Ross Kopelman, DO

It sounds like you’ve been on quite the journey with hair loss treatments, and there are a few possible factors at play here.

First, your experience with topical minoxidil is not uncommon—many people see good results early on, but if the treatment is stopped or even reduced, there can be a loss of the gains made. Finasteride likely helped stabilize your hair, but shedding after starting is also a common reaction, as the hair cycle resets. Oral minoxidil is stronger in terms of systemic absorption, but it can also cause prolonged shedding in some cases, especially during the first several months. However, six months of shedding is longer than usual, which raises some red flags.

The key piece of new information is your hypothyroidism diagnosis. Thyroid imbalances, especially when untreated or newly treated, can contribute to hair shedding and thinning. Hair loss from hypothyroidism often presents as diffuse thinning rather than recession, and once treatment stabilizes your thyroid levels, your hair may improve, but it can take months to see regrowth.

Given your timeline, it’s possible that both oral minoxidil shedding and thyroid-related shedding are overlapping. You may want to check your latest thyroid levels to ensure your treatment is optimized. Additionally, if the shedding persists, a more in-depth evaluation—such as bloodwork for iron levels, vitamin D, and other potential contributors—could be helpful.

In the meantime, maintaining consistency with your medications is key, as stopping and starting can sometimes trigger more shedding. If your hair is continuing to thin despite treatment, you might also consider alternative therapies, such as PRP or even a hair transplant if your recession is a primary concern.

It’s understandable to feel concerned when noticing thinning in a specific area, especially after a buzzcut where changes in hair density can be more noticeable. Thinning in the front left part can sometimes appear due to natural hair patterns or a parting that exposes the scalp more in certain lighting, making it look thinner.

Male pattern baldness typically follows a predictable pattern, often beginning at the temples or crown, rather than on just one side. If the thinning is isolated to this part and there’s no family history of early hair loss, it might simply be a natural part of your hair growth pattern or due to how the hair lays after a buzzcut.

It sounds like you’re following an intensive regimen for hair regrowth, combining high-concentration topical minoxidil, redensyl, procapil, caffeine, ketoconazole, salicylic acid, and oral minoxidil, along with supplements like Viviscal Man. This multi-pronged approach can be very effective, especially for individuals with more stubborn hair loss.

To determine if there’s regrowth, it’s best to track progress through regular, standardized photos taken in similar lighting conditions every few months. This can highlight subtle changes, like an increase in hair density or thickness, that may not be immediately noticeable day-to-day. If you've been following this regimen for at least three to six months, you should start seeing improvements if the treatment is working effectively for you. We would need to do a tricoscopy test to look more closely to confirm whether you have hair growth there.

Yes, thinning or balding at the nape of the neck and along the sides of the scalp can indeed be a sign of retrograde hair loss. Retrograde hair loss, also known as alopecia areata ophiasis, is characterized by hair thinning that starts from the lower sides and back of the head, unlike typical male pattern baldness, which generally begins at the crown or temples.

It sounds like you've experienced significant side effects that may be linked to minoxidil use, especially since your symptoms improved when you stopped. While it’s less common, some people are sensitive to topical minoxidil and may experience systemic effects even from topical application.

If you’re set on continuing hair loss treatment but want to avoid these side effects, here are a few options:

Reduce Frequency or Dosage: Some patients find that using a smaller amount or applying it every other day can reduce systemic absorption and side effects.

Switch to a Lower Concentration: If you’re using a 5% solution, switching to a 2% concentration might minimize side effects.

Explore Alternatives: Non-minoxidil-based treatments, such as topical serums with ingredients like rosemary oil or caffeine, may help support hair health without systemic effects. Additionally, treatments like microneedling can stimulate hair growth naturally.

Consider Oral Minoxidil: In lower doses, oral minoxidil is sometimes used with fewer side effects than topical forms, but this approach should be discussed with your physician to weigh risks and benefits.