gillenator

I think everyone who posted their opinions on this thread made some good points. And it is true that those individuals who experienced a shed from the "initial use" of finasteride are the exception and not the rule. It's just so hard to put it in percentages because I usually hear from the guys who are experiencing the shed from starting Propecia immediately after surgery "for the very first time". The guys who do not have this problem are happy and go on with life. All that I am saying is that it does happen and probably more apt to those who have a more diffused thinning pattern, not as much to those with recessionary loss. And as I stated, those who have a larger mass of weakened diffused hair, have a higher potential risk of both shock loss and sheds. So I think it's important to get started on finasteride well ahead of the surgery date than to wait until the day after. Even the diffused patterned guys who choose to never get on finasteride still have a greater risk of shock loss than others, generally speaking. And although IMHO it does not make that much difference in waiting for the regrowth from their procedure to take place over the next 6-9 months, introducing all of the meds for the "first initial time" can be more risky that beneficial regarding "timely" regrowth. I am just of the opinion that waiting for our own bodies to regrow the grafts is best when the individual is considered a higher risk for sheds and shock loss. Yet getting on finasteride is the best clinically proven hair loss medication to date than anything else out there. So we are not advocating not using finasteride, it's simply more of a question as to when to start "if" you are in the higher risk category for shock and sheds. MPB is progressive in nature, and those of us who have it will have to deal with it for most of our lifetimes which is decades of time. And when the guys who do experience massive shedding after surgery and have stifled regrowth, many docs will inform them that it's undoubtedly related to starting Propecia and that it would have been better to have started it six or more months before the procedure. So there you have it. So really, it's in the consultation appointment that the doctor should IMHO prescribe Propecia and get the individual on finasteride as soon as possible. And ideally, their procedure date put off for at least six months "if" the individual has a very obvious diffused thinning pattern with a fair amount/mass of weak native hair. The problem is that we are impatient. We want to do the procedure once we find the right doctor and who wants to wait 6-9 months? Yet it makes the most sense to stabilize the hair loss as much as possible and get their bodies introduced to the hair loss meds before surgery. So in conclusion, yes, it's critical to get on low dose finasteride. But the timing of when to start it can be more complex that what it appears to those who have a higher risk of shock loss and sheds. None of us hold a crystal ball as to how we will respond to the meds and surgery so that's the tough part of the decision making process. This is where we sometimes must simply fall back on just common sense. I know if I had a large amount of weak diffused hair, that I am more susceptible to the things that can cause it to fall out. So I have to be careful that I am not introducing my native hair follicles to numerous things that can cause them to retreat into the resting phase especially during and immediately after the procedure. That's an opinion base on what I have observed over many years and many HT cases. They are not just premonitions and guesses otherwise there would be no point in talking about them. I have better things to do with my time...

hsrp10, It was more like these guys had very delayed periods of regrowth and shedding. I usually heard from them once they reached 6 months post-op or longer. And it always involved guys who started Propecia for "the very first time" immediately after their HT procedures. Again, not a lot of men, but enough to start noticing the similarities between them and the resulting phenomenon. Then, one day as I was reading the pharmacology data on Propecia, I noticed that the inhibition period was between 90 and 120 days. It's not unusual for hair follicles to enter the dormancy phase once the drug kicks in...:confused: So my conclusion was that these guys were experiencing a shed cycle when they should have been experiencing new growth from their grafts. Some even think that their procedure failed and get angry at their docs but I tell them to be patient and wait it out for at least 12 months. Surely you also must remember some of these guys who come on to the forums with their stories of delayed regrowth. And we all tell them to be patient and wait. This phenomenon also happens to guys who start finasteride for the first time and never even have HT surgery. They begin seeing their hair fall out approximately 60-90 days after starting the drug and freak out and quit taking it. I usually tell them that this is a good sign because the active inhibition of the DHT is inducing a shed cycle and if they are patient, the hair will cycle back into the growth stage and may even grow back thicker. But the younger they are, the less likely they will continue with Propecia or they reason that taking it less frequency will reduce the level of shedding. It won't. Once the hair follicles retreat into the resting phase, they will rest for 3-4 months before they re-enter their new growth phase. And for reasons unkown to me, some guys who had surgery had very delayed regrowth periods as long as 9 months post-op. Then out of nowhere, BAM, new growth emerges like wild fire! We also will read of a few guys who have a HT procedure, then initially start Propecia, minoxidil, Nioxin, Nizoral, large doses of MSM, biotin, etc, etc, all at the same time thinking they will all produce a super sized result. Some of them experience a massive shed cycle as a result an then cannot figure out why. IMHO, when there are numerous combined products and meds introduced to our hair follicles for the first time, they often retreat into the dormant phase which is defensive behavior. This has been my observation. So I often tell guys, just let your own body heal itself post-op. Allow time alone to do its thing. That's what our auto-immune systems are for. Time alone will work miracles and often produce the best optimal results. Then once the regrowth takes place and you want to add these hair loss meds and supplements, have at it. They obviously have their potential benefits but timing can be a huge factor especially right after surgery IMHO...

