Got a buzz cut today and noticed small circular spots with no hair in them. Can’t tell if diffuse MPB? Doesn’t look circular enough or large enough to be Alopecia areata
Have been on 1mg finasteride since 2022-end 2024 and then swapped to dutasteride 0.5mg since then, also started 2.5mg oral minoxodil since end 2024.
Had noticed some thinning in 2022 and hence jumped on finasteride and largely stabilise since EOY 24. Jumped on dutasteride at that point and actually have had a lot of continuous shedding since then. Worsening in the last few months.
Hairline largely the same but a has felt notably thinner throughout and now after getting the buzz cut have noticed all these little patches - what is it and anything to try here?
I microneedle with a dermapen at 1.5mm for 10 min every now and again but admittedly not very consistent (maybe once a month)
TL;DR Can you post us your sides and back scalp? And if possible get A)Scalp biopsy B)blood test C)Trichoscopy done D)Tell whether you have/had autoimmune problems.
patches look like alopecia areta. thinning on vertex looks like androgenetic alopecia but thinning on temples or formation of widow’s peak is missing. a crucial detail is that if vertex thinning has “stabilized” per your terms with finasteride/dutasteride (vertex follicles are androgen sensitive (though not T but DHT for very large majority of cases) follicles), it is likely androgenetic alopecia. i would 1) recommend you to go see a dermatologist and have him/her look at your scalp with a microscope, if he/she has not such a device find another dermatologist. 2) if possible get a scalp biopsy and a doctor’s assesment in relevant to scalp biopsy done, this will clear everything up. alopecia areta also does not typically have that many and small (less than the size of a coin) patches but this is the closest guess imho.. possible vitamin deficiency perhaps? can you post photos of your occipital and temporal scalp, what you have given to us are vertex, parietal-frontal and lobes (or crown, midscalp and front etc. in layman’s terms). i am not aware of any skin condition that causes this also. i am baffled my man 
*keep in mind androgen sensitive does not mean that T (for it is androgen too) will cause hair loss, most of the time (a very large most) it is the DHT that causes it.
also a hair transplant from donor areas might fix your thinned hair on vertex. keep that in mind too, you can save your hair
