4chanhrn

That's a good idea. Waiting for a reply from Hattingen. I was watching your podcast with Hattingen. Dr. Muresanu says the jury on FUE(especially for high NWs) is still out because you need to harvest from outside traditional safe donor area and FUEs are a relatively new procedure so we haven't seen how the patients would age with them, especially if donor starts to thin. I guess this would be even more of an issue with people not on fin and young. People getting these large FUEs seem to be either on fin or much older(and have stabilized pattern/donor for long time) or both. I'm thinking 1 strip+FUEs with beard/graft after that. Hair loss can progress beyond initial pattern. Your hair loss will just end up naturally how you will lose hair. If you don't plan for it correctly or take that into account then your HT can look weird later. Fin can put the breaks on or help you keep hair that you started with. During consultation I got told that most likely I'm NW6. Although there are some areas of weakness, if I was a NW7, I would have been there by now so should be planning like a NW6.

Thank you. I asked Bloxham and got a similar response. #neverstrip seems to be the consensus and in an ideal world I should be going for a Zarev, Sethi or Pittella, but if one does not have the access to elite surgeons that have worked on NW6/7(I'm not sure you can even book Zarev. Sethi and Pittella would be like 1-1.5 yr wait away and expensive. $5/graft for 6000+grafts adds up quickly), then wouldn't FUE exhaust donor completely if I somehow progress to NW7 vs doing FUT first? That is really my concern. FUT leaves you with lot of grafts in the bank as an insurance policy+Verteportfin could end up giving more grafts down the line. I've been tempted by someone like Nader, who's cheap and excellent(I think I can be persistent in contacting him). There are other good FUE surgeons as well. But worried about FUE not leaving enough in the bank for later. The scar doesn't bother me. What do you think? Here's a good large case Nader handled:

Bloxham said I'll need 2 FUT surgeries of 2500-3500 for full coverage front to back. He said he wants to start with 1 FUT aiming for "as much as possible". He included crown in that estimate and I should still have enough grafts to do FUEs later after that if I really need those grafts/have more loss. That's very interesting. I would love to see your results.

Got it, thanks!

That's not too bad. How much longer do you think you'd need to fly and how did you get the staples removed?

Yea, I know. He's pretty low down on my list(because of his price) and I'm not completely sure I can afford him but it doesn't hurt to ask.

That makes sense. I was always curious about discrepancy in numbers. I've asked it to Bloxham as well. I know we've been spoilt by 10k graft transplants, but 4k was a big transplant just few years back. Also can you tell me how long you had to spend in NYC? I'm guessing till the staples are removed? I'm wondering how much would the hotel costs come to.

Don't you think I need atleast 4000-4500 for front/midscalp? Bloxham said in total would need 5000-7000 grafts with 2 procedures. I'm going to consult with more doctors and see what their opinion is. Different opinions are always good. I'm open to other locations if the price/quality of surgeon is much better. Not strictly restricting myself to North America. I'll contact Konior, thanks.

Do you know why Bloxham's numbers(how much he can extract) from 1 session are much lower than H&Ws? I'm just curious.

For me they are just 4 hr drive away. They are quoting me 4000-4500 grafts for first 1/2 to 3/4 scalp w/ FUT and it comes to 16.3-17.9k USD w/ taxes. Bloxham wants to do 2500-3500 grafts for 14-16k USD(plus flight/hotel costs?) for as much as possible starting from the front. Plus another FUT procedure later down the line if required. H&W is cheaper but I liked Bloxham's planning better. He was also very good answering questions and putting effort into the consultation. I'm looking for a long term plan to address my hair loss(especially because I'm not on a 5ARI) vs a 1 time procedure. I have a call with H&W consultant on Monday to ask questions but it would have been nice if I could talk to the doctor directly. Currently for me both are viable options. I'm taking my time to decide who to go with. I'll be consulting with other doctors as well.

Thank you. Your results look really good. Currently consulting with H&W. I have a call planned with their consultant on Monday. Dr. Wong is world class surgeon. There's no doubt about it. I'm hoping they can help me more with long term planning and I wish I could talk to the doctor directly.

Got it, thanks.

You're not hijacking the thread. It's a good discussion to have. I don't think you need finasteride. I feel it's a good thing for you to lost the hair more susceptible to DHT before you started your journey. I wish the same happened to me lol. Then I can start from a clean slate. I feel planning for you was really well done so you don't need meds as much as others. I'm really impressed. I've filled out Dr. Bloxham's consultation form looking at your case. Do you know what sort of wait time I would be looking at for Dr. Bloxham(or for other clinics)? Also I started Pyrilutamide today.

I'm going to try pyrilutamide(from grey mkt) soon. Although phase 3 trials failed, it did have hair count above baseline after a year, just not a lot above placebo. AAs seem better for maintenance vs regrowth so it could be decent for maintenance with much better side effect profile. IMO this might work as well as topical fin. If you look at trials for oral fin, the hair count over baseline wasn't too impressive either. Kintor's investor presentation heavily stresses on much better safety/side effect profile. Ofcourse you can't have 100% because AAs don't selectively target ARs on scalp, but I think this might be as good as we may get for a while. It's also non steroidal, which is better as far as side effect profile is concerned

I know. Have discussed it above. I've tried almost every variation and spoken to my derm, multiple doctors and their advice was not to take it because my body can't tolerate it. My body is very sensitive to 5AR blockers.

