Sides And Back Thinning On Dutasteride (pics)

[MKP05]

You may consider:
1) lowering your dose to 1-3 capsules per week
2) using topical dutasteride and or dutasteride mesotherapy ONLY on your crown and temples
3) have a good holidays + stress-relieving techniques (maybe your doctor will prescribe you a course of some antidepressant)
4) wait until Breezula (Clascoterone) comes out

Again thanks for your thoughtful and detailed response. As an FYI testicle swelling is a listed side effect of dutasteride. I know because as soon as my Dr confirmed the condition I looked it up and it is sighted repeatedly on medical websites across the internet. This actually put me at ease as I waited for my imaging tests to come back knowing that it was likely caused by the dutasteride and not a tumor.

The sides and back of my head have diffused so much that it’s making me ill to even think about. That hair when wet is now completely transparent. Also strange is that after about 8 weeks of lttle change to my Norwood area since starting duta I’ve now begun to lose a ton of hair the last two weeks most notably at my left temple (which is where my hair loss began 20 months ago and is still in the worst shape) and area just behind my hairline. Over the course of these two weeks I’ve gone from fairly stable in the Norwood region (which seemed like the one positive of the treatment) to very rapid loss. Combined with the loss on the sides and back I don’t know if I can stand continuing. I’m dangerously close to having to shave my head as my hair has begun to look ridiculous. Probably more so to me than to anyone else. At the same tine I know that throwing in the towel puts me at great risk to have a massive shed as the DHT comes crashing in. I may take your advice to lower the frequency to fewer times per week. The only question is whether I should take finasteride on the days in between.

Your comments about 15% min are intriguing. I quit min back in November. I was only applying to the hairline and wasn’t getting any regrowth but maybe it was helping me lose hair there more slowly. Maybe that’s why I’m losing so much hair there now. Where do you get your 15% minoxidil? I’m also considering using zix to try to maintain what is left.

I’m so discouraged right now. I know I’ve been lucky to make it this long without having to fight this battle even though I’ve had alopecia areata since I was 25 (currently no flare ups there and my last one from September filled back in within a couple months of injections). But it is so difficult to lose so much hair in such a short time span. I’m also lucky to be married and have 3 great kids and there’s so much in my life to be happy and grateful for. But this ordeal has taken a toll on me for sure and has impacted my happiness greatly. I feel like it has robbed me of time I could be spending with my family. And that is all my own fault.

In hindsight I should not have messed around with hormonal drugs. But what’s done is done. I wish there was a guide to get me out of this mess I’ve created. The last thing I want to do is keep compounding my mistakes. At least if I was not taking any treatment I’d know that what’s killing my hair is DHT and not the medication.

 

[MKP05]

This is brutal. I mean there’s already risk in these meds and for them to do harm is criminal.

The ‘shed is a good sign’ bullshit has failed me with minoxidil, Finasteride, and now out of desperation I’m going to try Dutasteride as well.

I know your history pretty well. I would advise against starting dutasteride given your reactions (or lack thereof) to other medications. Dutasteride has ravaged the only good healthy hair I had left which was in the donor area. And this was within one week of starting. I never knew this could even happen until I posted my results and got many responses from others who had the same thing happen. I pray to god that this hair grows back and that I only have to worry about the shitty hair I have left on my hairline and temples. I’m 2 months in and already looking to get out. And I’m not prone to making hasty or irrational decisions with treatment. As others have suggested I think your best option is to drop all treatment for a period of time and let your body get back into balance. I know you’re freaking out about what’s happening to you. I am too. But maybe hitting the reset button is the best way forward.

 

[Anatoly]

As an FYI testicle swelling is a listed side effect of dutasteride. I know because as soon as my Dr confirmed the condition I looked it up and it is sighted repeatedly on medical websites across the internet.
--------- If it helps you to combat stress, you may have some time spending here: https://clinicaltrials.gov/ct2/home, enter 'dutasteride', pay attention to confidence intervals and p-values to estimate the significance of the results; the evidence is simply inconclusive
If you study the original data, you're likely to be more relaxed about dutasteride & testicle swelling. Doctors even at the very best clinics do not necessarily rely on original data and simply site prescription info (which is a bureaucratic product, concerns about lawsuits and therefore excessive precautions etc- not necessarily a purely scientific product). This aspect is common for many drugs: if smth is listed as a side effect in prescription info for a drug, it does not necessarily mean that this drug raises one's chances of this side effect, there are many other non-medical variables that affect prescription info, life is complex) - ask those who are FDA expert voters.


The only question is whether I should take finasteride on the days in between.
------- I don't see any point in combining dutasteride and finasteride.

I quit min back in November.
-------- now an additional and very important variable enters your story)))); this has definitely contributed to your current shedding - this is why if one wants to quit minoxidil, one should do it very gradually, an abrupt stop causes enormous stress to your hair (and therefore shedding), this happened to me when I had an interruption in my 15% minoxidil supply for 3-5 days I guess, that was enough for me to loose some of my regrowth during next few weeks - one should remember there is always a time lag between e.g. minoxidil withdrawal and shedding as well as severe stress and shedding only in a few months after one experiences stress

Where do you get your 15% minoxidil?
------ you can google for Ideal Image Solutions minoxidil or Dualgen or Belgravia 12.5% minoxidil
But as I see, you're 47, therefore you should be more cautious. Your cardiologist should be sure that your cardiovascular system functions normally - e.g. if one has heart failure, high-strength minoxidil is contradicted (it is a vasodilator and causes water retention and therefore exacerbates heart failure).
I would suggest a simpler option: just use low-dose dutasteride + Rogaine 5% foam twice daily CONSISTENTLY for at least 3-6 month to see a regrowth. Once you stop, you'll lose your regrowth. However, 15% will get you to an entirely different level regrowth than 5%, but it's more reasonable to check first what you can get from a 5% solution when used consistently.

I’m also considering using zix to try to maintain what is left.
----- I'm sceptical that it will give you much additional benefit above low-dose dutasteride peregrine's week /topical dutasteride

alopecia areata since I was 25 (currently no flare ups there and my last one from September filled back in within a couple months of injections)
------ another additional variable: injections of a corticosteroid solution? any immunodepressant? these agents are tricky, once you quit, it's not infrequent one's state will exacerbate, ask your doctor about what can happen once you stop drugs like this; it may take you longer to live through corticosteroid/immunodepressant use concequences


I feel like it has robbed me of time I could be spending with my family. And that is all my own fault.

