Topical Finasteride with Minoxidil losing efficacy - what is my next course of action?

If topical Finasteride and Minoxidil are losing effectiveness, the next step would be to switch to Oral Minoxidil and Durasteride. A sulfatase enzyme is necessary to utilize topical Minoxidil. Some people have a diminished response due to enzyme deficiency. Oral Durasteride blocks one additional enzyme pathway in the formation of DHT from testosterone. You can also add PRP to the program. This type of combination therapy is most helpful. You will need 3 to 6 months to evaluate. Find a hair expert. Get a complete consultation.

Jeff Rapaport MD FAAD
Realself Hall of Fame

Your next course of action should be a consultation with a hair restoration specialist. Although male pattern baldness is the most common cause of hair loss, it is by no means the only one. A detailed medical history and examination, including trichoscopy, would reveal the cause -or causes- of your hair loss.If the cause is only androgenetic alopecia, you may consider switching to oral finasteride or dutasteride for better results.

If you are no longer satisfied with your topical treatments you may be a candidate for hair transplant. SmartGraft is a FUE procedure that is virtually pain free and has no linear scar. Final results can be seen in as little as nine months. See a board certified plastic surgeon near you for an evaluation to determine if you are a candidate.

It’s important to really figure out why they results are fading. Don’t make assumptions but do get expert advise. You’ll need to consider several possibilities: 1) your androgenetic alopecia is pushing forward and the treatment can’t keep up 2) the treatment is spoiled or no good or old 3) you have another hair condition going on that nobody recognizes 4) one of the treatments you started has caused the slow slow development of another hair condition that is now removing hair 5) you had another hair condition before that subsided and most of the improvements were actually due to that condition settling and now your AGA is progressing 6) you feel things are worse but they actually are not worse. Photos will help with that.

All in all, get advice. A full examination is needed. I don’t know your whole story but in many patients with similar stories I would consider dropping the dermarolling and doubling the topical long before adding fin 0.25. However, what you should do needs proper assessment first.