21, male, is this hair loss just androgenic alopecia? (Photos)

Question

I am currently 21. I first noticed lower hair density in 2019 when I was 18. Ever since then, my hairline has receded and my hair has thinned all over my scalp. I seem to have diffuse alopecia. I was wondering if male pattern baldness was the only cause of this hair loss or if there could be additional underlying issues contributing to it. Also, will minoxidil and finasteride be effective for my case?

Jeremy S. Wetzel, MD · Answer

Hello jimjohnboi -- from the look of the photos you posted, your hair loss does not appear to be classic androgenetic alopecia (AGA) or "patterned" hair loss, also known as male-pattern baldness. That is by far the most common type of hair loss affecting men, but there are other types. In AGA, there is a very predictable pattern of loss and it always spares the back and the sides, known as the "permanent zone". Even in the most advanced stages of AGA, the back and the sides are spared. Any time there is loss in the permanent zone, a different diagnosis should be sought.
There is another type of hair loss called Diffuse Unpatterned Alopecia, or DUPA, where the loss does not follow the classic and predictable pattern. The hair loss tends to be more diffuse and can affect the permanent zone on the back and sides. When there is hair loss on the back and the sides, especially when it is present in that area on the sides behind the ear, this makes me think of DUPA. Also in your case it seems to be affecting the right side more than the left. When hair loss is patchy like that, diagnoses like alopecia areata have to be considered. In some cases a biopsy can be helpful in making a diagnosis. 
Just based on these photos, it seems that DUPA is likely. To answer your question about the hair loss prevention medications such as finasteride and minoxidil, yes, these could definitely be helpful in slowing down the progression of the hair loss. Other preventative measures such as Low Level Laser Therapy and PRP can also be helpful in these cases. I would recommend seeing a hair loss specialist for a closer examination and to discuss treatment options.

Mehmet Erdogan, MD · Answer

Thank you for sharing your history.
Based on what you've described &mdash; progressive thinning since age 18 and a general decrease in hair density &mdash; it does sound somewhat consistent with diffuse androgenetic alopecia (a subtype of male pattern baldness). However, after reviewing your photos, we noticed that the most significant thinning seems to be localized at the crown (vertex) and behind the ears. This isn’t a typical pattern for classic diffuse androgenetic alopecia, where thinning tends to be more uniform across the top of the scalp.
Because of this unusual distribution, we highly recommend that you also consider a detailed medical workup to rule out additional or secondary causes of hair loss, such as:
1. Nutritional deficiencies (iron, zinc, vitamin D, B12)
2.Thyroid function abnormalities
3.Chronic stress or past illness (telogen effluvium)
4.Scalp inflammation or dermatological conditions
5.Autoimmune factors
In other words, before starting any treatment or medication, it’s essential to identify the exact cause of your hair loss. Otherwise, therapy may be ineffective or even inappropriate.
As for treatment - topical form of Minoxidil and finasteride remain first-line therapies for androgenetic alopecia and could still be beneficial in your case &mdash; especially if there is any hormonal component involved. 
1. Minoxidil can improve blood circulation and stimulate regrowth.
2. Finasteride reduces DHT levels, which helps prevent further miniaturization of hair follicles.
That said, if medications and supportive therapies prove ineffective and the hair loss continues to progress, then surgical options such as a hair transplant should only be considered a few years after the active shedding phase has ended. Performing a transplant while the hair loss is still unstable could lead to poor long-term outcomes, so timing and proper stabilization are crucial.

Bernardino Arocha, MD, FISHRS · Answer

Dear RealSelf member 0928793,
You're correct in that you have diffuse or generalized thinning. I'd recommend an in person evaluation. Two etiologies might cause this picture, DUPA and Alopecia Incognita. A thorough medical history and physical are needed, (and maybe even a scalp biopsy and lab), to delineate the difference between the conditions.

Christine M. Shaver, MD · Answer

Appears to be DUPA (diffuse alopecia). It is often best treated with combination finasteride and minoxidil. A biopsy can confirm with a board-certified dermatologist. You could also test for a thyroid condition. Scalp exam can identify inflammation or other causes and confirm with a simple biopsy.

Marco Barusco, MD · Answer

Pictures can be deceiving. However, there seems to be some thinning over the donor zone on both sides. You need to be examined for DUPA (Diffuse, Unpatterned Alopecia), which is a condition that causes hair miniaturization in the donor area as well. If you have it, then it will make you a poor candidate for a transplant, but DUPA can respond to medications, and since your hair loss is not very advanced at the moment, I would advise you to see a specialist as soon as possible, to start treatment.

21, male, is this hair loss just androgenic alopecia? (Photos)

Answers (8)

Answer: DUPA

Answer: DUPA

Answer: What type of hair loss do I have?

Answer: What type of hair loss do I have?

Recommended reading

Everything you need to know about Hair Loss Treatment

Our mission is to create a world where every investment in modern beauty is Worth It.

21, male, is this hair loss just androgenic alopecia? (Photos)

Answers (8)

Answer: DUPA

Answer: DUPA

Answer: What type of hair loss do I have?

Answer: What type of hair loss do I have?

Browse related questions

Recommended reading

Everything you need to know about Hair Loss Treatment

Our mission is to create a world where every investment in modern beauty is Worth It.