Anyway, this it temporary. You'll certainly find your regimen and forget this nightmare. I hope they support you in your desire to stay younger, handsome and happy. You may try a low-dose dutasteride + Rogaine + some biotin & zinc, avoid corticosteriods/immunodepressants for areata (if you're unready to use it consistently) and do it consistently and wait for 3-6 months.

 

[ali.talebi1994]

if you saw the shed that I had after ~6 weeks on Duta you would legitimately jump off a bridge -- power through it and stick with the medication

did you experience oily skin while on dutasteride???
in my case it caused a bad oily skin so that i eventually stopped the drug

 

[MKP05]

Anyway, this it temporary. You'll certainly find your regimen and forget this nightmare. I hope they support you in your desire to stay younger, handsome and happy. You may try a low-dose dutasteride + Rogaine + some biotin & zinc, avoid corticosteriods/immunodepressants for areata (if you're unready to use it consistently) and do it consistently and wait for 3-6 months.

Interesting you mention corticosteroids. Since I was 25 I have gotten areata flare ups. Always circular patches of hair loss and always on the back of my head. Patches have varied in size from a dime to the size larger than a softball. I was in remission from age 35-45. In February of 2018 at age 45 a got another flare up which eventually grew to the size of a softball from the nape of my neck on the left side. In all my years battling AA I have always used corticosteroid injections and I have always responded with regrowth. With very bad flare ups like this one I was also prescribed a very high dose prednisone pulse therapy to be taken once for 3 months. This time in February of 2018 was no different and after several months of injections and the pulse therapy which i started in June my patch filled in. Simultaneously to this is when I began suddenly losing hair very rapidly at my left temple and then my right. This loss did not look at all like areata and started in April of 2018 - one month after starting the injections but before the prednisone. Three different dermatologists confirmed that the temple loss was genetic and was not connected to areata or the corticosteroid treatment. By July of 2018 I had receded so rapidly at the temples (about 1.5 inches) that I decided to start finasteride and minoxidil. I stayed consistent with that treatment for 17 months but all I got was diffuse hair loss and continued hairline recession. I never got any regrowth from minoxidil but perhaps it was helping to slow down the loss. In any case, since I was still losing ground I decided to quit using minoxidil....I can’t remember exactly when but it was weeks before I dropped finasteride and started dutasteride. Why do you say to avoid injections/immunosuppressants for areata? They definitely work for me. In fact a whole year plus went by after my 2018 areata flare up until I got a dime sized spot right in the middle of the back of my head in September of 2019. Took 2 rounds of injections and it filled back in. The reason I’m asking is that every time I’ve gotten injections for areata both in 2018 and 2019 it was followed by an increase activity in frontal hair loss for a few months. Even though all doctors I’ve spoken with refuse to correlate the two and I’ve never found anything online suggesting a relation.

I hear what you’re saying about adding a topical back in but I’m really hesitant to do so. In addition to the probable initial shed the only benefit I may have ever gotten from 5% minoxidil was maybe a slight slow down in recession. It doesn’t seem worth it to add back in for poor results. Trying 15% is more appealing as at least it would be something new. I would have no idea where to purchase topical finasteride or dutasteride.

I’m still very much toying with the idea of stopping all treatments, trying to focus elsewhere and letting my endocrine system reset for a few months. I’m obviously terrified of the potential result but in my gut I feel like these medications have done me more harm than good. I think they work for an overwhelming majority but whatever other issues I have going on they have not worked for me. The other option I have is to reduce to three times per week or maybe every other day. I know that will reduce the benefit. My doctor wants me to quit the drug altogether as she feels that my reaction is not normal at all. She suggests taking proscar at 1.25 mg. I feel like I’m literally flying blind here. Again thanks for the discussion.

 

[Anatoly]

Interesting you mention corticosteroids.

DO make your history of glucocorticosteriods use the focal point of resolving your predicament. I hope you'll find a really experienced professional who'll confirm the points below and properly relate them to your current state. You probably do not need more opinions from other trichologists, you need a good immunologist who has a high-academic-level (not prescription-info-level) knowledge about a long list of nuances of how they work. It's not infrequent when trichologists/dermatologists lack sufficient specific knowledge with respect to glucocorticosteriods, although these drugs, that are very powerful and far from harmless indeed, are widely used in their practice. In the long list of indications for glucocorticosteriods these cosmetic conditions are hardly most important ones.

Your case is hardly unique (although in my previous post I started to assume that), besides the fact that areata is more rare than male pattern hair loss, although areata and pattern hair loss can co-exist, I've read a number of case studies of such extremely unlucky people.

Now in my eyes the rest of the puzzles have fitted the mosaic of your predicament. In your very first post you DO MENTION corticosteriod use. And I DID warn you about the consequences of these drugs' use. But you were more focused on finasteride and dutasteride your doctor put you on (now I doubt whether it has been justified), some other replies focused on this and eventually, I believe, the whole discussion has gone in an entirely wrong direction - a typical discussion of male pattern hair loss treatment's nuances. As the discussion evolved, I have simply forgotten that there is a corticosteroid variable in your story, I'm sorry for this inattention.

I've read and consulted a lot about glucocorticosteriods and immunodepressants for hair loss. I wanted to intensify my regimen. Now I'm firmly convinced that it is a road to hell. Just an example from my recent experience:
in early November I had an acne flare-up on my whole forehead. I was unlucky to have very important public events at that time, therefore I had to get rid of acne ASAP. Therefore, although I knew the risks (and my doctor reminded me about these), I had to use a topical corticosteroid on my forehead. By that time I already saw early regrowth of my frontal hairline and temples in particular. I used a corticosteriod topical (mometasone) for about 2 weeks (+ 7-10 days for discontinuation). Corticosteriods reduce inflammation whether it is about your joints or areata spots (autoimmune mechanism of inflammation) or DHT-caused inflammation in case of male pattern hair loss. I noticed that all things being equal (except corticosteriod), my frontal hairline regrowth started to grow very rapidly, I noticed new dense regrowth that additionally lowered my hairline +0.5-1 cm within such a short timespan. Although I discontinued corticosteroid gradually, not only I lost a corticosteroid-produced regrowth, I also lost almost half of my pre-corticosteriod regrowth (frontal hairline, temples). That was a withdrawal syndrome. I have restored what I lost because of corticosteroid discontinuation. Hopefully, my anti-hair loss regimen (it was constant during those weeks) turned out to be strong enough to help me overcome this. I managed to escape corticosteroid dependency.

Now I suspect you may not have a male pattern hair loss at all or you may have it in a very mild slow form that was exacerbated (your temples) by some withdrawal and dependency effect of your occasional corticosteriod treatment. And I do not know to what extent your scalp cells have become dependent on this drugs given your rather long story of use. Addressing a pattern hair loss, even if you have it, is unlikely to produce a desired result when there are corticosteriods & areata involved.

A crown area minituarization, thinning, then more or less symmetrically enlarging bald spot is usually a more reliable indicator of a pattern hair loss. This is in line with the fact that finasteride/dutasteride are more effective for one's crown area. Your crown does not look like that.

Areata does happen in temple and crown areas and may be mistaken for male pattern hair loss. You stress hair loss on your left temple that is, I assume, visibly more pronounced than your right temple. So, your dermatologists refuse to assume that it may be just another areata spot? Areata is known to migrate one's scalp - it may happen in one spot, then disappear, then emerge in another area. Male pattern hair loss - the key word is pattern: it is usually more or less symmetrical. Your crown actually looks good, not much different in density from your donor area. You also stress diffuse thinning, which is not a pattern hair loss. The scalp on your back is brownish/reddish (corticosteriods are known to lead to permanent change in skin colour), while your crown skin actually looks healthier.

'Three different dermatologists confirmed that the temple loss was genetic and was not connected to areata or the corticosteroid treatment.
Even though all doctors I’ve spoken with refuse to correlate the two and I’ve never found anything online suggesting a relation.'
-------- This is really surprising to me. Corticosteriods' effects + the nuances of a corticosteroid regimen are well-studied. At least they should have informed you about corticosteriod dependency and long-term adverse effects to avoid possible lawsuits. An example of a comparatively minor side is skin atrophy due to prolonged exposure, - hope you can guess what will happen to your hair in the areas of scalp atrophy. The fact that they are very effective to promote hair growth in particular is beyond dispute, but the long-term cost is very high. There may be some point in the future when your scalp becomes so damaged by these drugs that it is unable to grow hair. Glucocorticosteriods even affect one's DNA, its transcription in particular. If used for a long time, these effects can become irreversible. There is an abundance or articles.
With the duration of use, one often needs higher dose and/or more frequent use to maintain the same effect. When one stops, it's not uncommon one's condition deteriorates to a far worse extent it used to be before treatment. Corticosteriod dependency is well established in medical science. It's a kind of self-propelling viscous circle - e.g. stories of life-long acne and rosacea treatment are more common.
What is even more surprising for me is that you seem to be more concerned about side effects of finasteride/dutasteride rather than side effects and long-term consequences of corticosteriod use.

Given all these re-considerations, what options I could inform you about (to discuss with a proper doctor):
1) discontinue finasteride/dutasteride for let's say half a year + no minoxidil + a consistent corticosteriod use- maybe a combo of a week's/month's injections, oral solution on a regular basis, and more likely topical solution on an everyday basis. This is an economy-class option with long-term risks. A consistent corticosteriod regimen may be sufficient enough for you to resolve all your different aspects of hair loss without any help from AR inhibitors.
2) You can focus on newer and more selective immunodepressants, if you can afford these drugs that are incomparably expensive than e.g. corticosteroids/ Avodart/ minoxidil. Janus kinase (JAK) inhibitors are a family of newer (more selective) and more promising immunodepressants for a range of conditions - in several respects better than e.g. methotrexate (an old economy-class immunodepressant with serious sides). Some of JAK inhibitors are developed/being developed specifically for alopecia. Ask your doctor about this class of drugs. In case he/she happens to be unfamiliar with these - look for a more advanced doctor.
3) 15%minoxidil as mono therapy for your condition? I have seen a case where a guy managed to regrowth an areata spot on his temple with high-strength minoxidil. But you'll need a permission from your cardiologist. I assume you don't wanna die for hair. It exacerbates heart failure (a frequent consequence of a heart attack, what is your risk of a heart attack in 1--5-10 years?......). It can increase heart rate - there are also risks if you have a history of arrhythmias. Be sure that your cardiologist checks your cardiovascular system while you're on this regimen.


Hope, this post will be of better help than the previous ones. Wish you luck)

 

[MKP05]

Wow. I don’t even know where to start but that was a lot of very helpful information. Everything you have written fits into what I had suspected but was told was not the case.

At 45 years old with no previous male pattern baldness I found it extremely suspicious that this hair loss occurred when it did. I was on various areata forums asking if anyone had experienced hair loss in different areas of the scalp after starting injections. It all seemed way too coincidental. Of course no one had and, as I explained on my previous post, multiple dermatologists who were treating me for my areata indicated that the temple loss was a case of male pattern baldness without giving it any more thought. AA does have certain characteristics like exclamation mark hairs which can be easily pulled and round circular patches. The loss at the temple actually is very circular but it does not look like any areata I’ve ever had.

You are correct that my crown area does not have a noticeable bald spot. I experienced some thinning all over my Norwood region 4 months after starting finasteride (including the crown) but no pronounced bald spot ever appeared. I’ve been attributing this to the finasteride and dutasteride.

So now I’m trying to piece everything together. Keep in mind that I had areata for 10 years (using corticosteroids as necessary with flare ups) then remission for 10 years and now in the past 2 years I had one very bad flare up (the one which started all the hair loss) and then a more recent dime size flare up last September. In addition to the corticosteroids I had used clobetasol off and on since this started but most often to address the areata although I have used it at the hairline as well. But not in a few months at least. I don’t think I ever used it for more than a few weeks at a time but I do understand that it is very potent stuff.

