Misdiagnosed for 10+ years... until now.

Summary

Alesandro's decade-long struggle with hair loss involved misdiagnoses and unsuccessful treatments, including minoxidil and finasteride. After a hair transplant, his condition worsened, leading to a breakthrough when a nurse practitioner diagnosed him with alopecia areata incognita, not androgenic alopecia as previously believed. The correct diagnosis and treatment with corticosteroids finally sparked regrowth, highlighting the importance of accurate diagnosis and patient advocacy in hair loss treatment.

Takeaways

• 😔 Alesandro's struggle with hair loss began at a young age and was misdiagnosed multiple times by different physicians, including a transplant surgeon.
• 💊 Despite trying treatments like minoxidil and finasteride, Alesandro did not see improvement and eventually underwent a hair transplant, which initially provided good results but later thinned out.
• 🔍 The script emphasizes the importance of a thorough and accurate diagnosis, suggesting that many dermatologists may not provide the necessary care for hair loss patients.
• 🌟 Alesandro's situation improved when he connected with a community that provided data-driven approaches and eventually received a correct diagnosis of alopeica areata incognita from a specialist.
• 🧬 The story serves as a cautionary tale about the underwhelming care that many hair loss patients receive and the need for patients to advocate for themselves.
• 🔬 Clinical studies show that minoxidil, a common treatment for hair loss, only works for about 40-60% of people due to challenges in penetration and activation.
• 💉 Alesandro's experience with finasteride was not unusual; many users do not see significant results, and the script suggests that higher doses or different drugs might be more effective.
• 🌱 After a decade of treatment failures, Alesandro finally saw regrowth by combining topical finasteride, minoxidil, retinoic acid, and micro-needling, which enhanced the effects of his treatments.
• 📈 The script outlines a five-step framework for tackling hair loss: identifying hair loss types, aligning on goals, building a regimen, tracking results, and adjusting the plan based on data.
• 📚 Alesandro's story underscores the value of educational resources and community support in helping individuals navigate the complexities of hair loss treatments and find effective solutions.

Q & A

What was the initial diagnosis given to Alessandro by five different physicians?

Alessandro was diagnosed with androgenic alopecia on five separate occasions by five different physicians, including a transplant surgeon.

What treatment did Alessandro try before joining the hair loss community site?

Alessandro tried minoxidil, finasteride, and a hair transplant before joining the community site.

Why did Alessandro's minoxidil treatment not work as expected?

Alessandro's minoxidil treatment did not work as expected because topical minoxidil has difficulty penetrating deeper layers of the scalp skin, and many people lack enough activity of the enzyme sulfotransferase in their scalp for minoxidil to be effective.

What is the typical timeframe for seeing results from finasteride treatment?

Clinical studies show that it can take 6 to 10 months to see slight cosmetic improvements from finasteride, with the biggest hair gains coming between months 12 and 24.

Why did Alessandro's hair transplant start thinning after a year?

Alessandro's hair transplant started thinning after a year because he quit taking finasteride, which is necessary to stabilize hair loss and protect the investment of a hair transplant.

What was the turning point in Alessandro's hair loss journey?

The turning point was when Alessandro was correctly diagnosed with alopecia areata incognita by a nurse practitioner trained under Dr. Alfredo Rossi, after being misdiagnosed for over a decade.

What treatment led to Alessandro finally seeing regrowth?

Alessandro started seeing regrowth after incorporating a topical corticosteroid treatment into his routine, as prescribed by the nurse practitioner under Dr. Alfredo Rossi's guidance.

What role did the hair loss community play in Alessandro's journey?

The hair loss community provided Alessandro with resources, support, and a framework to reassess his situation, which ultimately led him to the correct diagnosis and treatment.

What advice does Alessandro have for others struggling with hair loss?

Alessandro advises others to be patient, stay vigilant, and be their own patient advocate, using the resources and community support available to them.

What is the importance of a thorough scalp examination in diagnosing hair loss?

A thorough scalp examination, using a device like a dermatoscope, is crucial for diagnosing hair loss accurately, as it allows clinicians to identify specific markers that can differentiate between various types of hair loss conditions.

Outlines

00:00

🌟 Hair Loss Struggles and Misdiagnosis

The paragraph introduces Alessandro's decade-long battle with hair loss, which was misdiagnosed multiple times as androgenic alopecia. Despite treatments like minoxidil and a hair transplant, his condition worsened. The speaker expresses frustration with the lack of clear communication and incorrect diagnoses from medical professionals, highlighting the emotional toll and financial costs of these failures.

05:00

🔬 The Science Behind Hair Loss Treatments

This section delves into the science behind minoxidil, a topical treatment for hair loss, and its limitations due to penetration issues and enzyme activation requirements. It discusses how combining minoxidil with retinoic acid and micro-needling can enhance its effectiveness. Alessandro's experience with minoxidil was unsuccessful, and the paragraph also covers his transition to finasteride, an oral medication, and the typical timeline for its effects.

10:01

🌱 Hair Transplant Journey and Its Aftermath

Alessandro's decision to undergo a hair transplant is detailed, including his choice of a renowned surgeon in Turkey. The paragraph outlines the transplant process, the surgeon's strategy, and the immediate positive results. However, it also describes the subsequent thinning of the transplanted hair and Alessandro's emotional struggle when he stopped finasteride, leading to increased hair loss.

15:03

🔍 Revisiting Treatments and Seeking New Solutions

After experiencing setbacks, Alessandro reconnects with his surgeon who recommends returning to finasteride. The paragraph discusses the importance of continued treatment post-transplant and the emotional impact of hair loss on Alessandro. It also touches on the desperation and common pitfalls people encounter when exploring various hair growth products without a scientific basis.

20:05

📚 Education and Community Support

Alessandro discovers the speaker's website and community, which offers data-driven approaches and personal support for hair loss. The paragraph explains the community's framework for tackling hair loss, including identifying hair loss types, setting goals, building a regimen, tracking results, and adjusting treatments. Alessandro's decision to join the community and his first interactions are highlighted.

25:06

🛠️ Implementing a New Treatment Plan

The paragraph outlines Alessandro's new treatment plan, which includes topical finasteride, minoxidil with retinoic acid, and micro-needling. It discusses the importance of adherence to the treatment and the use of progress tracking tools. Despite following the plan, Alessandro does not see immediate results, leading to further investigation into potential reasons for his lack of response to treatments.

