mahhong

What everybody has said here is very true!

The problem is people in their 20s tend to have the most ambitious plans, because they want to look young and to have lots of hair again. Of course, the fact it, the younger you are the more conservative you should probably be because you don't know what your hairloss will be like in the future, and you don't want to pack lots of hair into a relatively small space in your 20s and then have limited donor and advanced balding in your 30s and 40s+

Lots of people do have HTs in their 20s, but you should ideally be on meds to stabilise your hairloss as best as possible, and your goals have to be realistic. A good doctor won't let you blow 4000 grafts on your hairline just because it's getting a bit weak, because you could be heading for a NW 5+ and you need to have that in mind. But if your goals are realistic, your hairloss stabilised and you've done your best to keep a track of your hairloss and plan for where you might he headed, a HT in your 20s is a definite possibility.

I'm pretty sure Rooney has used concealer. I mean, firstly, I don't think he could have experienced that sort of growth in only a few months. Secondly, it's pretty easy to apply concealer without being seen. It's not that hard for Wayne Rooney to find 5 minutes to himself in a bathroom or something to chuck on some concealer!

Finally, I know a lot of people say "he'd never get away with it" in a changing room full of men - but there are a fair few men in that changing room losing their hair! Giggs and Berbatov, Darren Gibson etc.I don't really think it's that beyond imagination that he'd apply it without too much stick. As you've rightly pointed out, it's more likely a lot of the lads would laugh and then, when they see the result, ask where he got it from!

I use Nanogen and personally I think it's great. I very often leave it in my hair for a couple of days (obviously don't shower, just have to wash myself in the bath!) and it's very convincing I think. It's never come off or anything in public and it looks very natural. I think less is more with stuff like that - if you cake it on your head it'll be obvious, but if you apply it evenly and in not too big a quantity it can really help thicken your hair and reduce the contrast with your scalp.

It's not impossible to pack at those densities, but the risks of lower yield are much higher and, of course, you'd have to have either minimal loss or a huge amount of donor available - most men are not fortunate enough to pack at anywhere close to those densities you've quoted I'm sorry to say.

Techniques have really improved the last 10 years and doctors are still finding ways to provide greater yield or extract more donor - but as a few on here have said, the improvements are getting smaller. You will always have a limited amount of donor and even though sessions have been getting larger, they're unlikely to get much larger in the future simply because of the donor and surgical limitations.

As for the whole diffuse thinning without shockloss, finasteride usually limits shockloss once your hairloss has stabilised. I don't see anything new techniques on the horizon that will completely stop shockloss though - thinning hairs are weak and the trauma of transplant is often just too much. If finasteride doesn't hold on to them, the only option is further transplants to replace the loss (if you have the available donor).

Why do you feel you need 80/90g/cm2, if you don't mind me asking? Of course we'd all love that sort of density, but even 50g/cm2 will look very good if you have the right hair and the procedure is performed by a good doctor - in fact lower densities are common and still look great.

HTs are and will probably continue to improve, but we are sort of at the upper limits of what a traditional HT can allow. There isn't going to be any massive progression now without the next phase of science; hair cloning or stem cell therapies etc. But most men, even a lot of NW6s, are these days able to get truly impressive transformations with a combination of drugs and/or multiple procedures.

mahhong: I recommend a quick read of propeciahelp.com help for you. specifically this area

 

When FDA approved it as a safe drug for hair loss treatement, this did NOT include studies of long term affects. The scientific evidence seems to be quite strongly suggesting that a significant portion of people taking the drug ARE having long term permanent problems as a result. When I say significant, I do not mean 'most' or 'almost all', what I mean is that if you choose to take the drug, do not be suprised if it impacts you. The quoted numbers from Merck suggest close to 2% of people will suffer permanent effects after stopping propecia - others think this number is much smaller than reality.

 

One very, VERY telling sign that there is a significant risk of permanent problems after stopping the drug is the fact that in April of this year, Merck has modified their Propecia instruction leaflet to say this exact thing.

 

Claiming that there is no science to support the suggestion of long term effects is just plain wrong - even the company who makes the drug believes that there are. It is quite upsetting that you would take this issue so lightly as to write lengthy advice without appearing to have done any investigation into the matter yourself.

 

I appreciate that you are here to help advise people in your own spare time, and that you want to push an impartial opinion on this contraversial topic, however people should be scared of this drug. They might still choose to use it, like I have, but everyone making this choice should not have it hidden from them that there is a chance of things going very very wrong.

I've been to propeciahelp.com and have indeed read a fair bit about the drug, the side effects, and the changes that Merck have put on their labelling. However, these things must be put into perspective. A lot of people assume that a drug company are "hiding" the truth about drugs like finasteride, and the change in labelling is some kind of "admission" that the drug is dangerous.

Here is the thing. There is a scientific study that links paracetamol usage to infertility in unborn children later in their adult life. Long-term paracetamol users have a higher risk of developing blood cancer. Aspirin has caused intestinal bleeding and Reyes Syndrome. Anti-depressants can cause depression.

