calvinmd

WARNING -- This opinion isn't based on anything concrete. Unsubstantiated conjecture abounds in the road ahead: I wonder whether there's really any such thing as a truly 100% "safe zone" at all. From the attention I've paid to MPB cases & results over the years, I've come to suspect that basically ALL male scalp hair is gonna bald if you give it a long enough timeframe. The difference between "balding" and "permanent" hair would only be a difference of degree. So a guy who spends his whole lifetime without any MPB isn't truly 100% immune, it's just that he's immune enough. (If he lived to be 140 years old, he might show MPB by then. Just not within a normal-length lifetime.) Under this idea, the hair loss in both the donor and balding areas would be a governed by a combination of these two factors: 1. Amount of genetic susceptibility to DHT in general. 2. Amount of contrast between the susceptibility of the "balding" and the "safe" zones. So in this theory, a "diffuse thinner" would be a case of a low amount of contrast between the donor & balding areas, but a high amount of overall DHT susceptibility which is working to take everything out. "Donor thinning" makes sense too. That would happen if there's enough contrast in the susceptibility of the different zones to make a recognizable MPB pattern go bald early in life, but also enough overall DHT susceptibility everywhere to also eventually show thinning in the "safe" zones later on. This theory also doesn't bode well for early-balders. (Does anything ever bode well for this group?) It would make sense that earlier onset of MPB means there's probably more general DHT susceptibility. It would fit the idea that earlier MPB = worse donor thinning likely over time. ------------------------------------------------

WARNING -- This opinion isn't based on anything concrete. Unsubstantiated conjecture abounds in the road ahead: I wonder whether there's really any such thing as a truly 100% "safe zone" at all. From the attention I've paid to MPB cases & results over the years, I've come to suspect that basically ALL male scalp hair is gonna bald if you give it a long enough timeframe. The difference between "balding" and "permanent" hair would only be a difference of degree. So a guy who spends his whole lifetime without any MPB isn't truly 100% immune, it's just that he's immune enough. (If he lived to be 140 years old, he might show MPB by then. Just not within a normal-length lifetime.) Under this idea, the hair loss in both the donor and balding areas would be a governed by a combination of these two factors: 1. Amount of genetic susceptibility to DHT in general. 2. Amount of contrast between the susceptibility of the "balding" and the "safe" zones. So in this theory, a "diffuse thinner" would be a case of a low amount of contrast between the donor & balding areas, but a high amount of overall DHT susceptibility which is working to take everything out. "Donor thinning" makes sense too. That would happen if there's enough contrast in the susceptibility of the different zones to make a recognizable MPB pattern go bald early in life, but also enough overall DHT susceptibility everywhere to also eventually show thinning in the "safe" zones later on. This theory also doesn't bode well for early-balders. (Does anything ever bode well for this group?) It would make sense that earlier onset of MPB means there's probably more general DHT susceptibility. It would fit the idea that earlier MPB = worse donor thinning likely over time. ------------------------------------------------

Don't drop the stuff cold-turkey. Taper off it gradually and at least some of the negative effects of quitting may be reduced/spread out. (I'd pull down the dosage to zero over several weeks at least. A month or more would probably be better.) Fin really does a number on your hormonal balance, and the body's knee-jerk reaction to being flooded with it is not good. --------------------------------------------------

Tough case. Off the cuff, I'd suggest that cold-turkey quitting of Finasteride probably isn't a good idea in general. Tapering off is good. There's a halfway common opinion that Spironolactone (topically applied, forget about oral if you wanna stay a man) will block scalp DHT pretty well. But it really stinks like rotten eggs and it's generally not a fun regimen. ------------------------------------------------

The whole question is tough to answer. So many of the guys who've actually been in this game long enough to have an informed opinion . . . that means they also got early HTs from a hair mill in the 1980s/1990s. I think it probably boils down to one thing -- how well can you deal with shaving down short to cope with hair loss? If you can do this with any decent results, then most guys would say by all means do it. At least for a while and wait for better MPB treatment options. But if your head REALLY can't work a shaved-down look and you know it, then I'm not sure you have a whole lot to lose with HTs other than the money. --------------------------------------------------

