mahhong

It's a solid result. I think the issue with your logic, gbhscot, is that nobody really knows how their result is going to turn out. Some men would get a better cosmetic result than this, others perhaps even less cosmetically acceptable. You won't know until you pull the trigger - as it happens I think this is an almost perfect representation of the "average" result somewhere around 4,000 grafts will get you - not absolutely stellar but a very, very appreciable and improved cosmetic difference. This guy had significant hairloss, there wasn't really any native hair to blend into and if you've got 100cm+ of pretty much bald scalp to work into (I'd say it's at least that), you're somewhat limited. This gentleman probably still has another 2 - 3,000 left in the bank by strip and/or FUE. Another procedure to beef up the hairline and perhaps thicken the mid-scalp would go a long way. And there's always concealers or other cosmetics if you want a little fuller look. As it is I don't think he needs further work - this procedure has been planned well. There's possibly scope for more but it stands by itself. I think sometimes forums can give a slightly skewed sense of what is a "successful" HT. For 4,200 I would say this represents pretty much what a lot of men with that level of loss could hope to expect.

It's a fantastic result! I think keeping a lot of the forelock must have really helped him, but he was pretty substantially bald and his hair looks fantastic these days.

Sounds good! It is worth saying that sexual dysfunction is pretty rare with finasteride and dutasteride. The internet probably makes it sound a lot more common than it is - official studies put sexual side effects at somewhere between 1-3% of people using the drugs, anecdotally it may be a bit higher than that, but still maybe only around 5-8% (and that's very unscientific, just a general judgement based on forums such as these). However a lot of men choose not to take the drug, either because they're worried about about side effects or have experienced them whilst trying the drug. Some men find they can take a lower dosage and have benefit to their hair without experiencing sides and that may be worth considering. Rogaine and Nizoral are both effective treatments too, so it's good to stick with them (though generally speaking people see the best results using them in conjunction with an anti-DHT medication). Hair transplantation is obviously a very effective solution to hair loss too, just bear in mind you may continue to lost hair even after a transplant (whether you're on medication or not), so you may need several or more transplants to meet your goals and there is always a risk you may need more transplants than your donor would allow over the fullness of time. Finasteride and dutasteride usually halt or slow hair loss down a lot over the course of decades, so they remain the best way to reduce further loss whilst having transplants to deal with any current loss. However, many men successfully restore their hair without these drugs - ultimately the choice on how best to proceed is down to you!

Hi Darkhorse, I haven't used it but noticed nobody had yet answered. I do know however lots of men use dutasteride (also known as Avodart) for hairloss - some instead of finasteride or when they feel finasteride is no longer working for them. Like finasteride, side effects are fairly uncommon but can involve erectile dysfunction, watery semen, gynecomastia and some men also report a sort of "brain fog". However these side effects are not present and can nearly always be stopped or reduced by either coming off the drug or reducing the dosage. Dutasteride is slightly more potent than finasteride in that it inhibits two types of 5ar, where finasteride only inhibits one. This is thought to make it slightly more effective than finasteride, but it may also be slightly more likely to produce side effects - the likelihood would still be statistically low, however.

What Dr. Bloxham said. I've heard varying degrees of success but I've also heard that some men get the same sides as finasteride. It works in a different way but it still essentially does the same thing and it very likely still goes systemic, so the rest of the body may be affected the same way. Add to that the hassle of having to buy it and create your own vehicle to apply it, and it just seems like a lot of hassle without a lot of clinical study to back it up. That's not to say it doesn't work, but how well it works, or what is the best dose/vehicle to use is still without proper study, not to mention any real knowledge about long-term safety (no reason to suspect it's particularly unsafe, but it's all conjecture either way). I think finasteride, minoxidil and transplants are still the three best options, with maybe some good adjuncts like Nizoral etc. Personally I don't think I'd trust purchasing and creating my own anti-androgen!