I have also wondered how many guys may have experienced a shed cycle from receiving stand alone PRP treatments...:rolleyes:

One other thing. I know some docs believe that being on finasteride prior to a HT procedure will reduce the level of shock loss, but I don't buy that theory. Why? Because shock loss is more attributable to the level of trauma in the scalp from the effects of the procedure. And we all respond differently to the trauma, some worse than others. And this is also why shock loss is really unpredictable. And the larger the procedure, the more recipient incisions that are made resulting in more trauma. Obviously the more volume of diffused existing native hair there is, the more susceptible that hair is to shock loss. Many docs are leery of doing large sessions on females that have large masses of weak native hair that is diffused. Shock loss is a real risk with those candidates.

The opinions on this topic vary widely. A fair number of docs will start their mature male HT patients on Propecia right after the procedure once they discover that their patient is not taking it and will potentially benefit from taking it. Yet every now and then we read about someone what is having poor regrowth and yet went to a reputable surgeon. Every time that I hear from a guy who is having poor regrowth or delayed growth, the first thing that I ask them is if they recently started Propecia for the first time or another form of low dose finasteride. It's amazing how many say yes. And further, many of them have started all sorts of other topical applications along with starting Propecia right after their procedures. Many of them are beginning to experience a shed cycle from the drug right when their regrowth is about to start. But they are the exception and not the rule so I imagine if a higher percent of these men were having issues with regrowth, their respective docs may tell them to wait until the procedure fully grows in. We rarely hear from guys who were already on low dose finasteride having regrowth issues. In fact, some docs want their patients to be on Propecia for at least 3-6 months before the procedure. They also want their patients to stop applying minoxidil at least two weeks before their procedure. So I have not heard of any studies of men who started finasteride right after a HT procedure as compared to men already on it but I think it would be interesting to do one.

Regrowth is going to vary between individuals but as was already mentioned, by 12 months post-op, most of the grafts should have broken the scalp surface. There is some variation in hair caliber maturation and it can take up to 18 months to fully manifest. The profound thing about hair shaft diameter is the more it thickens, the better visual coverage attained...

The best way to determine the suitability on of one's donor hair is to have it microscopically examined by a doctor who is experienced in comparing differentials in hair shaft diameter. This is how the doctor can determine exactly where miniaturization is occurring and where it is impeding. Hair diffusion can be seen by the naked eye but only once it is in the more advanced stages. Miniaturized hair is much more difficult to notice unless the hair shafts are compared under a scope. Can one's donor zone change with time? Yes, but not for all individuals. The best way to answer this for yourself is to observe and consider the older men in your family history that have MPB. Some men will begin to experience thinned out donor areas as they age. Other families do not. But some men can experience the more advanced classes of hair loss such as Norwood 5-6, yet their donor zones remain strong and dense. That's a good sign. Most Norwood 7s experience donor zone thinning with time from my own observations.

In general, transplanted hair is not as susceptible to shock loss as weaker native hair. What we don't know is the amount of native hair that was in the recipient zone compared to transplanted hair. Shock loss for the most part is related to the level of trauma from the surgery. It really comes down to how each individual's scalp responds. So can prior transplants shock? Yes, but again not as readily as the native hair. Most of what you lost in shock should grow back as long as your surgeon was careful and competent in making the new recipient sites.

PRP is over-hyped IMHO. It is not going to thicken up your hair in terms of density or any improvement in hair shaft diameter. It does nothing to inhibit DHT. And there is no clinical proof that PRP does improve hair mass. It's just ambiguous at best. PRP on the other hand is very instrumental in facilitating the healing process because of the enriched count in blood platelets. So if you are not having HT surgery, it is of no real benefit to you IMHO. PRP is derived from your own body and blood. The only risk is a possible shed cycle that it might induce but there is no real or consistent evidence of that either.

