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A 25 year old male who has been using finasteride and dutasteride for two years to treat his hair loss, with no success. Other treatments such as oral minoxidil, topical anti-androgens, RU58841, latanoprost, topical estrogen, CB 03 01, microneedling, keto 2% shampoo, vitamin D, Omega 3, B vitamins and probiotics were discussed.

Topical finasteride concentrations are likely much higher than necessary for effective follicular DHT suppression, with current standards being 100-1000 times above the theoretical minimum. Lower concentrations (0.001-0.0025%) might still work locally while minimizing systemic exposure.

Derma rollers may cause scarring alopecia, leading some to prefer dermastamps or dermapens for microneedling. Combining minoxidil with microneedling is effective, but proper technique and healing time are essential to prevent damage.

Microneedling with 0.6 mm needles combined with 5% minoxidil is more effective for hair count and thickness than minoxidil alone or with 1.2 mm needles. Biweekly microneedling at 0.6 mm depth is recommended for better results in treating androgenetic alopecia.

A gel of keratin microspheres promotes hair follicle growth, showing similar effectiveness to minoxidil in mice. The treatment activates hair growth pathways and reduces inflammation, with potential applications in drug delivery for hair-related disorders.