I know I'm balding/thinning, but I need some advice

[3_Toads_in_a_Trenchcoat]

I checked this website and forum out a bit ago and, as someone who's thinning on top and worried about it, I thought I'd ask if anyone here has had/going through a similar hair loss pattern as I am. I'd also like to know if it looks like male pattern baldness or maybe something else.

For some background information, I'm turning 22 in a month and have been on hormone replacement therapy, taking an intramuscular injection every other week for nearly 5 and a half years to up my testosterone levels to match the average man. Other than the testosterone, I'm not taking any other medication that would cause hair loss. I was on a 7 month regimen of Isotretinoin (generic form of Accutane) about maybe 4 and a half years ago. I have done research to find that some people end up with their hair continuing to thin in a diffuse alopecia pattern despite taking it years ago.

I also have had a decade's long history of lightening and dyeing my hair. However, in May 2020, I buzzed my head and haven't colour treated it since (in fact, I haven't even received a hair cut since then). When my head was buzzed, I do remember the top of my head just being generally thinner than everywhere else when it came to my hair. No part of the top of my head was thinner than another spot on the top of my head, however.

I'm not sure if it's due to the fact that I have longer hair now and therefore it's much more noticeable, but it seems to have slightly gotten worse. There's also a significant difference that's come about recently where one half of my hairline has become way worse than the other. It's starting to concern me. In that patch, it appears that there's little baby hairs growing in as well (I've been observing their growth since I've noticed them and they've gone from a centimeter to maybe three centimeters now, but some vary a whole lot length). I'm wondering if there might be more than one thing going on that's causing me my hair loss whether they be medical or environmental.

I've been considering seeing a dermatologist about my hair, but I've recently bought some Rogaine and DHT blocking shampoo and conditioner that have yet to come in the mail. So, there's no doubt by these pictures that I'm definitely thinning on top, but what're your opinions on my issues and do any of you have any advice or wisdom you could give me? I'm not ready to be bald just yet.
Also I've always had a rather large forehead so that's not new.

Hope the pictures are clear enough.

 

[tggill32]

Ouch. Pretty aggressive loss you have there. Best bet is finestride but I’m not sure how effective it will be with how aggressive your hair loss seems to be. Do you have a lot of body hair? If so hairloss may be more down to your DHT levels as a pose to sensitivity of follicles which would yield good results from finasteride

 

[Norwoody]

You likely need dutasteride to prevent the T from converting to DHT.

 

[3_Toads_in_a_Trenchcoat]

Ouch. Pretty aggressive loss you have there. Best bet is finestride but I’m not sure how effective it will be with how aggressive your hair loss seems to be. Do you have a lot of body hair? If so hairloss may be more down to your DHT levels as a pose to sensitivity of follicles which would yield good results from finasteride

I think I have average body hair, but I know I have rather hairy arms and legs while just about none on my back so it varies in location. I mentioned my concerns to my endocrinologist who gives me my testosterone for my hormone replacement therapy and he said he had a medication he could put me on if I wanted.

 

[3_Toads_in_a_Trenchcoat]

You likely need dutasteride to prevent the T from converting to DHT.

Ohh, I didn't know about that medication. All I've been hearing about is finasteride. Thanks, for I may mention this to my doctor if he doesn't mention it first.

 

[NickyA]

You may also try microneedling or tretinoin to increase the effectiveness of minoxidil. Your hair loss seems very aggressive.

 

[Pentanol]

I'm very sorry you've been experiencing this— as other users have said, this does appear to be very aggressive.

I have a few questions:

Prior to the hormone replacement therapy, were you noticing hair loss? Did the loss begin after getting testosterone treatment? If so, there is a very high chance that your hair follicles are sensitive to the influx of androgens, and this is an unfortunate case of standard male pattern baldness. I'd imagine males in your family are also suffering from androgenic alopecia since your hair loss is very advanced at age 22. Were you warned that the testosterone injections may possibly lead to hair loss if you were predisposed to androgenic alopecia? If not, that is really unethical of your provider and earlier action may have saved your hair.

