20 year old looking for Doctor's opinion

[italian-guy]

Hey all,

I am 20 years old (August 6th), a male with thick brown hair. I began noticing my hair thinning slowly on the very front of my widow's peak, around the summer of this year I believe (although I believe it began occurring before that around 18-19ish). I have also been on Accutane since around July 20th of this year.

I had full knowledge of the 13% chance of thinning hair during Accutane, but I sincerely hoped it wouldn't affect me. My acne is subsiding, but I have reason to believe my hairline is now just beginning to recede. I believe this because the hairline on the right side of my head seems to be getting thinner, contrasted with my left side, it is thinner.

Also, I've noticed a new area on my right side which seems to be noticably thinner, producing a thinner spot when I put gel in my hair. My widow's peak seems to be slowly receding but nothing has become to the point of noticeable unless its me looking at it. The hairline hasn't receded yet.

I am not sure whether the Accutane has caused this or whether this was occurring before. I distinctly remember the front of my hairline thinning a long time coming, even before the Accutane. However, now I'm really starting to notice and I'd like to see your opinions on this. I've researched plenty on hair loss and I've decided if I'm going to try anything further, it would be Propecia. I refuse to take Rogain or anything else.

Lastly, the only problem really is, I haven't been losing hair. I check my hands while I'm shampooing, in the shower, no hair seems to be shedding off. I only noticeably see maybe one or two hairs shed a day from whatever, which should be normal (even to shed 50-100 a day apparently).

Questions:

1) Is my hair progressively thinning to the point of finally beginning balding?

2) Should I try to beat my temples and/or hairline before it recedes and begin taking Propecia?

3) Are there risks in someone who may or may not have the baldness gene taking Propecia?

4) Does Propecia actually work, and are the statistics put out by the Merck corporation accurate in regards to its devasting side-effects (is it really less than 2% chance?)

5) If it is the Accutane, are those effects temporary or permanent?

6) Do you have knowledge of whether I could get a prescription for Propecia in Canada (not Proscar, PROPECIA)?

PS: Please do not just conclude it is the Accutane. I've been noticing thinning on my widow's peak at least since I was 18-19ish.

[Dr. Glenn Charles]

Your situation is definitely tricky. Do you have a strong family history of hair loss? As you said it is known that Accutane can cause hair loss in some patients. In most cases the hair loss should be temporary if the patient does not have the gene for Androgenetic Alopecia. In patients who have a strong predisposition for MPB, the Accutane could speed up the process of the hair loss and may be permanant. Propecia has only been shown to have a significant effect in the mid zone and crown area. It may not have much of an effect in the hairline and temporal areas. Besides the potential side effects I have not heard of any potential danger of a patient taking Propecia that does not have the gene for MPB. I am quite sure you can have a doctor prescribe Propecia in Canada. I have many patients over the years of all ages that have had good success using Propecia.

[italian-guy]

Your situation is definitely tricky. Do you have a strong family history of hair loss? As you said it is known that Accutane can cause hair loss in some patients. In most cases the hair loss should be temporary if the patient does not have the gene for Androgenetic Alopecia. In patients who have a strong predisposition for MPB, the Accutane could speed up the process of the hair loss and may be permanant. Propecia has only been shown to have a significant effect in the mid zone and crown area. It may not have much of an effect in the hairline and temporal areas. Besides the potential side effects I have not heard of any potential danger of a patient taking Propecia that does not have the gene for MPB. I am quite sure you can have a doctor prescribe Propecia in Canada. I have many patients over the years of all ages that have had good success using Propecia.

My father is a NW6 on the scale. Both grandfathers, on my dad's and mom's side had hair. My father's father had hair up till 65 with a receding hairline at the temples, probably a NW3 judging by the picture. My mother's father (aged around 50) had a receding hairline only on the right side, strangely looks like my hairline. He probably died with a NW2 or around there.

Since the thinning seems to mostly target my widower's peak, I'd liek to ask the question: Is there such thing as a person's widower's peak receding but nothing else? If so, this would turn out looking pretty stupid on me, just wondered if that was a possibility.

What are the best methods for treating thinning of the widower's peak? Also, I have about a month left in my Accutane treatment. Should I just wait it out and see if it was only temporary or begin searching for a treatment immediately?

[Dr. Glenn Charles]

I would recommend finishing your treatment with Accutane and then try to see a doctor who specializes in hair restoration. It is possible to lose the hair in the widows peak area with little hair loss in other areas. It may be unusual, but anything is possible. It is very hard to determine from which side of the family you are getting your genetic influence in regards to your hair. It could also be a combination from both families genes.

[italian-guy]

I would recommend finishing your treatment with Accutane and then try to see a doctor who specializes in hair restoration. It is possible to lose the hair in the widows peak area with little hair loss in other areas. It may be unusual, but anything is possible. It is very hard to determine from which side of the family you are getting your genetic influence in regards to your hair. It could also be a combination from both families genes.

I've concluded that the dryness of my scalp may have caused a thinning effect along my hairline from the widow's peak to the right side of the hairline. I've begun using a conditioner regularly each day, as well as Nizoral shampoo 2% about 2-3 days a week in rotation with my generic shampoo. At this point in time results remain to be seen (it's been too recent) but my scalp and hair feels significantly less drier, even appears thicker.

I realize that the hair restoration effects of Nizoral shampoo 2% remain to be fully determined based upon scientific research, but I've heard positive results from it. Upon further research of the effects of ketoconazole on DHT levels on the scalp in addition to the absence of side effects has led me to commit myself to it. I plan to use it for the long-term, maybe the rest of my life, in hopes that it slows down or even reverses my receding hairline.

While I understand that approaching a dermatologist specializing in hair restoration may seem like a prudent method, I fear they may prescribe me Propecia, which contains side effects I don't want to risk. I understand that the side effects have a 2% chance, according to Merck, but I do not trust this fact because I believe there may be differing degrees of the side effects which may not be extremely noticeable but present nonetheless.

Also, I do not have faith in Rogaine either; applying it twice a day and having greasy hair as a result doesn't appeal to me.

I watched this video of Dr. John Crisler speaking on Finasteride: https://www.youtube.com/watch?v=B8e7HERXA3s

I'd like someone with medical qualifications to tell me how much of what he's saying has merit. Personally, I believe he's speaking the truth, but I'm more concerned with the formula he's offered: Usage of Nizoral Shampoo 2% in addition to a topical "compound" with spironolactone. Now, I understand what Topical Spironolactone is, but I do not understand what he means by "compound". Apparently a compound can be created by most pharmacists, but what I don't understand is what he means in reference to the contents of the compound. Does he suggest compounding Nizoral shampoo 2% WITH spironolactone, or is he simply suggesting that Topical Spironolactone (in some sort of special compound) should be used seperately with Nizoral Shampoo 2%.

Can someone please clarify this for me? He states his formula in the last 20 seconds of the 2 minute video. I'd greatly appreciate it if someone dissected it for me.