Besides DHT, Is There Something Else Responsible for Hair Loss?

If blocking DHT close to 90% still doesn’t guarantee a patient to save their hair, is it possible that perhaps there are things other than DHT responsible for hair loss? It seems a bit counter intuitive that even if DHT formation is halted significantly that one still continues to go bald. I understand that small bits of remaining DHT still slowly destroy the hair, and that Finasteride and Dutasteride cannot guarantee 100% inhibition. Why do some not respond to this drop in DHT at all? Perhaps we are attacking hair loss from a biologically inefficient angle?

Why is there no guarantee?

(Consider a 19 year old male, who went bald in a year, even while using propecia.)

This is a great question. Unfortunately, we don’t have a quantitative measurement of the DHT effect on hair. We are also not aware of all possible mechanisms of male pattern hair loss. That is why we will still see some degrees of hair loss despite the DHT blocking effect with high dose of medications. The information we have on the effect of alpha reductase inhibitor medications such as finasteride is based on the scientific quantitative and qualitative evaluation of the patients’ hair and not the microanalysis of the hair follicles at the molecular levels. Further advances in molecular biology should be able to help us better understand the complex mechanism of hair loss. Other causes of hair loss include other male androgen hormones, time (as it is progressive), and stress.