I’m pretty familiar with JAKs. since I have areata I have read some about these over the past 2 years. Ironically my latest dermatologist who i saw in December is from a large well known hospital in NYC and seems to know her stuff. She mentioned potentially putting me on zeljanz for 3 months to see how I respond as she was sort of baffled by my hair loss and history. I’m also aware of the costs although she apparently knows how to get it cheaper overseas and has testified that it is legit.

I will discuss what you’ve suggested with my doctor and hopefully she’s receptive. The fact that she’s already suggested Zeljanz makes me believe she’s at least suspecting that this is areata and perhaps not male pattern baldness. I now personally think it might be a combination of multiple things.

 

[Anatoly]

'At 45 years old with no previous male pattern baldness I found it extremely suspicious that this hair loss occurred when it did. It all seemed way too coincidental.... dermatologists indicated that the temple loss was a case of male pattern baldness without giving it any more thought.'
--------- So, as I understand, your frontal hairline and crown used to be more or less stable (just a mature, as I see, hairline, Norwood 1-2) before this recent round of corticosteriod intervention. In pattern hair loss, there are several mechanisms making one's temples and crown look bald - e.g. 1) gradually more and more follicles die, making one's hair count more rare in these specific areas; 2) the life cycle of a hair shortens - e.g. once a hair may grow for 3 years and shed, with the progression of pattern baldness it may only grow for for a year and then shed 3) miniaturisation - even if a follicle still survives, every next round of regrowth it only manages to produce a thinner and thinner hair; 4) scalp in these areas should become different in colour (closer yo tour face skin colour). In sum, pattern hair loss areas should be clearly visibly different in several respects from a healthy donor area. Your photos do not suggest this. Moreover, with dutasteride/finasteride initiation one's temples&crown should become more bald during the first months (because there are more 'dead'/resting hairs to shed in these deceased areas) than areas that are not DHT-dependent. This should be visible to an eye.

' experienced some thinning all over my Norwood region 4 months after starting finasteride (including the crown) but no pronounced bald spot ever appeared. I’ve been attributing this to the finasteride and dutasteride.'
------- I suspect this was a coincidence against the background of corticosteriod & (certainly to a lesser extent minoxidil discontinuation. There is always a time lag. And this lag can be different for different areas of scalp - as: there are different ratios of growing vs. dead/resting hairs in different areas of one's scalp; different lifecycles even in a people with no hair loss (e.g. up to e years of growth in some areas, up to 5 years of growth in other areas...).
You note how effective corticosteriods were to regrow your areata spot: in this spot there hardly were hair to shed, the rug reduced inflammation to allow regrowth. But it inevitable affected other areas of your scalp - you note temples shedding. It accelerated hairs' lifecycle there, prompting a shed after which one should expect the same or better regrowth. But you discontinued corticosteriods, therefore hairs on your temples were 'surprised and shocked' (besides some minoxidil-discontinuation stress). It's a real mess with all this variables.

'clobetasole .. I have used it at the hairline as well'
----- I could only say - never do it again.

'I’m pretty familiar with JAKs. She mentioned potentially putting me on zeljanz for 3 months to see how I respond'
------ In case you're lucky to get this business-class drug, I would advise taking into account the following:
1) apparently, given all this mess with a large number of variables to keep in mind, your starting background is not clean enough - some shedding pattern in this experimental model may be unpredictable - which areas will regrow first, where shedding will subside more rapidly, where it may intensify.... this may require a longer time to understand what really happens to your entire scalp while on this drug, so may discuss an option of probably 3-6 months to get a more definite assessment
2) eliminate as many intervening variables as possible: 1) discontinue dutasteride asap (+no finasteride etc) - there is no so pronounced withdrawal syndrome as is the case with e.g. minoxidil abrupt discontinuation; 2) do not use ketoconazole shampoo - it's an active science-based ingredient in a shampoo, it reduces inflammation as well etc - you do not seem to have dandruff or too oily scalp, therefore you're not going to loose much if there is no Keto-shampoo in your regimen; 3) do not use any other substances (biotin etc) that are known to affect hair loss.
You need a clean background to better evaluate independent effect of this newer powerful drug. I very much suspect that this mono therapy will be sufficient to resolve the predicament. Anyway, later this year you may add smth like biotin after you learn what this drug will really give to you. Wish you luck

 

[MKP05]

My timeline with treatment is as follows:

- 1996 - 2007 alopecia areata. Treatment was corticosteroids and occasionally pulse prednisone therapy.

- 2007 to February 2018 - no hair loss at all (aside from normal maturing). At this point I’m a Norwood 1 or 1.5

- Feb/March 2018 - bad areata flare up on back of head which eventually grew to the size of a softball

- April 2018 - Sept 2018 corticosteroid injections and 2 month prednisone pulse therapy (June and July)

- May 2018 - July 2018 - rapid recession of left temple. Recession of 1.5 inches in 2 months

- June 2018 - July 2018 - slight recession begins at right temple. .5 inch loss in 1 month

-July 2018 - finasteride, minoxidil and nizoral treatment begins.

- October 2018 - diffuse hair loss noted across Norwood region. Diffuse loss presents in horseshoe pattern.

- July 2018 - September 2019. Hair loss progresses steadily - mainly at hairline and temples. No regrowth. But no considerable additional hair loss anywhere other than hairline/temples. Occasional clobetasol use and also clindamycin for persistent head ache/folliculitis

-September 2019 - small dime size areata patch appears on back of head.

- September 2019 - November 2019 - corticosteroids injections. Clobetasol on back of head. Discontinue minoxidil (was only applying to hair line)

End of November 2019 - switch from finasteride to dutasteride.

December 2019 - January 2020 back of head and sides start thinning. Temples and hairline temporarily stabilize.

End of January 2020 to February 2020 - hairline and especially left temple begin to recede again.

I agree that maybe I need to reduce some variables and potentially start monotherapy with something like Zeljanz to see if this resolved the issue. I’m definitely scared to stop finasteride and dutasteride for fear thar I will experience a massive shed as DHT comes flooding back in (if DHT was the culprit which is still unknown). I plan to discuss this approach with my doctor.