30:07

🏥 Reevaluating the Diagnosis

As Alessandro's hair loss continues, the paragraph discusses the reevaluation of his diagnosis. It covers the possibility of other hair loss types, such as autoimmune conditions, that might be contributing to his lack of response to standard treatments. The importance of blood tests and the role of DHT levels in assessing treatment effectiveness are also explored.

35:09

🏠 The Impact of a Correct Diagnosis

Alessandro finally receives a correct diagnosis of alopeica areata incognita from a specialist, which explains his poor response to previous treatments. The paragraph details the diagnostic process, the identification of specific signs of alopeica areata, and the immediate treatment with corticosteroids. It also reflects on the simplicity of the diagnosis and the emotional relief it brings after years of struggle.

40:09

🌈 Reflections on the Journey and a Renewed Outlook

In the final paragraph, Alessandro shares his gratitude for the correct diagnosis and treatment, and the positive impact it has had on his life. He emphasizes the importance of education, community, and perseverance in the face of hair loss. The speaker calls for higher standards in hair loss care and offers resources to help viewers advocate for themselves in medical settings.

Keywords

💡Androgenic Alopecia

Androgenic alopecia, also known as pattern hair loss or male/female pattern baldness, is a hereditary condition that affects both men and women and is characterized by a specific pattern of hair loss. In the video, it's mentioned as the initial diagnosis given to Alesandro on multiple occasions by different physicians. Despite treatments typically used for this condition, Alesandro did not see improvement, which led to further investigation into his hair loss.

💡Miniaturizing

The term 'miniaturizing' refers to the process where hair follicles shrink, leading to thinner and shorter hair growth cycles. In the video, it's used to describe the ongoing hair loss Alesandro experienced, despite treatments. It's a key concept in understanding pattern hair loss, as it indicates the progression of hair follicle deterioration.

💡Finasteride

Finasteride is a medication often prescribed to treat hair loss, particularly androgenic alopecia, by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), which is implicated in hair follicle miniaturization. Alesandro was prescribed finasteride, but the script discusses his struggle with side effects and the decision to switch to a topical version.

💡Minoxidil

Minoxidil is a topical treatment used to stimulate hair growth in pattern hair loss. It is mentioned in the script as a therapy Alesandro tried without success. The video discusses the challenges with minoxidil's efficacy, including its inability to penetrate the scalp effectively in some individuals.

💡Hair Transplant

A hair transplant is a surgical procedure that moves hair follicles from one part of the body to balding areas. Alesandro underwent a hair transplant, expecting it to be a solution to his hair loss. However, the video highlights that without addressing the underlying cause of hair loss, transplanted hair may not thrive.

💡Autoimmune Hair Loss Disorders

Autoimmune hair loss disorders, such as Alopecia Areata, occur when the body's immune system mistakenly attacks hair follicles. The video reveals that Alesandro was later diagnosed with Alopecia Areata incognita, an autoimmune condition that was not identified in his initial consultations, which could explain his lack of response to traditional hair loss treatments.

💡Corticosteroids

Corticosteroids are a class of drugs that have anti-inflammatory and immunosuppressive properties. In the context of the video, they are used to treat Alesandro's Alopecia Areata incognita. After the correct diagnosis, Alesandro started using a topical corticosteroid, which helped to halt his hair loss and promote regrowth.

💡Microneedling

Microneedling is a procedure in which tiny needles are used to create small punctures in the skin to stimulate collagen production and improve skin texture. In the video, Alesandro tried microneedling as part of his hair loss treatment regimen, hoping to enhance the effects of minoxidil by improving its penetration into the scalp.

💡Retinoic Acid

Retinoic acid is a derivative of vitamin A that is used in skincare for its ability to increase cell turnover and potentially improve the penetration of other treatments. The video mentions combining retinoic acid with minoxidil to enhance its effectiveness, which was part of Alesandro's treatment plan before his correct diagnosis.

💡Differential Diagnosis

Differential diagnosis is the process of identifying the possible causes of a patient's symptoms and signs to establish the correct diagnosis. The video emphasizes the importance of differential diagnosis in Alesandro's case, as it was only through this process that his Alopecia Areata incognita was identified, which had been overlooked in his previous consultations.

Highlights

Alesandro's hair loss journey began at a young age, causing significant distress.

Despite multiple diagnoses of androgenic alopecia, treatments like minoxidil and finasteride failed to stop his hair loss.

A hair transplant initially showed promise but began to thin after a year, leading to further despair.

Alesandro's story underscores the common issue of misdiagnosis and inadequate care in hair loss treatment.

The importance of a thorough scalp examination and clear diagnosis before treatment was emphasized.

Alesandro's experience with minoxidil was not unusual, as many users discontinue use due to perceived ineffectiveness.

Combining minoxidil with retinoic acid and micro-needling can enhance its effectiveness.

Finasteride's full effects can take up to two years to manifest, which many patients and clinicians may not realize.

Alesandro's decision to stop finasteride cold turkey led to a rapid resurgence of hair loss.

The psychological impact of hair loss on Alesandro was profound, affecting his self-esteem and mental health.

Alesandro's encounter with a nurse practitioner under Dr. Alfredo Rossi led to a correct diagnosis of alopeica areata incognita.

The correct diagnosis of alopeica areata incognita alongside androgenic alopecia explained Alesandro's treatment resistance.

Alesandro began treatment with a topical corticosteroid, which led to noticeable regrowth.

The video provides a framework and checklist for individuals to advocate for themselves during dermatology appointments.

Alesandro's story concludes with a message of hope and the importance of perseverance in the face of hair loss.

The video calls for a higher standard of care in the diagnosis and treatment of hair loss.

