multiplier

I hope this isn't too a controversial question. When I first joined the community a few years back, there was a pretty small pool of doctors that HRN officially endorsed. They were all pretty well known already and were vetted a lot both by management and by the users here. I noticed in the last year, a new doctor was approved almost every month. 11 new docs I hadn't heard of since December 2011. I received an email asking for comments on each one. Before I realized it, each one had been quickly approved. I don't check into the forum often so maybe I'm missing a discussion. Is there a post about a change in approval criteria? Or did something change about the whole process? From what I understand, doctors pay a pretty good sum to be approved here, yes? Anyway, don't mean this to sound suspicious, but feel like I missed out something that had changed about the nature of the site. Thanks.

Finally spoke with the nurse at Dr Cooley's office. She said they had a lot of experience using 300-ish grafts to fill in people's scars with FUE, for people who go that route. She also mentioned ACell and PRP for maintaining hair going forward. Will try to have a consult there in the next few months and report back.

After this last surgery with Dr Shapiro in January, his words to me were basically that my donor characteristics and density were mediocre and that I should wait a year or two and re-evaluate. He did not seem optimistic that I should or could get any more FUT due to those characteristics. It will take awhile to see the real results of these last 3200 grafts. Obviously if you look at my hair loss blog, you can see that surgeries seem to continue shocking out hair that may not come back. This makes me wonder how my hair would look if I never got the last 2 surgeries with Shapiro. Impossible to say. But it feels like my loss has accelerated overall. Since the surgery in January, I haven't bothered to try to grow my hair back to its previous length. I don't like how thin it looked and styling it just looked like a modified combover which I don't want. So in a weird way, it's been liberating having it look kind of buzzed. It's obvious I'm thinning, but I'm 38 so that's not so unusual. And thinning causes a lot less weird looks than a combover full of Toppik. The main problem now is the length I'm keeping my hair in the back. You can see the scar if you look closely and it's exacerbated by some shock loss. For FUE, Shapiro recommended I contact Dr Cooley since he's located much closer to me geographically and has a good reputation. What I'm wondering now is, if it's possible to just give up on trying to fill in the mid-crown area and just using whatever FUE can be harvested to fill in around the donor hair so I can just keep my hair shorter. Has anyone done this? How many grafts were able to cover the scar well? (BTW, I would love to ask Dr Cooley directly about this, but I have called 6-7 times in the last week and have not gotten returned messages and have only gotten voicemail and busy signals).

I think that might be a bit of an illusion. Most of the work was done at mid-scalp, I just have a high hairline and am tilting my head a lot in that photo.

I would like to add, though, that using staples in the donor area has been much less painful than last time we used sutures. No trouble sleeping or shifting at all. And as usual, the SMG staff was very professional and accommodating.

This past Wednesday, I had another surgery with Shapiro Medical in Minneapolis. I wanted to give some impressions of the last surgery, this one, and the future. In Jan 2011, I had gone off off Propecia due to what I perceived as side effects. When I got surgery with Dr Shapiro in Oct 2011, he said we'd try to shoot for 2000+ grafts, but we only yielded 1400. He said that due to the previous MHR scar, the donor area was suboptimal, but he'd refined scar so the next yield should be better. For most of the year afterward, I stayed off of Propecia, and unfortunately I believe this just led to more hair loss. Thankfully, I have worked through a divorce and very tough period in my life and my libido seems to have mostly come back, so I'm back on the meds. But was there any gain from the surgery, or did I break even? Hard to say. Anyway, I had another surgery with SMG this week and Dr Shapiro again said we'd shoot for 2000 more grafts. In the end, we got 1800. When I asked why, Dr Paul said the donor area had become taxed, tight, and the density was poor. Going forward, he recommended I stay on the meds, see where I am in 2-3 years, and re-evaluate. He said FUE would probably be the best bet and it would actually yield more hairs than another strip. Around 1000-2000 he quoted? But again, the predictions keep falling short. He also mentioned considering micropigmentation at some point in the future which also requires maintenance and sounds to me like a last resort. At this rate, things are beginning to feel pretty abstract and discouraging. I can't say I ever had delusions about being an ideal candidate with dense reserves of donor hair. But at the same time, in my 3-4 meetings with reps from Shapiro, I was told my donor was Average at worst and that we'd get multiple sessions of 2000+ grafts. As time went on and surgeries were done and those numbers did not materialize, the more the reps began characterizing my donor as Poor, not Average. On the plus side, I have 3200 grafts that I didn't have 2 years ago. But what if I become resistant to finasteride? Or what if I get re-married and, at some point, need to explain to my wife that not only have I had 3 of these surgeries, I may need more in order to not look freakish? Has anyone in my position taxed their strip to the point where they've switched to FUE to help "finish" the job, so to speak? I don't mean to sound alarmed right now. But I'd be lying to say this is where I thought I'd be after starting this journey 10 years ago.

