Mycroft

Looks beautiful, and it seems like that gappy spot has evened out again. Very happy for you.

Photos are a bit blurry but it's clear there is a dramatic increase in density along the frontal hairline. The shape has completely changed.

I've heard that some dermatologists will prescribe it. You might be more convincing if you link to some of the articles written by doctors who prescribe it more regularly in their practice.

Seems like that would be a reasonably safe bet. I have also heard of people splitting their daily dose in two with half in the morning and half in the evening. I've seen a number of anecdotes where patients experiencing side effects solved their issue with this approach.

I started oral minoxidil about two months ago at 5 mg daily. The highest dose I've seen studied is 10mg daily but that is only in one study. Most doctors look at 5mg as the high end. Too early to gauge the response of my hair just yet, but no discernable side effects on this dose. I've been monitoring heartrate and BP and have found no change outside of normal variances. No sign of hypertrichosis. I'm expecting to see some sort of visual improvement by six months if one is to happen at all, and if I show signs of a positive response I will gauge full results around 12 and 24 months. Of note: I have not discontinued topical in order to reduce variables, so technically the scalp itself is being hit with a slightly higher dose of minoxidil. Oral minoxidil has a much better response percentage than topical, but it is worth noting that this response and statistical improvement in hair doesn't necessarily equate to cosmetically significant improvement. I've had a decent response to non surgical treatments thus far, so we will see.

I didn't say that. Why would it have a negative impact on body hair?

You'll see age 35 thrown around a lot as a generic reference for this, and there's some general truth to that although there are no definitive rules. By this point you will often have an indication of your full pattern if your alopecia is milder, and people with aggressive loss may have already lost most of the hair they're going to lose and be a full blown Norwood 6. All this to say, your loss (or at least rate of loss) tends to stabilize somewhat with age. Medication doesn't exactly lose efficacy per se. When you're losing ground 99% of the time it's just that there has been a slow, progressive creep of loss and it has advanced far enough for you to notice (kind of like you don't notice thinning initially until you've actually lost a good chunk of hair). So the goal is to get that progression to be as slow as possible, if not to stop it entirely. How successful you are is probably going to depend on how aggressive your treatment is, how aggressive your loss is, and so on. The more hair you start with, the better your odds of maintaining long term. Beyond that, more extreme methods like surgery can be used to help regain ground as the need arises.

As my generic cautionary advice, TRT will almost certainly accelerate any predisposition for hair loss (especially if you're not on medication) regardless of how old you are when you start it. I think not trying Finasteride is a mistake, but that's your call. Certainly if you opt not to do this you should be looking at some of the other medical treatment suggested in the thread. Surgery would be extremely risky at the moment and your hair loss isn't very severe. A topical anti-androgen and/or 5ar inhibitor is necessary to slow or prevent any further loss. Minoxidil is also an easy addition and may provide some regtowth. It could very well fill in some of that thinning in the crown since it's so minor. Edit: I personally wouldn't do SMP at this point for multiple reasons. Save more extreme options like that for after you have gauged your response to medical treatments. Even temporary trichopigmentation could stay in your scalp for years, and it will look very bizarre if you thin too much in a particular area and the pigment starts showing through in an area where no hair is present.

I completely understand you not wanting to answer, and in general I think negativity goes with the territory when it comes to hair loss discussions. Nobody thinks it's a positive thing, and we're all here because it distresses us. Diffuse thinning can be tough when your response to medication is subpar, or if you're worried that you will lose more ground. Realistically, this same issue is a concern for sufferers of Non-diffuse loss as well, even if they think they're safe. That's why it's generally important to try to plan for the long term, and to a certain extent to assume the worst case scenario in terms of possible progression. Hypothetically, budgeting your grafts assuming you may have to cover a Norwood 6 area would be a pretty "safe" plan, and arguably you might be able to loosen up a bit later in life as it's less likely (though not impossible) that you're going to suffer a sudden aggressive loss in your older years. As far as the transplant route, I think a diffuse thinner's best bet is to go for smaller procedures as needed to reduce trauma to existing hair, and to not jump the gun chasing native density. I'd honestly start looking at surgeons who have a good portfolio of diffuse cases and get multiple consults with advice on how to proceed with your journey. Probably wouldn't be a horrible idea to get an in-person consult with a surgeon periodically just to gauge how they think you're progressing (or not) so you have a more objective assessment. Realistically, if you've got DPA and not DUPA, you are probably seeing the progression hit harder in certain areas than in others. That is, you may be able to see the NW6 pattern but you've only really lost major coverage in, say, your hairline area. I don't think that your choice to address the front first is a poor choice if you had minimal coverage, and that's probably how I'd keep addressing this going forward. The trick now is to work with a doctor you like to form a long term plan. Be blunt in your request for an opinion. "I had X grafts into this area but think I have potential to become a Norwood 6. How many grafts do you think I have left? Do you feel this would be enough to provide adequate coverage if I lost most of the remaining native hair in this pattern? What is your recommendation?" Don't be afraid to be detailed and thorough in your questioning. In fact, you should insist on it. Any doctor who blows off the thorough questions is probably not somebody you want operating on you. Like you, I'm constantly distressed by hair loss as an issue. It's a horrible weight on my mind, even though most people would probably say I still have a good head of hair. If I didn't lose any more hair for the rest of my life, I could be content, but it's the uncertainty that kills me. Still, there's some comfort to be found in sitting down and coming up with a plan informed by the recommendations of doctors you respect. Knowing what your next step would be and what is likely to be achieved can be of some comfort. Tying back to the original post, the Norwood scale is woefully incomplete in terms of documenting patterns of hair loss. It's a shame because most of the alternative options aren't much better.

I think it's not necessarily accurate to assume that treatments will only buy you a few years. This is going to be completely dependent on so many unseen and unknown factors over a huge period of time that it's really hard to say. As an example, I've got an uncle who has diffuse thinning across the top but still has a lot of hair present even though it is being affected by miniaturization. Probably a 5/6 pattern, but still good enough density and coverage that it looks decent as a shortish buzz cut. I share a lot of physical similarities with him, and even my hair issues seem a bit similar. I'm likely looking at the same scenario based on what I can see on my head. Zero medical intervention, and he's around 60. For him, this was clearly a very slow burn, and I suspect if he was on even basic medical treatment (not even something more aggressive like Dutasteride) his hair would likely look great. I've also seen crazy outlier incidents where someone was able to grow a noticeable amount of hair with oral minoxidil after being slick bald on top of their head. Someone with a response like this could potentially be set for life if they catch it early enough and are able to continue tolerating the treatment. On the other hand, somebody who has aggressively quick diffuse thinning or a poor response to medication is likely only going to delay the situation a bit. The biggest crapshoot in hair loss in general is that none of us can REALLY be sure what's going to happen down the line. A Non-diffuse norwood 3 could turn into a six at at age 65 even if he has no family history to support that, or someone from a family where hair loss is expected could somehow end up being a Ronald Reagan level outlier. There's just no way to know. I don't think diffuse thinners are better or worse off than anybody else, but there are pros and cons to every situation. Diffuse thinners probably don't notice as early and will let things go longer than someone with a more clear cut pattern, but will likely have more cosmetic punch from medication when they get on it. However, diffuse thinners are also a riskier proposition for surgical intervention although I have certainly seen good outcomes. Someone with a clear pattern has more coverage issues initially, but high pattern diffuse thinners will eventually have much greater issues due to the large number of weaker hairs. I do want to clarify that I think someone who is a legitimate diffuse NW7 is likely going to be showing signs of miniaturization in that area of the crown early on when examined with a microscope. A true NW7 is somewhat rare, and in reality 6 is the highest that MOST people will progress to. Honestly, the biggest hair loss issue in the world is the lie people tell themselves that they're not subject to androgenetic alopecia. If you're a man, you've got it. Period. It's just a question of how severe it is, and that goes even for those hair god outliers. Whatever miniaturization they have experiencedis just so cosmetically insignificant as to be imperceptible, but I guarantee it's still there in some spots. @UnbaldEagle, I'm curious about your comment that you've nuked almost all DHT and testosterone out of your system. Are you transgender?

Yeah, this frontal density is very impressive to hold up to this kind of scrutiny. The hairline pullback shots look fantastic.

Agreed 100% I like the shape of most Norwood 2 hairlines, and generally only take issue with the fact that they generally have that diffused, thin look.

This guy has the "see through" effect pretty regularly. He spent 3,200 grafts to get it to this location, give or take. His first procedure was around 1,700 and basically put his hairline back where it was before the minor recession he was experiencing. The work was fine. Nothing spectacular, but fine. Then he lowered it below his natural norwood 1 hairline by a noticeable amount with another 1,800. That's a pretty large area of barren, no native hair scalp, and if you consider that he's wearing his hair up it's no wonder it looks sparse. If he was going to use that many grafts in the hairline he would have been better served adding more density to his restored natural hairline placement.

To me, this feels like a business thing more than a personal choice. When Zack from the Try Guys got his ARTAS hair transplant from the sketchiest hipster outfit possible I'm sure the work was done for free if he can wasn't paid for the promo work as well. Floyd probably has a nice quiet endorsement deal tied up in this, especially given how much money HOI seems to throw at marketing.