Transcripts

look here your hair is still

miniaturizing Finance rate is not

working with you I hit rock bottom you

know in my mind I wasn't thinking you

may have something else there is another

maybe kind of loss that is taking place

so I was 5 seconds away from an answer

for 10 years and it was clear to her and

it wasn't clear to them did they know

and not told me it's something that I

keep asking myself

imagine getting diagnosed with patternn

hair loss hopping on fastrite hopping on

minoxidil but over the next decade your

hair loss just gets worse imagine paying

thousands of dollars for a hair

transplant only for one year later that

transplant to start

thinning this is the story of alesandro

he's a member of our community with a

10year history of treatment failures

prior to joining our site today he's

finally seeing regrowth and in this

video we're going to detail exactly how

he got

there here's what I find Crazy

allesandro was diagnosed with androgenic

alipa on five separate occasions by five

different Physicians including a

transplant surgeon the diagnosis was

wrong his story is as much a cautionary

tale as it is a reflection of the

underwhelming care that too many

dermatologist provide to hair loss

patients I hope you can use the

takeaways from this interview so that

you never have to go through the same

experience we'll cover alesandro's story

and the datadriven approach that we

applied while working with him you'll

learn about his treatment mistakes his

successes the strategies for tackling

endogenic alopecia you might be

interested in strategies for autoimmune

hair loss disorders and most importantly

how to dominate your next dermatology

appointment and force your clinician to

give you a proper scalp exam and a clear

diagnosis we even have a video and a PDF

for that which you can download below

but for now let's get into alesandro's

story As Told by him and we'll make this

as educational and impactful as

possible my hair loss started when I was

really really young so I was like not

even 14 I was a child I went to the

barber and he told me he was a friend of

my father's and he told me I see some I

wouldn't say bold spots but you know

some lack of density here on the top of

of my sculp my type of hair loss was I I

started like to have a reeding hairline

basically to lose some density in the in

the in the center so from here backwards

yeah that was terrifying I was like in

high school so it was really really you

know tough on me as a as a kid and so he

told my father he told me and I was like

quite shocked we we met uh this

dermatologist and he told me I mean yeah

you suffer from alishia like your father

it's genetic there's nothing you can do

after a year or two years my situation

was getting worse slowly but surely

worse so that's when we swap doct we

change the doctor another dermatologist

told me maybe you should give minoxidil

a try so I went to a pharmacy here in

Italy I don't know if in the US as well

but we have pharmacies that prepare the

minox themselves so I went for for it

and uh I started doing this say therapy

so uh 2 milliliters uh twice a day for

those who don't know topical minoxidil

is a drug used to treat pattern hair

loss also known as androgenic alopecia

it helps improve micro circulation it

might reduce inflammatory substances

called prostaglandins and clinical

studies show a strong enough safety

profile for the FDA to approve minoxidil

as an over-the-counter medication for

androgenic Alopecia now safe is one

thing effective is another we're going

to get to that in a second but for now

just know that many pattern hair loss

patients who are younger than 18 they'll

generally only be recommended minoxidil

partly because it might help but also

because some of the more powerful drugs

used to treat pattern hair loss things

like faside they can POS developmental

risks for those who are still in

adolescence so how did alesandro's

experience with Minoxidil go I quit

minoxidil after one year when I was 15

16 I quit minoxidil nothing really

worked but I kept applying it blindly

I'd say I was really young so I didn't

even know really what to do and how to

do it this isn't surprising despite

being FDA approved alesandro's poor

experience with Minoxidil is not the

exception it's the rule in this clinical

study researchers found that 95% of

minoxidil users quit within one year and

2third of those users said that they

stopped because the drug had no effect

so is there any truth to corroborate

that well yes a deeper look into the

clinical data shows that topical

minoxidil actually only works for about

40 to 60% of people the reason why is

twofold first topical minoxidil has a

hard time penetrating into deeper layers

of the scalp skin where our hair

follicles reside and second topical

minoxidil is delivered inactively it

needs to come into contact with an

enzyme called sulot transferase in order

to sulfate or activate and then it can

attach to our hair follicles and have an

effect no sulfo transferase no way for

minoxidil to work and a lot of people

don't have enough activity of this

enzyme in their scalp for minoxidil to

get the job done fortunately studies

also show that these are fixable

problems if you combine topical

minoxidil with retinoic acid and Micron

needling you can enhance its penetration

and its activation potentially seeing up

to fourfold better results it's that

simple and if clinicians did a better

job educating patients about these

options my guess is that a lot more

people would be sticking with Minoxidil

a lot fewer people would be saying it

doesn't work alesandro did not have that

information so let's see where he goes

next when I wasn't like 17 18 I talked

to the doctor again to the first

dermatologist and he told me now you're

old enough to try the Finas

ride and I was I I wouldn't say I was

desperate I said yeah yeah let's let's

right I mean you are a doctor you're

telling me this and it's I I guess one

of the best or most uh famous treatments

for hell loss so I said yeah why not and

he he told me ah you're going to improve

a lot with this you're

like everything will be fine everything

is going to be all right so I I was

super happy that was almost 11 years ago

this makes sense alesandro is now 18

years old he's eligible for five Alpha

reductase Inhibitors like oral faside

these medications they lower levels of

dihydrotestosterone also known as DHT

which is the hormone causely linked to

the balding process and in doing so they

can help regrow hair for what it's worth

faside is considered the gold standard

drug for treating androgenic alopecia in

men dozens of studies show good hair

growth outcomes decent safety profiles

and sustained hair regrowth 1 2 5 even

10 years into the future this all sounds

great so what happened when allesandro

started taking finasteride what was his

response like so I started to to to do

with the to take the FAS ride and I was

I was thinking if I remember correctly

one milligram so I did this for a few

years and my hair loss was slow year by

year I couldn't tell if I was getting

really really worse or not so I thought

maybe it's working maybe it's not

obviously I didn't gain like new hair

I'm not improving but I'm not even like

getting worse so I was really confused

you know here's another thing most

clinicians will not educate their

patients on how long it takes for hair

growth drugs to actually work for finast

ride the clinical studies show that it

can take 6 to 10 months just to see

slight cosmetic improvements but the

biggest hair gains those actually come

between months 12 and months 24 all too

often our team sees people quitting

finast at month three month four saying

they tried it and it didn't work they

have no idea that it takes a full two

years to achieve its effects and if

clinicians let people know about this

while prescribing I think a lot more of

their patients would have better

adherence and thereby better outcomes

another thing is that most clinicians

don't tell their patients what it means

to respond to finasteride some patients

Envision full hair regrowth in reality

response means something different it

means any slowing stopping or partial

