GoliGoliGoli

It seems you are illiterate both in the classical sense and also in the scientific sense, but I will still try my best to explain my original point to you in another very long winded post. The TLDR is that you're misunderstanding what I'm saying by focusing on the follicle, whereas I'm talking about the entire scalp region and how it's health is impacted by DHT (and other factors not including DHT), and how the health of this entire scalp region (and not just the follicle) affects ones ability to permanently take hairs from the donor and plant them in the recipient. You'll notice how in the first very long winded post I use the world "scalp" 5 times and the word "tissue" 4 times, but used the word "follicle" only once. There is a reason for this as I'm very careful with my words. Hair health is directly influenced by the tissue the follicle is planted into and by using "scalp" and "tissue" I'm including both the follicle and the surrounding scalp tissue, whereas if I use the word follicle alone like you did that changes the entire point. The exact mechanism by which DHT causes hair miniaturization is completely unknown and at best people have different theories, but it seems that it's a combination of factors going on that affect both the hair follicle itself and the scalp tissue the follicle sits in. As I said there are competing theories on why DHT causes hair loss. There is the theory that DHT could be causing genetic changes in the hair follicle that cause it to shrink (This is very odd though given it has opposite effect in all other hair follicles in humans and all other mammals); there is the theory that DHT could be causing inflammation and slowly damaging the area; there is the theory that DHT is negatively impacting blood flow to the area. No one really knows and it's likely a combination of many different things, some of which have nothing to even do with DHT. So to circle aaaaall the way back to my original point: If you agree that the health of the scalp tissue plays a role in hair health, then it stands to reason that if you take hairs from the back of the scalp (donor) and put them on the top of the scalp (recipient), the newly transplanted hairs could fall victim to the same factors in the scalp that killed off the original inhabitants. They may be of "hardier" stock than the original inhabitants, but it doesn't mean they're invincible either. Basically, maybe "donor dominance" is 80% true but 20% false. Do you understand what I'm saying now? Were you even familiar with the term donor dominance before reading my posts? If not you're welcome for the free education. Wish your "Dr partner" (Whatever that means) well for me.

I tend to be long winded so here is the TLDR: Your donor tissue and scalp tissue can have the same amounts of DHT circulating in the blood supply, but that means nothing in regards to the levels of balding in each area. What matters is the concentrations of 5AR in each area, and the concentrations of androgen receptors in each area.

Think of it this way: DHT is converted from T via the 5AR enzyme. It's well known that the 5AR enzyme is more active in some tissue of the body than others. So if the top of the scalp has more 5AR than the donor, the hair on the scalp is going to be exposed to more DHT regardless of how much is circulating in the blood. Testosterone circulates in the blood at MUCH higher concentrations than DHT, so whether a specific tissue is exposed to DHT is more about the 5AR enzyme concentration in the tissue than the DHT concentration in the blood. Enzymes themselves really do not circulate in the blood, they stay put in the tissue. Furthermore, DHT by itself inside your cell does basically nothing. It's only when it binds and combines to the androgen receptor inside the cytoplasm and then moves into the cell nucleus that it causes the effects we associate with DHT (Muscle growth, body hair growth, scalp hair loss). So if the cytoplasm of the cells on the top of your scalp have much more androgen receptors than the cytoplasm of the cells in your donor, the hair on the scalp is going to be exposed to more of the effects of the combined DHT/AR complex. You'll notice in my post I first said "DHT activity" not "DHT". Then I got lazy and just started saying DHT as kind of a short hand, but what I'm really referring to is the DHT/AR complex because for this discussion its all that really matters. DHT is lipid-soluble so it freely moves in and out of the cell based on a concentration gradient (Just like with water and osmosis), and it's only when it combines with the AR and turns into the DHT/AR complex that it works it's magic. So you can have a huge amount of DHT in your blood, but if you don't have the AR it's not going to do anything to the hair follicle. My undergrad degree is in microbiology, but that really doesn't matter much in terms of understanding this stuff on a deeper level. I'm not a huge fan of credentialism, and most medical professionals have a very rudimentary understanding of molecular biology.

Your body has ways of transporting molecules to very specific areas. Just because something is transported by blood doesn't mean it is going to all your tissue in the same concentration.

It's possible that areas that are balding have higher concentrations of DHT. I haven't looked into it and I don't know if anyone else has either. That wasn't my point though, I'm just speculating. My only point was that 100% donor dominance doesn't seem to be true. Why that is remains a mystery. But yes, it's totally possible that areas that are inches apart in the scalp would have vastly different concentrations of DHT.

So your theory is that the hair follicle in the donor is genetically dissimilar to the hair follicles in the areas an individual is balding in? Do you have anything that supports this theory? Not saying this theory is wrong, but I can guarantee you there has been no evidence found that shows the hair follicle in the donor is genetically dissimilar to the hair follicle in the rest of the scalp. Of course absence of evidence is not evidence of absence, but when it comes to hair loss you should stay away from definitive claims like "This is not how it works". There is much we don't know, and at best you're just making an educated guess by claiming some genetic dissimilarity. What you mention about DHT in the face/beard actually supports my point - this is what's known as the "DHT paradox". AKA, why does DHT promote hair growth in every part of the body except for the scalp? One possible theory is the one you mentioned, that there is something genetic in the scalp hair follicles that makes them miniaturize from DHT. But such a "gene" or "cluster of genes" has not been found so it's at best theoretical.

