Postdoc

I've done a pretty through literature search and I can't find anything that substantiates low serum testosterone as a side effect of long-term finasteride use. Perhaps you were unlucky, but I wouldn't like to see others generalising from your experience. Regards, David (Postdoc)

Actually the evidence is that finasteride usually causes an increase in serum testosterone level. Ditto dutasteride. There is an inverse relationship between BMI and testosterone level, so weight gain is the more likely explanation for low serum testosterone. Regards, David (Postdoc)

Hi Jeff, Although it may sound counterintuitive to be on both testosterone replacement and finasteride, this shouldn't be a problem. In fact, some doctors prescribe finasteride to patients put on testosterone replacement to counter the increase in DHT levels. There's a short reference here: Testosterone replacement in the setting of Finasteride therapy: a therapeutic dilemma Regards David (Postdoc)

I started minoxidil after the HT. Regards, David (Postdoc)

I think it's very unlikely that more widespread shedding should be a problem. If my own experience is anything to go by, most of my shedding happened before I started the minoxidil and then I got a lot of early growth such that by month 4, I was able to ditch my bandana and have a short haircut. What's tricky to know is how long to continue the minoxidil after the grafts have grown in. I was using minoxidil at the front as well as on the crown and I stopped using it on the front about three months ago and I certainly haven't seen any shedding. I think the best way to view minoxidil is as an initial growth enhancer and it probably does this by promoting vascularisation of the grafted follicles. So it's probable reasonable to gradually phase out using it, although I'm not aware of any evidence from research for doing that vs. continuing it indefinitely. You might also want to use Nizoral shampoo twice a week for its anti-DHT effect although the evidence is fairly weak. As I mentioned before, finasteride or dutasteride are definitely worth taking, particularly if you're young. Regards, David (Postdoc)

There are plenty of references on the web to Dr Fotis Tsounis working at a hair clinic in Athens and they also mention that he uses the 'choi implanter', which is a way of placing grafts that's popular in Greece but hasn't been taken up by other HT surgeons who prefer a more precise approach such as the lateral incision approach of Hasson & Wong. Although there are plenty of hair clinics in Harley St offering FUT and FUE, they're all considerably more expensive than those in the US, Canada and Belgium, and the quality of their work leaves a lot to be desired. That might change, but I haven't seen any sign of that yet. The only reputable clinic in the UK are the Farjos in Manchester, although they seem rather focused on celebs and don't do the megasessions performed by H&W. Regards, David (Postdoc)

Whilst there haven't been any large scale studies on the use of minoxidil post-HT, small studies of just 12 patients have reported that minoxidil may prevent shedding and promote early growth. As long as you start using it once the recipient areas are fully healed (e.g. a week or so after the procedure), it would be reasonable to use it. Shedding due to minoxidil is very variable and if it did cause shedding, it should only be in the area where you apply it. I'd also recommend finasteride or dutasteride to help you hold on to the remaining hair. You can find some references to minoxidil use post-HT in this link: Minoxidil Recommended for Hair Transplant Patients Regards, David (Postdoc)

Dr Lindsey, As a doctor myself, I'm really impressed by your willingness to go the extra mile with unusual and deserving cases. Sadly, there's little such interest in the UK. Regards, David (Postdoc)

Shock loss wasn't too bad despite a 35 cm strip being excised. Healing was pretty straightforward and the scar is very fine.

