Why does my hair stop growing right above and under my scalp?

Hello, and thank you for the detailed question.

From the images and your description, it appears you're experiencing subsurface hair breakage or short anagen syndrome-like presentation, where many hairs are visible just below or barely above the scalp, failing to grow to full length. This phenomenon can sometimes resemble shedding, but with distinct differences.

Here’s a breakdown of what may be happening:

1. Finasteride and Hair Thinning
Finasteride (Propecia) works by inhibiting DHT, a hormone linked to hair miniaturization. Early in treatment, it's common to experience shedding as weaker hairs fall out to make room for stronger regrowth. However, some men experience an initial thinning phase lasting up to 6–9 months before stabilization.

Thinner hair shafts and shorter growth may occur during this phase, especially if follicles are transitioning from a prolonged miniaturized state.

2. Broken Hairs Just Beneath the Skin
Hairs sitting just under or at scalp level without emerging could be signs of:

Miniaturized follicles prematurely stopping in anagen (growth) phase

Follicular fragility – the hair shaft may form but break off early

Inflammation or follicular plugging, impeding normal growth

This isn’t typical of classic Finasteride shedding, and your doctor’s observation that these hairs are broken or trapped beneath the skin supports a more mechanical or inflammatory disruption.

3. Are These Hairs Dying?
These hairs are not necessarily "dead" but may be stuck in an abortive anagen phase or transitioning prematurely to telogen (resting) due to:

Persistent miniaturization

Scalp inflammation

Structural weakness of the hair shaft

4. Can Minoxidil (Min) Help?
Yes, topical Minoxidil may help, particularly by:

Prolonging the anagen phase

Increasing blood flow and nutrient delivery to follicles

Stimulating dormant follicles into active growth

However, it's important to know that Minoxidil can also trigger an initial shedding phase (similar to what you're seeing), particularly in the first 1–3 months of use.

5. Additional Considerations:
Check for underlying conditions such as seborrheic dermatitis, chronic scalp inflammation, or nutritional deficiencies (e.g., iron, zinc, vitamin D).

A scalp biopsy or trichoscopy could help confirm whether there’s an element of inflammatory alopecia, such as lichen planopilaris or chronic telogen effluvium.

Summary:
Your presentation isn't typical of Finasteride shedding alone.

The presence of broken or very short hairs suggests either miniaturization, inflammation, or mechanical breakage.

Topical Minoxidil may aid in stimulating regrowth, but monitoring response and scalp condition closely is essential.

If this persists or worsens, further investigation such as trichoscopy or biopsy may be warranted.

It's unusual but not unheard of for hair to stop growing just above or under the scalp, especially if you're seeing a mix of normal hair growth with shorter, broken hairs. Since you're taking Finasteride and your doctor noticed this pattern, there are a few possibilities to consider:
Shedding Phase (Telogen Effluvium): Finasteride can cause temporary shedding as part of the hair cycle. This shedding phase typically occurs in the first few months of treatment, but if hairs are breaking close to the scalp, it could be a sign of telogen effluvium, where hair enters the shedding phase more abruptly and appears shorter or broken.
Hair Cycle Disruption: The fact that some hairs seem to stop growing just above or below the scalp could suggest a disruption in the growth cycle (anagen phase), leading to shorter hairs that don’t fully mature. This can happen due to factors like stress, hormonal changes, or an underlying scalp condition.
Trauma or Hair Breakage: Hair breakage can sometimes mimic this pattern. The broken hairs might appear as if they’ve stopped growing, but in reality, they’re snapping due to weak strands. This can be due to excessive friction, harsh styling products, or scalp issues like dryness.
Finasteride Adjustment Period: While Finasteride helps prevent DHT-related hair loss, it can take 6-12 months for visible results. The thinning you’re seeing may be part of the initial adjustment period where hair cycles are resetting, causing temporary thinning before regrowth kicks in.
To promote regrowth, Minoxidil can be a useful addition. It works by directly stimulating hair follicles, increasing blood flow, and prolonging the anagen (growth) phase. Many patients see improved density and faster regrowth when combining Minoxidil with Finasteride.
If you’re still concerned about these broken hairs, consider a scalp examination for conditions like miniaturization (common in androgenetic alopecia) or telogen effluvium. Keeping track of your progress and adjusting treatments accordingly can help restore balance to your hair growth cycle.

A good scalp examination by a dedicated hair can probably help solve this. If this is not possible, then a biopsy will be helpful. trichotillomania, alopecia areata and traction alopecia are the top causes in this case-but of course there are other possible causes too. See an expert.