Motoro

All the folks I knew from 20 years back who espoused that philosophy as a hair loss treatment--at least those who advocated for it in opposition to 5-α-reductase inhibitors (as opposed to those who suggested healthy lifestyle changes to compliment proven hair loss treatments)--are now NW6+ or well on their way. Every singe one of them. That's a cold fact. An educated, active and ongoing awareness of what you put in your body and where it originated--not to mention the environmental and social impact of actually getting it on your dinner table--is critical to overall health, conscientious citizenship and individual well being. Just don't confuse or conflate any of that with stopping hair loss. Of course you don't need a stranger like me on some Internet forum to tell you these things. Time always gets the job done. The thing is, once your hair is gone, it's gone. There simply isn't enough time in this war, especially in the early stages when the stakes are highest, to make the wrong decisions.

If changing your diet has an effect on your hair loss, you're suffering from malnutrition, an almost unheard of malady in population groups who frequent Internet hair loss forums. Aside from Loniten, which isn't safe or predicable, there are three substances that pass through the mouth and arrest falling hair: finasteride, dutasteride and any sort of terminal poison.

Last night’s post put me in a reflective mood and I have a few additional thoughts about thinning, transplants and length. I didn’t talk about hair length in Dr. Lindsey’s video and I don’t want anyone thinking hair loss and long hair go together. They do not. My hair hasn’t been this long since 2001 and it isn’t going to stay this way. I grew it out to cover my FUE donor and recipient areas (all my surgical work is in and around my hairline). I did this with each of my four procedures and recommend it to those who want to keep their business private. As far as I know, nobody knows about my work aside from a handful of close friends and family. Advertising hair loss and your treatments focuses attention behind the curtain, where it doesn't belong. It’s much easier to find Waldo when you know where to look. On that note, I currently blow dry my hair and basically have long bangs. I generally wear a hat as much as possible during this “ugly duckling” recovery phase, but I can and do go hatless when necessary. A little planning is all it takes. That said, I normally keep my hair short and neat. To repeat that old line, hair restoration involves a lot of visual trickery. Short hair and low scalp contrast conceal thinning and loss. Indeed, dying my transplanted hair to reduce scalp contrast is something I’d consider if I wasn’t already going gray. Guys obsessed with looking “young” and dying their hair dark often end up with a shoe polish look that draws attention where it shouldn’t. Older white guys with thinning hair and dark dye jobs universally look terrible. That’s not a look you see in nature, which is generally the best measure of any treatment. SMP, which I’ve never had, can contribute to the contrast illusion from the scalp angle. Combined with very short hair, FUE and a nicely shaped head, SMP results can impress. But all density illusions break down with length, and if I had a nicely shaped head I’d just shave it off and call it a day. There are more important things in life than hair, but it didn’t feel that way to my 17 year old self, who committed to this endless fight. My shaved head looks like a still-lumpy proto-planet that's full of impact craters, however, and I don't regret my choices. To conclude on a positive note, I haven’t been excited about my hair since the mid-1990s, when I first noticed fallen strands in the pages of my high school textbooks. But I’m genuinely excited about going gray and getting older. Hair loss in your 30s and 40s is commonplace. Only now do people ask how I kept my hair when all my people went bald. There's still a 17-year-old kid in the back of my head who chuckles each time this happens. I’m entering new and uncharted territory as I close in on 40: no man in my extended family—to paraphrase an Irish saying—has ever combed gray hair.

I'm the dude in the video. I intended to chime in earlier, but my (healthy) aversion to hair loss forums kept me away. More on that in a moment. First of all, a big thanks to Dr. Lindsey and his staff, especially Wendy. This was my forth transplant with Dr. Lindsey, which says all you need to know. Donor hair is a limited resource and hair loss is a never-ending battle. Pick your surgeons carefully. I’m almost 39 and started losing my hair at 17. Every male in my bloodline, going back three generations, went NW6 by 30. I started minoxidil at 18, finasteride at 20 and dutasteride at 22 (replacing finasteride). I’ve been taking 0.5 mg of brandname Avodart each morning for the past 17 years. In the early 2000s—when the forums were less foolish and hysterical—people talked about “the big 3.” Minox/Fin/Niz. I took that to heart and never wavered, which is why I still have most of my hair in spite of genetics. In 20 years nothing has changed when it comes to drugs that work. The guys from the early forums who still have hair don’t have it because they ordered unapproved and untested drugs from China on the advice of online bro scientists. DHT-prone follicles are an even more precious resource than donor hair. Don’t mess around. Get on one of the two FDA-approved 5-alpha-reductase inhibitors and stay on it. Forever. While I’ve had four hair transplant procedures, they have all been relatively small FUE sessions—think 500-1000 grafts. I have thin hair and the illusion of density requires tight packing and multiple sessions. Realistically, that’s true of most people and is what you should count on. One and done isn’t reality for most guys and hair loss never stops. Let me say that again: hair loss never ends. The idea of “stabilizing” loss with meds before getting a transplant shouldn’t be confused with stopping loss—meds slow loss in good responders, at best, over a lifetime. And once you’re taken a surgical stand against hair loss, know that there will be more transplants in your future at your current vanity levels. Don’t think hair loss isn’t going to bother you once you’re reached some unspecified age. If hair loss bothers you now to the point where you can’t accept it, hair loss will always bother you. Finally, be careful about spending too much time on these forums. Countless folks lost hair they’ll never recover as a result of the finasteride hysteria that started around 2005. It’s easy to freak out online, quit the things that work and convince yourself your dick is about to break off and tumble down your pant leg. Don’t believe the hype. Take your meds religiously and if you decide to get a transplant, plan it out with the next several decades in mind. Thanks again Dr. Lindsey. I’ll stop by in 6 months or so to catch up.

I've had a dream multiple times where I wake up in the morning, walk to the bathroom, look at myself in the mirror and see a NW6 staring back at me. In this dream I'm not only a NW6, but I have a really, really bad haircut. It's longish in the back and on the sides and looks badly dyed. I look like an "accountant" from Central Casting... I have this dream once or twice a year. I also have the broken/missing teeth dreams. Terrible stuff.

Nice job Dr. Lindsey. With this guy's minimal hair/scalp contrast and limited scaring, this is going to be a great example of what a few transplants can do for an individual's overall look. The refusal to try medication is baffling to me, especially since this guy comes from a class 6 background, but he may just pull it off in the end. I'm looking forward to seeing a final update in a few years, after that second round.

For most men, there's no medical treatment that can regrow cosmetically acceptable hair in areas that are completely bald. There are exceptions to this, but they are just that: exceptions. Having said that, I'll also say this: I've been on dut for 13 years and during that time I have lost very little additional hair around my hairline. Keeping what you have for multiple decades counts for a lot. You can always fill in what's missing with a transplant or two.

Hey man, you are going to be just fine. You weren't botched, as far as I can tell. You obviously need more density, but the hair you had transplanted is growing. It's thin, but that's not the end of the world. It's also early, at only 6 months. Another pass by a recommended surgeon and you'll look great. Remember, most people need more than one transplant during the course of their lives. Some people need that second procedure quite soon after the first. You're one of those guys. That's no big deal--you'll turn out fine in the end. It's just going to take some time, money and patience.

What I'd suggest--which is what I have done after each of my three small FUE sessions--is to grow my hair out and just style it forward when I need to meet with people and can't wear a hat. The long hair is also able to cover up the shaved donor area in back. Again, this is for small sessions. It's not a perfect solution, but it gets the job done. As far as I know, nobody has detected that I've had anything done while in the ugly duckling phase. After three weeks, get a real haircut to even things out. And after six weeks, you'll be golden.

If you are concerned about your hair being dirty and greasy, take the extra time to take a shower. That's not very hard to do; it should only take a minute or two. If you are concerned about your hair loss (if you have any), start taking finasteride. That not very hard to do either. You'll be better off having done both things. Worrying about your follicles being clogged with "gunk" is a waste of your time and energy. "Gunk" may make you smell and look nasty, but it's not a big factor when it comes to hair loss.

How much hair are you having transplanted, where is it being transplanted, what transplant method is being used and how long will your hair be at the time of the procedure? Finally, who is your audience? Who are you trying to fool? Your family or co-workers/acquaintances? Cover up strategies should be based on the answers to the above questions.

What does this individual hope to achieve with his transplant(s)? Does he have realistic expectations, considering his starting point?

Nothing is permanent when it comes to hair. Even some hair transplanted from the safe zone may fail if you live long enough and are predisposed. Finasteride can slow the progression of loss to the point where you may only need one or two additional HT procedures over the course of your life, assuming you catch the loss early and are a good responder to the medication, as most men are (despite what you may read on the forums). You should shed the idea that there's something you can do to fix your hair loss problem permanently. You already have extensive loss and your best first step--regardless of how much hair you get transplanted and which method is used--is to save as much of your native hair as possible. That should always be the starting point once you've decided you want to walk down this path. There isn't a magic bullet and the best results, over the course of a lifetime, are going to be achieved by attacking the problem on multiple, proven fronts.

First things first. Post a picture so we have a frame of reference.

Don't count on it! We haven't had a major MPB breakthrough on the medical front in 20 years. Hanging out on the forums, it's easy to get yourself pumped up about things that might be just around the corner, but history suggests these future products: 1) Won't work at all. 2) Won't work well enough or better than anything we already have available. 3) Aren't going to be profitable enough for drug companies to bring to market for MPB. The online backlash against fin doesn't help here. At some point we'll see gene therapy address MPB, but probably not for decades. It's not something I'm counting on being available to me. Hair cloning falls into the same "don't hold your breath" category. Based on what I've seen over the last 20 years, I don't believe there will be a major MPB breakthrough brought to market between now and the time decades from now when gene therapy becomes an option. History suggests there may be a MPB product or two that hits the market between now and then, but history also suggests it won't be a breakthrough product that works much better than anything we already have. I'm not trying to be a downer. Quite the opposite, in fact. I believe most men who are starting to bald in 2015 can achieve a great outcome with fin and modern transplants. The trick is to catch the problem early and to remain consistent with the medical treatment. I'd also suggest staying off the forums once you've learned everything there is to learn about hair loss in 2015. Once you've done this, stop by in another 10 to 15 years. You'll likely find there have been advancements on the surgical front but not on the medical front. The forum conversations will all be the same. The old users may be gone, but there will be a new crop (who were young children when you were last on the forums) arguing with religious intensity about one thing or another. But the situation on the ground will be the same. This has been my experience.

The only doctor I'd consider in the DC area is Coalition member Dr. Lindsey. I've had three small FUE procedures with him. At the very least, I'd strongly suggest that you reach out and book a consultation with Dr. Lindsey AND with the individuals you've already identified. Ask a lot of questions and don't rush into anything. Do your homework and take your time. As for the ARTAS, it is just a machine. Be careful about clinics that advertise the tools they use. That's not necessarily a bad sign, but you need to keep your focus on the clinic's results and their philosophy. Don't confuse marketing with real world results. Ask to see pictures of patients or, better yet, meet other patients in person or even sit in on a brief FUE session. Don't take any of this lightly.

Very impressive. The patient went from looking like he had ridiculous doll hair to looking like a normal, balding man. Without doing anything else, I imagine this session will help tremendously with the problems the patient suspects his bad transplant caused in social situations. In that sense, the case is already a major success. Nice work.

Correct. That's exactly what they are doing.

Everything in this post hinges on point #4, which I consider to be factually incorrect based on my own experience. Two general facts about my hair: 1) I began losing my hair when I was 18 years old. I’m 35 years old now and have what most people outside the MPB forum world consider a full head of hair. 2) I have aggressive hair loss on both sides of my family. Every single male in my direct bloodline went bald at a young age. To be fair, there are cousins and uncles in my family who are less bald than my father or grandfathers, but my point is still the same: MPB runs very strong in my family. We bald early and aggressively. Like I said, I’m 35 years old now. I have been taking hair loss meds since I was 20. I was on finasteride for two years and then switched to dutasteride when I was 22. I’ve been on Avodart for the past 13 years, which is probably longer than almost anyone who has been taking the drug for hair loss. During that time I have maintained close to all my hair. I’m tempted to say that I haven’t lost any hair at all in the last 15 years, but that’s not entirely true (it’s close though). The point is that with the 5-alpha-reductase inhibitors, the loss has been extremely minimal even though the chances are very, very high that I’d be well on my way to being a NW6 had my genetics been allowed to play themselves out. Having said all that, I admit that the medication could stop working at any time. That’s possible. It has happened to other individuals, although I don't believe this to be the norm. Evidence so far, however, suggests that it’s unlikely to happen to me. In the age of Internet-stoked fears about finasteride, I think we’ve lost some perspective on how effective 5-alpha-reductase inhibitors can be when used consistently after the very first signs of hair loss. There aren’t enough people on these forums who have been in the game long enough and been consistent from the very beginning with finasteride/dutasteride to push back against the anti-finasteride tide. In this sense, these forums aren’t a great place to give someone new to this world a solid sense of perspective. So, having established that point #4 is questionable at best, points #1, #2, #3 begin to fall. Are they true? Yes, but with qualifiers that have already been identified in this thread. The fact is, if you respond well to a 5-alpha-reductase inhibitor over a period of years, you can feel a degree of confidence that you can get a hair transplant that will remain cosmetically sound for a long time. Will touch up jobs be necessary? Yes, probably. But will you be chasing something that’s ultimately unachievable as you age? Personally, even without further advances in treating MPB, I don’t think so.

Sorry for being a stranger Dr. Lindsey. I should have stopped in sooner for some photos and a chat. The truth is, I was feeling good about my hair after my second session and wasn't thinking all that much about my hair. Paradoxical, but true. About the white FUE dots: I couldn't care less. My hair is going grey/white anyway, so nobody is going to notice even if they look closely. And if they do, so what? I've been actively fighting hair loss with meds for 17 years. I've been through every emotion associated with hair loss during that time. Most of the guys I knew in high school and college are now bald or balding. I don't sweat tiny FUE scars. They might have bothered me when I was 18, but at 35 I'm in a much different place in my life and in this battle. Thanks again for doing such a great job. Looking forward to the next session in a few months.

Ok, quick update. I had a small followup FUE session on 9/20/13 with Dr. Lindsey. The goal was to thicken up the previous work and fill in a few problem areas from last time. Dr. Lindsey removed around 340 grafts using a 1 mm Feller punch (Dr. L., please correct me if I'm off on this). Most of the grafts in my 2012 session were singles, but there were a higher percentage of multiples (doubles and triples) this time around, which Dr. Lindsey strategically placed behind the front of my hairline. I'm hopeful the illusion of the transplanted hair will be augmented by the multiples, particularly because my hair is of a finer caliber. Not surprisingly, areas containing multiples from last year's session look significantly thicker than areas made up exclusively of singles. As was the case last year, everything went very smoothly and Dr. Lindsey, Wendy and the rest of the team were both professional and a lot of fun to talk to while the procedure was underway. In terms of recovery time, everything is pretty much back to normal a week out. All the "after" pictures were taken exactly a week after the procedure. There's not a lot of evidence that any work was done at all, which was one of the goals. Thanks again Dr. L.

I was never going to go with FUT. I had my mind set on FUE from the beginning, as I didn't want any sort of linear scar, however minimal, and also because I wasn't looking for a large number of grafts. If I needed or wanted more grafts, I may have proceeded differently. As for the discussion about FUE vs. FUT, if I remember correctly, it was what you might guess. We covered the issues one needs to be aware of when considering FUE, namely yield and the issues that can affect yield, like follicle transection. Dr. L. left the choice to me. The issue of the diameter of my hair shafts isn't related to FUE or FUT, except to the extent that FUT often produces more consistent, healthy grafts, which is desirable when you have fine hair and may need more grafts to achieve the illusion of natural density. Like you said, I was fortunate to have had great success with the meds. If that hadn't been going as well and I needed more hair, I may have proceeded with FUT. As it is, I'm just using small HTs to even out my mature hairline. As I approach my mid-30s, that seems an appropriate goal. Fingers crossed that things proceed the way they have been proceeding for the last 14 years. If so, my plan is solid.

No doubt I could cut the price by buying online or using generics from India. I could cut the price a lot, I think. The thing is, I've been doing the exact same thing for over a decade and I'm pretty happy with where I'm at. I don't want to mess with online pharmacies or drugs from India. I have little doubt that these meds are probably just as good as what I get in the local pharmacy, but buying what I've always bought from the place I've always bought it gives me piece of mind, which is worth a lot to me. It's certainly worth $4 a day. I actually don't spend much time on the hair loss forums, as I've found it plays into my OCD and I don't want to spend too much time thinking (even more) about hair loss, but I have read about daily fin plus a 0.5 weekly dose of dut. If that's working for people, I think that's fantastic. As for me, I'm going to stick with what I've been doing for the last 11 years. I switched from fin to dut not because fin wasn't working, but because dut was new on the market (this was way back in 2002) and my dermatologist suggested it might be even better than fin. So I made the switch and have been using everyday since.

Thanks man. There's no doubt I'm extremely lucky to have kept most of my hair. In an odd way, I'm lucky I started to lose my hair and got on Propecia and then Avodart before the Internet hair loss forums blew up in size and filled up with people paralyzed by fear of the potential side effects of the oral 5-alpha reductase inhibitors. Those concerns, which didn't exist when I started all this, may have frightened me away when I was 19/20 years old and kept me from the things that allowed me to get to 33 with most of my hair intact. I pay about $130 per month for 30 0.5 mg Avodart pills, from my local pharmacy. I was put on Propecia and then Avodart by my dermatologist, so I've always had a legit prescription and haven't messed with the online pharmacies, where I'm sure I could probably find a better deal.

I'm the guy in these pictures. A big thanks to Dr. L. and his team. Here are some quick comments and observations: I started noticing hair loss when I was 19 years old. When I was 20 I started on Propecia. When I turned 22 I transitioned from Propecia to Avodart (0.5 mg). Im 33 now and have been on an oral 5-alpha reductase inhibitor for 13 years (2 on finasteride, 11 on dutasteride). For the last 2 years I've also used liquid minoxidil, which may or may not be doing anything. To the extent that I'm still actively losing hair, it's happening at a very slow pace, mainly around the hairline. When I look at pictures of myself from 5 or 10 years ago, there's not a tremendously noticeable difference in my appearance. I attribute this to dutasteride, from which I've had no side effects at all (that I know of). Now, as for my HT case, the thing I want to drive home is how slow regrowth has been for me. It took months before my transplanted grafts fell out and nearly 6 months before I had any new minor regrowth. I'm closing in on a year now and I'm still seeing new hairs pop up (not a lot of them at this point, but I had at least a few brand new ones at month 11). What I've also noticed is that the hair that first regrew months ago is now, after many months of growth, really starting to thicken and darken up. I knew going in that regrowth happens at different rates for different people, and it turns out it doesn't happen very quickly for me. Like Dr. L. said, I'm going back for some additional work in September, mainly to fill in areas that need thickening. The bottom line for me is that this game requires a lot of patience. That's true of both medical and surgical hair loss treatments. You need to think in years and decades, not weeks and months.