I Tried Everything — PRP, Finasteride, Minoxidil – And Was Continuing to Lose My Hair

If you have tried PRP, finasteride, and minoxidil, have waited several months but noticed that your hairline continues to retreat, then this article will interest you. It will not tell you about trying another serum or just waiting a little bit longer. But rather about why PRP, minoxidil, and finasteride work wonderfully well on some men while doing nothing for other people.

This case is one of the most common in our practice. Let's look at it in detail.

Our patient — a 38-year-old man — first arrived to see us around two years ago. At the time of our meeting with him, he was suffering from an almost Norwood stage 5 to 6 hair loss – that's hair loss which is difficult to hide, with extensive loss in both the frontal region and the crown. However, what really got our attention was a picture he showed us on his mobile phone. It had been taken a year and a half prior to our meeting.

At the time, he still had almost complete hair coverage – a Norwood 1 to 2, minimal hair recession. In eighteen months, he had gone from having "slightly thinning" hair to being "extensively bald." Moreover, in those same eighteen months, he did everything right.

Once he realized that he was losing hair fast, his initial step was the application of PRP. This treatment course involved six visits in six months, each monthly visit. He shared with us that he had experienced a slight thickening effect initially. However, he did not stop shedding all the way through the entire process. In six months, he became disappointed with PRP treatment and decided to apply finasteride topically and orally, and do this throughout an entire year. When we aligned his photos monthly, the result continued being negative.

Thus, on paper, the patient underwent the two most proven treatments. At the same time, none of them worked. What did happen?

Why wasn't PRP able to help him retain his hair?

PRP (Platelet Rich Plasma) therapy involves extracting your own platelets from your blood along with all the growth factors, which are subsequently introduced into the scalp to promote their positive effects. They can potentially activate inactive hair follicles, enhance circulation in the area and thicken existing hair strands.

However, there is one critical detail that is worth mentioning. PRP does nothing to reduce the presence of DHT. As you know, male pattern hair loss is characterized by DHT bonding with follicular receptors causing gradual shrinking of those hair follicles in successive cycles. PRP improves the microenvironment around the follicle, but does nothing to the hormonal signaling leading to follicular miniaturization. Thus, in case of genetically driven hair loss, even though PRP can achieve temporary results, the overall battle will eventually be lost anyway. Studies confirm this by showing that PRP yields better results at early stages and requires regular procedures to maintain effects.

So he did not become a victim of deception. He just applied an ineffective treatment option.

Why wasn't finasteride working, either?

Finasteride is pretty much the only brake on male pattern hair loss that we can call a real one. Not only does it inhibit DHT formation; it also lowers the actual amount of DHT in the body. And for many men, it works quite well. However, it doesn't work for all of them – from studies, the efficacy of medication in question tends to fall in a broad range between thirty and sixty percent, while being far more effective on the crown than the hairline, where this particular patient experienced the biggest losses.

Besides, there are a number of men, for whom finasteride just isn't an answer. They don't lack willpower and aren't taking too low of a dose – they just aren't responding positively to it. Their hormonal balance, genetics, and hair follicles seem to be resistant to its effects. Apparently, our patient was among them.

We have here a case where a man took up both of the best non-surgical solutions and used them correctly for sufficient time but still ended up losing most of his hair. This would be very frustrating on its own. There was also another factor that worked against him; however, he was not aware of it at all.

What nobody seems to realise: stress, and what life does to your follicles

In explaining what happened over those eighteen months, something else came into view which didn't have anything to do with hair products. During that same time frame, he had gone through a divorce, seen his business fail, stopped eating right, and quit exercising. This had clearly been one of the most difficult periods of his life.

The significance of this is far greater than most people appreciate. Psychological stress leads to the activation of the HPA axis and an elevation in cortisol. High levels of prolonged stress hormones cause hair follicles to be ejected from their normal growth stage early and causes inflammation around them, making the scalp environment unsuitable for growth. When combined with malnutrition and a lack of exercise, the very building blocks necessary for repair are removed. There's nothing in your genetics for stress to cause MPB, but it can be used as a catalyst that causes rapid loss of hair where normally, things would happen slowly. In terms of hair loss, we've seen very few things as damaging as a combination of genetics and stress. Whenever you have the two together, there have been instances where no lotion, no shots, and no medication is able to stop the tide completely.

Was then the two-year treatment process wasted?

It is the point in the story where everything changed, yet was a point he was never aware of before.

Not really, they were not wasted. In fact, they have only worked differently than he was expecting, because they did not work for the hairs where he wanted them to work. While the PRP and finasteride therapy could not save the bald spots, they were actually stimulating the hair growth on the back and side parts of his scalp, the donor zone. The zone is inherently resilient to DHT and therefore makes a transplant possible. And with the increased blood flow and stimulation of the follicles over many months, his donor area did not just survive but flourished.

But this is not an exception, it is something we use on every single patient intentionally.

Our decision to ask about the previous treatment history even before the hair transplant itself

Here at our clinic we do not work from the patient as having the hair transplant. Instead, we are working backwards. The reason we start the assessment of treatment history is that in most cases, the most appropriate solution is the support treatment not the surgery.

Most of our patients are international, so they arrange their procedure with us about five-six months before visiting the clinic. We use this time deliberately; potential suitable candidates are advised to get PRP or mesotherapy before coming to the clinic. There are clear scientific reasons behind this. PRP and mesotherapy that is performed pre-operatively positively affects blood circulation of both the donor area and the treatment zone. As a result of that follicles get strength and the scalp becomes vascularised and ready to be operated upon. The transplant of grafts into the well-vascularised scalp will shorten recovery time and the growth of new hair will be stronger. From our practice, we have found that using this method helps us to achieve even 20-30% better end result and science has confirmed it too as extensive research has been done with PRP and it has been stated that graft survival is improved and hair regrowth has been enhanced. Our operations are performed in A+ fully accredited and licensed clinic situated in Istanbul.

What actually worked – From Norwood 6 to Dense Norwood 1–2

This patient presented as Norwood 6. However, due to the successful two-year-long treatment, the donor area was in excellent condition and provided us with superb grafts. We restored his hairline and thickness in such a way that he once again became similar to the man in the older picture on his cell phone, with thick and natural hair.

That is exactly what happened in this situation because of the mechanism of action of finasteride, minoxidil, and PRP. All these methods are aimed at preservation of already existing follicles in an area where genetics, and more specifically stress, were fighting them. In a hair transplant, however, there is another approach applied: follicles, which are resistant to DHT, are relocated from the donor area to the thinning one. They retain their initial DHT-resistance when placed somewhere else, and therefore continue growing successfully even after the medication stops working.

An honest disclaimer

The hairs that we transfer are everlasting; however, the native hairs that were not transferred will continue to thin and fall, hence the reason why we always tell our patients about the importance of maintenance and proper care of the remaining hair. If someone tells you that a transplant will stop your hair from falling permanently, they are lying to you. What a transplant offers is a permanent and natural hair regrowth of the treated regions – if done correctly.

If all else fails and you believe that nothing will work for you, then chances are that you haven't found the right tool for the problem you have. In that case, we invite you to find out what is really going on with your hair through our complimentary consultation session.