Doc confirmed hair is thinning on fin - any advice?

[HelpfulFriend]

Hey all,

Been on fin and minox (both 1mg) for 5/6 years, and it pretty much halted my loss. I was at a NW 2/3, and still am.

However, I went to my dermatologist for my yearly review, and under a microscope, the sides of my frontal lock have quite quickly began to thin.

She confirmed that they show miniaturization. This is the only spot on my head that does. Her solution was to try prp, but from what I've read, that's yet to be standardised and replicated consistently. So I'd rather not.

Does anyone have any advice on what to do, of what I possibly could do? I'm a bit concerned that the rest of my hair is going to just go.

I have extremely heavy balding on my dad's side, so maybe my genetics are just too much for the meds after all?

Thanks all.

Edited August 31, 2021 by HelpfulFriend

[Britanium]

I would stay on the Fin/Minox as it’s clearly helping you, could you show us any pics ? How old are you ? 
Maybe a transplant could be considered. I do agree that PRP isn’t really going to help you, particularly in the long term. 

[TommyLucchese]

A doctor I find to be very reputable doesn't rate PRP highly....his views are good enough for me.

You could try stronger minoxidil or adding topical dutasteride once or twice a week on top of what you're doing? You could try microneedling with a 1mm needle...they're about £10 on Amazon so worth trying. I saw good regrowth from that and topical fin/minox. 

Or maybe take some photos now and again in 6 months and see if there is much difference before you try anything?

[LaserCaps]

A couple of things.  There was a finding years ago indicating Min can help but, at about the 7th year, it looses some efficacy.  Most, when they see this occurring, they'll stop the med all together.  Don't.  You are obviously one that is taking advantage of what the med can offer.  It is time, however, to add another modality into the mix.  Propecia, PRP and laser are commonly what we discuss to help with this debilitating condition.  Now about PRP, (and laser).

Not sure why the medical community does not get together to discuss the subject.  I believe most are just either using the wrong equipment, solution, percentage....but some doctors are far more successful than others.  I've encountered practices that tried it with no success and others who are doing it very effectively.  Contact Dr. Arocha in Houston.  His results doing PRP combined with LaserCap are phenomenal.  

One last thing.....Nothing regrows hair.  NOTHING!  The meds are helping to halt or slow the loss.  From time to time you'll get enhancement of the native hair.  It looks like regrowth but it isn't.

[TommyLucchese]

I'm going to sign up again with the username "Ketchup" and start recommending ketchup as a hair loss remedy to people on here.

[Britanium]

3 minutes ago, TommyLucchese said:

I'm going to sign up again with the username "Ketchup" and start recommending ketchup as a hair loss remedy to people on here.

Saucy 😂

[1978matt]

Dutasteride

[gillenator]

If MPB is advanced in your family history, then yes it's probable that your genetic disposition is taking its course.

[HelpfulFriend]

5 hours ago, gillenator said:

If MPB is advanced in your family history, then yes it's probable that your genetic disposition is taking its course.

Thanks Gill, in this scenario, do you know if FIN will simply be too weak to halt the loss? I've read stories about FIN simply not working for people. 

It did work for me for about 5 years, but now it seems to have lost it's potency.

I'm really not too sure where to go from here. I suppose no one can really know.

[HelpfulFriend]

16 hours ago, TommyLucchese said:

A doctor I find to be very reputable doesn't rate PRP highly....his views are good enough for me.

You could try stronger minoxidil or adding topical dutasteride once or twice a week on top of what you're doing? You could try microneedling with a 1mm needle...they're about £10 on Amazon so worth trying. I saw good regrowth from that and topical fin/minox. 

Or maybe take some photos now and again in 6 months and see if there is much difference before you try anything?

I was thinking about adding topical dutasteride with microneedling, thanks for the advice. 

I'm not sure how easy it is to get in australia, that's the only thing.

[HelpfulFriend]

Would this also point towards transplants no longer being an option? 

[TommyLucchese]

1 hour ago, HelpfulFriend said:

I was thinking about adding topical dutasteride with microneedling, thanks for the advice. 

I'm not sure how easy it is to get in australia, that's the only thing.

minoxidilmax ships it worldwide so would assume australia too

[ciaus]

15 hours ago, HelpfulFriend said:

Would this also point towards transplants no longer being an option? 

Depends, you always want to be in one of the 'stable' periods of your hair loss. It sounds like that's not currently. As has been said, the finasteride just slows down the cause of your loss. Based on your family history and finasteride history it sounds like you need to proceed very carefully. Especially if you are still a younger guy. Keep doing the annual checks and start a photo record so that you can share those with a reputable HT doctor to help you know when or if to pull the trigger on a transplant. Worse case there are other options, like shaving it off, SMP, hair systems.

[pkipling]

As was mentioned before, this highlights an important misconception many guys have about finasteride, in that it doesn't "stop hair loss altogether", rather it "slows it down" - albeit often quite considerably. It's one of the reasons I stopped taking it after a few years. I was experiencing mild side effects, my hair loss has been fairly stable for the past decade, and I decided that the best decision for me was to let my hair do what it wants to do and I'll address it accordingly with another hair transplant should it ever come to that. 

At this point, I think you need to evaluate your situation and decide which approach you want to take. You can explore adding other medications/treatments, but keep in mind that ultimately, the best any of them can do at this point is slow down your hair loss. It could slow it down enough that you'll keep everything manageable for years and years, but there's always the risk of the medication reaching its limit of what it's able to do. 

I don't think this necessarily means that a hair transplant isn't a viable option for you. It still very well could be. You would just need to make sure that you're going to a surgeon who's going to take everything into consideration and come up with a conservative game plan that takes into account your rate of hair loss, age, genetics, family history, etc. And if you want to take medication in conjunction with a hair transplant, there are definitely reasons to do so - and the argument could also be made that you may be better off letting your hair do what it wants so that at the very least, you're going into a hair transplant knowing what you're working with. 

I would recommend getting a few consultations with some reputable hair transplant surgeons under way and getting their professional opinion on the matter after evaluating your situation. Dermatologists are great, and it's great she's being forthcoming about the miniaturization, but a dermatologist simply won't be as well-versed in hair restoration as a hair transplant surgeon is, and so the advice they give may be limited. 

[gillenator]

On 9/1/2021 at 1:29 AM, HelpfulFriend said:

Thanks Gill, in this scenario, do you know if FIN will simply be too weak to halt the loss? I've read stories about FIN simply not working for people. 

It did work for me for about 5 years, but now it seems to have lost it's potency.

I'm really not too sure where to go from here. I suppose no one can really know.

If you read the information regarding the clinical trials that Merck conducted, they clearly state that Propecia works efficiently in the crown and mid-scalp, but not the frontal third...there are some guys however who have stated efficiency in the frontal core but they are far and few between. 

So it does not surprise me when guys who take finasteride state that they still lose in the frontal zone....but is it still working efficiently for you in the crown and mid-scalp?...possibly you are only receding in the Norwood A class....is there any progressive loss in your family history affecting the crown or mid-scalp?...if yes, then I would recommend that you stay on finasteride....definitely discuss this with your doctor.

As long as you have good donor to harvest, there is no reason why you could not surgically restore your frontal third my friend.

Best wishes to you!