No drug is unquestionably "safe". Many millions of people take many different drugs and a huge, huge number of side effects or observations, sometimes serious ones, are reported. There is no drug that hasn't been blamed for serious adverse effects on a minority of individuals - often a tiny minority. Most of the time these observations are anecdotal - sometimes they are anecdotal but prevalent enough to cause drug companies pressure in changing their labelling. This happened with Merck. There are no wide-scale, peer approved, scientifically foolproof studies on why certain people get serious effects during or after taking propecia. Yes, there are lots of articles and abstracts you can point me to on the web; studies of 5 people, studies of 20 people, studies of 500 people perhaps. Yes, there have been no long-term studies (in fact a reason myself I am still on the fence about the drug). There are never long-term studies of drugs when they're released; if there was we'd still be waiting for half of them.

The reason I am hesitant to make instant negative claims about propecia is because millions of men take it and perhaps a few thousand, spread over the internet, have made serious allegations about the damaging effects of the drug. There is no major conspiracy or unknown variable about the drug - millions of men take it, millions of men are fine, a small percentage have some temporary or mild side effects and a very tiny percentage of men claim it has ruined them. Paracetamol has the same sort of statistics. Or warfarin. Point to any medicine on any shelf in the world and I can show you studies and theories that it's dangerous; cases of men and women who have been massively affected by them.

Almost every doctor on this planet has no problem writing a script for propecia. Yes, it has its detractors. Yes, it has enemies. Yes, perhaps there really are skeletons in the closet. But, statistically, prescribing or using finasteride is no more risky than virtually any other drug on the market. A few dozen men have probably popped the pill whilst I've been typing this.

As a matter of fact, however, propeciahelp.com is to propecia what Al Qaeda is to the Western World. There are men on those forums claiming they've eaten nothing but raw fruit for 3 years and are just starting to get their libido back. I do not wish to seem dismissive, but propeciahelp is not where you go for unbiased truth. I feel sorry for men who genuinely believe propecia has ruined their lives, but joining propeciahelp is probably just as negative a move as taking finasteride in the first place.

To that extent, it is not for me to go against the grain. I follow essentially the same line as any other doctor on these forums; try it and, if you get side effects, stop taking it and they should abate. It would then be unfair for me to say; "on the other hand, some men have reported it has ruined their life and if you go here and here and here there are suggestions that the drug is very dangerous and should be avoided at all costs". People are are intelligent and I'm just saying what most doctors would say.

Having had effects from finasteride, to the point I felt unable to continue taking the drug, I am actually dubious of the long term benefits of taking it myself. But millions of men are doing just fine; some for 10, 20 or more years. Medicine is not the realm of the safe and unsafe, it's just the realm of risk. You take a risk every time you smoke a cigarette or eat a McDonalds and far more people have been irrevocably damaged by both than by finasteride. I trust people to make their own minds up on the drug, but whisper words of caution in their ear excessively and they'll instantly start believing there are dark truths your doctor on the drug companies don't want you to know. There's no doubt finasteride can cause problems, but statistically it is still safe drug.

mahhong: side effects will "probably" go away when stopping. Not for everyone.

 

In fact, some people have reported that they didn't have any side effects until after they stopped.

 

DHT is an important chemical in your body, and when you get rid of it, the results seem to be quite unpredictable

I myself had side effects when taking finasteride and am unable to use it for this reason, and of course I'm aware of the testimony from some people that they've had persistent side effects that have started or continued after stopping the drug.

The overwhelming majority of men who take the drug appear to receive little or no side effects, and of those who do experience side effects the vast majority of men experience total cessation of side effects when they stop the drug. I know there are men who claim long-term and permanent damage from the drug, but these are a tiny minority of users and the cases are often anecdotal and, as far as I'm aware, there are few or no verified medical investigations that have established definite links between finasteride and persistent side effects after discontinuing the drug.

I'm not necessarily doubting men who claim long-term effects, I'm just saying the science is not currently there to support it. I myself am, in retrospect, not 100% convinced of the practice of lowering DHT values in the body, but similarly I do not doubt the testimony of most doctors that they see very few side effects and I don't think any doctor, certainly on these forums, has ever verified a case of sexual or psychological symptoms that have had definite links to finasteride use even after cessation.

I'm just wary of creating a biased opinion one way or another. The number of men who feel they've experienced genuine long term side effects from finasteride is absolutely tiny compared to the millions who take it just fine. And of those men who do report long-term effects post-cessation, there isn't any clear cut confirmation that finasteride is or could be the link. As a man who can't take the drug myself I'd be upfront about the fact that I'm not 100% convinced on the long term safety or efficacy of finasteride, but I don't like scaring people off it either, because it's by far the best tool we have in the fight against hairloss (save HTs, which are a costlier and more committed affair and come with their own limitations of course).

Thanks Mahhong, in your opinion what is the best density per cm2 ?

There isn't a best I don't think, because there's too many individual circumstances to take into account. In addition, most transplants involve different densities in different regions, with the hairline usually being the priority for density and the crown not as much so.

