My difficult situation (New Member/First Thread Post)

[Diffused_confidence]

I would use the $7900 for a hair transplant instead.

Why a hair transplant? His hairline seems ok. I've looked into hair transplants in case my treatment fails and I learned that a good surgeon is going to have a long term plan / goals set along with expectations before the first surgery. They aren't going to lower the hairline a ton because that is not necessary to provide solid coverage. I don't see why @Raccooner would need a hair transplant. Best to have him get on treatment.

 

[Raccooner]

Why a hair transplant? His hairline seems ok. I've looked into hair transplants in case my treatment fails and I learned that a good surgeon is going to have a long term plan / goals set along with expectations before the first surgery. They aren't going to lower the hairline a ton because that is not necessary to provide solid coverage. I don't see why @Raccooner would need a hair transplant. Best to have him get on treatment.

What kind of treatment do you suppose? I fear though I have scarring hair loss. What do you think?

 

[Diffused_confidence]

What kind of treatment do you suppose? I fear though I have scarring hair loss. What do you think?

I don't think it is scarring alopecia. Scarring alopecia looks patchy like alopecia areata. Now house is right that the hairline can be lowered with surgery but the crown area just looks like thinning. It's also looks like wet hair and a lot of people would have that parting hair because hair gets clumped together.

 

[Norwoody]

@infamousrodi we love you buddy

 

[infamousrodi]

@infamousrodi we love you buddy

I know im annoying sorry man.

 

[Raccooner]

hairhelp777:​

I do get itching and burning sensations. I was having a big problem with this last winter. I would bet it is folliculitis decalvans, especially given the location. Not a single dermatologist or trichologist suspected this examining my scalp! It makes me wonder why they have jobs given they either don't check carefully enough or don't know much of anything. I guess I will need to see a scarring alopecia specialist.

 

[hairhelp777]

The photo you posted showing the frontal loss could be MBP- I can't really tell how many miniaturised hairs you have. It's possible to have MBP and a scarring alopecia. LPP often affects people in patches (often on the vertex) as well as sometimes in a vertical line down the vertex to the front. LPP is not always patchy -but sometimes causes patches. It is misdiagnosed very often - but in the vast majority of cases people have itching/burning symptoms. I know you've mentioned tingling - but do you also have itching burning? I'm not very familiar with the plasma stem cell treatment you mentioned - but I think it's a new technology not backed by strong evidence yet.

If you have itching burning in the area of hair loss - that is a strong sign it could be LPP (and maybe MBP too). If no itching, it's probably not LPP (but still could be). There are also variants of LPP like frontal fibrosing which cause frontal loss - but usually this is accompanied by eyebrow loss.

 

[Raccooner]

The photo you posted showing the frontal loss could be MBP- I can't really tell how many miniaturised hairs you have. It's possible to have MBP and a scarring alopecia. LPP often affects people in patches (often on the vertex) as well as sometimes in a vertical line down the vertex to the front. LPP is not always patchy -but sometimes causes patches. It is misdiagnosed very often - but in the vast majority of cases people have itching/burning symptoms. I know you've mentioned tingling - but do you also have itching burning? I'm not very familiar with the plasma stem cell treatment you mentioned - but I think it's a new technology not backed by strong evidence yet.

If you have itching burning in the area of hair loss - that is a strong sign it could be LPP (and maybe MBP too). If no itching, it's probably not LPP (but still could be). There are also variants of LPP like frontal fibrosing which cause frontal loss - but usually this is accompanied by eyebrow loss.

Yes, I had itching in my scalp. The itching I felt was a symptom of depression, stress and anxiety. The thing is I had itching too on the areas that were not affected. So then it begs the question why only one side did notable hair loss occur?

 

[DoctorHouse]

Why a hair transplant? His hairline seems ok. I've looked into hair transplants in case my treatment fails and I learned that a good surgeon is going to have a long term plan / goals set along with expectations before the first surgery. They aren't going to lower the hairline a ton because that is not necessary to provide solid coverage. I don't see why @Raccooner would need a hair transplant. Best to have him get on treatment.

I agree he needs to be on finasteride but his hairline is at a NW3 level and diffuse. PRP is not going to bring it back. I would not be happy with his hairline. That's just me.

 

[Norwoody]

Especially being in his 40's, I'd just opt for a transplant. Most of the guys who get significant regrowth usually only do so when they are under 30; exceptions are rare.

 

[Raccooner]

I contacted my trichologist a couple of days ago by email.

Dear _______,

I've been doing research on what I may have. I know you told me the condition I have is male pattern hair loss (this is true in the receded temples) however there are symptoms I might have forgotten to discuss. I was getting plenty of itching, pruritis, burning sensations, redness, pustules and bleeding on the scalp last winter. Given the location of the area of concern in the right vertex, which is thin (I think you recall), I might have folliculitis decalvans. If you believe I am misguided in my analysis, could you explain to me why I do not have this condition? Thank you for your time.

