You know how with senile alopecia or DUPA, the hairs miniaturize but don’t (usually anyways) actually shrink to the point where they fall out and stop growing altogether? They miniaturize to a certain extent but then stabilize in a miniaturized state and are still retained (hence why you don’t see people with DUPA develop totally bald scalps because the hair is still there, just much thinner). Well, can the same thing occur with patterned hair loss? Where the hairs in the thinning areas of the scalp (vertex and/or hairline depending on the Norwood level) miniaturize to certain degree but then stabilize at that point and don’t continue to miniaturize to the point that they fall out and totally stop growing altogether? Or in patterned hair loss, miniaturizing hairs in a thinning area of the scalp will most definitely shrink to the point of no more growth?

You are drawing a lot of conclusions about DUPA. DUPA may be another form of Senile Alopecia or just a variation of genetic hair loss?  I don’t know, but I doubt it.  DUPA might progress over time, possibly leaving very little hair on the head.  i have seen this in women but never seen a man with such advanced DUPA that his entire head became very thin. DUPA is different because it impacts the Donor area and every other place on the head.  Someone can have genetically patterned hair loss and then develop DUPA, which I have seen. These men are in a tough spot, as their patterned hair loss may progress to full balding, leaving a fragile donor area. 

An Article published in the British Medical Journal in September 2016, based upon “two populations of men free of risk factors for erectile dysfunction and other sexual dysfunction or its treatment: men aged 40 or more with benign prostatic hyperplasia who received a prescription for a 5-alpha reductase inhibitor (finasteride or dutasteride) or alpha blocker, or both, and men aged 18-59 with alopecia”, suggests : “The incidence rate of erectile dysfunction was lowest among users of 5-alpha reductase inhibitors only (15.3 per 1000 person years, 95% confidence interval 14.3 to 16.5), and similar among users of 5-alpha reductase inhibitors+alpha blockers (19.2 per 1000 person years, 17.4 to 21.1) and alpha blockers only (20.1 per 1000 person years, 19.6 to 20.7). Compared with users of alpha blockers only, the adjusted incidence rate ratios for users of 5-? reductase inhibitors only and 5-alpha reductase inhibitors+alpha blockers were 0.92 (95% confidence interval 0.85 to 0.99) and 1.09 (0.99 to 1.21), respectively.” Of further note: “cases of erectile dysfunction were more likely than matched controls to be overweight or obese (as measured by body mass index) or to have a diagnosis of non-erectile dysfunction sexual dysfunction, hypertension, diabetes, hyperlipidemia, depression, orchitis, or alcohol misuse before the index date.”   Of course, this study was done in an older population that is prone to Erectile Dysfunction

https://www.bmj.com/content/354/bmj.i4823#:~:text=The%20risk%20of%20erectile%20dysfunction%20increased%20with%20increasing%20number%20of,odds%20ratios%20were%20statistically%20significant

Comment:  The risks of ED rises with age, so the groups tested were clearly at a higher risk of ED than younger men.  The statistics reported by this article suggest that in this higher-risk population, the risk of ED was 1.3%, less than was reported in the original Merck study or in the Propecia ED risk factors brochures. I am wondering why so many younger men are reporting ED, considering the above statistics?

I have published on the genetics of the persistent frontal hairline. This man could bald and yet keep his frontal hairline.  For a hair transplant surgeon, that means that he will not have to get the leading edge of his hair transplant, saving the patient money and donor grafts.  For him, it means that he will retain a frame to his face with a good comb-back of his hair for styling purposes.  

What’s the consensus about microneedling/dermarolling without using minoxidil? Does it help or is it just a waste of time (and tears)?

Microneedling works on its own. Recognize that it works by creating a wound near the stem cells in the upper part of the hair follicle that may control hair cycling. It produces a healing cascade that stimulates the stem cells as part of the cascade.

Post-menopausal women (50% of the feml population) often develop hair loss or diffuse thinning.  Finasteride works well in some of these women; however, when a pre-menopausal woman has this condition, it may not work very well. In addition, pre-menopausal women have significant risks with this drug if they become pregnant so they should not take it with that risk over their head.

Most posts I read on various hair loss forums like Reddit, seem to be from guys who’re in their late teens/early 20’s who were probably going to be able to grow beards anyway, but for whom the minox may have just accelerated the process. Any success stories from older guys? I’m nearing 40 myself and looking for some inspiration. Much appreciated.

Men react differently to hair loss at any age. The most common reactions involve opting for very short haircuts or even shaving their heads. This trend is noticeable in places like airports or shopping centers. Some men embrace this change and never look back.

Others take a different route, seeking ways to regain their hair. Many of them share their experiences and seek solutions on platforms like Reddit or various forums. Some younger men might become fixated on their hair loss due to familial experiences.

Then, there’s a group who prefer not to rely on medications and choose the hair transplant route. They seek an immediate solution, despite the significant cost involved. I’ve performed hair transplants on men as old as 92, driven by various reasons like wanting to appear younger for dating purposes. Typically, men between 35 to 55 years old make this decision. With today’s technology, unlike older methods, about half of men can restore their hair in a single transplant session.

The crucial question here is personal: Does hair loss bother someone enough to (1) commit to lifelong medication (assuming it works), or (2) opt for a hair transplant despite the cost?

There are numerous success stories addressing hair loss, many of which are shared on platforms like Reddit.  Are you bothered enough to go through treatments such as daily medications or a hair transplant.  Only you can answer this question.

Young men are very sensitive to finasteride and minoxidil as shown here in just 4 months of use.  As he continues to use it, more new hair will likely appear.