mahhong

There has been something that has confused me a little bit for a while that I thought would be great to get an answer for. Quite often I see patients on this forum who have had an HT with their doc, who has described their hairloss pattern as, let's say for example, NW3. But when I look at the pictures even though the general "pattern" may be an NW3, it's very clear that they have miniaturization in, for example, an NWV or VI pattern. This has always left me a bit confused since I always presumed the "pattern" would be classified by the extent of observable miniaturization. So, if there was any significant miniaturization that area would be classed as also experiencing MPB. I hope I make sense. I was just curious since I see it a fair bit these days, when a patient is described as say a NW3 but it's very clear in their transplant photos that there is still miniaturization in the crown and vertex, but not as much as in the NW3 regions. I always assumed that if an area was experiencing miniaturization it was a fairly safe bet that area would one day also be gone.

Ah, to dream! It's not beyond the realm of possibility but I don't think that's likely to happen in our lifetime. Science does indeed move at an alarming pace these days, but the exact nature of androgenetic alopecia is still not 100% understood and a clear "magic bullet" has not even really been proposed yet. I think over the next decade or two we can look forward to more treatments in the form of potentially pills, topical medication, improved hair transplantation techniques and stem cell therapy and similar treatments. But I'd hazard a strong guess no one specific technique will enable you to get all your hair back. I think the more realistic proposition is that over the next 20 or 30 years we can combine several techniques to make a more significant impact on the amount of hair we can get back and the quality of it. Hopefully we'll be able to get to a point in the not so distant future where the majority of people can restore a very good head of hair at a not ridiculous cost. We're already pretty close really but hopefully we can improve on that in the coming years. But the magic pill? I think it's too much to ask for, given the complexity of hairloss. One day, very possibly. But one day that we'll still be alive to see? Not so sure!

I actually don't think it's done maliciously all that often. I think most of the time, in honesty, people feel awkward about broaching the subject and a bit of humour or light-hearted teasing seems the best way to go about it. If you start going bald and it becomes noticeable, as pretty much all of us on here have experienced, it's very difficult for people to know how to approach that. Saying nothing can almost feel a bit like refusing to acknowledge the obvious and I think most people would rather make it clear they notice it an accept it than say nothing or get all serious and concerned about it. It's not a nice thing to be losing your hair, we all know that. But I also think if you lead by example and try not to take it too much to heart it helps people feel more comfortable and reduces the comments about it - or at least your hurt when you hear the comments. In some ways I would take heart from the fact that people can poke a bit of fun at baldness but not, say, other skin diseases or genetic problems, because it's so common and ultimately so accepted in society. It happens to a huge portion of the male and indeed female population and more often than not I think people just get a bit confused and unsure about how to deal with it and try to do so by adding a bit of humour to the situation. How you react to that is nearly always the determining factor in how people continue to deal with it. I think if you take it too seriously and get too wound up by it people know it's a sensitive subject, and then either fall into the camp of becoming increasingly worried about getting anywhere close to the subject, or go the other way and rib you mercilessly about it. I think you have to try and be a little bit relaxed about it, if only for your own personal happiness and health. But fundamentally I think most people just want to deal with the obvious and think humour is the best way to go about it. After all hair and appearance are big in conversation and if everybody feels they can't even mention the fact you're clearly balding it puts people on edge. Don't get me wrong, vindictive insults or continued reminders are not right or good for anybody. But I think you just have to let certain things go and understand not everybody who makes a little comment or has a little tease is trying to hurt you.

Good stuff Jacob! The doctors will really be able to let you know what your options are in a way nobody on these forums can, so I'm sure you'll be able to develop a really good plan after talking to them! Best of luck for the future and look forward to hearing how things work out!

I can't imagine anything in your lifestyle would have triggered the increase in hairloss. Propecia works by lowering the DHT in your system but it doesn't eradicate it (for very good reason) and it doesn't alter your genetic sensitivity to hairloss. As a result, over time you're still likely to end up experiencing increased hairloss but at a much slower rate than somebody not on propecia. Dutasteride is the next step in terms of DHT blocking, but the jury is still out on how much more effective it is and issues like increased side effects etc. In addition, DHT blockers have never really been brilliant for most people's hairlines, so the loss you're experiencing might not necessarily slow further even if you did move to a stronger drug. I think the options really boil down to moving to dutasteride and/or considering a HT to reverse the loss in the hairline. Most men on propecia have to consider this stage eventually because the hairline is rarely safe from MPB - but you're lucky you still have a good crown and no sides from fin! Also, though I'm sure you know, don't stop taking the fin as this will just cause catch up loss, and your hair could very well fall out very quickly and very badly (not definitely, but possibly). Hope you find a suitable solution!