Sincerely,
_____________


Hi _________,

Here is an image of the top of your head where the classic symptoms of Androgenic alopecia is very present. The only topical treatment that has been FDA approved and is the less harmful of all treatments for AA is Minoxidil 5%

In my professional opinion your scalp does not show any symptoms of any other scalp problems. You do not have foliculitis decalvans. Your Androgenic Alopecia has progressed a great deal due to the fact it has been untreated for many years.

As a Trichologist I take my profession very seriously and I work with all dermatologists. Hair loss is very traumatizing, I want to make sure you are getting the very best treatment.

I have done the very best for you. I have made my professional opinions, yet you still want more answers. This is your right, and this is why Im suggesting your next step is a dermatologist.

My suggestion is for you to see a dermatologist and ask for a scalp biopsy if you feel that the right side area near your crown is burning and itching.


Wishing you all the very best.

 

[Raccooner]

I agree he needs to be on finasteride but his hairline is at a NW3 level and diffuse. PRP is not going to bring it back. I would not be happy with his hairline. That's just me.

I tried Finasteride for 3 1/2 weeks. I couldn't tolerate it and was getting scalp issues and facial spasms using it. Instead I take other DHT blockers that are natural. I am using red clover, fenugreek, fo-ti, mushroom complex (like Reishi), nettles, etc. I tried using pueraria mirifica and vitex but they made my condition worse as well. A lot of this is trial and error stuff. I am of the opinion that you are correct in that PRP won't bring my hair back but am going to give it a shot in the unlikely event that I do respond. If I don't respond within say 18 months of doing a nanofat and PRP procedure then I think transplant is my only other option left. The other hopeful possibility is hair multiplication technology comes by then and believe me, I'm not holding my breath! My guess is we're 15 years away from this being brought to the marketplace. By then my situation will be very serious. I'm think I'm screwed unfortunately. Oh yes, I tried dutasteride as well, a horrible drug!! I wouldn't touch that stuff again with a 10 foot poll!

 

[Selb]

I’ve gone down the rabbit hole of scarring alopecia. It’s very unlikely. Like 1% that your hair loss is from that especially as you already have a receded hairline indicating androgen sensitive hairs. If you want to rule out scarring alopecia for your peace of mind, go to a dermatologist specializing in hair loss and push for a scalp biopsy in the affected area.

But even then, it’s not definitive. I got a lichen Planopilaris diagnosis from a scalp biopsy but a major specialist in scarring alopecia examined me closely and said that it’s unlikely I have it. He felt with his hands and used microscopes too. I think he mentioned you can choose a random full head from the streets, do a scalp biopsy, and one hair can have lichen Planopilaris show up in the biopsy. That’s because male pattern baldness and LPP have similar inflammation and fibrosis.

so even scalp biopsies can lead you astray. What you need to look for is: inflammation, burning pain, rough skin, hair can easily be pulled out, and hair loss continually happening in that area. And if your biopsy shows lichen planopilaris, that’s what it is. Better yet two biopsies would be definitive.

 

[Diffused_confidence]

I’ve gone down the rabbit hole of scarring alopecia. It’s very unlikely. Like 1% that your hair loss is from that especially as you already have a receded hairline indicating androgen sensitive hairs. If you want to rule out scarring alopecia for your peace of mind, go to a dermatologist specializing in hair loss and push for a scalp biopsy in the affected area.

But even then, it’s not definitive. I got a lichen Planopilaris diagnosis from a scalp biopsy but a major specialist in scarring alopecia examined me closely and said that it’s unlikely I have it. He felt with his hands and used microscopes too. I think he mentioned you can choose a random full head from the streets, do a scalp biopsy, and one hair can have lichen Planopilaris show up in the biopsy. That’s because male pattern baldness and LPP have similar inflammation and fibrosis.

so even scalp biopsies can lead you astray. What you need to look for is: inflammation, burning pain, rough skin, hair can easily be pulled out, and hair loss continually happening in that area. And if your biopsy shows lichen planopilaris, that’s what it is. Better yet two biopsies would be definitive.

Have you considered titrating your dose?

 

[Raccooner]

Have you considered titrating your dose?

Thought of it but still think taking it will hurt me. If the body doesn't want it I shouldn't be having it at all. I figure if natural DHT blockers exist and my body doesn't reject them then it makes better sense to go that route instead. The question is how effective they are. Supposedly the reishi mushroom is supposed to block as much DHT as Finasteride based on percentages from studies. What matters is how does it react in real life in the body. Are its properties effective when broken down in the body.

 

[Raccooner]

I’ve gone down the rabbit hole of scarring alopecia. It’s very unlikely. Like 1% that your hair loss is from that especially as you already have a receded hairline indicating androgen sensitive hairs. If you want to rule out scarring alopecia for your peace of mind, go to a dermatologist specializing in hair loss and push for a scalp biopsy in the affected area.

