JDEE0

LCMS is indeed the better method of testing as @bald-and-bearded points out. It is indeed strange that your DHT is well below the reference range, considering that you said your T levels are normal; you would think that as long as you have normal amounts of testosterone available, that the usual percentage of around 10 percent (total) would be converted to DHT via the 5a-r enzyme. What were your levels of total and free T if I may ask? I'm certainly no doctor/endocrinologist, so just complete (and very probably inaccurate) speculation on my part (and I would strongly advise you go and see an expert in the field to figure out what's going on), but perhaps you have some sort of deficiency in the 5a-r enzyme. Though this usually comes with very severe and obvious symptoms so I'm sure this would've been picked up a long time ago; you would likely have not experienced masculinisation etc during puberty. Maybe the deficiency can be less severe and result in less symptoms in some cases though, I really have no idea. I do know that Testosterone levels, for example, can be falsely read as well below their normal levels if someone gets their blood taken after a night or two of poor to no sleep, heavy drinking etc. Maybe DHT can similarly be falsely misrepresented by external factors too, and it could be a false reading essentially, but again I'm not sure.

I think we'll just have to agree to disagree. To play fair, I'm not saying that my statement you've highlighted there in your reply isn't assertive in any way, I just vehemently believe that it is correct and in the best interest of prospective patients; I wouldn't have a procedure in the UK myself (which is where I'm from), I wouldn't recommend anyone I care about in my personal life does either and so I'm just extending that to people on here as there are better options nearby. I also don't think that it or anything else I have said equates to me somehow presenting myself as an authority figure. By it's very definition that would insinuate that I am sort of commanding people to do as I say, or at the very least suggesting that I have some sort of power over them and bashing them if they do the opposite, which I absolutely don't have (and would never do). If someone chose a surgeon I wasn't a big fan of, I would simply wish them well and hope it works out in their favour... I simply offered the truth that the UK has generally poor options for HT surgery, or would you say that we are on par with the likes of Belgium, for example? I certainly wouldn't. Dr Ball and Dr Reddy are the only two who are experienced enough and have enough patient posted results, both generally speaking and with good enough outcomes in my eyes, to even be a choice in my opinion. I then simply stated that I think there are better choices very close by, at a fraction of the price at that. I in fact did state there were some ok choices in the UK, just not really worth it when you consider what's on the doorstep. I don't really understand what's suspicious either; I could If I was bashing a certain clinic, or promoting a certain clinic, but I'm not. I would also say that the majority of all countries in the world are poor choices, not just the UK, it's nothing personal. Anyways, I really don't care to go back and forth and create drama on an online forum, I'm just here to give a little information back where I feel I can before I have my transplant and likely leave the forums alone and forget about my hair for as long as I can (until I inevitably lose more and come back at some point, hopefully way down the line).

