j1mmy

Hi HCH, I am having a surgery in exactly a week, so I can relate to your situation of several months of research . I agree about your hairline being too aggressive. As someone said before, imagine 1cm of hairline is 1000-1500 grafts for good density. Your suggestion is a solid 2cm, and that is then neglecting everything behind it. I recommend you consider M or V shape hairlines, they are actually graft preserving, and age well. Look at Melvin's hairline on youtube if you can. Not to mention that it is very aesthetic, but if he had decided to opt for your suggested hairline in line with his midline-frontal point (the lowest point), he would have to spend more grafts filling in more temples. Given that an average donor of 6000 grafts, I don't think it is unreasonable to "use" 2500-3000 on the frontal third, and feather in 500-1000 in the mid-scalp. It is individual, but I think Eugenix recommendation was too limited to the very front for my liking, and your design was too aggressive. Temporal points do not need to be fully reconstructed, you have some density and shape to the lower portions of them. You can add some density to the tops of them, as they become your temples and frame the hairline. That way you don't use 700 grafts on the temples, but say, 200. Your worries of 45grafts/cm^2 forget that your native density is not 0, as the good DrT alluded to. But, such a density in the front of the hairline should give you a decent hairline. Your challenges with medication are a shame. I agree that topical dutasteride seems worth looking into, or your topical OR oral finasteride should not be daily, and be cautious. A small amount goes a long way in terms of its effect on DHT, and maybe negates side effects. I think that even though oral minoxidil is becoming increasingly popular for the braver people, as some good Dr's are prescribing it. It is worth remembering that oral minoxidil is the very origins of topical minoxidil, but topical was created exactly for the very reason that oral minoxidil was not a viable option for treating hair loss. You are doing a great job of doing your due diligence, and I don't think you will be dissatisfied with Eugenix, but as you see, it helps to be an educated patient, to maximise the best possible chance of being a satisfied patient.

I think with concealers of course there is always a concern that your cover could be blown. At least with dermmatch it can't really be washed out (without scrubbing) or blown out etc, it does not run or drip. I have over the years used it here and there, arguably one could use it for special occasions. The problem as you alluded to, is that, whilst it can be clever for the crown/mid-scalp where people aren't really looking, it works best if you ALREADY have good coverage. Therefore, if you already have good enough coverage to just say F it, is it worth the risk of direct sunlight or spot lights revealing that your scalp looks a little "off". I used to use it to subtle effect on my mid-scalp and hairline. Once a friend pointed out in the sun that I had mud on my head. "oh? thanks, i'll rub that off". Embarrassing but no harm done

Well that's good. I only use it once a day, due to the half-life of minoxidil and it's accumulation, it should be just as effective once a day in my understanding of the pharmacology of it. I do however definitely use more than 1ml, as do you (2ml), so a higher dose that we use could be more effective than 1ml. Obviously don't change that now, since you are great at doing twice a day, and any change could cause unwanted effects. it is just something worth knowing for the future if you feel that twice a week is inconvenient. Dermmatch is just a concealer, aiding the contrast between hair and scalp, giving an illusion of density. It is very waterproof so it doesn't come off like toppik does. When used right (a dryer application than recommended), it works rather well for many, but less well in the hairline. Could find some youtube before/afters to see if it is something that could be interesting. Your pictures showed that you have an impressive enough density that your scalp is not showing as white, but almost a tinge of black, I think for that reason dermmatch works well. It works best when you have ok density, and less well if you are trying to "paint" bald areas.

You are doing absolutely the best thing being on fin/min. Are you consistent? Are you using minoxidil on the crown? My opinion is your hair looks better slightly longer (in these pics), and if you have to use product don't use wet products. A surgeon could disagree, but my understanding is that your hair density is essentially higher than the limitations of what transplants try to achieve. The only area diffuse enough is maybe placing 500 grafts near the crown. If it was me, I would absolutely not consider a transplant right now. Try some toppik or dermmatch to help you go outside feeling confident.

