Minoxidil stopped working. Should I move to PRP or is there any other solution? Need suggestions (Photos)

Thank you for your question. You submitted several photos of the top of your scalp, and state you were using minoxidil close to two years, and apparently, the minoxidil stopped working after about six months. You also state you were taking finasteride, and unfortunately you felt the finasteride was causing testicular pain. You’re asking if you should undergo PRP treatment or a transplant.
I can give you some guidance on how I answer these questions in my practice. 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. Hair transplant has been an important part of my practice for many years. I am also the founder of TrichoStem™ Hair Regeneration Centers based on a technology we developed that evolved out of hair transplant, and uses PRP or platelet-rich plasma and Acellular matrix to help men and women from all over the world who suffer from androgenetic alopecia.
It is important to understand that you have to choose when to do a transplant very strategically, if you’re going to do it at all. There is a challenge depending on the age of onset, the rate of progression, and the degree of hair loss. When I look at the photos of the top of your scalp, it looks like you have very diffuse thinning. With diffuse thinning, a hair transplant is usually not that practical. The reason is when you have an area which is very smooth and has no hair, that’s an ideal place to do a hair transplant because you can actually place the grafts without worrying about existing hair. When you have a lot of existing hair even though it’s thinning, you’re going to end up with collateral loss when you do transplants into those areas. You’re making multiple stabs, for example getting a transplant of 1500 grafts, that’s 1500 incisions being made into your scalp and that will result in collateral loss. I think most transplant doctors would not be excited about doing a transplant in your situation.
So where does PRP as well as our treatment Hair Regeneration fall in your situation? We learned over many years of doing this procedure to differentiate PRP from Hair Regeneration. PRP is platelet-rich plasma, a concentration of wound healing and growth factors necessary when you get a cut. We use PPR a lot in our practice for wrinkles, under eye dark circles, acne scars, and a lot for skin improvement. What we have observed, and from the feedback I get from patients who come to use who have gotten PRP elsewhere, is the effects of PRP on hair stimulation are relatively short-lived. PRP is stimulating hair growth in a way that can prolong the lifecycle of that hair, but you have to do it relatively frequently. I have heard patients going into places where they went once a month for injections, which can be difficult to sustain, no matter how motivated you are.
Hair Regeneration, which which we developed and started the company TrichoStem™ Hair Regeneration, evolved 7 years ago when we were doing hair transplants. Initially we were using a material Acellular matrix which leverages your body’s ability to generate stem cells for wound healing, combined with platelet-rich plasma. We did this to help improve the graft yield of the transplanted hairs, as well as improve the donor area. A beneficial side-effect was that thinning hair became thicker. We’ve been treating men and women of all ages in large volume for the past 7 years, and the overall majority of patients have had a benefit sustained for 5 years. We customize the treatment in terms of concentrations, methods of delivery, and other protocols derived from experience.
I caution you that we cannot tell what age you are by the photos. You may fall into the younger age group under 30 where you have a young age of onset, and whether it’s a rapid or moderate rate of progression that is more aggressive than a male who comes in in their 40s or 50s with a similar clinical picture, which is very important.
When you think about management, you do have to understand your pattern is more aggressive, and PRP as well as Hair Regeneration are pushing the growth cycles for as long as is possible for that hair follicle. What we have learned doing platelet-rich plasma and Acellular matrix combination is we have been able to stop the progression of hair loss, see reactivation of hair that is not growing, and see thickening of thinning hair, effectively prolonging growth time and quality of the hair.
However, I would say the best candidates have been people who have moderate degrees of hair loss with a relatively moderate level of aggressiveness. These are people who can be as young as in their 20s, but their progression is a slower progression, as opposed to a younger person who has a more aggressive progression. We have been able to establish a significant benefit of 5 years with a single injection, and we have adjusted protocols for other patients who have more advanced hair loss. However, we have been challenged with younger people who have more aggressive patterns who may not be able to get to that 5 year mark, even though we can prolong the growth cycles as much as possible.
I think it’s important for you also speak to your doctor about the side-effects of finasteride you experienced. You may or may not be making a correlation-causation error of the effect of the drug and the testicular pain you’re experiencing. Finasteride, like any medication, can have side-effects, but speaking from my experience, finasteride has been well-tolerated in prescribing to patients for about 20 years, and colleagues from around the world also feel the same. The original studies showed about 2% of men had sexual side-effects, but this was both in the active drug group and the placebo group. There are multiple causes of these types of symptoms, whether they’re sexual side-effects or testicular pain. It might be worth considering to try an alternative drug such as dutasteride, but this is a discussion for you and your doctor.
Think about stabilization, and maximizing the lifespan of your hair, and try to buy as much time as possible before you move forward with a hair transplant, or require a hair transplant. 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.

None of these hair restoration measures are perfect. I am sorry to hear that minoxidil has stopped working for you- at this point you may consider starting propecia and PRP together. PRP will likely be a series of treatments- most providers recommend a series of 3 treatments, spaced 4-6 weeks apart.  These treatments are aimed to reduce continued hair loss, improve current hair thickness, and increase new hair growth.  Ultimately you may hope to achieve a 20% improvement, but these results can vary widely. 
Not everyone is a good candidate for this treatment so please see a Board Certified or Board Eligible Plastic Surgeon to evaluate if you may benefit. Good luck!
This content is for educational and informational purposes only. It is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare professional.  You should always seek the advice of your physician or healthcare professional for any questions you have about your own medical condition. 

In my opinion,  you may want to try starting a compounded minoxidil  taken orally. We have had success with .25 mg of minoxidil. In addition, you can add a low level laser to your program. We have found that PRP with  low level laser and oral minoxidil is an excellent  combination.  Find a hair loss expert. PRPHAIRMD.COM