That's cool about shaving your head - it really is a personal decision and if it's not for you, then it's not for you. The situation of multiple HTs is more tricky. You only have a finite amount of donor hair on your head - it will run out if you keep using it. Most men have around 6000-8000 grafts in their donor region to use in their lifetime (some maybe as many as 10-12,000 and some as few as only 4-6,000). On the top of a man's head (in the balding region) I would estimate there may be anywhere being 18-25,000 of these graft equivalents. In other words, if you were to lose a significant amount of hair in the balding region, you would never have enough grafts to replace them all. Now, a HT works on the principle that if you replace say 40-60% of those grafts in an artistic way, you can achieve a good looking head of hair that looks full and dense in most situations. But you cannot get back to where you were at 15 - not even half way close really. In a lot of men this doesn't matter because they want lose every hair in the susceptible balding regions. Some men may only be a NWIII or IV right into their old age. That means those precious donor grafts will have less area to cover and thus be more effective. On the flipside of that, some men may experience pretty much total MPB, leading to a high NWVI or VII. In those extreme situations, a HT is ultimately not the best idea. 6000 grafts spread over 250 or 280cm2 of balding area will not give a lot of density - you'll just have a light spread of coverage that will look pretty odd frankly. Even 10,000 or 12,000 grafts on a severe NWVII case (which would be nigh on impossible) would not really give sufficient density - and you have to remember that every follicular unit you lose through balding is both an area to be covered and an area that cannot be harvested as donor. The net result being, the more hair you lose, the more you have to cover with less donor. In a man your age, there's no way to tell where your balding pattern will end up. If you were to have a HT now of say 2500 to 3000 grafts (about what I imagine you'd need), you may find by the time you're 40 you could be a full blown NW7, and in that case you would very likely just not have enough donor to do the rest of your bald area even if you went for another 2 or 3 procedures. And then you'd end up with a fairly well transplanted hairline and a very bald or wispy crown and sides - not a good look for a man, certainly not in his 30s, 40s or 50s. Propecia will slow down, maybe even halt your hairloss - but in reality likely not forever. At 22 you could be on the drug for another 50, 60 years or even more if you want to carry on seeing benefits from it. But in that time your hairloss wouldn;t just stop indefinitely - propecia might slow it down but in 20 or 30 years time it's a good bet you would have lost more hair. In short - the degree of confidence to which a HT would be beneficial for you is very vague at the moment. Early balding is unfortunately usually (but not always) a sign of heading towards advances balding; NW6 or worse. If a doctor does a procedure on you, they have to be absolutely certain it's a journey worth taking. You'll never have enough donor to do a total restoration, but if you have advanced balding later in life chances are you won't even have the donor to do an acceptable restoration - and nobody would want to end up with a light, see through and fuzzy HT and no donor left. This is just the worst case scenario and only a doctor can make any accurate diagnosis of things, so please don't think I'm trying to put you off. A HT could still absolutely be the best route for you if a doctor agrees, I'm just trying to demonstrate how simply committing to as many procedures as you need is not guaranteed to let you reach your goals. If a doctor can't be relatively confident of light at the end of the tunnel for you, they will suggest you wait until maybe your late-20s/early 30-s to see where you're at then. That's a very annoying thing for younger people to hear, but not half as annoying as getting to 40 and having made a major mistake committing to a HT so young. As a final note, I wouldn't imagine hairspray would be doing too much damage. It's certainly not the healthiest thing to put on your hair, but it doesn't make hair fall out unless it was going to anyway, so if it's part of your look then I think you'll be fine with it!

Hi Jacob! Thanks for your post and the history of your hairloss. You're certainly not alone here, so I'm sure you'll get some great advice and support! First off, getting on propecia and minoxidil was a good call, but as you know you really have to use that stuff daily to see the benefit! Both drugs, particularly propecia, work very well at keeping what hair you have so you should hopefully see your loss slow down or even stop for a good while. One thing I would say though; propecia and minoxidil tend to work best in the vertex and crown of your head and not so much in the hairline. I only say that because what it'll likely do for you is keep the hair you have in the middle and back of your head, but not make a huge impact on the frontal area - so don't go off the drug thinking it's not working for you, as chances are it still very likely is keeping hold of what you do have! I can't vouch for the burning or spots but I am not on any drugs and get the same feelings sometimes! I often wonder if it's inflammation that causes these problems. Either way I would not worry too much about them, but obviously you can always go to the doctor if you feel it's not right. Regarding a hair transplant, the major issue is your age. I know it's frustrating to hear but significant hairloss in your teens and twenties often means you could be heading for a lot of further balding, so good doctors will be cautious about using up your donor hair too much, too soon. That having been said you can get a lot of free online consultations with top doctors (you can find them on this website), or you can visit a few in person for a full consultation (the much better option if you have the time and money). A doctor will try their best to help you and accommodate your wishes, but at your age they will be more cautious about doing anything too aggressive or extreme. But make sure you get as many opinions and consultations as you can - you want to find out the truth about your situation from the best doctors and not hear what you want to hear from any old doctor! So far you've definitely done the right thing - the propecia is your best chance at keeping the hair you have and maybe seeing some regrowth. In the meantime, you can do research on this forum and visit the websites of recommended doctors - many of them will happily look at your pictures and give you their opinion and you can hopefully make a consultation with one or more of them for a proper examination and a frank conversation about what you'd like to do and what the doctor feels is appropriate. I hope this doesn't sound facetious, but have you also considered the shaved head look? I only say this because it is an option, it costs pretty much nothing, and it can look great on some guys. Of course you know whether this is something for you to consider and I'm only mentioning it as just another option in the arsenal of weapons you have against hairloss! If it's not right for you I'd totally understand - but it's always something to consider! On a final note, I would be cautious about considering just FUE. You may find, if you're able to have a transplant, you need a relatively significant number of grafts and FUE might not be the best option. It's of course a personal decision if FUE is the route you wish to go down, but my instinct would be talk to some FUT doctors and at least consider that route alongside FUE. And a final final thing! I don't wish to sound like the party pooper, but you have to consider the long term journey for your hair restoration. It may be the case that you need more than one HT in your lifetime to keep up with your hairloss and maintain the head of hair you want. I only say this because it's often, especially in younger men, not thought through enough. There is a lot of time, money and healing that goes into repairing advanced hairloss, and unfortunately it's a journey you can't really stop half way through (unless you're happy with the results of course!). These forums will give you a lot of answers and advice, and everybody on here is going through what you're going through! I'm sure you'll be able to find a way forward that gets you closer to where you want to be - so good luck and looking forward to hearing from you in the future!

