Where do I go from here? finasteride/dutasteride non-responder.

[kindasadtbh]

I've been shedding a lot of hair ever since I was around 17-18 (I'm 26 now) and started noticing my thinning (I'm a diffuse thinner) around 3 years ago. I went to the dermatologist and was prescribed finasteride (1mg/day). I also started daily liquid/foam minoxidil and ketoconazole shampoo (Nizoral) , which I've continued to this day. Finasteride initially worked wonders: within just 4-5 months it stopped my terrible itch and stopped my shedding to almost undetectable levels. I went from shedding 100+ hairs in the shower every day to less than 5 or 10 even if I scrubbed my head hard. I even noticed some regrowth. It was incredible.

After around 8-9 months the shedding started again and wouldn't stop. Even though most people couldn't tell I was thinning (because I styled my hair in a way that it was hard to detect), I still noticed it getting worse. After about a year and a half on finasteride I went back to my dermatologist, explained my situation, and was prescribed dutasteride (0.5mg/day), which I've been on until today, meaning I've been on it for almost 1.5 years as well. The shedding never really stopped ever since I started dutasteride and I can't tell if it slowed down my hair loss, but as of now it's gotten to a point where it's almost impossible to hide my hair loss anymore. My remaining hair is dry as hell, wispy, and just generally looks terrible. I started using hair fibers to help hide my thinning but even that is getting difficult with how bad my hair is getting.

I got blood tests done throughout the years and while my testosterone levels have increased slightly and my DHT levels have plummeted to extremely low levels, the fact that I'm not responding well to finasteride/dutasteride is extremely depressing. I guess my hair loss is just that aggressive.

My question to all of you is: where do I go from here? What would you guys do? As far as I'm aware there aren't any other medically proven treatments for hair loss, and getting a hair transplant as a diffuse thinner who still hasn't stopped his hair loss isn't a good option. I was considering going for a hair system, but I'm starting med school in a month and I'm worried that I won't have enough time to get used to everything and learning how to take care of the system/my scalp since I want to do most of the maintenance myself.

Should I stop taking all my medications (dutasteride/minoxidil) since they don't seem to be working? Should I go back to finasteride as a last-ditch effort? Should I just buzz my hair short and call it quits? Should I try for the hair system and still quit my meds? Honestly I'm not sure what kind of advice I'm looking for here. Just trying to see what you'd all do in this situation.

Thanks to anyone who read this all.

 

[Pephair]

Do you have any photos?

Personally, before a hair system, I would AT LEAST try oral minoxidil 2.5mg - 5mg and just see if I have sides.
Also before a system, I would definitely try going back to finasteride, maybe dutasteride was too much.
Also before a system, I would buzz my head and get SMP.
THEN, I would get a system.

 

[kindasadtbh]

Do you have any photos?

Personally, before a hair system, I would AT LEAST try oral minoxidil 2.5mg - 5mg and just see if I have sides.
Also before a system, I would definitely try going back to finasteride, maybe dutasteride was too much.
Also before a system, I would buzz my head and get SMP.
THEN, I would get a system.

Thanks for your suggestions! I unfortunately don't have any "before" photos though.

I may try the going back to finasteride suggestion..it doesn't seem like dutasteride is helping at all considering I've been on it for 1.5 years and going back to a less-potent drug shouldn't really cause much issue.

Can I ask why you suggest oral minoxidil? I've been on foam minoxidil for the past 3 years and while oral minoxidil would make life easier (not having to put foam in my hair every night would be great) I don't see why it would drastically change things. Is the 2.5mg-5mg dosage higher than normal? If it matters I use a lot more than the suggested capful of minoxidil per application because I need to get it all over my scalp rather than just on the crown or the temples.

 

[OfficialWater]

Try derma rolling

 

[kindasadtbh]

Try derma rolling

I was considering trying that again after cutting my hair short. I tried dermarolling at 1.5mm a few times (even bought a Derminator 2) but it was incredibly painful so I stopped. I might try going down to 0.75-1mm and seeing if it's more tolerable.

 

[Pephair]

Thanks for your suggestions! I unfortunately don't have any "before" photos though.

I may try the going back to finasteride suggestion..it doesn't seem like dutasteride is helping at all considering I've been on it for 1.5 years and going back to a less-potent drug shouldn't really cause much issue.

Can I ask why you suggest oral minoxidil? I've been on foam minoxidil for the past 3 years and while oral minoxidil would make life easier (not having to put foam in my hair every night would be great) I don't see why it would drastically change things. Is the 2.5mg-5mg dosage higher than normal? If it matters I use a lot more than the suggested capful of minoxidil per application because I need to get it all over my scalp rather than just on the crown or the temples.

You started finasteride and topical minoxidil at the same time so I'm assuming you don't really know if it's working or not. You could be a non responder to topical minoxidil and not even know it (some scalps have low sulfotransferase enzymes which dramatically decreases effectiveness) . Oral 2.5mg is a low does and results are typically much better than topical. I believe oral minoxidil 2.5mg is 4x stronger than 5% topical minoxidil.

Obviously, talk to a dermatologist/hair surgeon about this beforehand, but generally it's tolerated well at 2.5mg-5mg with minimal side effects.

 

[kindasadtbh]

You started finasteride and topical minoxidil at the same time so I'm assuming you don't really know if it's working or not. You could be a non responder to topical minoxidil and not even know it (some scalps have low sulfotransferase enzymes which dramatically decreases effectiveness) . Oral 2.5mg is a low does and results are typically much better than topical. I believe oral minoxidil 2.5mg is 4x stronger than 5% topical minoxidil.