Nonetheless:

At the state you are at in your hairloss, please skip the stage most beginners pass through where they spend hundreds on products that are on Amazon or their local beauty store. These products are backed by (pseudo) science, and anecdotal evidence that is somewhere between the placebo effect and general delusion. A dermatologist will be able to prescribe you finasteride or dutasteride and this in conjuncture with minoxidil (either oral or topical) will be able to begin your road to hair recovery and maintenance.

 

[Norwoody]

A topical AA like RU58841 may be in order as well.

Some good points in these:

 

[3_Toads_in_a_Trenchcoat]

You may also try microneedling or tretinoin to increase the effectiveness of minoxidil. Your hair loss seems very aggressive.

Thanks for the advice. I was considering trying microneedling or dermarolling, for I've seen some amazing before ad after pictures, but I was unsure. Guess there's nothing to lose in trying it.

 

[3_Toads_in_a_Trenchcoat]

I'm very sorry you've been experiencing this— as other users have said, this does appear to be very aggressive.

I have a few questions:

Prior to the hormone replacement therapy, were you noticing hair loss? Did the loss begin after getting testosterone treatment? If so, there is a very high chance that your hair follicles are sensitive to the influx of androgens, and this is an unfortunate case of standard male pattern baldness. I'd imagine males in your family are also suffering from androgenic alopecia since your hair loss is very advanced at age 22. Were you warned that the testosterone injections may possibly lead to hair loss if you were predisposed to androgenic alopecia? If not, that is really unethical of your provider and earlier action may have saved your hair.

Nonetheless:

At the state you are at in your hairloss, please skip the stage most beginners pass through where they spend hundreds on products that are on Amazon or their local beauty store. These products are backed by (pseudo) science, and anecdotal evidence that is somewhere between the placebo effect and general delusion. A dermatologist will be able to prescribe you finasteride or dutasteride and this in conjuncture with minoxidil (either oral or topical) will be able to begin your road to hair recovery and maintenance.

Prior to HRT, I don't think I experienced any hair loss. But also I didn't start it until I was 16.
The hair loss seems to have only started within the last year or so, so that's about 4 years into taking testosterone. The missing patch on my hairline, though, that's very new.
I personally have no clue if I am predisposed to androgenic alopecia, but I knew going into the HRT that I may one day lose all my hair. I don't see a lot of my family members, but my dad has been slowly going bald over the years (he's in his late 40s, almost 50 right now). I don't know when he started, however. I also don't know if me being born female (I'm a transgender man) complicates anything in relation to being predisposed to male pattern baldness. It's hard to find studies out there.

But thanks. Good thing I haven't bought anything off of Amazon yet. I did look because I'm a genuinely curious person, but a lot of it was suspicious to me.

 

[3_Toads_in_a_Trenchcoat]

A topical AA like RU58841 may be in order as well.

Some good points in these:

Thanks! I lot of it went over my head because I've never done like anabolic steroids for body building or anything like that. But good to know that the testosterone I take isn't one of the "bad" ones (I take testosterone cypionate), and thank goodness I'm not taking extreme doses. I only use testosterone to get it up to par with the average man's levels of the hormone, for I take it for gender affirmation.

 

[Norwoody]

Thanks! I lot of it went over my head because I've never done like anabolic steroids for body building or anything like that. But good to know that the testosterone I take isn't one of the "bad" ones (I take testosterone cypionate), and thank goodness I'm not taking extreme doses. I only use testosterone to get it up to par with the average man's levels of the hormone, for I take it for gender affirmation.

Actually, testosterone (at least in terms of hair) is one of the worst things if you don’t use a 5ARI. It is worse than an equivalent amount of anabolic steroids, which would be a relatively low dose. Anabolic steroids are designed to be LESS androgenic versions of testosterone. In any case, you should be taking finasteride or dutasteride to prevent the T from converting to DHT.