Harry Bosch

On 3/8/2023 at 3:58 PM, Chrisno said:

Just be mindful that testosterone also causes hairloss, but at a slower rate that DHT. Testosterone also slowly chips away at your hair. That's why a few men actually lose more hair when they switch from Finasteride to Dutasteride, because scalp testosterone increases by a large amount when your DHT levels are crushed, much more so than when on Finasteride.

Of course mindful.

My protocol will focus on steady, conservative deliver instead of weekly spikes.  One outcome of that strategy (hopefully) will be to minimize the onset of sides.

Interestingly, when I tried to introduce Dut in the past, I felt I responded poorly.  Both times were limited 1-2 month trials.  Maybe I overreacted to an initial shed.  In theory, my success with Finasertide would have been indicative of a good reaction to Dut.  Perhaps your remarks about additional T on the scalp could have been true.

Makes me wonder if I should re-introduce RU to be on the safe side.  I stopped using prior to my surgery.  Something that I wanted to get away from - sourcing and compliance are obviously a tall order.  Never loved working with gray market clinics.

I will say, my goal is not to blast into supra physiological levels where one really enters unsafe territory for hair.  Just return to that natural, healthy levels of a younger man and, obviously, feel better -- that's why I'm doing this, not for cosmetic reasons.  Although a boost in body composition would not be unwelcome.

If I do lose ground with hair, I can always get another procedure.

On 3/2/2023 at 3:50 AM, rambo man said:

Fantastic result. Enjoy your hair

You’ll be there soon enough, too!  

6 hours ago, Big Rome said:

Jesus Wept… that’s a glorious head of hair lol you must be over the moon! Looks really good man 👏🏻👏🏻

Thanks brother!

I will say that when my hair is dry or dehydrated, the result looks a bit weaker.  But that’s more about my hair type (wavy to curly).  Really thick hair in forelock and midscalp vs. lower density hair on the hairline and transplanted regions.

Making my hair look good always required moisture and product, even before my loss pattern progressed into HT territory 

18 hours ago, Judelaw said:

World-class work, the way he blended those extra 200 grafts is pure artistry. I can’t imagine getting a result like this then making a lifetime commitment to hop on the juice. 

Right, and that’s on my mind.  It’s a separate conversation.  There’s a few TRT vets who I’ve talked to on here on how proceed in hair-safe matter.

Important clarification is that TRT is not the same as anabolics or “juice.”  I’m just trying to return to healthy level and feel better.  It’s not a cosmetic decision but entirely quality of life.  Blasting into unnatural supraphysiological levels, and/or adding steroids, are the vanity based decisions that really threaten hair.

2 minutes ago, stephcurry30 said:

wow 10/10. Amazing result!

Cheers mate!

Funny enough, I was inspired by @Sitries1 refinement with Dr. Ferraira and considering a little touch-up way way way downstream to address a couple weak points. Hard to be unhappy, but also hard not get greedy in my position.

But that’s maybe a year+ in the future, and I plan to live a little in the mean time.

I am likely to begin a conservative TRT protocol, so getting ahead of some expected recession would be wise.

On 2/22/2023 at 12:36 PM, Big Rome said:

any update brother? @Harry Bosch 

Yes, attached are pictures at 9.5 months.

MEDS

1.25 mg/day Fin

5 mg/day Oral Min

Topical Min 4-5x/week

Nizoral 1% 2-3x/week

PICTURES

Wet/damp hair immediately after shampoo + conditioner.

Presented in multiple states.  Messy, slicked back, and combed in both directions.

My hair and the overall cosmetic result look much stronger when hair is wet.  Weaker areas are exposed when hair is dry and dehydrated, which is common for my tumbleweed up top.

I am strongly considering TRT myself.

My feeling is that Fin or DUT will be sufficient to offset the increase in T if your protocol keeps you in the normal range.

I think the aggressive combo of Fin and Dut together is what is crushing your DHT score.  Maybe scaling back to Dut once per week is advisable.  Are you experiencing symptoms like lethargy ?

A good middle ground might be reducing the 5-AR intake while introducing a topical AA Like Pyralitamide 

10 hours ago, Tiger2050 said:

The worst thing you can do at this point is re-introduce topical minoxidil back to your regimen, it will certainly cause another shed. Just stick it out with oral minoxidil, the hair you lost from stopping topical minoxidil will come back in the next few months. Speaking from experience, stopping topical minoxidil induced a shed that lasted several months and it took me a long time to recover on oral minoxidil but it all eventually came back. You have to be patient with hair loss meds, constantly changing medications will cause more shedding.

Curious for thoughts on this.

Fwiw.  The timeline.

I had been using Topical Min for 10+ years alongside Fin.

In January 2021 I started Oral Min and used it concurrently with Topical Min + Fin for 15 months up until my surgery (May 2022).

Post surgery I ditched the Topical Min but stayed on the Oral Min.

So I’ve really been taking Min all along.  I don’t think reintroducing Topical while staying with Oral, too, would create a significant shed?

I think there is something to the localized effect of Min when applying to weak spots.  Can’t say I’ve been a huge responder to Oral Min alone, and I’ve got a fairly large sample to determine that conclusion

1 hour ago, Big Rome said:

any update brother? @Harry Bosch

Update at 7 Months.

I believe I’ve had some regression since my 6-month update.

Nothing tragic.  Perhaps it’s just some shedding and/or de-synchronization of growth cycles.  Hard to say.

I do think a I’ve lost some native hair surrounded the transplanted area.  My left side has historically been stronger but it looks worse, perhaps worse than pre-surgery.

Recall that I have had a post-surgical bump in the two recipient temple regions.  That, along with that fibrosis region (scarring alopecia?) has contributed to some ongoing anxiety.  Both my temporal regions, as well as my grey streak, present some weaker, wispier hairs that are don’t look healthy and are resistant to styling tricks.

Speaking of that fibrosis region, recently my hair has been lacking lift in that area.  Hard to support that combover wave I personally fancy.  Makes me wonder if I got any growth there - I guess we can’t be sure unless we shave down and assess that area.

Overall there are improvements.  There’s the temporal closure on the right side (which was the weaker side, pre-op).  The temple peaks are stronger, although I’d like the right side to be a bit less concave.

I’m comfortable with the fact that my current look is short of my surgical goals.  This was not unexpected.  My density behind the recession was unlikely to be matched with one operation.  Plus, the threat of continued loss and thinning threatens every patient.

At 6 months I was generally satisfied, but right now — when it comes to styling — there’s not a real material improvement vs. pre-op.  Again, perhaps it’s just a shed or a brief setback.  This was not the case one month ago. My hair is wavy and tends to stand up, which makes the hairline and loss pattern look bad.  That was the motivation for the temple closure.

I think there is foundation here for a successful refinement, and that was always a likelihood based on my hair characteristics.  I’m a bit discouraged by the regression on my left side, and certainly have ongoing anxiety about the two bumps and fibrosis.  The gaps in my frontal tuft still exist but are smaller.  We’ll see if the next five months offer some form of rebound and improvement.

As far as protocol, I’ve been loyal to 1.25mg/day Fin + 5mg/day Oral Min.  I abandoned topicals (RU and Rogaine) post-op, so that might be a factor in the result-to-date.  I plan to reintroduce Topical Rogaine alongside the medications, as it’s possible I grew some reliance to it after 10 years of use.  It’s possible I’m not a huge responder to Oral Min, and I certainly don’t have the associated sides such as excess body hair.

Pictures, both wet and dry, are attached.  Harsh bathroom lighting.

2 hours ago, Iceee222 said:

Looks incredible man congrats!!

 

Certainly helps with styling, camouflaging, and coverage.  But very high maintenance and sensitive to dehydration!  One of the reasons I felt a procedure would really help cosmetically.  When hair was dry and unhealthy, it’s stand up and look like tumbleweed and really expose/exacerbate the appearance of recession vs. laying down flat for a combover style 

23 minutes ago, Gramatik said:

Really good result. Congrats. Do you have pre op pictures with long hair ?

There are a few pre-op pics from clinic earlier in the thread.

I attached a few that I’d sent to various clinics during my assessment conversations.  I actually rebounded a bit from these images - at the time they were taken, I suspect my Fin pills had degraded through poor maintenance by me.  I was also less consistent with applying Min.  
 

Around the time of the first images (fall 2020) I started applying RU.  In January 2021, I stacked Oral Min on top of Fin, Topical Min, and RU.  Kept that protocol up until surgery and had some improvement.

Just now, Harry Bosch said:

Pinto People:

@Bonek @Falconary @Iceee222 @JDEE0 @rambo man

@therambler

Pinto People:

@Bonek @Falconary @Iceee222 @JDEE0 @rambo man

6 Month Update

Hey gang.

Attached some pics at 6 months.  Outdoor lighting, post-shower, damp hair *
 

(*hairline looks a lot better and homogenous when moist; dehydration- which is common with my wavy hair type - makes everything look more sparse)

Overall hard to complain.  My goals were aggressive, and in that sense it’s been a positive change but I’ve got a few weak points.  My thick hair type + loss pattern demanded a lot of density in the recipient area.  Cosmetically, it looks good and responds well to some mild, strategic fiber application (not pictured).

Downstream I will consider a touch-up.  I haven’t yet grown evenly everywhere, notably those two small gaps in my frontal forelock.  And I’m sure I’ll lose some thickness in the front to gradual MPB progression - my left side (stronger side, historically) does look like it’s become a bit more concave than a I prefer.  But these are small critiques, and not worth addressing for some time - hate to endure another shave/ugly duckling. Of course we all become hyper critical and greedy once we’ve taken the HT leap.

Speaking of shave, I know my case was unique with that peninsula of 200 grants that Dr. P implanted into a region affected (we think) by fibrosis.  I can’t really determine how that has grown or impacted the outcome, and I suppose I couldn’t know unless we shaved down again.

I do have a small smooth bump in each temporal region.  Initially we figured this was natural swelling from the dense pack, but Dr. P’s prediction that it will resolve in time has not proved true.  He did assure me it wouldn’t impact the final outcome.  Had anyone else experienced this long-term subtle inflammation (?) in the recipient?

Protocol

1.25mg Fin/day

5 mg Oral Min / day

Nizoral 1% 2-3x / week 

No topicals since the operation.  Had previously used topical Min for a decade, and RU for about a year.  Reluctant to return to the latter given its gray market status, anecdotal evidence,  and complete lack of safety information.

Interested in Pyralitamide.  I’m in that age pocket where TRT is a real option with much-needed physical benefits, but obviously hair safety is important to me. A legit, tested topical AA would be a great adjunct.  I did not respond well to oral Dut (in two limited samples) and hesitate to try the topical, endure a shed, and be able to confidently source it long-term.

Feedback welcome.

Pics below:
 

On 9/21/2022 at 11:02 AM, Calihome1 said:

I like the sharp temple point design.

Hey thank you.  My weaker temple has grown in pretty well.  That, along with my pristine donor, gives me hope a more aesthetic change is coming for my weaker areas on the hairline 

51 minutes ago, Falconary said:

I think it looks really good so far, in about 1-2 month you should notice great progress. I also have one week side, my left side is a bit weaker, but I'm the only one noticing it and it basically because we are much more critical of our own progress and look through everything in great detail. But honestly my first reaction of your new pictures were "wow it looks really good and natural". Look forward to see your progress further on. 

Thanks brother.

And I think most of us have some weak point.  On my weaker side my hope is to go from this to this:

4 hours ago, FITA said:

I’ve just been through your thread and I personally think your results are looking great so far. I think 99% of people on this forum would kill to have even had your pre-op hair, but I definitely see a difference already with the new hairline and temples. I definitely think you’re in a good place for 4 months. By 6 months you’ll be spot on.

How much does Pinto charge per graft? He’s definitely on my radar now, if I can get on this of course..

Thanks for the input.  I hope you are right!

At the time of my surgery, he was about $3 euros per graft.

And I agree I’m in a better position than most and was trying to qualify my observations as more curiosity than panic.  No one wants to invest time and money without seeing the desired improvement, and that fibrosis region he discovered has been the looming complication in my mind.  I also still have slight smooth bumps underneath the implanted area on the hairline.  
 

So many variables that determine the outcome, and I enjoy sharing with the group for education, conversation, and of course (selfishly) peace of mind !

40 minutes ago, BDK081522 said:

My experience has been that hairs in the immediate front of the hairline have always come in thicker and actually softened around the 6-7 month mark. Could just be my physiology but the hairline always looked less dense and more natural after some 6 months. 

I see.  It’s easy to be misled by testimonials on here that feature faster growers.  Really what I need to hear right now (and believe) is that my current progress and hairline presentation is not predictive of the outcome 

A few more pics of dry hair in outdoor light.

Really hoping that weaker side begins to improve — that was the primary goal of the surgery, to be able to move away from the combover look.  Looking underneath the hood, it’s still awfully concave with some thin wispy hairs existing non-homogeneously.

My expectation was that those front line singles would grow in first and approximate the aesthetic hairline that the surgeon designed.  And then they’d thicken over time as the doubles behind it all grew in.  Was this a wrong assumption ?  Is it feasible I’ll experience new hairs growing into those corners to create the temple closure we wanted?

@therambler @rambo man@Falconary @JDEE0

5 minutes ago, Vann said:

it can definitely be a mental game when it coems to waiting. I recommend staying strong and waiting for results more so than letting the worrisome thoughts take over. Theres nothing you can do other than let time pass. Dont stress over anything because its already done. 

