Sudden Triangular Thinning Patch

General
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Hi everyone,

I’m 31 and have been on DHT blockers for almost 4 years. My routine:

  • Finasteride 1 mg, 3x a week since Dec 2021

  • Added Dutasteride 0.5 mg once a week in Feb 2025

  • Oral minoxidil, but inconsistently (usually only when I take my other tablets — I know it should be daily).

Up until now I’ve had no visible crown or temple loss. But just recently (noticed this week) I’ve developed a triangular patch of thinning on the upper part of my scalp. It’s NOT on my crown, more the part on front of the crown on the top of the head. The border is fairly sharp, and I don’t recall it looking like this before. Whilst that area was a little thinner before I started treatment, this “patch” must have developed in no more than the last 3/4 months (which would seem awfully fast for MPB) . The rest of my crown looks normal (as you can see in the other photo).

I’ve attached 3 photos taken today:

  • Two of the thinning patch from above

  • One of my crown from the same day

It would seem weird to me if this were MPB related because this part of the hair doesn’t usually thin before the crown, hairline and temples (all of which are intact for me).

Could this be a medication related shed?

Some thoughts and advice would be appreciated. Thanks folks.

2

It almost sounds like you’re describing alopecia areata, but that looks too close to the crown to me. Isn’t it more likely that it’s been thinning and it just reached a critical point where you can see it clearly? Are you microneedling?

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I think the photo is a touch deceptive. It’s more like the area above the infamous island area.

I’m up to the teeth on DHT blockers and should (having started about 8 months ago) be reaching a “protective peak” with Dutasteride, and so this is why it doesn’t make sense to me.

I’m very “mirror” aware, and this spot, whilst always being a weaker area (even as far back as ten years ago) it has never worsened until literally the last 3 months (at the most).

I felt like it could be caused by other factors like shedding etc but because it’s in a weaker area it maybe just looks more prominent. And again, I don’t have any temple or crown recession, and so it feels outside the “pattern” of male pattern hairloss for it to randomly start here.

and no, I don’t microneedle.