I think the main concern with RU (apart from the fact getting it and creating the formula is, to my knowledge, technically illegal) is just a lack of genuine data on how well it works and how safe it is, as well as no truly established guideline on how to produce it (i.e. the best solution, concentration etc.). Most men who try RU are, frankly, men who are probably also using minoxidil, finasteride and often "boosting" that with dutasteride, saw palmetto and various other vitamins and oils. More power to them if they want to do that, but it makes it very hard in most cases to truly know how much benefit RU offers, and it's also potentially damaging to your health too. Of the few studies/abstracts that have come out, it seems that RU is at best maybe comparable to finasteride. It possibly has a lower side effects profile due to the way it works, but if you're planning on combining the two that wouldn't matter much anyway. Personally I don't think I'd try it. I've heard nothing to suggest it's seriously unsafe or anything, but I don't much like the thought of concocting my own, not really tested anti-androgen - especially if there wasn't at least seriously good scientific evidence it had a really beneficial impact. The concept of using both is sound but it just doesn't seem practical and nobody really knows about the safety or usage aspects. It seems like an awful lot of work and energy for little more than a hope.

In my experience I would say the average man's donor yield, via FUE, is usually around the 6 - 6.5k mark. I think to only get 5k would be fairly rare, but to get more than 7.5k isn't that common either. In most of the cases posted on here on reputable doctor's websites that contain the relevant information, a yield of about 6,000 - 6,500 grafts seems the most common. I also think you bring up an interesting point about FUE being able to "spread" the hair more evenly from donor to recipient region, and in doing so balance out the overall density of their hair. I've heard a few doctors say this and it does have some merit. Going into what Dr. Bloxham said too, it might be that FUE opens up the donor area, and that going the FUE route gives the patient the option to "rebalance" their hair density across the scalp rather than simply removing a strip of hair and replacing it in the recipient site, leaving the remaining donor region at native density. I don't know if it would pan out that way, but it's interesting. I also agree that true NW7 seems pretty rare, but one thing I do think we need to keep in mind is that the Norwood scale just approximates someone's balding to a visible pattern and is not a predictor or accurate indicator of balding. Two men may both be NW5 but one could have 140cm2 of area that needs to be transplanted into and the other 185cm2, depending on a variety of factors. I do believe the donor area in most men is slightly larger than the defined SDA, but it still varies widely from man to man even if they have ostensibly the same balding pattern. And of course the problem is you can't really undo mistakes in hair transplantation, at least not to the donor region. If you overharvest you may still have some options with body hair and micropigmentation but I think most men would feel pretty glum at the thought of having to fix their donor area!

Significant improvement with a small number of grafts - great result! He looks like he'd easily have another 3 - 4,000 grafts left too, and great hair characteristics to make the most of them if he decides on a second procedure or one day needs further work.

Nice result, I'm pleased it's worked so well for you! I agree minoxidil can be a pretty potent drug by itself. It's often seen as a little "boost" to finasteride but I think in a fair number of guys it can make a big difference. That's particularly true of guys with diffuse loss, where a combination of a healthier, thicker hair shaft and more hairs in anagen phase can make a real big difference (and minoxidil can improve both!). I think you were a really good candidate for minoxidil improvement. You had a lot of miniaturisation but it's clear there's still a lot of hair up there, it was just weaker and thinner. Minoxidil looks to have thickened it up nicely and hopefully the Nizoral is helping too.

It's hard to tell with Johnny Depp. He definitely receded and thinned at the front and that was apparent as far back as 10-12 years ago or more. Certainly in films like The Rum Diary it's clear he's experiencing some frontal loss, though as usual it's hard to tell exactly what's what as there could be any amount of concealer/styling/Hollywood magic going on in movies. For a while he sported the long hair with a side parting, which I think he used to cover up some of the recession but exposed some of the thinning around the mid-part line. This photo also seems to show more extensive frontal loss: These days he's either sweeping his hair back or sort of wearing it messily, which helps to conceal some of the thinning. When his hair is brushed back I would say his hairline does look a little like a transplanted one, but it's hard to be sure. Either way he's still got a fairly good head of natural hair for a 53 year old. He definitely thinned out a bit in the front but I'm not sure if he got a transplant or just styles it more selectively now. My instinct is he probably did get one - he just seems to have more at the front than he used to, but I think he styled around it for a long time so there's no glaringly obvious before and after comparison, though a quick look at the last two photos shows a definite difference around the hairline and temples to me.

