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Q. I have male pattern baldness with extreme hair fall. Please help.

Answered by
Dr. Sidharth Sonthalia
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Sep 15, 2020 and last reviewed on: Sep 19, 2020

Hi doctor,

I am a 45-year old male. My father has male pattern baldness and had lost his hair in his 20's. But I may not have inherited it fully as I have not lost my hair fully at 45 yet. It comes and goes but grows back. But the problem is increasing. And more importantly, it is a very strange hair loss problem, and I do not think it is male pattern baldness.

I have this periodic (6 monthly) hair purge that happens to me. I call it hair purge rather than hair loss because it is just that. I start with a very full and dense head of hair. A purge gets triggered from that state, and in 4-6 weeks from a full head of hair, I am suddenly close to bald with scalp shining through thin streaks of hair. It is like my hair does not have roots anymore. I can keep combing my hair, and the hair keeps coming out. My life comes to a halt, and I am terrified and traumatized during that period. But every time, I feel that somehow I can struggle and stop it by taking some measures each time (Nizoral Shampoo, Zinc, Minoxidil, Biotin, protein, etc.). Every time I find the solution is different, and it stops and my hair grows back gradually to 80% of what it was. Alternate purges are terrible. Every year it has been getting worse. Last two times, I felt that I was able to stop it by having protein supplements. But this time, that is also not working.

I got terrified during the last big purge one year back. So to try and stop this occurring again, I started a regular regiment of daily Centrium multivitamin, and in addition separately daily vitamin C (1000), vitamin E (1000), Omega 3, vitamin D3, a very heavy dose of Biotin (20000 mcg), with some magnesium and selenium. I had been having this for a year, But irrespective, it started again four weeks back, and this time it is worse than ever before. I have just started Zinc as well. And also, I started protein shakes again. I am trying everything, but I still face the hair fall. I am putting Desonide lotion in my hair to soothe the itch but hair purge is still there. I started Minioxidil when this started four weeks back but that increased my itching and so I stopped that.

The mechanism, (I feel) is that it is the oil of my scalp that kills my hair. I wash every day with Nizoral shampoo. When my scalp is clean, there is less hair fall. But in 24 hours, my scalp is oily again and starts itching and hair starts falling like hell. If due to some reason I miss a hair wash one day then the next hair wash is brutal with clumps of hair coming out and I come close to crying.

The most important symptom I can give you is that the hair falls from all over the scalp equally and not just the top. The amount of hair fall from the back of my head is also the same or sometimes more than the fall from the top and front. I can just run my fingers through the back of my head and get 10-15 hair leaves in my hand right now. And then run it again and get four or five more. That is quite strange to me. The hair shedding is from all over. Also hair has become visibly thin. Smaller hair falls more. Another couple of things I noted were:

I had noted some dandruff this time. Its no more there due to daily Nizoral wash, but hair fall is still increasing. Before the start of the purge this time for a couple of months prior, I had a lot of dryness on my face and forehead with dry circular spots with flaky skin and itching. Kindly suggest a solution.



Welcome to

I appreciate the details of the problem mentioned by you. This makes our diagnosis relatively easier; however, there are specific issues that need further clarification.

Have you ever noticed well-demarcated isolated clean patches of hair loss at some point of time? I mean, not the overall generalized hair loss, but appearance of absolutely bald patches within the scalp? Have you noticed shedding of hair from eyebrows, eyelashes or other parts of the body? Do you have any associated medical condition related to thyroid, kidneys or liver?

The above questions are being asked, keeping the possibility of a condition called alopecia areata (AA). This condition typically presents absolutely distinctive clean bald patches surrounded by normal hair. But a special type of AA, known as generalized or diffuse AA, there may not be bald patches separately; instead, it presents with the diffuse episodic falling of hair, the way you have described it.

Of course, you may be suffering from a combination of early stages of male pattern baldness (MPB) and generalized AA. There may be an additional contribution from nutritional deficiency or thyroid disorder, which is called chronic telogen effluvium.

Now, to make a more accurate diagnosis and help you, optimally, I would need the following:

1) It is ideal if you send us some close up well-focused photographs of the hair loss areas. Video conferencing would be ideal.

2) I would advise you to get the following tests done as a part of blood evaluation: Complete Blood Count (CBC), serum TSH levels, serum vitamin B12 levels, serum ferritin levels, anti-TPO antibodies, anti-parietal cell antibodies.

3) The eruption that you experienced over your face was definitely because of excessive dandruff. To control that, use Candid-B lotion as an overnight leave on-lotion over the scalp for 10 nights and use 8X shampoo for alternate day scalp wash, with a five-minute leave-on time.

4) You may require a scalp skin biopsy to confirm the exact reason of your hair fall.

I hope the discussion above may have helped you understand the complexity of the situation of your diagnosis.

Thank you doctor,

The hair fall seems to be quite even. However there is one bald patch on my crown. This can be seen in my attached photo. Sometimes, after I get up I notice some of my body hair shedding. But not always and not from the eyebrows and eyelashes My renal function was normal except for a slightly lower creatinine - 0.7 (0.8-1.5) and globulin 1.7 (1.8-3.6), liver function tests were normal except for a slightly lower globuln 1.7 (1.9-3.5). Thyroid was done and my T4 and TSH were normal. I am attaching additional photos. Please let me know what to do next. The tests will take a lot of time as I am traveling right now. I will start the dandruff treatment as you advised.



Welcome back to

We have received the answers to my posted counter-queries and your serially arranged photographs (attachment removed to protect patient identity) to my satisfaction. The possibility of generalized alopecia areata with additional moderate male pattern baldness seem to be contributing to your overall and dramatic hair loss. The former condition (generalized AA) in your case would ideally require a skin biopsy from the central portion of the scalp by a dermatologist at the earliest opportunity for confirmation so that a strong treatment may be put in place. There is a little likelihood of you having something known as cicatricial alopecia, which is often irreversible in late stages. However, from the pictures, this looks pretty unlikely (although can be ruled out with 100% confidence only after a skin biopsy). So kindly ensure you get a biopsy done by a good dermatologist near you at the earliest.

Pending the biopsy and its reports, I would suggest you the following protocol for getting the condition in some control. Remember, these treatments will take at least two months to show a good effect, as one needs to be really patient in hair treatment. And unless your condition is diagnosed to be what I m suspecting, with absolute certainty, these medications may not be able to help you completely. I hope you may have gauged the importance of skin biopsy by the above discussion.

Treatment suggested:

1) Follow the dandruff precautions with the lotion and shampoo as suggested earlier.

2) Instead of using Candid-B lotion in the night, use it in the daytime over the dry scalp (after shampoo) and leave it on until night.

3) At night around 7 PM, without shampooing again, apply a lotion by the name of Hair-max-forte 1 ml over the entire balding area. The lotion will sting a little for few seconds, but that sensation will finish off. It is a combination of Minoxidil (5%) with additional components Tretinoin and Azelaic acid.

4) Use Grocapix gel (containing Capixyl A) around three hours after applying Hair-max-forte lotion. It is a blue gel, and you need to apply a small blob, sufficient to cover the scalp of the balding area.

5) Take capsule Harvest or Adgain one capsule every day after breakfast.

Later after confirmation of diagnosis you may require intradermal injections of certain medicines to arrest further hair loss and promote hair regrowth. You may also require stronger medicines by mouth depending on the final diagnosis. So start these medications and get a scalp skin biopsy done asap.

I hope this helps.

Hi doctor,

Thank you for your kind help.



Welcome back to

You are welcome. Keep in touch for further doubts.

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