zenmunk

Agree with gasto. Odds are, trying the propecia again will not cause any long lasting damage, perhaps no noticeable sides at all, so if you think you should try it again, then go for it, especially if you're seriously considering a HT when you can afford it. Personally, I'd consider the shave down, healthy lifestyle approach gasto has prescribed. I'm of the opinion that anyone past a Norwood 3 should seriously reconsider a HT. I know there are some impressive success stories for more advanced hair loss sufferers (and you could be one of them, I suppose), but I tend to think they are few and far between. However, ultimately, it comes down to your expectations and the kind of result you're willing to live with. "A MEGA session or 2, or 3" will be a long, arduous and expensive journey which you cannot turn back from once you begin. Think hard on that one. Best of luck.

Very impressive! Lucky guy. However, for the benefit of newbies contemplating finasteride use, "this type of transformation is not to be expected in every case" should be changed to "this type of transformation is far from typical."

Awesome! Thanks for the update.

I think what it comes down to is your expectations - what you're willing to live with and what you're willing to invest. If a relatively minor cosmetic improvement is good enough for you and your current situation really bothers you that much, then go for it. Consulting as many proven HT docs as you can is essential. My personal opinion is I wouldn't bother with a HT in your case, but what matters is your opinion. Regarding meds, I think you're in a difficult place. Your degree of hair loss makes me seriously question if taking the meds is really worth it. Sure, you may retain what you currently have indefinitely, but at what cost? It's a powerful drug which affects people on a hormonal level. Don't take it lightly. Remember that you have to stay on the meds for life if you want to continue receiving the benefits. Do some research on finasteride first. Talk to a GP or urologist about it. That said, if you do go forward with a HT, then I'd say get on the meds. If you're going for it, then go all the way and give yourself the best chance of a positive outcome. On the up side, if you do try the meds, you can always stop if it's not working for you or you experience sides, and odds are you'd have no lasting problems from having taken it (although there are no guarantees).

As others have said, unfortunately you're not a good candidate for a HT. Really man, don't waste your time and money. It's a life-long commitment and quite the emotional roller coaster. Work on improving other areas of yourself and your life. Perhaps advances in technologies designed to address hair loss will give you options down the road, but not now. And, yeah, don't bother with propecia - it's not worth it in your case. All the best.

I think most of the problems you've described are probably age and stress/anxiety/depression related. You're approaching 40. Not saying that's old (hell, I'm 39), but you're not 25 anymore, and that's something we all have to come to terms with as we age. Stress/anxiety is a killer. It creates a lot of symptoms in the body that are often mistakenly attributed to other ailments. It also exacerbates symptoms from legitimate illnesses. It's something to be taken very seriously. Some things that work to reduce stress: - exercise (anaerobic and aerobic) - meditation/yoga - engaging in enjoyable activities which get your mind off of your problems (another form of meditation, really) - psychological counseling which will hopefully help you identify and deal with the root causes of the stress/anxiety/depression. - maintaining a healthy diet - watch your fat and sugar intake. - Anxiety meds should be a last resort, but shouldn't be taken completely off the table. It sounds like you're depressed in large part because of the troubles in your marriage. If I were you I would try my best to resolve the problems and make it work with my wife, but I wouldn't force things. After my best effort, if things were still strained, I'd seriously consider moving on. I believe in commitment, but life is too short to stay in hopeless situations. By the way, I agree with others who have said that finasteride is probably not causing any of your symptoms. 12 years with no sides is pretty strong evidence. All the best.

Hey Sugar, It's very difficult to pin-point why the propecia is not working as well for you lately. I doubt it has anything to do with your lifestyle (as described), but who can say for sure? If I had to put money on it, I'd say it's simply genetics. Those of us with the MPB gene(s) will probably eventually lose whatever hair we were programmed to lose even if we're on finasteride. It just takes longer. How much longer varies from person-to-person. Actually 10 years is a pretty good stretch on fin. without much hair loss. I'm in a similar boat. Just turned 39. I lift weights regularly, too. Similar hair loss (Norwood 2.5ish). No crown loss. I've been on propecia (1mg/day) for 13 years. Little-to-no observable sides. It's pretty much halted further hair loss. Been pretty lucky in that regard so far. But for how long? Who can say? I've always been a little paranoid about the possible non-observable side effects of long-term fin. use. I'm actually seeing a Urologist on Tuesday to do a battery of tests to see how things are going in the semen, prostate and hormone dept. I already did a blood test to gauge liver function. Granted, I'm being ultra-cautious, but it's only because it's serious stuff, and I've been on fin. for a long time. I don't think I'd ever consider dutasteride as it's a much more powerful drug. Bottom line - I suggest you seriously research dut. before starting it. In the meantime, you may consider getting at least your hormone levels checked for testosterone (serum & free), dht, etc. Couldn't hurt. z

