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Ferreira is great, nearly pulled the trigger with him myself but went for Pinto in the end. Good choice.

Yes, Finasteride will certainly affect your Testosterone levels. If anything, DHT is probably the least noteworthy thing to look at in your bloods as you already know its going to drop by 60-70 odd percent, so it's expected. Not saying you shouldn't include them in your test, obviously do so, but the results will, expectedly, just show that DHT levels are low, likely well below the reference range. Which is the whole point of course. If you want to get your bloods done properly, it's somewhat complicated and most doctors are pretty awful with endocrinology and interpreting blood results, on top of that, you have to use the right methods to get an accurate reading. You really want to get high-performance liquid chromatography with tandem mass spectrometry testing, as I learned from Derek from MPMD. without high sensitivity testing, results can be very inaccurate, see this article for detail and try to really understand what is being talked about https://moreplatesmoredates.com/the-most-accurate-testosterone-blood-test/ In terms of what to generally look out for in a blood test, this video will cover absolutely everything you need to know, so take notes: Hope this helps.

I understand your concerns - and by the way, I wasn't suggesting you were neurotic or anything, I was just saying if you happen to be the overly anxious, paranoid sort of type then it's probably best to steer clear and not nocebo yourself into a bad state as people like this generally always tend to convince themselves of the worst, even when there's nothing actually physically wrong. Anyway, as I say, I can understand your position after reading that you've had bad experiences in the past. If you don't want to take it then that's completely up to you of course. You don't have to, you just have to accept that you're much more likely to experience further loss than if you did take it. Regarding your pic, you don't have too much more to lose on the top, no. But, you're essentially a NW5 from what I can see, however it looks like your crown doesn't dip down the back of your head at all, and your sides aren't too low, although they are dropping a bit right now by the looks of it. So all in all, based off that pic (would need to see different angles really to judge properly) you're a somewhat less severe NW5 maybe. So, although you might think you don't have much more to lose, go and look up a NW5 vs a NW7, that crown - could - easily drop another few inches deeper into the back of your head. Not saying it will happen, in fact, the fact you're 55 and it hasn't is probably a pretty good sign that you won't go that far, would be best to get examined by a good surgeon. You certainly could just go ahead with a couple of Hair Transplants and forego the meds, yes. With your age, you could well be correct that there is little left to lose, and you very well might not lose too much more hair now. But like I say, you could still progress to a NW7 in say the next 10-20 years, I have no way of knowing. If I was you I would consult with some great doctors and get their take. And get scalp examined for miniaturisation to predict future loss. A good doctor is probably going to advise two procedures a year apart; the frontal third first at probably 3 to 3500 ish grafts, followed by the crown/midscalp at around 2-2500 grafts. After this, you might have anywhere from 0-2000 grafts left for any future procedures. depends on your donor, but you'll probably be looking at being close to your limit (if you go straight FUE anyway). I don't think it is the most irresponsible decision in your case to go ahead without fin considering your age, and I imagine as long as your donor is decent and you're not clearly miniaturising into a nw7 pattern upon examination, most doctors will consider you to be an ok candidate without the fin. I would get in touch with Dr. Bisanga, Dr Bruno Pinto, Dr Ximena Villa, Dr Ferudini, Dr. Bruno Ferreira and Dr. Rafael De Freitas and get their take, but that's just my personal list of my current favourite doctors. Do your own research and come to your own conclusions of course. If you're in the States, and don't want to travel (all of those options will be considerably cheaper than US docs and just as good/better than some, but it is a long way) then look at Hasson and Wong, Dr. Konior, Dr. Shapiro, Dr. Cooley - there's more but that's just off the top of my head as I've never considered doctors over the pond.

Hi, What meds were they if you don't mind me asking that you took in the past that were similar? Because unless it was Dutasteride, I doubt it was similar in any way to finasteride; these are medications that block the 5-alpha reductase enzyme (to different extents, finasteride to a substantially lower degree and Dutasteride to a higher degree whilst also blocking an additional isoform of 5a reductase that is found in different tissues that shouldn't really be relevant to hair loss). If you look at my post history, I left a comment for another user regarding finasteride yesterday, I don't want to repeat myself, so check it out. But essentially, the simple answer is: try them and stop if you feel you need to, there's not much more to it than that. The only caveat I would have to say is that if you are a particularly neurotic type of person, for lack of a better word, who worries non-stop about things then I wouldn't even bother for obvious reasons. PRP and laser therapy aren't valid alternatives to fin unfortunately, neither is minoxidil alone. The only way to tackle the root of the problem is to reduce the amount of overall androgens (DHT in particular) available to reach the androgen receptors in your hair follicles. Minoxidil may aid growth for some people, for others it doesn't do anything due to the lack of the required sulfotransferase enzyme that some people naturally are missing in comparison to others (this is necessary for monoxide to work essentially, although it can be negated somewhat by taking oral minoxidil). But even If it does work, it's not going to prevent further loss. As for having to take fin for the rest of your life, if you don't have sides, which is overwhelmingly likely to be the case statistically speaking, there is really no issue. But in any case, I'm pretty confident that there will be a number of alternative treatments available in the next 5-10 years that will be just as, and I would argue likely more so, effective than fin and should hopefully come with a very minimal side effect profile (finasteride already is minimal, but hopefully the things I'm talking about won't have systemic absorption, that is the plan). None of that is guaranteed of course, maybe no treatments will come out (although I think that is unlikely) but my point is that I don't think you'll have to take it for the rest of your life if you don't want to, but until alternatives are available, its wise to hold on to what you have. also, the fin may drastically improve your hairs current state, and on top of that, it will protect your donor hairs too. Additionally, unless you are a Norwood 7, trust me you can lose more hair, even if you're a NW5 now and you feel you're pretty much as bald as you can get, your sides can drop an inch, and your crown can dip two inches at the back and then you're pretty much screwed - this is particularly relevant if you're still young/showing the potential for this to happen (you'll need to be examined with a dermiscope or something similar by a competent dr).

I'm glad I could help out in some way. As far as the possible birth defects go, there is no evidence to state that this is possible scientifically speaking or that it happens in any way. Studies have shown that, whilst some levels of finasteride can indeed be measured in the sperm of a man who takes it, they are in very small amounts and aren't going to transfer over into the DNA passed on and cause issues. There are zero (confirmed) cases of birth defects linked to the use of finasteride, I'm sure you can find the odd anecdotal story online of people who say that they unfortunately had children with birth defects whilst on fin, but you have to remember that even if true, there is an incidence rate of this amongst the general population, just like anything else in life (not that these stories are common or anything, I've never personally seen any, but I'm sure you can find if you look). I'll say this, I'm sure that with tens and tens of millions (probably more) of guys having taken this drug over the course of numerous decades at this point, the number of babies that have been conceived whilst the father was using fin must be extremely high; I don't see how there wouldn't' be some sort of causal link noted by now. It's a possibility in theory, yes, but it's really not something you should worry about. Now if the mother were to take fin, then that's a different issue, it would certainly be extremely harmful and potentially cause birth defects, same as if a developing child were to (I'd imagine it would have to be on a regular basis to actually cause real harm realistically) ingest finasteride - it would permanently halt the development of many important things. So those two things are a clear no no - keep fin away from kids and women who might become pregnant for sure. But at the end of the day, if you want to just play it safe, I can respect that. But instead of never taking it, just simply take a break from fin when trying to have a baby - it's really that simple. As long as there's no issues and you're not trying for years or something, you shouldn't lose much ground over the course of a number of months and you can just re-start after. Hmm, the Gyno is potentially something that fin could affect - you're still very likely to be just fine - but if I was you I would just get a blood test before taking fin and during taking fin to measure Estrogen levels - it's that simple. The only reason fin can potentially cause Gyno (rarely) is because once you take it, you have more testosterone floating around your bloodstream due to the fact that finasteride blocked whatever proportion of it from being converted into DHT. But, Testosterone doesn't just convert into DHT, it also aromatizes (turns into) to Estrogen, higher levels of which in a male will cause Gyno over time. So, if you were really concerned, just get your bloods taken periodically and check your Estrogen levels (get a blood test before hand and compare to baseline), if they rise significantly, then you know you're at risk. If they don't, then you're not at any risk, at all. Here, read this article, it should cover absolutely everything you need to know in regards to this: https://moreplatesmoredates.com/finasteride-gynecomastia/ Hope that helps you and anyone else that comes across this in the future!

Bit of a strange post. You're just scaremongering potential newbies who are coming here for information without any prior knowledge; I feel bad for you of course, but this is completely nonsensical. You had what is, by todays standards, basically a surgical procedure from the dark ages. Things are very different today than they were nearly 45 years ago. Hair transplants are performed completely differently and have come a very long way. That's not to say people don't still get butchered regularly and end up with terrible results, excessive scarring and physiological issues not unlike yourself, but that's why this forum exists... so people can avoid that. As long as you do your research, are aware of what you're getting into and go to a very good doctor, there is essentially zero chance of these things happening. the simple fact is, if you're a good candidate for surgery to begin with, are proactive at maintaining your native hair and make wise decisions regarding choice of doctor etc, you can have your hair restored and enjoy it for a very very long time; well into your later years in life.

Work looks good, I'm sure you'll be a happy man come next year. Word of advice though, I'm in a somewhat similar situation as you, except I'm a few years older and my loss is a little bit less severe than yours was here, but you should really re-consider the use of fin. You said you only realised you were losing hair 3 years ago - what do you expect to happen in another 3? Even if it slows down and you're still ok in 5 years, you're pretty much guaranteed to lose more hair as time goes on and no one knows to what extent. Maybe you'll run out of donor, who knows. Not to mention the aspect of potentially chasing your hair-loss through surgery every X amount of years and having the financial and emotional burdens (recovery time etc) that this will incur. Just a thought, I see no reason not to give it a go and see how you get on. I understand you're afraid of sides but you should go and look at all of the long term clinical studies on finasteride. There are a fair few, up to the span of 10 years, with thousands of participants collectively involved - you can look up the incidence of side effects vs placebo, drop out rate due to sides etc and gain a more rational understanding of the likelihood and actual severity of side effects as opposed to reading horror stories in the echo chambers that are most hair loss forums. No one who is rational is saying sides don't exist, of course there's a possibility, albeit statistically slim. But if you took it and were really are convinced you truly had sides, then just stop taking it. The idea that they can be permanent has no scientific proof, and even if this was true (which I obviously do not believe) the chances would be so slim that they would be insignificant statistically speaking. Lots of drugs that people routinely take and don't bat an eye lid at have the (slim) potential for catastrophic consequences. An example being I had to have an anti-coagulant injection after breaking my leg a few years ago, right before being administered the Dr. casually informed me that there is a very small chance it could lead to fatal internal haemorrhaging of the organs, including the brain and leading to a massive stroke and causing death very quickly, and advised me to ring an ambulance straight away if I have any strange symptoms such as a severe headache etc. I still took it of course - as I'm sure tens and tens of thousands of people do every day across the world. Bit of a tangent, and I don't wish to have any debate about fin with anyone as it's been done to death a million times, but you see my point. It's ultimately your choice, but you might live to regret it big time. All the best with your growth anyways!

I believe some doctors do charge more for afro hair (I'm about as pasty as you can get, so I've never researched into afro hair too much for obvious reasons haha, so I'm not sure how common it is) as it can be more laborious and time consuming I believe, resulting in a higher price; similar in principle to how FUT is cheaper than FUE.

Hi Hrnzaire, I would definitely wait it out (if needed) and go with Dr. Bisanga, no question. I know he's recommended here, but I've never been too impressed with Dr. Arshads work since first seeing him on here. Nothing against the guy, and I have seen a couple of pretty good results out of his clinic, but also a fair few that I think fall short of what is expected. Especially with yourself having Afro hair, and it being FUT on top of that, I would go with Bisanga who has decades of experience working with both of these factors. I'm pretty sure that Bisanga's price will probably even be a bit cheaper than Arshad with his £5 per graft quote (don't quote me on that, I'm not certain), so it's really a no brainer to me, he's probably the best in the entire world for Afro hair (and one of the best in general). Hope that helps!

You absolutely don't need PRP, so if the doctor is insisting that you do then he may well be trying to upsell you as you seem to be suggesting. It is debatable as to how efficacious PRP is or isn't, both from anecdotal evidence from clinics/patients and also within the existing literature on the subject. It seems for some that it can help to regrow/maintain hair, but for most I would have to go out on a limb and say that it does nothing but drain their bank account. That's not to mention the fact that there is absolutely no regulation around what actually constitutes/makes up a PRP treatment; most places will employ their own techniques of how they prepare it, some may actually be useful, whilst others may be completely ineffective. What I'm trying to say is that there is no standardisation and you don't know if you're getting the most half-arsed PRP treatment possible or not. In any case, I'm not really a big believer that it does much/anything at all to help. In regards to the surgeon not being able to plant grafts as there is already a fair amount of hair there that is miniaturised, that is fairly common practice. Some surgeons opt not to implant in thinning areas too heavily as they believe it will shock the somewhat unhealthy hairs and they will never come back, others seem to have no problem doing so and will implant in the existing hair, I've seen lots of cases of both, but either way there's nothing suspect about him saying that. As for finasteride, he is right there. It very well might allow for regrowth in the crown and as a result the need for grafts to be placed there may be negated entirely, so it is best to give it a go for a year or so and see if that's the case or not. Also, if you're progressively thinning (as essentially everyone who is balding due to AA is) then you're just going to keep losing hair if you don't take finasteride - with it, clinical studies show around about an 85-90% chance of maintenance or improvement from baseline at the ten year mark, with no data beyond this time, bit it will continue to work. You will still lose hair over the decades, but it will be at a much slower rate and maybe you can stave off another hair transplant for a few decades (- maybe -) rather than (potentially) a handful of years if you don't take it. Yes, that is generally how it works; you transplant hair where you need it, then if/when you lose more hair down the road, you fill those areas in too (donor reserves permitting). To be honest, I would suggest forgetting about Harley street clinic, I believe that's where Dr. Reddy worked, but I think he has left/opened his own practice? I'm not sure to be honest, but you mentioned it would be a dr raja doing your procedure in any case. If you absolutely have to stay in the UK, Dr. Reddy seems like a decent choice, he is the only Dr. I would personally let touch my head in the UK, but for cheaper/a similar price you could easily go to the best options in the whole of Europe: Dr Bisanga, Dr Ferudini, Dr Bruno Pinto, Dr Rafael De Freitas, Dr Bruno Ferreira and Dr Ximena Villa is my personal list.

It certainly isn't over-harvested to a terrible degree that has left tracts of scar tissue all joined together like you see a lot of the time from really bad surgeries, but I would have to respectfully disagree with Melvin a little and argue that it is an overall poorly planned extraction that for whatever reason has left you with undeniable patchy areas in your donor. I would hazard a guess that your hair wasn't super dense before the surgery to be fair (could be wrong?) and so that may have contributed, but either way planning should take this into account and I wouldn't really expect to see any signs of over harvesting from a reputable doctor. If I was you I would get some opinions from some really high level surgeons and see what their take is.

It's shock-loss from the procedure, not scarring. It happens sometimes and is mainly due to the general trauma induced and anaesthesia/epinephrine injected into the area which can temporarily reduce blood flow to the hair follicles and force them into a Telogen or resting phase, which typically lasts 3 months or so. So it should start to recover in the coming months - I wouldn't expect any real improvements for a while yet. As to why it has only happened above the ears and not at the back of your head, this seems to be a fairly common occurrence with shock-loss from what I have seen and heard from experienced doctors. There will obviously be some scarring in the end as with any hair transplant, the extent of which will depend on how good of a job the dr did with the extractions (i.e. if he over-harvested or not, and how well you heal as an individual, both of which you will find out later on down the line.

Do you have any pictures of it grown out? it's impossible to say really without seeing it after say, 6 - 8 months or so, as I personally think that if it's still patchy/visibly lacking density after this timeframe then it's most definitely going to be a case of over-harvesting than simply shock-loss. I assume it is obviously looking patchy as you have said you're concerned about your donor, and it must have also been at least 6 months since the surgery since you said it was last year, so it very well may be over harvesting in my opinion unfortunately. As far as the extractions go, it doesn't look awful, but I'm not the biggest fan of it based off of your pictures - seems like some of the punches were taken a bit too close together to me and have almost formed sort of rows or lines if you see what I'm saying as a result.

Hi DJ, I'm a longtime lurker of the forum for a number of years, first time poster as I'm not much really one for online posting, but I thought I might be able to give you some recommendations and help out as I have been in the same situation. The head shaving and exposing what I have been doing my best to hide with hairstyling for all to see for a good 4+ months post op is also something that has really put me off since I began researching a few years ago, and honestly it seems there are limited options Europe wise for a non shaven recipient (I assume you're ok to shave the donor short for extraction and just leave the recipient unshaven anyways?). There are a number of good docs - Bisanga, Lupanzula etc - that partially shave the recipient area just on the borders of the implantation zone where the grafting will blend into native hair, but I also didn't want that either as it seems sort of pointless as you would be unable to style your hair as usual. The only doc that I could find that really offered a fully unshaven recipient zone was Mwamba, who I nearly pulled the trigger with, but ultimately the lack of patient and even clinic posted results put me off and I decided against in the end. Nothing against Dr. Mwamba though, he is an extremely competent doctor with a long time in the field and is without doubt a good surgeon, I just didn't want to go ahead without any real case references. In the end I was considering Dr. Bruno Ferreira or Dr. Rafael De Freitas and just biting the bullet and shaving my head as the end result is what really matters, but I came across Dr Bruno Pinto who, in my opinion, does work on par with the likes of De Freitas etc, and also offers unshaven recipient in the right cases (yours seems like one that fits the criteria from what I can see). If you go on the Spanish forums (there are two for some reason - recupera tu pelo & recupera el pelo) he has 40+ patient posted results from start to finish, pretty much all of which are very impressive. There is only one 'failure' in which the poor guy's results weren't very good in terms of growth and he later was diagnosed with Lichen Planopilaris after a scalp biopsy. Have a look anyways - I've booked in with him myself, not had actually had surgery yet so I can't really comment on anything else other than the results have impressed me, but maybe this will help you!