Thank goodness you were not offended and glad to see you keep your focus. I have also read through some of the other posts and there is always going to be a huge controversy with finasteride. It is a personal decision and if it's not for you, that's something you and only you can decide. I have been taking it since 1996 and have no problems whatsoever with it. But that's me. IMHO, the sides happen more frequently than what is reported by the manufacturer and I base that on my own observations. Every guy that I hear from is asked if he takes low dose finasteride and then I ask their permission to inquire about their use and how they responded. Overall, about 20% of the men responding stated real side effects. It was interesting to also discover how many were pre-determined they were having side effects when in fact, they were not. Some of them took it more than prescribed, some less. I found a fair number of young men under 25 years old who only took it if they happened to think of it during their busy schedules. Meds have to be ingested as prescribed or they will not work efficiently. Then I found several men who were taking the entire 5mg form of Proscar daily, a big no no. It was amazing to hear how many simply went on the internet to purchase their finasteride without ever consulting a doctor much less being formally diagnosed with MPB. Obviously anyone who experienced the worst of symptoms and side-effects will feel that it is poison but that simply is not true IMHO. We all respond differently to meds and I know an endless number of men who have and still have a good response to it and virtually have slowed their hair loss over the long term like myself. There is no question that I would have progressed to a Norwood 6 had I quit taking it and after having 6900 grafts in my life, the last thing I want is more surgery. So does that mean that I am a huge proponent of the drug? No. Because again, the guys who had a bad reaction to it are going to think it's the worse thing in the world of medications. And for them, that's a reality and none of us can deny that for their own reactions to the drug. And after all, who wants to take any meds? None of us. All that I am saying is that to date, there is no other hair loss medication that I am aware of and observed that stabilizes the progression of MPB like low dose finasteride does. So in the end, whatever you feel are "your" most viable options are going to be your choices. What works for one individual may or may not be right for you. I just want to encourage you to know as much information as possible to make the best informed decisions. Wishing you the best as you journey through all of this...

I was hoping that you would not take it that way. That was certainly not my intention. Sometimes the truth hurts however better that you know this before you end up regretting that you ever got started. Too many times I hear from guys that tell me, "If only someone was straight with me and told me the honest truth". They spend endless amounts of money only to end up with more and more hair loss as they get older and even lose their transplants. Just the other day a guy told me that he would have been better off bald with his savings than bald and broke...:confused: You seem like a good guy and listen, if your grafts were lost because your donor is not terminal hair, would you be angry that no one informed you? Honestly, sometimes I read threads like yours and it's much more tempting to play it safe an say nothing. Yet I know there are doctors out there that would bleed you financially knowing that you are not a good candidate for surgical restoration. They know fully well that the first procedure may initiate an aggressive loss pattern causing you to rush back in for more and more, as long as you are willing to spend the $. If you take the time and do the research about the type of loss that you have, then what I have conveyed will be obvious and make sense even though you may not want to hear it. So I truly apologize if I offended you and wish you the best in your journey.

IMHO, that would be Dr. Rahal...

Nice to hear that the regrowth is coming along...

Obviously Blake did his homework on this drug which is well appreciated by myself and many others. I knew there had to be more to the story. I was not aware that it was a case not involving MPB. Yet this drug could prove to be a cure for AA, AU, DUPA, and the like. After all, hair loss is still hair loss and even if this drug helps a smaller percent of hair loss sufferers, that still a big stride of achievement IMHO...

I took a closer look at your photos and first want to commend you on sharing your story. Just by looking at them, I observed a number of things. First off, if you noticed this progression of loss 4-5 years ago, and you have progressed this much by your mid-twenties, you have the potential of reaching Norwood 7 earlier than you want to see it happen. Without knowing your family history, I already know there men who are Norwood 7s. And you are correct, the degree of diffusion has crept deep into your donor zone, and your rims are already losing. The photo showing the entire top of your scalp tells a lot. You will eventually lose everything of top of your scalp, everything. Your donor zone appears DHT receptive which means it will thin out greatly with time. You may even experience DUPA or advanced generalized loss over your entire scalp and as I said, it's already affecting the sides/rim of your scalp. So in conclusion, I am happy to read that the doctor you saw refused to do a procedure on you. Undoubtedly, he is seeing the same things that your photos show. I know this may be hard to accept, but the last thing you want to do is start having HT procedures because honestly, you are not a candidate for HT surgery. If I were you, then I would only consider buzzing/shaving my head or possibly going with a full hair system, if you have to have hair. Hopefully, there will be a breakthrough in the industry in the future that will grow a full head of hair. I saw on the news last Friday about an arthritis drug that claims it grows a full head of hair. It was not a commercial promotion but a news segment. I was disappointed that they gave very little data and did not even mention the name of the drug. Wishing you the best in your journey.

