zenmunk

stashthecash, I'm no doctor or pharmacist, so take my advice with a grain of salt. Always consult a physician expert in these matters before taking action. Here are some finasteride observations: - How does finasteride work? Testosterone floating in the bloodstream of the typical adult male routinely combines with an enzyme called 5-alpha reductase. The result of this interaction forms the more potent sexual hormone known as DHT (Dihydrotestosterone). When a man begins to lose his hair, certain genetically programmed follicles begin to develop DHT receptor sites. The DHT attaches itself to these receptor sites and begins to treat the follicle as a foreign object in the body. This chemical change not only affects hair. It can cause itching, inflammation, and oiliness. During this time, the follicle, under the attack of DHT, begins to miniaturize with every growth cycle, until after several years, it simply is too small and short to be seen. When finasteride is taken, it works to inhibit the formation of DHT in the system. Within a few months, the overall DHT levels will have remained low enough on a constant basis that the adverse effects DHT is having on the follicles will stop, resulting in a cessation of hair loss. - When one first starts taking finasteride I suggest following Merck's directions - 1mg or 1.25mg (in the case of splitting proscar tabs) every day for a minimum of a year before evaluating the effectiveness of the results. If you experience mild-to-moderate sides, try to wait it out for a few months, without reducing dosage/frequency, to see if they resolve on their own; they often do. If they don't resolve, then consider reducing dosage/frequency. If you're having severe sides, you should discontinue using the meds. - Finasteride starts to inhibit DHT right away, but it may take several months before you notice less hair loss. In fact, it’s likely that you will experience a shedding phase for the first few months (usually around 3-4) after which time the miniaturized hairs will (hopefully) be replaced by stronger regrowth. - Finasteride seems most effective at the vertex and mid-scalp, but that doesn't mean one won't preserve one's hairline or even regrow some hair at the hairline. However, from what I can tell, impressive hairline regrowth is uncommon. - Everyone responds differently to finasteride based on their unique physiology (similar to hair transplants). It may work wonderfully for a long time or it may not work at all or something in-between. - It's very important to take the meds regularly. Having a set schedule helps to avoid missing a dose. - If you discontinue finasteride you will eventually lose the hair the meds were preserving for you (usually within six months). - After one has been on finasteride successfully for a while (I'd say a minimum of 1 year), then it may be OK to start experimenting with dosage/frequency in order to save money, reduce minor sides or simply because one feels better taking less meds. The key word is experimentation, but remember that experimenting (deviating from Merck's recommendations) may involve some degree of risk. In other words, you may lose more hair. Also, check out these threads: - http://www.hairrestorationnetwork.com/eve/166975-finasteride-dosage-frequency-conception.html - http://www.hairrestorationnetwork.com/eve/163746-those-considering-starting-finasteride-therapy.html Good luck! z

Sorry to hear it too, mb30. Maybe consider temporary SMP as an adjunct to a 0 guard buzz? Or, maybe forget everything and free yourself from this roller-coaster once and for all. Either way, good luck.

Cant decide, I agree that Sean's hair must be enviable for many on this forum, but I think the issue is yield. He had a little over 3000 grafts implanted mostly at his hairline. That's a lot of grafts for a relatively small area. I couldn't guess what his yield percentage must be, but I'd venture to say that it's lower than what should be expected from a world-class surgeon like Dr. Rahal, FUE notwithstanding. While I wouldn't consider his procedure a failure, I think it was reasonable for Sean to expect a denser result, and I can understand why he would be disappointed given that expectation. z

davidaaronhardy, I hate to be the bearer of bad news, but I do not believe you are a candidate for FUT or FUE. You have too little hair at your donor, and what hair you do have appears rather weak or diffuse. Who knows what the future holds regarding medical advances in hair restoration (cloning, etc.)? Perhaps you will be a candidate someday. If you really want to do something to address your hairloss now, then I suggest you consider the following: 1) Buzz your hair to a 0 or 1 setting on the clippers, 2) Research temporary Scalp Micropigmentation (SMP) from Milena Lardi of Beauty Medical. They are based in Milan, Italy. I think her work (what I've seen of it) is the best I've seen so far. It's a temporary tattoo procedure which creates the illusion of a scalp full of 0 guard hair. The advantage to that is if you don't like the outcome, then it will fade to nothing in two years. The disadvantage is if you love the work, then you'll have to have frequent touch-ups (probably every one or two years depending on the individual). Spex is the UK and Overseas representative for Beauty Medical. Drop him a line for more information if interested. z

Sean, Thanks a ton for all that insight! I really appreciate it. I'm afraid you're right - I'd probably have to leave North America to find an FUE doc that meets all (or most) of the criteria. What do you think of Dr. Bisanga? He's been practicing FUE for quite a while; I think I read around 8 years. I was always impressed with Dr. Bisanga's well spread out extraction patterns. I know he uses a manual punch; uses 0.75mm - 0.9mm punches; accepts international patients; extracts grafts himself (although I think his techs extract most of them); and, has consistently good results. What do you think of his hairline designs and density? Do you think they are natural? Do you think he approaches the 60fu/cm2 range? I anticipate continuing to consult numerous of the best FUE docs about my two-procedure plan and their approaches. Hopefully, I'll be able to choose the best doc for me sooner than later. By the way, motorized FUE extraction is not necessarily a deal-breaker for me. As you know, many patients have had great results with that extraction method. The potential problems with motorized extraction may be somewhat mitigated by having two smaller sessions instead of one big one. Fatigue is fatigue regardless of the extraction method. z

Thanks, MAGNUMpi.

Thanks for your input, HARIRI.

Thanks, Mickey. I would expect the dreaded shockloss to bum me out for a while. You know who seems to take a lot of care planting into native hair - Dr. Wesley. My impression of him is he's a pretty conservative, careful and methodical doc. He might be a good person to consider for implanting into native hair. He also does FUE and uses punches as small as 0.75mm. I definitely plan to take monthly photos to document growth. z

Congratulations on your successful surgery, Rob. Your points are well-taken. However, what constitutes an FUE megasession is not clearly defined. Some people say 2000+; some say 2500+; some say 3000+; and, so on. Also, not everyone does well with FUE (or even strip) regardless of the number of grafts. My plan is to do FUE procedure #1 to strengthen my forelock, sort of as a test to see how well it grows. And, then take it from there. I realize it prolongs the agony so to speak, but I think it may be worth it. I'll be discussing my plan with docs and make a final decision after getting their feedback. z

Sean, Thanks a lot for your thoughtful reply. I appreciate you looking out for us based on what you've learned from your experience so far. So, if I were to list your main points they'd be: - manual punch may be the better way to go especially if I'm splitting the 2000 grafts into two smaller procedures 8 months apart, - doctor extraction may be superior to technician extraction, - A hairline density of 60 fu/cm2 would probably be OK for someone with my hair characteristics, - punch size between 0.8mm - 0.9mm should be used if possible. OK, if you were looking for top FUE surgeons who use manual punch; create densely packed and natural hairlines (up to 60fu/cm2); use 0.8mm - 0.9mm punch; accept international patients; extract grafts themselves; and, have consistently outstanding results, then who would make the list? Have you heard of docs like Rahal, Feller & R. Shapiro using a manual punch if requested for smaller sessions? z

Sean, Thanks for your input! I'm seriously thinking that's the way I'm going to go. I may even have two different surgeons do the procedures. The first should be done by one who is exceptionally skilled at planting into existing native hair. The second should be done by one who is exceptionally skilled at densely packed and natural looking hairlines. If I can settle on a doc that's really great at both, then all the better, but I won't necessarily limit myself to one doc if I'm not confident that s/he can handle both approaches to the utmost. Given your experience, which extraction method would you now prefer - manual or motorized? We don't have enough info yet regarding robotic extraction. Regarding density, when I was quoted 2000-2200 grafts, it was with a hairline density of approximately 60 fu/cm2 in mind. Do you think that degree of density is too risky? Thanks, z

Hi folks, I've been quoted as needing approximately 2000 grafts to restore my hairline. I'm toying with the idea of splitting that number into two FUE procedures. Procedure 1 of maybe 600 grafts to strengthen my forelock (section 1 below) first to see how it grows. My forelock is in fairly decent shape, but there is some diffuse thinning which needs addressing. If after 8 months things are looking good, then go back for 1400 densely packed FUE grafts to widen the hairline which is currently bald (sections 2 below). Of course the numbers quoted for each procedure are guestimates on my part, but they're probably close. I figure I'd accomplish two things that way: 1) I'd see if I naturally yield good growth via FUE. If I don't, then it will be limited to a part of my scalp where I still have a decent amount of hair so hopefully it wouldn't be much of a change for the worse, and I would scrap FUE procedure 2. But if I do yield good growth, then I can go more confidently into FUE procedure 2. 2) I'm avoiding an FUE megasession which might help me achieve better yield overall. Thoughts? Thanks, z

I'm impressed with the work of Milena Lardi from Beauty Medical. They are based in Milan, Italy. I think her work (what I've seen of it) is the best I've seen so far. It's a temporary procedure. The advantage to that is if you don't like the outcome, then it will fade to nothing in two years. The disadvantage is if you love the work, then you'll have to have frequent touch-ups (probably every one or two years depending on the individual). Spex is the UK and Overseas representative for Beauty Medical. Drop him a line for more information if interested. If you're interested in a permanent SMP solution, then check out NHI (New Hair Institute) in Los Angeles. There are others offering permanent SMP as well, like "Good Look Ink" in Minnesota and "HIS Hair Clinic" which has an office in L.A. As to who is the best among the permanent SMP practitioners, I couldn't say; you'll have to do the necessary research and decide for yourself.

JackW91, Thanks for the documentation. It does clearly state that "palpitations (feeling your heartbeat)" were reported as a side effect. I'm happy your cardiologist gave you a clean bill of health. By all means, stay off of finasteride if you're afraid it's causing palpitations (and you clearly have legitimate cause to be concerned). Gasto, I got those quotes from other hair loss forums. I would've preferred linking to them, but that goes against the rules of this forum. If you google "propecia heart palpitations" you'll find the following: The first quote, by Dr. McAndrews, was from baldtruthtalk dot com, thread subject entitled, "heart palpitations and finasteride." Dated from 2009. Post #2. The second quote, from Dr. Rassman, was from hairlosshelp dot com, thread subject entitled, "Heart palpatations, possible allergic reaction to propecia?" Dated from 2007. The tenth from the top, from "hairdoc" who is clearly Dr. Rassman based on the photo. Perhaps heart palpitations were not listed as a possible side effect of finasteride when those doctors made those comments. z

cinematic, This info. may help: http://www.hairrestorationnetwork.com/eve/166975-finasteride-dosage-frequency-conception.html z

JackW91, Here's what a couple of IAHRS Recommended Hair Transplant Surgeons had to say on the subject: "Finasteride first went into studies approximately 24 years ago [updated, would be 27 years ago] at 5mg (which is 5 times the dose of Propecia). There has been no increased incident of heart palpitations compared to the placebo pre or post FDA approval. There is a small group of people in the Dominican Republic that do not produce Type II Alpha 5 Reductase secondary to a genetic defect. Type II Alpha 5 Reductase is the enzyme finasteride binds to and therefore inhibits the conversion of testosterone into DHT. These men do not have increased heart palpitations. These men do not develop androgenetic alopecia, they do not grow terminal hair in their ears, nose or backs, their prostates state pre-pubital, and they do not develop prostate cancer. They live healthy normal lives." - Paul McAndrews, MD "Heart palpitations may indicate an underlying medical condition. You should see your primary care doctor and discuss this problem. Topical minoxidil use should not generally give you palpitations. Rather too much of its topical use may drop your blood pressure. Minoxidil in oral form is a blood pressure lowering medication. With respect to Propecia (or finasteride) heart palpitation is not a general side effect. As stated earlier, it may be a sign of an underlying medical condition." - William Rassman, M.D. I couldn't find where "heart palpitations" were listed as a side effect under "other." Could you provide us with a url to that information? Perhaps finasteride is a contributing factor, but I wouldn't jump to that conclusion. There are other more likely causes. I'd suggest seriously exploring finasteride as a cause once all the others are exhausted. However, if you're that concerned or convinced that finasteride is causing the palpitations, you can always just discontinue the meds. It's good that you're seeing a cardiologist and getting tested. Stress and anxiety can definitely cause heart palpitations. Acid reflux/indigestion can do it as well. It's possible that you experienced some palpitations (which everyone does from time-to-time), and then anxiety took over to exacerbate the symptoms into a nasty downward spiral. Anxiety is a bitch. It's psychological tension which can manifest physically. It should not be underestimated. Good luck, z

LOL @ snake oil pic! Yeah, BadBeat's probably right. Proceed with extreme caution.

Great advice on this thread. I agree with Bill when he says, "If you enjoy sporting the cropped look, a combination of FUE and SMP might be worth considering." If I were you, I'd do the following: 1) Get on Finasteride and Rogaine, and see how they work 2) Consult with the best Docs especially regarding the condition of my donor 3) If my donor allows for FUE, then follow the interesting strategy outlined by "TC17" in this older thread: http://www.hairrestorationnetwork.com/eve/140863-does-getting-fue-done-first-decrease-total-yield.html The exchanges between "TC17" and "the B spot" are particularly informative. In a nutshell, they are exploring how one may use FUE to establish a decent hairline to frame the face and have sufficient coverage for the rest of the balding area to sport a very short hairstyle. The shorter the hair, the better the illusion of density. This case was used as an example of how a man with less hair than you was able to get impressive coverage after one surgery of 3250 grafts FUT: Hair Restoration Site for Abby Post HT, he kept his hair very short for at least the first 9 months of growth. FUT and FUE are not the same animal, and your hair characteristics appear finer than the man in the example which could work against you (requiring more grafts), but it gives you an idea of what could be accomplished if you go to one of the best FUE docs (assuming you have enough grafts in the donor bank to make it possible). If you're indeed a candidate for FUE, you should be prepared to have a minimum of two FUE procedures at least 8 months apart to do the job. 4) Definitely follow Spex's advice regarding temporary SMP with Milena Lardi. With a successful FUE it would be awesome. Without FUE it might also equal a big positive change. And, if it's not for you, it will fade to nothing in about two years. Good luck, z

Count me among those wondering.

Sean, I'm sure I speak for everyone when I say we appreciate your dedication to the updates, so thanks for that. And, thanks for posting the video of Rahal's interview. I didn't know he had one of those robots. As far as your hair and photos go, have you considered trying the style you want, but with Toppik or Dermmatch artfully applied? Since you have plenty of hair at your hairline, I'm sure those products would be very effective. z

Sean, I definitely appreciate your willingness to meet up when the time comes. It's very cool of you to do that as well as field tons of questions from forum members interested in FUE. Most people stop reporting on their progress long before the 12 month mark, so it's a real service to the community when patients finish what they started. You've consistently updated us, and you're just about at the finish line. Not only that, but the process is an emotional rollercoaster which takes its toll on anyone going through it. You've earned the right to take a breather and pace yourself fielding questions. As always, best of luck with your growth, z

Interesting analysis. Bottom line is there is no universally correct way to address MPB. Just do what's right for you. Distance yourself from people who want to bring you down. Don't waste too much energy trying to figure out their motivations, because in doing so you're inadvertently raising their status which diminishes your power.

See the post addressed to you (#9) on this thread: http://www.hairrestorationnetwork.com/eve/166975-finasteride-dosage-frequency-conception.html It's all about experimentation to find what works for you, but with that comes risk.

Congrats! Grow well, Spanker.

Here's another interesting find: The chart above (from the Gisleskog study of finasteride and dutasteride) measures finasteride levels (not DHT) in the blood over a 24 hour period after a single 5mg dose. Apparently blood levels of the drug peak rapidly 2 - 3 hours after taking a dose and then drop sharply the rest of the day. However, the other charts indicate that DHT remains fairly suppressed for several days after a single dose. I think that's why some people elect to split their dosage into morning and evening doses, because they believe it helps keep serum finasteride levels higher throughout the day, but I'm not sure if that affects DHT suppression. If it does, it's probably to such a small degree that it may not be worth the added inconvenience.