It really depends on how much donor you have, how extensive your balding is (or is likely to become) and your goals. If you were able to get an average of 50g/cm2 that would likely look very good, but it would require a very large amount of grafts on a NW5a. What most doctors would do is look to put a higher number in the hairline and then fade it back, so maybe around 50g/cm2 in the hairline and come back to 20 or 30g/cm2 in the crown (these are just example numbers, not facts or anything).

Only a doctor can tell you what's best. What did you do for your first procedure? Were you happy with it? What are your goals with this second procedure?

You should be able to get a script for propecia easy, but proscar is something some doctors are a bit funny about. Technically speaking it's not prescribed for hairloss (same drug but much different dosage, as you know), so a doctor is having to "trust" you if you ask to use it for hairloss. Doctors like to keep themselves covered!

A primary care doctor should have no trouble giving a script to you for finasteride (whether propecia or proscar, depending on what they're comfortable with). It's pretty commonplace.

Most men don't experience side effects with finasteride so you should be fine! If you do experience anything you can always stop and they should go away just fine!

Hi Johhny,

As most people have mentioned there are loads of variables here. Did you and your doctor decide on 3000 for the first procedure, or was that the maximum he/she could harvest despite their best intentions?

Most people have about 6-8,000 follicular units in their donor area and so, based on the information about the extent of your hairloss, we can presume you probably do have another 3,000 or so up there for your next procedure. But nobody on these boards can say for certain because unless you're a doctor with access to your history and a physical examination there's no way of telling.

Usually, if people get the maximum number of grafts they can for their first procedure, subsequent procedure produce lower numbers of grafts. It's usually a case of the law of diminishing returns. But, as Jotronic says, it depends a lot on your doctor. Good doctors these days are regularly performing 3-5,000 graft megasessions and if you're looking for maximum yield 3,000 doesn't sound particularly high.

Did you discuss an overall plan with your doctor when you went for your first transplant procedure? It sounds to me like you only planned one procedure with your doctor and you're now thinking about another totally separate procedure. That's obviously doable, but usually people have a good idea if they're going to need one or more procedures to reach their goal and what each procedure will aim to do.

In regards to density, it's hard to say but 50grafts/cm2 sounds decent. But it really does depend on so many other factors - there's not necessarily any number to aim for. But to get to 50g/cm2 would require a lot of grafts. If you had 150cm2 of baldness to cover you'd need 7,500 grafts. You describe yourself as 29 years old and NW4/5a. This could potentially mean further loss in your future - perhaps more 5a/6 even. This might not happen, but if it does, you may need to have donor available to cover additional balding in the future.

I think you need to have a proper discussion with a good doctor who will develop a long term plan for you that takes everything into consideration; balding pattern, potential future loss, medication, goals, hair type, donor left etc. etc. As you know donor hair is finite and if you use it all up aiming for 50g/cm2 you may end up losing the battle. Few people manage to get to 50g/cm2 across their entire balding region - in higher hairloss patterns you'd need an awful lot of grafts and many men would simply not have enough. You could be different, but only a doctor and you can make that call.

So yeah, I'd get in with a doctor and come up with a long term plan that balances your goals and your available resources. Just getting disjointed procedures done trying to get your hair back could lead to trouble - you need all the facts and a few frank discussions before you make the next move.

Hair loss is a difficult one, especially combined with depression or people prone to depressive thoughts. Some people are able to accept hair loss as "one of those things", but not many people on these boards would count themselves in that company! Hair loss can run very deep psychologically and probably manifest itself as something almost like a body dysmorphic disorder or similar syndrome. I don't know the facts on the psychology of hairloss, but it related deeply to perception and our visual imagination of ourselves. We all walk around with a perception of what we want to look like and that changes how we feel. Hair loss robs many men of the ability to form a comfortable perception of themselves.

When I first noticed I was losing my hair it did hit me hard, though I am very fortunate that I am not prone to depression and wouldn't say I've been "depressed" about it. That having been said, a large part of my ability to deal with hair loss is based in the hope and belief I have options on the table when it comes to the right time; shaving down, HTs etc. I don't think the shaving down route would work for me (although I'd be happy to try it), but HTs are of course a potential option. If I wasn't suitable for a HT I don't think I'd necessarily become depressed, but I would feel unfairly robbed of my personal image and that does force you to change how you feel about and work with yourself.

It is a vicious circle though, in that feeling unattractive or undeserving makes you so. Most men who feel a victim to their hairloss are usually more mentally damaged than physically damaged. They beat themselves up, tell themselves they'll never be attractive or like they were, that they're getting old and are less masculine. That train of thought leads you to go out into the world without confidence or belief that you can achieve what you want and then, just as you feel, it happens to you.

Look at men like, for example, Jason Statham. Jason Statham is NW6/7 and not even a particularly good looking guy. But he IS sexy to women and confident to men, because he wears himself with pride. He works out and looks after himself and just shaves down and "gets on with it". If Jason Statham went the other way and put on 20 pounds and said to himself "you're a big bald failure", he'd be no more attractive than any other man on the street. There is nothing special about him save for the fact he feels special.