reversal of hair loss versus a placebo

technically you can still be benefiting

from finast but still losing hair just

at a slower rate than how you would if

you weren't using the medication we talk

about this in our video series about

finasteride non-responders so keep this

in mind a slowing of hair loss is still

technically a response now let's go back

to alesandro and what he decided to do

next when I was 23 24 I said okay that's

enough uh nothing is working with me the

only solution I thought was the hair

transplant so I started looking for

surgeons and I found a top one a really

famous one which is in Turkey uh not to

be confused with those guys that you

know they they sell you hair transplants

for

$2,000 it's not one of them he's a great

guy and he's like really really famous

so I went to talk to him in

turkey and he told me yeah what we have

to do here is do five 5,000 grafts which

is the maximum they can take from the

side and the back of your head and put

it in the top so he said let's not lower

the hairline let stay there and let's

work our way from here to the back so my

my hair transplant reached let's say

here so I didn't touch the vertex the

vertex wasn't involved he told me you

can you could be a great patient uh your

transplant is going to turn uh really

great uh let's do it so I did it I was

24 so six years ago the clinic was

awesome uh it was treated like a king

everything went well uh the day of the

operation the surgery after the surgery

they told me your crafts so the hair

they plucked from the sides and the back

survived really good they were healthy

everything went well uh so I went back

home I waited a few months obviously I

wasn't sleeping at night you know I was

like oh my God I'm gonna have new hair

it's gonna be awesome and I must say the

hair transplant worked really well the

hairline was great was so natural the

results were was amazing to me so I was

really happy um they told me one year

before the the transplant they told me

keep keep taking Finas ride don't don't

quit the Finas ride because the finess

ride will help you also after the

transplant so that's what I did I kept

taking Finas ride uh what's funny is

that when I went to the clinic to meet

the surgeon he put He put my scalp under

a microscope and he told me look here

and he he pointed at my hair you're

still your hair is

miniaturizing so fin R is not working

with you and I was like I was struck I

was like what I mean crazy and he told

me yeah but you know maybe maybe it's

because the you're taking the one

prepared by the pharmacy so maybe it's

not that strong uh use the proser which

is a famous one you can find anywhere so

yeah I said yeah maybe maybe it's uh

that's why maybe that's why for

reference there are a number of dosing

studies on faside with participants

testing anywhere from2 mg up to 5 mg

daily for regrowth these doses they all

roughly reduce the same amount of serum

and scalp DHT however most of the

studies still show directionally better

results for people on higher doses of

finasteride Alexandre was prescribed 1

milligram daily procar is the 5

milligram version of finasteride so I

understand why his surgeon made this

recommendation there's a little upside

with a higher dose however the key word

here is little The increased hair gains

going from 1 to 5 migs of finasteride

it's very marginal which means this is a

low leverage recommendation with a not

so big payout what would have been more

impactful well perhaps maybe switching

from finasteride to dutasteride as

dutasteride can reduce more DHT and lead

to significantly better hair growth

outcomes versus finasteride and yet

dutasteride in many domains will share a

similar safety profile so if you find

yourself in this situation keep in mind

that there are High leverage regrowth

options at your disposal now back to

alesandro so after one year of the

transplant my results were complete

let's say I was happy I was still taking

a Finas ride but at that point I said

okay now I have like a good situation

I'm happy I don't want to take Finas

ride anymore I don't want to be on drugs

uh I don't want to be taking any any any

medication any drug so I made a huge

mistake I guess maybe I quit to cold

turkey only after a few months so after

a year and six months after my

transplant I started to see some loss of

density in my in my scalp so I panicked

and I said oh my God it's not possible

it's not possible that my situation is

getting worse again just after a year

and a few months after my transplant so

that was really really when I hit a

really rock bottom you know it was like

mentally was super tough because I had

the impression the idea that

I I was able to overcome my problem and

after just one year and a and a half I

was back at I wouldn't say square one

because I still kept some hair but it

was noticeable for people in alesandro's

position this sentiment is incredibly

common a transplant can dramatically

boost the appearance of your hair to the

point where you can feel so good so

confident that you forget that hair loss

in the surrounding areas can still

progress if you want to protect that

investment that hair transplant you

generally need to make sure that your

hair loss is completely stabilized and

the most studied and reliable way to do

this for men is with finasteride so what

happens when somebody quits that drug

well here's a chart showing that within

3 months hair shedding starts to

increase and within 12 months you're

usually back to where you would have

been prior to using the drug in the

first place the bottom line you should

be aware of these risks be aware of the

withdrawal effects even if you're

feeling good about your hair that was

really really when i h really rock

bottom you know it was like mentally was

super tough because I had the impression

the idea that I I was able to overcome

my problem and after just one year and a

and a half I was back at I wouldn't say

square one because I still kept some

hair and uh it wasn't like day by day

but it was noticeable let's say that's

when I talked to the surgeon again and

he told me yeah you quit Finas ride you

shouldn't have let's I want you to go

back on Finas ride and let's see what

happened so a few a few more uh months

have passed and then the pandemic hit

and was really tough yeah what happened

was I I didn't

have any solution at that point I was

stuck this is not unfamiliar territory

for hair loss sufferers when people

experience setbacks when they experience

treatment failures desperation can set

in it's as if every hair growth ad

starts to find you and you fall into

this habit of maybe buying pills topical

supplements shampoos devices without any

trial and error process in place and

without knowing if these marketing

claims that you're seeing even align

with scientific reality most of the time

they don't and in researching one

product allesandro had bought that's

actually how he stumbled across our site

so one day uh I was reading an article

uh on R mushroom because I was always

looking for you know new information or

some something new I just bought a 40 €

40 uh

lotion from a you know a really

well-known

brand where some R mushroom was in it

when I started reading the article I was

so so angry man because I thought maybe

this RI mushroom is can you know can

work it's a solution but then I and I I

was mad at the the guy who wrote the

article because I said ah this guy is's

lying no it's working it will work for

me and but in the end I must admit the

article was really really well done and

I started to say who's this guy I mean

who's this website and it's it's so

interesting I reached out it was

obviously was your your website your

community I reached out and uh just

after a few days I I read all the

literature on the website I read all the

you know all the guides you you wrote

and I was super hopeful I said this guy

is going to help me I know we can find a

solution together I know we can work

together and uh yeah that's that's when

we we met the first time alesandro ended

up joining our membership Community this

is where we offer educational resources

and personal support for people fighting

hair loss prior to joining most members