Hi Mustang, This is very interesting. I couldn't quite understand what happened to your pre/post serum/scalp DHT levels from your three separate protocols, if you tested all of them? I understand the insinuation is that serum DHT was least affected by topical dust, but reduction in scalp DHT was high. Do you have your numbers? Obviously everyone is an individual, I assume your TRT has raised your DHT or not? Cheers

Hey Harry, Step 1, try medication - finasteride and minoxidil are ideal for diffuse thinners like yourself, and myself. Given your area of loss, and degree of loss, medication is your slap in the face first step. If you suffer from dandruff, nizoral shampoo 1-2 times per week can also be a useful tool in your arsenal. Finasteride - Propecia 1mg, and with a pill cutter you can even cut the pill into 4 to ease your mind starting slowly - 0,25 twice a week, then 3 times a week, etc. This will most likely slam on the brakes of your hair loss. If this is something working for you, you can eventually buy Proscar 5mg instead, and split that, as a cost-effective long term hair loss treatment. IF you experienced something you don't like, go back to the previous dose. The vast majority of people who do experience side effects experience them temporarily, i.e. they pass. This is your first and most powerful weapon. Minoxidil - once per day, at night is the most convenient I and others have found. Foam is usually better tolerated than liquid, even if more expensive. If you are a good responder to this, a proportion of "lost" hairs can be regrown. The downside is putting something on your head every day. This is your auxiliary weapon, as consistency and convenience becomes difficult over years, and results may fade, as it is not attacking the cause of hair loss, DHT, like finasteride is. Both medications will likely cause the sensation of "shedding" for up to 8 weeks, to allow for the hair cycle to re-initiate and make way for better times. So things get worse before they get better.

Very cool, congrats! Happy growing It is a bit fascinating to get an inside look into a HT doc's preferences after seeing patients wishes for years. I like the strong temporal peaks, nice M-shape hairline, careful macro irregularities. I have to ask, is this based on your natural hairline, or was this more artistic? It is a bit like when you go to the barber and you ask, "what would you recommend?" (based on my face, head, hair etc), and they usually say "it's up to you, come on what will it be?". When really you actually want to know what they think looks good, know what I mean?

It will certainly affect the native hair and accelerate your genetic disposition for DHT to damage the follicles, making you lose coverage. Will it affect your transplanted hairs? My guess is they would be ok, or you would see them minituarize over time as a confirmation. Both would be affected less in the presence of finasteride, but the coverage you will lose will depend on how much transplanted vs native hair you have on the top.

I agree with the advice of @asterix0 @ciaus @Melvin-Moderator, even if it may seem they do not match together perfectly, they are all offering you very wise advice, and I urge you to really listen to what they said. Right now you are probably not a good candidate for any medication, and definitely not surgery. Do not rush into these things, you are desperate now and it is clouding your judgement. Instead, consider talking to your GP about your previous depression, ask to be referred to someone to talk to about how much you are struggling. I think if you want feel like you are tackling your hair loss problem at least in the short term, rogaine/regaine (minoxidil) once per day will give you that. If you can't handle that your hair will probably get worse to make way for new growth for the first 4-6 weeks taking it, it is not for you.

You might find such a result that looks satisfactory I agree, perhaps with the right hair caliber, colour, over 3.0 hairs/graft. Let's assume the frontal third of a person is is 70-90cm^2. 2500 grafts standing alone gives you a density of 27-35g/cm^2. It is not unusual to aim for 45-50^2 as a "nice coverage", and Konior has suggested 50-70g/cm^2 provides "the best coverage". That's certainly more than 2500. Maybe the NW7 after being bald for 30 years is happy with 30g/cm, not the young guy who is struggling when his hair loss is at 60g/cm right now.

Supposedly the active 5% minoxidil is like-like. My guess is the "bonus" added ingredients are not doing anything, but warranting a higher price. The focus is on which additives is your scalp tolerating without irritation, that is what we can strive to achieve. I agree foam is nicer to apply and less greasy.

