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Some of the doctors offer it at their clinic. That bugs me. They should be doing studies to prove it works, before they start selling it to their patients.

Your doctor may still prescribe it "off label" meaning he knows it's not for your prostate (ask him). You still save money that way. It's illegal to sell any prescription medicine without a prescription, and it's illegal to sell generic Finasteride inside the USA (if you do it via mail order you are doing it on the sly). If you want Merck's brand of Finasteride (Propecia or Proscar) rather than another brand from outside the US, you have to go through the conventional channels. Otherwise look around for a website that looks reputable that sells those drugs (I can't make a recommendation on that, sorry). I think the worst case scenario is that your package gets confiscated, but as long as you are not ordering in bulk you should be okay.

It seems to me that when one state takes an action, then other states sit up and take notice, and are willing to consider similar measures. Getting a start in Massachussets and Minnesota means that other states will take your suggestion seriously. Do not focus on your own results, make the focus illegal or unethical activities such as: <UL TYPE=SQUARE> <LI> Salesmen making surgical recommendations and doing follow up exams (illegal practice of medicine by a non-physician)<LI>Unqualified personnel doing most of the surgery (medical techs) without proper supervision <LI>Asking the patient to sign a legal disclaimer just a few minutes before surgery starts, when he can't spend time reading or thinking about what he's signing <LI>False advertising ("Regrow your Hair"... that's not what hair transplants do, all they do is move hair from the back to the front. That's not "Regrowing" your hair. There are many many other examples) <LI>Throwing away valuable grafts, because the clinic overbooks the surgery. If someone else is scheduled to start their surgery at 3 in the afternoon, for example, many clinics just throw away any leftover grafts in order to make sure the room is available at 3 <LI>"Upgrading" the patient: selling the patient extra grafts, on the day of surgery. Revising the estimate the patient got during his consultation, at the last minute. <LI>Using concealers (Toppik) in patient's After photos. <LI>Full disclosure: Not disclosing the common risks and common problems. Bad scarring, poor growth, accelerated hair loss, need for additional surgeries. All these things should be disclosed and understood well BEFORE the first surgery. Many guys only find out bad scarring or shock loss is possible, when it actually happens to them. Most "patient education" happens after the fact, and that is inexcusable. <LI>Using outdated techniques and tools. For example multibladed knives to remove the donor strip are typical, even though they waste a lot of precious donor hair. These are just a few of the problems that need to be addressed. At this point, the doctors have already been given MORE than a fair chance to alter their own behavior and/or police themselves, and the problems remain the same in many clinics. To me, that indicates that outside pressure and outside regulation is necessary. Guys like Pat (owner of this website) and other individuals do a lot, but can only do so much or only say so much, because of the threat of lawsuits. It's time to bring in outside regulation, in my opinion. It is simply unacceptable that in 2005 some clinics are still breaking the existing laws, or still using outdated techniques (while telling patients it's "state of the art" or that they are "leaders in the field"), or still misleading patients with their advertising or during their consultations. It has to stop. If you conatct your state legislators or states attorney's office, ask them to consider adopting a bill that is similar to the proposed Minnesota or Massachussets bill, that is intended to regulate the hair transplant industry.

Sorry about including the links Robert. I should have known they would be a red flag. When you see the MHR commercial they make it sound like all these top docs are lining up, trying to get into their "training program". Apparently it's just the opposite...

If you're not especially young, your doctor may write you a prescription for Proscar. You may even get your insurance to help pay for it that way. And you would have some more peace of mind that you weren't getting counterfeit drugs (that's a huge racket nowadays) by getting your Proscar at a local pharmacy, not via mail order from overseas, where accountability may not be guaranteed. The reason I mentioned it being an option for older guys, is that Proscar is widely prescribed for guys with prostate problems, which is common in older men. If a doctor prescribed Proscar for a 20 year old, it might raise some eyebrows. But if you are in your mid-30s or above, then your doctor may be willing to do it... ask him. If cost is an issue for you, you may want to mention that. Some doctors are willing to do this kind of thing, especially if it means the difference between the patient being able to afford treatment or not.

