21 year old female with thin hair on top of my head since I was 16. Met with a dermo in high school... (Photos)

Thank you for your question. You submitted your question with several photos, stating you’re 21-years-old, have been experiencing hair loss since high school, so somewhere aged 16 you saw a dermatologist and received treatment which included spironolactone, hair laser therapy, and biotin. You have seen some improvement, then a relative plateau. You are concerned about the degree of hair loss on the top of your scalp. You are seeing another dermatologist, and are looking for some additional guidance on what to do.
I can share with you our experience with a relatively small group of patients who fall into your category, and I have become much more aware over time. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a system we developed using Acellular matrix and platelet-rich plasma (PRP) to help treat androgenetic alopecia, or male and female pattern hair loss, mostly genetic pattern loss, as well as other conditions.
I can appreciate the challenges you are facing. When we started developing Hair Regeneration about 7-8 years, this was developed after seeing the positive side-effects that occurred when we were doing hair transplant. We used a material called Acellular matrix with platelet-rich plasma (PRP), and found out that thinning hair became thicker in certain patients about a year after hair transplant. We started working on developing processes to use it as a way to treat hair loss in both men and women. I can tell you that for female pattern hair loss, moving the clock forward and now having a lot of experience, it’s been a significant benefit in helping our patients manage hair loss.
It’s important to understand that if your diagnosis, which I am sure your dermatologist already established either clinically or by biopsy, is androgenetic alopecia, then it is a genetic issue. We’ve treated a patient as young as 16, and when I heard about her in the hallway in my way to the exam room, I was already prepared to have her go through extensive work-up of endocrine, hormones, biopsies, etc., but when her mother was accompanying her had the same exact genetic condition, she actually had androgenetic alopecia with an early age of onset.
Outside of the female pattern hair loss patients typically in middle-aged women 45 and older experiencing diffuse thinning often associated with changes in the estrogen-testosterone ratio, we have also identified a significant group of younger women, as young as your age, and into their mid to late 20s into their 30s who also have androgenetic alopecia. When I first started seeing patients like this, I always wondered if I was going to miss anything, so I would do biopsies of the scalp to see what’s going on, and to rule out an autoimmune, inflammatory, or scarring conditions.
The challenge in front of you is really managing a hair loss progression, which is somewhat not consistently predictable. The goal of hair loss management is to maximize coverage for as long as possible. It’s also important to have good medical management, including seeing an additional dermatologist if appropriate to at least confirm the diagnosis, checking hormone levels, and any other systemic potential contributors to hair loss. Spironolactone is an anti-androgen to deal with possibly the contribution of testosterone to your hair loss progression.  
We have performed the Hair Regeneration injection treatment typically over 2 sessions, separated 15-18 months apart, and watched our patients have improvement. Improvement is defined by reactivation of growth of hair follicles currently not growing which is a characteristic of androgenetic alopecia where hair growth cycles in the active growing phase get shorter, and resting phases get longer; reactivation of hair then adds to the numbers; thinning hairs also get thicker; and it’s also established scientifically that the growth cycle gets longer so the hair stays on the scalp longer.
We treat these patients with great care because it is difficult to predict, and it represents such as small percentage of hair loss patients who have typically in terms of gender, more of a middle-aged and later age category. Nonetheless, we have found benefit to the application of Hair Regeneration to help these patients. Often ,people who have this condition have such significant hair loss they still end up wearing wigs and other things to try to have an appearance more socially appropriate for their age. Nonetheless, I think you are clearly on a good path of getting information, and you really need to have this team approach.
I think it’s worthwhile exploring the use of platelet-rich plasma (PRP) and Acellular matrix to help you manage this condition. As I tell all our patients with male or female pattern hair loss, this is something hardwired in the DNA, so there is an inevitable progression. However, medical management is to try to delay that progression and prolong the coverage of the scalp to be optimized for as long as is possible.
I think it’s important you have this discussion. Hopefully, further research about PRP and Acellular matrix will be a value for you. Continue your pursuit of finding the optimal medical treatment as well as hair specific treatments to optimize your hair growth. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

This needs an in-person evaluation. I suggest seeing a hair loss expert now to evaluate and go over your condition and provide you information about your best treatment options. There are great non-invasive options like prp/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

After reviewing your photos I recommend you see a hair restoration specialist.   You need a microscopic examination looking for miniaturization and blood work in addition to reviewing of your family history. You could always consider SMP (scalp micro pigmentation).