 

[MKP05]

Thought I’d share an update. 11 weeks on duta. Compared to even a week ago the thinning on the back and sides seems to have subsided a bit (I think). However, in the last two weeks my hairline and temples (especially the left temple) seem to be receding again. My doctor has advised me to stay on dutasteride for 4-6 months. I will not be using clobetasol ever again and will only consider corticosteroids if I develop another areata patch (which is bound to happen at some point). So I guess I’m going to try to power through this. I may or may not re-add minoxidil to the hairline and temples and may use my dermapen too if I go that route. I’d really love to stay off minoxidil but it may have been helping to slow (but not stop) my hairline recession. If I could just get some regrowth at the temples and hairline I’d be happy. At this point I’d take maintenance but I’m not at all happy with how my hair looks versus when I started 2 years ago.

 

[Anatoly]

My doctor has advised me to stay on dutasteride for 4-6 months. I will not be using clobetasol ever again and will only consider corticosteroids if I develop another areata patch I may or may not re-add minoxidil to the hairline and temples and may use my dermapen too if I go that route. I’d really love to stay off minoxidil but it may have been helping to slow (but not stop) my hairline recession. If I could just get some regrowth at the temples and hairline I’d be happy. .

a) An option of completing the experiment on dutasteride effects seems reasonable as well, given that you've been on it for 2+ months. Extra 4-6 months of dutasteride seem sufficient for you to live through corticosteroids & minoxidil discontinuation syndrome and evaluate independent dutasteride effect on your temples and crown. During this time you may pay attention to the following: 1) try to take a capsule daily - to make it sure dutasteride does its best; 2) do not add any minoxidil or analogues (aminexil etc); 3) do your best to avoid a need for oral antibiotics; 4) do not use corticosteriods (oral/topical/injection) - this intervention will ruin the research model again. Even of you develop an areata spot during these months, I would advise against corticosteriods/immunosuppressors (unless you're gonna use then regularly) - they will inevitably affect your entire scalp. Keep your hair a bit longer (+ probably some Toppik) to hide the spot. You can always get rid of it later.
b) Nizoral: in this case you should consider keeping it, probably not on a daily basis. Esp. your back scalp is visibly inflamed and dutasteride is highly unlikely resolve this.
c) dermapen: it's very effective (inter alia e.g. against wrinkles) if the needles' length is enough to trigger wound healing rather than mere better e.g. minoxidil absorption. It's definitely a more preferable 'topical' option than minoxidil, as one needs it once a week. You'd better consider adding it only in 4-6 months if dutasteride is insufficient to improve your hairline. I don't use it, as I have almost achieved a desired hairline on my current regimen + do not want to risk replacing minoxidil with dermapen in the sheme.
d) minoxidil: once you start, you cannot stop. Once I had an interruption in 15% minoxidil for less than a week, I simply used Rogaine twice daily, that did not save my regrowth. I lost a lot of high-strength minoxidil-produced hairs during next month despite proper resumption. This point is that high-strength minoxidil is incomparably more effective than Rogaine. But I cannot miss it a single day + I cannot miss a hair wash a single day. I use Rogaine 5% in the morning to allow proper social life- it makes my hair a bit 'dusty', but it is easily resolved with a bit of Truefitt&Hill pomade. I use 15% minoxidil before bed, otherwise I have to wear a hat if I go out.
In case dutasteride, then depmapen add-on fail to provide a desired hairline & back, 15% minoxidil is highly likely to do this. During these months you may consider psychologically preparing yourself for minoxidil route, in the end you have to brush your teeth twice daily- it's not so difficult spending extra 3 min for minoxidil daily routine. You may consider IIS 15% minoxidil + 5% azelaic acid or Dualgen or even stronger Polaris NR 10 (besides 15-16% minoxidil , it contains a menu of other strong research-proven ingredients- like finasteride and GHK-Cu).

 

[MKP05]

a) An option of completing the experiment on dutasteride effects seems reasonable as well, given that you've been on it for 2+ months. Extra 4-6 months of dutasteride seem sufficient for you to live through corticosteroids & minoxidil discontinuation syndrome and evaluate independent dutasteride effect on your temples and crown. During this time you may pay attention to the following: 1) try to take a capsule daily - to make it sure dutasteride does its best; 2) do not add any minoxidil or analogues (aminexil etc); 3) do your best to avoid a need for oral antibiotics; 4) do not use corticosteriods (oral/topical/injection) - this intervention will ruin the research model again. Even of you develop an areata spot during these months, I would advise against corticosteriods/immunosuppressors (unless you're gonna use then regularly) - they will inevitably affect your entire scalp. Keep your hair a bit longer (+ probably some Toppik) to hide the spot. You can always get rid of it later.
b) Nizoral: in this case you should consider keeping it, probably not on a daily basis. Esp. your back scalp is visibly inflamed and dutasteride is highly unlikely resolve this.
c) dermapen: it's very effective (inter alia e.g. against wrinkles) if the needles' length is enough to trigger wound healing rather than mere better e.g. minoxidil absorption. It's definitely a more preferable 'topical' option than minoxidil, as one needs it once a week. You'd better consider adding it only in 4-6 months if dutasteride is insufficient to improve your hairline. I don't use it, as I have almost achieved a desired hairline on my current regimen + do not want to risk replacing minoxidil with dermapen in the sheme.
d) minoxidil: once you start, you cannot stop. Once I had an interruption in 15% minoxidil for less than a week, I simply used Rogaine twice daily, that did not save my regrowth. I lost a lot of high-strength minoxidil-produced hairs during next month despite proper resumption. This point is that high-strength minoxidil is incomparably more effective than Rogaine. But I cannot miss it a single day + I cannot miss a hair wash a single day. I use Rogaine 5% in the morning to allow proper social life- it makes my hair a bit 'dusty', but it is easily resolved with a bit of Truefitt&Hill pomade. I use 15% minoxidil before bed, otherwise I have to wear a hat if I go out.
In case dutasteride, then depmapen add-on fail to provide a desired hairline & back, 15% minoxidil is highly likely to do this. During these months you may consider psychologically preparing yourself for minoxidil route, in the end you have to brush your teeth twice daily- it's not so difficult spending extra 3 min for minoxidil daily routine. You may consider IIS 15% minoxidil + 5% azelaic acid or Dualgen or even stronger Polaris NR 10 (besides 15-16% minoxidil , it contains a menu of other strong research-proven ingredients- like finasteride and GHK-Cu).

