Diagnosing sudden hair thinning / hair loss

[Fireproof]

I've had great discussion offline with Nelson, but figured others might benefit from this discussion (and might have other ideas / anecdotes to share).

Short story: I've been on TRT for over 2 years (pellets about half the time, then moved to injections) and never experienced hair loss. Now - suddenly after 6-8 weeks on new protocol from Defy Medical - I'm seeing hair thinning and shedding.

On prior protocols, I only used Test Cyp and Anastrozole. Nothing else. Both clinics were a bit conservative - didn't allow me to run very high levels. I would say I averaged 500-800 total test, but I did peak to 1900 at times with pellets and when I did every 2 week injections for a short time (dumb, I know, but that's why I left them). During those peaks - I had extra bloating and acne due to rise in e2, but never hair loss.

Switch to Defy! Since being with Defy - I've felt probably the best I've felt in 15 years. It made my previous 2+ years on TRT seem like a waste of money. BUT - I'm seeing hair loss and not sure why. Protocol is this:
- 80mg Test Cyp E3.5D.
- 350iu HCG E3.5D.
- 0.3mg Anastrozole 3x/week (compounded with DIM) (i'm very sensitive to e2 and feel better at lower levels)
- 30mg/30mg Daily of DHEA/Preg
- Also doubled Armour thyroid to 60mg twice daily vs. once daily before.

So several new things added - HCG, DIM, DHEA, Pregnenolone.

I initially thought my DHT was jacked up. So got a recent blood test to see - here are the results:
- Total test = 1282 (range 348-1197)
- Free test = 32.9 (range 6.8-21.5)
- DHT = 76 (range 30-85)
- Sensitive e2 = 53 (range 8-35). (I skipped my 3rd dose for the week and as expected e2 was high).

Prior DHEA-S level at 6-week labs was 337 (range 71-375)

Questions/Thoughts:
1. Could the higher test levels be causing it even though DHT is still in range? If it is - Nelson suggested that trying to reduce may not help unless I reduce it to such a level that I'll be Low-T symptomatic again. Which I don't want to do obviously.

2. Might it be the DHEA? I've read here and a few other places (and Nelson confirmed) that some experience hair loss with DHEA. Since this was newly added, maybe this is the culprit?

3. Nelson suggested high levels of thyroid could also contribute. Maybe I'm pushing my T3 too high? Is there away to tell if this is likely contributing by the way I'm losing my hair? (For example - I'm not experiencing receding hair line or thinning just at the crown - like male patterned baldness. It's overall on my head - the hair is thinner, not growing, and falling out).

Fortunately - others (including my wife) didn't notice my hair loss. But I want to stop it before it gets worse.
I've purchased Defy Medical's hair loss formula of Minoxidil 5%/Ketoconazole 2%/Latanaprost/Azelaic Acid 12.5%
 in the meantime.

But if I can tweak my protocol to deal with it at the source of the problem, that's what I want to do...

All thoughts/comments welcome.

I've requested a consult with Dr. Saya or Nurse Jill if they have a cancellation - as both are booked out 3-4 weeks. I do have an appointment on the calendar 3 weeks from now, but don't want to wait that long if there might be some obvious changes to try...after all - it's my body and hair. For now. LOL.

For now - I've dropped the DHEA/Preg just in case...

 

[PAUL-E]

One thing to consider is although your DHT is in range its more towards the top and if you are genetically predisposed to male pattern baldness it might be enough to effect you(plenty of bald guys not on TRT). I also believe lower IGF-1 can have a negative impact on your hairline, I knew a test subject that took mk677 it's hair became thicker and less fell out but when it stopped a lot of hair fell out.

 

[Vince Carter]

I've requested a consult with Dr. Saya or Nurse Jill if they have a cancellation - as both are booked out 3-4 weeks. I do have an appointment on the calendar 3 weeks from now, but don't want to wait that long if there might be some obvious changes to try...after all - it's my body and hair. For now. LOL.

I know for a fact that you can email Jill or PM Dr Saya (here on this forum) and they will give you some simple guidance without needing a consult.