I agree. It was really misleading to go on live TV and outright lie, especially when the doctor is sat there and not being honest either. They should have just been upfront and said there was concealer and styling being used to make the most of his result - there's no crime in that, but when you're charging tens of thousands for transplants you should be honest about what can be achieved and especially honest when you're showing off a patient's hair that is using extra help to look good.

There's no hard and fast rule, unfortunately. I presume you're talking about FUE (as the donor area remains largely unchanged apart from a thin scar with FUT, even after two or three sessions, so long as it's well closed and the laxity is there). I would say that 8,000 grafts would be an extremely good yield from FUE. The norm is much closer to 5,000 - 7,000 grafts. Most men should be able to get 4.5 to 5k grafts, some men will be able to get 6.5-7.5k. I would imagine some could get 7.5k+ but that's definitely more of an exception than a rule. As to when it starts to look thin, it varies from man to man. Men with higher densities of follicular units per cm2 will generally be able to take more donor before it begins to look thin. Men with good hair characteristics (wide diameter, curly, coarse etc.) will also be able to use more before the donor area begins to look weak. Your strategy is the best one - taking around 2.5 - 3.5k grafts means you can give your donor area time to heal and, when you come to plan a second procedure, you and the doctor can have a good examination of the donor area and a good doctor can make a proper recommendation about how many grafts you have left before the donor begins to look thin. Sometimes it can be surprising - after healing a man's donor area may look surprisingly strong even after 3-4k grafts getting removed. Other times it may look weaker than expected and a more conservative second procedure may need to be planned. The odds are you should have at least another 2-3k left in the donor area before it begins to look thin, but that is just going by the odds and you need that confirmed by a doctor before really planning out the second procedure. You'd be a lucky man to have another 5k available by FUE but it's not totally impossible, just rare. You'd probably have at least another 3.5-4k available via FUT if you were willing to consider that option. Overharvesting from the donor is a real problem so the best doctors will urge caution and be realistic. You should still have a fair bit left for a second procedure, but it's worth erring on the side of caution and finding a good doctor who will be optimistic but also realistic about how your donor is looking and what could be realistically achieved from a second procedure.

Yeah Costner's is a good one, always looked very natural and wasn't overly ambitious. Jason Gardiner's hair transplant isn't the best, though I think as Mick50 says it's perhaps just that he needs another pass or something. However, I think Gardiner (and his doctor, Ziering) were extremely misleading when they went on daytime TV here in the UK. Gardiner was blatantly using a lot of concealer give his HT a dense look, but didn't declare that at all (in fact I think he outright insinuates at one point it's his natural result): It's particularly bad that his doctor is sat next to him not being truthful about it all. I remember at the time dubiously being willing to give him the benefit of the doubt but the photos I've seen of his hair since completely confirm he was using a lot of product to make his hair look like that, and in fact his overall results are OK but nothing special. I have no problem with concealer, use it myself and it can really make the most of a modest amount of hair, but you can't go on TV and pretend you have a result that you knowingly don't have! I'm pretty sure Simon Pegg has had one: I don't know how bald he got but even back in his twenties/early thirties he was receding. It looks like he's sort of kept that receded hairline, maybe just thickened up the forelock and mid-scalp. Then again, it could just be meds and concealers, it's hard to tell because of the way he styles it now, seemingly to hide the thinning perhaps. Alastair McGowan, a British impressionist, has had something done. I think he was going bald, wore hairpieces for a while and has now got a modest transplant (possibly didn't have the donor or just had too much head to cover as he had a fairly large balding area). Before: Hairpiece, possibly? How I've seen him most recently: I can't tell whether he was wearing a piece or, possibly, had a transplant and the area has continued to thin, as he did have some hair, though very diffuse, in the front half, for a while. I wonder whether he just got a transplant and now that's pretty much all that's left. Either way I'm not really a fan. I think perhaps he just had too much area to cover and not enough donor, or maybe he just hasn't got around to a second or third procedure (I can't see it though). I wonder if he's just sort of accepted how it is now. It doesn't look horrendous, it's just a bit strange. He doesn't help himself with his styling, but to each their own!