Looking great, my friend!

We actually already did it in my previous surgery - we punched out more like 20 grafts and re-used them. Presumably, anyway. I never heard whether there was any trouble re-inserting those particular grafts and don't know how I would monitor whether or not they grew successfully. Re: donor hair, it's impossible to say what the final result would be once it's taxed, but I would rather have thicker hair that's receded, than lower hair that's very diffuse... So has no one had this experience of punching out / reshaping the hairline like this?

I'm getting a second surgery with SMG in January. The current shape of my hairline is a deep dip of the widow's peak and recessed temples. I'd like to round it out a bit more. I'm hoping to have 100+ grafts punched out of the very point of my frontal hairline and re-transplanted to thicken the area behind it. Since I have average donor hair anyway, this seems like a better use of the hair. I never really minded having a receding hairline anyway, it's more the all around diffuse thinning I'm hoping to fix. Anyway, has anyone had surgery where hair was essentially "moved around" successfully to reshape the hairline?

Indeed, I do have a new short haircut and the photo is zoomed in and in quite a bright light. Here is what it looks like in normal light with Toppik - Yeah, I am thankful to have a dialogue with them, even if the results aren't optimal. I spoke with Dr Paul yesterday and we agreed that going off Propecia surely had some effect. But I am also worried I more than predisposed to experiencing shock loss and that future surgeries won't accelerate that. Regardless, I am back on Propecia, and have always been on biotin, minox and niz anyway. That is the idea. Will speak to SMG again this week to see what we decide.

I realize the lighting and proximity are pretty different in these 2 photos, but regardless - At this time last year, I was really looking forward to seeing a year's results, feeling more confident, and using a lot less Toppik daily. Unfortunately right now that doesn't seem to be the case. Some things to know. In both surgeries I've received, I've had moderate shockloss. In both cases, I got a lot of reassurance that shockloss would be temporary, but both times it's seemed permanent. Also, since last year's surgery I've abstained from Propecia because I thought it was causing side-effects but have recently determined they were psychological and have started up again. It's not unreasonable that this accelerated the loss. The procedure itself was smooth and very professional. I did speak to the rep from SMG who said things looked right on track according to my blog. The photo above is a bit more revealing. Regardless - I'm not sure how to look on the bright side here. My hair is thin as ever and I will need another surgery, if not 2 more. I can't really brush or style my hair, as is, and the Toppik I need to look halfway decent is significant and looks very suspect. Moving forward, I've been told my donor is average. At SMG last year, we hoped to get 2500 grafts, but only 1400 were harvested. If I get another surgery of 2000 but it continues to knock out all my native hair, I've essentially broken even, hair-wise, and will still have thin & unmanageable hair. Obviously I am pretty nervous about that scenario. I trust that SMG would not work on me if they didn't think I was a candidate for the surgery or if they weren't optimistic about my game plan. At the same time, I could appreciate some encouraging words here. I have cc'd the folks at SMG so they can give additional feedback.

Boy does this sound familiar - Finding help for pelvic pain: A patient

Heheh, sorry about the TMI. Just wanted to get all my thoughts down to re-read it all chronologically and see what other folks thought.

But what is it, specifically, about the drug that causes a 'mechanical' issue?

I have one other question - prior to last year, did you hear much about the long-term effects people suffered after discontinuing the pill? I've lurked on a lot of hair forums since around 2001, and I never heard of anyone have symptoms that weren't fixed after discontinuing. It was only in the past year or two people started speaking up. Does that mean, a) people weren't comfortable speaking up before, or 2) the people who did speak up stoked peoples' fears and caused psychosomatic symptoms in others? Or is it 3) people have been discussing this for 10 years, I just haven't noticed?

Thanks again, Aaron. And thanks to folks who've been supportive on this board. One thing I struggle to understand - are people experiencing ongoing effects from finasteride actually able to see this verified in blood tests? I've gotten 2 blood/hormone panels in the past year, and stuff like testosterone, prolactin, DHT, etc, are all totally normal.

Since it's been awhile and I've been deliberately taking a break from hairloss forums, I figured I'd update everyone on this ongoing issue. When Iast posted, it was November 2011 and I recently gotten an HT with Dr. Shapiro. To offset any shock loss, I'd gone back on taking .5mg Propecia every day. Since I'd already been experiencing decreased libido, I didn't notice any real change, nor did I feel any more or less confident that it was the drug causing my issues. At the first of December, my wife moved back to town and I'd thought we would work things out. I had been tense and depressed since moving back to my hometown. I wasn't working much, just a bit of freelance. I slept a lot and felt down in the dumps. I had been hanging in the balance of the separation for almost a year at that point. But, when she moved back, she said she didn't want to be married anymore, which just heightened my depression. Throughout December and January, I felt pretty helpless. Toward the end of my marriage, I'd had an extremely high-sex drive, coupled with extreme guilt for wanting every woman I saw, except for my wife. When she moved out, I actually thought I would then be free to get laid all the time. But as you read in my previous post, it was right around that time my libido went away. Toward the end of January '12, I began getting morning erections again. No real explanation. Nothing had changed with my wife. But getting one morning erection changed my mood. That's all it took. It happened again the next day. I wasn't sure what it meant, but ever day it gave me confidence, and that confidence seemed to help me have a libido, or at least 80% of the libido I used to have. Late January, I went away to Asia for a couple weeks on a work trip. At the end of the trip, I had 2-3 spare days to essentially sit by the pool and relax. Suddenly, I began having the urge to masturbate 2-3 times a day. I don't know if it was the relaxation or the distance from home or what. Something felt different. When I came back to the States, I felt confident. I got up early. I got morning erections again and started noticing women. My erections felt 80% as strong as they'd been before my wife left, but then again, that period of time was fraught with so much temptation and sexual urges... it'd be a pretty high libido to match. Meanwhile, I visited my wife a couple times and I finally felt like I didn't miss her anymore. I suddenly felt like I wanted to meet new women. Believing my problem to be mental, not meds, I began taking 1mg Propecia daily again. After 3-4 weeks of feeling good, one day, I thought I noticed my erection was less strong. I thought about it all day. I probably obsessed about it. Could it be happening again? Within a week, not only did I slowly start missing my wife again, I started losing my sex drive again. I don't know which happened first, or which caused the other. But I got really depressed all over again, often spending the day in bed. Once again, I had screwed up the Propecia "test." What I should have done is returned to the US, felt good, and not introduced Propecia into it for another few months, to really decouple the issue of stress vs. meds. So I went off meds again. A few weeks later, I visited New York and saw a bunch of old friends. I was drinking a lot and having fun. One female friend I had dreaded seeing because I knew she liked me and it might test my sex drive. But then I found myself in her bed. I was amazed that we rolled around half-naked together for about 3 hours after many drinks and I had an erection the entire time. I felt no "tightness" in the prostate or perineum as I had for months. At some point she seemed to act like she wanted to have sex and I quickly got nervous and lost my erection. But I was able to get it back later, even though we never ended up having sex. Coming back from that New York trip, I felt great. My attitude had changed, I felt this surge of confidence. Once again, this lasted maybe 2-3 weeks. But out of nowhere, I began longing for my wife, feeling terrible that our marriage had failed. I begin feeling tremendously guilty that she had loved and cared for me so much, and I was never able to return it because she was mentally unstable and because I'd lost my attraction to her somewhere down the line. Every day I beat myself up over that. And so, in the last few weeks, my wife and I have been in contact regarding a divorce. I have continued to have catastrophic thoughts and difficulty sleeping. I can still masturbate when I want, for the most part, which is good, but it does feel half-hearted. There isn't the effortless, fully-erect feeling I'd had up until last year. In fact, it's been over a year since I've really gotten "spontaneous" erections during the day, unless I'm looking at porn or something. I guess the good news is that the only 2 times I've been with a woman in the last year, I have been able to get it up. Yet not so much when I'm alone. The whole thing has become baffling. So right now, I'm taking no Propecia, but feeling pretty depressed with life. I've lost a lot of money, bailed from my old city and old job, had libido problems, had an HT, and lost my wife. I do have a therapist who is great, and I just started Trazodone for sleeping. One thing I realized the other day—whenever I've seen my wife to talk about divorce, I can feel pain in my penis almost like a throbbing headache. It's almost like an extreme fight-or-flight reflex. So, I do realize there are vocal sufferers of long-term Propecia side effects, and I cannot say what the real truth is. Obviously I would like to think that I'm not one of them. I have been to a lot of doctors in the last year (a couple family docs, 2 urologists, 2 psychologists) and all of them dismiss the idea that I'm suffering because of Propecia, but instead because of extreme stress, depression and loss. Of course, none of them has done much research about Propecia either. The reasons I think & hope that this is all stress-related: • I was on Propecia for 12 years before any of this started, and never experienced a single side effect. Always had a strong libido. • I even took Dutasteride in 2003-2004 and never had side effects • Upping my meds after 12 years from 1mg to 1.5mg for only a week does not seem like it would trigger side effects suddenly. Doctors agree. • I have read a fair amount of articles about how trauma and depression can cause loss of libido. There seem to be more of these articles documented than Propecia studies. • As a teenager I experienced a lot of anxiety about sex that led to occasional impotence. It was sort of like the fight-or-flight thing. If I was with a woman who wanted to have sex and was forward about it, I would not be able to get an erection and was very stressed about it. It wasn't until college that I figured out how to relax. But I think something deep in my subconscious is telling my body something that my brain doesn't understand, back then, and maybe now. I hope some of this might be able to help someone, or maybe shed some light. Maybe when we're actually divorced next month I will feel better. I am happy at least I could hook up with someone and not have this issue get in the way. At the same time, I have been experiencing this for over a year, and the timing of a) upping my meds, and b) my wife leaving has led to a lot of conflict and confusion within me, since the side-effects of Propecia and depression can be so similar. I may never know what's caused this, but I can only hope it doesn't go on indefinitely.

Looking great as usual Aaron, I think that style works for you regardless. Most of us would rather have that amount of hair and a good style. Unfortunately I don't have enough HTs to style my hair in a flattering way yet, but hopefully it'll come. Posting some pics today, in fact. Be in touch...

My donor hair is average and a bit my procedure involved reducing the MHR scar, so to my understanding, those things limited Dr Shapiro in this procedure. But he predicts with this smaller/neater scar, the next procedure could yield 2500 or so grafts.

You can go here to my blog and see each photo taken on the first of every months since the procedure. I also created a sequential photo - It will probably be a few more months before the full cosmetic effect is clear. My procedure was also relatively small and I will probably do another one this summer. Right now it's still tough to really brush my hair into any flattering style, but that has been true since I was about 25, so I'm used to it. With the right bit of styling product + Toppik, it's not too bad. I'm not trying to conceal the fact that I'm balding, but I still dislike any scalp showing.

Once again, I'm jealous Aaron That must be awesome to see in the mirror every day now. Thanks for keeping up with my updates too. Been really busy but will try to post here more often...

Man, I'm jealous! It looks perfectly natural and the density, shape, etc, all look appropriate.

It seems strange that of all the HT docs in the world, the one who's considered the most talented seems like the least secure about his reputation. Imagine if you owned a restaurant and it was reviewed heavily on Yelp. The positive ratings are 95%. But for those 5% bad reviews, you swooped in and argued with the patron or threatened retaliation. Every business has online reviewers. It's understood that they aren't always reliable. It seems like Feller is shooting himself in the foot in more and more cases these days, rather than sitting back and being content that his reputation is otherwise so sterling, as any Google search demonstrates. At this rate, his reputation as a surgeon is going to suffer for reasons that have nothing to do with his medical skills. Aaron is right that we shouldn't jump to conclusions, but the defensiveness we've all seen in this past year in the forums does seem like overkill.

Aaron, looking better than ever my man, I'm jealous

Can't thank you guys enough for your feedback - seriously. It's just not the kind of thing I can really delve into with friends, most of whom have young kids and busy with lives of their own. 2011 has really been a drag of a year all the way around. I've kind of been at war within my own head. I'm going to try to focus on what you guys and all my doctors have said, which is that stress seems to have taken hold in my body in strange ways and it's hopefully just incidental to my finasteride use. It sucks that the lines became blurred between finasteride's side effects and the effects of stress, because the symptoms are so similar. I have not been getting exercise or sleeping particularly well. I'm not getting any younger and need to re-evaluate all that stuff. It's worth mentioning that getting the HT with Shapiro was actually one of the least stressful issues of 2011, even though wearing hats, etc, afterward has been a pain. But the surgery was 9 months after my symptoms I can't say it's contributed to any of the stress. Thanks David - I'm sorry to hear about that situation yet somewhat glad to hear it's not uncommon. With a little Googling, I did find another anecdote from a middle-aged guy whose wife left him and he immediately experienced 'numbness' and some ED for the following year. There must be so many levels of the subconscious that store those feelings that just aren't accessible to us most of the time. Yeah -- when she moves back down here in a month, I'm hoping it clarifies whether or not we have a future together, and if it's not clear, we need to be ready to move forward. I'm just so hesitant to do anything rash since we barely got a chance to experience being married - we immediately moved to a huge city, changed careers, experienced a death and then drifted apart in the course of a year. But I guess if there's no way forward, we may have no choice but to move on. Both very true. I'm a pretty intense perfectionist and put a ton of pressure on myself. I'm also becoming aware that I'm not a 25-year old anymore. Truthfully I only tried it twice, while I was by myself, so I really don't know the extent which it can help me.I guess in my mind, I thought "I'm too young for this drug", but if it helps kickstart things, it's worth trying again.