Anything else I can do or look into?

[jim1973]

Looking for guidance on why my hair loss won’t subside and if there is anything else I should do or look into.  I began using Finasteride and topical Minoxidil in 2013, which did well for me.  My hair loss subsided, and I maintained what I had through 2020.  I noticed hair falling out 2020 so in early 2021, I made some additional changes.  I still take FIN but also incorporated Dutasteride.  Every 3 days, I replace FIN with DUT (5mg).  I also incorporated oral Minoxidil (2.5mg) daily.  I have no side effects from anything that I’m doing.  I use 2% Ketokonazole shampoo twice/week and use a Theradome laser helmet twice/week.  I’ve recently started microneedling my scalp once/month (depth of .75).  Eight months ago I had bloodwork done my bloodwork showed that I was low on Iron and Vitamin D so began taking supplements to bring those into normal range.  Everything else was in normal range such as hormones, thyroid, etc.  I recently had my DHT levels checked (blood/serum), and the test concluded that both DHT and free were very low (below reference range – 9L and .76L), so I no longer have high DHT (although not sure how to measure DHT in scalp specifically).  To summarize, I feel as though I’m doing everything possible to at least maintain the hair I have but my hair is still thinning, miniaturizing and falling out.  I'm wondering if I should go back to topical Minoxidil if the oral isn't working for me.  I have a scheduled hair transplant in April 2023 but am nervous about proceeding if I can’t stabilize my current hair fall.  Is there anything else I can do to stabilize my hair loss or something else that may be causing it? 

[Melvin- Admin]

You're on the most powerful stack there is, both oral minoxidil and oral dutasteride is the best treatments for hair loss. Everything else will make a marginal difference. Something like a lasercap may help get you a 10% improvement. 

[Curious25]

I’m guessing you mean 0.5mg dutasteride?
 

You could up the oral minoxidil to 5mg daily, which is the dosage that most dr’s want to get their patients up to. 

Daily 0.5mg dutasteride would also be an option, however if your serum DHT is really at rock bottom already, some people subscribe to the trail of thought that scalp testosterone can also cause follicle miniaturisation to those that are susceptible to androgens, albeit not at the same velocity as DHT. This is why some people seek to add in a topical anti androgen, such as RU or Breezula.