put on HIV Post-Exposure-Prophylaxis, where you take actual HIV medicine for 4 weeks in order to potentially prevent the infection. Needless to say that these 4 weeks were the worst 4 weeks of my life, with days days of constant anxiety and stress, after which I have developed depression and a severe trauma, together anxiety and panic attacks that still persist, not to mention loss of sexual desire whatsoever. The results for HIV came back negative after I finished the course of medication, however, I lost MOST of my hair on top and crown in just 3 weeks The medicine I took did not mention alopecia as I side effect, but when I have googled it there have been some anecdotal cases of alopecia with the given medicine. I have read that usually drug-induced alopecias are reversible, but that they can sometimes also accelerate male pattern baldness and are irreversible. What is interesting is that it seems like I havent lost my transplanted hair, but I have lost my "old" hair, and I have lost it usually where male pattern baldness is present, which could tell me that I should probably not expect my hair to come back I read that medication can cause anagen effluvium (usually starting days or weeks from treatment) but is mainly related to chemotheraphy, and telogen effluvium (usually starting 2-3 months after initiating medication). However, my problem is that I had TELOGEN hair with my hair loss, but it happened in 2-3 weeks, which I simply cannot decipher what it is. If the medication just accelerated male pattern baldness, shouldnt these hairs come back at least thinner in the next growth cyclus, and not completely dissapear?!

I am just devastated for so many reasons, for going through that trauma for 4 weeks (even though my HIV risk was very minimal), and in the end for losing my hair, I literally dont know how I will continue with my life now. I cant shave my head due to FUE scars, and I cant have my hair long again as it bald on top...

I spoke to my hair transplant surgeon, he proposed to go on Finasteride, and so did my dermatologist, but I dont know if its worth the risk having in mind that I am having severe anxiety attacks and depression from this event, and the fact that Finasteride in most cases doesnt regrow lost hair?

The only other reason I can figure out my hair was completely lost in 3 weeks, could be the minoxidil that I have stopped for 4 months after having my hair transplant and then continuing on the 4th month post-op? However as I lost my hair on the 7/8 month post-op, that is 3/4 month after restarting minoxidil, isnt that too long for a minoxidil shed?

Has anyone had any experience with medication induced alopecia, or if you have any other information or opinion I would be more than thankful! I am attaching my before and after pics, the before pics are literally less than a month ago, and the current one are from few days ago....

 

[snooze]

Anyone? :/ Ive read that there are some drug-induced alopecia cases here, would really appreciate any kind of feedback...

 

[ButWhyTho]

I'm actually confused as to why you never tried finasteride in the first place. Taken early enough if usually halts or dramatically reduces the loss of hair. Why did you decide to go straight into a transplant without trying it? Or even in conjunction with the transplant?

 

[snooze]

I'm actually confused as to why you never tried finasteride in the first place. Taken early enough if usually halts or dramatically reduces the loss of hair. Why did you decide to go straight into a transplant without trying it? Or even in conjunction with the transplant?

My surgeon said it wasnt absolutely necessary... and I reached more or less the balding pattern of my father, which was exactly the same, and in all fairness, my hairloss completely stopped, I think I had zero shedding when showering, applying rogaine etc... All until I took this medicine, and in 3 weeks I lost all my hair. I a going to start Finasteride today, but I really dont think there is any use or any hope.

My dermatologist says that the hair might come back on its own if its medication-induced, but I think it wont happen and that is the case only when women lose their hair due to medication and those who dont have male pattern baldness...

I really dont know how I am gonna cope with all this, it happened so fast that I cant even realise it yet.

 

[Tommybommy1363]

Dang that’s rough man. All you can really do is take propecia and hope it grows back. Add dermarolling as well

In the mean time I would no gaurd or shave, it looks really sickly right now

 

[hailbrotzu]

I would add dermarolling, perhaps get a derminator. This might help nourish the follicles. I doubt you have permanently lost hair that fast, even then regular derminator could probably bring a lot of it back.

Did you stop using minoxidil or are you still using it? I know hair is supposed to shed quickly after stopping

 

[snooze]

Dang that’s rough man. All you can really do is take propecia and hope it grows back. Add dermarolling as well

In the mean time I would no gaurd or shave, it looks really sickly right now

I feel like my life is literally destroyed in a months time. It has impacted my life in so many ways... I am starting Propecia today and see how it goes, although I am scared as hell of the sides, especially because ai an already heavily depressed because of the whole situation, and have a non existint libido basically.

Yep I did a no guard as it looked awful, but my FUE hair transplant scars are unfortunately very visible...

 

[snooze]

I would add dermarolling, perhaps get a derminator. This might help nourish the follicles. I doubt you have permanently lost hair that fast, even then regular derminator could probably bring a lot of it back.

