calvinmd

AllMaple, seems like you've stirred up a pretty good debate. Here's my 2 cents:

-- Not too young for a HT, but probably too young to mess with the temples. And you're not really safe for dense-packed grafts anywhere.

You might be relatively safe to do your hairline in the front/center and some slight thickening in about the same area if you choose. But don't touch the crown yet.

Either way, if you're considering a HT in your 20s then you're almost sure to have a disappointing hair-life ahead of you. So begin soaking that in & coping.

Just about anyone in the HT office during their 20s falls under this blanket: Maybe your hair expectations are especially high, or maybe your natural loss pattern is especially aggressive, or maybe it's a little bit of both issues. The common thread is that there's a large mis-match between the hair situation you want and the one you have. HTs can't do enough to truly close a gap of expectations that is so large so early.

------------------------------------------------

I heartily agree.

Everyone in the HM world is disturbingly silent when the subject of "cosmetically-acceptable" hairs comes up. I think they may just be ecstatic because they're finally growing anything at all. Read enough about the hair cloning efforts, and you find more than one reference to "short, curly" hairs rather that traditional-looking hairs.

I think saving your existing hairs is still gonna be the paramount way to treat MPB for at least the next 1-2 decades.

However, both of these new treatments seem very promising. If both of those drugs were to reach the market (and if they are actually as effective as the tests seem to indicate), they would probably be more effective than Minoxodil and Propecia combined.

The androgen receptor drug seems most promising to me. It sounds like using that drug for a continued length of time might eventually cause some amount of PERMANENT reduction in hair loss even if its use is discontinued.

--------------------------------------------------

Burt1973:

Whatever you choose to do, my only input is to be brutally honest with yourself about how much hair you'll need to get transplanted for decent results (both now and later on). Being financially over-a-barrel for decent hair is bad, but it's a lot worse to end up over-a-barrel for hair that is still unsatisfactory.

And any time a person refers to their hair loss problem as something that hurt them "at a young age," then that probably means there is more than one HT surgery in their future.

-------------------------------------------------

Finasteride stops the DHT from damaging your hair follicles in the first place.

Minoxidil only prevents your body from executing the follicles that DHT has already damaged.

Let's suppose you use finasteride for a decade and then decide to quit. What happens?

Your scalp will take almost a decade longer to go bald than it naturally would have, even if you never take finasteride again.

That's truly some PREVENTION of baldness.

But if you use minoxodil for a decade and then quit . . . The DHT was still damaging your hair follicles during that whole decade.

So once the minoxidil is discontinued, then your body will immediately begin to execute ALL the hairs that you would have naturally lost during that decade. It won't take another decade for you to lose the decade's worth of hair, it will all be rapidly gone in a matter of weeks/months.

Minoxidil is much more of a "life sentence" than finasteride for this reason.

------------------------------------------------

I would agree with the comment that the travel money shouldn't rule the process of choosing a surgeon. Don't let a three-digit travel cost factor into what is probably a five-digit surgery.

--------------------------------------------------

It's difficult not to get excited about this stuff.

If ACS-J9 turns out to be even somewhat effective at what it's purported to do, then it's already right up there with the existing Holy Trinity of MPB meds.

Blocking the androgen receptors in the hair follicles would function the same way that DHT inhibitors work right now. So by that logic, ACS-J9 would most likely be effective on all the same men that finasteride is effective on. And without any hormonal side effects.

------------------------------------------------

The idea of a topical that might actually be effective for more than half a day per-use is absolutely intoxicating.

That's not just hair regrowth. That's actually being FREED of a little piece of this MPB sentence.

--------------------------------------------------

NOT EVERYONE HAS ENOUGH DONOR HAIR TO RESTORE THEIR ENTIRE HEAD! Many balding men cannot EVER get a good result from hair transplants because they do not have enough donor hair to cover their bald areas.

If it is very likely that you will not have enough donor hair for your baldness, then it is a MUCH better idea never to get any hair transplants at all so you can still shave your head without any scars showing.

It is always possible to cover a whole head with a few hairs, but the transplanted areas will be so thin that it will not look very good at all. Most of the successful hair transplant patients would still like to have more donor hair to make the transplanted areas even thicker if it was possible. Anyone who becomes a Norwood 4 or worse will probably always wish they had more donor hair to use, even though they are satisfied with their transplant results because it looks much more acceptable than baldness.

Norwood 5-6 cases are very difficult. They require a highly-skilled doctor. Even with a great doctor, it still usually requires ALL of the donor hair they can possibly take off the person's head just to create an acceptable result. These patients will definitely require several transplant surgeries and a lot of money.

NW7 patients are almost always BAD transplant patients. In almost every NW7 case, these patients cannot get thick enough transplanted hair to look acceptable. There is simply too much bald scalp area to cover and not enough donor hair to put over it.

