Curious25

I should add, that on the flip side, it may mean that I am not actually benefiting from much efficacy. But something is better than nothing. And it is part of a multi combination routine, so I am content.

If the topical has shown some form of propensity to go systemic, then you have to realise you are essentially applying 25mg of finasteride per 1ml of solution onto your head - so even if only 25% of that ended up systemically, and you were applying if MWF, combined with the rule of the half life . . . Well you can do the maths. The last thing I want is a systemic reduction in DHT, so the way in which I try to avoid this, is by micro dosing a low concentration (0.025%) on a twice weekly basis. My rationale is that even if 100% were to go systemic each time, it would be the equivalent of taking 0.5mg per week, which I don’t believe has been shown to have any major impact on systemic reductions in DHT.

The best post op after care you can do is follow your surgeons guidelines. And for the love of god, please don’t derma roll until you are given the all clear from your doc to do so.

@RMancini

The strength of their formula is a massive overkill,

How do you feel with your results ?

Subtle intervention, yet a big positive change in appearance - love it. You’re now a forum poster boy for how low end NW’s can be aggressive in approach (when candidacy allows) and greatly benefit from hair restoration. If you were to have started a thread on here with your pre op pictures and asked for advice, there would have been a large amount of dissuasion in relation to going for surgery. Yet look at where you’re at now. Keep on top of preservation for as long as you feel comfortable, and enjoy that killer mop 😉

Incredible coverage ! Congrats Hugo!!!

I have long hair so applying topical isn’t the easiest I have to agree. I try to part my hair and directly drop onto the areas of the scalp and massage it in.

Cool - I’m not agreeing or disagreeing with you, I just thought it would be interesting for you to elaborate a bit more on that point, as there is usually a particularly strong opinion, or better said, consensus on the forum that they have become the go to specialists for higher Norwood cases. I think discussion like this, and the points you have raised makes for a much more beneficial and healthy environment for research to take place.

Ah ok. Got you. So assuming this, orally is likely to remain in unwanted areas of tissue at the same rate. A further argument for trying to avoid first pass, and go topical?

That’s all I was trying to convey to the wider audiences.

What do you mean by this?

Unless you take it every 4-5 days?

Correct - I made a point by saying the conditions were similar, not exact, as this picture appears to have been taken in natural light (indoors) - however the emphasis was placed upon what I think is fair to say, quite a considerably different appearance. Do you think the pictures originally posted on this thread are an accurate representation of the limits as to what hair transplants look like in outdoor lighting?

No, it’s absolutely not.

Your crown could have quite easily always been this way.

I’ll be as diplomatic as possible so not to offend Melvin. If your purpose of this thread was to highlight the realities of a HT result for prospective patients, I would argue to say that, although it is a ‘how long is a piece of string’ subject, depending on the initial starting point and hair characteristics of the patient etc - it is wrong to assume that this is how a hair transplant in 2022 will always look under these conditions. I’ve attached a picture from a user on here (only at 7 months post op) in not too dissimilar lighting conditions after his hairline transplant - which I think can be agreed, appears vastly different to the pictures you have provided.

Im assuming it will be because patients on their 3rd and 4th transplants likely have a higher ratio, if not total, scalp full of previously transplanted hair - which is theoretically as stable as you can get, given it has been harvested from permanently non DHT affected zones. Whilst shock loss can occur on any type of hair follicle, the only real cause for concern is permanent shock loss - which is only ever truly associated with hair that is miniaturised, a state in which previously transplanted hair shouldn’t ever reach. Surgeon error, and damage to surrounding follicles could also cause permanent shock loss to even the healthiest of hairs (whether this is in your donor during extractions or recipient during implantations) however under a top surgeons hands, this shouldn’t be much of a concern or consideration.

All I’m going to say, is that the posts on this thread just emphasise both the absolute imperativeness (in my mind) and benefits of hormone profiling before and during using a hormone altering medication - (sounds pretty common sensical right). If side effects present, it’s not because of the physical pill itself, but rather because of the changes in your natural or usual hormonal profile - which with data and knowledge of where you usually sit at, or where would be a good place to sit at . . . . Can feasibly be addressed by either titrating the medication and/or addressing lifestyle changes to things such as exercise and diet - it’s not actually rocket science, and should be viewed no differently to the emphasis placed on people to run their bloods before, during and after running steroid cycles. It is completely irresponsible of doctors to not recommend this to their patients before commencing on 5AR inhibiting medication - because it’s quite a simple step to take, that can be the key to resolving any potential issues that may or may not occur down the line. This is not an anti fin or scare mongering of sides post in the slightest, it is actually quite the opposite - as I have came to learn that managing finasteride use effectively, is actually a relatively simple game of individualised titration of the medication through trial and error monitoring of efficacy vs. general feeling of well-being vs. hormone analysis. Here’s an example - who can categorically say that for patient A’s level and rate of hair loss, 1mg daily oral is what he ABSOLUTELY needs compared to 0.025% topical twice weekly? Maybe the twice weekly topical has a fantastic effect on his hair loss - now work out the difference in systemic exposure between the two types of administrations just mentioned. You’re welcome.

It doesn’t really make sense for your sides to have thinned since starting finasteride - after 8 months, existing hair quality is usually thicker and healthier, and if it were to be from a shed of miniaturised hairs, that would suggest you to have had a considerable amount of donor miniaturisation, which going off your pics . . I don’t feel would be a very likely reality. Your donor looks good to me anyway - I think when Matt says it looks average, he probably mean average density wise (between 70-80 follicular units per cm2). Your hairline looks surprisingly strong, given the level of crown loss you present with, slightly further recessed on the right hand side, which is very common, but the frontal density still seems pretty strong. If you wished to restore this area in anyway, I would probably advise at looking to bring the right hand a little more level with the left, and lowering it in a widows peak style, as I’ll take a stab in the dark and predict you naturally had somewhat of a widows peak? Your temples also look good, creating a narrow looking forehead, which is very advantageous in terms of facial framing, so all of this combined with your wavy hair characteristics, puts you in a pretty strong position, in terms of being a hair transplant candidate. Meds wise - try topical fin, if you feel uneasy with taking it orally - this can be microdosed via different concentrations and/or taking on a less frequent basis than daily. I wound recommend derma rolling - and I would also recommend oral minoxidil. However first of all, I would recommend speaking to multiple and relevant dr’s about these recommendations first of all - rather than just taking my, or anyone else’s word on here, with what to do with medicines 😉 Personally the only two doctors I’d feel comfortable with visiting for a crown restoration would be Dr Wong or Dr Konior, but that’s just from my observations over the years, I admittedly haven’t ever looked into crown restoration too deeply.

If you’re concerned about side effects - starting with a topical formulation from a credible source is a no brainer IMO. Avoiding liver metabolisation has been proposed countless times now as being a, if not the, fundamental aspect to limiting the systemic absorption.

Rumours? There’s no question about it.

Good advice

Why do you want to touch your temporal peaks if you aren’t on medication and believe you are heading to a NW6/7? Your crown should be left well alone as well, at this stage.