Brief Answer:
Androgenetic alopecia unmasked by Telogen effluvium

Detailed Answer:
Hello. Thank you for writing to us

I have read you query in detail and I have also reviewed the Image. I understand that you are concerned about reduced hair density on frontal and mid scalp.

I have also reviewed the treatment which you have been taking for hair fall and i completely agree with it.

In my view you could be having both Androgenetic alopecia which has been unmasked by Chronic Telogen Effluvium, due to reduced iron stores.

Your Iron stores, suggested by serum ferritin levels are quite low and your hematologic parameters are deranged.
You have anemia even though your hemoglobin is within normal range.
Your anemia is partially compensated by increase in red cell count which is likely responsible for within normal range hemoglobin.

The pattern of hair loss that is visible in picture is suggestive of androgenetic alopecia. There is widened part width which is due to reduced density of hair from the center part of scalp i.e front, and mid of scalp.

Androgenetic alopecia is genetically determined.
Most of those affected don't have underlying hormonal imbalance though it is more common in those who have hormonal imbalance.
Androgenetic alopecia is characterised by reduced density of hair mainy from the center part of scalp i.e front, mid and vertex part of scalp.
There is gradual miniaturization i.e thinning of hair follicles (hair becomes fine) and shortening of anagen phase (growth phase) of hair growth cycle. Patient notices this shortening of anagen phase as reduced length of hair as compared to that once it used to be. They will usually complain that scalp hair does'nt grow as long as they used to earlier before being shed ultimately.

As result of these 2 processes i.e minitaurization and shortened anagen phase there is reduced volume and density of hair in androgenetic alopecia.
This is manifest as widened part width initially and later on as scalp being visible at places.

Androgenetic alopecia may start at any time after puberty in genetically predisposed. It is more common in 30's and 40's as compared to 20's.

Androgenetic alopecia may be unmasked at an early age by hair loss due to other causes like telogen effluvium.

I have reviewed you treatment and I feel that it is perfect for your problem.
You have been asked to use minoxidil solution which is a non-specific hair growth promoter. Ideally it should be used 1 ml twice daily but for convenience your doctor has asked you to use it once daily.
Oral finasteride is specific for androgenetic alopecia and helps to arrest or reverse miniaturization and shortened length of anagen.
WORD OF CAUTION: YOU SHOULD NOT GET PREGNANT WHILE ON FINASTERIDE BECAUSE IT CAN CAUSE FEMINIZATION OF MALE FETUS.
However, finasteride is usually not a problem in females who have completed there families and can ensure adequate contraception.

Besides you have also be advised to take Oral Iron supplement and an Oral Biotin supplement.
Vitamin C (Limcee) is to engance bioavailability of Oral Iron.
Oral Iron would replenish reduced ferritin stores and correct hematologic parameters, which is probably responsible for telogen hair loss.

Oral Biotin would aid hair regrowth as well.

Aim of treatment in androgenetic alopecia is to arrest further progression.
However, patients who start treatment dueing early stages of androgenetic alopecia also notice new hair regrowth and reversal of miniaturization.
Treatment is long term and results are quite gratifying for those who begin therapy early and continue for a long duration.

Regards

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Brief Answer:
Specific answers to queries related to hair loss

Detailed Answer:
Hi.

1. Autrin and limcee would be enough. You need to take these for at least 4- 6 months to replenish iron stores.

2. Foods rich in dietary iron and protein. Red meat, poultry, seafood, green leafy vegetables, dry fruits, peas etc are rich in iron.

3. Normal range of serum ferritin levels is 12-150 ng/ml. Your levels should be within this range.

4. There are no long term side effects of minoxidil and aminexil apart from side effects like dryness, scaling of scalp. You have to use them regularly and over long duration. If you stop them hair would start falling again.

5. Finasteride would inhibit the enzyme 5 alpha reduactase present in hair follicles which convers testosterone to dihydrotestosterone (DHT); DHT is the main culprit behind androgenetic alopecia.
Stopping treatment altogether (both minoxidil and finasteride) won't cause rebound increase in hair fall but you would certainly lose all retained hair and any new hair that you would have grown with treatment.
In my opionon even if you take finasteride alone the results would be good in andrigenetic alopecia. However, they would be better with both minoxidil and finasteride. Finasteride is to be taken life long to maintain the results.
Results are slow and you need to wait at least 6-8 months fo noticeable results.
Traditionally minoxidil was to be used in a lower strength in females i.e 2% rather 5% precisely for the reason that 5% can cause unwanted hair growth on face and forehead. 5% is commonly used in males.
Anyways lot of doctors prescribe 5% in females because of better results and unwanted hair growth is not a problem if it is not allowed to come on to face.

6. This treatment would retain exisitng hair and also increases the chances of new hair regrowth if used over long term and regularly.

7. No I wont suggest any hormonal test in the absence of any signs of hormonal imbalance like menstural irregularity, facial hair Or acne etc.

Regards

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