Are we 100% sure Antonio Conte is still transplant? I know he had one but his hair these days looks incredibly dense. I guess he did keep a good forelock and has good characteristics and the right sort of styling though. If it is still totally transplant he's done very well, because he lost an awful lot of hair in his mid-scalp. I'm not 100% sure McConaughey is a transplant. Could be, but possibly more of a frontal system since there's photos of him looking full, then thinning, then full again. He's not exactly a full blown international celebrity but a transplant I always thought was impressive was the UK actor/comedian Rob Brydon's. He was very thin a few years back but he looks to have had two transplants over the last few years and his hair looks great now. It's definitely a HT - he's still a bit thin in the back and you can see by the way the hair looks it's a transplant, but he must have had good characteristics because he really does look to have coverage and density. I watched him recently in The Trip to Italy and his hair holds up pretty well even in strong sunlight. It's a really interesting show if only because it shows a lot of natural, candid front and back shots of his transplant - sort of a good example of a successful but realistic result! There were two series, one called The Trip and a sequel called The Trip to Italy that was maybe a year or two later, and I'm fairly sure he's had a second procedure between the two. I think in both Brydon and Conte's cases they're helped enormously by retention of a forelock. Both lost pretty significant hair in the mid-scalp and Brydon lost the crown too somewhat, but having even just that tuft of hair at the front can really make a difference when it comes to creating the illusion of density, particularly from the front, because I guess in that front 2cm or so you have a pretty dense hairline and that just helps blend the mid-scalp in.

Having had a closer look at your photos as well I really wonder if adding SMP might be a really good option for you. You look like you have the right characteristics - uniform black hair and a good complexion to your scalp too. I've seen some great results with people using SMP and long hair to really create the illusion of greater density. You have good quality hair so I think SMP would blend really well with it. It's a tough one - I do think a little coverage in your crown would make a big difference for you. If that was combined possibly with SMP I think you could look great. I do agree with Spanker's point about your mid-scalp - unfortunately us men with higher Norwoods do have to prioritise the hairline and mid-scalp, especially if finasteride is not in the mix (although even then you have to exercise caution). You do want to focus more of your hair there to create a natural look and put the donor where it's going to make the most impact. With that having been said, you have good hair characteristics, you're willing to consider beard hair and you also have options like SMP and concealers enhance the illusion of density (I think both would work great in your case). To that extent, I think some light crown work is achievable and I do think it would make a difference to have some hair back there. It wouldn't look full but sometimes all you need is less contrast between fuller mid-scalp and bald crown to really improve the look, and even a little bit of hair back there gives you options with concealers/SMP.

If you're willing to consider the body/beard hair route (if you ever did need it), then a procedure on the crown may be something you could do with some (but not all) of your remaining scalp donor. Personally I think beard hair works best when it's used to add further density in and around previous transplants, rather than used purely in one area (for example solely on the crown). Because of the slightly different characteristics beard hair has, it looks better spread evenly throughout the scalp to provide more density. To that extent, my personal option would be to use maybe 70-85% of your scalp donor to create general coverage over your head, with the focus in the hairline and frontal third/half and lighter coverage to your crown. You leave the remaining 15-30% to add further coverage if your continue to bald, as your sort of "rainy day" fund. Then you can use beard and body to add maybe a bit more density to the crown and midscalp, probably not really using it for hairline or immediately behind the hairline, where you really want to try and focus your scalp donor. If you have favourable characteristics the beard hair should blend pretty well with the scalp and it's usually thicker than scalp hair, so it adds a bit more illusion of density (although they're usually only single grafts). I think that would be the approach I'd be most interested in and it's the one I'm considering when I do get a transplant. We all recognise the need to prioritise the frontal third and accept that crown density is probably unrealistic, but I think coverage in the back half that could be beefed up by some beard hair in the mid-scalp and crown is realistic. I think if men have decent density in their frontal third even a dusting in the crown goes a long way to reducing the contrast from "not bald" to "bald" - some guys only need a few grafts per cm2 in the crown and it creates a much more impressive and aesthetic look than a sudden transition to baldness. Although you say you don't want to use concealers, if you have some coverage in the crown they work amazingly well just to thicken up the look of that area (and the mid-scalp too). It might be that you're not dependent on them, but could still use them just now and then when you really want to go for the thicker look. The other option is SMP - it's only really suitable in certain candidates but, again, if you have some coverage it can work amazingly well to reduce scalp contrast and make average coverage look pretty full. It's not useful only for the "buzz" look, it can also be used with long hair in properly managed cases to really impressive effect. So that would be my plan - use maybe 70-80% of your scalp donor to get good coverage front to back (with density focused in the front) and then maybe beef that up with some body/beard hair if you have the characteristics. SMP or concealer can do an excellent job of completing the illusion and you have a maybe 20-30% scalp donor left if you do see significant advancing of your balding in years to come, so you'll be able to address newly miniaturised areas with some scalp and maybe beard again if needs be.

I myself don't take finasteride due to experiencing some side effects whilst trying it several years ago (they were mild but they did persist whilst on the drug, they discontinued when I stopped it). With that having been said, whilst I don't doubt finasteride may be able to cause serious and sometimes possibly long lasting effects, it's important to say just because a man attributes his depression, sexual dysfunction and/or suicidal feelings to finasteride that doesn't make it so. Suicide is the leading cause of death in men under 40 here in the UK - there are a great number of men who become suicidal or severely depressed, sometimes without any blindingly obvious trigger. It goes without saying many of them do not take or never have taken finasteride. Similarly, sexual problems are incredibly common in men, not just in their 50s or 60s but increasingly in their 20s and 30s too. I only say this in the interest of balance. Whilst I do think there is perhaps more to finasteride with regards to potential side effects and doctors should be upfront about this and not gloss over it, similarly I feel it's a little premature to label finasteride poison and claim it's causing sexual dysfunction in large numbers of men, or driving many of them to suicide. There isn't any definitive medical evidence this is the case - though I welcome further investigation into it and do see how there is plausible science behind it. In addition, as others have pointed out, this is a drug taken by tens of millions of men internationally, yet the community of those ardently claiming Post Finasteride Syndrome is probably less than ten or twenty thousand members, perhaps not even half that number. If it was ten times that number who were suicidal or sexually destroyed, that would probably still only represent maybe 0.5 - 2% of finasteride users at most. In the same way we must not be overenthusiastic to minimise the uncertainties over finasteride, I think we mustn't be overenthusiastic to proclaim it a killer of men too. I hope we do get further investigation into the drug and better data on what it's doing and, if PFS is definitively discovered, we can develop a protocol on how to stop it or reverse it. However correlation does not equal causation and just because a man says finasteride drove him to depression or made him suicidal or destroyed his sex drive that doesn't categorically mean it's true. Many men suffer such problems and cannot find any particular cause, and often put it down to stress, to lifestyle problems, to other medication or other physiological problems. The same potential issues are happening in a small number of men who take, for example, SSRI based drugs too. Again, a definite causal link has yet to be found but similar causes are being investigated (endocrine and genetic etiologies etc.). It seems some men are particularly fragile and any imbalance in their hormonal system may cause far longer lasting damage than usual - this could be drug based imbalances, poor lifestyle etc. I think the bottom line is the problem is far more complex than simply finasteride = depression and sexual dysfunction. Some men suffer both with no drug usage, some men suffer nothing even though they're on finasteride, antidepressants, recreational drugs and more. We need to better understand the endocrine system and root causes of these problems in general. It comes down to the rather mundane but usual truth - you have a very slim but real chance of serious, long-lasting side effects if you take finasteride, or any other endocrine altering drug most likely. In the case of finasteride, it's a purely elective medication, so you simply have to make a choice whether you take that risk or not.

Sounds good! I think a face-to-face consult with a trichologist or hair restoration surgeon is the best way to go. I'm sure they'll at very least be able to look at your scalp and get some sense of where your hair is at, and then you can use that info to plan how you go forward.

Yeah, I think virtually all men experience at least a little recession - it's definitely a rarity to truly retain your juvenile hairline indefinitely. Also, Spex has great hair but not every man can hope to achieve that. If you've lost a significant amount of hair you can't really opt for a strong hairline with a "little recession". Not only are you likely to need to build a hairline a centimetre or two up from your NW1/2 starting point, but the hairline is going to have to be more conservative with greater recession too, to conserve donor. The "age appropriate" hairline is more about recognising that there usually just isn't going to be enough donor to truly give a man a dense, low hairline, so you build something that looks like it's naturally recessed and thinned a little, but is still strong and defines the face well. If you've got a lot of crown loss and want to try and deal with that, or conserve donor for that eventuality, you have to be realistic about what you can achieve. Also, it's not really accurate to post example cases and say they make no sense. Sometimes the donor simply isn't there to build a really strong hairline so something is better than nothing. Also, if a patient is maybe taking a two or three step transplant approach, chances are they may start with a more conservative hairline and lower it a little in the second or third pass, so they can rebuild their hair in stages rather than getting themselves into a position they can't get out of. The example you posted is a world away from Spex - if the gentleman had wanted a hairline like Spex's he probably would have had to forget so much as touching the back half of his head, at least in one procedure.

Reviving an old thread, so apologies, but the original post got me thinking. Hollywood is not a good place to look for accurate hair and something didn't ring true to me about Bruce Willis - in the relatively new film Looper he's virtually a NW7 (certainly a full blown NW6) but, as the OP said, in the 90s and 00s he often looked to be a NW4. I did a little more looking and found some revealing photos. The Letterman photo is from 1990. Although he still has a fairly decent head of hair (at least at first glance), it's clear his crown is opening up already. The Cannes photo is from 1994/1995, not long after Pulp Fiction (when he was approximately 39/40). Even though sunlight is strong, I would say it's fairly clear he has extensive loss on the top of his head and his lateral humps are fading too. In fact I would say his final hairloss pattern is pretty clear. This photo shows better in less harsh light: http://media.gettyimages.com/photos/cannes-film-festival-pulp-fiction-in-cannes-france-on-may-20-bruce-picture-id113994437 I actually think Bruce was either using very good concealers and styling to hide his more extensive baldness or perhaps a partial system, or even a total system with receding hairline (bizarrely!). His receding hairline was always part of his look to some degree, so perhaps he wanted a full looking head of hair with that characteristic thinning at the front. Here's another photo from the film Twelve Monkeys (1996) which I think shows his balding was far more considerable than most of his movie roles give away: http://www.rtl2.de/sites/default/files/images/spielfilm/1100009606/12-monkeys-bruce-willis-1316209.jpg Bottom line is I don't think he balded particular savagely and suddenly in his later years. I think his pattern was fairly established by his early thirties and it was just a combination of styling and makeup/hair tricks that made it look fuller, though still receding, in other films. To my eyes he looks essentially bald by the time he was 40, and then probably lost the last of his lateral humps and saw the crown open up in his 40s and 50s. But I certainly don't think he was rocking any particularly thick hair past his late 30s - it's just the typical Hollywood smoke and mirrors!

Like Bill said, I don't see anything in particular that makes me think you're definitely not a good hair transplant candidate. In the donor2 photo your donor region does look a little thin, but not that bad. In addition, you look to be outside, possibly with fairly strong sun shining down. Also, and this may be a completely erroneous observation, but I wonder sometimes if some digital cameras (particularly on smartphones/tablets) sort of up the contrast slightly on photos, as quite often I see more contrast between hair and scalp in a photo of someone than appears in real life. I may be completely wrong about that. At 38 you seem to have relatively minor hairloss and although your donor may not be the best, it doesn't look hopeless to me either, and I've seen a lot of men with what at first glance appears to be sub-par donor go on to have very good transplants, without compromising their donor area. I think your goals seem realistic; to spend maybe 2,000 to 2,500 rebuilding a conservative but improved hairline and adding some density in that frontal third. Are you able to go to an in-person consult with somebody? Photos are good but I think a proper examination of your donor area is the only way to get real answers about what kind of candidate you are.