Well, getting on Propecia is a serious decision, just like getting on any drug long-term. But it's not any more serious than deciding to get a hair transplant, where you can't change your mind afterwards. I think the odds with Propecia are pretty good, if you can believe Merck's stats. About 80% of guys get some benefit, and side effects are in the 5% range. If you are unlucky enough to have side effects, there are some tricks or options you can try, by cutting your dosage down, alternating days, and so on. Some guys report that the side effects were temporary, too. Keep your doctor in the loop if you have any Propecia concerns or problems, and you can always turn to the 'net if you want someone to bounce your comments or questions off of.

WOW. Great post, Pat. I'm too embarrassed to take off my hat, but I certainly tip my hat to you, Sir. SO many great points in your post. Probably the one that really stands out... that the "good" doctors actually WANT informed patients. (Not know-it-alls, but patients who know what they are getting into, and appreciate what makes a "good" clinic good). For one thing, it saves the doctors time, because when these patients walk in the door, the consultation doesn't have to start at square 1... "what is a hair transplant" etc. Only the doctors who have something to hide, or who peddle a second-rate product, don't want the scrutiny that they get from an informed consumer. The top docs realize that scrutiny is just going to show off all the aspects that set their practice ahead of the pack. Scrutiny just makes them look good in comparison. I'm sorry that this process of patient education is only restricted to the patients who come across websites like yours, before their first surgery. For that reason, in my opinion, there needs to be some intervention, regulation and 'cleaning up' of the industry. The bottom-feeders need to fold up their tents and find themselves an honest way to make a living. That's where I am putting most of my energy nowadays. I want to improve the fortunes of the patients who may not be looking for information on the internet. We all have our own roles to play. I tip my cap to you for trying to educate patients on the "positive" aspects, and trying to steer them in the right direction.

I'm sure a lot of people have seen the MHR infomercials on TV, it seems like there is one on every hour, on one station or another. There's that stupid "Hair Dudes!" one, and there's one where they're sitting around having the phony "panel discussion". I can't stand watching them but sometimes I'll leave it on for a couple minutes, and I always notice little misleading comments, exaggerations etc. Anyway, they always talk about how MHR has this exclusive training program, and how they turn away doctors who apply, as if they are cherry picking from the best of the best. Since the doctor who is in charge of the MHR training program is also the doctor who "botched" the heck out of me, basically wrecking my appearance for life, I always raise my eyebrows when they talk about their "elite" training program, and how not just anybody can get in. So imagine my surprise, to see this online: An open-call classified ad, looking for new MHR doctors, posted on an Emergency Medicine bulletin board. A Career With Serious Growth Potential MHR Fellowship Program "?? An intense, cutting edge 12-month curriculum. "?? One of the Few Fellowship Programs recognized by the International Society of Hair Restoration Surgery "?? Candidates are personally selected and train under the supervision of Dr. Matt L. Leavitt. For Fellowship information, please call Dr. Carlos Puig @ 713-629-0740 Medical Hair Restoration 45 Locations Nationwide [links to promotional websites edited - Robert] Maybe I misunderstood, but the MHR commercials made it sound like there were elite doctors pounding the doors down trying to get into MHR's training program. Hardly...! The doctors reading that website looking for jobs aren't going to have a background in dermatology (skin and hair) or cosmetic surgery!!! They're not going to be doctors who already have an interest in aesthetics. They will be doctors who are tired of doing emergency surgery, and looking for something easier.