Hey Sugar, It's very difficult to pin-point why the propecia is not working as well for you lately. I doubt it has anything to do with your lifestyle (as described), but who can say for sure? If I had to put money on it, I'd say it's simply genetics. Those of us with the MPB gene(s) will probably eventually lose whatever hair we were programmed to lose even if we're on finasteride. It just takes longer. How much longer varies from person-to-person. Actually 10 years is a pretty good stretch on fin. without much hair loss. I'm in a similar boat. Just turned 39. I lift weights regularly, too. Similar hair loss (Norwood 2.5ish). No crown loss. I've been on propecia (1mg/day) for 13 years. Little-to-no observable sides. It's pretty much halted further hair loss. Been pretty lucky in that regard so far. But for how long? Who can say? I've always been a little paranoid about the possible non-observable side effects of long-term fin. use. I'm actually seeing a Urologist on Tuesday to do a battery of tests to see how things are going in the semen, prostate and hormone dept. I already did a blood test to gauge liver function. Granted, I'm being ultra-cautious, but it's only because it's serious stuff, and I've been on fin. for a long time. I don't think I'd ever consider dutasteride as it's a much more powerful drug. Bottom line - I suggest you seriously research dut. before starting it. In the meantime, you may consider getting at least your hormone levels checked for testosterone (serum & free), dht, etc. Couldn't hurt. z

You definitely found the right place for sound advice and support. I suggest you re-read all of the above posts, especially mahhong's. They are thorough and spot on. You're def. beyond a Norwood III and FUE is probably a no-go unless it's used as a adjunct to FUT. Definitely consult as many good docs as you can and research the hell out of HT. Btw, I'm 39, and my hair loss still matters to me. You'll find most guys my age and older feel the same way. It's probably wise to assume you will care when you're around 40 as well. Plan for it. People have suggested shaving down as an option. You're against it right now. That's cool, but keep an open mind about it - it might be something to consider down the road. I don't mean to be insulting, but a comb-over look at any age is not a good look; at 22 it's a disaster. Even if you don't shave down, seriously consider other styling options. Lastly, I'd say pour most of your energy into improving areas of your life you can control - work, school, health, fitness, etc... Try your best to get those things order, or if you already have, then maintain them. We all know how important hair can be to one's self-confidence, but it's by no means everything. Collectively, and even individually, attempts at mastering the other areas I mentioned will go a long way toward improving your self-esteem, confidence and overall quality of life. Best of luck to you.

It's wise to get H&W's input, but I don't think they do FUE, so keep that in mind moving forward.

Good advice. Thanks, Spex! That's pretty much been my plan except I was hoping 1300-1600 grafts would do the job. I am prepared for a second pass, so if it becomes necessary, either because of less than adequate yield or less than adequate density due to insufficient graft numbers, then I will go for it.

Thanks, Sean, I appreciate that. Glad you think the proposed hair line is on point (for a conservative approach). I think, based on my recession, it would put my hair line pretty much where it would've been had I not lost hair beyond a mature Norwood II. In other words, the lines tie in well at the temple points/triangles and still frame my face fairly well. I think less is more in my case, with my particular kind of recession, and will allow for the most natural result. Styling goals...good question. I'd love to have the option to do all of the above, actually. My hairstyles vary a lot over time. Currently, I'm buzzed to a zero guard, but in the last pic posted my hair was pretty long, like shoulder length (that was like a couple months ago). I've also worn it short and messy on top and slicked back as well. If possible, I'd like to hold on to that variety. How do you think that affects graft count/hair line design? Good points. I don't know what the graft groupings may be, but I'm glad that my density seems good. Since I only have on average 0.5" or 1.3cm to fill around my hairline, I think the doc will probably have to stick with ones for most, if not all, of it. However, I think he can safely use multi-hair grafts in the area outlined in orange in the first pic. Even with dense packing, I expect that will undoubtedly leave me with a thinner result toward the back of the hairline, because my hair is fine. Unfortunately, I think that's unavoidable, but I don't mind sacrificing some density for the most natural result. Since many men suffering from MPB recede the way I have, a thinner appearance toward the back of the hairline is pretty natural. I'm OK with that as long as it's not too thin; in that case, I'd go in for a second pass. Thanks, yeah, I think it's crucial to utilize as much of the area outlined in green as possible especially considering my long-term plan. Minimizing the appearance of white dot scarring and donor thinning is very important to me. Even if it's only 1300 grafts, I want those extractions really spread out. I hope I don't need more than 1300-1600. We shall see. Thanks a lot for your input, Sean. I really appreciate it.