Biotin definitely helps with hair quality and overall health! But as far as hairloss goes, I don't think biotin has much if any impact. The big problem with going this route is that none of the suggestions are truly verifiable. You'll have no shortage of suggestions and, in theory, there's a chance one of them could work wonders for you. But it's very unlikely you'll see a real improvement to the point that it could be considered medically beneficial. There's no doubt androgenetic alopecia is an inflammatory condition and some people do suggest diet can play a part in that whole side of things. There's anecdotal evidence in the way that hairloss seems more prevalent in cultures with high saturated fat diets, but hairloss is everywhere, so there's no magic bullet waiting to be discovered. I know plenty of people who are as fit as a fiddle and eat pretty much pure, healthy, wholesome diets but are still bald. The reason is because whatever the exact process for balding, the root of the problem is genetics. Your body is predisposed to go in that direction, and ultimately you can't do anything about that save for slow it down via proven medication or replace it via hair transplantation.

Unfortunately there's no diet or supplements around that can truly slow, halt or reverse hairloss. There's many people who claim they've used things like Biotin, Green Tea extract, Pumpkin Seed and pretty much every other supplement you'll find in a health store and had positive results, but I've never seen any truly impressive results and there's no proper scientific studies into any of these concoctions. At the risk of sounding pedantic, a healthy diet and good multivitamin supplement certainly isn't going to hurt your hairloss, but the only way to slow down or halt hairloss is by using minoxidil and/or propecia. It's tempting to believe those who tell you otherwise, but it's really not true. In the interests of fairness, there is a section on these forums and many other forums devoted to proposed herbal and dietary ways to treat hairloss. Some people report (anecdotally) good results on their proposed regimens, but you'll quickly find photo evidence and scientific corroboration are hard to find. The bottom line; don't trust anything unless you can see it working and quantify how and why it's doing so. We all know how tempting it is to believe you can pick up some capsules from a health store and start saving your hair, but always wait for the evidence, and you'll quickly see that apart from propecia and minoxidil, there isn't much evidence for anything else working.

Also, I could be wrong, but I think the OP was talking about the number of hairs per cm2, and I think the 100 per cm2 figure applies more generally to follicular unit, which can contain anywhere between 1-4 hairs. I think that's right anyway!

It's quite a passionate subject, propecia is! The truth is simple. Your balding pattern is determined from the day you're born and nothing is ultimately going to change that. Propecia might slow it down, even halt it, for years and perhaps decades - but it cannot change the way you bald or ultimately stop it. If you're lucky enough to not have a severe balding pattern and you're willing to have as many transplants as it takes to get a good head of hair, then there is every possibility you could have successful surgery without drugs. You'd more than likely need several procedures or more, but if you have the right donor and a manageable balding pattern it is possible. Of course, nature's cruel trick is that there's currently no way to tell what your balding pattern will be precisely. There are ways to guess it better, but it's possible that a man with a full head of hair at 35 will end up a Norwood 7 at 60, and a man who looks Norwood 3 at 22 might end up still being Norwood 3 by the time he's 70. The general rule of thumb is that the earlier the balding and the more severe it is the higher chance of it ending up advanced NW6 or 7 - but there are exceptions and that's not an absolute truth by any means. So the logic with propecia is that it's better to take a pill that costs not much daily than buy more procedures that cost thousands of dollars and takes time and recovery. Also, if you are going to have advanced baldness, propecia is your best chance at holding on to anything and making any procedure worthwhile. But the simple truth is many men have had successful procedures without drugs because their balding has stabilised and they've had the donor to make a suitable cosmetic impact in the bald areas. Of course, even if you do have the balding pattern and donor available to make surgery successful without drugs, you absolutely have to be willing to have multiple procedures over the course of years or decades because it's almost certain you will continue to bald and lose the hair you're destined to lose. The only way around that is to wait until the balding stabilises (or seems at its limits) and then get a procedure done - but most men don't really want to wait it out like that! There are lots of men on here who think hair restoration without propecia is idiotic, and similarly there are lots of men who think propecia is Satan's own drug! But I think the truth is in the middle; propecia is a useful drug if you can or are willing to take it, but it's not absolutely necessary in hair restoration under the right circumstances. But it's the best insurance for your HTs, so it does make sense to use it if you aren't too averse to or can't for any reason. But, to also bring some balance; finasteride is not a guarantee to keep all your hair. Most men report it holds their balding stable for years, some two decades or more. But long-term effectiveness of propecia at maintaining hair is not accurately known and some men report propecia losing its effectiveness only 4 or 5 years after they started it. In addition, whilst some men have a fantastic response on the drug, most have at best a stabilisation, and some little effect at all (though it's overwhelmingly the case that it usually works to at least some degree). Ultimately, propecia is the best insurance you can get for keeping your hair, but even propecia is not 100% successful - certainly not over 4 or 5 decades. You just have to decide for yourself what's best for you - but there are options whatever you choose to do and some people can have HTs without drugs and make it work for them!