Sure, no problem. I can be as transparent as you like and answer whatever questions you have... Yes, I joined a few weeks ago, but I've been researching hair transplants for a number of years now, and pretty intensely at that. I have spent a lot of time on this forum, (multiple years at this point) just not as a member, as well as a number of others, reading, learning and gathering information on all things to do with hair transplant surgery, hair loss and figuring out which clinics are the better ones available to us as patients. I was also someone who took a long time to muster up the courage to start meds and am the type of person who likes to know what they're getting into, so I spent a lot of time reading papers, looking at results of studies, learning from knowledgeable youtubers etc. before I did so, and have since kept up on my research trying to learn around the topic and also with future treatments etc.. I don't really understand why you keep on regurgitating this fallacy of me coming from a place of 'authority', or that I'm some sort of self appointed 'expert' as you have previously claimed. Please point me to where I made any claims that could even be mistaken for that. I'm just a guy who feels as though he has amassed an ok amount of knowledge on the subject and can potentially help newbies to consider meds a go or not go and pick any old random clinic. Never claimed to be an authority figure, nor an expert. I've never told anyone to do or not do anything, just offered my own opinion and told them to take a look at X, Y or Z clinic for themselves and do further research for themselves. I've never told anyone to blindly follow anything I say, after all I'm a random person on the internet as we all are, but merely point them in a direction that I genuinely feel is best and to decide for themselves after using their own brain to decide. As far as I'm aware, i'm pretty sure you can't do a degree or gain a PHD in hair transplant studies, so I don't really understand what gauge or metric you're using to decide who is knowledgeable enough to offer advice; we're all just people who've learned what we can and are trying to pass that on to others to make a good decision for themselves,. After all, we're all in the same boat. If you believe my knowledge is wrong in some areas I've posted on here, by all means, point it out. Show me where I've made false claims scientifically, or reccomended doctors that aren't objectively highly skilled and respected.. No, I don't work for a clinic, not really sure why you'd even ask as I have recommended a pretty varied list of doctors and never said that one was better than the other. I've only pointed out that I'm not so impressed by a couple of doctors work in response to threads where people have asked if they are a good choice. Again, so what? what's the problem with that. If you really want me to link you to a number of cases to back up why I feel this way, I could very easily do so. But I'm sure you don't. Nope, not had surgey yet, but I'm booked in with Bruno Pinto in Portugal at the end of the year. I can easily provide you with proof of that as I've paid my deposit etc. To play you at your own game, for those of you lurking and reading, don't blindly trust any website or forums opinions or reccomendations on surgeons. Especially ones where there are clear incentives for mods to act like this towards someone (who is doing nothing but trying to help others) because they politely recommended another user to pick a world renowned surgeon who specialises in afro hair (for an afro patient) over a fairly new surgeon on the scene who's results I just happened not to find overly impressive. I didn't even say a bad word about him haha, this is so ridiculous. To be honest before joining I had a lot of respect for you but you've just shown your true colours in my eyes.

Haha, I actually have no idea what your problem is Melvin. You're a very confusing character... I have no idea how I've asserted myself as an authority figure, if you could please let me know exactly how you've come to this conclusion then I'd love to hear it. Probably 80% + of my postings have been giving advice on people who have stated they aren't going to/are unsure about starting medication. I've literally just given some words of encouragement to these people to read papers and studies rather than hanging around forums like tressless all day... Beyond that, I've recommended a few clinics to people (in appropriate/relevant threads), in which I have clearly stated that this is just a list I personally like after lots of research, and that there are many more out there. The only reason you've taken a disliking to me is because in ONE thread, I stated that I wasn't so big of a fan of a certain Dr's work who is recommended here, and instead suggested that they go to Dr. Bisanga over said Dr. (the choice of the poster was between the two). Hardly a crime is it. I have never even said anything bad about the Dr, and have even said that that if someone likes anyones work, including his, (after reading lots of patient posted results) then by all means go ahead and book with them. It's all in the eye of the beholder at the end of the day. I'm pretty sure it never states on this site when joining that you have to be of some sort of certain rank that Melvin deems appropriate to offer advice on clinics or doctors, it seems as though if someone disagrees with you, even politely, that they're subject to your ridiculous claims and accusations. It doesn't scream impartiality at all to me, which is what I thought the whole site was supposed to be about. You're right, anyone reading this should be able to read between the lines. I invite them to go through my history and try and find out what I've done wrong other than use my own free time to help others in a situation I was once in, I've been completely fair and objective in every one of my posts and clearly have absolutely no agenda. You're really leaving a sour taste in my mouth with this behaviour, as you wouldn't be acting this way if it was any other doctor you're not affiliated with. Finally, regarding your point about a VPN, I'm not sure if you're aware how one actually works, but you'll find that, generally, the IP attached to you is constantly changing; you normally don't just get one static spoofed IP from a VPN provider and that's it. Check mine periodically on different days, it will be the same every time as I have not had a VPN on at all since joining this site. If you want, ask me a way of any choice of yours to prove I have no VPN on, screen shots, video sent via PM etc, and I'll be more than happy to do that for you... just ridiculous.