Thanks, I appreciate that. I know how you are feeling. Losing my hair at 20, I was the only one of my friends in that position, and am still the worst off 10 years later. It is not nice to feel your looks and attractiveness eroding at a young age, feeling as though you are already "dying" of old age is how I felt. The opposite of vital, like I should have felt at 20. What exactly did you take from Belgravia? It does not turn you into a female, you have been reading propaganda, or too many transexual websites . It lowers your DHT by approximately 70%. You still have DHT, and your body upregulates testosterone a little as one of the feedback mechanisms. DHT's main role is in male sexual differentiation (i.e. puberty), after that it has a "minor role" as a circulating endocrine hormone, 1/20th the circulating concentration of free testosterone. Your plan of action should be focused on thinking of other things, other than just your hair. If you got cancer tomorrow, you wouldn't care about your hair anymore, put it in perspective. Minoxidil is not a prescription drug, finasteride is. If I had previous issues with anxiety, I would want to separate these two medications, starting with the one you are most comfortable with, minoxidil. You notice positive effects of regrowth, if you are a good responder, after 2+ months of using minoxidil. This seeing of new hairs for the first time in years can be enough to encourage you, and may be something you want to stick with for many years. I don't think your anxiety about it lends itself to starting finasteride right now, because you are too worried about it, and I don't think you have reason to. An effect from minoxidil buys you time in your 20's to make the right decisions going forward, whether that is finasteride, surgery, shaved head, hair piece. But if you were to start after seeing results from minoxidil, and felt in the right position to do so, then you might consider finasteride. I would definitely start by taking as little finasteride as possible to ease your mind. Prescriptions can be got from boots online in the UK, amongst others. I would buy a pill cutter from the pharmacy, and cut a 1mg pill into 4, and take 0,25g twice per week for a month. If that was ok 0,25g three times per week, etc. If I noticed any side effects, I would go back down to the previous. This has worked for hundreds of people that I have heard of. You should check out TheBaldTruth show, now broadcasted on youtube Friday 9 or 10pm GMT. The hosts have taken finasteride for 50 years combined, and spoken to literally thousands of callers over 20 years. Anyone reporting side effects has reported transient side effects, and nobody permanent side effects.

The point is that surgery can give you coverage NOW, sure. My opinion is that 6000 (+2000) grafts gives thin coverage to a NW7. That's assuming all three procedures and £30,000 went to good use, with no permanent shock loss to the native hair . So let's say he is 35 years old at that point, is he going to be happy with less coverage than he has now, after three years of the last 10 recovering from surgery? That's not to mention that miniaturization in the donor hairs is real depending on the person, affecting your future transplanted hairs. An action plan based on "keeping ahead" of your loss is an optimistic one, and may lead many people to a dead end, with no donor left, and unsatisfactory coverage. Some people have achieved it, but it is a dangerous game you are playing, and all too easy to look at the people that got there by accident, repairing previous surgeries and hair loss until they ran out of donor with decent coverage, not because they planned it that way all along.

Waiting serves a multitude of benefits: Making emotional decisions at the peak of your anxiety makes you a poor candidate for hair transplant surgery. It makes it likely that you are not emotionally equipped to deal with an unsatisfactory, or unnatural result a surgery could give you. Not to mention complications; poor growth, cobblestoning, necrosis, infection, nerve damage, death. Hair loss is a progressive disease. Your hair loss will get worse. "Fixing" what hair loss pattern you see right now, will evolve one year from now, especially without medication. This can look very unnatural, leading to worse emotional down spiral. With time you learn to desensitize to your issue, and address your problem on other levels, other than just life-threatening surgery. You explore emotional coping mechanisms, work on confidence, learn about all hair transplant treatments, can camouflage help, different hair cuts. Time allows you to get perspective and due your due diligence. Research all the options, and make decisions that are weighted and not rushed, so you don't make your situation potentially worse by trying dangerous treatments or dangerous transplant doctors.

Yeah, I don't say this lightly since many people might feed you this on the forum. But, 99,9% of people would have no idea you were balding. I can see what you mean, but your hairline is natural, your curly hair suits not being super dense. The only "tell tale" right now is the tinning crown. Have you tried derma-rolling, or laser cap? You are diffuse, but have so much hair, that you just need another minoxidil-like product to kick up the density. I am having surgery with Dr. BF in two weeks, and I spoke to Feriduni 5+ years ago like you. When Feriduni turned me away for the same reasons, I definitely had less density than you do now. I still think Dr. F is a top, ethical doctor, and he had a good point, we are/were not good candidates. I have significantly more recession and more thinning than you now, 10 years later, so it is the right time for me to go that route.

To the original poster, nobody can tell you what do do, you are your own person. The side effects you described do not sound in-line with what I have heard over many years, so I am inclined to think they were probably psychosomatic, and that you made yourself anxious after reading about side-effects. Unless of course you took oral minoxidil, and therefore you may detect a blood pressure effect (light headed, heart palpitations, dizzy). My guess from listening to The Bald Truth for 10 years, reading this forum and others, listening to hair transplant doctors, would be that 80-90% of "informed" hair transplant patients take finasteride, and "uninformed", who knows...25%? That is partially because they do not go to doctors who inform the patient, so they don't know any better. For those informed people who chose not to take it, it seems to be a personal choice. Some of them are fortunate enough to have very good donor supply, or discovered serendipitously that they can live with just transplanted hair (no native hair) on top of their scalp after going the multiple transplate route without medication. Someone made a good point, the original trials showed side effects of around 4%, and placebo group was around 2%. It doesn't help to be neurotic, and the suggested route of slowly titrating dosage up (even if it may have no physiological effect), may help with neuroticism and thus psychosomatic side effects. There are around 10 million people taking finasteride according to prescription stats, and you hear complaints from a small handful - probably 4% of them if I was a betting man. I haven't personally heard from someone suffering from permanent side-effects, though for sure it is possible to experience transient side effects. I have taken finasteride for 10 years, started when I was 21. I experienced, like I have heard many a dozen others experience, a feeling of being kicked in the nuts for few days, and then it went away. Being aware of people talking about side effects, I thought I could notice lower libido, but absolutely no sexual dysfunction. Perhaps I have got used to it, but I have a very active sex life and experience no issues. During these 10 years I lost ground with my hair when switched to a generic finasteride for several months, and going back to a named brand I got kicked in the nuts once again for a day. I also increased my dosage after becoming a bit "lax" with how often I was taking it, and I got kicked in the nuts the next day. This is my "only" side effect, and I do believe this is physiological. In a very short period of time after starting the drug, my scalp ceased to be itchy, and my hair felt strong like you could tug on it and nothing would ever fall. My perception is that if you have aggressive hair loss (under the age of 30, and especially closer to 20), finasteride is really the only thing that could save your hair. That's not to say anyone has to take it, you can shave your head, or move on with your life. I have had friends talk to me about hair loss and about finasteride. They say that they do not wish to take it after reading the horror stories. I do not tell them what they should do, just inform them. Secretly however, I think that if they want to keep their hair, I would prefer they tried finasteride, and simply stopped if they experienced any side effects. Minoxidil is another story entirely, acting in an entirely different pathway, and very safe applied topically (e.g. rogaine). I saw regrowth from it, reversal of miniaturization, enough to get a visual difference. Over years I became tired of the daily application, and with that noticed a loss of physical impact it gave. So as long as you use minoxidil it can be a good tool, but be prepared to use it consistently for many years. I have recently re-started it, and regrowth has happened again that I am prepared to maintain as my hair is a little worse than when I started this journey 10 years ago.

With the few "world class" doctors that have many years of consistent results, for example; belgian doctors (Feriduni, Bisanga, Lupanzula), UK (Ball, Reddy), Spain has many good but they are generally very busy, I would personally not be so concerned about who is performing the majority of the work. That is a different case if I didn't know anything about a clinic. What you can say they have in common though is very good teams, world class technicians. Some of them have more or less involvement, but all produce "top" results. It is up to you how much this determines your decision about a particular clinic, but they wouldn't use technicians to delegate work if they thought it would compromise their results. I would ask who is in their team, and who is performing which roles in the surgery. Are the technicians consistent members in the team? How long have they worked with you, how many years? How many patients are you working on each day? All these very respected clinics should have clear and satisfying answers to these questions, but it is worth asking so you know. I personally like that my doctor is making all extractions, and all incisions, and I am the only patient for the day. Another person could argue my doctor would be tired, and perform sub-optimally, and they may be right. Food for thought

! Just do your best to stay on medication, so you can keep as much midscalp/crown as you can over the next years/decades. Even with a good donor capacity, you can see that you could not repeat this density throughout the top of your scalp if you should have future procedures, should you lose more ground over time. So on the one hand, you should get incredible density in the target area, nobody can question it should get dense. On the other hand, half of your donor had to be sacrificed for that, where others might have given up 2000 grafts from their donor for a coverage that looks "relatively full". I think you are on to a good result now, just have to be patient, and with a good response from finasteride you can be sitting pretty for decades Caliber is simply the average width of your hair shaft, as you referred to "fine" hair, that might typically be anything under 50 microns lets say. In theory, based on surface area, very fine hair requires a lot more density to achieve coverage. But when we are looking at 4500 grafts in a small area, hair caliber will have little to say. I was just curious if you recall them measuring it, since your hair looks similar to mine.

Ah ok, that is a relief That should be good then! Yeah there is no doubt on the density, if you get good growth, that is the most hairs i've seen in hundreds of cases i've studied in my research before procedure! Good luck during the patient phase!! Did you take note of your hair caliber measurement?

I wish you all the best, I like the design, and it is a lot of grafts so the density is basically going to feel like native. My only skepticism, though I am by no means an expert, but 150 single hairs seems on the "low" side for virgin hairline reconstruction and temple points. I typically see the homeruns with 400-500+.