One month after switching to Dutasteride - shed or loss? (Photo)

Question

I didn’t think a shed could be this bad (maybe it can’t). I’m a month into dutasteride after 3 years on finasteride. I can see the horseshoe outline. Is there any way to know if it’s a shed or if I’m still receding?

Jeremy S. Wetzel, MD · Answer

gary_sanders -- I think the key to answering this question is in the timing. I'm not sure how much time had passed between those two photos but it certainly looks like there has been some progression of loss. If your loss had stabilized on the finasteride and been stable for a long period of time and then you switched to the dutasteride and within a couple of months noticed significant shedding, then likely it is a shedding phenomenon. In theory, if shedding can happen when someone first starts finasteride, due to the drop in DHT levels, then it can also happen if someone switches from finasteride to dutasteride -- bc you are dropping DHT levels even further with the dutasteride. So if this sounds like your timeline, its probably dutasteride related shedding and the hair should come back. If it was only a couple of months between those two photos, I doubt its progression of hair loss. That would be fairly considerable progression in a very short time for someone taking finasteride or dutasteride. 
With that being said, there is still some progression of hair loss despite prevention in many cases, but I would expect it to be much slower. So if you told me that those two photos were taken a year apart despite being on the finasteride, then I would say there has been progression of loss. In those cases, doing other things to maximize the preventative regimen, such as adding minoxidil (topical or oral), adding a laser cap and periodic PRP procedures, would be recommended. 
So to summarize I think it all has to do with the timing: if it was fairly rapid then likely shedding from the medication switch, but if it was over a longer period of time its probably progressive hair loss.
Hope this helps.

Ross Kopelman, DO · Answer

It's completely understandable to be concerned, especially when seeing a lot of hair shedding after switching to dutasteride. Shedding can happen when transitioning from finasteride to dutasteride, particularly in the first few months. This shedding is a result of the hair follicles resetting as they adapt to the more potent DHT-blocking effects of dutasteride.
A month into dutasteride is still very early, and what you’re seeing is likely part of the initial shedding phase, which can last up to 3 months. This is a common side effect as the weaker hairs fall out, making way for potentially stronger regrowth. While the shedding can be alarming, it doesn’t necessarily mean you’re continuing to recede. The hair will often start regrowing after this shedding period, but it can take several months to see visible results.
To differentiate between shedding and ongoing hair loss, give it more time (around 6 months). If you start noticing regrowth after the shedding phase, it's a good sign that dutasteride is working. Patience is key with dutasteride, as it can take time to show its full effects.

Jacquelline Leva, DO · Answer

Look for hairs on your pillow and shower drain if you have more than 100-150 hairs a day you may need to be evaluated. Alot of times you can haver more than 1 type of alopecia. You can have telogen effluvium which can cause rapid shedding, especially after stressful events, emotional or recent big surgeries. You may need to add other therapies to dutasteride

Viktoryia Kazlouskaya, MD · Answer

The question of hair loss progression is far from simple. While it might indeed be a result of androgenetic alopecia (AGA), there's also a chance of an alternative diagnosis such as telogen effluvium. In fact, it's quite common for individuals to experience a combination of different types of hair loss. I would advise a thorough in person evaluation by a professional.

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