find themselves in a position where

they're not seeing success they're tired

of earning cash they're over the

marketing gimmicks and they're ready to

have a clear path forward one that will

respect their treatment preferences and

also come with support from people

people who only care about getting them

a good outcome not selling them into

some hair care brand cuz they affiliate

with them allesandro had also opted for

our coaching package which means that he

and I would have the chance to connect

every week during a 1 to two hour group

call I like this format because it

creates multiple touch points it helps

with accountability and those things for

people who have complicated cases really

help to go for the best outcomes on our

first call together allesandro detailed

all of his treatment attempts all of his

failures the transplant everything then

after getting that information we began

to implement a framework that we use

with everybody inside of our site one

identify your hair loss types two align

on goals three build a regimen four

track for results and five adjust

accordingly Based on data not emotion so

let's apply this framework using what we

know about alesandro so far first he's

got a familiar history of androgenic

alopecia he also described hairloss and

regions associated with androgenic

alopecia the temples in the frontal for

loock of his scalp he says his hair loss

has been gradual over a series of years

and he's had four or five dermatologists

and a transplant surgeon all align on

the same diagnosis androgenic alopecia

nothing else this makes for a very

strong case that allesandro is dealing

with androgenic alipa so we'll call that

step closed for now second alisandra let

us know that he wanted new hair growth

but he also was getting side effects

from oral finasteride and he wanted to

find a way to quit the medication this

allowed us to Define clear goals first

get alesandro hair regrowth and second

eliminate his side effects from fastr

for step three we have to take in

account alesandro's treatment history he

didn't see hair regrowth from faside

however he noticed a big shed when he

quit the drug that suggests that maybe

faside was working he just fell into

that category where it was slowing

things down not necessarily reversing

the loss moreover allesandro quit

topical minoxidil after one year but he

didn't know about all these adant

therapies the retinoic acid the Micron

needling that might have helped him turn

into a responder given the alignments of

his diagnosis the past treatment

attempts the strong data supporting the

things that we just talked about in

helping androgenic alpia patients we

decided to show him this data and we

also showed Alexandre the results

Horizons for these treatments that's the

time that it would take for them to

start producing cosmetic results after

reflecting on all of this alesandro

settled on the following plan topical

finasteride which some studies show

should allow him to Leverage The Power

of oral finasteride but with a lower

risk of side effects 5% minoxidil

combined with retinoic acid and finally

micr needling which along with the

retinoic acid should help to enhance the

effects of minoxidil alesandro also oped

to try some other stimulation-based

interventions like the scalp massages

because he felt that his scalp perimeter

muscles appeared to be really tight and

he found the exercise to be very

relaxing so this was his new plan

allesandro intended to try these things

for at least four to 6 months which is

the short end of when we might expect

cosmetic improvements and he also chose

to track his progress through self

assessments and subjective measurements

of his own hair shedding now those

metrics they're certainly not perfect

usually we want people to be tracking

with our progress logs tool where you

upload your regimen your photos you tag

the dates you tag the scalp regions of

the photos and then this Autos sorts to

give you a fully private fully

standardized log that is super easy to

navigate super easy to update and

examine your progress in any specific

scalp region and if you choose you can

also share that log with our community

so our team and others can provide

feedback and support but for people who

have been fighting hair loss for a long

time they often have the self-awareness

to know if something is or isn't working

alesandro had that and so these

measurement tools that he settled on

were going to be what worked for him

personally I had high hopes for

alesandro's protocol I mean the clinical

data strongly suggests that this new

regimen if followed properly should

achieve some significant results and

while adherence can be a problem for

some people which is why we built our

treatments calendar which sends you push

reminders via your phone for when you

need to micro needle or apply topicals

or use a shampoo with ketoconazol any of

that alesandro happened to be a person

who was highly motivated and as our

group calls continued it became more and

more apparent that he just had no issues

on the adherence front so fast forward a

few months allisandro is adhering to the

plan he's showing up to the calls he's

engaging our team he's even reported

that his side effects from finast ride

have subsided this is great news one of

our goals is already accomplished but

how was his hair doing I was spending

like quite some time you know every day

working on my sculp I did everything I

could and uh I made sure I did it

correctly so I was like asking you

thousand questions to make sure I was

using the micro needling I bought a pen

so it was like also an economic you know

um investment I was doing all these

things and I was applying the uh at this

point I switched from oral to topical

Finas I was applying it after after the

minoxidil every night and it was leaving

my hair horrible in the morning and

after a few a few months I was hoping

that the massages would be working in a

way but I didn't see any growth the

micro needling as well wasn't even you

know I wasn't getting the results other

people were getting this was hard to

hear despite the new protocol allesandro

had seen effectively no changes to his

rate of hairfall no changes in the

progression of his hair loss no signals

that what he was doing was doing

anything now keep in mind that while

that experience feels discouraging we

have to remember our fifth pillar using

data to make adjustments responding to

these treatments would have been

wonderful but not responding to them

that's still great data because that

data even if it's negative helps to

provide insights that we can start to

use to troubleshoot maybe ask better

questions and adjusting the plan so what

might be going on here well possibility

number one is that maybe allesandro

needs more time for results

after all we've only just reached that

minimum viable point for results

Horizons especially with faside the best

results aren't even realized until year

two of the medication now In fairness to

alesandro he had been using finast on

and off for the better part of a decade

so while this was still a possibility it

might not necessarily be a plausibility

even still this is an easy thing to test

all Alexandre needs to do is just keep

trying his treatment protocol and we can

evaluate in the coming months Poss Poss

ility number two is that something else

is going on either allesandro has

something preventing him from seeing

hairy growth from androgenic alopecia

treatments or he might have another type

of hair loss that needs to be treated

differently preventing him from getting

results so let's start with that first

category these blockers to hair regrowth

from androgenic alopecia according to

the clinical data people with igf-1 or

growth hormone deficiencies they tend to

see really poor responses to hair growth

drugs like minoxidil and finasteride

again this is easy enough to test just

get a serum test for igf-1 if it's low

medical professionals can help you

identify why that's low and in many

cases get you treatment and get those

levels back to Optimal moreover many of

our members who consider themselves

non-responders to finasteride will later