I started noticing my hair loss around 26 years old; not as young as you, but young enough. So, I know the feeling. It sucks, but even more-so when you're young. You seem pretty well-informed regarding MPB and HT. That's a big advantage. You'll probably avoid many, if not all, of the pitfalls. Your degree of hair loss looks similar to mine, perhaps a little less, but in the same ball park. My advice is if you can hold off on a HT for a few years, you should probably do that, and just continue your current regimen. You are still quite young, and your hair loss is fairly minimal. As you know, HT is something you cannot turn back from, and it can be quite expensive. You'll always have the option to do it later on. In my case, the propecia really helped for a long time and continues to do so. I'm only now considering my first HT, 13 years after starting the meds, and I'm almost 39. Everyone's different, however, and if you feel like you must get a HT in the near future, then I'd suggest you avoid strip. I don't think your degree of hair loss warrants it. FUE is statistically less successful regarding yield, and you may have to go in for a second pass, but I think in your case (and mine btw) it's probably the better route to take at this time. Just make sure you go to a stellar FUE doc, and since you're considering Feller and Rahal, I think you'll be just fine. I suggest you make sure the doc uses the most intelligent FUE extraction pattern possible. You want to minimize the appearance of white dot scarring and overall donor thinning. Spreading out the extractions as much as possible and using the smallest punches will go a long way toward achieving that objective. Be willing to shave down completely for the procedure (not just over the occipital area); do what you must to help the doc give you the best possible outcome. You ask about taking grafts from outside of the standard donor area, aka the universal safe zone. Personally, I'm going to give my doc permission (and sign something if necessary) to do just that if it will increase the chances of a spread out extraction pattern. I'm not concerned with some of the hairs being non-DHT resistant, because if the meds fail me in the future, I'm not going to chase my hair loss with surgery after surgery for the rest of my life, but rather shave down, so some of the transplanted hairs falling out with the rest of my native hair would be a blessing in that case. But that's me. You must ask yourself what you are prepared to do long-term. That will dictate whether or not venturing outside of the safe zone is right for you. You'll work all of that out with your doc if/when the time comes, but I think a doc will probably try to accommodate you if you fully understand the risks and are willing to sign off on it. Best of luck with your decisions moving forward.

Unfortunately, HIV stigma & discrimination is not limited to Canadian medical practices. This is a world-wide phenomenon. Despite the ethical concerns and illegality of discrimination (in the U.S.) by medical personnel, and universal precautions available to prevent the transmission of blood-borne pathogens in a clinical setting, there are numerous reports of HIV discrimination in medical practices. Some doctors/practices have been sued. This is from a 2009 American Medical Association article: "A 2006 study of specific-service health care professionals in Los Angeles County found HIV discrimination to be prevalent. The researchers surveyed 131 skilled nursing facilities, 102 obstetricians, and 98 plastic and cosmetic surgeons to determine how many of these institutions practice a policy of blanket discrimination against people living with HIV. Of the institutions surveyed, 56 percent of the skilled nursing facilities, 47 percent of the obstetricians, and 26 percent of the plastic and cosmetic surgeons refused to treat people living with HIV and had no lawful explanation for their discriminatory policy." This is from the Canadian Human Rights Commission: "The Canadian Human Rights Act provides that it is not a discriminatory practice for a service provider to deny goods, service or facilities to a person if the denial is based on a bona fide justification (BFJ). The Canadian Human Rights Commission policy on BFJ recognizes the service provider's right to ensure a person is able to comply with a requirement that is essential for the safe and effective delivery of the service. Incidents have been reported of service providers refusing to provide services to a person who is HIV positive on the grounds that to do so would pose an unacceptable risk of infection to them or their employees and, therefore, would constitute a BFJ. For example, it had been thought that rescue workers, such as police and firefighters dealing with trauma victims who were HIV positive might come in contact with the body fluids of HIV-positive people and, therefore, be at added risk of infection. The CMA has, however, concluded that in such circumstances the risk of transmission is extremely low, and no cases of transmission have been recorded. As a general measure to minimize the risk of infection, the CMA states that workers should take reasonable precautions when handling human blood or other bodily fluids capable of transmitting HIV. For the reasons explained above, the Commission would not generally accept a BFJ based on an alleged danger to the service provider. It is well established that employee or customer preference is not a legitimate reason for a discriminatory action. Therefore, employee or customer concerns about dealing with a person who is HIV positive can not be the basis of a BFJ." Your friend may have a case if he/she chooses to pursue it.

I actually received graft estimates from two clinics. The online/phone consult was with Matt from SMG. He said, based on my pics, that 1200-1600 would be appropriate, and the number would be narrowed down in-person. The in-person consult was with Dr. Feller. I'm in NYC, so it was quite convenient for me to visit his office. He said that 1300 should do the job. Thanks, man. Yeah, I would never shoot for something that aggressive. Those days are long gone for me. I took one or two Polaroids (yup, I said Polaroids lol) of my hairline before starting the meds. I wanted to document my starting point and compare it to my 1 yr. results. Unfortunately, I don't know where those pics are now. Been a long time. Sorry that I don't have them to share. I realize it would've been interesting for you guys to see the difference. However, I'm quite confident that the propecia pretty much halted my hair loss. If you look at the last pic that I posted (with my hair grown out) you will notice a thinner area which corresponds to the area outlined in orange in the first pic. I'd say that over a one year period of time that area has thinned slightly, and I mean slightly. Other than that, I haven't lost any hair; those pics pretty much represent how my hair looked 13 years ago. My theory is the loss was due largely to stress. Prior to starting the meds that area was thinner than the rest of my hair, so it's been fighting pretty hard to hang on. Two years ago some personal stuff happened which made my life a living hell. The first year is when I noticed the thinning, but then it stabilized, and I haven't noticed any further thinning/loss over the second year. So, I can't claim no further recession in 13 years, but I can claim almost none, so perhaps that qualifies as moderately impressive. Yeah, believe me, I've debated how aggressive I should be with the temples/corners. I think I'll start more conservatively and see how it goes. I always have the option to do more later. I'll take your 1800 graft per one procedure suggestion under serious consideration. I have a feeling that 1300 may not cut it at the end of the day, regardless. I mean, if the yield isn't as good as I'd like with the first procedure, then I'm gonna have to address it with more grafts anyway. And, we all know statistically FUE falls a bit short. Thanks! Very happy to hear it! Gish and corvettester, thanks a lot for your input. Much appreciated!

Thought I'd throw up some pics to show my hair loss situation. I'd appreciate any constructive input from the community. - Do you think I'm on the right track with the following plan? - Do you think the proposed hairline in the pics works? As you can tell, I have fine hair. I've read that may be an advantage toward achieving a natural hairline result, but will also require more grafts to achieve density when compared to those with coarser hair. I expect dense packing is in order considering how fine my hair is, but I know there are limitations. That's why I believe a relatively conservative hairline is best, not to mention age-appropriate (I'll be 39 this month). I've been quoted as needing around 1300 grafts to do the job at an in-person consultation. - Do you guys think that's an accurate quote for my situation? I'm going the FUE route. If necessary, I'm prepared to have a second FUE procedure done to address poor growth from the first. Been on propecia for 13 years with few observable side effects. It's stabilized my hair loss since I started it. The chin-to-chest and 3/4 pics shows the hairline I'd like. Chin-to-chest also outlines, in orange, the area behind my hairline which needs some grafts to improve density. The profile pics and pic of the back of my head show the donor area outlined in green. I want the FUE extraction pattern to be spread out to use as much of that entire area as possible. In other words, despite the relatively small number of grafts needed, I don't want the extraction pattern limited to only the occipital region. I'm not concerned with the doc venturing outside of the safe zone, and I'm willing to sign something to that effect. The donor area goal is to minimize the appearance of white dot scarring and thinning as much as possible by using the widest extraction pattern and smallest punches. Thought a pic of my hair grown out would be helpful, too. Thanks in advance.

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I think it's already been established that you are not as desperate about your hair loss as your original post communicated, and that's a good thing. However, it appears as if you may be missing the point some of us are trying to make. No one is saying that hair loss doesn't adversely affect the quality of our lives. We wouldn't have gotten a HT (or be considering a HT) if it didn't. It's not hypocritical to say that the dissatisfaction hair loss causes varies from person-to-person. There is a wide spectrum of disturbance ranging from a little annoyance to the feelings illustrated in my original post regarding BDD. The main point is if anyone finds themselves on the more serious end of the spectrum, then they should not get a HT, but rather seek psychological help. And, you have every right to express your feelings here. A very important part of this forum is the support element. Just realize that people are going to react accordingly to how you express those feelings. You also do not have to justify your decisions. If you never get a HT, then that's fine. Do what's right for you.

hairmee, The perception that you may have a deeper problem was given to us by the way in which you expressed yourself. The language you used, the overall vibe of your initial post, was kind of intense. I, for one, was not trying to judge you. My apologies if it came across that way. I was just concerned and trying to offer some perspectives which may be helpful. Of course we're suffering from hair loss, too. I don't think there is a man alive who has lost his hair who wouldn't say it adversely affects the quality of his life. However, it's a matter of degree. For some it's a relatively small problem; for others quite large. We don't have the advantage of actually knowing you. We can't see your face or hear your voice when you talk about these things. We only have your words. If you don't want to be misinterpreted, then make sure what you write accurately reflects how you feel. I'm happy to hear that your situation is not as dire as it appeared. Best of luck to you.

Congrats on your progress! Any updates?

It is important to stress that HT is a cosmetic procedure. It's elective, as is taking finasteride in doses, and on a schedule, appropriate for hair loss. No one here has to do it for health reasons, hygienic or otherwise. We choose to do it. As someone who has taken the drug and tolerated it well (as far as I can tell) for many years, I still believe people are justified in their concerns about the possible side effects of finasteride, both short and long-term. No one can say with certainty that the drug is not causing serious damage on levels which are hard to detect. I won't be certain even after I get the tests done, but I'll be a lot closer to certain, and that'll have to be good enough if I choose to remain on the meds for the long-term. Some people can shrug off the concerns quickly. Others need to do more research or testing or what-have-you to be confident that it's a risk worth taking. Life involves prioritizing and assuming risks. Can't escape it, but we can try to make the most educated guesses. Ultimately, it's a personal choice - whatever works for you - but regardless of what one's position is regarding taking medications to prevent hair loss, it should not be taken lightly. Just as getting a HT demands a lot of time, serious thought and research, so does starting on meds.