In most of the severe balding cases (like Norwood 5-7), the patient decides that they do not want the same density of transplants over their entire head. They often choose to put thicker hair in the front and top, in exchange for thinner hair in the crown area. This is because a thin or bald crown area is normal in many older men. So when the patient gets older and all of his original hair is finally gone from the balding areas, the transplanted hairs will still look very much like a normal "thinning" pattern. It is also important to leave the temples receeded. Filling the temples consumes a large number of hair grafts, and it will not continue to look natural if the patient has become much older and his crown area is thin.

-------------------------------------------------

None of these things are guaranteed.

Scientists have been cloning new hair for at least 10-20 years in experiments, but nobody is doing it well enough to be useful yet.

There are several groups working hard at perfecting this technology right now. They are definitely closer than anyone has ever been in the past. But they still have not published any results that look like real normal hairs, so we don't know how far they are yet. And they are only halfway finished with the government-mandated tests to prove that it works and it is safe. So that problem by itself will take several more years just to get past before they can offer any kind of cloned hair to the public.

There is a lot of news saying that cloning new hair is only a few years away. However, these researchers depend on other people's money to keep working, so they have a good reason to predict the advancements sooner than they might really happen.

It seems likely that SOME KIND of new hair loss treatment will be available in the next 5-15 years because there are so many different new possibilities being investigated right now. But nobody knows which methods it will be, or when it will be released to the public.

---------------------------------------------------

Lots of good advice so far. Here's my two cents on the age/HT debate:

For a 20-year-old, I think it's mainly important to determine whether or not a class 6-7 is likely. If you're gonna bald that severely, then it's a different debate and your options at 20 years old are a lot smaller & riskier. But if you're probably only gonna do a NW#3-5 pattern, then I think an early transplant just into the center forelock & vertex may be pretty safe if you can say yes to these things:

-- Gotta be willing to live with HTs in general. Not shaving down short ever again, gotta be okay with the "illusion of density," etc.

-- Gotta be willing to get a strip-scar eventually, even if not at first. It's probably not gonna be feasible to do a major-league reconstruction without it. FUE is WAAYYY expensive, demands smaller graft numbers per session, and often still seems to be a bit lower-yield than strip.

-- Gotta be willing, both surgically and financially, to have multiple future HTs. Probably all the way to exhuasting your donor supply.

-- Gotta be willing to leave the temples recessed to some extent. NW1 is a pipe dream and NW2 isn't even a good idea. NW2.5-NW3 is a much better risk in front. I say this partly for graft conservation at a young age, and partly just for more natural looks if you can't cover the crown later in life.

-- Even after all this, gotta be willing to live without ever really covering the crown much. A bald spot may always be visible even after moving thousands of grafts and exhausting the donor area with multiple HT surgeries.

If you can say yes to all these things and you're not headed straight for NW#7 territory, then maybe an early HT at 20 years old isn't a bad idea. MAYBE. Just don't underestimate how much you'll care about your looks later in life. If you care enough now to get surgery, then you'll probably still care A LOT even decades from now.

And I still vote to wait a while. My case of hair loss TOTALLY contradicted to rest of my family and it didn't start to show until my mid-20s.

------------------------------------------------

The plane flights are expensive but the surgery you are considering is several times more than that.

I don't blame you for not wanting to piss money flying to other continents several times just for early consultations & stuff. But when it comes time for the actual surgery, I really hope you won't let the extra money affect your decision. Each surgery costs as much as a decent used car and everyone's donor hair is too precious to waste.

------------------------------------------------

-- Propecia daily and Nizoral 1% shampoo about 3x/week. I just started everything about 6 weeks ago so it's too early to know much.

I'm only taking .25mg per day of the fin.

(Who needs Proscar? Even true Propecia ends up being pretty cheap when each pill lasts for 4 days. And there's no way to hack Proscar pills down small enough for .25mg anyway.) Even the .25mg/day has been enough to give me sexual sides. Definitely made me a believer that fin's dosing curve is kinda flat. I'm not sure whether I'll stay on fin or not. It's powerful stuff. Mild testicular ache when I started and I would have quit within days if it had not faded away. I still don't trust this stuff at all.

I don't know how the rest of you guys are, but I can really feel the inflammation on my scalp when the DHT is pumping. Seriously. I first started using Nizoral because I could feel the difference. There have been times of high stress/hormones when I've actually taken an unecessary shower in the middle of the day for no other reason than to use Nizoral to cool down my inflamed scalp.

I don't even have to remember to take my daily finasteride dose in the morning or not, because I can literally feel the difference on my head any time I forget. Half an hour after I swallow the pill fragment I know I did it. I wasn't expecting anything so dramatic & immediate before I started Fin.

------------------------------------------------

Lately it seems like we're getting more and more signs that it is possible to cause hair to grow from bald skin using drug therapies rather than any type of transplantation (including HM).

It makes me wonder if having a conventional HT using current methods (FUE, for example) would eventually cause problems with future developments. Some of these developments might eventually give a TRULY full head of hair. But would it only work well with virgin scalps that aren't full of scar tissue (not to mention damaged original follicles from the HT implantation process)?

I'm not thinking about a strip scar. It's a likely to be somewhat of a problem, but it's also a pretty small amount of surface area to have trouble with in the big scheme of things. I'm thinking more about the recipient sites of the grafts and scarring issues, because that's a MAJOR portion of the entire head. And I suspect that the donor sites with FUE would probably pose similiar problems.

We all know that original density is probably not achievable for most patients with existing HT methods, and that's fine if donor hair is a limitation overall. But what if it wasn't? Would recipient scarring limit future "needle 'n grow" methods?

------------------------------------------------

Young Gun:

My grandfathers both lived up to their 70s/80's with NW#2 hair. My father is 62 with no hair loss since high school either. My only blood-related uncle is still a NW1 in his 50's.

My hair looked awesome at 20. It still drew compliments from strangers at 24 . . .

And yet now I'm 28, and I've become visibly a NW3. I'm eventually headed for a NW4-5.

If you're 23, be careful. Be very careful.

------------------------------------------------

What's interesting to me is that it can be the people with the smallest problems who are really messed up over it.

Michael Jackson wasn't exactly ugly to begin with. And even then, he had gotten his nose to the perfect caucasian-shaped appearance he was seeking by the early '80s. But no-o-o . . . he just kept cutting.

What's most ironic is that 20 years later it's becoming more and more embraced in the entertainment industry when people like him keep their ethnic-looking noses for a bit of uniqueness/character. (Or at least have them less drastically whittled than in the past.)

The rest of Jacko's (original) face looked well-structured. The ethnic nose didn't really hurt his appearance back in the day, and his face probably would have aged great if he had just gone easy on it.

------------------------------------------------

Personally I'd go through anything for while if I knew it would fix the situation in the long term.

I swear, I'd be willing to walk around with my head covered in green algae for two years if that's what hair multiplication took to work correctly and final results were guaranteed.

--------------------------------------------------

Here's a short set of answers, thickerhair:

Hair transplants don't create new hair, they only move it around on your head. The operation is more of a "skin transplant" than a "hair" transplant. The surgeon is cutting off a long strip of skin (in an area of your scalp that is still growing thick healthy hairs) on the back of the patients' head. Then the surgeon divides the strip of skin into thousands of smaller pieces, and then he puts the tiny pieces ("grafts") back into the patient's head on the front/top. When everything heals up a few months later, the bits of transplanted skin will continue to grow hairs hairs on the front & top of the patient's head.

Hair transplants are good for people with small and medium baldness problems who never want to shave their heads. People with severe baldness at an early age are usually not suitable for HT surgery because everyone has a limited amount of skin that can be taken from the back of their heads before it becomes obvious and ugly. A severely bald person will usually run out of "donor hair" at the back before the surgeon can cover their bald areas everywhere else.

It is a big risk to get hair transplants at a young age because you don't know how bald you will eventually get in the future. And baldness problems usually continue to get worse for the rest of your life. So if you have a big problem at a young age, that is a bad sign because it means you will probably have a MUCH MORE baldness eventually.

The worst situation that can possibly happen is when a man gets a lot of hair transplanted into the front/top when he is young, even though he was a bad HT candidate, and then the man goes VERY bald later in the future. The man won't have enough donor hair for the surgeon to cover the rest of his head later. So eventually the man's head does not look normal the way the hair grows because of the half-finished transplanting process, AND the man can't shave his whole head short/bald (like a normal bald man often does) because of the ugly scars on the back of his head that would be showing.

To avoid this situation, you and your doctor need to always plan for the WORST POSSIBLE baldness problem that you might ever get. Even though the surgeon might be able to transplant a lot of hairs from the back into the front and make you look great at first, this is a terrible plan for the future if the surgeon uses too much "donor hair" when you are still a young man.

------------------------------------------------

Any time someone studies the effects on physical attractiveness in areas where it's "not supposed to matter" they come back with more or less the same results: It DOES matter, and it matters more than even the highest estimates, and it matters almost as much even in situations where it has no relevance. Many of the people talking about their findings literally sound shell-shocked. They often sound hurt/disgusted with human nature in general.

Our culture likes to spin the subject of cosmetic improvements into softer contexts like "gaining confidence" and all that. But IMHO, the ugly truth is that Attractive = Better Life. Humans are already hard-wired to pay attention to this to some extent, and now we live in the most appearance-focused society the earth has even known.