 

[Fireproof]

One thing to consider is although your DHT is in range its more towards the top and if you are genetically predisposed to male pattern baldness it might be enough to effect you(plenty of bald guys not on TRT). I also believe lower IGF-1 can have a negative impact on your hairline, I knew a test subject that took mk677 it's hair became thicker and less fell out but when it stopped a lot of hair fell out.

Yeah - I was thinking maybe it's just running at higher levels of test (and DHT) more consistently than in the past. But I've had periods of really high levels before (pellets) when we were first dialing things in, and didn't notice any hair changes. So I'm just wondering if it's something else. If not - so be it - but that would be a bummer.

 

[Fireproof]

I know for a fact that you can email Jill or PM Dr Saya (here on this forum) and they will give you some simple guidance without needing a consult.

Oh - I didn't know we could do that. That's good to know. Thanks.

 

[PAUL-E]

Yeah - I was thinking maybe it's just running at higher levels of test (and DHT) more consistently than in the past. But I've had periods of really high levels before (pellets) when we were first dialing things in, and didn't notice any hair changes. So I'm just wondering if it's something else. If not - so be it - but that would be a bummer.

yeah I agree, I just started shaving and got used to it eventually.

 

[Fireproof]

yeah I agree, I just started shaving and got used to it eventually.

Clear out some of your private messages so I can PM you. ��

 

[Dr Justin Saya MD]

Fireproof - it sounds like you are experiencing hair SHEDDING (not permanant) vs male pattern balding (permanent).

Look up Telogen Effluvium. Hair shedding (sometimes rapid...albeit not permanent as noted) can occur due to many factors including stress, dietary changes/sensitivities, HORMONAL CHANGES (not necessarily high or low), and many others. This can also be a normal part of the hair follicle cycle.

With true male pattern baldness, the hair doesn't actually "fall out", but rather the hair follicle becomes progressively smaller and smaller (over an extended time) and consequently produces smaller and finer hair shafts until eventually the follicle can no longer produce a hair shaft. Thus, MPB is more of a gradual/progressive hair "shrinking" and ultimately loss (hope that makes sense).

 

[Fireproof]

Thanks Dr. Saya. That makes sense. I hope you are right. I'll research that and see if I recognize that in myself. I have not noticed any "thinning" at the crown or whatever that you typically think of with going bald.

I sent Jill and email and asked her to pass it along to you as well (don't have your address), before seeing your post here. Thanks for all the help!!

 

[Loki]

Dr. Saya, I am a patient of yours as well... I have been trying the Latanoprost foam from APS and it seems to work fairly well, I would say much better than minox. For the benefit of the group what's the overall feedback on this product from your clients. The only thing that bothers me is the hair loss doctors and community are not pushing this... Also do you recommend Empower's topical Fin/Latanoprost? I did my bloodwork yesterday and will be following up with you soon... For whatever it's worth I do seem to "shed" more on DHEA as well....

 

[Loki]

Thanks Dr. Saya. That makes sense. I hope you are right. I'll research that and see if I recognize that in myself. I have not noticed any "thinning" at the crown or whatever that you typically think of with going bald.

I sent Jill and email and asked her to pass it along to you as well (don't have your address), before seeing your post here. Thanks for all the help!!

One thing to keep in mind is you can lose up to 50% of hour hairs density until you notice visible thinning...

 

[Fireproof]

One question about TE - If I'm unsure, is it still fine to use the Monox/Fin/Keto formula daily? I'm assuming that won't hurt anything, but just want to be sure.

One thing to keep in mind is you can lose up to 50% of hour hairs density until you notice visible thinning...

Yeah - I know some is normal. But I've been styling my hair with pomade/fiber type stuff and kind of spike it up in a "messy" look. Typically it looks fine. But the last month it makes me look like I'm going bald - due to noticably less hair, when the gel stuff clumps the hair together, I see much more of my scalp than previously.

ALSO - I don't know if this is a clue or not - but I typically get my hair cut every 3.5 - 4 weeks like clockwork. This last time I got my hair cut - she had to trim the back and neckline and above the ears - but didn't cut ANY off the top of my head. It's like it didn't grow in length this past month.