I saw a brief segment of this claim on NBC Nightly News broadcast last Friday evening. They never stated which arthritis drug was used, provided no clinical information, gave no background on the man they claimed to grow a "full head of hair". They showed his before photo "slick bald", then a pic showing a full head of hair with way above average density. Did you see this too? I am always leery of claims like this when they present the claim like it's sort of private promotion or something. It would also be traveling the world like wildfire if it had any true merit so to me, it appeared more like a scam than anything else. I do hope I am wrong and there is some wonder drug like this to grow hair in massive volumes...:cool:

shikari83, Good to see that you are doing your research. I did not think an individual needed a prescription for minoxidil in the UK. In North America, it can be purchased over-the-counter or online. Potentially minoxidil can help your crown with some possible new growth however the spot is barren of any hair so it's really low dose finasteride that will help your crown from getting larger and broader with loss. The crown can and will demand as much as 60% of one's available limited scalp donor. So I always recommend to keep the density low in the crown because as you already can see, you have broader temporal lobe loss going on and eventually your entire hairline is going to thin out with time. It's tempting to want to address the areas that have no hair however if you use up too much of your donor for the crown, what will you have left for the frontal zone? Something to think about as you plan for future loss as well as current loss. Best wishes to you...

johnny2000, Think of shock loss on a bell curve. It occurs for most patients at around 2-4 weeks post-op and can last for another 2-4 weeks thereafter. So that's a broad window period of roughly 8 weeks. Not many patients experience it beyond 6 weeks post-op but it is certainly not unheard of. In addition, some guys experience a shedding cycle which is different from shock loss. Shock loss is almost always related directly to the level of trauma the scalp is under post-op as a result from the surgery. A shed is simply a time component of the complete growth cycle affecting a larger percent of hair follicles entering the resting phase and thereby losing hair density overall. It generally affects areas outside of the recipient zone. It is usually thought of as generalized thinning throughout the scalp. When the scalp heals and the trauma dissipates, the shocked follicles rest and eventually enter the growth cycle. Hair follicles generally rest for 3-4 months whether they rest from shock loss or a shed cycle. It's the dormant period in the growth cycle. The hardest part is to relax and allow your body to do it's own healing and resting. It's simply takes time and patience, and I know firsthand that it is easier said than done...:rolleyes: Hang in there johnny...you're going to be fine!

Taking any meds for hair loss is certainly not what any of us want however it's the DHT that is the source of the problem. Unless we can inhibit or block the DHT in our hair follicles and the sebum layer of our scalps, the progression of MPB will continue and we will lose more hair as a result. Minoxidil does not inhibit DHT, but it can potentially improve hair shaft diameter and also rejuvenate new growth in some individuals.

I also do not believe that Nizoral does anything to inhibit or block DHT. Nioxin is the one to be careful of and overuse can cause shedding IMHO.

Yes Dr. Frank played in the NFL however most of the pro football players as well as many pro athletes went to college with plans beyond their sports career. So for him, it was something he aspired to go into the medical field and why he chose HT surgery, I really cannot answer. Nothing against him, but I cannot say he would be my first choice however he would not be a recommended surgeon within this community unless he demonstrated the type and quality of standards set forth to be recommended. I have seen only a couple examples of his work and IMHO, it was good. Dr. Konior and Dr. Haber have been doing HTs for a long time, are ethical, and do very good work. The bottom line is, never make your choice based on location or geographical convenience. You have to know what your goals and expectations are working within your own limitations. Then start looking at each surgeon's work on other patients that have similar patterns of your own hair loss as well as your hair characteristics. You need to dialogue with each doctor before you make any final decision. You want to first prepare and have a list of your questions and potential concerns to ask and see how each doctor addresses your concerns. Most of them will be accommodating to do a virtual consultation with you. Max & Erma's is a hot spot, sports club restaurant in the heart of Columbus...:cool:

Harakiri, I took a peak at your profile and only saw 1 pre-op pic and one post-op at 3 months or did I miss something?

Absolutely correct. Scalp excretions, one's lifestyle, personal hygiene, etc all will vary between individuals. I also use water only at high pressure between shampooing and my hair and scalp is much more moistened when doing so, less frizzing, more body. I use a cream rinse to finish off the rinsing and allow it to dry. So I use shampoo twice per week and no more than that. If you read the ingredients on any shampoo bottle, you would be shocked at the volume of inactive additives that are chemical based. Lots of alcohol based additives too which can dry out the hair. You get what you pay for. Most of the cheapest shampoos have artificial chemical additives and many times are the harshest on the hair and scalp. IMHO, best to use a quality product even if it's less frequent.

You mean your grafts right? Or are you seeing some fall out related to shock loss?

Here's the deal. Many men who had HTs comb their hair shafts straight back for several reasons. First, they do it to create more illusionary volume and density. For most individuals, that is not the natural direction of the hair yet if you try it on yourself, you will see what I mean. Brushing the hair from front-to-back creates even more of the illusion versus combing. I do this myself. The secondary reason is that you get more of a comb-over effect when there is thinning or a balding spot in the crown. And the longer you grow the hair shafts, the more coverage you get! Again, I do this myself.