You make some good points. It's clear that finasteride can cause, even if in rare circumstances, sexual dysfunction and low mood/cognitive side effects. Although I believe the incidence of this is probably higher than the 1-2% found in studies, I do also agree with you that many men probably worry a great deal about taking the drug after reading and researching online, and that this stress and uncertainty can contribute to or even be the sole cause of their problems. I would say the incidence of finasteride side effects has "boomed" the last few years, but that has correlated with a general increase in the discussion and caution regarding the drug found on forums such as these. It's hard to tell which is the chicken and which is the egg - has increased finasteride usage revealed more men are susceptible to side effects, or has more daunting discussion about the potential effects of the drug causes men to become scared and hyper-sensitive to the drug? Either way a small number of men swear finasteride has caused a serious, long-term impact on their sexual and overall health. Whilst it's impossible to know for definite how true this is, and how serious or long-term the effects are, I do think more investigation is warranted and I myself am admittedly a little cautious of the drug. I'm also interested in many of the questions you raised. I do believe it would be in the interest of men to check their hormone levels before starting any hormone altering drug. One of the "drawbacks" I perceive with finasteride (and I say this as a layman, I have no real knowledge of this area) is what seems to be to be an arbitrary lowering of DHT levels by about 70% (assuming 1mg of finasteride per day), regardless of the baseline. We know that men's testosterone levels and, by extension, DHT levels, can vary quite dramatically from man to man. It would seem more prudent to me to know what a man's baseline hormone level is and to devise a dosage around that, looking to find the best balance between lowering DHT whilst maintaining enough of the hormone to allow men to function normally. I don't know if this is really a factor, but the common sense part of me says it must be - if a man has low DHT and lowers it by 70%, that must surely be different to if a man has relatively high DHT but also lowers it by 70%. I think ultimately this is why "natural" 5ar/DHT inhibitors don't, on the whole, seem to work very well. Chances are they just don't lower DHT by very much and if you take enough of it to significantly lower DHT, well then to my mind it's no different to taking finasteride (I'm not convinced whether you do it "naturally" or "artificially" matters). That's why it always amuses me when some men are dead against fin but are ingesting huge cocktails of natural DHT inhibitors. The progesterone angle sounds interesting, and one I had never heard of or considered before. Perhaps it's a case that progesterone inhibits 5ar//DHT in a different way and thus produces less side effects. Perhaps it inhibits less than finasteride, but still a significant amount, hence the balance between DHT reduction and side effects management is better? Perhaps you are just not prone to side effects - even by the gloomiest statistics the vast majority of men won't get sides on fin, so it's not necessarily surprising. I think the main concerns for me regarding finasteride are long term usage (what does 30 or 40 years on the drug do... possibly nothing, possibly something?) and also the relatively "blunt instrument" dosage of it, whereby it's essentially a case of blindly giving all men the same dose without monitoring hormone levels or other markers. I do think a more tailored approach to each individual would be good and I'm surprised there aren't lower dosages available. Certainly it seems a fair number of men who can't tolerate 1mg every day can do 1mg every other day, or 0.5mg per day or every other day, and can still get some benefit from the drug. Similarly other men claim quite a serious adverse reaction to even tiny amounts - I guess we just don't know for definite how it all works!

Tj287 - That sounds interesting about using progesterone. Do you really think it causes less sides? The only reason I ask is because I don't really understand how it could. So far as I can tell, inhibiting 5ar and therefore DHT is the cause of sides, however that inhibition occurs. I know a lot of men want to use Saw Palmetto for example, because they perceive it to be a "natural" way to lower DHT, but this has never rung true for me. I don't think synthetically inhibiting 5ar is the reason for sides, it's simply the fact that lower DHT has the potential to cause sides, however you go about it. That's my understanding anyway, but I'd be interested to know if you have a different opinion or understanding of the situation. The same for the potential for long-term effects from finasteride. Although it's still being researched, it would seem the potential for long-term effects from finasteride stems from the altering of hormone balances creating a sort of long-term hormone/chemical imbalance in a very small number of susceptible men. However, wouldn't the same outcome be possible using progesterone? I'm interested in knowing more about this side of things - I'm also a bit on the fence about oral finasteride though there's still no doubt it's the best option for men who want to halt their hairloss. Alternatives, be they a different drug or a local or different way of lowering DHT, would be interesting (though I'm not convinced there is a way for a man to lower DHT without increasing the risk of sides, or that there's a truly local/topical only way of lowering DHT).