Yea losing most of it pre HT I think is actually a blessing. I don't think NW6/7 needs meds if pros don't outweigh cons. Low dose oral min may help you if youre comfortable taking it. It improved my hair a lot.

Solid results and very solid long term plan. Planning for you was very well done. I think we are very similar cases. I think it would be actually better to lose existing hair before surgery so that I can start from clean slate. Are you on medication now? I remember coming across your post on reddit thread that I had posted. I think I'm going to do a consultation with Bloxham and look at what he says. 2 FUTs might be the way to go.

Yes, I completely agree. I also feel people's opinions are skewed because people look at select cases where great surgeons have managed to overharvest(not sure if this is the right word) from unsafe donor and still managed to make it look great. But it is risky for many reasons. And very expensive because you need to pay for the best. One underrated thing about FUT is that it reduces overall area of the scalp, while the actual overall density remains the same. If you do FUT, you can always goto a Zarev or Pitella later. That option is completely open to you. You could also just get more FUEs. Scar is a complete non-factor for me, but I understand why people would be concerned about it. Before I knew what transplants were and if I had looked at Joe Rogan's scar, I wouldn't have known or cared at all. I am open to using beard/body hair. FUT+beard/body hair+FUE w/ Verteporfin can potentially give huge no. of grafts vs just doing FUE today and probably much cheaper?

This is also a good video I found. If their calculation is right, then it's 40% more grafts for avg person from safe donor areaby doing FUT first? That's not insignificant.

That's a good idea. I will consult with him as well. He's a great surgeon for sure. Not sure about price/location, but I can try to make it work if he's much better option. I don't want to beat a dead horse, but hormonal changes can cause sleep disturbances. From my understanding fin/dut can mess with HPA axis, which can lead to nightmares/sleep disturbances. Fin/dut can also affect neurosteroids. It is possible that it was placebo, because placebo effect can be strong, but I have used 5AR blockers for more than a month and everytime I end up with prolonged similar effects. From people's posts on the forum, Xyon's topical dut still had significant effect on blood DHT levels. I am hopeful for Pyrilutamide, because their press notes say one of their primary markets is as a hair loss medication for people that can't tolerate 5AR inhibitors and safety trial data looks good. Like I said I was closely monitored by my parents who are both MDs and their strong recommendation was to discontinue use of 5AR blockers. I also consult with a dermatologist who also told me not to take 5AR blockers because I can't tolerate them.

I'm on oral minoxidil, which is supposedly a mild AR blocker. I'm going to try pyrilutamide. Also use saw palmetto tablets sometimes+keto/SP shampoo. So I'm not completely off medication. It would have been nice to use a 5AR inhibitor, but I can't seem to tolerate it. Yes, I have super strong beard/body hair and I do not have high expectations. I can grow a beard like Bin Laden(maybe not the best person to compare to but you get the idea) and have body hair as thick as bear fur if I don't trim it down. This is my hair 4 years back at 23 before starting minoxidil and after bit of TE. It's not a whole lot worse today(may actually be better), but it was better little later after TE improved and minoxidil worked for sure.

I left it on for a day without washing. Its hard for weird dreams/nightmares, sleep issues for few days after applications, complete lack of morning wood for 1.5 weeks to be nocebo, especially when I am normally opposite to this.

Yea all good options..

That's my thinking. I also think Verteporfin+FUE would likely work out for better donor management. The trials are very promising. FUT now gives me the option to use Verteporfin for FUE later when it's better studied. I'm OK with a bare/bareish crown. Looking for front/mid coverage. I don't have high expectations because of my level of loss+not using 5AR inhibitors. Also I don't think I would care as much in 40s/50s.

Got sides after single application. Tried 2 applications 3 days apart for sides to fully kick in. Sides went away after around 1.5 weeks of discontinuation. This is consistent with other 5AR blockers I have tried(topical/oral fin). Topical fin microdosing sides came in after few weeks. I stayed on it for a month hoping it would improve and had complete limp dick. I am very sensitive to 5AR blockers. My parents are medical doctors and their recommendation was not to use 5AR blockers when my body does not like it. Every body can react completely different to medication. What works for you may be poison for you. It sucks but you can't do anything. Oral Min is complete opposite for me. It feels like it gives me so much energy and has improved my cardio. Maybe Pyrilutamide can help. I'm waiting for it to arrive in mail. I'm completely fine with the scar. Like you said it's a personal decision to make. I want to maximize grafts and I do not mind the scar at all. Even if I at all need to buzz it down, I don't think I would mind it, especially in 40s/50s. I'm not trying to cheap out, but I do not have unlimited money and would like things to be cost efficient. There are excellent surgeons(on HRN recommended list/recommended by patients) that are very good, but still not prohibitively expensive. I'm thinking I may have to get a little expensive large FUT, because there aren't a lot of good FUT surgeons(and most of them are in North America). I've listed the ones I'm considering above. And then I can get cheaper FUEs down the line. Laorwong, Nader, Pekiner, Keser, Eugenix(I often travel to India so would be easy to get done) are all good enough options for FUE without breaking the bank. There are many surgeons that charge much more, but are subpar in quality. As for travel, it's a similar story. H&W is 4 hours drive for me. Hattigen would be a long flight+like a week worth of trip+arranging visas well ahead of time. Visas for Schengen countries can be super hard to get sometimes(depending on your passport). It adds inertia to the whole process. I can do it, but if costs, quality of surgeon aren't that much better, it is harder to justify. Dr. Zarev is very good, there is no doubt about it. For me, his costs and availability make it a non-option.