Obviously, talk to a dermatologist/hair surgeon about this beforehand, but generally it's tolerated well at 2.5mg-5mg with minimal side effects.

Sounds good, I'll visit my derm and discuss it with him. I'm assuming that oral minoxidil will promote hair growth all over the body too, right? Worth the trade off for me, just curious.

 

[Derelict]

Sounds good, I'll visit my derm and discuss it with him. I'm assuming that oral minoxidil will promote hair growth all over the body too, right? Worth the trade off for me, just curious.

I didn't notice any new hair growing on my body with oral min, no chest or back hair before and still don't, existing hair might have thickened up a tiny bit but nothing drastic.

 

[jambap]

Dermaroller. After 20 years of hairloss treatments I've found this is one of, if not the best. Suck up the pain like the rest of us if you really are serious about keeping your hair

 

[jazz1]

What brand finasteride did you use and did you switch medication brands?

 

[jambap]

Hey bro. What dermaroller do you suggest. Do you think I can regrowth my left temple with It? I've regrowth almost all my hair with dutas and oral minoxidil 5mg but can't seem to regrow the left temple. I just have 4 or 5 thick hairs there that looks ridiculous.

Hey mate, I am confident that you can regrow your temple seeing as it is a relatively small area. It may take some time but the good news is from the moment you start it should only improve. Here is a pic of my temple after a year of dermarolling. I know it still got a ways to go but keep in mind that the hairs you can see at the front of the temple, some even quite far forward have been dead for about 15 years. So see that area come to life again has been nothing but astounding. And with each session I do of the roller the thicker the whole hairline gets, which keep in mind includes the area further back which was thinning badly. Now it looks good enough to still look full in direct sunlight. I'm telling you Dermaroller is a gamechanger. And I've only used 1.5 but many say they have success with 1 some with even less. I don't think either is a problem but I do it quite aggressively with lots of blood all over my scalp. But once that's cleaned off the area just looks red and sore for a day or two. And then the hair comes to life. I also apply minoxidil after half an hour of rolling. All I can say is it's worked for me and I've been battling my hairloss for 20 years now. Best of luck

 

[jambap]

Your temple looks very good, I'll have to give it a try. It is so cheap for the great results you can get. How often do you use dermaroller?

I use it once a week sometimes every 2 weeks. It does hurt. I am literally crying as I do it. But the pain goes once you stop and becomes general soreness for a day or 2 that doesn't bother me

 

[kindasadtbh]

I didn't notice any new hair growing on my body with oral min, no chest or back hair before and still don't, existing hair might have thickened up a tiny bit but nothing drastic.

Oh that's actually good to know. Thank you, I'll discuss this with my derm soon then.

Dermaroller. After 20 years of hairloss treatments I've found this is one of, if not the best. Suck up the pain like the rest of us if you really are serious about keeping your hair

I am serious about keeping my hair but it was genuinely painful. Like you said in one of your later comments, I was literally tearing up/crying as I dermarolled, and it would leave red marks for a few days afterwards that would be hard to hide since they're all over my head. It just didn't seem practical to me. I'll try it again with 1mm of depth and see if it's more tolerable and leaves less noticeable marks. I'll try it weekly and see how it goes.

What brand finasteride did you use and did you switch medication brands?

I used the generic proscar brand the entire time I was on finasteride. It was 5mg but I cut it up into 4 pieces, so 1.25mg/day. I actually forgot I did that, sorry for mentioning 1mg/day in the original post.

 

[Derelict]

Thanks. Can I also use 1.5mm on my face? I've seen people using it on face too and improved their enlarged pores.

Use 1.5mm for wrinkles etc you should use a smaller one for enlarged pores, like 0.5mm.

 

[jambap]

I am serious about keeping my hair but it was genuinely painful. Like you said in one of your later comments, I was literally tearing up/crying as I dermarolled, and it would leave red marks for a few days afterwards that would be hard to hide since they're all over my head. It just didn't seem practical to me. I'll try it again with 1mm of depth and see if it's more tolerable and leaves less noticeable marks. I'll try it weekly and see how it goes.

Good man. It's true that it does leave redness and if your scalp is very visible then yes, it will show a bit. I think I use too much force with the Dermaroller to be honest and I think you can go a bit lighter which would reduce the redness and how long it lasts. I reckon if you find a moderate pressure then you should be fine. Also do it on the night before a day you don't go out so much (maybe Saturday or Sunday) then it should only take 1 day for the redness to subside. I get that you feel it's not worth it, but I think it absolutely is. Don't give up on it yet, find a way to make it work because it's a very powerful weapon in your arsenal. Good luck.

 

[jambap]

Thanks. Can I also use 1.5mm on my face? I've seen people using it on face too and improved their enlarged pores.

I think 1.5 is meant to be too much for the face. I have done but didn't keep it up for very long. I probably should but am a bit lazy and am more concerned with my hair than my wrinkles

 

[Derek Clapton]

It's a bummer that some treatments work for some and not for others. Fina and duta worked for me but the side effects were too much - low libido and motivation, gyno etc so I had to stop. minoxidil doesn't do much - maybe slows it down. Dermarolling didn't help at all but if it works for you, do it. It's not that painful at all even with a 1mm needle. I have sensitive skin that scars easily so it probably cries when I dermaroll it and just uses it as another excuse to shed more hair.