Just to clarify her suggestion was to give dutasteride a total of 4-6 months. This coming weekend will mark 3 months so she suggests another 1-3 months of use to see where I’m at. I’m really uneasy about this route. It’s not that it’s unreasonable. It’s that my hairline and temples have once again started to recede very quickly and so my hair loss is more noticeable than ever. It was probably a terrible mistake to drop minoxidil even though I was only applying once daily at night at the hairline. I rarely if ever missed an application in one year so I was ok with the routine. I stopped applying in the mornings about 6-8 months into my hair loss because it was impossible to apply only at the hairline and then style my hair and when I did it looked greasy and awful.

Can you tell me why you mentioned oral antibiotics? I’m prone to getting sinus infections so I’m wondering what effects amoxicillin has on hair loss.

You’ve mentioned 15% minoxidil and azelaic acid previously. Duelgen and Polaris NR. Do you buy these online and if so where do you get them?

I agree that in my case it would be preferable to remove as many variables as possible and try to stick it out with duta over the next few months. I just don’t know if my hairline can hang on and if it doesn’t I’m finished and I might as well shave it off - something I really don’t ever want to do.

 

[Anatoly]

This coming weekend will mark 3 months so she suggests another 1-3 months of use to see where I’m at.
------ At least +3 months, I would suggest.

It was probably a terrible mistake to drop minoxidil even though I was only applying once daily at night at the hairline.
------- Very likely it was. You may google for minoxidil pharmacokinetics - once daily is simply insufficient. Its vasodilator effect lasts for half a day at best. This is why in prescription info for Rogaine they suggest twice daily, applying a daily dose once daily would not work the same.
I apply minoxidil on my temples, mid-scalp and crown - larger area to ensure more minoxidil will absorb into my blood.
Have you considered oral minoxidil? Unsure, whether in the USA they can prescribe this.

it was impossible to apply only at the hairline and then style my hair and when I did it looked greasy and awful.
------ This can easily be resolved with proper haircare & styling products: 1) use Rogaine foam, it's far better than liquid for one's hairstyle; 2) once I started Rogaine my hair looked greasy as well - because of my scalp condition: it absorbed poorly, my scalp was not well-peeled and was too oily, most of this foam rested on my hair, it used to take me much longer to wait until it dries. Now the situation is very different: I first use a Vichy shampoo to get rid of dirt, oil etc, then Nizoral 2% thoroughly massaging my scalp and leave it for 15 min, then balm, + hair peel once weekly. Now this foam absorbs within less than a minute - just after morning wash when my hair is a bit wet to make it easier to get to my scalp more precisely + it better absorbs into warmer scalp, I part my hair cm per cm apply a thin foam line and massage a bit with a finger, trying to avoid touching my hair, although inevitably some rests on my hair roots but I cannot say it's visible - my hair there simply do not shine as the rest of my hair. Sometimes I have just minute to do this with no precision application, I cannot say my hair looks dirty, it just does not look shiny, therefore I use a water-soluble pomade. This point is that if you see Rogaine foam makes your hair greasy and it's visible, the cause is 1) application technique; 2) more importantly - your scalp condition. Reconsider your haircare. Now in my case Rogaine soaks far better and quicker, although at the start I had to do some ugly combover to cover the sh*t that appeared after this foam.


Can you tell me why you mentioned oral antibiotics? I’m prone to getting sinus infections so I’m wondering what effects amoxicillin has on hair loss.
--------- ) There are more and more variables that stand between you and your desired hair). Hair loss as a side should be in prescription info. IT's very common. I am definitely not an exception. Every time I have to use amoxicillin I'm prepared to see some shedding of my new regrown hairs. It gets into your blood and reaches your follicles. It affects your stomach and absorption of nutrients essential for healthy hair growth. There are several mechanisms. Consult a gastroenterologist.

You’ve mentioned 15% minoxidil and azelaic acid previously. Dualgen and Polaris NR. Do you buy these online and if so where do you get them?
------ You cannot buy these at a chemist's. Another difficulty is that you live in the USA, FDA is watching you). Although Polaris is produced in the USA. There are plenty of websites offering shipments. It's more difficult to find such supplier in the USA than e.g. in Russia. Therefore, I cannot point to a particular supplier. But I also know it's possible, some friends of mine in California get it. You have to google.

I agree that in my case it would be preferable to remove as many variables as possible and try to stick it out with duta over the next few months. I just don’t know if my hairline can hang on and if it doesn’t I’m finished and I might as well shave it off - something I really don’t ever want to do.
---- come on,) your hair at 47 look definitely good (probably not good enough for tough American standards of beauty), better than my hair at 27 before treatment. These are perfectionist's thoughts.

 

[MKP05]

Showing some improvement in the back (I think). Unfortunately my hairline and temples are getting hit hard right now. 3 month mark on duta.

 

[Anatoly]

Your scalp there definitely seems less inflamed/reddish. Given the quality of the photo far from ideal ... probably there're some signs of early regrowth. Do 5-10 min scalp massage while washing - esp your temples - to get rid of 'dead' hairs more rapidly - to see a regrowth there sooner. Obviously, there are still hairs to shed (as a result of previous erratic treatments). A healthy growing hair will never go out easily (you'll have to make an effort + you'll feel pain), if these hairs go out easily while washing/massaging - there is not point crying over these already 'dead' hairs. You may consider a weekly derma pen (+ antiseptics before&after the procedure, + some panthenol if needed, don't apply it if your scalp is oily) for your temples to allow faster regrowth. But do not use it if your scalp is inflamed/itchy/reddish there.

 

[MKP05]

Your scalp there definitely seems less inflamed/reddish. Given the quality of the photo far from ideal ... probably there're some signs of early regrowth. Do 5-10 min scalp massage while washing - esp your temples - to get rid of 'dead' hairs more rapidly - to see a regrowth there sooner. Obviously, there are still hairs to shed (as a result of previous erratic treatments). A healthy growing hair will never go out easily (you'll have to make an effort + you'll feel pain), if these hairs go out easily while washing/massaging - there is not point crying over these already 'dead' hairs. You may consider a weekly derma pen (+ antiseptics before&after the procedure, + some panthenol if needed, don't apply it if your scalp is oily) for your temples to allow faster regrowth. But do not use it if your scalp is inflamed/itchy/reddish there.