No idea if certain areas have more DHT, just kind of espousing my general suspicion that "donor dominance" is 100% true as a concept. There is lots about balding we don't understand.

I've always been suspicious of the idea that transplanted hair is "as permanent as it would be had you left it in the donor". If you take 100 people from town A where it is very clean and move them to down B where it is polluted with toxic waste, don't be surprised if they get sick. If you take 100 hair follicles from the donor where maybe there isn't as much DHT activity, and move it to the scalp where there is a lot of DHT, I guess you can't be surprised if those hairs minitarize. But this is just speculation, maybe the hair follicles in the donor are just not as susceptible to DHT due to some physiological/genetic reason compared to the rest of the scalp, and it isn't about DHT concentrations varying at all.

In @MazAB thread he recommended Slick Gorilla styling power and it's been great for taming my transplanted hairs that stick up a bit. May be worth looking in to. I'm 9 months out from my HT so I'm hoping they continue to "tame themselves" over time to look more like my native hair.

The others have already responded well and in-detail, so I'll keep this short: The only reason to opt for FUT is if you have very good scalp laxity as this allows you to harvest more grafts over your lifetime. So if you have good scalp laxity and thing you're going to need every graft you can get, FUT can give you like approximately 1000 more grafts (Don't quote me on that number) if and only if you have good scalp laxity.

Argument by analogy is a really poor way to make an argument. I get that you were exaggerating to make a point, but the analogy and the point you're trying to make is not as good as you think it is. How am I over simplifying? It's literally shaving someone's head, and visually scanning for miniaturization in the retrograde area. What about the process or the research am I over simplifying?

Are you really comparing designing a self driving car with shaving someone’s head and scanning visually for signs of miniaturization? You’ll go far kid, keep it up

Ok ya, basically just shaving the retrograde area and looking for signs of miniaturization. Lol the way Umar makes it sound is like it's some novel innovative process.

Whats the test? Post link please

I'm honestly not sure, probably varies patient to patient. Even googling "safe donor area" and looking at the images you'll see different heights of what is suppoedly the safe donor area. So it really depends.

Does not matter.

You don't have to be a HT surgeon to recognize very basic facts about the process. If you understand even the bare minimum about hair transplants, it's easy to see OP was not only not a "good candidate" but he was in fact not a candidate at all. How Eugenix accepted him as a patient is truly beyond me. Lol

Thank you for the detailed response. I understand now, so the first four pictures were 8 years ago, and the last 3 are from today.

What you're probably asking about though is something that is more accurately called the "Patients Predicted Safe Zone". And of course this varies patient to patient. But yes even by that definition there are certainly plenty of cases where Dr's harvested grafts in areas that seem to quite obviously be prone to future thinning.

It depends what you mean by safe zone. If you're talking about the thin strip from the mid ear to the top of the ear, then yes of course they do. You can confirm that for yourself simply by looking at any high/medium norwood's post op pictures.

It isn't at all uncommon on here to see grafts taken from areas that are already thinning, or that will likely thin in the future. Here's the point: Never just blindly trust your surgeon/clinic. A lot of people think that "doing research" on a HT is just finding a Dr who has good reviews from people who were in a similar situation that you're in and then pulling the trigger. But it's a lot more than that. If you're serious about getting a HT then YOU need to become an expert on how to plan a HT. Even if your Dr is ethical, only you can ensure that you construct a lifelong plan that fits your needs. You're asking the right questions though.

Whether the yield was good or bad or average is irrelevant TBH. OP should've been turned away as not a good candidate and I can say that without even seeing his donor pic. Just knowing the high % of beard grafts that had to be used means he isn't a good candidate. Tony, I would consult with Pitella and a few others, but I think in your case you're probably best off saving your money and not pursuing any further HT's. Eugenix seems to take on nearly any candidate. Is there any anecdotes of people being turned away by them? A sign of a good clinic is how many candidates they turn away and I don't remember hearing of anyone getting turned away by Eugenix.

Do you have pictures of before and after his first op? How many grafts was the first? It looks like a lot did not age well

No one should ever get results from a transplant that leave them with an unnatural pattern of baldness, and sadly in this case that's what happened. Even if the plan going in is for 2 consecutive transplants what happens if the person has an unexpected financial/health situation that means they can't go through with the 2nd procedure or have to delay it significantly? Not piling on, but I know you're someone who doesn't mind a frank assessment and that what I'm saying is things you've already said yourself. On the bright side, you did seem to get GREAT yiel, and can at least style it in such a way to mask the issues until you get HT 2.

Just trying to gauge how common retrograde alopecia is among those of us with MPB, and what better sample is there to poll from than you chumes!