A book I recommend a lot of guys read is 'The Game' by Neil Strauss. Yes, it is ostensibly a book about how an ordinary, ugly-duckling guy becomes a pickup artist and beds loads of beautiful women using a well honed technique he learns, but, there are some deeper ideas in that book about what success is and how success is earned and strove for. Interestingly Neil Strauss is as bald as any man on here and he shaves down to the skin. Unlike Statham he doesn't even have the body! But the guy learnt that "picking up girls" is the same process as winning jobs or finding investment or toning your body - its about visualisation, belief, understanding and action. Fundamental to being who you want to be is working very hard at all areas of it. Hairloss does not destroy any chance you have of being a real man or a real success, but it can allow you to destroy it for yourself.

The book is fun and also recommends a bunch of other books on NLP and learning body language etc. I know a lot of guys dismiss the whole thing as "lifestyle nonsense" or just being about shallow things like sleeping with girls but there is a deeper message there, and certainly in the other books and ideas suggested.

In many ways hairloss can both cause depression and be just like depression. Depression is something you cannot stop from happening unless you research and take proactive steps. We all know now it's a real disease and so is MPB. But it's also the excuse a lot of men need to berate themselves into even more hopeless states. Most people beat their depression by working at it - it's not easy and it's not a switch you can flick whenever you want, but it is a disease you can work at successfully lifting from you.

So yeah, hairloss is bad news and we don't have all the answers for it yet, but there are things you can do both within and outside of the hairloss problem to improve life in general and make hairloss less of an overall problem. If you tell yourself a HT will cure all your problems then you're deluding yourself. Usually it cures one problem; confidence. And once that's cured everything else falls into place. But hair is not the only way to get confidence and learn self respect so I urge guys to think deeper about why their hair is important to them!

3000/140 would be approximately 21g/cm2, which I don't think would be enough to make an appreciable difference to your hair. You also have to factor in that grafts are rarely places evenly; a doctor would likely want to put more grafts up front for your hairline and less at the back in the crown area, and fade in between those two areas. 3000 grafts would make some difference, but as you sound like you're looking for transplantation into the vertex/crown and not the hairline it's hard to say. Those areas need a notoriously high number of grafts to make a real difference.

Nobody can make any sort of accurate assessment without pictures and a firmer idea of what you're looking to achieve, but 140cm2 is a relatively large amount to fill and usually it's only figures of around 30-40cm2+ that will start to make a real cosmetic difference to your hair.

If you wanted to get 30g/cm2 in 140cm2 of space that's 4200, and I would hazard a cautious guess you'll be looking at at least 4000 grafts to really tackle hairloss of that size in that area. That having said, you could easily put 5 or 6000 grafts in that sort of area, and even at maximum that's still only around 42g/cm2. That's a decent density for transplantation, but still not native sorts of density.

Only a doctor can give you a proper diagnosis and without pictures it's hard to say, but my honest guess is that you have to be looking at around 4500 minimum, especially if you have a strong hairline and want to fade from that hairline to your mid-scalp and crown. You could of course get 3000 grafts and have some appreciable difference to your hair - but the results would be limited at that density.

No way does he use concealer on the pitch,i dont see rooney after the game having his shower then looking in the mirror applying concealer infront of his team mates,then going out for post match interviews.He has some miniturused blond hairs on his vertex so he dyes his hair so his native hair is as darkly pigmented as his transplanted,its stupid to say he wears concealer on the pitch in all fairness..

Not that it's important in the context of this topic, but I don't think it's stupid to suggest he wears concealer. He's been pretty upfront about his hairloss and his transplant so the idea that he has a shower and then puts concealer on is hardly ludicrous. I'm pretty sure if he didn't want to do it in front of his team mates he could find somewhere private like a cubicle to put it on!

I've played football with Nanogen on and it works fine. It probably does wear off as you perspire and head the ball and mess your hair up but a fair bit of it stays on - it's not like you go on the pitch with hair and come off bald or anything!

Stephen Ireland played football with an entire hair system on! And he was notoriously less candid about his fight with hairloss even to his own team mates. My best would still be that Rooney has used a bit of concealer. Especially when he came out at the start of the season with a full head of hair. No way was that his results at 3 or 4 months.

To be honest it's a more realistic representation of what his hair should look like. I don't know if he uses concealer on the pitch but I get the feeling he does and that, combined with less harsh light, gives his hair a fuller look.

It still doesn't look bad though; for 6-7 months in all told. He's in his mid-20's and looks very much like he's heading towards an NW5/6 without meds or surgery, so there is a limit to what can be achieved anyway. no matter how much money you have! His hair is pretty short and ultimately, in strong light, I'd still say it looks like a decent job.

What most other people are saying!

There is lots of interesting research and I do think several of them are promising, but even the most promising are still a few years away and we have not had any absolutely concrete, latter-stage trials to hint we're really getting close at something coming onto the market. Nothing comes out of the blue in medicine!

In addition, people hear of Aderans and Histogen and all these other companies doing exciting research and the word "cure" is bandied about as a result, but most of these companies have much more modest goals in their trials. Nobody is close to claiming a treatment that will enable you to go in bald and come out with a full head of hair and, in fact, most are using the sorts of results propecia get as a kind of baseline.

In short, even if something does come out in the next 5 years, which I actually think is relatively likely, it's probably just going to be another tool in the fight. It'll likely still have to be combined with the current drugs and/or hair transplantation to give people a real net benefit. Don't get me wrong, it'll be massive progress if we can find a drug or treatment that gives you back even an additional 5-15% of your native density, but that would still have to be combined with one or more HTs and possibly also current medication to make it really worthwhile.

So I, too, would live for today when it comes to hairloss. I am optimistic about the future but these things are genuinely slow and usually evolve rather than coming into market as "THE" cure. I think the most rational hope is that in the next 5-10 years we can have a few more tools that can add density and improve on traditional techniques, perhaps enabling NW7 men to consider hair restoration, or giving NW5/6 men 50-70% of their native density instead of 30-50% But it's these sorts of goals that are probably, at best, achievable in the next decade. And that means it's very likely HTs, fin and minoxidil are still going to be a part of most people's hair restoration for a long time to come.

I reckon the majority of men who have transplants will be taking drugs to support that transplant, but a fair minority do not.

If you haven't tried the drugs it's always best to give them a go (after being prescribed by a doctor, of course!). There are however quite a few men that either can't or won't take them; especially finasteride. I am one of them as I experienced pretty bad side effects both the times I tries fin and wasn't comfortable with the idea of continuing to take the drug long term (just to note, all the side effects have gone now I have stopped taking the meds).

Hair transplantation without meds is inherently riskier because of the higher likelihood of future loss - but there are a fair few stories of guys on here having success without meds. Luck and judgement do need to be on your side though; if you have an advanced hairloss pattern that can be a problem, although in reality these days even some NW6 patients are getting excellent results from transplantation, but NW7 is still pretty much a definite no-no especially without meds!

The other aspect is that you'll be chasing your HT if you're off meds. Unless you're older and your balding might have stabilised, chances are you'll get an HT and without meds, 2 or 3 or 4 years later you'll need another one to fill in the areas of continued thinning. You may need to have 3+ procedures before you can really fill in all the loss.

And of course, density is an issue. The guys who hold on to their native hair have more hair, to put it bluntly, than the guys who don't. Density can still potentially be excellent even if you lose your hair or don't take meds, but clearly any extra native hair is only going to add to the effect!

The meds are still the cheapest and easiest way to restore and maintain your hair and can pave the way for a stable HT procedure that will stand the test of time. Doctors are ethically obliged to come up with the safest, least intrusive and most stable plan for you that they can, so it makes sense to advise taking FDA approved drugs and have as small a procedure as possible to combat your hairloss instead of advising you not to take drugs and end up needing multiple, costly procedures to deal with the consequences. Doctors plan every procedure to look natural and be effective on its own, and stabilising your hair with meds is a huge part of that plan.

But ultimately, it is possible to restore your hair without drugs if you meet the criteria for doing so; mainly having a more limited pattern of hairloss, committing to multiple procedures over several or more years and being fully aware that nobody can know where your hairloss will truly end up, despite all best guesses. In short, there's always a risk you could be sailing into the unknown, especially without the meds, and doctors are ethically bound not to let you do this is if there is a better plan on the table. But if you have the donor required to meet your eventual balding pattern and the time, patience, money and dedication to pay for the transplants you need, then there are guys out there that go the HT without meds route and do just great.

It's possible an NW5a might progress to a 6, especially because you're only 30 (though it's not definite, of course). Finasteride is your best chance at halting any further loss though obviously if you're concerned about side effects that's something you need to weigh up. Lots of men do report mild side effects that disappear after a couple of months or so though, so if a sore nipple was the worst you experienced might be worth giving yourself 8-12 weeks on the drug and see if the side effects decrease or if you experience further problems.

30 is not necessarily too young to get an HT, though a lot of the success of an HT depends on whether the loss has stabilised. If you're 30 and on fin, or feel that you can achieve your goals without fin and can commit to a longer term restoration plan, then it's not unusual to have a HT around that age.

It's obviously entirely up to you but I would urge caution over SMP or FUE for the #1 sort of look. Both can be a success but they're built pretty specifically around the very short, clipped hairstyle and, essentially, that leaves you with as few choices than if you didn't have a HT. In addition, the difference between #0/1 and #1/2 is in my opinion not worth the money, time and commitment - especially if further down the line you want further procedures to expand your options. That having been said there are successful cases of guys going down the 2-4000 graft route and/or SMP so they're not out of the question if you like the look and want to consider it more seriously.

A bulk analysis or miniaturization test might help in determining whether you're thinning in any other areas than the obvious ones and might go some way to answering what NW you could be (though it won't be 100% accurate and can't be used as a firm diagnosis). Generally speaking if you're around an NW5a at 30 the chances are higher you're heading for further loss - but there are a fairly good number of men who buck that trend so it's probably best to discuss that with a doctor who can give you a better analysis.

In the meantime though, the #0 look is really suiting you. I'm seriously considering having a go at it myself but am absolutely convinced it won't look much good at all, so I do envy men that can pull it off so naturally!

I think it looks great! This sort of style is very popular these days and you have the right head shape and figure for it, so I'd say definite success!

On a purely personal level, especially for younger guys with advanced loss, I actually think unless you can afford or commit to multiple, larger procedures, this look is more youthful and convincing than an HT (for most men). I think if you can afford and be able to get a procedure of more than 4/5,000 grafts for an NW5 then it might start being worth considering, but quite often guys in their twenties, thirties and even forties who get maybe 2/3,000 and grow their hair out a bit don't quite look right - the density is just too low to look natural on them, or the hairline and crown restoration too conservative (not that I'm advocating trying to get back to an NW1, I just mean the very conservative hairlines).

I would say stick like this for the time being and, if you do consider a HT, it probably has to be FUT unless you're looking for a modest procedure and to continue buzzing down. For the larger hairloss patterns its an all or nothing in my opinion - you either have to accept the loss or be prepared for one or more major procedures to get the density and coverage you want.

But seriously, this looks very good on you! The buzzed down look works because it IS a "look" - you've totally taken command of the hair loss and that's half the battle. I know a lot of guys who have hair (either naturally or through a HT) and just wear it all over the shop and they don't look half as good.

I would agree with TakingThePlunge that your photo album may hint at some diffuse thinning, though it's impossible to say whether this is MPB, stress or what the cause might be.

Other people on here have given great advice. You're in the vicinity of some very good hair specialists and going to see them should help you out. It is better to start finasteride as soon as a diagnosis of MPB is made (if that's what you have), but I also understand your dermatologists concern that, with your other conditions, it is something that has to be weighed up. A diagnosis of MPB is the most important factor and a good hair specialist is the best person to do this.

Everybody on these boards will take you seriously, so have no fear about being as frank as you need to and you've already taken a great step forward by joining up and sharing your pictures/videos. We're all here because we're worried about our hair and would much prefer to not lose it or be able to get it back, so you will find many friends here!

The other good news is your dry hair (and even your wet hair) still looks great! There's no sign of any thinning in the video and your hair looks fantastic. You are dealing with this very early and you have absolutely the best chance of making sure you keep your hair as a result.

The Christmas season is often an emotional one so I do understand the stress you must be under and how these concerns must be making it worse. But you do have a great head of hair and these forums are giving you the advice you need, which you are pro-actively taking. With all that in mind you have the best possible opportunity for a successful outcome and to conquer your concerns, so speak to your therapist and try and look forward to the new year!

I'm not a doctor or a professional but now having watched the video, my bet would be that you're not balding in the donor region.

Unfortunately only a microscopic analysis can tell you for certain if this is the case. Nobody, not even a doctor, can be accurate with just a visual exam. I would say there are no signs of thinning though. The only place that looks different in the crown/whorl region, which is prone to looking thinner even in non-balding men just because of the way it grows out from that region in certain individuals.

Out of interest how old are you? I only ask because from what little I can see of you in the video, you look pretty young. If you're younger than 30 I would be cautious over whether now is the right time to get a hair transplant. That's not to say you couldn't or shouldn't, but your dilemma highlights the problem; you've often got little information as to how severe your balding could become in your 20s (especially younger 20s). I know hairloss sucks, but a badly planned transplant sucks more!

A bit of divergence from doctor to doctor is to be expected on what they consider good donor or good density. Some doctors are very conservative or modest in their approach, others a bit more robust. But again, nobody can be totally accurate with a quick visual inspection - your donor density would need to be mapped to stand a good chance of ascertaining exactly how good a candidate you are.

And of course, finally, make sure you're seeing a reputable surgeon! You'll always be able to find a surgeon out there who'll tell you what you want to hear; make sure the people you're seeing are thorough and only deal in the truth.

Does density on the top is the same as it is in donor site, on person who don't have hair losing?

Somebody else will probably answer this more accurately, but I think the hair on top is usually the same or more dense than hair in the traditional donor region.

You've pretty much highlighted the limitations and problems with the Norwood scale!

There is some debate over how the NW scale should be used and how people interpret it and chief amongst these problems is whether people decide to use it to interpret current hairloss or perceived eventualy hairloss. The problem of course stems from the fact that nobody truly knows where your genes will ultimately settle your hairloss. Some guys can "look" like an NW3 at 30 but be well on their way to an NW6 by 35, and others can "look" to be headed towards an NW6 based on visual observation and miniaturisation analysis but, in the end, perhaps the vertex doesn't thin as much as suspected and the patient ends up an NW4 or 5 instead.

Strictly speaking it's probably only accurate in categorising final stage hairloss, but this is tricky. Some men have done all their balding by the time they're 30 and others are still balding aged 50 or 60 or even older. Some men never truly stop balding in their lifetimes!