Not sure there is any point to derma rolling without a topical. A few if any users are reporting growth results without minoxidil or some other topical.

My hairline is a mess. Just to give an idea here are some pictures illustrating how much it has recessed in 20 months on AA.

First picture is June 2018 two weeks before starting finasteride. Front looks fine but the temples had receded quite a bit in two months.

2nd picture is November 2019 -16 months after starting finasteride.

3rd picture is December 2019 - 1 month after starting dutasteride.

4th picture is today.

I’d estimate I’m at least a full inch back from where i started. All of the hair immediately beyond the hairline is weak and dying - at least another 2 inches back. Density everywhere is completely shot - Id say 30% less than baseline and that might be generous. I know the hope is that the dead hair will be replaced by thicker regrowth but considering I took that same failed approach for 17 months on finasteride I’m not very optimistic. I’m very down today. This is the worst my hair has ever looked and the decline has come on very rapidly the last several weeks. My temples are also a mess but that could be a thread of its own.

 

[Anatoly]

1) you mentioned you have derma pen, it's an effective research-proven way of boosting hair independently of minoxidil etc + it might be particularly suitable in your case:
- this forum is biased, as most of derma pen users use minoxidil as well, nevertheless, I've come across is a number of cases on this forum where users (who experimented with different regimens) specifically stress derma pen as the strongest component of their regimen;
- there is a principal difference with respect to the needle's length: shorter needles are used for better absorption (of minoxidil etc), longer - to trigger wound healing, I'm talking about the latter, usually 1.5+mm. Short needles make your scalp reddish. Long needles make small slightly bleeding wounds; longest needles at a doctor's - consider FDA gradation
- FDA regulates this gradation with respect to safety (for home use, for medical professional use...), but it hasn't approved needing, although there's a good number of small-scale studies of needling for face scars/wrinkles/hair loss
- needling works against atrophic scarring e.g. acne scars and with respect to hair loss zones - as a follicle dies, over time it's replaced with fibrous tissue, it's very difficult to regrow hair is areas of scarring, even if you manage to control inflammation e.g by dutasteride and a follicle 'awakens', fibrous tissue around prevents regrowth; microneedliong breaks down fibrous tissue; ask your doctor about //google for autoimmune hair loss & connective tissue diceases
- it stimulates collagen production (proven by e.g. biopsies) - essential for hair + against wrinkles, on YouTube there're stories of women reducing scars and wrinkles by triggering wound healing
- wound healing means your body naturally sends growth factors etc to that zone, which besides healing boosts your hair
- it's a safer and simplified version of a popular procedure of platelet-rich plasma mesotherapy (= needling + growth factors taken from your own blood and inserted where needed)
- dermapen is superior to derma roller: a derma roller with long needles will cause torn edges of your wounds, which increases risks of infections, uneven scalp/skin + time-consuming; derma pen allows strictly vertical wounds that heal better with lower risk of infections

2) your photos do not fit well the kinds of male pattern hair loss progression I've seen; your temples have progressed, but not in a typical miniaturisation manner; hair density dispersion in your Norwood 2-3 zone is really bizarre; + remember your crown is good; so they still do not assume that areata may affect your temples/hairline? maybe a more thorough microscopic assessment of the extent of scarring? maybe scalp biopsy to better understand how areata affects your connective tissue in this particular zones + whether it's results will support a prescription for an immunosuppressant?
To me these suspicious aspects remind of a condition like this http://www.bad.org.uk/for-the-publi...lic/patient-information-leaflets#.Xkno-C17FQI

 

[MKP05]

1) you mentioned you have derma pen, it's an effective research-proven way of boosting hair independently of minoxidil etc + it might be particularly suitable in your case:
- this forum is biased, as most of derma pen users use minoxidil as well, nevertheless, I've come across is a number of cases on this forum where users (who experimented with different regimens) specifically stress derma pen as the strongest component of their regimen;
- there is a principal difference with respect to the needle's length: shorter needles are used for better absorption (of minoxidil etc), longer - to trigger wound healing, I'm talking about the latter, usually 1.5+mm. Short needles make your scalp reddish. Long needles make small slightly bleeding wounds; longest needles at a doctor's - consider FDA gradation
- FDA regulates this gradation with respect to safety (for home use, for medical professional use...), but it hasn't approved needing, although there's a good number of small-scale studies of needling for face scars/wrinkles/hair loss
- needling works against atrophic scarring e.g. acne scars and with respect to hair loss zones - as a follicle dies, over time it's replaced with fibrous tissue, it's very difficult to regrow hair is areas of scarring, even if you manage to control inflammation e.g by dutasteride and a follicle 'awakens', fibrous tissue around prevents regrowth; microneedliong breaks down fibrous tissue; ask your doctor about //google for autoimmune hair loss & connective tissue diceases
- it stimulates collagen production (proven by e.g. biopsies) - essential for hair + against wrinkles, on YouTube there're stories of women reducing scars and wrinkles by triggering wound healing
- wound healing means your body naturally sends growth factors etc to that zone, which besides healing boosts your hair
- it's a safer and simplified version of a popular procedure of platelet-rich plasma mesotherapy (= needling + growth factors taken from your own blood and inserted where needed)
- dermapen is superior to derma roller: a derma roller with long needles will cause torn edges of your wounds, which increases risks of infections, uneven scalp/skin + time-consuming; derma pen allows strictly vertical wounds that heal better with lower risk of infections

2) your photos do not fit well the kinds of male pattern hair loss progression I've seen; your temples have progressed, but not in a typical miniaturisation manner; hair density dispersion in your Norwood 2-3 zone is really bizarre; + remember your crown is good; so they still do not assume that areata may affect your temples/hairline? maybe a more thorough microscopic assessment of the extent of scarring? maybe scalp biopsy to better understand how areata affects your connective tissue in this particular zones + whether it's results will support a prescription for an immunosuppressant?
To me these suspicious aspects remind of a condition like this http://www.bad.org.uk/for-the-public/patient-information-leaflets/frontal-fibrosing-alopecia/?showmore=1&returnlink=http://www.bad.org.uk/for-the-public/patient-information-leaflets#.Xkno-C17FQI

I am familiar with frontal fibrosing alopecia because I was initially concerned that I was suffering from scaring hair loss due to the fact that it can be closely associated with areata which I know I have. Every dermatologist I’ve seen so far does not believe that I have FFA. But these were always based on a clinical diagnosis and not a biopsy. that’s probably a good next step so that I can be sure that is not the issue.