But even then, it’s not definitive. I got a lichen Planopilaris diagnosis from a scalp biopsy but a major specialist in scarring alopecia examined me closely and said that it’s unlikely I have it. He felt with his hands and used microscopes too. I think he mentioned you can choose a random full head from the streets, do a scalp biopsy, and one hair can have lichen Planopilaris show up in the biopsy. That’s because male pattern baldness and LPP have similar inflammation and fibrosis.

so even scalp biopsies can lead you astray. What you need to look for is: inflammation, burning pain, rough skin, hair can easily be pulled out, and hair loss continually happening in that area. And if your biopsy shows lichen planopilaris, that’s what it is. Better yet two biopsies would be definitive.

This is interesting. So what in the biopsy does the pathology show that is different between lichen planopilaris and androgenetic alopecia? I'd rather avoid the scalp biopsy as it is a lose lose situation. Even if it comes up with a good result I am left with a couple of small scars that cannot be reversed. The real deal will be whether my hair will regrow from intervention. If not, then the biopsy might be appropriate. Now just because I've had inflammation or itching in the area from stress does that guarantee it is scarring alopecia? I read androgenetic alopecia can have itching and burning associated with it too. Is this the case?

 

[Raccooner]

I’ve gone down the rabbit hole of scarring alopecia. It’s very unlikely. Like 1% that your hair loss is from that especially as you already have a receded hairline indicating androgen sensitive hairs. If you want to rule out scarring alopecia for your peace of mind, go to a dermatologist specializing in hair loss and push for a scalp biopsy in the affected area.

But even then, it’s not definitive. I got a lichen Planopilaris diagnosis from a scalp biopsy but a major specialist in scarring alopecia examined me closely and said that it’s unlikely I have it. He felt with his hands and used microscopes too. I think he mentioned you can choose a random full head from the streets, do a scalp biopsy, and one hair can have lichen Planopilaris show up in the biopsy. That’s because male pattern baldness and LPP have similar inflammation and fibrosis.

so even scalp biopsies can lead you astray. What you need to look for is: inflammation, burning pain, rough skin, hair can easily be pulled out, and hair loss continually happening in that area. And if your biopsy shows lichen planopilaris, that’s what it is. Better yet two biopsies would be definitive.

Might you show a picture of your scalp where the lichen planopilaris was found? Having photos to study could be a way to know better what to look for after seeing many examples. If I am not mistaken doesn't lichen planopilaris grow in area with time over the scalp unless it burns out or is treated?

 

[Selb]

This is interesting. So what in the biopsy does the pathology show that is different between lichen planopilaris and androgenetic alopecia? I'd rather avoid the scalp biopsy as it is a lose lose situation. Even if it comes up with a good result I am left with a couple of small scars that cannot be reversed. The real deal will be whether my hair will regrow from intervention. If not, then the biopsy might be appropriate. Now just because I've had inflammation or itching in the area from stress does that guarantee it is scarring alopecia? I read androgenetic alopecia can have itching and burning associated with it too. Is this the case?

The biopsy may not show it, but it will have a lot of overlaps with lichen planopilaris. Basically inflammation and fibrosis. A lichenoid reaction is usually the difference but I had that and the specialist still thought it was just male pattern baldness.

I feared the small scars too. I can tell you now that you most likely don’t have it. But unfortunately the human brain can believe one thing today and another thing tomorrow depending on your mood. I understand this because I was in your position. So maybe you can be aware of this and ignore it or you can do a biopsy.

Might you show a picture of your scalp where the lichen planopilaris was found? Having photos to study could be a way to know better what to look for after seeing many examples. If I am not mistaken doesn't lichen planopilaris grow in area with time over the scalp unless it burns out or is treated?

Yea lpp keeps growing until it burns out. So if your hair loss has been going for years without a visible scar or scarred over bald spot, it’s most likely not that. Male pattern baldness can occur unevenly too.

I don’t have photos of the area unfortunately because the derm chose the spot in the back, so I only have photos after the fact

 

[Raccooner]

Based on my latest reading on dermoscopy, white dots will indicate the loss of follicular ostia. If I see none of these upon my next trichoscopic exam in the problematic areas then I think I'm out of the woods.

The biopsy may not show it, but it will have a lot of overlaps with lichen planopilaris. Basically inflammation and fibrosis. A lichenoid reaction is usually the difference but I had that and the specialist still thought it was just male pattern baldness.

I feared the small scars too. I can tell you now that you most likely don’t have it. But unfortunately the human brain can believe one thing today and another thing tomorrow depending on your mood. I understand this because I was in your position. So maybe you can be aware of this and ignore it or you can do a biopsy.



Yea lpp keeps growing until it burns out. So if your hair loss has been going for years without a visible scar or scarred over bald spot, it’s most likely not that. Male pattern baldness can occur unevenly too.

I don’t have photos of the area unfortunately because the derm chose the spot in the back, so I only have photos after the fact

 

[WaccWaccWacc]

You’re 42, atleast thats what your bio says. If so, density loss is to be expected at that age. I would agree with @DoctorHouse and just go for a transplant. If you want your hair through your 60s hop on finasteride as well. A transplant is going to give you the biggest bang for your buck and if there ever was a time in your life to get it, now is it, at 42 your long-term plan isn’t very long like most 20 year olds on here.