Dutasteride, minoxidil, finasteride & HRT - why don't my medications work? What's the possible diagnosis? (Photos)

Question

Im 27 years old, had hair transplant 2 years ago, experiencing hair loss 1 year ago Currently on dutasteride 1mg, oral minoxidil 1mg and finasteride 1mg plus 5% topical min every day, also on HRT and take estradiol valerate and triptolin. Pull test is negative only 2 3 hair from 60 to 80 strands of hair.thinning is happening all over my head back,sides and hair line it's less noticeable at hairline , had 3 prp session which makes hair loss worse, someday i lose 300 hair.biopsy is in photos

Mehmet Erdogan, MD · Answer

If you’ve already been on dutasteride, finasteride, minoxidil, and even HRT, and still aren’t seeing improvement &mdash; then something’s off, and it might not be about the meds themselves.
Here’s what could be going on:
Maybe it’s not androgenetic hair loss.Everyone assumes it is, but if it's actually something like chronic telogen effluvium, autoimmune alopecia, or even a mild scarring condition, DHT blockers won’t help.
Some types of hair loss just don’t respond to these meds.For example, diffuse shedding from stress or hormones might need a different approach &mdash; sometimes even just time.
Your body might be missing key support.Things like low ferritin, zinc, vitamin D, thyroid issues &mdash; if one of these is off, no amount of dutasteride will fix it.
Inflammation on the scalp.If your scalp is oily, itchy, or irritated, that underlying inflammation could be limiting how well treatments work.
Maybe it’s just too early.These meds don’t work overnight. Dutasteride especially can take 6–12 months &mdash; or longer &mdash; to really show effect.
Bottom line? If you're on everything and still not seeing a difference, it might be time to stop throwing treatments at it blindly and go back to basics: clear diagnosis, blood work, and scalp check.

Anna Chacon, MD, FAAD · Answer

Hello,

Experiencing continued hair loss despite being on multiple treatments can be frustrating, especially after undergoing a hair transplant. Here are some considerations and potential diagnoses to discuss with your healthcare provider:

Medication Efficacy:

Dutasteride and finasteride both inhibit DHT, a hormone linked to hair loss. However, they may not completely halt hair loss in all individuals, and some may not respond as well to these medications.
Minoxidil works by increasing blood flow to hair follicles, but its effectiveness can vary from person to person.

Hormonal Factors:
Being on hormone replacement therapy (HRT) with estradiol valerate and triptorelin could influence hair growth patterns. Hormonal imbalances or changes might contribute to diffuse thinning.

Telogen Effluvium:
A condition characterized by diffuse hair shedding often triggered by stress, hormonal changes, or medications. Although your pull test is negative, this condition could still be present.

Diffuse Unpatterned Alopecia (DUPA):
This condition involves hair thinning across the entire scalp and could be a possibility, especially if the hair loss is not localized to typical androgenic alopecia patterns.

Scalp and Follicle Health:
The biopsy results, which are crucial for diagnosis, should be reviewed with a dermatologist or trichologist to check for any underlying scalp conditions or follicle health issues.

PRP Treatment:
While Platelet-Rich Plasma (PRP) therapy can promote hair growth for some, it might not be effective for everyone and, in some cases, may initially seem to exacerbate shedding.

Comprehensive Evaluation:
It’s important to have a comprehensive evaluation by a dermatologist specializing in hair disorders. They can interpret biopsy results, assess hormonal levels, and review your treatment regimen to provide a tailored approach.

Consider discussing these points with your physician to explore potential adjustments to your treatment plan and further diagnostic evaluations.

Warm regards,

Dutasteride, minoxidil, finasteride & HRT - why don't my medications work? What's the possible diagnosis? (Photos)

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Dutasteride, minoxidil, finasteride & HRT - why don't my medications work? What's the possible diagnosis? (Photos)

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Everything you need to know about Hair Loss Treatment

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