It's not inevitable you'll be an NW7. The general rule of thumb is that if you lose your hair severely when you're younger there's a higher likelihood it will keep advancing further in your 30s, 40s and 50s. But genetics are genetics; you may find your balding stabilises over the next few years and you are an NW6, or you may find it continues at a strong pace. Unfortunately, nobody can truly tell you what will happen. You can look at your family history for some indication, but this isn't a sure-fire way to know what's going to happen. But if you look at your father, your grandfathers, and if possible your great-grandfathers you might be able to get a sense of what's going to happen to you. If they're all NW7s then that might help to see where you're going! If they're less severe cases though, ask them when they went bald etc. (if you're comfortable). You might be able to get some sense of what might be in your future - but nothing is absolutely guaranteed. The other practical thing you can do is find a doctor who will 'map' your hair for miniaturization. That basically means they'll look all over your scalp (back and sides) for evidence that your hair is thinning in different areas. Again, it won't be an absolute answer, but it can pick up where thinning is happening in hair that looks, on the surface, thick and full, so it gives a stronger indication of what might be happening behind the scenes, so to speak. You might find you have lots of invisible miniaturization, which would strongly suggest a severe NW6/NW7. Or you might find no further evidence; which doesn't guarantee anything, but does offer some suggestions. If you're not on the meds it's worth talking to a doctor with a view to starting them. Finasteride side effects are pretty rare and usually not an issue - but of course it's a decision you have to make. It'd certainly stabilise your thinning and you may get a fair bit of regrowth. Minoxidil is another option - generally speaking it's not as effective but some people do report great results on it all the same. Or you can use both to maximise your chances of stabilising hair and getting some regrowth - they work synergistically together to be more than the sum of their individual parts. You could in theory get some FUE to get a bit of coverage in your hairline/crown but you have to be really careful here. As you probably know you will never have as much donor hair as you need to properly cover all the balding areas on your head. A skilled surgeon can artistically use your donor hair to make it look as good as possible - but in your situation, even if you don't bald further, you will be looking at needing a lot of grafts to make a real positive impact on your hair. I would say you'd probably be wanting at least 3-5000 grafts to make a real cosmetic impact, but in reality you could put 8,000 grafts up there and still want more (if you have that number of grafts available anyway!). If you get an FUE session of maybe 1-2000 grafts done, the honest truth is that it won't make a huge impact on your hair - especially if you spread that out over the whole balding area. And if you just concentrate on the hairline you could end up with a tuft of hair at the hairline and then virtually nothing over the rest of the scalp - a situation that would not look good! I think it's worth talking to your doctor again and really coming up with a realistic plan around what you want to achieve, what you can afford and what can be done. Medication is a real important consideration because without it you'll almost definitely continue to lose more hair and, whilst you may not progress to a full blown NW7, it's already clear you're going to have quite a large balding area to cover. That's going to require a serious commitment of donor grafts to make any cosmetic impact on - and then you need to consider what might happen if you continue to bald in the future. All in all, I would recommend you think about getting on medication and waiting at least a year to get a procedure. If you really don't want to take the medication then I would recommend thinking hard about the HT route; you will need to commit a lot of your donor supply towards making your hair even halfway decent, and you'd need to consider future balding too. Either way I think getting some feedback on your hairloss from other doctors might be a good idea. They'll have a much better idea of what can be achieved and how realistic your goals might be. But if you get a procedure done, really it's either going to need to be a pretty big procedure or nothing at all, I think. You're not going to be able to patch in hairloss as widespread as yours a thousand or so grafts at a time, unless you're willing to play a long waiting game for decent results. Whatever you choose to do, though, best of luck! There are options and if you carry on researching and discussing your hopes and concerns with people on here and professionals, I'm sure a suitable plan can be developed for you!

