What to do when still thinning and on propecia?

Question

I'm 30. I've been on propecia for 4+ years. I had a consult last year and I'm around a NW 2.5-3. My recession and hairloss is, or was, confined to front half of scalp. 1 year ago I started drinking soy semi-regularly and using zinc pyrithion shampoo daily. I heard both *might* help. In any case, I've noticed lately my forelock appears to be narrowing and thinning more. What are my options if propecia is losing effectiveness? could soy or zinc pyrthione be playing a role?

David Deutsch, MD · Answer

Propecia can lose its effectiveness over time in some patients.Other adjuncts that can be substituted include Minoxidil (Rogaine),Low Level Laser Light therapy and/or PRP(Platelet Rich Plasma).Based On your description you may also be a candidate for hair transplantation.I recommend consulting an experienced Hair Restoration surgeon.

Jason Emer, MD · Answer

I suggest seeing a hair loss expert 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

Jeff Donovan, MD, PhD · Answer

Great question. There's a few things to consider.  I don't think the zinc pyrithione or soy are adding much here. This is likely driven by genetics.

1. Is there any other diagnosis? Although it's clear that you likely have male pattern hair loss, anyone with this story needs thyroid, hemoglobin and iron studies. They will likely be normal, but should be done.

2. There are options to add minoxidil (Rogaine) to your plan.

3. There is an option to ADD a small dose of dutasteride or switch to dutasteride.

4. You can consider adding hairs via a hair transplant.

Kyle S. Choe, MD, FACS · Answer

Male pattern baldness is mostly due to a genetic link. Without knowing your full family history it is difficult to assess. However, given your history I would not be surprised if you will need hair transplant surgery in the near future. Propecia can lose its potency after several years.

Brian Goertz, MD (retired) · Answer

Finasteride is FDA approved to reverse hair loss in the crown (vertex) and works in most men if hair loss is treated early. It is not FDA approved for anterior scalp hair loss. Once the crown is completely bald the hair in middle of the crown will not regrow but may stabilize the fringe. Finasteride does not work well in the frontal area of the scalp and your story is not surprising to me. You most likely have male pattern balding and you may be a candidate for hair restoration surgery. If that is something you are interested in, do your research well and choose a well qualified full-time hair restoration surgeon.

William Rassman, MD (retired) · Answer

You have reported that Hair loss continues on Propecia,.  First I suggest that you speak with the doctor who prescribed it.  One of the possible solutions would be to double the dose from 1 mg to 2 mgs [rpvided that you do not get side effects.

What to do when still thinning and on propecia?

Answers (6)

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