The problem with younger HT cases has several causes: -- Younger at thinnning = worse thinning for life. Usually the earlier that you look like you need some hair transplanted, the worse of a HT candidate you will be overall. Some people are simply not candidates for HTs with current technology. -- The eventual thinning pattern may not really show itself until your later 20's. And donor thinning happens later in life, too. (Once again, the worst donor thinning is usually in the early-balders.) Tons of guys' final hair loss patterns could never have been identified before their late 20s. -- The younger patients usually want the most agressive hairlines of all. They're 22yo and they just wanna look 22yo again. It's understandable, but unfortunately the only sensible long-term plan for them is to spend all that big money on HTs and still have to settle for a 32yo hairline at 22. --------------------------------------------------------

I think it depends on how bad a particular issue on your face/body has gotten before you address it. If you're doing it early in life, then the results are gonna be less dramatic but on the other hand it's less obvious that you had it done. Doing surgery for the first time later in life can reap a more dramatic gain. But on the other hand you spent more of your middle years looking worse first, and then everyone knows about it when you have it done. -------------------------------------------------

Behappy, that's exactly what I wish more people understood these days. The end of widespread baldness has been "5-10 years away" since at least the early 1980s. I'm personally not willing to get any HTs that can't stand alone with no future advancements and no continued meds. I dunno. I do think we're closer than ever before now, and I also think that 15 years is gonna be a whole different story too. It's not so much becuase of any single advancement but rather the enormity of the market that is coming. I'm not the first one to float the idea that boys are getting MPB younger & younger than ever in the past. And at the same time, the importance of youth & attractiveness (in the photogenic sense, not the same as true bodily health) has been skyrocketing for males in particular. It shows all signs of only getting worse. (It's not just that 100% of the guys in the future are gonna care more than before. It's that once a high enough percentage of them do, the others won't be able to get laid & promoted without hair anymore and they'll HAVE to care just to get treated normally again.) They'd better solve this problem soon. At some point in the next 10-25 years, the demand for a real baldness cure is gonna start outweighing the demand for crude oil and the mainstream medical community is really gonna take the gloves off. ------------------------------------------------

Yeah, the hairline work really will look much more natural than in the past. It's not 100% perfect (and it probably never will be), but realistically you have to be a fellow HT guy to spot many of the hairlines being done by the top doctors nowadays. The "pluggy" look of a lot of older transplants are simply not what you get from the better doctors anymore. Everyday people off the street simply won't know the difference. (I remember there was a recent case of a guy on one of the hair loss message boards with a transplanted hairline, and he actually got hired to model shampoo for a small photoshoot. The newer HT hairlines can be THAT good.) The limited supply of donor hair is still the deal-breaker. The current HT doctors can do work that looks pretty amazing compared to 15 years ago. Their work would functionally "cure" baldness for most of us if they weren't limited by that. (And the growing & selling of cloned/multiplied hair follicles for baldness is showing signs of being a reality within another 10-15 years, so even that may change.) For a lot of reasons this is a MUCH better time to be fighting baldness than in the early 1990s. ------------------------------------------------

The degree of thinning isn't always given the level of attention as the NW levels because of the eventuality of losing those areas. Assuming you're dealing with HT candidates in the first half of their lives, anything that's visibly thinning is gonna be gone eventually. The balding pattern's size and shape are what really matters. The specifics of the current progression are less relevant than what the ultimate situation will be. 1-- one year for trying meds 2-- 1-2 years for getting a HT and growing it out 3-- another 1-2 years for a second pass (which seems more common than not) That's 5 years, even in the most rushed cases. The thinning situation is probably gonna be different by then anyway. ------------------------------------------------