do blood tests for DHT and a huge

portion of them have found that their

serum DHT levels they're not depressed

they're actually within normal to high

ranges the implication here is that for

these members maybe those DHT reduced

drugs might not be having much of a DHT

reducing effect again this is easy to

test for just get a serum DHT test if

it's low great if it's normal or high

consider upping your dose of finasteride

switching to dutasteride switching to

topical dutasteride these things have

helped many of the members in this

category move from that non-responder to

responder class for 5 Alpha reductase

Inhibitors so on this front what were

the results for allesandro well he got

blood work his IG F1 levels looked

totally normal great that's another

piece of data so what about his serum

DHT levels well allesandro had actually

gotten a number of DHT tests while still

taking oral finasteride an oral

finasteride at 1 milligram to 5 mg is

supposed to reduce blood levels of DHT

by about 70% he told us his results his

DHT was always in the normal range

sometimes it was even high unfortunately

allesandro was a bit stuck on what he

could do about this because keep in mind

that he already got side effects from

oral finasteride which is why he made

the switch to the topical if he UPS his

topical dose more of that drug might Le

into the bloodstream and start causing

the same side effects as the oral

medication now he could try to lower his

scalp DHT through other means like

Androgen receptor antagonists this might

include experimental options you might

have heard of some of these topical

spirolactone topical flil topical cb31

ru58841 topical pomide and others but

but all of these options they lack

long-term safety and efficacy data on

men so understandably alesandro wasn't

really interested at this stage in

exploring them so what about the

possibility of other hair loss types

maybe masking as androgenic alopecia or

preventing a response from alesandro's

current treatments well we have some

tools to evaluate this here you can

evaluate your health history and then

cross reference any unusual symptoms you

have with conditions that are linked to

hair shedding dis disorders such as

telen of fluvium then you can go about

systematically tackling each of those

suspected causes so say you've got a

thyroid disorder or a vitamin deficiency

or anything if it's having an impact on

your hair then if you address those

causes it should also help to improve

your hair for anyone interested in help

on this we have a regrowth road map

Health assessment survey inside of our

site that can help you out with that

process but alesandro did lab testing

here too based on his symptoms and the

results didn't really tell us too much

we checked my testosterone levels dedr

testosterone levels so we we I did

plenty of exams I did really everything

and uh I would say results came back

pretty normal except my bil Rubin so as

you said before maybe um I had elevated

Billy Rubin which is correlated to uh

the Gilbert Syndrome which is just a

condition I I it doesn't have any impact

on on your life but it gives me some uh

yellowish let's say in my in my eyes but

as you as you rightly said before always

thinking about the let's say standard

androgenic alopa not not you know not

outside of those of that box the good

news was that alesandro's lab tests

helped him rule out some of the

potential secondary causes of hair loss

the bad news was that it didn't

definitively answer why he remained such

a poor responder to such a strong hair

growth stack and as another month or two

passed he started to go deeper into

those results Horizon Windows yet his

situation was not changing no slowing

down of hair loss no decrease in hair

shedding nothing at all could something

else be going on given all the data so

far we felt it was important to start

operating under the assumption that the

answer might be yes so we started to

revisit one of the big initial

assumptions about allesandro that he was

actually dealing with androgenic alipa

and I know that that sounds crazy to

consider given that he has a family

history his patterning of loss the five

medical professionals on five separate

occasions converging on the same exact

diagnosis and nothing else even still

there were some Oddities around

alesandro's case for instance alesandro

had some mild symptoms associated with

autoimmunity we won't list them here but

if somebody has an autoimmune condition

their likelihood of having a second

autoimmune condition increases keep in

mind that there are some autoimmune

conditions that cause hair loss and that

these conditions they have different

causes than androgenic alopecia so they

require different treatments secondly

when we asked Alesandra to describe the

hairs that he was shedding while combing

through his hair or taking a shower he'd

routinely mention that all of the hairs

that fell out were the exact same hair

diameter he never noticed a mixture of

thin hairs and thick hairs now this

isn't unheard of but for men with

androgenic alopecia you would typically

expect a mixture of both thick hairs and

thin hairs to shed as this indicates the

presence of hair follicle

miniaturization which is a defining

characteristic of male pattern hair loss

yet allesandro wasn't experiencing this

even over months and months of tracking

his hairfall so let's do a quick recap

allisandro isn't seeing a robust

response to FDA approved hair loss drugs

he has symptoms of autoimmunity

unrelated to his hair his hair shedding

is uniform in diameter his hair

transplant continues to thin and that

started within a year after his surgery

these are all signals that perhaps this

androgenic alopecia diagnosis is maybe

wrong maybe it's incomplete in my mind

uh I wasn't thinking like you you may

have something else there is another

maybe kind of loss that is taking place

there is something aimmune I didn't

think about it I mean I was so focused

on you know trying all these approaches

that I was thinking one will work and or

maybe will take more time but something

will move the needle but nothing nothing

really did I I was really starting to

you know to lose hope and to think that

maybe it's just the way I am you know so

it was yeah as I said it was really

really tough mentally so if we lean into

the framework that we outlined and we

start reassessing all of this data what

are the possibilities well in all of our

calls together allesandro indicated that

he had no history of scalp pain scalp

redness significant scalp discomfort or

massive bouts of hair shedding following

scalp pain this indicated that a

scarring Alopecia masking as androgenic

alopecia something like diffuse Lyin

planopilaris was probably less likely

that's because these hair loss types are

often but not always accompanied by

bouts of scalp pain and bouts of hair

shedding that left us us with another

possibility diffuse alipa Arata or alipa

Arata incognita this is a type of hair

loss that can look in some cases exactly

like androgenic alopecia it can even

present alongside androgenic alopecia

but it comes from completely different

sets of causes and thereby requires

completely different sets of treatments

some studies also report that shedding

an alpia Arata it can be uniform and

present without hair diameter diversity

that sort of sounds like Alesandra which

means that this might be a reasonable

hypothesis worth exploring so we brought

all of this data up to allisandro we

sent him our guides on alipa Arata that

feature photos of people with alipa

Arata Incognito we also asked him to

find a dermatologist specializing in

this type of hair loss and in his

location preferably one connected to a

university and who publishes research

this was a big ask for alesandro and he

didn't necessarily know where to start I

mean he was based in Italy and he'd

already seen a lot of dermatologists in

his area and was understandably

disenfranchised with the level of care

that they were giving him but by

complete chance another member of ours

Carlo also happened to be from Italy

Carlo had seen significant hair recovery

from a rare hair loss disorder known as

Lyin plop Polaris and he happened to be

very familiar with the university-based

dermatologists in alesandro's area you

told me why don't you talk to Carlo I

think I think he really like his his um

his uh profile uh overlaps with yours

and and you can you can talk to him like

talk to him I said yeah sure I'll I'll

talk to him so I connected with Carlo

which is a fellow Italian and uh we we

talked a lot and he was uh so so kind

and he he told me I'm I'm living here in

Italy in Rome right now and he he's

living there in in California I guess

and he told me there is a guy there's a

doctor which is a really good one and he

lives in Rome he he visits patients in

Rome and that was a quite a coincidence

right and he told me why don't you call

this doctor and and uh and talk to him

through Carlo alesandro was able to

connect with somebody called Dr Alfredo

Rossi he is a world-renowned clinician a

professor at the University of Rome a

co-author of over 80 peer-reviewed

papers and a specialist in the

identification and treatment of rare

hair loss disorders and this doctor

showed some really you know good

insights some good ideas on how to

tackle his kind of hair loss let's say

autoimmune hair loss with an approach

that was that wasn't really used by

someone else so it was like a Trail

Blazer in a way right so ones that you

know open New Roads and I was really

interested in this guy so I talked to

him and uh he also knew your website

when I talked to the guy uh I called the

the to to book an appointment with him

and the the assistant told me he's not

available for five months when I when I

went on to Google to search for this guy

I I suddenly I I I realized he was super

famous here in Italy and uh he was all

only in in those blogs that talk about

hair loss he was everywhere it took

months to get an appointment and when

allesandro finally did he walked into

the clinic met with one of Dr rossy's

staff members and this is where the

story gets crazy just listen to what

alesandro says so I waited and firstly I

took an appointment with his let's say

his a he wasn't there I talked to

another person but they assured me was

like the same so I went there I sat down

she saw me and she said yeah let's let's

take a look so she took like a magnifier

I don't know what to call a microscope I

she put my my my

scalp under and after a few seconds she

took some pictures and she said you have

Al alopa I mean you you have androgenic

alopa but you also have Alisha

incognita and I was what I mean really

what what's that for those who are

wondering alipa Arata is an autoimmune

disorder it's where your hair follicles

lose immune privil and the body starts

to attack them the estimated risk of

developing alipa Arata is about 2% over

your lifetime so it's rarer but it's

common enough that clinicians and

dermatologists see it on a regular basis

it usually presents in patches like this

or like this but not always it can also

present diffusely and evenly across

somebody's scalp and when this happens

it's particularly harder to diagnose

especially in cases where androgenic

alopecia

is also present even still a good

dermatologist should be able to make

what's called a differential diagnosis

why because there are very clear markers

for a differential diagnosis that all

dermatologists should know about so she

said ah look look here you can see some

small really really tiny white hair

that's some indication of Alish cogn and

she also said something that I I kept

thinking about she said you have some

empty

follicles and the standard let's say

traditional androgenic Alisha doesn't

get you there so it's when with with

alopa and you you you you can tell it

far better than I I'm doing right now

but with alopa under genic Alisha you

have a smaller hair every cycle let's

say in a rough way you don't have a

empty empty follicles that's what she

told me I don't know if that's correct

but she said that's why I could I could

you know tell you it's alapa right away

it was so evident to me this is

important both androgenic alopecia and

diffuse alpia Arata can present with

hair follicle miniaturization the

patterning of loss even the disease

progression can look very similar but

with diffuse alipa Arata or alipa Arata

incognita you'll also often see yellow

dots surrounding the follicles you can

see the presence of white unpigmented

hairs you might see distopic or

exclamation Mark hairs while shedding

and if a clinician doesn't know how to

look for these things they cannot make

that differential diagnosis yeah that

was that was really interesting you know

after all these years it was so easy for

her to diagnose this and I was obviously

was quite shocking to me it didn't you

know take I don't know months or

multiple exams to get there it was

obvious to her and also to the to the

Doctor Who visited me like a few months

after this is what blows my mind

apparently five doctors along with a

transplant surgeon didn't know how to do

this the nurse practitioner trained

under Dr Rossy did she spotted it within

5 Seconds what was really interesting

was that as soon as I as I sat down the

Doctor Who was like trying to examine my

my scalp it took like two seconds five

seconds and she said this is Alish inog

like five seconds so it was five seconds

away from an answer for a year let's say

or for 10 years and no one told me and

and and at that point my mind was you

know going everywhere like was crazy

because what my first thought was If

Only They you know the surgeon would

would have told me the the day before

the transplant when you apply for a

transplant you go there the first thing

they do is they examine your scalp I

don't remember now the the the the

what's the reason the main reason but

they do and they also take some blood

you know they they they do some exams

and it was clear to her and it wasn't

clear to them to an E of people you know

that it's just doing this every day to

multiple people I mean did they know uh

and not told me or they didn't even know

I don't know what's worse you know I

don't know if it's the uh not knowing or

not not even paying attention I I don't

know but that was something that you

know I it's something that I keep asking

myself in my eyes this new diagnosis for

alesandro was sort of like the aam's

razor moment it's the simplest

explanation for why all of his past

treatments had failed yes he still has

androgenic alopecia but now he also

knows he has this other hair loss

disorder alipa Arata incognit and that

might have been preventing him from

achieving results I said Rob you can

believe this I mean she she said this so

it's an outo a immune condition and we

were both happy about it I mean we were

both like also excited about it right so

she explained what kind of you know uh

thing that was and she just really you

know it didn't take much for her to give

me this

corticosteroid it's this this like foam

alipa Arata isn't treated with Minoxidil

it's not treated with finast it's

treated with corticosteroids and maybe

by incorporating corticosteroids into

his routine

perhaps he'll finally turn a corner so

that's exactly what he started to do he

added in a topical corticosteroid once

per week olux or cetol to his scalp and

she said apply this foam once a week

which was weird as a you know once a

week I mean it's isn't that too little

like once a week what's that gonna do I

mean nothing is working with my hair and

she said yeah just apply this and keep

on applying minoxidil and keep on

applying uh topical n right every day so

I was doing once a week one let's say

handful like like this of the

corticosteroid called Olu once once a

day I was using the uh minoxidil so one

ml a day and one mill of topical faside

so I was doing that I started applying

this and she was right I mean they were

right the doctor was was there as well

the say the main guy was there as well

and they told me yeah you improveed so

we we we comp paired pictures together

and uh that was a there was a bit of

disappointing right there because I

remember telling you about it by email

and the pictures were the quality of the

picture was not good and there this was

January so four months in and the

picture they took me the they took the