So the NW pattern is really only useful for recognising trends in patients, or analysing patients whose hairloss has clearly settled down. So if a man reaches NW5 or 6 or 7, you can judge that much more accurately than a man who is an NW3 or 4. Similarly age is another factor; a man who is 50 and NW3 is unlikely to see a huge increase of further thinning, but a man who is 23 and NW3 could literally be heading anywhere.

It's just an approximation chart really. Even between the NWs there's a huge amount of of variation, so it's impossible to call. Some doctors and patients even suggest the whole thing should be overhauled or scrapped as it doesn't really offer much in the way of useful prognostic help.

The man in your first link is a prime example. Strictly speaking I would put him around an NW4 in terms of current loss, but there is clear thinning in the zones attributed to NW5 and 6 loss as well. Where will he end up eventually? Who knows! He could have the same amount of hair at 75 years of age, or he could be a full blown NW6 in 2 or 3 years time.

Without being pessimistic I would say the general rule of thumb is that if you have thinning in any area you would assume that area will eventually be bald one day. That's not always true, but better to erroneously plan for being an NW6 than foolishly convince yourself you're an NW3. I could probably pass as being an NW3/vertex at the moment, but I know for a fact I have thinning in NW5/6 areas and have to assume that's where I'm headed, even if I never get there. My father is the same; at 52 years of age he's caught somewhere between an NW5/6, with pretty high sides but a fairly large balding crown.

People tend to just use the NW scale for approximations and it has no prognostic value unless you're at one extreme of the scale or another. Your genes have already decided every single follicle that's going to be affected by DHT before you're even born, and the NW scale is just a pattern of general observations unfortunately. But, if you look like the guy in the photos, I would say assume you're on the way to an NW5, because it's always better to be cautious and end up pleasantly surprised!

It couldn't hurt to get a professional opinion on it, but I see this sort of thing quite a bit in non-balding men too. I think it's something to do with the direction and what in which the hair grows, but I couldn't say for certain.

As I say, couldn't hurt to get it checked out, but everything else looks too dense and normal around it for just that little strip to be thinning.

I have to say, and this is just a personal opinion, that in the majority of BHT cases I see I honestly think the results look not particularly nice. I understand, as Joe said, that for patients with simply no other options they represent the opportunity to repair nightmare procedures and shoddy work, but despite the coverage they offer, I honestly just think quality of the hair looks horrible.

I see a lot of guys talking about NW7 to NW1 but I think if you're really thinking like that, there is some psychological imbalance you've developed where you're simply seeing coverage as king. Yes, the coverage you can get with BHT is indeed impressive, but the density and quality isn't in my opinion. It usually ends up looking like scraggly wire wool and your options for future styling are very, very limited.

I am not saying this just to be harsh to men that have or are considering BHTs - it is up to them and the option is clearly there. But I would seriously urge people to start thinking, why do they want their hair back? Having something on top of your head does not automatically make you more attractive or look younger or improved. I think a lot of men get to the stage where mentally they simply equate putting hair on their head as the realisation of their goals. Hair is only useful if it's good quality and able to be styled and incorporated as part of your look. All the genuine success stories I see on these forums nearly always comes down to men that have a HT that allows them to have a head of hair that goes with their overall look and improves it. Some men have a HT and just let it grow and leave it untouched and in all honest I sometimes see cases where I think the patient would have looked better just shaving down and being proud of it. This is my personal opinion, I realise it is not fact or should have no bearing on the patient, I am just saying what I see.

I would really urge people to think seriously about what an HT is for, because I think there are sometimes deeper psychological issues akin to those found in plastic surgery. There are plenty of people that get addicted to the procedures and not the results of them. It's always sad to see people walking around with horrendous cosmetic surgery and their stretched, taught skin and lifeless features. But in their head they're planning the next improvement - clearly they have forgotten the point of what they started out for.

I think the same thing is possible with HTs, perhaps more so. We all know of "hair greed" and in most men that's fine - they just want to use their available donor to improve on what they've already had done. But I do sometimes see guys talking about NW1 restoration and I look at the results and, honestly, just think I'd rather have no hair. I do wonder if they got to the point where they simply assume if they can't see scalp glaring at them, they assume success.

As I have said, these are my opinions, I have not come here just to be a nuisance. It's not my place to say what is or isn't good - but I do think sometimes people need to think further than just getting their hair back and think about why they want it back, how they imagine themselves with it. Some people talk about BHT NW1s like they're going to look like Brad Pitt or George Clooney and I worry that they've lost focus. If you feel a BHT will genuinely get you your goals then you have to go for it I guess, but if you really think about it and find you've been wanting your hair back for the sake of wanting any sort of hair back, then I honestly wonder if the time and money and commitment of a BHT will genuinely make you happier, healthier or more at ease with yourself. A HT is an emotional journey and even though the changes may be physical, that's not really where the true changes happen.

If I'm totally honest I would say, given your relatively minimal level of loss at the moment, a hair transplant at 22 is inadvisable with or without medication. I would also not necessarily agree that you HAVE to be on finasteride to consider a transplant - but there are some major considerations to think about if you're not.