Yes, I'm in London. Dutasteride has been OK apart from the usual problem of reduced ejaculatory volume; libido unaffected, though. I've been on it for just over 2 years and I guess the difficulty is knowing when to stop it or reduce to 0.5 mg every other day. I did try finasteride briefly a few years ago but was put off it by the same side effect as with dutasteride. I didn't get any irritation with the Nizoral but it tends to dry out the hair; I'm just using it once a week now. Best, David (Postdoc)

Thanks, Redman. I was taking dutasteride pre-op and have continued post-op, which may have helped. I also started using minoxidil from day 5. Another possible factor is that I developed quite marked erythema when Dr Hasson was making the incisions for the grafts. Although he seemed a bit spooked by this, it may have actually helped with the vascularisation of the grafts. Best David (Poistdoc)

Many thanks for all your nice comments - much appreciated. Having the HT really has been one of the best things I've ever done and I can see why so many talk about it being life-changing. In my case, throwing away the hairpiece (in fact, tearing it up into little pieces and then ceremoniously burning it...) after so many years of 're-grooms' is positively liberating. Best, David (Postdoc)

Impressive result - many congratulations!

Thanks, Blake. Where have you got to with your medical training?

Well, after 4 months of bandana-wearing, I finally had a haircut. It may be early days, but I'm happy! Hair Restoration Site for Postdoc

Mr Michael May has been around for ages, but unless there's been a dramatic improvement in his surgical technique, he's one to be avoided. Garageland has written about his experiences with him in the '90s: Hair Restoration Site for garageland Sadly, FUT and FUE in the UK still seems to be way behind the US, Canada and Belgium. The Farjo Clinic in Birmingham is probably the best, but I don't like their celeb hunting and they tend to be conservative with graft harvesting. Regards, Postdoc

Yes, it's pretty unfair but I don't know of a way around it. Canadian border control is also rather paranoid about visitors trying to milk their health service, so they usually want to evidence that you've paid fees in advance of having the procedure. Regards, Postdoc

I'm a doctor myself so I sent in my own scrip. Normally you'd get your GP to do a private scrip or you can get an online consultation and private scrip which costs 20 GBP.

The price is certainly tempting but there are too many bogus meds out there to take the risk. Their price for dutasteride (Avodart) is ridiculous: 130 USD for 30 tabs. PharmacyGB sell it for 24.75 GBP for 30 tabs.

I wouldn't advise buying anything other than the real med: there's no guarantee that 'dutagen' is really dutasteride. The UK online pharmacy I mentioned earlier in the thread only provides the real licensed product.

Sounds like a very well adjusted way of dealing with the whole thing! How was your experience at H&W? Regards, David

NW3 at their ages isn't too bad. As I said, your hair looks good. If you're really convinced that there's some thinning at the hairline, then I'd recommend topical treatments to see whether that holds your hair as it is. There are some HT surgeons who will transplant younger patients (Dr Armani in particular in the US and also Dr Rahal in Canada) but it can be a very expensive business if you start chasing hair loss at your age. It really is better to wait until your 30s when hair loss is likely to be more stabilised. But if you're still not convinced, why not contact one of the HT surgeons mentioned on this network and ask for an opinion? And yes, the point about transplanted follicular units is that they're genetically programmed not to respond to DHT in the same way as the follicles at the front and on the top or crown. Regards, David

It seems to be going OK. Two months post-op, there's hair where there wasn't hair before and the very long scar is disappearing. I've been applying minoxidil since day 5, which could account for my observation that about 20% of the hairs haven't shed, but that may all change over the next few weeks. I also had a fair amount of shock loss which isn't that surprising given the amount of strip removed. But it's early days... Regards, David

Dear Sharan9895, Your hair looks very good to me, although the photos are a bit blurry. I doubt that any reputable HT doctor would really want to consider either FUE or FUT at your age and given the current state of your hair. It's also important to know what your family history of hair loss is, i.e., who has MPB, when it started and how far it has progressed. If there's no history at all, then you probably have little to worry about. If here is a history, I'd recommend topical treatment to start with, such as Nizoral (ketoconazole being the active ingredient with an anti-DHT effect) shampoo every other day plus 5% minoxidil. You shouldn't have any problem sourcing these in India. I hope my advice helps. Regards, David

Hi Alix, Yes, I bought from them myself. It's just a UK pharmacy with online business. I'm a doctor myself and would never touch something that wasn't legit! Regards, David