bonkling

Hey everyone,

Just wanted to share something I've noticed which highlights the dynamic nature of shedding/hair fall.

I know it can be extremely worrisome, but I've noticed it really does come and go.

For instance, I travel for work, and occasionally I need to travel into extremely cold regions of New Zealand (I am based in Australia).

Without fail, every trip, within two or three days my hair starts shedding - even if I had zero shedding in Aus. 

It could be the weather, or simply that I end up wearing a beanie 24/7 which may cause the hairs that would shed daily, to remain loosely attached.

Has anyone experienced anything similar? More-so found this to be curious, and hopefully it shows how easily hairs can shed, and for those in shedding phases to not stress too much.

In my experience, hair usually bounces back quite quickly from these falls, even if they last a while.

3 hours ago, Dr Blake Bloxham said:

Hi PA, 

So just to be clear: you started 1mg finasteride in July of 2018, and seemingly did not see any sort of initial shedding phase? By around 4.5 months post-op (November), your hair looked great and you appeared to be an excellent responder to finasteride. Then from November until now, you experienced gradual and worsening thinning to the point where you believe you have pretty much lost all gains? 

Typically people experience a shedding phase for the first 3-4 months; the follicles are somewhat "shocked" into a telogen phase (which lasts around 3-4) and then wake up and begin functioning better -- and growing stronger, healthier terminal hair as a result. If we presume that you did not experience an initial shedding phase but did experience one starting in November, it would likely end around March or so and should start exhibiting noticeable improvement by June or July. 

If you were my patient, I would probably tell you to wait 6 months from when the transition from Telogen (rest) to Anagen (growth) occurred. If we say the resting cycle ended in March, you would maybe want to wait until September before declaring that you have experienced no benefit from the finasteride. 

Now, how likely do I think this is? Probably not too likely. However, I have seen stranger things when it comes androgenic alopecia. 

I also think there is another possibility; and fair warning here: I do not think my experience and opinions when it comes to finasteride are necessarily as "main stream," but I feel pretty confident in what I have seen thus far interacting with thousands of hair loss patients over the past 5 years. 

I personally believe finasteride is a "kick the can down the road" type medication. In the end, androgenic alopecia is genetic. It is like your height, eye color, or any other inevitable physical trait based upon your genetic code. In the end, your genes are going to win out. You take a drug like finasteride and put someone on it while they still have a lot of their own native hair, and it may help them hold on to this hair or hold on to a greater portion of the hair for a longer period. In the end, however, they are still going to get to the same point. It just may take a little longer on finasteride. When you get to a certain point where you have already lost a good portion of hair or maybe the "horse is out of the barn" a bit, the drug tends to do less. You specifically may have been further along in the process, and there was just simply less that the drug could do. Maybe an initial "bump" was all that was possible before your body started making more DHT or expressing more DHT receptors in the follicles because that is its coded mission and there was not much you could do to slow it at this point in the mission. I know this is not the rosiest of theories, but I often find it holds water. While preventive medications are great and I always have a detailed discuss about using them with patients, they do have limitations and they cannot overcome what is hard-coded in your programming. Does this mean you should give up on it if you are not experiencing side effects? No, not necessarily. But it may be time to research other adjuncts (surgery possibly being one of them) to help. Just remember to play it safe and try to stick to tested and approved treatments. 

Again, the above is my educated opinion based upon my experience with the medication and hair loss patients. Other doctors may feel differently and they are absolutely entitled to their own conclusions based upon their experiences. I also say the above not to discourage anyone from using preventive medications; I do think they are useful adjuncts and recommend that all hair loss patients research and consider them. 

 

Dr. Bloxham, given that inevitably the medication can give way to genetics over time, do you think this could be an issue for those headed to a NW 6/7?

As in, for those with prospective aggressive hair loss, is a transplant without medication enough to secure a long-term result?

Wow, you and your hair look incredible! What a result. Congratulations

8 hours ago, jj51702 said:

I believe that’s part of the reason why treatments like finasteride are recommended by many surgeons for younger patients with aggressive hair loss.  It can likely help preserve your donor better and if you are destined to be a higher Norwood, the biggest thing you want to achieve is trying to stop the lateral humps from dropping.

That's very true. I've been on it for a couple of years now (finasteride that is) - I just hope it can stop my loss enough to have a long-lasting transplant.

11 hours ago, LaserCap said:

My recommendation is to schedule a couple of consultations.  Go to two or three different doctors and see what they say.  Make sure they truly look at the donor area. Touch it, move the hair around, check for elasticity, etc.  Just "looking" is not doing a proper job.

You purchasing a USB microscope is not going to do anything other than to show you a close up look of the scalp, hair, etc.  A true professional, however,  can tell you how many hairs are in a CM2 by looking at an image.

The first thing I would do is scalp stretching exercises.  This can ultimately help the elasticity of the donor area.  The second thing i would do, is to get on medical therapy ASAP.  This will help save your donor.

Lastly, take photos every 3-6 months and keep a record.

18 hours ago, BeHappy said:

This doesn't exactly answer your question, but something you should keep in mind is no matter what your donor looks like today, it may not be the same some years down the road. You should definitely try to get some kind of idea where your hair loss is going by looking at some older relatives who had a similar pattern as you at your age and also see how much and where your hair loss is occurring the most and the fastest.

Many Drs will give you an estimate of how many lifetime grafts they think you have, but that is based on what your donor looks like at the time he is giving you his estimate. If you were to wait 10 years and then get a new donor estimate, it may be much lower, so don't really rely on that too much. I think many people make the mistake of thinking they can use up a certain amount of grafts because they are led to believe they will always have x amount of extra grafts that they can use later in life if they need to, but that is not always true. As you age and your hair loss expands, your donor may eventually thin out as well. Those 2000 extra grafts you thought you had may only end up being 500.

 

Thanks for the advice, Laser and Be happy, you are both some of the most knowledgeable and helpful on this forum, and have helped me a tonne with every reply. 

I was wondering if you could share your opinions on my situation. 

I'm late 20's, NW3, and on both main medications.

My older brother is 8 years older, and is a NW 5/6. Looking at him, he simply doesn't have the donor to facilitate a HT, and neither does my father. 

Given finasteride and people with aggressive loss, and donor changed, would taking finasteride potentially keep enough hair to warrant a transplant? I'm just concerned with getting one, only to have my hair fall out in a few years.

Thanks a lot. 

Hey my man,

This is an awesome story.

Well, your ordeal sucks, but I'm stoked you got a good result. Your hair looks amazing! I've always loved that style.

Just wondering, if you were to do it all again, how would you tackle it?

As you said, it's hard in Melbourne, we can't go to a good salon, get the shave, the system, the style, and so on.

Also, how do you plan on the maintenance? As in, do you just shave your own hair if needed every few weeks, re-apply the system, then get it blended at your salon?

Thanks mate

Hey mate,

I'm in a similar situation. 

From Melbourne, but don't really know about the whole transplant thing. I've got an extensive family history, and feel like I'm gonna lose it anyway.

How'd you go with a system clinic?

I've seen a couple around, but don't know if they're reputable.

Wow, I'd never seen this post.

Really sorry about that result, mate. 

Did you ever contact H&W to discuss what went wrong? Hope everything worked out for you!

2 hours ago, BeHappy said:

If you have aggressive hair loss that's going to bring you to a NW 7, then your body is probably going to win out over time and start ridding your head of your hair even if you are fighting it with finisteride. You may hold on to it for a few years, but the aggressiveness of your hair loss genes is not going to stop. If you were only going to lose a small amount over 10 years then finisteride may have an easy time beating out your genes for those 10 years or more.

Over a 10 year period if finisteride saves 2000 grafts on someone who was naturally only going to lose 2000 grafts then it did it's job and held on to all of your hair. However if you are going to naturally lose 25000 grafts over 10 years and finsiteride holds on to the same 2000 amount of grafts, is it really worth still taking it? You lost 23000 grafts anyway. Is it worth the side effects? Everyone has different side effects so some may feel it is, yet some may feel it's not.

 

 

That's a really good point, BeHappy.

This is exactly my dilemma. My father is a NW 7, and my older brother is a NW 5 and is only 8 year older than me. 

More likely than not, that is where I will end up. I'm currently a NW 3, or so, and have been in finasteride for a year. 

Neither of them would have the donor that would facilitate a procedure, and yet I want one so bad. 

I guess I may just have to wait it out, and hope for the best.

On 7/16/2019 at 11:32 AM, jj51702 said:

Look up the 10 year finasteride study online by Rossi et al. Younger patients aren’t able to hold on as much as the older ones but it still should give you some idea of the efficacy of the drug.

Great study. I think they showed that the best results were seen in people over 30.

I'm similar to you, Greg. It didn't work that well on the front of my hair, but did on the back. 

Where that leaves us I'm not sure 😂

Hey all,

Does anyone have any tips, tricks, or help regarding their donor?

There isn't anywhere near me, or even remotely close that could check my donor for suitability. 

Should one invest in something like a USB microscope? Or are the standard photos good enough for a surgeon?

Cheers.