The idea behind the benefits of topical Dutasteride is that the drug does not absorb systemically to any large degree and thus does not alter serum DHT levels significantly; maybe only 20 or so percent as opposed to the 70 ish percent of oral fin and the near 100 percent of oral Dutasteride. Instead, it is hoped it is absorbed straight into the scalp/dermal papillae and targets the AR locally instead. However, there is really no substantial clinical data that currently exists to corroborate this at all; most of the evidence comes from online forum posters who have had their bloodwork done on topical dut and compared this to baseline. But it does seem promising and seems that this may well actually be the case. You could fairly easily test this for yourself by getting your own bloodwork done before and during taking topical dut; if it only drops marginally after say 6 months of continued use, then you can be confident that it indeed is only going minimally systemic. The real issue is that there is also no real clinical data to prove that topical dut works to significantly prevent hair loss. Perhaps the reason that it doesn't seem to go systemic (which it is speculated is due to it's relatively high molecular weight of above 500 daltons) also means that it doesn't really do much in the way of stopping miniaturisation. I'm not saying that this is the case, I do actually think it's promising, but who knows. I personally wouldn't bet my hair on it right now as there's no evidence that it works whilst we have lots and lots of evidence that finasteride indeed does work. I'll say that if you absolutely won't use fin, then I would certainly recommend using topical dut if you're willing to do so. There are a number of high level surgeons who have been prescribing topical dut for a while now and say that it works well, so that bodes well in its favour also. But if you don't mind taking fin, I would personally recommend to just take that. It's proven to work and has decades of highly controlled scientific data to back this up.

No problem, and to OP: apart from trying your best to take a step back and realise that finasteride isn't going to ruin your life if you try it, you should contact some elite HT surgeons, but key word here being elite (and ethical). No hair mills, whether that be in Turkey or anywhere else, as (apart from the fact they will probably ruin your donor and give you a poor result) they'll just accept you and tell you what you want to hear. if you look through my post history, you'll see some Dr's that I would recommend. Send them over as much info/pics as you can, explain your situation and see what they advise. Lot's of people do get HT's without taking meds, so I'm not saying all hope is lost, just that things would be much more favourable if you could/would take them. Dr's like Bisanga now actually prescribe a lot of Oral Minoxidil with a topical fin/dut. Maybe this is is something you would feel more comfortable with at a low dose, I don't know. Be proactive and see what your options are with them.

Yeah, that's fair enough, I understand. Well, I can understand your logic behind wanting to stay in the UK with the option of easily access to the clinic if any issues arise etc, but the blunt truth is that the UK generally has poor options for HT surgery, the very few one or two who are ok (at least in my opinion) are very expensive (and not as good as cheaper options abroad). In addition to this, there is really only so much that's ever going to go wrong with a HT performed by a top surgeon. I've seen this sort of reasoning posted countless times by other people, but I can't think of any real problematic possible post op complications that are even anywhere near likely to happen in the first place with a good performing Dr. If you were that concerned, you could stay 5 days or so to let the scalp heal up to the point that an infection is extremely unlikely (even though it's unlikely in the first place) and then what else can really go wrong that you need to be close by? But, if you must stay in the UK, Dr. Reddy does seem to be a pretty top notch surgeon. He's going to cost you probably in the region of more than double than some of if not all the other surgeons I mentioned (as well as others I didn't) abroad, whilst in my opinion not being *as* good. So it just seems a bit crazy to me. But he's a good bet; the only person I'd consider in the UK personally. As far as the other two you mentioned, Farjo has been around for a long long time, but they're not known for outstanding results. They've had a couple of decent ones on here recently, but you want to pick a clinic that has many amazingly consistent patient posted results from start to finish, results that make you think wow I wish I could have that (especially if it's a similar case to yours and this is actually feasible), rather than oh yeah he looks better than before but there's X, Y and Z I can instantly critique it on. That's not to say HT's are perfect, be reasonable, but go and compare your listed choices in the UK to someone like De Freitas (patient posted on the Spanish forum) and tell me the results are anywhere near similar. As far as Arshad goes, I've said before I'm not a huge fan and I think he does mediocre work with some pretty decent results sprinkled in here and there along with some pretty bad results sprinkled in. I imagine I'll catch some flack for that, again, so I'll leave it at that. But he has a decent amount of patient results on here and the UK forum, so as I say, look them up. If upon seeing them you think 'wow, these are all consistently really good and I'm really impressed', then by all means go ahead with him. Yeah, your idea to compare UK and surgeons abroad is probably the best thing to do, just try to make sure they're majority patient posted, and then forget everything else and go with the surgeon who's results impress you the most and who you get the best gut feeling with upon speaking to the clinic themselves.

