Postdoc

It's probably worth splitting this up into stages. Strip removal is definitely the most uncomfortable bit. The surgeon will do this section by section, injecting local anaesthetic, excising the strip and then stapling or suturing. None of that is exactly painful but it can be very uncomfortable having your face pressed down against the couch for up to an hour. The next stage of recipient area incisions and graft placement is painless apart from the local anaesthetic that's injected as a nerve block for the entire scalp. Post-op, the main discomfort will be from the tightness due to the sutures or staples, particularly when you're trying to find a comfortable position to sleep!

Don't despair! Can you post pre-op pics + numbers of grafts?

I guess if you really want to maximise the minoxidil being absorbed into the scalp cutting your hair short would make sense, but I'm not sure that it would really make much difference.

This looks like an excellent hairline and I don't think you've got anything to be worried about. Once grown out, the added fullness should balance your face well.

Absolutely, although I guess one just feels more confident with finasteride. That said, a friend of mine has done a brilliant hatchet job on drug companies called 'Bad Pharma' and Merck Sharp & Dohme are as bad as the rest.

You may find some old fashioned department stores selling stock 'toupees' off the shelf, but if you want something that stands more chance of going unnoticed, you'd do better contacting Forever Hair in Covent Garden who'll order you a custom hairpiece and fit it. Forever Hair - Hair Replacement and custom hair system Specialists (promotional link removed by moderator)

And happy growing!

Because research into dutasteride for hair loss stopped with Glaxo's phase II trials, any effect post HT is all a bit anecdotal. One very small study suggested that adding 0.5 mg dutasteride a week to regular finasteride had an enhanced effect but this wasn't in the context of HT. But unlike minoxidil, there's no need to stop dutasteride pre-op. I can't see any reason why there should be a difference between FUE and FUT as once placed the grafts are the same. If you're relatively young, I'd recommend starting finasteride pre-op and then adding minoxidil a week post-op to help vascularisation of the grafts. If you've been on finasteride before and are thinking of switching to dutasteride, then remember that it has a long half-life and side effects can be a pain for some (e.g. reduced ejaculate). There's then the issue of what you do with dosing in the long-term.

I don't want to dent your enthusiasm but you'd be better off doing monthly updates as weeks will go by with nothing much happening.

The UK situation for HTs is puzzling. So many of the clinics are pretty faceless with unspecified doctors and techs trained up to do the procedure. The Farjo clinic at least puts the husband and wife team upfront. If you look at the Farjo pics, a lot of them go back a decade or more and the results are pretty mediocre with small graft numbers applied to high Norwood levels. They do seem to be doing higher graft counts now (3000+) but I'm not convinced that their results are as generally as good as the likes of H&W. They also seem to go after celebrity endorsements, which makes me rather suspicious, and I wish they'd just get on with the job and not make so much noise about what they're doing. If I was to go for a 2nd FUT session (1st was with H&W), I'd like to choose someone in the UK, but sadly, I still don't think that's a viable option. If Farjo can prove me wrong, I'd be pleased to hear from them.

Congratulations! With Dr Feller's surgery and your curly hair, the result should be excellent.

I'd continue it for another month and then phase it out. There aren't any hard and fast rules.

I was really in the same boat as you, i.e., a Norwood 5a and fed up with wearing a hair system. I decided on H&W because they have such a good track record for megasessions. From an online consultation they suggested between 4000 and 5000 grafts to get reasonable overall cover. When it came to the actual surgery, my laxity wasn't that great and I also had quite a pronounced erythematous reaction when the incisions were being made. The total length of the strip removed was 37 cm and involved 120 staples. That amounted to 4416 grafts in total. That's really very long and I'm sure other surgeons would have been more conservative. The end result is very good and I was able to make the transition from bandana to short haircut four months after the HT, which means that I've been free of the hairpiece for eight months now. I thought that I might have to wear some sort of piece while the hair was growing in, but the bandana was a much easier option.

5-6 GBP is really expensive if that's for FUT rather than FUE. There shouldn't a waiting list for consultations with the Farjos' patient coordinator, so he'd be a good start. He also pops op on this forum quite regularly, which is always a good sign. The good, non-UK, European doctors are mainly based in Belgium. Feriduni, De Reys, Bisanga and Devroye are the names to look out for. They're all cheaper than the 5-6 GBP per graft you were quoted. If you're prepared to travel further afield, I'd personally recommend Hasson & Wong in Vancouver.

The only recommended HT doctors in the UK are the Farjos up in Manchester although they appear to have a long waiting list even for consultations. They charge ?95 for a consultation with either of them in Manchester and ?125 in Harley St. Seeing one of their 'patient coordinators' is free, though. Transform doesn't have a good reputation for cosmetic surgery in general and tends to adopt a hard sell approach, so be wary. A number of guys on the network have reported good results from London Hair Transplant Clinic but they have a habit of training lots of doctors and hair techs, so quality assurance can be an issue. When you see them, try to find out who would actually be doing the procedure and I think you'll find that they dodge that issue. You'll also find that HT in the UK is expensive!

Yes, both front and crown. Difficult to be sure about the difference but crown crown was probably a couple of months slower.

The evidence isn't that strong for minoxidil post HT but it's probably sufficient to make it worthwhile. My own take on it is that any way of improving the vascularisation of newly transplanted FUs is worth trying. See this link: Improving the Outcome of Hair Transplantation with Minoxidil « Avacor® Hair Regrowth Blog It's also difficult to say when should stop using it post HT, but if you've got sufficient regrowth that makes it difficult to apply the minoxidil to the scalp, that may be the deciding factor. In my case, I started it one week post HT, applied it twice a day until month 4 and then just used it on the crown where growth was slower.

Although I no longer wear a hair system having made a successful transition with a hair transplant, alarm bells ring when I hear of anyone being tempted by the dubious and expensive offerings from companies like Hair Club for Men and Advanced Hair Studio. Whatever phrase they care to use - "strand by strand" and "bio-matrix" being the ones I recall - they're selling a hairpiece that can be bought far cheaper and probably at higher quality over the internet from companies like Coolpiece, Toplace, Hair Direct or Hairpiece Warehouse. You can also avoid being tied into any expensive contract if you source the piece yourself and then find a local hairdresser to cut it in. You may want to start with getting a stock piece (usually 8" x 10") that can be cut down in size. The easiest way of attaching the piece is to use double-sided tape and for the scalp to be shaved so that you get a secure attachment. The tape will need changing weekly (you'll learn how to do it) and the hair shaved down again once a month. Some guys manage to do the whole thing themselves (including cutting down the piece and trimming their own hair) but that takes a lot of experience. Any of the above companies would be happy to answer any questions and guide you through the process. Best of luck.

Three weeks isn't long and redness is to be expected. Superficial nerves also get cut when the strip is removed, so don't be surprised if you experience numbness or other sensations in the months ahead. I'm guessing that the wound was closed with sutures and the white area at the end of the scar in the 2nd pic could be where there's some infection, so get your own family doctor to check it out. It's always possible that a suture or two weren't removed which could predispose to infection.

Jeff, T4 an T3 are thyroid function tests and would be part of an endocrine screen. TSH (thyroid stimulating hormone) is often included in this screen. The normal range for free T4 is 10 - 25 pmol/l and total T3 is 1.0 - 2.5 nmol/l, so your results are normal. Happy Christmas!

A search on Google is hardly the same as a literature search of peer-reviewed articles, but I understand that this is a contentious issue and perhaps my viewpoint is too mainstream medical, so I won't be contributing any more to this thread. Happy Christmas to all, anyway.

GNX1 is being somewhat alarmist. A free testosterone level of 219 isn't that low and it's unhelpful for him to say that it's "of a sick 90 year old man". The normal range is very wide, ranging from around 240 to over 1000. It's not that unusual for testosterone levels to drop as one gets older and there are probably hundreds of thousands of men over the age of 40 who have a low testosterone level without realising it and without it causing any problem either. It's definitely essential that you see an endocrinologist and he may decide to watch and wait rather than start you on replacement therapy. If he does start you on replacement the objective would just be to bring your level within the normal range and I'd be very surprised if this had any impact on your scalp hair, particularly as you already take finasteride. You mention having gynaecomastia and it sounds as if this was before you started on finasteride. DHT blocking drugs like finasteride and dutasteride can rarely cause gynaecomastia, so this happening before you started the drug needs an opinion from then endocrinologist. Both hydrocele and varicoceles are entirely benign conditions and shouldn't affect the production of testosterone. The exception would be if the blood supply to the testis is compromised, e.g. at surgery, but the endocrinologist might want you to see a urologist just to make sure. Regards, David

I think diffuse thinning is more common in women who are hypothyroid but it's difficult to be certain. I'm inclined to think that the stubble sized shedding is more likely to be associated with the hypothyroidism as that when untreated does lead to brittle hair that breaks off easily. I doubt that it's anything to do with shedding due to the finasteride if you've been on that for a year. Regards, David (Postdoc)

Drugs prescribed for ADD like Adderall and Ritalin can cause hair loss although this isn't related to androgenic hairloss. As you're three months post HT, I'd be very wary of going back on anything that might impact on the hair that's about to sprout forth. As a UK medic, I'm also very sceptical of the diagnosis of ADD in adults anyway. Best of luck with your growth! Regards, David (Postdoc)

Sorry to hear that you've been diagnosed with hypothyroidism. As you probably know, both hypothyroidism and hyperthyroidism are associated with a speed up of the conversion of testosterone to DHT, so hair loss in both conditions can be a problem but isn't inevitable. The pattern of hair loss tends to be different in the two conditions, so hypothyroidism is more associated with loss of body hair and, strangely, the lateral third of the eyebrows, and hyperthyroidism with diffuse thinning. As you're already taking finasteride this should hopefully be somewhat protective. The other key thing is to get the dose of thyroid hormone replacement right. 50 mcg sounds a good starting dose but you need to make sure your family doctor is keeping a close eye on your thyroid function tests. Regards, David (Postdoc)