Here's some highlights of the HT advancements in the last 10-15 years in a nutshell. Hopefully it will help you begin to make sense of all the internet HT chat: -- I don't know whether or not you've had large round "punch-grafts" taken from the back of the head in past surgeries, but that method of HT surgery is obsolete now. -- "Mini-grafts" and "micro-grafts" are history even from strip-style work. It's "follicular units" now, which are grafts in 1-hair, 2-hair, and 3/4-hair chunks. Nothing bigger than 4-hair chunks is acceptable from the top doctors anymore, and the best hairlines are being done with primarily single-hair grafts all across the front where it's most visible. The results can often look almost indistinguishable from nature's hairlines even up close, if the patient has enough donor hair for it. -- Donor strips have gotten larger in terms of per-session grafts. Getting 2500-3500 (follicular-unit) grafts is very normal for patients of top doctors, and a few people on earth have literally had 6-7000 grafts done in a single huge HT session. So in terms of how much hair you want to get transplanted during a single surgery, your available donor hair and financial situation are the big limitations. The only big downsides of the huge sessions are worse swelling/healing times, and longer strip-scars that often extend all the way to the ears or beyond. -- FUE (Follicular unit extraction) is the "hot" new thing in the HT world right now. It basically means taking grafts from the back of your head one-at-a-time with a sort of a big needle, rather than cutting off a strip of skin & suturing-up the large wound. (Think of it as sorta like doing the old punch-graft HT work, but only using tiny needle-sized punches for getting 1-4 hairs at a time.) FUE still produces scarring, but it's more like thousands of little dots all over the donor area rather than a big line-scar or the "shotgun" effect. FUE obviously heals a lot quicker too. The biggest downsides of FUE work are that you have to shave your head (almost bald) for the procedure so the surgeon can see what he's doing, and it also costs essentially double the price of strip-style HT surgery for any given number of grafts because it takes so much longer to perform than strip HTs. FUE isn't really replacing strip-style HT work yet, but it still is growing in popularity all the time. Right now, many of the most extensively-transplanted HT patients are getting a combination of FUE and strip-style surgeries. They're trying to squeeze their donor areas for every last graft possible, and FUE work allows docs to raid larger areas of your head that were unreachable with the old strip-surgery & punch-grafting. The FUE docs can basically "thin" the hair over your entire donor area pretty evenly to get all their transplanting grafts, rather than pull a visible bunch hairs from any single spot in the back that has to be covered with grown-out hair hanging over it. ------------------------------------------------

I don't think it's a question of whether or not Fin is "safe." We all know it's not 1000% safe, almost nothing that we use for medication is totally problem-free. (And if it was, then it would be sold OTC.) It's just a question of whether the side effects are significant enough to make it worth using or not. Technically speaking, I'll bet that Fin's side effects are probably present in every user and it's just a question of severity. That's how it goes with all kinds of other drugs that we consider relatively "safe." ------------------------------------------------

From what little I've been able to read about Avodart, the major-league sexual side effect issues sound pretty common. Dutasteride is known to do a much more effective job of lowering DHT levels. Funny how it also seems to do a much more effective job at lowering sex drives. (Hmm . . . ) More hair = less sex drive. If you're prone to the sexual side effects, then this is what you're dealing with. I don't think you can cheat on this basic equation with any amount of playing with doses, times of the day, skipping days, etc. Honestly, I think I would rather take a larger dosage of Finasteride than mess with Dut. Fin targets DHT#2 without affecting DHT#1 much at all (unlike Dut), and Fin also gets out of the body a lot faster. So if you're trying to achieve a given amount of DHT inhibition, then reaching that point with a larger hit of Finasteride seems to me like a safer way to do it than taking even a small amount of Dutasteride. -----------------------------------------------

Just to voice an opinion that's relevant to long term HT plans -- I'm taking Finasteride right now and it's not ruining me or anything, but I still have absolutely NO faith in Fin as a long-term option. I don't think it's really safe for the sexual function and I don't even think it's gonna continue to hold off additional hair loss for more than 5-10 years at best. Fin is buying us some time. And it's possibly giving a slight decrease in the eventual baldness pattern if you've got it blocking the DHT for a bunch of the most critical years during your 20's/30s. But nothing more. We still need something better & safer. ------------------------------------------------

I think the "temple regrowth is rare" thing is a misunderstanding. With both Finasteride & Minox, the drug companies didn't test/study the temples. I suspect it may have just been a practical matter because crown loss is more steady & predictable from case to case. (Everybody has different natural hairline locations & shapes, etc.) Temple regrowth from meds may or may not happen, but it's really an "unknown" from the research rather than "unlikely." Medically speaking, the temples bald for the same reasons as the crown so I see no reason that Finasteride wouldn't work there just as well. Either way the drugs are fighting your natural susceptibily & loss, and that makes more of a difference than anything else. If you totally lost temple hair 15 years ago and your crown is just now getting thinner, then of course you're gonna have a lot more crown success than temple success from the drugs. But that's not because the drugs "don't work at the temples," it's just that the drugs are less effective on areas of older & more significant loss regardless of where you have it. I see no medical reason that the drugs would discriminate between temple loss and crown loss. ------------------------------------------------