Certainly hope you're right, chix. I'd love to report to you guys that everything is OK. I really didn't like the idea of going on the meds back in '98, so the only way I would allow myself to do it is to commit to the blood tests every six months to monitor liver function and pay close attention to observable sides. I certainly believe going the HT route w/o meds is a viable option, but it's not for me. If I get the FUE done, then I'm basically committing to the meds until 1) a health issue forces me to stop, or 2) the meds stop working for me. The thought of a lifelong (or indefinitely long) commitment to the meds is daunting. I like the idea of being able to stop the meds anytime I want; the option is comforting. However, the thought of restoring my hairline and continuing to maintain my native hair with the help of the meds is quite seductive. What if 1) or 2) occur after I've gotten the HT? That keeps me up at night. The only solution I've been able to come up with is go the FUE route, make sure the smallest possible punches are used (safely of course) and insist that the extraction pattern be spread out as much as possible, throughout the entire safe zone (sides and back) and beyond (I'd sign something giving my doc permission to do it). The hope is that approach would minimize the appearance of white dot scarring and spread out donor thinning as much as possible. Then, if the meds eventually fail me, shave down and use copious amounts of ridiculously high SPF sunblock to keep the tan contrast between the scars and scalp at bay. It's an imperfect plan, but the best I've come up with so far. Or, maybe say %&$# it(!), forget the HT, ditch the meds and shave down! I must admit, some part of me would just love to do that and let all of this worry go... But then, one worry gets replaced with another. A good friend of mine is a Norwood VII and has been shaving down for many years. He says he wishes there was a way to have his remaining donor hair permanently removed so he doesn't have to shave everyday. He was even looking into some kind of laser treatment. There's no easy way to address hair loss. Pick your poison. I'm getting a semen analysis to make sure everything is healthy regarding fertility issues. Finasteride exposure is a trickier subject. Merck states that a pregnant woman's contact with the semen of a man taking finasteride is not an issue for concern. The FDA info on Finasteride states: In 2 studies of healthy subjects receiving Finasteride 5 mg/day for 6 to 24 weeks, Finasteride concentrations in semen ranged from undetectable (< 0.1 ng/mL) to 10.54 ng/mL. In an earlier study using a less sensitive assay, Finasteride concentrations in the semen of 16 subjects receiving Finasteride 5 mg/day ranged from undetectable (< 1.0 ng/mL) to 21 ng/mL. Thus, based on a 5 mL ejaculate volume, the amount of Finasteride in semen was estimated to be 50 to 100 fold less than the dose of Finasteride (5 mcg) that had no effect on circulating DHT levels in men. The FDA info on Finasteride also states: Intravenous administration of Finasteride to pregnant monkeys at doses as high as 800 ng/day (estimated maximal blood concentration of 1.86 ng/mL or about 143 times the highest estimated exposure of pregnant women to Finasteride from semen of men taking 5 mg/day) resulted in no abnormalities in male fetuses. The Merck and FDA statements notwithstanding, the facts that probably millions of men worldwide have fathered healthy children without discontinuing finasteride use & there are no major news stores decrying finasteride-related birth defects are pretty strong evidence that the odds of a male fetus having developmental problems because of the amount of finasteride in the father's semen are infinitesimal (Of course, a pregnant woman ingesting or handling broken finasteride tablets is another story altogether). However, if one believes it's unwise to be on meds while trying to conceive, then the question is: how long before conception should a man discontinue the use of finasteride? I haven't been able to find a definitive answer to this question. Some subscribe to the half-life approach. Dr. Rassman states: Some sources say finasteride half life is 4-5 hours. Some say it is 8 hours. My Epocrates drug database says it is 6 hours. Half life is the time it takes for 50% of the drug to be out of your bloodstream. So if you assume that the half life is 6 hours, then most of the medication should be out of your bloodstream and excreted out of your body in a day or so (it is excreted in your feces and urine). But being out of the bloodstream does not always correlate with it being out of your body per se, because some form of the medication is left in your tissue. If we go by the half-life approach, finasteride is probably out of most men's bloodstreams after 7 - 10 days of discontinuing use. If a woman is most fertile approximately 4 days per month, a man could stop the meds 7 - 10 days prior to starting efforts to conceive, then spend the fertile 4 - 7 days trying to conceive. That would mean he'd be off of the meds for approximately two weeks. Two weeks is a snap - no hair loss and no risk to the fetus (as long as the man wears a condom during sex for the duration of the pregnancy). Great, end of story, or maybe not... The sperm production cycle may confound the half-life approach. The sperm production cycle is 90 days. Sperm are produced in the testicle and take about 90 days to reach full maturity. After the sperm have been produced, immature sperm are deposited in a receptacle called the epididymis. There, the sperm continue to mature and develop their “swimming” ability until ejaculation. If one took finasteride within the 90 days prior to stopping for 7 - 10 days for conception purposes, the sperm one produced will probably still contain or be affected by finasteride despite stopping for 7 - 10 days. How much will remain after stopping for 7 - 10 days is anyone's guess. Would stopping for 7 - 10 days reduce the chances of developmental problems in a fetus? Who knows? I plan to ask a urologist about this... Regardless, it's clear that if one wants to be 100% sure that there will be no finasteride in one's semen, then there's no choice but to discontinue finasteride use at least 3 months prior to conception and risk losing some amount of the hair maintained while on the meds. I appreciate that mahhong. For the record, I'm not an alarmist or hypo(cyber)chondriac (I realize you're not suggesting I am in your statement). I simply realize that finasteride is a powerful drug, and I've been on it for a long time. Before I get a HT, and commit to the meds indefinitely, to whatever degree possible, I must make sure the propecia is not hurting my health in areas most commonly reported.