This is still a good example of what you can likely expect if you're not some kind of outlier and make smart choices. High severity hair loss with a non-elite donor area. Good coverage and design achieved over the course of several years. This is the kind of result most young guys should be looking at when they consider a transplant, as well as the story behind it.

Gorgeous result, especially considering how much work you'd already had done previously. Very happy for you.

I think it's interesting that strips of approximately 3k grafts are recommended as the upper limit to promote the highest chance of favorable scarring. I wonder if this recommendation would be lowered on subsequent strip procedures once scalp laxity has been compromised by a surgery.

Oh, he had an affiliate/promo thing with his clinic too. The point being he will basically sell whatever, and since he's currently an example of making bad choices but getting away with it (at least for now), his message to not get a transplant seems more like pandering and click bait than anything else. I DO think we should have more people trying to talk people out of the knee-jerk hair transplants and trying to drive home how very possible it is to get fucked up either but short-sighted thinking or pure bad luck, but it's a tough pill to swallow from a guy who had surgery to placate his dysmorphia and will switch up his message for the next sponsor who will pay him to do so. No hate against the guy on a personal level, I just think he's full of misinformation. No negative sentiment towards @UnbaldEagleeither, because I obviously agree with the general point you were wanting to make.

This particular Youtuber is a pretty negative influence on younger hair loss sufferers. If you haven't watched his videos, the key context here is he's had two transplants on his hairline. One was to restore the recession of his hairline, which I don't inherently take issue with, but the second one was to lower his hairline to a position much lower than his actual juvenile hairline. Maybe he will get lucky and actually get away with this, and maybe not, but how many uneducated guys are going think "I'll probably be fine too" only to end up progressing to a NW6 and be stuck with a fucked up scalp for the rest of their lives? We see these guys on the forum ALL the time. They're in their early twenties and their hairline isn't quite that NW1 anymore. They're clamoring for a transplant and completely dismiss medication because some guy on another forum told them it will make their dong fall off, and refuse to listen to anyone trying to talk then out of this huge mistake.

Haha thanks. A few of the spots that were in the worst shape are still a little weaker than others and can be noticed, but I'm feeling good about the progress I've made and hopefully I can maintain most of it for a while to come. As you said, I was very fortunate with the timing.

Sure thing. I put a link to my thread below with before and after pictures about six months from my first treatment. I did another one around twelve months from the first treatment and it's now been 14 or 15 since that second treatment. Not rushing off to do more because of COVID caution and I'm also trying to get a better feel for how long my physiology might retain the results rather than just relying on a general recommendation. The photos attached to this post are photos of my hair taken just now at your request. https://www.hairrestorationnetwork.com/topic/53847-prp-with-dr-arocha/

I will say I had a good response to PRP+Acell that improved my hair thickness and density a fair bit. Even improved the frontal coverage which is less typical. However, in my case I still had quite a bit of obvious native hair on my head and a somewhat high density of vellus/super miniaturized hair, so my suspicion is that this was a key factor in my response. Like I said, I'm not a doctor but my read of your situation is that you are more likely to see marginal benefit, if any. Haven't tried exosomes, but although I'm interested I feel as though my positive response to PRP probably means I wouldn't see much additional improvement from exosomes. The clinics I've talked to generally agree that it is a step up, but none of them are saying it's leagues beyond what they were able to do with PRP.

The most likely outcome for you would be that those hairs you can see in your picture will thicken and lengthen to be closer to their original strength. If you have some vellus hairs you may see those get some pigment and grow out a bit more to have more cosmetic value. Based on the description of your goal I think you'd have to be an exceptional responder to the treatment to get what you're hoping for.

I think the second factor is most likely the thing that got him, like it gets so many others. Too many clinics promise a transplant as a one and done procedure and permanent solution to hair loss. In reality, it should be presented as the first step of a holistic process. All patients should at least be attempting medication. All patients should be presented with the fact that there's a good possibility that they will need at least two procedures to stay on top of progression or achieve their desired density over time. Many clinics have sales reps who sell the surgery as a quick miracle fix, because the reality of the situation isn't as appealing a pitch, and they're paid to put patients in the chair. Edit: In general I've quietly ruled out the opinions of any doctor that isn't being realistic about the above, because it's a huge red flag.

Yeah, the bleeding would make the operation itself challenging and could hinder the final outcome because the grafts need ample (and urgent) blood flow to survive. Your situation isn't super common so the posters here wouldn't necessarily know which doctors might operate on somebody with factor IX but it occurs to me that you might have better changes of success pursuing multiple smaller ops, and we do have some examples of that on the forum. @Gasthoerer had a pretty small operation done with Dr. Feriduni, so it might be worth contacting his clinic to see if he'd be open to trying a smaller case along those same lines.