Sorry man, I of course don't get any joy out of making you feel down. I think we all here know how depressing losing hair can be, but it's in your best interests to see the objective reality of things. I of course cannot see into the future, so I have no idea of where you will end up, but take a look at the second picture you posted... If you're honest with yourself, I think you'll come to the same conclusion that you're already showing a clearly evident pattern of a higher NW. Which, if we're being blunt again, really means that you should be classed as such already, yes you're not technically there yet, but it's clear to see where things are going; that miniaturised hair is only going to continue to do exactly that. The good news is that some of that hair on the top of your scalp still looks relatively healthy and terminal, and you could potentially see some re-growth or increase in density with meds. The bad news is that you've self-admittedly confessed that you're terrified and are even frequent PFS forums/groups without ever having touched the drug... I don't even think I would recommend you trying finasteride until you get a more balanced view of reality. You've hung around in echo chambers where you've convinced yourself that you're going to suffer irreversible side effects as a result of taking the drug, which is just nonsense and is in no way backed up by science. I would usually recommend people to take it and if they truly feel they are getting some sides, then discontinue. No problem, everything will go back to normal upon cessation. But I feel as though you would just nocebo yourself into a bad state. To be honest, I would make a start by getting away from any forums that aren't purely knowledge/information based such as this one, most are no good for your mental state. Then, instead of reading anecdote after anecdote about how fin somehow is responsible for everything bad in these peoples lives, go and read the actual long term clinical studies that are backed up by science, have placebo control groups etc... you'll be able to see how things actually are in reality, what side effects actually came up in a sample size of thousands of men, how severe they were, whether they had to discontinue and also how similar experiences of the placebo groups were. Finasteride can of course have side effects, I don't think any rational person would ever dispute this. It's going to change your hormonal profile to some extent; test levels, estrogen levels etc will change somewhat, there are probably very small alterations to neurosteroid levels etc etc. But, generally speaking, the changes these make to the vast majority of users will be so subtle that they have no noticeable effect. Hence why actual studies show incidence of side effects to be pretty low, and generally similar to placebo. In any case, the point is that you stop taking the drug, the 5a-r enzyme commences to be produced at normal levels, T will convert into DHT at a normal rate again and you'll go back to normal. It's not perfect, but it's the best we've got for now. This is why I hate people who fearmonger and say don't try fin, it's so dangerous etc. Yes, it's possible to get sides with it if you're unlucky. So what? If this happens, just stop and you'll be fine. I don't really understand what the big risk is, this completely irrational narrative that trying it is like playing Russian roulette has been created by very obscure/underground groups of people with a confirmation bias online, when in reality, hundreds of millions of men have taken Finasteride or Dutasteride over the course of a number of decades at this point. Just start looking objectively at facts from properly controlled scientific studies with no agenda, rather than anecdotal evidence from what is a very, very small and specific sample size of users (vehemently anti fin online forum dwellers) out of the tens and tens of millions of men, if not more, currently ingesting the drug into their bodies every day. I don't understand why fin would affect your sports performance in any way, no. Also, tresses is an awful place for the most part. I'm not saying you definitely do have retrograde, I'm just saying from that last picture it looks like you might to my eyes at least; I can see a difference in density unless its just the angle you took the pic at. You need to have your scalp looked at by a competent dr. To answer your question of can you go ahead without, of course you could. but you're most definitely going to lose the rest of the hair on the top of your scalp in my opinion as it's already miniaturised/diffusely thinned pretty severely, why would it just stop? Beyond that, I don't know, maybe your sides and crown would never drop into a NW6/7 and a NW5 or so is your final pattern, but I have no way of knowing. I assume you're fairly young and probably have 50+ years of life left to live. They very well might do, that's a long time (granted I think there will be a large number of additional treatments way way before 50 years passes, and probably a cure by that point, but for now you have to assume that what we have now is all we will have to be safe). It's just so naive to say ah I'll get it done and do nothing to prevent further loss, especially when you're experiencing hair loss severely like yourself, you'll probably run out of donor hair and have to chase hair transplants for the next 10 or 15 years until you do.

Yeah, I understand your point, but I'm by no means saying that his hair will look the same indefinitely as long as he stays on fin, just that it *likely* will do in 3, 4 or 5 years time. longer periods such as 15, 20 or 30 years is a different story. Of course he's not guaranteed even this 5 year or less period, as you yourself didn't experience, but all of the actual clinical data collectively lines up and shows that stabilisation compared to baseline can be expected in nearly 90 percent of users at the 10 year mark. Hence why I made my statement. But as Aaron says, you should always prepare for the scenario that things won't go to plan, nothing is guaranteed and yeah you could end up needing one sooner than you had hoped.

Yeah, as @SD1984said, the post you shared was just the result of an awful surgeon. This is what can and often does happen when people blindly pick any old doctor; looks like terrible planning (nowhere near enough grafts and spread out over a huge area) combined with a high NW starting point and probably also a lack of growth. As for you, you're undoubtedly destined to be a NW5 or 6 as you have diffuse thinning all over the top of your scalp, without meds, this is just going to disappear completely over time. Maybe you'll keep that very frontal tuft, but that's about all I would imagine may stay. Also looks as though you may have retrograde on the nape of your neck which effectively would make your donor zone smaller and mean you have less overall grafts to give. I would strongly reconsider going ahead without meds.

If you do go FUE, don't forget your options in Spain and Portugal! consider De Freitas, Bruno Pinto, Ximena Villa, Bruno Ferreira; al in the 2.5-3.00 per graft range and honestly probably the best FUE results around right now! Donor looks to be decent, probably average to slightly above average maybe. I don't know, it's hard to say really, but based off the picture with it grown out a bit longer, looks like you certainly won't have any issues with it.

As a side note, not sure if it's just the light, but it does look like a NW5/6 sort of pattern is potentially emerging... just something to bear in mind.

I would have to disagree and say that you've certainly lost enough hair to warrant a hair transplant... you're a fairly severe NW3. You're on meds, which is good, your loss hasn't been particularly fast by your own admission, so as long as you continue on with preventative measures indefinitely, and accept that you'll likely need a couple more procedures over the coming decades, I really don't see the point of waiting another 3, 4 or 5 years until you're in your 30's to get a transplant. On meds, your hair likely will just look exactly the same as it does today... makes little sense to me. If it's bothering you a lot, then you're certainly within reason at this point to do something about it. Fair enough if you want to go FUT first, it is a sensible choice in the long run, but you could still just go FUE first now, then if and when you lose more hair down the line, (maybe it won't be necessary to if you stay on fin, plus potentially utilise whatever future treatments that - may - come out over the course of the next 5, 10, 15+ years) get an FUT at that point and still maximise grafts fairly well. its not going to be as optimal, but you could still do this as your procedure isn't going to be absolutely massive; probably in the 2500-3000 range. And as a result, maybe you can avoid ever needing to go FUT and have more than enough grafts with FUE alone and thus escape the linear scar. If you don't particularly care about the linear scar though, then by all means, go FUT first. I would just go with Dr. Bisanga in that case, very safe bet (for both FUE and FUT, but he's one of the last few who has decades of experience performing FUT in an industry saturated with people who have only ever done FUE). Pretty sure he would accept you as a candidate no problem unless there's some sort of unknown issues with your donor etc.

Meh, I'd say he is in a worse starting position than you are. Yeah, hair type is fine, maybe finer than yours yes. Who knows. You can certainly achieve a result like that with one surgery, but I would aim a little higher (not saying it's a bad result by any means, and I'm not sure if it's the haircut making it look worse, but It's not as dense as I would be happy with and I'd have to do a 2nd pass personally). It depends. Generally, I would say you don't 'need' multiple just because you have fine hair, no. As I say, a good surgeon should be able to create a good result with one pass, fine hair or not, especially if we're talking a 'smaller' session like yours with not severe loss. Of course, there are lots of times where another pass is needed, and most elite surgeons will tell you before that they think you'll be happy with the one surgery for this sort of hairline session, but that there is a chance you may need a 'touch up' after 12 months. But generally, as long as you accept Its not going to be native density and will be somewhat see through in harsh, wet conditions etc, then you should be good with the one (with the right surgeon). Here is what I would expect (in a result from a case actually a fair bit more severe than yours in terms of loss/grafts required but probably similar hair calibre, and something I would myself be happy with) in just one pass. https://www.recuperartupelo.com/viewtopic.php?f=8&t=304

No, fair enough, not trying to convince you to do or not do anything; if you've done your research and looked into his results, his practices etc and have come to the conclusion that he's a good fit for you, then fair enough. Was just offering a word of caution. Yeah, your hair is fairly fine in calibre, but it's not that big of a deal. You can still have a HT. I suggest you reach out to your doc if you're booked in now, he should be able to answer your questions and put your concerns to rest, otherwise he shouldn't be accepting you in the first place. But in general, just look at various results online. You'll see many of people with similar looking hair to yourself with similar loss and good results.

Yeah, it looks like you have fine-ish hair. I don't know about 'very fine', possibly, but certainly looks to be somewhat on the finer side. My hair is darker, but looks fairly similar to yours both in terms of thickness and degree of hair-loss. You can still do a transplant just fine, I wouldn't worry about it too much. Yes, hair calibre is an important aspect of a HT. Essentially, the thicker the hair, the more coverage can be achieved with a lesser amount of grafts. However, especially with your not so severe level of loss, it's not so big of a deal. A good surgeon will know how to account for your calibre, and there are countless cases of finer haired guys having stellar results. It just means you may overall have less grafts available to adequately cover a large area in the long run compared to someone with thicker hair, but you can still have a top notch result with no problems. Really though, you should have seen results from Yaman on hair types similar to yourself that have made you want to go with him. Why did you chose him if I may ask? I haven't seen that many results from the guy, so I really cannot comment too much, but I would not go to him myself... I have seen some poor ones, and If I recall correctly, I remember seeing a case on the Spanish forum in which the Dr. I have chosen to carry out my procedure actually fixed a Yaman patient's poor result... I wouldn't say it was a 'repair'; just a very poor result that didn't grow very well at all. But either way, not ideal. I would honestly reconsider if I was you, but that's just my 2 cents.

Hi @DaveTay I mean this with all due respect (and with your best interests in mind), but I think you need to cool your jets a little bit and take some more time to study surgeons. I see you said you've done your research, but the fact you've even considered clinics like the crown clinic (who, as Matt said above, are generally just extremely meh and have no real amount of patient results on forums), and even clinics like KSL, who are probably the biggest cowboys in the game, says otherwise to me. It seems you're located either in or close to Manchester and so you're looking at clinics nearby and ultimately basing decisions on geography over skill and results. If you can afford the £3 per graft mark as alluded to by yourself above, I would personally without question just bin off the idea of the UK and get yourself over to Spain or Portugal; look up Dr's such as De Freitas, Bruno Pinto, Ximena Villa, Bruno Ferreira (who are all generally in the 2.5-3 euro per graft range, so actually probably even a bit cheaper). And if you can afford a little more, add in Belgium to your considerations, Dr Bisanga, Ferudini etc. With it being what I would assume is a hairline case if we're talking 1800 grafts, in the same price range you could also consider the few trustworthy Turkish clinics who have lots of good patient posted results online; Pekiner, HLC etc. Do your own research into these and other doctors, but point is there are so many better choices you can pick from; it's not as if you're coming on here saying that you're unprepared to pay more than £1.50 per graft or something that would pigeonhole you into choosing between a very small number of clinics. If you'll pay in the £3 sort of region there are lots of amazing choices.

As an add on, if it really bothers you that much and you can't stop thinking about it, go to a reputable hair transplant doctor/dermatologist and get your crown examined properly for miniaturisation, they'll be able to tell you objectively if there is any.

I don't really think it's indicative of MPB or anything to worry about. Yes, it could be the very beginning signs of a slightly thinning crown, but it's more likely that your crown has always been this way and you've just now noticed it, resulting in you being hyper-aware of it and beginning to worry. If you have any pictures in similar lighting conditions to compare from say a number of years back and it has objectively changed for the worse, then maybe you could say that it has begun thinning. Really though, I wouldn't sweat it. You're 21 and have what I assume is a full head of hair. Honestly, stop worrying, get off this forum and go enjoy your life. Keep an eye on things by taking photos in the same lighting every 6 months or so and otherwise forget about it, if it looks the same as time progresses then great. If not, then you've caught things very early and you can intervene with medical therapy and likely still have a full head of hair for a very long time without the need of transplants etc. These types of posts are regular on forums and you sometimes see the same person coming back time and time again asking the same question (not saying that's you) and it's really unhealthy; people begin to obsess over an issue that really doesn't exist. You don't want to be that guy, so like I say just keep an eye on things in the background and otherwise forget about it.

There isn't a clear cut answer to this question to be honest. Some of the best in the world such as H&W regularly do over 6,000 grafts in a single day, granted they are usually FUT from what I can gather. I think the extraction method matters, with FUT you can do extremely large amounts as the trauma to the overall scalp is less. With FUE, you're punching thousands of tiny holes into the head, above a certain number and things can get tricky in terms of damaging surrounding tissues, disrupting blood supply etc. That said, there are even some cases of FUE mega sessions from surgeons such as Zarev who harvest similar - higher even - amounts via FUE. I think generally though for most people, not going above 3500 grafts with FUE in a single session (whilst more has been done many times) is a good upper limit in which I see a lot of surgeons I personally like the work of draw the line. Usually they dress the frontal third with this number for example and then you come back a year later for a few thousand in the crown or wherever the grafts are needed. But as I say, there are many cases of higher amounts with good results so you can't really draw any solid conclusions.

Yeah, it's not what you want to hear, but just getting a transplant now at the age of 23 whilst doing absolutely nothing to preserve your hair (finasteride) is a recipe for disaster. You absolutely shouldn't do that, there's a decent chance you'll just be in the same position in another 3 or 4 years except now you'll look extremely strange with a band of hair at the front extending into your temples and slick bald areas behind. And if it continues to advance aggressively then you'll run out of donor and just be in an all around terrible position. I don't think it's a given that you'll proceed to be a NW7 by the time you're 30 though, you might do, but who knows. To be fair your hair does look pretty strong everywhere else so I would actually think you won't proceed to a NW7 anytime soon, maybe never, but you'll almost certainly continue to lose more hair in any case. If you do nothing though and you are destined to be a high Norwood, you'll certainly know about it in the next few years as you'll be well on your way by the time you're 26/27/28. You need to get on finasteride and then wait until you're in your late 20's; if you get on fin now and in the next 3 or 4 years your hair stays pretty similar to how it is now then you'll be in a decent position to go ahead and get a HT.

Melvin is right, you could easily test for yourself by just getting bloods done prior to using the topical Dut and then comparing to baseline down the road (ideally on multiple occasions over the course of many months to ensure that it isn't slowly accumulating and lowering DHT/affecting other hormones slowly over time until it reaches the same inhibition as ingesting orally would). I'd say if after 6 months or a year (just as a random marker) your DHT levels have stayed consistent at a small reduction in serum DHT compared to baseline, well you know that it indeed doesn't go systemic to any large degree. I do agree with @bald-and-bearded though, it is really necessary for some sort of actual clinical data/studies on its efficacy to be released to put the issue to rest and solidify the idea that there is actually a good alternative to oral finasteride/dutasteride for those who can't or don't want to take it. The main question is does it actually work? Without actual data from a properly controlled study, who knows. Yes, you can quite easily find out if it goes systemic to any large degree for yourself with blood tests, but we need studies to know if that's a good or a bad thing. Good because, if it actually does work and doesn't go systemic, that's great. Bad because, maybe studies will show it's not actually effective at stopping hair-loss due to the fact it doesn't go systemic. I'm not sure. Either way, up until this happens it's all anecdotal evidence, and there is no proof to state one way or the other yet. I do happen to think its promising though; a number of great clinics run by great doctors have been vouching for it for a while now and say that it works on their patients (H&W, Bisanga etc) so that is a good sign. As well as number of users from online forums, but really I would need to see some clinical data to know one way or another. If Dr. Wong says that there are some companies starting to do trials, then that's good news. Hopefully we will have some solid answers in the next few years.

No problem @bald-and-bearded. To be honest it's going to be extremely difficult for a lot of people to be able to carry out this level of testing, and admittedly it probably is overkill. I myself never did any testing before or after taking fin, but in an ideal world I would have done so to the standards set out in the video. Problem is that a lot of countries just don't seem to have companies/doctors who are readily available to offer any sort of high quality hormonal based blood testing (not just for before starting fin for hair-loss, also for checking because you have low libido/anxiety/depression/fatigue etc, or before starting a cycle of anabolic steroids for example). Here in the UK it's next to impossible; it's hard enough just to get a blood test that is actually accurate and measures basic markers. If you're in the US though and can do the testing from the Lab that Derek (the guy from the video) is in partnership with, then he is a very credible guy and to be honest I would entrust his chosen labs and the tests they carry out way more than any random GP I could go and see. He's very legit.

Well, I can only assume you're talking about me, seeing as I'm the only one who has recently joined and has 15 posts within this thread at the time of your comment, or should I say completely unfound accusation to be more accurate. Not really sure what your problem is, but I can only say that I find your statement to be pretty indignant. Firstly, if you go back and read up, I think you'll find that it in fact was not me who mentioned anything about Dr. Arshad being worthy or unworthy of recommendation; that was another user. I simply advised another forum member of what I personally feel would be in their best interest by a country mile; to pick Dr. Bisanga over Dr. Arshad for an FUT procedure on Afro hair, and on a female at that (we all know that female hairlines are a skill in and of themselves....). So what If I said that I don't find his work to be particularly impressive? It's my honest opinion, there is absolutely nothing odd about that in any way and it's frankly bizarre you would state otherwise. I happen to be from a city in the UK not so far from where Dr. Arshad is in Leeds, and have been following his work since on the UK forum since before he even popped up on your radar over here; I even considered him at one point for my upcoming procedure. I never said he was a terrible surgeon or does terrible work, just that his results don't impress me anywhere near the same degree as a number of the top European/US doctors do (and yes, I'm talking a collective amount of patient posted results here, not one offs or clinic posted as you seem to suggest. Think Dr. Bisanga, Ferduini, Konior, H&W etc etc on here.... De Freitas, Ximena Villa, Pinto etc over on the Spanish forums. Unimpressive results, whilst they do happen, are in my opinion rare/occasional with these high caliber surgeons, as well as others... that isn't a comprehensive list, just some off the top of my head for anyone reading). In my eyes his results just aren't on par with those sorts of surgeons I mentioned - I'm not a fan of the large graft numbers in a single day, and indeed just in general with a number of the results that I've seen so far. I've also seen some pretty good results for the record. Isn't the whole point of this forum to have an open dialogue and try to offer information to other users, I may be a newbie on this site, but I think I've amassed a decent amount of knowledge on the subject of hair transplantation in the past few years during my research. I'm not really one for online forum posting, but I felt that I owed it to give back some knowledge to those in the same position as I was a few years back looking for answers, so I joined up to do so. I was just giving advice to the OP of the thread as its a decision we all know will impact the rest of your life, so I advised what was best for her in my opinion. So, I'm either a shill, using a duplicate account or a previously banned user? Hmm ok then, makes sense. Go ahead and check my IP, my fist time joining the forum mate. As for being a shill, most of my posts have been on a couple of threads regarding meds as I'm interested in the prevention/medical/scientific side of things - who am I shilling for exactly, Merck? Also, when did I say I was an expert in anything. That was all you. To be honest I don't even know why I've taken the time to write this lengthy response back, but I think it's good for people to see if this is how you're going to act just because I, what, said I'm not the biggest fan of a doc who is recommended here? I came here to offer a bit of advice where possible and post my own Transplant results with Pinto at the end of the year to give back, it's not really something I absolutely couldn't wait to do, in fact I'd rather not, but I felt it was only fair to pay it forward. But, and look I do have some respect for you for moderating the site Melvin; it's existence helped me a lot, if you don't approve of me and you want to accuse me of this and that then fair enough I'll just be on my way and you can ban me and delete this comment - as I have a feeling you might just do - it makes no difference to me.

Whilst @LaserCaps is correct, it is usually more expensive for a no shave, as I mentioned in my first post, Dr. Pinto (as far as I am aware and I know this as I've just booked in for November) doesn't charge extra. 2.60 EUR per graft at the time of writing. Look up some of his results on the Spanish forums, and if you're a fan, well there's a good option for you to consider.