Some people see regrowth from microneedling coupled with finesteride. If somebody’s hair loss is not entirely related to dht then would just microneedling have a better chance of working then for somebody who has dht related loss? For example some women experience this trichotillomania related hair loss issue and they most likely don’t have dht related loss. Do you think it’s worth a shot to try only microneedling? I already started but I wanted to know what you think.

At the end stage, trichotillomania causes traction alopecia and it is usually permanent. IF the person still has growth potential, all they need to do is to stop picking on the scalp and then wait for 6 months, when the hair will usually grow back.  Adding microneedling to this might accelerate the growth of hair that is not ‘dead’ but will come back normally after 6 or so months

I have have a really bad, receding hairline with dense hair and no crown problems. I was going to start minoxidil and add finasteride in 2 to 3 years since I still haven’t finished my puberty. I really want to try to recover my hairline, the thing is, I am okay with getting a HT in a few years.

I often prescribe finasteride to 18 years old men. This drug often works very well with a high degree of reversal. If after one year it doesn’t reverse, add oral minoxidil to your routine and worst case, add microneedling 6 months after than it it doesn’t work. Actually, I don’t think that the first or second will fail.  A hair transplant is out of the question for at least 7 years and by that time, if you don’t treat it now, you may bald far more than you see now. 

It was great to see your monthly progress

 Right now i am just dermarolling for 6 months with my short hair. If i do smp, will it be realistic or look artificial?

SMP is an art form and some people do great SMP and too many others do not. Just make sure that you meet patients that had it done before going forward with a particular provider.  All people who do SMP are not equal.

If I microneedle weekly and use minoxidil and finasteride, when I get results, can I stop the microneedling?  How often is best for microneedling?

The problem with microneedling results is that we don’t know if they will stick around after the microneedling ends and if so how long. Most people using microneedling are using it weekly.  I suspect that at most, it will last a single hair cycle which could be 2-3 years in a young man. 

I have taken Dutasteride for 2 years and for the last 6 months, I have had lost my interest in sex and have complete ED. I had a girlfriend and I think that she left me because of it. I am now off of it for 5 weeks and don’t care about my hair anymore. The hair is falling as if there is no tomorrow. my beard is getting fuller and I am feeling more energy since I stopped the drug 5 weeks ago, but my ED is still there and my interest in sex is still there.  Can you help me?

You have been on dutasteride for 2 years and have gotten side effects on libido and ED.  You have noticed improved beard growth and more energy since you stopped taking the drug 5 weeks ago.  Since it has been only 5 weeks that you have to be off dutasteride, it may take 6 months or more for the symptoms to resolve.  Some people may take a year or so to get the symptoms to go away.  With dutasteride half-life of 6 weeks, you have to wait it out and even after the blood half-life extends into many more months, there are tissue levels of dutasteride (in the hair follicle and elsewhere in your brain and penis) which I don’t believe that anyone understands. Reach out to me when these symptoms disappear or in a year, whichever comes sooner. 

When I first started thinning around 21 I hopped on minox and would apply it gently to my scalp. I think I was afraid of the manual shedding that would be caused by really rubbing it in. After 6 months I stopped using it because I didn’t notice any improvement. I continued using keto and 1.5 mg fin for the next 8 years. With a very slow progression of thinning. About 6 months ago I decided to try minox again, and instead I rub the minox vigorously into my scalp for probably 20 seconds. While at first I did notice a lot of hair in my hand from the rubbing, over time less and less hair would fall during the rubbing.

I feel like now my hairloss has pretty much halted, and maybe even a little regrowth (it’s hard to tell because I’m a diffuse thinner).

If minoxidil didn’t work initially, then you might be in the 60% of men that will not respond to topical minoxidil but will respond to the oral form. Read this: https://baldingblog.com/sulfotransferases-and-minoxidil/