Did you stop using minoxidil or are you still using it? I know hair is supposed to shed quickly after stopping

I ordered a dermaroller 1,5mm yesterday actually, I am going all in... nizoral, minix, propecia, dermaroller... and yeah, Im still using minoxidil, never stopped apart from first 4 months post op. But ive been on it more than 4 months now.

I really hoped its not permanenet, even though its been a bit more than a month and a half I started the bloody medication, and 2 weeks since I stopped it, but I still see insane shedding. For me the worst thing was that Im shedding mainly my own hair, and the transplanted ones, which could be an indicator that my “dht” hairs have been hit, and that the medication super accelleratrd my hairloss?! I dont know anymore, I am completely devastated...

 

[hailbrotzu]

I ordered a dermaroller 1,5mm yesterday actually, I am going all in... nizoral, minix, propecia, dermaroller... and yeah, Im still using minoxidil, never stopped apart from first 4 months post op. But ive been on it more than 4 months now.

I really hoped its not permanenet, even though its been a bit more than a month and a half I started the bloody medication, and 2 weeks since I stopped it, but I still see insane shedding. For me the worst thing was that Im shedding mainly my own hair, and the transplanted ones, which could be an indicator that my “dht” hairs have been hit, and that the medication super accelleratrd my hairloss?! I dont know anymore, I am completely devastated...

It sucks. Trinov should be coming out today or this week, I'm going to try it, maybe it could help. The light is dim, but it glimmers.

 

[snooze]

It sucks. Trinov should be coming out today or this week, I'm going to try it, maybe it could help. The light is dim, but it glimmers.

I wanted to say “NOT the transplanted ones” up there, was a typo...

But yeah, thanks, lets see how it goes... do uptade us on Trinov if you get it..

 

[snooze]

So, a little update... the hair still seemed to shed quite a lot, I buzzed it and jumped on Finasteride 4 days ago. I just cant believe what happened, I look like a NW5/6 right now, and it looks awful with spikey FUE hairs all around, from a FULL HEAD OF HAIRS just a month ago.

Also, what I have noticed is that my facial hair and body hair have DRAMATICALLY increased, and I have hair on the face and arms and legs where I usually didnt have before, what can all this mean?! Not to mention ball ache, loss of libido and oily face (prior to starting Finasteride) as well. Could the meds, or the continuous stress for 4 weeks that I have contracted HIV, have made some kind of shift in my hormones?! Is there a chance this will go back to normal by istelf?

 

[Umber]

Increased body and facial hair isn't typically a side effect from finasteride, and in any case wouldn't pop up in just 4 days. Ball ache and loss of libido are fairly common though, but for most people the side effects go away after a week or two. Just hang in there. If the loss is from the medication you took, odds are your hair will grow back once you get off it

 

[snooze]

Increased body and facial hair isn't typically a side effect from finasteride, and in any case wouldn't pop up in just 4 days. Ball ache and loss of libido are fairly common though, but for most people the side effects go away after a week or two. Just hang in there. If the loss is from the medication you took, odds are your hair will grow back once you get off it

I was actually implying that the body and facial hair increase, ball ache and loss of libido were either from the medication I took before finasteride or from the stress I had while taking that might have somehow impacted my hormones and caused this entire chaos in my body (and hair).

Im a bit worried that I jumped on finasteride while I already had the ball ache and loss of libido (either from these previous meds or stress), so I might not notice the potential side-effects?

Thanks, thats what Im hoping for, although I am getting a bit hopeless. Either the meds have caused the hairloss, or the immense stress (cortisol among others) has somehow made a hormonal imbalance and accellerated my male pattern baldness? Either way, I am still confused how it couldve done so much damage in only 3 weeks..

 

[snooze]

Just a quick update on the situation, my hair looks even worse than a month ago...

This is me mid-November after 2 FUE hair transplants:

And this is today:

I do see some weird hair growth on the crown already though, but I keep shedding short beard-like hairs (such as these below that are regrowing)

All in all, I have no idea anymore whats going on with me. My beard is not coarse and pointy and sharp anymore, but my body hair is still very crazy. I notice that the hair on the head (the one that did not fall out) is growing insanely fast, and the same goes for the body hair. I developed also flaky and itchy scalp on the sides, and my eyebrows are shedding (although not thinning yet as far as I can see).

I have seen also two hair transplant surgeons, who say this is definitely not normal, nor a Male Patterned Baldness (even though I have it from before, hence the two previous hair transplants), and they say that it can either be a severe drug reaction, hair loss from severe stress, or even diffuse alopecia areata induced by stress. I will go to a dermatologist on Wednesday to see if she can do a biopsy.