Whether there was a wasteland or not, it definitely will take time to say whether or not you remember this current feeling once everything kicks in. 

100%

I think part of me, understandably, is wishcasting that some of the more educated transplant experts here might be seeing promising signs that I’m missing, or perhaps too biased to see - not uncommon to judge ourselves in less favorable light than objective observers 

On 7/20/2022 at 9:20 PM, Harry Bosch said:

Alright fam. Moral support time.

This is my update at 2 months (9 weeks).  I think I’ve shed or outright lost native hair since my last update at 7.5 weeks.

Understand that this is the absolute nadir in the ugly duckling phase, and I’ll stay here for at least another month.  You have to go backwards to go forwards.  Hopefully the experts and veterans have some positive feedback.

Attached are multiple pictures from multiple angles during dusk.  Good lighting but not super intense.  I also added one comparative picture from the pre-op / post-shave that clarifies my conclusion that some shock loss (or native AA progression) has occurred.

 

Here is my update at 4 months.

Meds:

Finasteride = 1.25mg/day

Oral Minoxidil = 5mg/day

Overall, there has been a slight improvement.  I was of course hoping to be as far along as Pinto patients @JDEE0 and @Falconary at the same stage in their timelines, but alas we aren’t there.  The hairline is not yet resembling the homogenous (admittedly aggressive) surgical design of Dr. Pinto.  At minimum, I’d like to see those two large gaps in the frontal forelock start to fill in a bit.

Interestingly, I have that two-face Dr. Jekyl / Mr. Hyde dynamic going.  One side has healthier denser hair; the other side (with the greys) remains substantially weaker and translucent under harsher light.  I fear that the fibrosis area that Dr. Pinto discovered might continue to be a wasteland and perhaps we should have done a scalp biopsy to evaluate if there was an underlying medical problem.  Optimistically, perhaps this area is simply destined to come along slower — but by now I’d like to see evidence that it was improving.

Every patient timeline is different and hopefully months 4 and 5 bring about positive cosmetic change.  I feel that I look worse now than I did pre-surgery.  That might be temporary, or it might be indicative of a looming sub-par result.  Like I said, at this point we are just looking for signs that growth is approximating the design.  Hopefully soon.  

What can my expectations be right now moving forward ?

4 hours ago, Falconary said:

Those baby hairs will most probably thicken up a lot in the coming weeks and you should also start seeing new hairs sprouting the coming weeks. It's hard to see the fibrosis, visually It seems that you are on track. Have you tried massaging the fibrotic tissue to break it up? 

Thanks mate.  Still early.  Like we talked about in PM, this is the part of the timeline where patience starts to get tested and you’re just looking for something/anything to feel confident it’s gonna work out.

Dr. did not advise me to do anything specific for the fibrosis.  Something he remarked he wouldn’t have noticed had we not shaved down.

Update at 3 months, and 1 week.

My procedure was May 17.  So we are 14 weeks out.

Its still early and not time to panic.  But no indications of new growth yet.  I was hoping some of the work on temple peaks might be evident by now.  Alas, it’s still the desert.  Of course, my hair is long enough now that navigating the ugly duckling period isn’t too troubling.

The fibrosis condition that Dr. Pinto detected and attempted to remedy still looms for me.  It is an added worry, and that’s why I have the two-face scenario going on.  My better half present denser and healthier hair.  My bad side looks especially weak and sparse — basically the grey hair is a line a demarcation between the stronger/weaker side.

My donor looks totally undetectable, fortunately.  I faded from a 1.5 to a 1 and no scars are visible.

I know going in that my favorable position and hair characteristics portended a strong outcome.  And my donor healing has been promising.  I did not have a terrible presentation of redness or irritation in the recipient.  Hopefully that means I’m on track.  On the other hand, I stopped Topical Min and RU in the weeks prior to the op and have elected not to continue (I’m on 5mg oral min).  I definitely look worse than I did pre-op.  And of course that fibrosis and grays.  So those will inform some concern until if/when new growth begins.

Alright fam. Moral support time.

This is my update at 2 months (9 weeks).  I think I’ve shed or outright lost native hair since my last update at 7.5 weeks.

Understand that this is the absolute nadir in the ugly duckling phase, and I’ll stay here for at least another month.  You have to go backwards to go forwards.  Hopefully the experts and veterans have some positive feedback.

Attached are multiple pictures from multiple angles during dusk.  Good lighting but not super intense.  I also added one comparative picture from the pre-op / post-shave that clarifies my conclusion that some shock loss (or native AA progression) has occurred.