Advanced Hair Loss Case in a 41-Year-Old Male: Biopsy and Custom Plan After Transplants, PRP, and Finasteride in Houston & Katy, TX
Provider: Reena Jogi MD – Hair Loss & Scalp Specialist | Houston & Katy, Texas
Hair loss treatment isn’t one-size-fits-all—especially in patients who have already tried multiple options. At our Houston and Katy, TX hair loss clinic, we recently evaluated a 41-year-old male patient with longstanding diffuse scalp hair loss and a history of aggressive treatment efforts, now seeking clarity through a scalp biopsy and expert consultation.
Extensive Treatment History
This patient had been proactive for years, having already undergone:
Two hair transplants (2020 and 2024)
Topical and oral finasteride
Topical minoxidil (via Hims formulation)
Oral vitamins from Korea and Turkey
Home-use laser cap therapy
Avoidance of harsh products, hair dye, and even standard shampoos (he uses only water)
No known chronic illness or systemic conditions
Despite these interventions, he continued to notice ongoing hair thinning, leading him to seek a second opinion with Dr. Reena Jogi.
Patient Concerns
The patient expressed interest in:
High DHT-suppressing treatments like dutasteride
Scalp biopsy to rule out hidden inflammatory or autoimmune hair loss
Exploring any overlooked causes such as heat exposure from saunas or oil treatments
Clinical Evaluation
A full scalp examination and trichoscopy revealed:
Miniaturized follicles and hair diameter variability, supporting androgenetic alopecia (AGA)
No signs of active inflammation or scarring, ruling out classic autoimmune alopecia (e.g., lichen planopilaris)
However, given the complexity and previous surgical history, a punch biopsy was performed on the left medial frontal scalp to rule out any underlying scarring alopecia.
Punch Biopsy Details:
4mm sample collected under local anesthesia
Sutures placed and scheduled for removal in 10 days
Pathology results pending
Working Diagnosis:
Androgenetic Alopecia (Male Pattern Hair Loss)
Longstanding, genetically driven condition with a history of gradual progression
No scarring or autoimmune component noted on clinical exam
Expected scarring from previous transplant sites
Treatment Plan: On Hold Pending Biopsy
Dr. Jogi advised the patient to continue his current regimen until biopsy results are reviewed. Future options to be discussed may include:
Oral Dutasteride (more potent DHT blocker)
Oral Minoxidil for systemic stimulation
Additional PRP or AlmaTED therapy
Scalp microneedling or advanced medical therapy
The patient was also counseled on:
Expected progression of AGA
Realistic goals post-transplant and after multiple therapies
Potential risks of ongoing therapies
Next Steps
The patient is scheduled to return in 2 weeks for:
Suture removal
Biopsy result review
Adjustments to treatment plan based on final diagnosis
📞Call Honey C. the office to schedule an appointment now!
