What should I do 18M facing extreme hair thining and dandruff

What should I do I am really stressed about it to the point where I can’t go on with my daily life I am just laying around not knowing what to do I am only 18 it has been like this for 3years now tried some natural oils and anti hair fall shampoo but nothing happened a year ago I visited a dermatologist but she couldn’t help much either I researched a lot about everything but I can’t cope with the min commitment and fin side effects thought about transplant too but can’t afford it I also have severe dandruff now I just don’t know what to do and I am breaking apart can any of you please suggest me some kind of treatment that I can do rn.

get a trichoscopy done immediatly. you are balding quite aggressively, might be CTE, TE or the classic MPB (AGA, aka male-pattern balding/androgenetic alopecia). I hope that it is CTE/TE, not the MPB. Natural oils, hair fall shampoos etc. are useless for MPB and for those who have routine hairfall but the kind of hairfall where hair re-grows on its own back and even then most are snake oil in my belief. Finasteride’s side effects only affect roughly the %5 of men and they typically go away after stopping it or sometimes keeping on track with treatments. PFS is rare. Dutasteride, fucking ironically, although stronger than finasteride for some reason is thought to have less side effects as it is larger of a molecule and binds to plasma proteins, so you may also go that path under the strict guidance of a doctor, don’t go alone yourself if possible. The time to act is precisely right now my man, good luck! :slight_smile: .

Consider these strictly under the guidance of a doctor if it is confirmed with a trichoscopy that you are losing your hair due to male-pattern-baldness (MPB):
Finasteride 1-1.25mg or Dutasteride 0.5mg Every Day Once (For stopping the further progression of MPB and getting some regrowth.)
Topical Minoxidil 5% twice daily with tretinoin or Low-Dose-Oral-Minoxidil (2.5-5mg) Every Day Once. (For regrowing what you had lost, aka “regrowth”.)
Ketoconazole 2% 2-3 times a week. (For dandruff and very, very mild anti-androgenic effects. Not for oral use, don’t ingest, toxic to the liver.)
Some supplements (eg biotin, these won’t do much but will help nevertheless.)

>>You can also add dutasteride 2-3 times a week orally, while on fin. It is better than finasteride alone, probably not better than dutasteride alone as they are competitive inhibitors, always refer to a doctor and keep that in mind please.

Check for any weight gain, edema, conduct blood and hormone tests if possible throughout the process. For supplements, research whether the amount of eg. zinc that you would be getting is in danger zone or not. In my country 50mg of zinc is easily available over the counter in pharmacies, which is not good typically at that dose. Also hair loss medications if it is due to AGA, are all chronic medications so stay on track if you are prescribed with treatments for as long as possible.

For oral minoxidil, always conduct blood pressure checks if possible. I had adverse effects at 2.5mg per day, but most people are alright so that is why I had included it too, statistically your chance of sides is low but be wary of it nevertheless.

Also the dandruff is typically caused by yeast feeding off the sebum, overproduction of which (the sebum) is triggered by DHT and this in turn may lead to dandruff indirectly. DHT → Overproduction of sebum → Yeast multiplying and feeding of off the sebum thanks to its abundance → Dandruff. Which (Sebum) also can cause acne too. Through ketoconazole+finasteride/dutasteride, you will likely A)get rid of the root cause (DHT) B) get rid of what directly causes dandruff.

I mentioned tretinoin with topical minoxidil as tretinoin upregulates the follicular production of SULT1A1 enzyme which in turn converts minoxidil from its passive form to active form of minoxidil sulfate that signals the hair follicles to start growing hair (DPC signaling). Minoxidil Sulfate, in its raw form is extremely unstable, so don’t try to obtain it. Just get a regular minoxidil and tretinoin with a doctor’s advice. 0.01, 0.05, 0.1, all will likely work, 0.1 would be more irritating but stronger. Pick it wisely with a proper doctor.

Reference on effectiveness on fin vs. dut.