That's fair enough - as someone who has had multiple HTs (I have not) I'm not really in a position to challenge the facts of your hair restoration journey or the opinions you've formed based on it, I just feel that whilst it's technically possible to "escape" from an FUE, that mindset is not a good one for even starting HTs in the first place. Most cosmetic surgery is very difficult to retract, and impossible financially and in terms of time and effort. I think studious research and a frank, honest expectation, combined with finding and working with the best doctor you can, should mitigate most of the risk of wanting to be able to "go back" to how you were. I mean, let's face it, you can't truly go back. The donor has still been compromised; the poor result is still on top of your head (albeit in shaved form). If it's gone badly enough wrong that you want to erase it then I feel something has gone awry down the line; either your expectations were too high, your doctor did not perform the surgeries you agreed on to a high enough standard, or you are in the unfortunate and overwhelmingly small number of cases of inexplicable poor yield. I mean, in theory I do agree with you - your logic is sound. But you're basically likening hair restoration to a massive gamble that you want as much damage limitation recourse from as possible. I think if anybody is worried enough about a HT that they'll spend a few extra thousand dollars and a couple of extra years of time just to have the option to back out, then either a HT isn't for them or time and money isn't an issue. For most people, time and money is an issue and they want their goals met on budget and in a timeframe as accommodating as possible. I would argue, perhaps wrongly, that these days the risks and rewards from a HT plan can be fairly well analysed and mapped out and the vast majority of men can make a very educated assessment of where they can expect their hair to be with the options available to them. Yes, there will always be cases of poor yield, bad work or unexplained poor results, but these are small risk if considered and acted upon properly. The top and bottom of it is that every HT is a life changing, checkpoint making moment in a person's life. You possibly shouldn't go through with it if the exit doors are too important to you. And the top and bottom is that FUE does not automatically leave you a line of retreat. Under the knife of the best surgeons, and if you have favourable genetic characteristics, your scarring might be minimal to the point of unnoticeable even when buzzed. But equally I've seen men whose scalps are clearly pockmarked with little scars even after a successful procedure; who can barely shave down further than an FUT patient. The truth with FUE is not black and white. As alway's, it's about the individual case. Ultimately, if this guy goes FUE, which I am not necessarily saying he shouldn't, his wallet is considerably emptier and the time it takes to achieve a decent result (in this case I would imagine over 4 or 5 procedures) could be half a decade or more. I'm not sure if I'd consider those extra burdens worthwhile just for the opportunity to be able to forget about the whole thing anyway. If your HT is going to look bad come 40 or 50, don't get it done - via FUT or FUE.

Exactly! I really would love nothing more than Gho to be legitimate. I just don't buy all this "he's too busy/he doesn't do large cases/nobody has had multiple procedures" etc. If the process is a working process there should be at least someone with the money, time and dedication to have gone to Gho multiple times for 6000+ grafts. And if Gho was able to make even one patient a NW6/7 into a bona fide non-bald, good density case, my instinct would be he'd jump at the chance. He didn't invest this sort of time and money into a procedure to do 1500 graft surgeries for the rest of his days. If Gho can make the donor hair limitation a thing of the past, he'd be begging for someone to come through his door wanting 8 or 10 or 12,000 grafts. I agree that it would take time to see larger cases emerge, so there is still hope. But until they do emerge I would advise anybody to stay away and watch cautiously. I know that sounds a little dismissive, but you owe it to yourself to assume Gho is doing nothing more significant than decent FUE until you've seen a whole bunch of brilliant, larger cases on severely bald people. This Dean Saunders could be one of those higher profile cases, but he's still going to need multiple, successful surgeries if he's going to be considered a benchmark for this new procedure.

Everybody who has done their research knows a strip scar is not "invisible", but it's fair to say with a good haircut that doesn't go too short at the back and sides, and a good doctor who produces a decent, thin scar, this isn't a problem. Not being able to buzz down is a limitation of HTs full stop really; if you want hair, you've got to be prepared for this sacrifice. In addition I don't see how FUE is going to lessen any of the problems you mention above. You still have to take meds if you want to keep your native hair, you still have limited donor hair, you still need multiple surgeries if you have advanced balding or want seriously good density. I think what you're getting it is the idea that if you continue to lose more hair after an FUE procedure you can still buzz down and get away with it. Granted the scars with FUE are much more diffuse and easier to hide, but there are still scars. You would still have spent a lot of money and time on a procedure(s) that ultimately didn't work for you. In addition, the cost-per-graft scenario you mentioned above doesn't always pan out. The fact is if you add up what someone spends on getting lets say 6000 grafts via FUT and 6000 grafts via FUE, it's going to be a lot more than FUT. Even if it was the extra $2 a graft that's still $12,000 more. But it's not; it's the travel and accommodation for more procedures, it's the time off work, it's the smaller sessions yielding less discount. Whatever the benefits of FUE, the costs are undoubtedly quite a bit higher across the board. I do see where you're coming from, but I don't think you can approach hair restoration that way. If you've got money-no-object and you're willing to go through the extra time, extra procedures, extra waiting then I would say FUE is easily as good an option as FUT with the right surgeon and will probably pan out to look a bit better from the point of view of the scars. But if you're seriously concerned your HT goals couldn't be met convincingly, with enough contingency for problems or disappointments, then you shouldn't get an HT. In an ideal world there would be no consequences of attempting a HT. But there always will be, and you can't circumnavigate these problems by trying to slowly build up a head of hair with the least possible room for error. If you get three FUE procedures and suddenly want to stop taking meds, or buzz down, or abandon your hair restoration plans - you're still in a pickle. You still have scars, you still probably have thousands of dollars invested in a failed project. You might (might) be able to buzz down and think less of the scars, but you can't just go back to where you were prior to starting. The HT journey is nearly always going to be an all or nothing ride, especially if you're looking at anything over a NW3. If you're lucky enough to be able to "patch up" a bit of loss then your strategy might work fine, but if you're clearly an NW6 you can't dip your toe in the water and then get out half way through. If you've planned correctly and chosen the right doctor, that strip scar should never be seen by the public. That having been said, I do like FUE and do agree it probably gets treated a little cautiously around here. If the OP wants to go FUE and can afford to with the right doctor, I'd say jump at it. You should get similar results to FUT and you probably will have less obvious scarring and more options overall. But you'll have paid a lot more, gone through a lot more, and be waiting a lot longer, for the results you want. If that's a trade-off you're willing to make then FUE is as good or better than any other option - but as always you have to pay a price for the method you choose.

I think that's a bit harsh. I know there is a lot of very colourful debate on FUE vs FUT but I think what thehairupthere said is largely good advice. The slow and steady FUE approach is not necessarily the best way to do things. It's more expensive, it's very possibly more invasive in terms of the number of times your scalp and hair will be tampered with. It doesn't offer any more (or, admittedly, less) chance of good yield or acceptable results. Most people want to get their new hair as soon as possible because the idea of "slow and steady" doesn't really hold true. You can't really "build up" a good HT - we all know there isn't going to be enough hair to give us natural density (or even close really) so you can't go slow and steady - you're just going to want more hair and more hair! I am a fan of FUE, but not at the expense of FUT. Yes the strip scar is a fact of life, yes you can't completely get rid of it. But we all know scarless FUE is not really a possibility either. I concede some FUE scars have been fantastic - but the word is SOME. Similarly, some FUT scars have been brilliant too. As far as I can see if you wanted to go the FUE route on a case like this you'd have to have probably anywhere between 6 and a dozen sessions. You'd be wise to wait in between sessions to see the results of each session (or at least 4-6 months to let the procedure heal), so you're talking about about a long term project that could last anywhere from 3-6 years (and that's a commitment to that, too). I do think FUE could get this guy what he wants, so I'm not in any way anti-FUE. But I do think that all things considered, the default approach is still FUT in the first instance, That's not to say FUE is a second choice, but you know what I mean. FUE isn't by any means bogus, it's just another way of doing things with its own strengths and limitations. But for someone looking at probably 4000+ grafts being needed, it's not the obvious first choice I don't think.

Lots of interesting thoughts on this thread! I am somewhat biased because I took fin and did feel it was messing with my sexual prowess to a noticeable degree. I do not discount that this could have been psychological, but it didn't feel that way and I'm not prone to worry about medicine in that way. I did mess with dosages a bit (possibly not as much as I could have done) but on both occasions felt there were physical effects that were beyond what I would tolerate and that these weren't acceptable to me. I would counter a little bit the idea that finasteride is like brushing your teeth. It's not a "commitment" in the sense that it takes time or energy or anything like that, most certainly. But it is a drug that alters your physiology on a permanent basis (whilst you're taking the drug) and, to that extent, you do have to commit to actually doing something to your body every day. To those who experience no effects then it may as well be like brushing your teeth but, ultimately, this is not about cleaning your canines! This is a body altering drug - even if the only alteration you notice is more hair. As I say, I don't necessarily feel that trying to conceive whilst on finasteride is a bad idea - the literature certainly doesn't support that idea. And zenmunk is absolutely right that millions of men have likely fathered children whilst on the drug and there have been to my knowledge no reports of birth defects - certainly nothing linked explicitly with finasteride.

I do take your points Shadow, and understand that to be conservative is nearly always the best thing. But I think what 3000 grafts has done for this man is proof in itself that the surgery was justified. He probably has at least another 3000 grafts and Dr. Pawlinga has already commented on this patient's family history. Does all this add up to a guarantee of long term success? No, but I also think that over the course of his lifetime this patient will still be glad he went down the HT route. Also, when I say increase donor yield, I mean increasing the ability to extract usable donor hair. I understand you can't literally increase the amount of donor hair, but you can and do find doctors who are more successful at getting as much of it as possible. I wouldn't necessarily say the number of NW6 patients with successful transplants is miniscule. I don't, of course, have any real access to the data, but nothing leads me to believe there are vast numbers of NW6 patients who have had HTs and came out with a bad result. Granted, the higher the NW number the less likely your results are ever going to be anything less than decent, but this is based on individual opinions on what's acceptable or not. The bottom line is that the patient and the doctor, based on far more information than us, took the decision to go with a pretty conservative procedure that came out with some pretty solid results. Will these results be sustainable in the long term? Nobody, of course, truly knows, but I see no reason why not. On a final note, one thing I definitely do disagree with is that hair restoration is about narcissism. Losing your hair is, for many men, not like getting middle aged spread or crows feet or jowls. It's a deeply affecting issue on their confidence and self-image that goes far beyond wanting to "improve" yourself. Narcissism is a sort of arrogant belief in your own looks and a deep desire to remain "top of the pile" - for a lot of men an HT is just about feeling somewhat whole again. Granted many men don't become so attached to their hair that it has this affect, but most who seek out an HT will not just want to look a bit better, but change fundamentally how they feel about themselves. Ultimately I think this patient did the right thing for himself and the results have justified that. Yes, he took a risk. All HTs are a risk. But for 3000 grafts he has quite literally gone from bald to not bald, with quite a bit left in the donor tank if he needs or wants it (which, we all agree, he most certainly will need). It's true that a HT in your 20s can be a mistake, but I think the problems lie more in the expectations of the patients at that age than with the results themselves. This man has made a little go a long way and I hope it continues for him.

I think fin is ultimately a very safe and usable drug for the vast majority of men, but this is a good post. My major concern after experiencing sides was really the fact that this was a lifelong commitment. You have to take fin for the rest of your life if you want to maintain any results you're having with it. Whilst I don't think taking fin is "playing with fire" by any means, I do think as you and your body change the older you get, it is difficult to know if or how the continued dosage of fin will affect you. I am not a scientist or even particularly informed on this subject, but to me it stands to reason that if you continue taking a drug over the course of decades then you should really monitor as effectively as possible if you have any issues with it. The other massive factor is starting a family. The vast majority of literature states that it's safe to take fin whilst trying to conceive (so long as the mother doesn't come into contact with the pill itself) but I think most men would find it a risk not worth taking. When there is another life potentially involved no matter how small the risk it just seems a bit foolish to be taking the drug. And I'd hate to take fin in my 30s and maybe late 30s be with a woman I love, decide to start a family, and then stop the drug and see the effects just evaporate (not to mention the money and time I spent on the drug). Long term efficacy, as chix says, is also still an issue for me. I know all the literature points to the drug being safe and fine to take indefinitely, but we just don't have men who have been on the drug for 40 or 50 years alive yet to verify they've been fine. Also, the type of person I am, I know if I was to ever suffer with ED or sexual problems later down the line, I would have a hard time not feeling guilty about fin if I was taking it. My logical mind knows you're more likely to get ED from just getting older or other health or lifestyle problems but, well, I don't want to be worrying about my hair AND worrying about the medication I'm taking for it! I think most men who take fin feel just fine and look at the "problem" of taking the drug as a non-issue for them. Similarly most men who have yet to start see it as quite a big hurdle to climb. I couldn't tolerate the drug physically anyway but even if I could I'd have constant reservations about whether it was the right thing to be doing anyway. And I just mean right thing for me - knowing myself and knowing the drug. I think zenmunk's rigorous health check-up is a good idea, even if it seems a bit full on for some. I'm not into conspiracies or hyping things up but, whilst I believe fin is probably safe for most men, there is no doubt the jury is still out over exactly what the drug does over the course of a lifetime. And with men as young as 18 or 19 getting on it I just wonder whether potentially 60 or 70 years taking a hormone-changing drug for the sake of your hair is worth it with so many long-term variables ultimately poorly understood.

I haven't had a HT but I did try finasteride on two occasions and, on both of them (the first 3 months, the second 6 weeks) ended up with moderate side effects that troubled me enough to stop. Whether these effects were genuine, psychosomatic or something else I don't know, but I would be very reluctant to make the meds part of my future routine because I don't want those sorts of effects again and would see the risk of them developing as too high. I don't think meds are essential but, as mattj says, they are very useful. You have to remember the hair on your head, if you're balding, is constantly thinning until the follicle either stops producing hair or the hair is so fine and light as to be useless cosmetically. What finasteride does is slow this down and, in some cases, halt it for long periods at a time. I am of the opinion personally that, long term (30+ years perhaps), men who have HTs on finasteride and men who have HTs without will end up in similar places with regards their hairloss. Finasteride does not stop balding indefinitely and the results vary in individuals. Some men report a great response 10 or 20 years after starting the drug, others say their hairloss is catching back up with them after maybe only 5 years. A very small percentage of men don't seem to have much response to the drug at all. But I think the man who doesn't use meds will, at very least, absolutely have to commit to a long-term and perhaps more modest goal when it comes to hairloss restoration. That means being more conservative in their goals, committing to multiple procedures and understanding that hairloss may be more rapid without the medication to help stall it. Another important factor that hasn't been discussed is miniaturized hair being compromised when you have a HT without meds. If you have a lot of miniaturized hair and you have a HT, there is a good chance that can cause shockloss around the transplant site and, if the hairs are already very weak, they may not come back at all. The worst case is that you transplant say 3000 hairs, and lose 5000 hairs in the process! Men on finasteride will encounter this problem much less. With all that having been said I believe there are still men who don't take meds who, if they commit to the cause, can still have a great result. Look at it this way, how many very bald men only learn about transplants and meds when they've already lost their hair? Quite a few. There are some very notable examples on these forums! But, several procedures later they have great heads of hair. Most of them are taking meds to prevent further loss (if there was to be any) but, nevertheless, a lot of the damage has already been done. You don't need to take finasteride to have a great result from HTs, but the default position would be that if you can tolerate it, you should. Why wouldn't you? It slows down hairloss, often makes miniaturized hairs healthier and thicker. Some men start taking it and end up not even needing an HT (best case scenario), or suddenly their 5000 graft plans get revised down to 2500. For me personally I am not yet ready (financially or otherwise) for an HT, but will have to consider one without drugs. My family history and my own current loss would have me think that I'm heading towards a NW Va or VI in the future if I'm like my Dad or his Dad I may get away with NW V, but my Mum's Father was easily NWVI or VII (thankfully my hairloss has not expressed like his - he had less hair at 24 than I do at 28 and much more temple recession - not a guarantee but a positive indicator). I think I may be lucky enough to not experience drastic hairloss but it will be relatively progressive (I think), and it will require pretty much as many grafts over multiple surgeries as I could get most likely. So, I'd say at least try the meds. Also, in response to your other question, I think about 6-8000 grafts is the average donor yield. Hair characteristics will also play a big part in the success of any future procedures - some men can make 2000 grafts look like 5000 grafts on other men! Meds are not the be all and end all of the hairloss world but they can have a drastically positive effect on some men, and the thinking is if it's only popping a pill everyday, surely it's better than spending $x on another HT? But the other side of that coin is the success stories some men who don't take meds have experienced. It is possible to get through this without meds, but only in some cases, and only with the right goals and the emotional and financial dedication to see it through.

