Curious25

You should have a read through some of the documented studies, and perhaps get in touch with some European clinics to get up to speed - you poor North Americans are losing ground at the moment in comparison to mainland Europe with the failure to be progressive with the newer treatment options available - largely oral minoxidil and dutasteride mesotherapy. OP - I would agree with previous sentiments regarding sticking it out with finasteride for a longer period of time before making any upgrades with your regime - like someone mentioned earlier, it’s always good to keep something in your locker for down the line should your hairloss potentially worsen. I would however, recommend consulting with a dr with regards to switching to oral minoxidil - especially as you have expressed annoyance with the daily topical application. I believe it to be much easier to adhere to, and very efficacious, particularly with diffuse thinning.

9 months +

I would suggest consulting with a medical professional and not to look to seek advice from a group of random people on a hair loss forum.

What’s happened in 4 weeks ?

Yes.

I think oral is largely likely to be superior due to patient adherence, and the consistent dosing quantity. Then, after that, bypassing the enzyme issues. I’ve been on 5mg daily for 8 months now, and it’s been great. Never used topical though so I’m unable to compare.

Pretty bold statement after 4 weeks 😂

Yes, and yes you will risk that. Different surgeons have different styles - Bisanga and H&W for instance both tend to transplant into thinning areas to account for future loss. Other doctors leave these sorts of transition zones alone, and just stick to completely slick bald areas.

I’m afraid to be the bearer of bad news, but your loss would be classed as more towards the aggressive end, than non aggressive given the pictures you have presented us with. With regards to your hairline design, transplanting into the forelock will be necessary, not only to help ease the aesthetics for when future loss creeps up on you, but it already shows to be mildly diffusely thinning as it stands today. A simple flat line across from the lowest part of your forelock won’t cut it in terms of naturalness, due to your temples showing recession also, therefore I would recommend some mild work in this area also, mainly focusing on the corner point connection from the hairline and upper temple region, which shouldn’t use up too many grafts. Without knowing your hair calibre or average groupings, I would hazard a guess of at least 3000 grafts for your frontal restoration, and between 2500 - 3000 for your crown. In an ideal world, you would look to restore the front over a 2 day period, (1500 grafts each day) . . . Wait 9-12 months, and go back to address the crown. The Spanish docs such as De Freitas and Lorenzo have historically lead the way and championed this form of step by step intervention, and it works very well; mitigating a lot of surgical risks, which potentially saves the patient thousands of grafts. All the best,

Look at the OP’s pre op hairline and temple point design. Why an earth would it make sense to add gaps and sparsity to an aggressive and juvenile shaped design - safely assuming that candidates seeking this type of design are seeking a youthful appearance, as opposed to looking 35+ with ‘natural hair loss’.

Unfortunately that is the predicament that we all face. Spend some time speaking to relevant doctors and not forum users, to learn and understand more about the different types of medications available. Get blood tests, consult some more, then weigh up the pro’s vs. cons for you personally. Your mindset going into medication is important. If you go in worried and resentful, the chances are, you won’t stick it out (which is a big mistake) and possibly convince yourself of things that may just be in your head. If you go into a regime you’re happy and confident with, holding a positive mindset that you are doing something productive to combat something that has been an issue in your life, you’re more likely to be a success story. Fact of the matter is, only you can make up your mind on what route you take, and you will hopefully make the correct decision for yourself. Everyone has an individual threshold of what they can accept and live with, we’re just fortunate to have a lot more ‘options’ these days, as opposed to older generations. On that point - I do acknowledge that there is arguably cause for speculation that physical appearances are much more focused upon in todays age, so maybe that can slightly negate the sympathy we have for our fathers and their peers. Just to end this - I’ll leave you with three take aways. Don’t listen to the idiocy written by hysterical forum posters on both sides of the coin, listen to well respected and educated doctors. Remember the type of person in the world the typical hair loss forum poster is likely to be, and ask yourself, would you take their word as gospel if you were to meet them in the street ? Secondly - if you genuinely care and get preoccupied and affected by your hair loss, the worser your hair loss gets, this form of stress and anxiety is quite able to lead into physical illnesses and ailments similar or worse, to certain side effects hair loss medications potentially come with … , given your mentality is unable to be changed on your perception to your hair loss. And finally - if you are struggling to keep up with regularly using topical minoxidil, have a look into the oral version, and consult with some Dr’s regarding it. Much easier and more practical to use, from an application standpoint - and more and more research is suggesting, also superior in efficacy.

But you’re a fan of the transparent lacking in density ones ? Strange comment. Hair transplants that match native density as closely as possible are as natural looking as you can get - given the hairline design is sound, the angles are correct and the appropriately textured hairs are used. For any form of hairline lowering and temple point work - unless you go dense, it’s not worth doing. Thicker haired candidates may get away with slightly lower implanted density - but due to the singles and softer hairs required in these areas, a higher density count should always be planned for with these types of interventions.

The greatest thing you will have achieved is no doubt strengthening your donor area, probably making you a much more suitable candidate than before for surgery, should you choose to go down that route. Keep up the good work!

He travels frequently to London for consults, and I have seen he has also done consults when he has been in the US. His reps are very active on here so get in touch with them and I’m sure they’ll be able to help. @sl @Raphael84 You can’t compare an online consult to in person. Always go in person.

If you are chasing the most efficacious medication available - then you will be looking at a combination of daily 0.5mg oral dutasteride and 5mg oral minoxidil.

Assuming you mean best in regards to the efficacy - oral dutasteride, without question.

I’ve only skim read through this thread, so apologies in advance if any of my advice has already been mentioned. Transplanting into areas where hair already exists, be that miniaturised hair, or stable hair, can be and is done - certain doctors and methods are superior at this, for instance the stick and place method tends to come up trumps for these types of cases. Being shaven is important to help aid the surgeon with the delicate placement, and being on medication will mitigate the risks of shock loss. I think in your particular case, your age, is the most limiting factor in terms of you being a candidate. And I mean that not because 26 year olds shouldn’t be able to get transplants - but the fact that you are diffusing and not stable, indicates you will continue to lose all of those hairs in that area eventually, and require further surgeries down the line, which, again, whilst a feasible strategy, given the donor is adequate, and you have the financial means - isn’t the optimum strategy, when considering factors such as recipient scar tissue, donor transection rates, and unpredictability of donor sustainability (you may have 8,000 available grafts at 26, and plan for restoration based on this figure, however without stabilising, due to potential miniaturisation may only have 5-6,000 total grafts available in your late 30’s). I haven’t read your stance on medication - which is a different discussion if there are any concerns there, but from a medicative standpoint, a combination of oral dutasteride and oral minoxidil would reverse you back into a NW 1 after 6-12 months (if Bisanga is correct, and you really do still have all your temple hairs, albeit miniaturised). This however is a pretty aggressive approach to take, and understandably wouldn’t suit all patients. Europe, in particular Spain, is really leading the way at the moment with innovative approaches to hair loss medication, and there is no question in my mind that oral dutasteride and oral minoxidil combined are as good a ‘cure’ to hairloss as we have ever, and will ever have, for a long time. At the very least, oral minoxidil 5mg daily and dutasteride mesotherapy is certainly something I would recommend you to look into, and I know that BHR offer and advocate both these treatments. You should read up as much as you can about medications from scientific literature and studies, and consult with the relevant doctors - do NOT listen to the online nonsense whether that is pro or against medication, and most importantly wait until you feel comfortable in your decision before making a commitment either way. It ultimately comes down to how much your hair means to you, and what lengths you are prepared to go to in order to help maintain and regrow. In summary - I think Bisanga has made a good call with his assessment. It’s not that you aren’t a candidate, it’s more so that you’re a much better candidate for a different route. Diffusers always feel like the hard done by demographic because they are typically less suited to surgery, particularly at a younger age, however if you flip that on it’s head, one could argue that they are in fact the lucky demographic, because they are usually much more responsive to the currently available medications, and often times don’t even have to worry about surgery, given they find a regime that works for them. Much cheaper, no downtime, and no scarring 😉 Good luck.

Go slow and steady, and trial different protocols that work for you - which could involve combining both oral and topical formats. As has previously been mentioned, there have been studies proving that there is actually little difference between DHT reduction from 0.2mg daily oral and 1mg daily, so smaller doses certainly still ‘do the job’. Your hairloss is pretty aggressive for your age, so assuming you want to give it your best efforts in keeping your hair up top for the next 30 upwards years, you’re really going to have to try and crack the DHT riddle as part of your maintenance regime somehow. Just look at it as hormone optimisation as opposed to it being a detrimental thing in your life - the juggling act and science is no different to guys bio hacking with TRT. Have a play around with different protocols, and find what works best for you,

Whilst I think what derek theorised in that video was for the most part quite likely to be spot on, you all have to remember that individuals are individuals, and their bodies will react, feel, and perform totally different to the next person, regardless of a generic level and/or ratio of androgens, and the ever evolving changes to this throughout a course of their lifetime. Managing taking 5AR inhibiting medication is an art of trialing and erroring what dosage and frequency works for you personally, in achieving good efficacy, and maintaining bodily performance and functioning. Some people can develop ED from lack of sleep, poor diets, drug and alcohol abuse, whilst some people can continue perfectly fine whilst adopting all of these poor lifestyle habits - why? Because people are different. The key is finding what works for you.

Just x10 to get mg per ml. 0.025% = 0.25mg per 1ml 2.5% = 25mg per 1ml So if you took 1ml of a 2.5% formula MWF, and 25% were to go systemic, you’d be theoretically exposing yourself to almost 19mg of finasteride per week, which is considerably more than the FDA approved oral dosage of 7mg per week. Just a consideration, as people who tend to opt for topical formulas are usually doing so in vain of reducing systemic exposure.

I agree. Look, ideally, given the choice, no one wants to alter their hormone profile in any form of negative way, however, as it stands, it is the only effective way we have of combatting hair loss right now, therefore, the trade off between running into potentially long term unknowns vs. maintaining your hair and not balding during your lifetime, will be appealing for some, and not so much for others. The beauty of freedom of choice ey? Dutasteride mesotherapy is VERY interesting, yet unfortunately doesn’t seem to be taking off across the Atlantic like it is in Europe, but I know some inactive users on here who I speak to and they are experiencing very encouraging things right now. Hubermans great.

Everyone should take note of this because it is the most responsible thing you can do for yourself, for this, and or any other medication you may be potentially using for that matter. It is only then can you make an informed, and correct decision for yourself, taking into account all factors and personal emotions that you associate with hair loss or potential hair loss. Personally, I studied 5AR inhibition medication for over 6 years before coming to a decision and protocol that I was comfortable to pursue…. Which is why I can read both sides of extreme end perspectives on the matter, and maintain being at peace with what I do, because I made the decision based on everything that I had studied and learned. Anyway - to add some helpful insight that I think a lot of people may find interesting, here’s a good podcast with the relevant time stamps to have a scan through, Far more detailed input than any hair loss surgeon will be able to go into, so take your advice from the relevant and qualified medical professionals. https://hubermanlab.com/how-to-optimize-your-hormones-for-health-and-vitality/

‘Okay, if you do not have a natural level of DHT resistance in your follicles, which is what i refer to when i made my post, how do we explain how some stop their hair loss entirely and why specifically the donor area is considered more "permanent"?’ Each follicle has a unique genetic make up, that determines first of all, whether or not it is affected by DHT, and second of all, the rate at which it’s miniaturisation process occurs as a result of DHT binding to the receptor. No, because it isn’t about the body having a natural DHT blocking ability - it’s about some hair follicles being less sensitive than others. When you hear the expression ‘DHT blocking’ being referred to - it’s in relation to the process of inhibiting the 5AR enzymes (Type I and/or Type II) from converting (reducing) testosterone into DHT. So it’s actually more accurate to say blocking the conversion of T into DHT. The male body doesn’t naturally ‘block’ this process, therefore your terminology would be incorrect in this sense. I think you’re on the right lines, you’re perhaps just confusing yourself with certain terminologies.

Natural Scalp resistance isn’t a thing. AGA is due to individual hair follicle sensitivity to DHT. The miniaturisation process was correctly described above. So if you are a man affected by AGA, if you lower the levels of DHT in your body (and therefore scalp) - you are effectively reducing the speed of the miniaturisation process. Since the scalp tissue is the tissue of concern - it has been proven that by directly focusing on reducing DHT levels in this area of the body, as opposed to systemically reducing DHT levels, this can be an effective treatment option, such as dutasteride mesotherapy. Anyway - RE. using 5AR inhibiting medication. Depending on follicle sensitivity; - If your follicles are super sensitive, the reduced DHT levels throughout your body may slow down the balding process. - If your follicles are moderately sensitive, this may appear to ‘halt’ the balding process, and slow down the miniaturising process greatly, to the point at which you are classified as ‘stable’ and appear to be maintaining your native hair. - If your follicles are only slightly sensitive, this may reverse the hairloss experienced, and regrow miniaturised hairs back into terminal healthy hairs. Every man has a different varying sensitivity range to each follicle on his scalp - hence why even some peoples donor areas are affected, whereas others aren’t. Look at high end Norwoods - some have amazingly preserved donor hair regions (the Zarev cases are good examples), whereas some have lost it all on top, and even their NW7 ‘safe zone’ has become unstable to the point at which it looks diffusely thinned. Each hair follicle is genetically programmed as to what it’s resistance timeline against DHT will be. If you are able to reduce the thing that attacks the hair follicle, 9 times out of 10 you are able to at the very least, delay the onslaught.

This really wouldn’t quantify as being ‘terrible’ in my books, without knowing the graft count and the state of your hair loss beforehand, I’m going to assume survival rate has been ok, and your donor from the pics you have provided doesn’t look bad either. It’s just not a good hair transplant - but is a relatively easy fix, you could strategically place singles and finer grouped hairs to soften the harsh appearance, or even go one step further and look to redistribute the multi grafts and then re-implant softer and single hairs into the hairline area, which would be more costly, require more than one surgery, and only a select handful of doctors would likely agree to do this - but maybe you would prefer to opt for this. Anyway, despite it not being terrible, it’s certainly a result that no reputable doctor would leave you with, therefore if there’s only one take away from my post, it should be, don’t go back to this clinic, because they are clearly not very good at what they do for a living. There’s a nice thread on here from a blonde US patient who had a very good similar to your hairline repair from a US dr I really can’t recollect ? However @Melvin- Moderator has featured his results quite frequently, so hopefully he know who I am referring to and can share the thread as an example.