second picture uh say of the second

visit where blurred in a way they were

kind of dark uh and the first pictures

were bright so they was like yeah is

that improving or is it just what you're

telling me so you had I had these doubts

and how could you blame me I mean after

10 years of suffering you're you kind of

you know you lose your mind a bit so you

lose also some you know trust in people

understandably allesandro was a bit

skeptical at first I mean he hadn't yet

noticed any regrowth for himself and he

had a very frustrating treatment history

with other dermatologists but then he

had a follow-up appointment booked

months later so perhaps he'd start to

notice things by then and that's

actually exactly what happened it was

March and was I went back there so he

said yeah come on over let's take a look

and at that point that was my happy day

because when I went back two more months

were uh passed at the time was like six

months in and uh I I really noticed the

difference and he he told me you you do

not see because you you you're not you

know you're you're not a doctor but I I

can see it like from here and I'll show

you right now and I really did see a

difference the difference was mainly

with the size of the hair the diameter

the scalp overall looked healthier and

the the way he took the picture was he

split my hair here and part them like

this and I could clearly see the

difference between the first time I went

there and that time so there you go

finally a decade into fighting hair loss

allesandro is no longer seeing this

progressively worsen for the first time

he is seeing hair regrowth and it's

continuing to regrow and it's all

because he got into the hands of a nurse

practitioner and a doctor who actually

knew what they were talking about and

because he was willing to evaluate and

re-evaluate that initial assumption

about his case in the face of new data

first I want to say that your website is

golden is amazing because when when I

when I got there was like oh my God this

is how it should be done this is how

people should tackle this because you

offer in a really clear concise and and

really really well organized way it's

it's an opportunity you know to for

people to to Really you know it's a deep

dive you know they you you just go there

and you see all these resources and all

this data and I think it's uh it's

really well done and it it really

changed my life uh because it's losing

hair and or suffering from hair loss is

not just about the hair itself we all

know it's about you know you're the way

you you see yourself the way you appear

the way if you're really young like I

was you felt like old and it's like it's

it's it's really hard you know I'm a

sensitive type of guy so it's it's it

was really tough on me you really offer

some clarity and you really you really

you know earn the trust of of people

there because it's uh I felt I felt at

home you know it's it's weird to say

because we just met on here on on Zoom

or we did we made calls on but also the

community itself is amazing and people

are really helping each other and it's a

small community but it's really valuable

allesandro today is continuing to see

regrowth and he finally has relief in

knowing that this problem is no longer

getting worse for him he also wanted to

share some words with anybody who

decides to watch this video two things

are really important for people who

maybe will watch this for me to to to

know and one thing is that if they're

looking for a really a a way uh to to

cure their uh hair loss or to improve

their situation your website is the

place to start because it's uh again

it's so well done and well organized

yeah and this world is so full of you

know the industry itself is full of

interests so every everybody's pulling

you from another a direction right so

you're like in the middle and you're

confused and you don't know where to go

so that's why it's really valuable what

you do and uh I'm so happy we we met

because otherwise I wouldn't be I

wouldn't be here today I wouldn't be as

happy as I am today and don't lose hope

and this thing take time and uh you you

said it in the website as well it's a

marathon it's not a Sprint so just you

know be patient and keep working on it

and uh maybe you'll find some solution

and some some light at the end of the

tunnel so again I'm so I'm so happy with

it this and uh I'm really open for

everybody who wants to maybe talk to me

or connect with me and uh please share

with everybody my my I don't know my

number my email address because I'm I'm

really happy to help not just them but

also what you do I feel I I I really

think is uh super valuable when I

reflect on alesandro's story on the one

hand I am Overjoyed I mean he had spent

so much time so much energy and the

sheer relief that it must feel to

finally know that this problem is no

longer getting worse it's finally

improving I find that to be beautiful

and moving I wish that for everybody

facing this and yet I also find myself

devastated that he had to go through

this in the first place I mean why was

he misdiagnosed by five different

clinicians five separate times why

didn't any of his doctors know how to

make that differential diagnosis why

didn't they rule this out before giving

him a trans plan why was it that our

team who has no diagnostic capabilities

or access to micro zoomed photos of

alesandro scalp why were we the first to

even suspect this why weren't his

clinicians tracking his treatment

responses over the decade and revising

recommendations accordingly why was

allesandro left for 10 years to figure

this out all on his own that's the kind

of stuff that really bothers me because

if alesandro's Case were just a one-off

that would be one thing it's not it's

this lacking standard of care that is

far too prevalent and far too common for

hair loss sufferers and it's time that

things change I wish everybody who's

fighting hair loss had access to an

alfredo Rossi or a Jeffrey Donovan or a

top hair loss clinician I wish these top

tiered dermatologists didn't have months

to years long waiting lists I wish

bottom feeder dermatologists would stop

selling their hair loss patients into

PRP or PRP plus a cell or stem cells or

exosomes or any other poorly supported

autologus therapy many of which have

shown no benefit over mic needling

despite costing 1,000 times more money I

wish popular hair growth Brands would

stop manipulating the setup of their

clinical trials to include participants

who will get results from a nutritional

supplement but who won't reflect the

average consumer of the product that

that company is selling and I wish

dermatologists would stop recommending

those products to fill their pockets and

at the expense of your hair so to

allesandro I thank you for your

perseverance and your commitment to

Carlo I thank you for your your

incredible support to our community and

to everybody else I remain hopeful for a

better future for now you need to stay

vigilant you need to stay educated you

need to be your own patient advocate and

to help you where we can we've put

together a new video and a PDF checklist

about how to dominate your next

Dermatology visit so if you have been to

a dermatologist and felt that they

barely looked at your hair or dismissed

your health symptoms or didn't really

evaluate your hair loss with scrutiny

this is never going to happen again we

have a framework and a list of questions

in this video in PDF that you can bring

to your dermatology appointment and they

cannot answer those questions unless

they actually examine your scalp

thoroughly with a micro zoomed device

like a dermatoscope or a photo triog so

use that video use that framework use

that PDF checklist and hopefully you

won't ever need to wait 5 years for a

5-second answer that could change

everything again most people watching

are not going to face allesandro

situation most people watching this will

not have alipa Arata or alipa Arata

Incognito for the few that do I hope

this changes things for you and for

those who don't please still use this

framework the lessons this video this

checklist to level up on your hair gains

thank you for watching and I will see

you next time