I see where you're coming from, but this is still a really generalised view of things. Firstly, we don't know anything about him as a patient. We don't know if he's been tested for miniaturization in other areas of the head; if any sort of potential balding pattern has been ascertained. We don't know if or how long he has been on drugs. Yes, it's true to say severely balding men in their 20s don't make good candidates generally, but that's still a generalisation and with the improvements in the techniques of HT and the increasing donor yield, progressively more options are available. In addition, we don't know much about his donor characteristics, save that he looks to have pretty good qualities. All this is vitally important in the long term. I'm with you that this guy is probably heading to NW6, but that doesn't mean an HT was a bad idea. There are lots of NW6 patients who have successful results from (usually multiple) HTs. This guy might be no different. I reckon he would have at least another 4 or 5000 grafts left in him and the 3000 he's had already have made a significant impact on an already severely bald area. Balding is balding - your genetic code is already ascertained. Yes, severe balding when young does suggest a high NW level, but that doesn't mean to say this guy is going to have massive lateral and posterial hairloss. Some guys are as bald at 30 as they are when they're 60 and, provided this guy doesn't have a sudden and massive continuance of hairloss from the back and sides of his head, and provided he's happy to undergo more HTs if and when they're needed, this looks like a success to me.

I must admit I was also a bit confused by this. H+W also prescribe, I believe, Dutasteride in the event that finasteride isn't working (I am only saying this based on several H+W cases on here where I read as much). They're doctors and they have their reasons for changing recommended dosages or medicines, but I was always led to believe that anything over 1mg finasteride had, at best, a negligible improvement over the 1mg dosage. That having been said, whilst I personally wouldn't be sure about taking 2.5mg of finasteride, it's still well within an "acceptable" dosage range as far as the medication is concerned. It's a shame that aman doesn't seem to have been back on here though. Would like to see how his results are doing and also know he's well, as he was quite worried last time I heard anything from him.

Yeah I noticed that went up not long after I posted this! It's a shame about ACell, which doesn't look to be holding up to early expectations. I was hopeful there might be some progress in this area and the science, at least on a basic level, seemed sound. But it looks like ultimately it's not really having much of an impact at all, certainly not in the "autocloning" capacity that everybody was so excited about. That's the value of rigorous scientific testing, though! It's better to know it doesn't work than keep deluding ourselves it might. Other than that most of the news seems focused around improvements to already existing techniques and general discussion on the pros and cons of differing surgical techniques.

I wouldn't say he was a lousy candidate at all. It's not like he's gone and blown 7000 grafts or something. He's had a relatively conservative number of grafts, probably has at least another 3-5000 left in the bank and his hair is much, much better now than it was a year ago. He's almost definitely going to have more loss in the future, but then it sounds like he's almost definitely committed to more transplants. If he's on the meds he's probably stable too, at least throughout his 30s. I don't think having an HT young is a bad idea, I just think you need to be aware you have to be conservative and assume you'll need a couple more HTs at least down the line, if you're going to maintain a decent amount of coverage and density. If this guy was 38 we'd be saying it was a solid result, but he could still go on to be an NW6 by the time he was 45 and he'd be in the same pickle anyway. Having HTs young is only a problem if you think you're gonna look 16 again, or think you can have one procedure and be done with the problem. If this guy knew he'd very likely need more work sometime in the not too distant future and was comfortable with that then he's in a good position now.

I assumed as much. It's an interesting case because it does throw up a lot of additional concerns and questions about future MPB likelihood, donor reserves and the patient's goals. I was just curious to know what the considerations were in the eyes of the doctors. But, clearly, if advanced MPB was very unlikely and given the very high donor yield, this was a very, very vaild surgery for the patient! The results look fantastic anyway. And it's always good to see different cases like this, where traditional MPB is not the primary concern for the patient. All HTs are life changing, but this one is perhaps even more so, given where this patient started out!