8 hours ago, hair4tomo said:

You did the best with the information you had at the time. I just created the same poll on another forum (Reddit), and the results (so far, been about 12 hours) look a lot more optimistic than in this forum: 

So to be honest, I've even had second thoughts about taking the medication after all. Like Lenney and Bonkling say, the type of people who visit this forum may be more likely to have had problems with Fin.

Whilst your point is theoretically sound, I might disagree because the poll results I collected from the other forum (see image above) are much less pessimistic. They each took the time to vote too, yet the vast majority have no perceivable side effects.

Very good point. Thanks also for linking that knee study! The placebo effect is a powerful thing. I think more research is needed to use only the power of the mind to help heal certain conditions, especially those involving pain.

People you know in real life, or on the internet? Did you know these people before they were even considering Fin?

Both. Some in person, some over the net, and I knew the ones in person prior. 

3 hours ago, Lennney said:

Alternatives which have less symptoms, not really right now. You can try what other symptom sufferers do, and go on saw palmetto.

As far as results go, you're in a bubble. The bubble is people who

A. Are available on this forum

B. Have accounts

C. Took time to visit thread

D. Have heard symptom warnings repeatedly on this forum.

 

Again, these results don't see my former co-workers who have been on fin for 7 and 10 years, they don't get a vote.

A+B is simple removal from the at-large population. This may skew results either way, but...

C. Is the interest in this thread. This will invite the strongest opinions (same as reviews for a restaurant, only the really impressed or disappointed people review [and habitual reviewers]). This would be my guess at the bias. Logically there are more than (at the time of writing) 13 fin users on this entire forum. You're likely getting the negative reviewers who take time out to vote where other members and by extension, A. visitors do not.

D. Many of the side effects are in the mind. I'm not arguing that there are not real side effects, only that there is a statistically small chance that a new user will experience them. Placing a placebo in the mind is actually very powerful.

Please at least look at this article...

https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo-surgery-for-knee-osteoarthritis.html

 

Long story short is, people with knee arthritis had same (favorable!!) results with a placebo as they did with the surgeries.

It completely changed knee surgeries for osteoarthritis.

When you're in an echo chamber which pushes a "lookout for symptoms", it becomes very possible to manufacture these symptoms, especially since the symptoms are largely mental and not physical.

My guess for D. Is that docs warn the patients, but don't go on to tell horror stories. These patients don't hear the bad, and don't think about it. These patients would therefore not have a reason to look for the symptoms. These patients would then be less likely to make accounts A+B, and less likely to post in the poll C.

Anyway, good poll to have. Like all polls and surveys, a lot of thought has to be placed into the application and potential bias.

This is very true. This is a tiny subset of what would constitute a representative sample of a population. 

Also, you've got to consider that a lot of people on this website have hair loss that either: A) needs to be remedied with an actual transplant, or B) have had bad reactions to medication which has left a transplant as the only option.

I know of quite a few people that got on fin, it kept their hair, and they never thought about hair loss again - or at least not as we do.

I.e. the people who had a positive result on fin are most likely not on forums such as these.

Lenney had some good natural options, that might be a good start. Either that, or start at a very low dosage. 

Been on it about about 2.5-3 years.

Had sides for like, the first two days, but I put this down almost 100% due to my mental preparation.

I read about the sides, thought I might get them, then as soon as I popped the pill my brain was like, "welp, you got em".

After I convinced myself how ludicrous I was being, I was back to normal.

I take natural supplements (fenugreek) to boost any libido issues I have. Admittedly, this is mostly peace of mind as I never actually had any issues. 

The trouble with ED, is that there is such a huge mental aspect. I.e. if something triggers a minor episode, our mind can cause this to unravel and go beyond a physiological stressor.

Hard to say if I've got brain fog, or not. Im one of those perpetually tired people that is always half asleep, and have always been. So my natural mode is foggy 😂

You can always try it at a low dosage: 0.25mg, then 0.5, and so on. Incremental changes are the best way to avoid long term effects, or so I am told.

3 hours ago, LaserCap said:

That will depend on how much native hair they currently have.  So, if you have lots that still hasn't left the building, I would get on all of them.  Give them a year.  Keep a photo record.  You could photo every 3 months.  If you look the same or better, than you know the medication is helping.  If you are losing, despite the meds, get off of them because they are not being effective.

I've done this for the past couple of years, to which I've been on .5mg of fin and 1mg ln minoxidil.

My temples are slowly receding (maybe), but the rest of my hair has gotten a lot more full, as has my crown.

Bit of a weird one.

23 hours ago, LaserCap said:

Good subject, particularly when you consider all the factors that go into it.

Yes, family history is important as it will give you information. At least you know that the possibility exists and, if you are going to be proactive, start by visiting a dermatologist or a hair transplant specialist.  Medical therapy should be the next consideration.  (There are several tests out there in the mail order form which can help confirm if hair loss is in your future.  A derm can also biopsy and give you that information).