I also came accross this interesting article:

A 55-year-old man who previously underwent a successful hair transplantation for androgenetic alopecia now presents with rapid onset hair loss over the anterior to mid-scalp areas during a 2-month period. The alopecic area noticeably extended diffusely from anterior hairline to scalp vertex while rows of previously transplanted hair follicles appeared intact. Further dermoscopic features and a scalp biopsy were consistent with alopecia areata incognita. This patient was subsequently successfully treated with intralesional steroid injections. This case report is the first demonstrating the relative resistance of transplanted hair follicles to the process of alopecia areata when compared with local indigenous hairs.
https://journals.sagepub.com/doi/abs/10.1177/0748806817699926?journalCode=acsa

As in my case, my rapid hair loss is in the exactly same area, and it is mainly the transplanted hairs that have survived on my scalp... I dont know, I am just completely devastated by all of this, and have no idea how to move on.

 

[snooze]

Went to a second dermatologist today, and she wasnt interested too much to pay attention to what I was saying, just looked briefly under a dermoscope and told me "I have stress induced hair loss", on top of my male pattern baldness. When I asked her is that "diffuse alopecia areata"? She just nodded her head and prescribed me Elocon, a steroid cream, told me to come back in 3 months, and sent me on my way.

So yeah, still lost, and not sure what to do? :S

 

[jj37]

I can imagine this is incredibly upsetting... and probably no one on the internet can tell you anything definitive.

Based on the circumstances: i.e. a time of significant acute personal stress followed by en masse hair loss, it very much sounded like it could be telogen effluvium... simply induced by a very stressful life event (and possibly not the PEP drug... was it Truvada?). Your hair would recover after that (although possibly some marginal miniaturized hair wouldn't come back).

That dermatologist really doesn't sound like a good doctor if "she wasnt interested too much to pay attention to what I was saying."

Have you tried reaching out to Dr. Rassman via the form on his blog (baldingblog.com), or user wrassman on Reddit or wrassman@newhair.com? He's pretty responsive to general hair loss questions and given how much expertise he has... it could be something he could have a plausible theory for.

 

[snooze]

I can imagine this is incredibly upsetting... and probably no one on the internet can tell you anything definitive.

Based on the circumstances: i.e. a time of significant acute personal stress followed by en masse hair loss, it very much sounded like it could be telogen effluvium... simply induced by a very stressful life event (and possibly not the PEP drug... was it Truvada?). Your hair would recover after that (although possibly some marginal miniaturized hair wouldn't come back).

That dermatologist really doesn't sound like a good doctor if "she wasnt interested too much to pay attention to what I was saying."

Have you tried reaching out to Dr. Rassman via the form on his blog (baldingblog.com), or user wrassman on Reddit or wrassman@newhair.com? He's pretty responsive to general hair loss questions and given how much expertise he has... it could be something he could have a plausible theory for.

Yeah I havent really been myself ever since it happened... worst part is that it happened 7th month FUE post op, just when I was actually getting really happy with the results....

The drugs were actually Descovy (apparently new and safer version of Truvada), and Prezcobix. Truvada is used for PrEP (pre exposure), and PEP is used for post-exposure, taken for 4 weeks and usually includes 2 or 3 medications. Doctors say as well theyve never seen the hair loss happening, even though I had fever and a rash while taking them, which was a drug reaction/erruption. I dont really know anymore myself, Im so tired of everything, feels like Ive been living in hell since it happened.

Dr Rassman did respond on Realself briefly, he said only a severe drug reaction could cause this big loss, and so fast, and that at least the FUE hairs would return, but I might contact him there as welll just to follow up, thank you. As said I also spoke to two experienced transplant surgeons here in Scandinavia, who are really puzzled with how it happened that quick and to that extent. I lost a lot of hair diffusely all over my front, top, and crown (hairline was affected 5-10% but only from the back somehow), and my sides got thinner a lot. On one side of a crown I lost hair in something that looks like a thin uneven patch where I already got regrowth of some small hairs:

So, yeah... I am on finasteride for 2 weeks now, rogaine, and nizoral 1%, I will wait a bit with this corticosteroid lotion I got from my derm, until I got a second opinion... Thanks again for your post!

 

[snooze]

I got a response from Dr Jeff Donovan on Realself as well...

It could be drug induced hair loss, but I really don’t favour this as the top cause. Not at all. A drug induced cause wof hair loss would more likely “diffuse” in nature. I would need to see your scalp up close to say what’s going on but the autoimmune disease alopecia areata may be way more likely (sisiaphoo variant) than a drug induced cause. See a dermatologist to see if a biopsy is needed. This appears to be an uncommon form of alopecia areata.

I really have no idea what to think anymore...

 

[snooze]

A small update... first pic was taken today, and the second 3 weeks ago. It started filling up slowly, but still looks beyond awful...

 

[snooze]

Now when I look at this patch up there in the pics, it does seem like a weird form of alopecia areata bald patches + diffuse alopecia areata. :S