Hi everyone,
I’ve been on minoxidil and dutasteride for about 10 months now. I originally went to a dermatologist when I noticed the slightest recession in my corners due to genetics.
She prescribed dutasteride + minoxidil.
At that time, during a comb test (dermatologist told me to use it to track shedding – comb for 1 minute and count hairs), I was losing around 15 hairs, which is normal.
Fast forward ~6 months:
Even while on therapy, I started losing 60–80 hairs in the morning and again at night. I only do the comb test when I notice increased shedding during the day.
At first, I thought it was just a shedding phase, and my dermatologist said not to worry and that I had new hairs coming in.
And yes — I did notice new hairs.
But at the same time:
• My hair overall kept getting thinner
• Texture became weaker
• I started losing hair from the sides and back, not just top
• Hair strands that fall out are thinner at the root and slightly thicker toward the ends
• Overall density is clearly worse
Now (month 9–10):
Things escalated:
• 80+ hairs in the morning
• ~115 hairs at night
• If I run my hand through my hair ~5 times → ~30 hairs fall out
• Constant shedding throughout the day with white bulb
Also, I’m seeing short “exclamation mark” hairs, which from what I’ve read can be a sign of alopecia areata incognita.
Dermatologist update:
I went back, and she finally admitted I’m losing more hair than I’m regrowing.
Her approach is still:
“We just need to adapt therapy better”
She added mesotherapy, which is fine, but I feel like she is still focusing mainly on DHT.
And honestly, this doesn’t feel like a pure DHT problem anymore:
• Diffuse loss (including sides/back)
• Massive shedding
• Texture change
• Continued worsening despite strong anti-androgen (dutasteride)
Where I’m confused / what I’m thinking:
I’m starting to suspect there might be something systemic or inflammatory going on, not just androgenetic alopecia.
Some things I’ve been looking into:
• Small Intestinal Bacterial Overgrowth (SIBO) – CONFIRMED METHAN
• Mast Cell Activation Syndrome (MCAS) – I match many symptoms
• Histamine intolerance / chronic histamine issues 4.7 DAO enzymes test
• Seen people talk about Chronic low-grade inflammation markers like:
◦ Matrix Metalloproteinase-9 (MMP-9)
◦ Transforming Growth Factor Beta
I’ve read these can:
• Affect hair follicle cycling
• Cause fibrosis / miniaturization independent of DHT
• Did all autoimmune test and they came back clear
My main concern:
This doesn’t feel like standard AGA progression.
It feels like:
• Either alopecia areata incognita
• Or some inflammatory
• Possibly triggered or worsened by systemic issues (gut, histamine, etc.)
What I’m looking for:
- Your opinion — does this sound like something beyond AGA?
- Has anyone had a similar pattern (diffuse + sides/back + heavy shedding on dutasteride)?
- Recommendations for top dermatologists / trichologists in Europe who: