JDEE0

Yeah, I'm with you there too, however when stacked with some sort of 5AR inhibitor, I would feel comfortable even just doing it 3 times a week/every other day/just when I can remember or be arsed. Since you're not really relying on it at that point and it's just supplemental, it would still be a good protocol overall imo. Obviously wouldn't be as effective as the intended daily application, but certainly still beneficial and dosing schedules could always be ramped up if it became clear loss was progressing (although 3 times a week is still a bit of a pain, it's a small sacrifice for the greater good). Topical dut once a week or every 10 days would be completely fine, wouldn't really be a nuisance at all to me at that frequency. Yeah, I think that's probably the best bang for your buck strategy or plan in terms of halting hair loss vs risk-reward ratio for someone like you who is a bit hesitant to hop on but obviously still realises the benefits for stopping loss. I have indeed actually questioned that before and posted so on here when all the threads initially started popping up around topical dut last year. There was quite a lot of anecdotal evidence from users on here and other sources online that it only reduced their serum DHT by a small amount, 10 percent or so, so I felt fairly convinced that it doesn't go too systemic for the most part. And people can just do their own bloodwork to confirm this aspect of things, so it's all good there. But like you say, I wasn't sold on whether it actually worked and questioned if the lack of systemic activity suggested that it really didn't do much. However, at the time, there wasn't much in the way of evidence, which is still true, but if Hasson's data is good (as he suggests it will be) then it will be clear that it does actually also work to stop loss and this has given me a lot more hope that it will be effective.

Yeah, I understand, but there will be no real consensus amongst people here unless we're just talking scientific in which case it would be use a 5AR inhibitor, but I know you're trying to avoid doing so which I can understand. I would probably suggest using topical dutasteride and getting your bloods checked periodically for a 6 months to a year or so to see what drop you get in serum DHT. You'll most likely be fine, have no sides and not notice much reduction, beyond that, you can always quit if you feel the need to. Topical AA's are interesting, just very problematic in that we have no real data on any and no official sources apart from black market Chinese labs. You can still get good quality stuff relatively easy so that's less of an issue, but again, no real data on efficacy or safety. Either way, I think all available and future topical AA's in the pipeline will help, but are ultimately unlikely to be as effective as finasteride or dutasteride and will be much better suited stacked alongside.

Hi mate, I don't really believe that the concentration of DHT or any other androgen is the main, driving factor behind MPB. It certainly plays a role, but as you allude to, it's almost certainly down to a follicular sensitivity to said androgens due to genetic factors in our DNA. It plays a role because if you do have some level of sensitivity, then of course more of the active hormone itself in your body is going to worsen the issue. But at the same time, you can have huge amounts of DHT and very little sensitivity to the point you basically never lose hair. Think of a bodybuilder who never really had any hair loss, but started blasting massive amounts and lost decades of hair in a 5 year span or something due to the massive increase in androgens. My point is, most people with MPB fall within the reference range for serum DHT levels and have similar measurements to yourself as opposed to sitting somewhere at the top or slightly out of it. Here is a study which shows the average levels of DHT of around 400 men before treatment to be roughly 390/400 ng/ml (+/- standard deviation, so some a bit higher and some a bit lower in reality, of course) https://academic.oup.com/jcem/article/89/5/2179/2844345 I'm just trying to say that most people who take fin are going to be pushing themselves way out of the reference range, and this should be taken as a given for most people rather than the assumption being that you would take fin to only push you to the low end of the range.

Good choice! I stayed for a couple nights, arrived Wednesday, had surgery on Thursday and flew home Saturday morning. The clinic pay for one night in a hotel for you (I think it's called the Bessa Boavista if you wanna look it up). It's only a 4/5 minute walk to the clinic and the hotel is nice enough, so I just asked Emilio if he could book me in for a couple extra nights that I just paid for once I got there. Was gonna get an airbnb, but since they already put you up for one night it was just easier to stay there for 2 more nights and it was very convenient being only a few mins away. It's not ideal walking back from the clinic to the hotel right after surgery looking like you're deranged haha, so it was nice to get it over with quickly. I'd suggest just doing the same as I did if you're staying a couple extra nights.

I was under the impression that some surgeons in the U.S/Canada also had potential waiting times of up to a year or so (H&W, Konior and so on) but I've never tried to consult with any seeing as I'm in the UK, so maybe not, could be a more this side of the pond thing. Yeah, they're all led by one doc, but some do multiple HT's per day and are more tech oriented than others. Ferreira and Pinto for example do everything themselves, from extractions to implantation, whilst others such as De Freitas and Couto take more of an overseeing approach with their their techs doing the extractions, and so on. It is crazy though, I'm with you on that, especially people like Couto where you really struggle to even get a consultation let alone a date for surgery. If you do manage, you're looking at 2 years minimum! Personally I could never wait that long, up to a year I can understand, but more than that I would find someone else.

There certainly are many clinics who have waiting lists of over a year, some up to and over two years... No one is saying that they don't have cancellation lists, of course they do, but try and book in with any top doctor in Europe at least and you'll most certainly find that their initial dates for you are a year or two away. Not sure what the 'be real' is about, it's common knowledge. I had a 12/13 month waiting list for De Freitas when I contacted him a year or so ago, and that's on top of the initial 2-3 month reply for the online consultation, even longer for Couto who I couldn't even get in touch with. Ferreira is now not even taking consultations he is so busy, but I was told the next available date I could be booked in when I contacted him was about 10 months down the line.... the list goes on. They're not losing any business, it's a direct result of their demand being much higher than their supply. They have a surplus of people wanting surgery with them, not the other way around.

I had surgery with Dr. Pinto back in November (you can check my thread out on my profile if you wanna). He speaks very good English (as well as fluent Spanish and Portuguese, obviously). Dr. P has a pretty huge patient portfolio on the Spanish forum/s with 60+ patient posted results, just not many on here. DM me if you would like a link.

Thanks man, much appreciated. Glad to hear you found your way to a good surgeon such as Dr. P. Will you be posting a thread?

Looks as expected - you'll probably experience more shedding over the next 2 weeks, and maybe even up until month 2 or so.

Cheers mate, I appreciate the encouragement! I'll post another update in a few weeks at the 3 month mark so we shall see how it progresses now things are starting to pick up and happen a bit!

As others have said, you're getting older and the problems you describe happen to quite literally tens of millions of men every year, often spontaneously and often with increasing prevalence as the years tick on by and with no explainable cause. Personally, I highly doubt the root cause has anything to do with fin seeing as you have been taking it for so long, it's far more likely to be caused by hormonal changes with age, stress from work, maybe getting out of shape and not being as fit as you once were (speculation of course, you might be in great shape, I don't know), being with the same partner for decades who no longer gives you the same feeling or fulfilment as when you were 25 and so on.... I don't mean to overstep the mark there or make any assumptions, but you get my point, as the list really is endless in terms of what can affect this sort of thing. This is very common in all men, fin or no fin, as they get older. Just look up rates of ED etc by age group in whatever country you're from, and you'll see exactly what I mean. Most obviously don't use fin and it happens anyway. With that said, if you think maybe it really is being caused by finasteride (which I personally doubt based on the history you've given, but it's certainly possible, and only you know your body) then it might be worth stopping for a bit and seeing how you get on. There is really no way to know either way, no matter what doc you see or what tests you do, no one can tell you one way or the other at the end of the day. It would all be conjecture or speculation. Really, the only thing you can do is make the necessary change if you feel you need to and see if it helps or not. Even then, it could be nocebo, who knows, but I wouldn't rule out trying if you think it could be the culprit.

Hi mate, just wanted to post and say don't jump the gun too early and think at this point you will need a repair job or anything, I actually think it's looking pretty good man, although I of course understand the creeping doubts that inevitably set in as the weeks and months go by and you might not quite be where you hoped you would be right now (with a full head of early growth hair haha). Either way, you've got a while to go still man, like I say, don't worry too much just yet, I actually think you're on track and will be pretty happy with things by the 7-8 month mark for the most part. Maybe you won't have the exact refinement in certain areas that I can see you now appreciate at this point after spending a lot of time on the forum and becoming a bit of a HT nerd yourself, (i.e. if you're not completely happy with the temporal points blending in to the native hair exactly as you would wish etc) but that can always be addressed in the near future (if it is needed in the end, as you have said). Month 5 is early days and things are coming along nicely, give it another couple of months and I'm confident things will be even better.

Cheers Digi! I'll do my best to keep the updates as detailed as possible. I saw you posted an update recently actually but I was rushed for time so didn't get the chance to check it out, I will do so now. P.S. - I saw you mention the other day that you were considering going to Dr. P if needed at the end of the year (I don't think it will be necessary for you just as an FYI), but if you have any questions or anything you think I could maybe help you out with then just shoot me a message mate.

Thanks Melvin - hope all is going well with you, mate... keeping an eye out for your thread to see your next update!

I had a hair cut yesterday at exactly 10 weeks post-op and thought I'd post an update for the the donor mainly, as I believe it to be completely healed now and I don't think it's going to look any different in 6 months or a years time from now really. Hopefully helps to document and show how very short hairstyles can (everyone is different, so it's not to be taken as you will look the same, could be better, could be worse, but still) look after FUE when done with an appropriately sized punch in the hands of a good doc. Also added a couple of pics of the recipient (left side only) as I may as well since I'm already giving an update.

Yeah, pretty much. A hair transplant does nothing to treat the cause of MPB, it only 'replaces' what is already lost. You'll continue to lose hair in whatever pattern you are genetically predisposed to. The speed at which is variable, say you do start as a NW3 and are destined to end up a NW4 or so in the next 25 years, then you probably won't notice any separation between old and new as quickly as 2-5 years, might take double that before the loss catches up. But maybe you're destined to end up a NW6 in the next 10 years or so, then yeah you'll probably experience what you've described above. This is why it's recommended that people use preventative meds that slow hair-loss down drastically if you are young and or likely to progress further along the NW scale. At the end of the day though, everyone is going to continue losing to some extent meds or no meds, and all of this is why you also should never get a HT if you have a one and done mindset, especially if you're say a NW3 and clearly have more hair to lose. You just have to accept the inevitable that you will need multiple transplants over your lifetime.

Surprisingly, he went to the Wimpole clinic in London (I say surprisingly because he's had a good result from what I can see, and that clinic is not good). He has said himself publicly, if you google his name and the clinics name you'll get some articles

Any chance you could just post some pictures of your hair combed completely back both wet and dry? Don't get me wrong, if you're not happy with the outcome, then I understand why you're going for a second HT and I'm not trying to call you out or say you shouldn't feel the way you do. But, it does seem to me that most of the photos you have posted have some sort of downlight above your head, your hair doesn't seem to be particularly styled either (you seem to go more for the more natural messy textured look) or you're just spreading the hair to show the weaknesses. My point is that I don't think many hair transplants are going to provide fullness in these conditions - the hair is somewhat going in different directions and angles due to the messier style you have as it allows it to flop around and not all be layered together, if that makes sense, and once you add some downlighting into the mix, light is going to bounce off and show scalp. Your 8 month update on page 4 for example doesn't seem to have any downlight and your hair looks solid and I see no scalp or density issues in those pics as a result. I would imagine in this style and just being outdoors or anywhere not directly under a light, it looks completely normal? Really I'm just wondering how it looks in say normal light stood by your window or something just combed back.

I see what you're saying, to be fair I have heard the Italian one does that now you bring this up (although I have seen lots of meh results on there that weren't deleted from well known surgeons), but the Spanish forum doesn't, they leave up all reviews as is done here. You can find the good and bad of all surgeons who post on there. In any case, I'm not suggesting we link up with these forums or something, I'm just making the point that there are numerous surgeons out there already in the world who are well respected, have good reputations and lots of patient posted results; I just don't see the point in adding unknown surgeons with none of this to the reccomended list here when there are more people like De Freitas out there to push people towards or look into and perhaps ask to post on here (which I assume is what happened with him as he was recently added here last year and without any real patient posted testimonials, but that's fine with me as he has a lot on recuperarelpelo).

I agree with the above sentiments already posted, but I'll give my own 2 cents also. I think that any clinic to be added to the recommended list should have had a steady stream of real time patient posted reviews for some time, with a clearly positive trend in results over said time (and it doesn't necessarily have to be just on this forum, someone like De Freitas is a good example of this as he has tons of reviews on the Spanish forums). The problem is, as @Curious25says above, any clinic or surgeon with at least a bit of skill can and does get good to even great results a certain percentage of the time. I do think Felipe's results look really good and have been impressed by them, and I'm sure he's a good doctor, but you can go on YouTube and type in Cosmedica or some other similar clinic and you'll see a number of quite impressive results... Point is that really most clinics can cherry pick a handful of their best out of every few hundred (or more) surgeries performed and most likely impress whoever they're showing it to. In my personal opinion, a clinic should only be considered for recommendation once they have a decent body of patient posted work out there on one forum or another... I understand this takes time (probably a few years), but it's something you can't fake. There are enough surgeons between say this forum, the Spanish ones and the Italian one who have this and either aren't recommended by this site or aren't really even talked about much by it's representatives. Makes more sense to me to invite these types to post more and consider an already established clinic for recommendation in the process (although I'm aware not everyone is interested in joining). With newer and as far as I am aware more unknown clinics that have no real patient portfolios out there such as in this case, it makes sense to ask them to get some patients to post on here for a while and then re-consider.

Never heard of this doc and I've never seen any cases on the Spanish forums. Just pick Dr. Ferreira or Dr. Pinto if you're in Portugal, there really is no need to look any further than these two.

I think they're all good choices and great clinics, although I would go Pinto or Ferreira out of the 3. Every clinic has unsatisfactory results, and the two cases you're referring to are quite hard to actually judge in my opinion as the 2 guys do seem to have exposed the weaknesses of their HT's in their threads and I struggle to actually see the full clear picture (not having a go at them or saying they're in the wrong, if they're unhappy that's fine, I just don't think I can judge properly based off the pics they've provided in their threads). There are many clinics in the world who are great that the doc doesn't do the steps you've mentioned, so it isn't causative to good results, although I personally do like the touch and it was much appreciated and put me at ease with my own surgery with Pinto. I'm pretty sure all 3 will provide a free of charge top up if the doctor feels the result isn't quite what they themselves are happy with.

Nope, the others are referring to grafts, whilst the UK clinic is referring to actual hairs. A graft has an average of around 2 hairs in It, so their 1800 grafts equals 3600 hairs as they say. it's half the amount of all the other quotes basically, and is nowhere near enough for a good result for you I don't think. It's hard to say exactly as the first picture your hair doesn't look too thin in the frontal 3rd, but in the second it looks very thin. I imagine the second is a more accurate representation of the harsh reality, so I think around 3-3500 grafts is a fair quote for you. Honestly, Yaman is the only one on the list you should even consider, but even then I would strongly urge people to spend a bit more and pick a better option as he is pretty much the lowest you can go and still have some decent quality. Have a look at this list, you really don't need to look any further than it. My opinion is that all the doctors from (and including) Dr. Vila onwards are world class, best of the best category HT surgeons with very little difference in quality even as the price increases (which start at 2.5 EUR per graft): https://www.hairrestorationnetwork.com/topic/61215-top-doctors-table-prices-technique-doctor-involvement/ The cheaper doctors in the list previous to Vila are also decent options too if you're really on a budget, but like I say, the others are all top tier choices out of all surgeons worldwide and I would just pick one of those, a minimum price of 2.5 EUR per graft is not that expensive. People like Aygin might be mentioned in GQ articles, but it doesn't matter. Hair transplants are extremely tricky as very few people really know the ins and outs of them (only really us forum dweller types), most people see a clinic featured in a popular magazine, that picks you up in a brand new Benz from the airport, puts you up in a 5 star hotel and has brand new modern facilities and assume it means they are quality. But it doesn't, trust me. The journalist who wrote whatever article you saw probably got caught up in the exact same trap himself when doing the research for his piece, and he/she also has no idea about what makes a good HT surgeon. Aygin is a bad choice. Actually, here's a case of a guy who went to Aygin recently and incidentally ended up to go to the same surgeon I just had my hair transplant with to get it fixed up a little. Now, it's not a terrible butcher case or anything, but it's just poor quality, and as you can see he wouldve been much better off just going to Dr. Pinto the first time around; would've saved him money in the long term, some grafts, scarring and a lot of stress/time - 2.6 Euro's per graft is extremely reasonable to begin with.

Digi and the others have given you good advice and valuable insight. I'll just say this, and I mean no offence, but it's clear you've only recently had the idea of undergoing a HT and really know very little about the overall subject itself. I don't think you know what makes a good surgeon/clinic, what practices to look out for and avoid, what can go wrong, how often this happens (especially with clinics such as the one you've chosen) and the resulting consequences that can become a living nightmare if this happens to you. I would strongly suggest cooling your jets, spending a few months (at least) reading and researching on this forum, asking questions, looking at results, and overall getting to know about the intricacies of the overall process. It might just save you from making one of the worst decisions of your whole life.

Completely depends upon location. I'm not going to include hair-mill prices as I would never ever recommend anyone go to them, but for world class surgeons, the price is going to vary significantly between North America and Europe. As you have said, for good surgeons in the U.S. and Canada, you're probably looking at between 6 and 10 (and above in some cases) dollars or so per graft on average, in Europe, (generally) between 2 Euros at the lowest and 5 Euros at the highest per graft on average. Most fall in the middle at 3-4 Euros per graft, and again, I'm talking about top surgeons here, you can obviously find cheaper in Turkey etc, but it's a no from me. I had a similar hairline to yourself and paid 2.6 Euros per graft at Clinica O Porto, but here is another useful list of doctors and their prices in addition to the forums officially recommend list that Melvin has linked. Between the two, you have all the options anyone would need to ever consider for a HT: