u/David_XXX7

I’ve been dealing with chronic hair loss since 2021, and the psychological toll has been devastating. I’ve lost three jobs because of the stress, and it’s affecting every part of my life. I’m hoping to get some perspective on my symptoms and the conflicting professional opinions I’ve received.

Background:
The shedding started after two perms in a very short timespan (the first failed, and they did a correction immediately after). Yes yes, why I’ve done this - pathological family, abuse, traumas, harassment from peers - thing like this do not lead to best choices.
My hairline has stayed relatively stable over the last 5 years, though my temples might be slightly thinner. I’ve had naturally large temples since childhood, so it is hard to judge.

Current Symptoms:
Pattern: Diffuse thinning on the top and front. Density is consistently worsening.
The Pull Test: Always positive. Hairs come out extremely easily, even during a light water rinse.
Shedding Characteristics: Shed hairs always have visible white bulbs (club hairs). I shed a mix of thick, thin, and short hairs from all over, including the sides and the occipital area (back of the head). Thin, colorless hairs are less than 20% of all what I shed.
The Scalp: Severe seborrhea (oily scalp), keratin/sebum plugs, chronic itching, and red inflamed patches (especially on the back of the head). I also deal with folliculitis and pimples near the neck and occiput.

Bloodwork (Late 2025):
Vitamin D: 10 ng/ml (Severe deficiency; supplementing for 8 months now).
Folate: 2.84 (Low; supplemented later).
Ferritin: 112 / Iron: 118.
Prolactin: 426 mU/l (Elevated).
Thyroid (FT3/FT4/Antibodies): Mostly normal.

The Conflicting Opinions:

1. Dermatologist Diagnosis (Quick Dermoscopy): Androgenetic Alopecia (AGA) + Telogen Effluvium (TE).
2. Findings: Hair diameter variability, single-hair follicular units, yellow dots, and vellus hairs.
3. Treatment: Topical Finasteride spray.
4. My Concern: She was very hasty, ignored the inflammation/folliculitis entirely, and didn't check the occipital area which is also somewhat thinning.

2. Trichologist Diagnosis (Full Trichoscopy):
Diagnosis: Seborrheic Dermatitis, Folliculitis, and Chronic Telogen Effluvium (CTE).
Findings: Severe buildup/deposits, yellow dots, and reduced follicular efficiency.
Her Take: She specifically stated that this is not androgenic alopecia. If it was, she wouldn’t treat me. She noted that the severe scalp inflammation and deposits made a final diagnosis difficult, but emphasized the inflammatory nature of the loss.

What Confuses Me:
The Hairline: It’s been stable for years. The thinning is diffuse, not recession-based.
Chronic Inflammation: My scalp has been reactive and inflamed since this started.
Miniaturization: While there is hair diameter variability, I don't see huge amounts of transparent vellus hairs, and I see dark "spikes" of regrowth around the hairline.

Does this sound more like:

Diffuse AGA?
Chronic Telogen Effluvium mixed with inflammation?
Seb Derm/Folliculitis causing chronic shedding and pseudo-miniaturization?
A mixed condition?

I’m struggling to decide if I should start the Finasteride or focus entirely on clearing the inflammation and fixing my deficiencies first. Has anyone had a similar experience where inflammation mimicked the signs of AGA? I know the photos are not the best but at least for me I don’t see any significant recession aside from thinning. I’ll be very glad if someone would share their opinion - and yes, I know that specialist should diagnose me, I’m searching for a better one now.