I'm sure a lot of people have seen the MHR infomercials on TV, it seems like there is one on every hour, on one station or another. There's that stupid "Hair Dudes!" one, and there's one where they're sitting around having the phony "panel discussion". I can't stand watching them but sometimes I'll leave it on for a couple minutes, and I always notice little misleading comments, exaggerations etc. Anyway, they always talk about how MHR has this exclusive training program, and how they turn away doctors who apply, as if they are cherry picking from the best of the best. Since the doctor who is in charge of the MHR training program is also the doctor who "botched" the heck out of me, basically wrecking my appearance for life, I always raise my eyebrows when they talk about their "elite" training program, and how not just anybody can get in. So imagine my surprise, to see this online: An open-call classified ad, looking for new MHR doctors, posted on an Emergency Medicine bulletin board. A Career With Serious Growth Potential MHR Fellowship Program "?? An intense, cutting edge 12-month curriculum. "?? One of the Few Fellowship Programs recognized by the International Society of Hair Restoration Surgery "?? Candidates are personally selected and train under the supervision of Dr. Matt L. Leavitt. For Fellowship information, please call Dr. Carlos Puig @ 713-629-0740 Medical Hair Restoration 45 Locations Nationwide [links to promotional websites edited - Robert] Maybe I misunderstood, but the MHR commercials made it sound like there were elite doctors pounding the doors down trying to get into MHR's training program. Hardly...! The doctors reading that website looking for jobs aren't going to have a background in dermatology (skin and hair) or cosmetic surgery!!! They're not going to be doctors who already have an interest in aesthetics. They will be doctors who are tired of doing emergency surgery, and looking for something easier.

I've heard shedding phases are normal. Try to stay calm and ride it out. I know it's hard. But try to measure your progress over the long-term (don't obsess about the day to day). How's Propecia been doing for you, all in all? Oh yeah, re: shedding. I understand that 100 hairs a day is a normal shed, for guys with no hair loss and a full head of hair.

Good luck Bill, I hope this works out for you the way you hope. You mentioned in your original post that dense packing is controversial. I don't think that at this point, it can really be called contoversial any more. Higher graft counts are the norm at the so-called better clinics. A 2000 graft procedure is considered normal (not high) and anything less might be called on the low side (if the patient needs lots of grafts). The only issue with density, is finding a balance between "area of coverage" and "density"... you can't have a large amount of "both". You still have a good amount of hair remaining... high sides and some remaining hair in the crown and vertex (I think). Do whatever you can to retain your high sides!!! It makes a huge difference. Every little area you don't have to graft, is to your advantage. Good luck and good healing.

Hi Harve I can't add anything to the discussion regarding doctors in Arizona. But if you are still losing hair, it makes me wonder if you are on a regimine to prevent hair loss? Are you using Propecia (Finasteride) by any chance? I'm sure you know that a transplant doesn't do anything to stop future hair loss. Getting a transplant without putting your hair loss in check, is a losing proposition. 99% of guys can never "keep up with hair loss" with surgery alone. I hate to keep using the same line, but it's like bailing water out of a leaky rowboat. The more of your original hair you can keep, the better off you're going to look, in the end. Propecia is not all that good at regrowing hair for most guys, but it is usually very good at helping you keep the hair you still have. Are you using it?

I agree with Robert. Don't just go to whoever is most convenient! You're talking about permanently altering your appearance, so please don't just leave that up to chance, just based on whatever your address might be. Lots of people assume that hair transplants can't be all that complicated, and they're all about the same... nothing could be further from the truth. In my opinion there are only a small handful of truly excellent doctors in the field... and anything less than truly excellent, is just not good enough. An "okay" hair transplant looks like an obvious transplant, and that's not worth paying a penny for. Don't waste your money, or your limited "donor hair bank". Look around, do some research, seek out the best. Avoid "just okay" or "pretty good" doctors. You will be glad you made an extra effort. The best thing you can do is spend some time reading up about transplants... what makes the good techniques good? What makes the bad techniques bad? If you can spend some time reading and learning, you will empower yourself and help yourself make good decisions. The rookie patient usually doesn't know what to look for and what to watch out for... he can't tell the good doctors from the bad doctors. Even to an experienced guy, the doctors sometimes can all seem about the same. They're not all the same.

I didn't notice any difference in speed of hair growth using MSM. I'm not saying it won't work for you, but it might not work for everybody. Or maybe it was just an improvement that I couldn't notice. It doesn't prevent hair loss, as Robert said. And like him, I don't really know why it seems to be a trend to take it.

Sorry but this is kind dumb, to say that you can't be president and be bald. How many people get to be president, period? Forty three guys so far. I am sure some of the early (founding fathers) presidents were bald, but during that time it was common to wear a wig. LOTS of bald guys wield political power today, look at Vice President Dick Cheney. Forget what Berlusconi says, he said a bunch of other kooky things too (do it for the honor of your family). Bald guys are well represented in essentially every high office in the country. If you blame your lack of success in life on hair loss, you will always be looking for an excuse. If it wasn't baldness it would be something else, I guarantee it. I once heard a guy complain that he was handicapped in life because he was "too tall". If hair loss is the biggest obstacle you have to confront in life, consider yourself lucky. Bald guys can go absolutely anywhere and do absolutely anything. If you want to do something in life, just go for it. Hair loss is not holding you back, you're holding yourself back with a "can't do it" attitude. I apologize, I know this is a board where guys come to vent about hair loss, but lets not say it keeps you from doing whatever you want to do... it doesn't.

Hah, there's the solution... after your hair transplant, never go outside with out a hat. Good idea! A hat will make any hair transplant look better.

Think about using a DHT blocker like Propecia, along with Minoxidil 5%. Combination therapy is supposedly more effective. Until you address the DHT issue I think you are swimming upstream. Don't start and stop treatments, just decide on a sensible regimine, and do it. You're not helping by starting and stopping treatments. Some guys find Minoxidil irritating, if that is an issue look around for a formula with no Propylene Glycol.

Gerald Ford was balding. Probably a Norwood 5 Jerry Ford pic Plenty of presidents have had a degree of hair loss... Nixon, Roosevelt, LBJ spring to mind

Check out a website called Bald R Us, they are all about this kind of thing. The shaved look is big now, I see a lot of guys doing it. I live in a big city and every day I see guys with shaved heads, hanging out with good looking chicks. At worst, most girls don't mind, and some girls really like it. Because I have hair loss myself, I can't help but notice 90% of these guys shaved it probably because of hair loss. Who cares? Nobody else really cares except other neurotic bald guys like us. Only a neurotic person who needs to get a life (me, I guess LOL) is going to stare at your head looking for the "missing stubble". Some people say that only big muscular guys look good with shaved heads, I don't think that is true. Look at Moby, Michael Stipe (REM) Billy Corgan etc. These guys are far from muscular. I'm sure there are lots of other examples I can't think of, right now. You can still try using Propecia, even though you are shaving your head. It may be a good idea (?) to try to retain the hair you still have, even if your hair is shaved or short. If you ever change your mind you will appreciate saving that hair. It's good to keep all your options open. Hell you can always wear a hairpiece again, if you change your mind. I would say go for it.

Get on preventative medicine right away, to stop your hair loss from progressing. You should try a DHT blocker like Propecia (Finasteride). Use it for at least a year before judging your progress. A hair transplant doesn't prevent future hair loss! You should be on preventive medicine BEFORE you even think about a hair transplant, in my opinion.

First of all, nobody says HT don't "work". the hair that gets moved, will grow. That part works. Now whether it looks natural is another story. I'd say (in my opinion only of course) that 90% of the hair transplants being done look like obvious transplants, and in my opinion they are worthless (note some guys don't care about being noticeable, as much as I do. Maybe you don't). The guy from The Trouble With Hair Transplants website had a huge problem with shock loss. The surgery left him with less hair, in the end. This is a very real risk for some guys. Most HT doctors are not that good, hence the need for a website like this, to steer guys towards the better clinics.

The issue is not purely "age". It's that you want a transplant to return you to the point where you used to be (or are "supposed" to be). A hair transplant can't make you look like you have no hair loss whatsoever. Look at some of the guys in the gallery section here. They look like they lost some hair but kept some hair too. Hair transplants create an "illusion" of coverage, they do not restore a full head of hair. So part of the problem is that you have unrealistic ideas about what a hair transplant can do. It's not purely age related. If you were 19 and totally bald, and you had realistic (low) expectations about getting your hair back, you would be a better candidate than a guy who is just beginning to bald, who wants to go back to "zero" (pre-hair loss condition). Another potential problem is shock loss. Did you know that surgery can actually accelerate your hair loss, for the hairs that are currently "at risk"? The worst case scenario is that you end up with LESS hair after surgery. The first goal for you, should be to stop your hair loss from getting worse, and strengthen the hair you still have. The main thing is DO NOT PANIC. You are vulnerable to getting seriously ripped off or screwed up, when you panic. Be careful, there are sharks in the water who will prey on your insecurity. If I were you I would buzz my hair down all the way, get on Propecia or another serious DHT blocker (and maybe start Minoxidil later if you need something else) and just keep my fingers crossed. Give yourself a year on Propecia as a bare minimum, then a year later re-assess your situation. (Take high quality pics for the best comparison). Most guys can stop their hair loss from getting worse, using Propecia (it doesn't work for everybody, only about 80% of guys slow or stop hairloss, a few lucky ones can reverse it). The good news is that the more recent your hair loss is, the more likely it is you will be a "good responder" to Propecia. Since you guys are young, you have a real shot at success. I have never heard of a guy getting surgery at your age, who didn't think it was a huge (life-wrecking) mistake. Try to learn from other peoples' mistakes.

I think sexual activity is off limits for a week or two. You really have to take care of yourself after a transplant. You don't want to jeopardize your results. Remember that this is going to affect the rest of your life. Don't get impatient or careless. After about 2 weeks the grafts are pretty much "in", although you should be tender with them for at least a month. Really the biggest concern is your donor scar. You want to avoid putting tension on it, or increasing your blood pressure ("internal" tension). Lifting weights can temporarily blow your blood pressure through the roof, while you are doing an exercise. Certain exercises are especially bad, like leg presses, squats, deadlifts... The problem is that tension is a huge factor in forming a problem donor scar. In the best cases, your donor scar can be thin and some guys say it's not an issue whatsoever. Tension can cause the donor scar to stretch, so that it becomes a visual problem, that you would be better off avoiding. The donor area takes a while to heal, as the surgery does rquire "deep healing". Everyone thinks of their hair as being "external" and most guys don't realize that a transplant is real surgery. It's not like a trip to the barber or even the dentist. It takes months for the donor area to completely heal. If you are an exercise buff then you will have to modify your workouts, go very very easy at first and avoid doing anything that stretches the donor area or raises your blood pressure because of hard effort or exertion.

Great thread. That information (on ratios of Ones, Twos, Threes etc) is out there. If I remember correctly, ethnicity can play a role in what your numbers are. You will have to look around, I don't think I can link to outside sources. Doctors have alreeady done studies on this. You do bring up a key point: "Density" in the donor area is one of the factors for successful results. However in the donor area "density" is not the "closeness" of the follicular units to each other... Density is the number of hairs in each FU. It turns out that everybody's Follicular Units are spaced about the same. The main difference in "density" is that a guy with lots of 3 hair FUs has "more density" than a guy with lots of single FUs. I think a donor density of about 2.2 is considered average. So guys with dense bushy hair will probably have better donor density, and thus better coverage from a transplant (they are moving more follicles over, per graft).

I think two weeks is a bare minimum. Some guys will take less time, but other guys take more time. Forget about going back to work the next day. Some guys get swelling around the eyes between day 3 and day 5, do not be stuck going to work under those conditions. You also need to take it easy and give your scalp time to heal, without putting any pressure or tension on the area. Physical strain from just bending over and tying your shoes, should be avoided. Keep your head upright and don't put any tension on the area. Is the area that you're transplanting into, a large area? Lots of grafts? Do you have fair skin? Are you a slow healer? Do you smoke? Is your hair short? Do you have a job where you have to do any physical labor? These factors would add up to you needing more time, not less. I would say a month is ideal, even more if you can swing it. Can you wear a hat at work? Do you work from home? Do you have a desk-type job? Longish hair? A smaller or medium number of grafts? Are you exceptionally healthy and physically fit? A fast healer? These things might help add up to needing a little less time.