I think for men in their 20s (especially early 20s) hair transplantation should only really be considered in exceptional circumstances and as part of a major long term plan. Even on medication, it's practically impossible to imagine a man in his 20s will only need one HT in his lifetime. To my eyes your current hairloss pattern is very difficult to establish; you could be nearly finished balding (unlikely but possible), or you could be heading for a NW7 (again, unlikely). In truth you'll probably be somewhere in the middle of those two. Although your family history suggests the possibility you may not advance much further, this is something that simply cannot be known and only time can tell.

I haven't had a HT but I too tried finasteride and also had side effects to the point where I wasn't comfortable taking the medication - certainly not for the rest of my life. I gave finasteride two trials (one around 3 months, the other around 6 weeks) and messed with the dosage a bit, but ultimately couldn't get rid of the side effects whilst taking the drug and decided to stop. Whether these effects were psychosomatic or caused by other factors I'll never know I guess - but I'm 28 now and if I'm fortunate to have another 60 or even 70 years ahead of me I don't want to be taking finasteride for all or even most of them!

You can have a HT without finasteride, but as other posters have mentioned, the risks are higher and the commitment to multiple procedures and using most if not all your donor hair is much greater. In addition, if you are going to have a HT without finasteride, doing it in your 20s is almost certainly not a good idea. You need to have a much clearer idea of the extent and pattern of your loss and what you can realistically expect to achieve with your available donor. Let's not forget, though, finasteride is a drug that slows down hairloss - it isn't going to stop it permanently and it's likely that in a decade or a few decade's time even on finasteride you'd likely see further loss and the possibility of multiple procedures. I don't say this to be anti-finasteride - clearly it's the best drug we have against hairloss, but I just wanted to give the other side of the equation and say it isn't impossible to have a HT without drugs, just a bigger commitment and a greater risk that requires a more brutal and frank understanding of what you can expect, what you will need to do and the results you can hope for.

In answer to your question though, tempting as it may be I would not go for the 1800 up front right now. It's just too much of a risk in my opinion. Frustrating as it may be you may just end up chasing your hairloss for the rest of your 20s and still losing the battle. Hairloss in young men is always difficult to approach because it could so easily progress and progress and often does. I was about 25/26 when I first started to notice my hair going and I'm 28 now and even that's probably still too young to be seriously considering a HT in my current state (especially without drugs). Maybe in a few year's time I'll be at a point where I can start to really see what I'm up against and make a proper decision on the next phase going forward.

That having been said it still might not hurt to speak to a hair restoration doctor (a good one) and get an opinion. It's pro-active and they'll know more about your options short term and long term. I would feel a hypocrite telling you to get back on the meds not being on them myself but if you're happy to, I would give them another go. Side effects do sometimes disappear after a few weeks/months. It's obviously a lifetime commitment though, so I do understand the dilemma.

Hope you find a suitable way through it all!

Dr. Quatela, this is one of the best results I've seen from you and your staff.

I concur! I've followed a lot of Dr. Quatela's cases on these forums and have seen improvement after improvement as time goes by. This result is absolutely first class! The patient must be thrilled and I'm really looking forward to seeing your next presentation!

This is a toughie!

On the one hand I can see how it could be construed that what your wife did was a bit inconsiderate. I mean, it is a private thing and it's not necessarily dinner table conversation unless you're comfortable with it.

On the other hand, she has probably just done you a big favour. Trying to hide a HT can probably be difficult, stressful, annoying and frustrating - and most people will still likely know anyway. I mean, in a way it's sort of silly - most men don't have hair, disappear for a week or two, and then a year later they have hair again. We might not chat about it openly but most people know what's gone on!

So, what your wife has done is negated that problem AND probably also proven to you that a HT is not that outrageous a lifestyle choice. I mean, you didn't ask to lose your hair, why is it so silly you're doing something to get it back. It is completely illogical why we feel so insecure about the idea of doing something to improve how you feel about yourself. If you said you were going to join a gym because you hated having a fat body, people would applaud. But somehow, if we attempt to improve ourselves in other ways (especially men), it's seen as being vain or superficial. That might be the case for those who get dozens of tiny surgeries to fix up a wrinkle here or a blemish there, but in the case of something as fundamental as getting your hair back, it's no different to buying new clothes because your old ones are out of date.

Maybe your wife has actually been smart in all of this; she's taken a huge weight off your shoulders and it's not like your friends are going to be any less friends as a result. I think it's quite nice your wife is so comfortable with what you're doing - better than a wife who's more embarrassed about a HT than you are!

It's quite nice to see HTs becoming more socially acceptable to discuss and consider. I have to admit I'd have a hard time owning up to getting one - but when I think about it logically I can't for the life of me imagine why! Hairloss isn't something I can stop, or it isn't a reflection on me as a person or a man, so why am I so embarrassed about doing something about it?

Just look forward to the HT now! And it's nice to know your friends will support you when it's healing and growing. If there are any bald male friends amongst your company they'll probably be considering it themselves before long!