Unfortunately there are just no hard and fast rules when it comes to hairloss. I would say that, very generally, the older you are are when you notice hairloss, and the slower it seems, the less likely you are to progress to an advanced level of balding. If you're 21 and already severely thinning/receding the chances are you're going to progress to the higher end of the Norwood scale. Conversely, if you're mid-30s and only just noticing some thinning or recession, there's a decent chance your hairloss will be slower and less aggressive. There are always exceptions to the even that very general rule, however. There's no surefire way to know where your balding will end up but there are a few things you can do to try and get an idea: Look at your family history - fathers, grandfathers etc, on both sides of the family. Did they bald? If so, what was the progression of their baldness like and how advanced did it get? There's no direct comparison, but a history of advanced hairloss in your family gives you some idea of where you may head. Hair bulk/miniaturisation mapping - Your hair can be looked at closely under magnification and via other techniques to map where it may be thinning. Even in some areas where your hair looks full, there may be evidence of thinning not visible to the naked eye. Again, not a guaranteed way to predict future hairloss, but it may show up some clues or a pattern that wasn't immediately obvious. In terms of preventing hairloss, outside of HTs your only other options are meds. You say you want to go the no-fin route and that's fair enough, but the honest truth is there's just no way to truly know what's in your hairloss future - meds are the only way to slow down any progressive loss that's inevitable and, as you say, there's always a risk you could get to a point where HTs alone couldn't cover all balding to a satisfactory degree.

Funny enough this also crossed my mind when I read about it - funny how us hairloss sufferers think, eh! I'm actually not sure how well this would work for transplanted follicles - if it had any benefit I would imagine it would be for follicles already miniaturising on the scalp - but I have my doubts. The degradation of healthy blood supply to the hair follicle and the resulting weakening of that follicle is definitely one of the major causes of hairloss. Although it's quite a complicated and not entirely understood process, broadly speaking a genetic susceptibility to DHT seems to cause a kind of signalling cascade, causing inflammation in and around the hair follicle and scalp which leads to a reduction of blood supply and essentially causes the follicle to shrivel and eventually lose the ability to produce hair (or only produce inconsequential vellus hair). Promoting blood supply to the hair follicles in theory and in practice produces reverses some of this damage. That's partly the reason why minoxidil works and also why there may be some truth to the idea that massage could work too (though I think the detumescence theory has been far from proven). So you could see in theory why cupping might offer benefit. I'm sceptical for a few reasons though: Firstly there's no seriously good scientific evidence cupping works at all. Yes there's a lot of people who swear by it and anecdotal evidence too, but I don't think it's been rigorously studied scientifically. Secondly, even if it was proven to have some efficacy, I'm not sure how easy or safe it would be to cup the scalp. It's not like the back or shoulders or legs, where there's a lot more fat, muscle and flexibility. It's pretty tight up there, so I'm not sure how easy it would be to cup or whether it wouldn't cause injury. Thirdly, it wouldn't stop the genetic "attack" on your follicles. This has always been an issue with minoxidil - it can work well but it doesn't stop the underlying reason for the degradation of the follicle. That's not to say long-term benefit couldn't be achieved via different methods, but ultimately I still think the most effective treatments would look to disrupt the underlying mechanism by which the follicles are attacked. Finasteride does this by inhibiting DHT, but there may be other more targeted ways of disrupting MPB (this is still very much under research though). I think when it comes to microneedling, laser combs and all the other weird and wonderful ways of saving your hair, the main problem is just lack of research or lack of proof of efficacy from that research. I daresay needling and lasers and massage and rubbing pumpkin oil on your hair may have some benefit in some men - but without any data it's impossible to say how much benefit how many men can expect it. And of course, none of us really want to spend 3 or 4 hours a day massaging and rolling and pouring all kinds of gunk on our heads, especially without any proof it does anything! The bottom line is nothing has gotten close to working as well or as often for baldness as finasteride and minoxidil (particularly finasteride). Whilst of course there are some question marks over safety and side effects in some men, the simplest and most effective way to save your hair is to pop one pill every day or other day and maybe combine that with a lotion you apply once or twice a day. Everything else, with the exception of maybe ketoconazole, has yet to really prove itself as having any major benefit, and there's also the issue of time and expense where it would become prohibitive to spend tens of hours and dollars a week using a treatment cocktail that hopefully offered some benefit. For what it's worth I think massage and microneedling could both have some role in treating MPB - but the issue of how well they work for the effort and time is murkier. We need more studies but they're unlikely to be forthcoming in any great number. I'm not sure I can be disciplined enough to engage in deep massage once or twice a day for twenty minutes a day in the hope it will work even as good as finasteride or minoxidil!