 

[PAUL-E]

Clear out some of your private messages so I can PM you. ��

Done, thanks fills up quick

 

[Dr Justin Saya MD]

One question about TE - If I'm unsure, is it still fine to use the Monox/Fin/Keto formula daily? I'm assuming that won't hurt anything, but just want to be sure.
.

It is absolutely okay to use that formula even if TE is occurring. Topical is the treatment of choice and we have several different combo treatments.

 

[Dr Justin Saya MD]

Dr. Saya, I am a patient of yours as well... I have been trying the Latanoprost foam from APS and it seems to work fairly well, I would say much better than minox. For the benefit of the group what's the overall feedback on this product from your clients. The only thing that bothers me is the hair loss doctors and community are not pushing this... Also do you recommend Empower's topical Fin/Latanoprost? I did my bloodwork yesterday and will be following up with you soon... For whatever it's worth I do seem to "shed" more on DHEA as well....

The topical latanaprost has obtained very good results for most patients that have used it. The combo formulas (can be any combo of minoxidil, ketoconazole, azelaic acid, finasteride, latanaprost) tend to work even better than a solo treatment.

 

[PAUL-E]

The topical latanaprost has obtained very good results for most patients that have used it. The combo formulas (can be any combo of minoxidil, ketoconazole, azelaic acid, finasteride, latanaprost) tend to work even better than a solo treatment.

Not trying to thread jack but will this also work for women?

 

[Nelson Vergel]

For those needing background information on all hair loss treatment options, read this thread:

Testosterone and Hair Loss: What You Need to Know

 

[Dr Justin Saya MD]

Not trying to thread jack but will this also work for women?

Yes, works on females the same as males. A common use for females is to grow eyelashes. We have many females using for hair thinning (or simply to thicken hair), the same as males.

 

[SoCalSurfer]

I found this on another site for baldness. I have not tried it yet but worth a try it sure cannot hurt my thinning hair. After being on TRT I have noticed my hair on my head is getting thinning out but by god I can grow it on my back, chest, neck and everywhere else. WTF...

Here is what I found: Baldness – combine coconut oil with lavender, rosemary, thyme, cedarwood, Jojoba oil, Grapeseed/ castor oil and a little cayenne pepper. Apply three times a day (or before bed) to affected area of hair loss and massage in. Coconut oil and these essential oils supports cell regeneration.

 

[Fireproof]

Okay - after a lot of research, I'm pretty convinced I am suffering from Telogen Effluvium.

Here's a couple articles for those interested:
http://www.dermnetnz.org/topics/telogen-effluvium/
http://www.webmd.com/skin-problems-and-treatments/hair-loss/effluviums#1

Some reasons I think this applies to me:
- I see no male pattern baldness at all. No receding hair line. No extra thinning at the crown only. It's all over the scalp.
- The onset was sudden. Almost overnight I started noticing a bunch of hairs in the sink ever day - very consistent and once again - all over.
- I've changed a lot in my protocol - basically going from Test & AI only to Test, AI, HCG, DHEA, Preg and boosting all to top of range or slightly over. So PERHAPS this "shock" to my system trigged T.E.
- Finally - I've read about others jumping into steroids or comprehensive TRT that think they triggered this as well.

From what I've read - it can either be 'self-correcting' in the case of some acute trauma - things settle down after a few months. OR it can be resolved by "fixing" the root cause (like thyroid problems, etc).

I have scheduled a consult with Dr. Saya - but unfortunately it's 3 weeks from now. UGH. I'm trying not to panic in the meantime.

I don't know if I should...
- See a dermatologist to verify that it is in fact T.E. (apparently they can tell by looking at the hairs under a microscope)
- Or assume it is based on all the evidence I have.

And if we assume it is (or find out that it is) - I don't know if I should...
- Stay the course with current treatment and hope my body gets used to my new hormone levels and the hair fixes itself
- Or if I should reduce levels a bit
- Or if I should stop taking certain things and hope that helps things to settle down (since this didn't happen in the last 2 years of TRT)

Right or wrong - I did stop my DHEA/Preg because I've read that guys seemed to have experienced hairloss and increased shedding with it. But I don't want to make any other knee-jerk adjustments before talking to Dr. Saya. I'm just panicking a little bit because I will NOT look good bald.