Keep in mind that people with FFA typically start losing at the hairline and the loss goes straight back from there in a line. My hair loss began at the temples and I do have the distinct M shape pattern associated with male pattern baldness (see picture1) even though my vertex is good. Also FFA is VERY rare and, even then, predominantly affects post menopausal women. I also don’t have any visible signs of scarring even though I understand the scarring from FFA may not always be visible.

Even still something doesn’t seem quite right with my hair loss. My left temple recession has always had a round circular shape to it. This is what is looked like when I first noticed hair loss in May 2018 (picture 2) which progressed to this in one month and was the reason i jumped on finasteride (picture 3) and here’s what it looks like now (picture 4) - 20 months on finasteride and now dutasteride. The last picture is even more dramatic because If my hairline had not receded so much you’d get a better idea how large this area has actually grown over 20 months. Could it be areata/immune related loss? Possibly. But it’s presenting enough like male pattern baldness to convince 3 dermatologists that’s what I have. Again, a biopsy could provide some answers.

I’ve definitely made mistakes along the way - most notably dropping minoxidil from 2x to 1x after 8 months and then dropping it altogether after 17 months. Because I was still losing ground and not getting regrowth I assumed it was worthless (and maybe even causing harm) but in hindsight it was at least helping to slow the progression regardless of how marginal it appeared at the time. I also wouldn’t have been so liberal with clobetasol - my thought process was that if I could control the inflammation then the finasteride would have a better chance. Again, after not seeing results I dropped it and likely caused a sort of dependency similar to minoxidil as you’ve mentioned previously. At this point I’m only using duta ED and nizoral about twice a week. I’m very tempted to jump back on minoxidil and/or minoxidil and the dermapen. But maybe I should see what dutasteride does or doesn’t do on its own before reintroducing additional variables. It’s hard though because I feel like I don’t have much more hairline to lose. Once the hairline is gone (and it’s pretty damn close) then there’s no point. I could have a great vertex but with no hairline it just looks silly. And quite frankly I’m already there. The hairline and temples are so thin that I can’t style my hair the way I have my entire life. It looks ridiculous. It would be one thing at my age if these changes were gradual. But I’m talking about major changes to the way I look in a very short time. When I look at pictures of myself from May of 2018 I honestly look 10 years younger than I do today. It’s been pretty devastating even at this stage in my life. No one wants to look 10 years older in the span of 20 months.

in any case I don’t have many options left. Dutasteride was my Hail Mary. I was really hoping it would at the very least slow down the progression to a more acceptable rate. It still might but I’m losing faith. I’m getting a cut tomorrow even though I’ve lost so much density in the front and forelock that it looks like I just had it cut. Never in my life has my hair looked this short and less dense 4 weeks after getting my last hair cut. It’s actually incredible. I looked at a picture from 4 weeks ago after my last cut and the length/density looks almost identical to today. But a picture from 2 weeks ago shows it to be longer and more dense than it is today. So within the last two weeks I’ve thinned out so much that it looks like I just got my hair cut. Very disconcerting.

 

[Anatoly]

Every dermatologist I’ve seen so far does not believe that I have FFA. But these were always based on a clinical diagnosis and not a biopsy. that’s probably a good next step so that I can be sure that is not the issue.
------ My point is that the purpose of biopsy is not to confirm/disconfirm this very rare condition. FFA is just an extreme example of how complex things are. A biopsy may help better understanding of why you fail to see temples regrowth (your connective tissue variable etc). Fibrosis occurs in pattern hair loss as well. Usually it's a question of 3-10 years, but given your areata & corticosteroids intervention (topical & injections), this process may have accelerated. This is why (one of key factors) it's easier to regrow what was lost a year ago than 5 years ago. Dutasteride cannot get you rid of fibrous tissues, but with along with wound healing it may produce a synergic effect. You should give needling a try.

These photos are of better quality. Now I see there are signs of miniatiruzation + yes, clearly M-shaped (the first photo). But your temples scalp does not look like it's going to produce hairs soon. Probably there is some hardening. Have you considered factional laser therapy for your temples - to rejuvenate your scalp in these clearly deceased zones (they look like your forehead skin, which is not good, - compare to your crown scalp)?


But it’s presenting enough like male pattern baldness to convince 3 dermatologists that’s what I have. Again, a biopsy could provide some answers.
----- There are arguments to support pattern hair loss. But given your progression over less than two years, despite finasteride/dutasteride, a stalemate of today is puzzling. Addressing pattern hair loss does not seem sufficient. I'm sure you're not going to use topical steroids on your temples again, they do facilitate scalp atrophy.

But maybe I should see what dutasteride does or doesn’t do on its own before reintroducing additional variables. It’s hard though because I feel like I don’t have much more hairline to lose.
---- Given these latest photos, I'm more sceptical dutasteride alone will regrow what you lost. Your scalp condition is a concern. There must be some other factors at work. If you fail to see improvements within next 3 months, you should consider adding dermapen at least. 2-3 months is usually sufficient to see improvements thanks to wound healing, if it fails, you may opt for minoxidil route.

But I’m talking about major changes to the way I look in a very short time.
---- This is very suspicious, pattern hair loss alone does not usually evolve like this. Also, I have a Q about your hair colour: have you used any colouring shampoo//hair-dye in 2018? Or your hair has greyed so severely within so short time?

/QUOTE]

 

[MKP05]

I have never colored my hair. My hair has grayed severely since 2018. I have an identical twin brother. He’s also going gray at the same time but he doesn’t have any hair loss (aside from gradual aging). His hair condition looks like what mine used to look like.