I have homework for you.  Go to the mall....Look at all the people that are truly class 7s.  They  lose hair in a particular way.  They tend to keep a bit in the forelock, they tend to lose everything else, and will typically dip in the back considerable.  There is then some hair in the donor.  And not enough to allow for a full set of hair.  There may be enough, however, to allow for a forelock....which, again, is how a class 7 typically loses hair.

The main thing to consider is looking natural and pattern appropriate.  Got to work with what you have.

Returning to the subject of family history.......this is a complicated message that is passed to the offspring. It can skip generations.  Plenty of documented cases out there...Everyone is fine and, all of the sudden, someone experiences severe loss.  Upon researching they learn that a great uncle experienced hair loss.  It happens. 

In my own family.. My grandfather was a class 20.  My grandmother had tons of hair.  Everyone, except for my uncle, has hair loss.  My uncle, however, seemed to have kept his mother's genes.  Awesome hair.  This also can happen.

My suggestion, given your question, consider medical therapy and visit with a doctor.

 

Very good points there.

With medication, would you think someone even headed to a NW7 could keep enough hair that transplants can provide good coverage?

I've often wondered this.

Like, should you get a FUT to cover for future loss if it's all gonna go anyway? And then you've just got a scar and hardly any hair 😛

3 hours ago, jonnyalex said:

 

 

I honestly think you should be banned from here, any time someone says something you don't like, you get really aggressive and resort to name calling; I've seen it multiple times with you. I never called you any names..

You talk about intelligence yet attack me multiple times in your reply. I simply told him to give it 6 months and then go from there. Yes, the result is going to be bad, clearly it is. In six months however, I feel he will know what is required in a second surgery. 

I am quite clearly asking you 'why do you think I would have gone with Dr Keser if I thought his work was at Dr. Bhatti's level?' I mean, I'm reading it again and it's not hard at all to work out. 

 

You'll come to realise that @JayLDD is extremely sensitive, and ultimately defensive when it comes to even the most innocuous of statements.

His lack of control is a testament to his short-comings, not yours, so I wouldn't take it to heart. He's simply an angry little man that types big paragraphs on the internet, nothing more

5 hours ago, Kvn said:

This question is mostly for guys who have (or know someone who's) had a hair transplant and ultimately ended up clean shaving their head anyway. One of the things that makes me hesitant about a HT is potentially losing all of my hair anyway, exhausting my donor, and then rocking a head full of visible scars for the remainder of my life. 

How visible are the scars? Do they attract any attention in public? Other than SMP, are there any other successful options in mitigating the visibility of the scars?

 

Any input is appreciated

This is honestly what has stopped me from pulling the trigger.

I've always worried that even if I get a HT, for one reason or another, it may fail - even if it's within a few years.

I'd rather have a fully shaved head than a receding/messy hair line, and not being able to shave it if something went wrong is my ultimate concern.

Unfortunately, all transplants will have scarring, especially at a buzz cut. 

At mentioned, the current state of the literature suggests that fin results in a more specific detection, and at a later date. Hence, the initial study may have seemed to suggest an increase in aggressive cancers. It appears to have been a case of correlation and not causation.

Studies since have found no causal relationship between fin and aggressive cancers, and they've had quite extensive and robust sample sizes. 

Of course, it's hard to say definitely, either way, but as of now the consensus is that it is only a positive in terms of prostate cancer.

I've had surgeons tell me that if doesn't need to be stable.

Admittedly I don't know about thinning, as in if the donor is thin, whether that makes a difference to the follicles removed.

Probably needs to be fielded by a surgeon or rep.

Hey gang,

I've seen a couple of posts/comments recently, discussing travel and the best way to proceed post and pre-surgery.

Feel like it would be a good idea to get some tips for everyone to use.

Specifically, tips regarding:

How early you flew out; how close you stayed to the clinic; tips for when going through airports, the flights, and security; how many days should you set aside post surgery.

Keen to hear any experiences.

I've read that too, but it may just be here-say among forum members. 

Further to this, I've been quoted around 1500-2000 grafts from multiple docs - considering their amazing high count FUT results, would going FUT with them be overkill sort of?

I'm considering FUT due to extensive family history of balding, and sitting at a NW4 in my early 30's.

Great post mate! It really can make a huge difference.

Hey everyone,

When it comes to these extremely skilled, and well-respected surgeons, is there much of a difference between them?

As in, is one more involved in a certain type of procedure, versus the other? Or are they pretty much the same?

Also, when going with them, does a patient choose who they want to be operated on by?

I'm more-so just curious about how clinics that have multiple reputable surgeons operate.

Thanks all.