I'm already seeing benefits from taking .25mg per day for only about three months. Nothing huge. I have a slow balding pattern anyway and the results of Fin aren't spectacular or anything. But I'm a 29yo NW#3, and I'm already seeing a few square centimeters of temple-hair regrowing since starting the stuff in late April. It's just thin little hairs and nothing major. But it's unquestionably a new regrowth and I did say it was temple hairs. The only other thing I'm using is Nizoral 1% about once a week on average, so I think it's pretty clear that it has to be the Finasteride doing the regrowth work. This is a much larger topic, but several people have argued that Finasteride seems to at least sort of dose-independent. There seems to be some evidence that the differences in effectiveness are not as large as the numbers would suggest between dose sizes. (Meaning that taking 1mg seems to offer less than double the benefits of .5mg, and taking 2mg offers less than double the benefits of 1mg.) I started at only .25mg in the first place, and I never once did 1mg in a single day. (I rarely ever even took .5mg in a single day.) I think that may have been part of it. If I had been steadily taking 1mg or something and then tried to drop it down to .25mg, then I doubt my body would have reacted to the small dosage as effectively. I'm toying with the idea of upping my dosage to 3/8 or 1/2 of a milligram per day. The side effects are pissing me off but they have not been a total deal-breaker so far and they're not getting any worse. And I'm encouraged by the effectiveness that the small dosage has had. ------------------------------------------------

To be perfectly honest, I agree with you. But I'm not confident enough to bet my whole future appearance on it. I'm losing my hair slowly. It's a NW#4, or maybe a NW#5A pattern at worst. So I don't even need the full-blown HM to pan out to get what I want. All I need is just need some type of new medication that's more effective at loss prevention than the current stuff, and I'm probably good to get transplanted to a NW#2. ------------------------------------------------

I dunno. I do think they're closer than ever with the cloning/HM stuff. I still think that prevention of loss may do more to free our kids of MPB than any hair replacement method that we come up with. It's always simpler/cheaper/more effective to prevent any problem than to fix & replace it. ------------------------------------------------

Two possibilities that I see: 1. The grafts were taken from a non-permanent zone of your head. 2. You're experiencing diffuse thinning all around your head, and your natural "donor" hair is susceptible to it as well. Most men's donor hair isn't really 100% stable & safe from the effects of MPB. It's just a hell of a lot more stable than the areas that we lose early in life. But the donor areas can still experience some thinning with age. ------------------------------------------------

I don't know about you guys, but I can easily & reliably break a 1mg Propecia tablet into nice evenly-sized quarters just by hand. -------------------------------------------------

Very good post. Your brother's thinning donor from age 22-59 really makes the point. It all just makes me more and more convinced that getting HTs below the mid-20s is a bad risk regardless of the indicators. We just need to realize that we're not making a safe move at that age. We're really betting our future appearances on the idea that better MPB treatments will bail us out within 20 years. ------------------------------------------------

Picture this: What if Finasteride were NOT an official hair loss drug? Then this would be a whole different discussion. There would probably be TONS of posters all the time saying that the stuff is the cure to hair loss with virtually no side effects, but the evil Pharma industry is just keeping it from us so we'll go bald. If it weren't available, the feedback around the 'net would probably be that it's the cure-all with hardly any more side-effect instances than Advil. Just look at the side effect numbers for Dutasteride, and then look at how much inquiry there is about why it's not available for MPB yet. Finasteride isn't perfect and it isn't without risks & sides. That's why it's only sold with a perscription. IMHO people just need to do some research and decide for themselves about it. -------------------------------------------------------------------

Nobody gets it without having had it. You'll be lucky if you can even convince most of your friends/family that you're not really "causing it" somehow. (Eating, exercise, pulling your hair too much, etc.) Most people will probably just say "Don't worry, you'll look fine bald." The fact that they're prone to absolutely sh*tting themselves over a single bad hair DAY, whereas you've just been sentenced to a bad hair LIFE, and yours will only get worse every day for the rest of your existence . . . You can tell them, and they'll hear your words clearly, and they can repeat it back to you. But they never really GET IT. ------------------------------------------------

-- Is it probably the propecia? Yes. ("Everybody, let's welcome the newest member of The Largest 2% in History!") -- Will the mere knowledge of this instance make it potentially worse, and/or cause you mentally-induced trouble in some cases where it might not have even happenned chemically? Probably so. -- Will it go away over time if I keep on the drug? Probably, but maybe not 100% gone in some cases. -- Will I have to quit the Finasteride just to get my weiner back ever again? Probably not. Just because it happened once doesn't necessarily mean that it's gonna be an ongoing recurrence. ------------------------------------------------

What a dork. That's almost like laughing at certain students for having zits or something. If I was that teacher, I wouldn't have said anything to those kids even if I was pretty sure of my guesses about it. And I'm not just saying that because I've got MPB now; I would've felt this way before I had any hair thinning. That just sounds kind of cruel. ------------------------------------------------