If you live in a society that values education then you go to school, right? If you live in a society that values the art of war then you join or support the military in some form, right? Well, we live in a society that values appearances.

------------------------------------------------

I wonder if the lack of density of the HT areas affects things. (Not in the way the individual hairs form & grow, but rather in the way that they lay & clump together in groups.)

I know that in my thinner areas, the hairs probably seem more curly just because each individual hair is more "freed up" than the thinner areas. The thicker areas have more "weight" to the hair mass and every hair has more hairs close around it which helps hold it in line. Areas with more thickness/density seem to hold everything a little bit straighter that way.

--------------------------------------------------

Rob,

I'm not quick to push finasteride on anyone, but this sounds like you might be a good case for getting on finasteride ASAP. You've just dumped a bunch of new androgens into your system and that probably means a big spike in DHT levels as well. Finasteride will suppress the type II DHT that seems to most directly kill hair.

At least for the short term until the 'roids are out of your system, a very mild dosage of fin might not even cut your DHT levels below their orignal baseline but rather just help get them back towards normal. Then once this cycle is over, you can re-evaluate and make a longer-term decision about Fin usage after that.

And by the way, PLEASE don't rush out and go overboard with Finasteride dosing in a knee-jerk reaction. Fin is powerful stuff. It has messed up some guys as badly as the 'roids. In some cases it's very capable of ruining your sexual function and causing gyno (and these cases don't always seem very reversible, either).

Used in a healthy way or not, a lot of guys can immediately start feeling effects from it at no more than 0.50mg or 0.25mg per day. Start reading up on finasteride before you mess with it at all.

Regrowth potential for the lost hair?

Probably too early to know. Probably depends on how much of the sudden hair loss is due to your natural MPB being accelerated, versus how much was because of the overall jolt to your system that the 'roids caused.

------------------------------------------------

Cause a big wound on your entire head, and get white hair growing back to show for it? WTF?!?

But seriously, this sounds like it might have some potential for development. At the very least it seems to be another sign that there could be real regrowth options outside the transplantation/HM field. It's another case of "dead" follicles, and/or bald skin in general, getting re-haired by methods other than just manually transplanting grafts/cells into them.

------------------------------------------------

Money investments with hair loss:

I think a lot depends on your specific condition. Your age, your marital/relationship status, your overall attractiveness and how much the hair situation affects it, etc.

And most importantly, how much MPB are you headed for. If you're only destined for mild MPB, then dumping big money into medications & HTs could mean that the outside world never has to see you lose any hair at all. That could be huge in your life. Espeically with possible future advancements in the field, taking drastic early action could mean that you never have to endure publicly-visible hair loss in your life.

But if you're genetically headed for NW6-7 status in the first half of your life, then even the biggest medication regiments are probably only going to buy you some time. You'll probably show significant MPB within a few years anyway.

Same with hair transplants.

Let's say you're 30 years old with a given amount of money to spend for two Norwood levels of improvement:

There's a huge difference between a NW#4 getting transplanted back to a NW#2, versus a NW#7 getting transplanted back to a NW#5. The NW#4-2 guy looks entirely free of the MPB problem after two levels' worth of HTs, whereas a NW#7-5 is still basically a "bald guy" in the eyes of young women even after all that investment.

------------------------------------------------

Word to the wise -- My own case has definitely taught me not put too much faith in genetics.

If MPB can happen to me, then it really can happen to just about anyone at any time. Both my grandfathers lived until their early 80s with full heads of hair. My father's still got no MPB hair loss at age 62. My father's brother is in his 50s and he's still a NW#1. I can even point to exactly which specific relative's hair color & thickness & curl I inherited, and he never had any MPB either. I had to look at my mother's cousins & second-cousins before I finally found a single blood relative with any signs of MPB.

I had GREAT hair in my teens and even early 20s. I still occasionally got complimented on my hair by total strangers as late as 24-25 years old.

. . . But now I'm a NW3 at 28 years old, and I'm probably headed for an eventual NW4a or 5a. You just never know.

-----------------------------------------------

Wasn't it just in the news that Curis has dropped research into the headgehog agonist thing because of safety concerns?

Anybody?

--------------------------------------------------

I'm 28. It's not a huge deal, but I reason with myself that earlier finasteride usage might make the possible damaging effects more of an issue.

The body is still doing some slight maturing/changing in the early/mid 20s, regardless of what it looks like (or what the legal system says). I read one source saying that DHT seems to peak at about 25 years old.

So whatever developmental effects that DHT might still be having at age 24-26, at least I've gotten through that point knowing that I'm 100% free of long-term problems being caused by the finasteride use at an early age.

------------------------------------------------