Is Medication Really Necessary?

[TrixGlendevon]

Hello! So, I would like some advice please. If any doctors want to give an opinion, I would very much appreciate it too. I have been researching this for about 2 years now. I was lurking here, and other similar forums, for months and months reading before I joined.

 

I am between three options for what I want to do about my hair. I do not take and do not want to take medication so take this into account when/if you decide to give advice.

 

I think I am different to most other people on the forum in that nearly everybody wants hair to style and run their fingers through as their main goal. I don't care about that. I have low expectations in terms of the result I would like. I am in my early-mid 30s and have a NW3v and I would be happy staying as a NW3 forever (2.5 would be ideal but I'd be more than happy with a 3) and just filling in behind the forelock where it is starting to go. I wouldn't even mind not having a complete crown. I see other men saying they need to top up the crown so it is better and I think, I wouldn't mind having that forever. I just don't want to be bald and want the whole thing to look natural. That is it, I don't need my 18, or even 27, year old hairline back to treat this as a success.

 

1) Forget it and shave it all off (I have a forelock though and shaved heads look better on tanned/olive skinned/black/Latino men than pale, white Northern Europeans)

 

2) Get FUE and give myself just enough on top over 2-3 procedures to give myself a shadow and then shave it off to a humber 1 or 2 (or even shorter) and keep it that way forever so it looks like I was losing my hair and then just cut it short. This looks suits me anyway.

 

3) FUT procedures to get max out of my donor and make the most out of it according to what the surgeon thinks and then FUE the scars.

 

The deciding factor is, of course, I do not want to take medication so if 2 or 3 aren't viable, I will do 1. I am hoping at least one of 2 or 3 will be though.

 

As I said, any advice would be much appreciated.

[JayLDD]

Probably best to get your specific intended doctor's opinion as they likely know best what they can actually achieve and the suspected outcomes with or without medication.

 

At norwood 3v you obviously have a good head of hair left though so you're still in the ideal circumstances to benefit from medication. Only 2-5% of users get sides from fin, probably not a bad idea to consider it as in some ways in the longer term you will benefit more from the medication than a hair transplant. By the sound of your expectations and goals the typical results of medication are more what you're looking for too.

 

If not, FUT is ideal. From the way you say "2-3 procedures" I think you underestimate the potential of a good doctor in a single pass, particularly with FUT. Your goals sound very achievable even without meds, but meds seem like the smartest option in the short term to be honest.

[TrixGlendevon]

Thanks for this feedback! It is actually a 3.5V as the bit behind the forelock is going and is quite bad now. I am going to be meeting with the usual Belgians/Belgian based doctors over the course of this year. The only issue with FUT is that I won't be able to shave it down in the future should it get worse. I think at my age it should be quite stable-ish now though. Dr Feriduni said to wait until I am 35 before touching my crown as he would like to see the pattern before advising. He said to wait until next year for my frontal third for the same reason so I will be following these guidelines (pending in-person advice from them, including Dr. Feriduni)

[Spanker]

Imo it is. I'm 7 years on fin and five years post op. Started fin at 31 and transplant at 33. If you start losing at 45...Fin may not be needed, but anything younger, its the best idea. Had I not got on it, I'd probably needed another pass by now. Fin just lets you keep your result for much longer and slows you loss.

[TrixGlendevon]

Thanks for your reply. I don't mind having another pass later in a few years. I have the money and if I have the donor to cover it, I don't see the issue. May I ask how many you have had?

 

The issue I have with the drugs is: Rogaine messes up your scalp and they don't even really know how it works. This rings alarm bells immediately. Given the amount of money in the industry, they can't determine how it works and therefore they can't know what long-term side effects there may or may not be? Not for me.

 

With fin, it wears off anyway and I will essentially be at the mercy of a drug for the rest of my life, planning trips and work contracts abroad around if I can get it or not etc. Also, let's say I live to be in my mid-80s, that is another 50 years of taking a drug. What are the long-term side effects? There haven't been any studies for that kind of length of time. It also has some "interesting" side effects re. prostate cancer/problems and the ability to detect these problems.

 

I am currently just getting other laypeople's opinions (would love the opinion of a doctor though) and will of course leave the final say to the doctors when I meet up with them during the course of this year. Out of interest, I see you're the rep. for Dr. Konior who has a great reputation. What is his advice, if he has ever been asked, on this subject?

[Spanker]

I've had one transplant, 2100 grafts. I don't think fin wears off. You start losing eventually, but less than if you weren't on it and at a slower pace. There are studies to back this.

 

Konior doesn't say it's mandatory but he strongly advises it.

[Swooping]

Well, it's always many times better to take medication. AGA is unpredictable and you can't foresee the future. You can map for current miniaturization, but nobody in this world can map for future miniaturization.

 

Deviating from SDA only makes things riskier, I think that is where FUT shines anyway.

[gillenator]

I tend to think that those individuals that have a diffused thinning pattern (especially in the crown) potentially benefit the most from low dose finasteride. I include myself in this as I had a thinning diffusing crown for 4 decades.

 

I started low dose finasteride in 1996 and been on it ever since. Although my crown was thinning, it has not changed since I started taking it. In other words, it has not progressed with more visible loss.

 

My maternal grandfather and uncle both reached class 6 and I took on the same pattern. So I am rather convinced my crown would have been completely barren by now had I not started finasteride when I did.

[ArochaHair]

There is not a single study we are aware of that shows that finasteride "wears off". The reason that some people believe this is because finasteride only slowed their loss and it took time for them to notice that the progression is much slower rather than completely halted.

[Spanker]

There is not a single study we are aware of that shows that finasteride "wears off". The reason that some people believe this is because finasteride only slowed their loss and it took time for them to notice that the progression is much slower rather than completely halted.

 

The Merk study shows hair count peaks at a few years and starts to drop, but the decline is much less steep than the placebo group. To me, this is showing that it is always working, just that the follicles can still be overcome by the amount of dht that is left.

[mikeyhwk]

The Merk study shows hair count peaks at a few years and starts to drop, but the decline is much less steep than the placebo group. To me, this is showing that it is always working, just that the follicles can still be overcome by the amount of dht that is left.

 

In theory since fin is always working then I wonder if dut works over a lifetime as well. Current game planning says use fin and when losing way jump ship to dut but if this theory is correct and that fin is just slowing down loss and what you see is the cumulative effect down the road then you'd have probably been better off to get on dut immediately so the overall loss over the same period is lessened. Assuming you could handle the sides. It just seems that jumping on dut later in life offers little as the damage is done already so the longer you can benefit from dut the better in theory, thoughts?

[Spanker]

In theory since fin is always working then I wonder if dut works over a lifetime as well. Current game planning says use fin and when losing way jump ship to dut but if this theory is correct and that fin is just slowing down loss and what you see is the cumulative effect down the road then you'd have probably been better off to get on dut immediately so the overall loss over the same period is lessened. Assuming you could handle the sides. It just seems that jumping on dut later in life offers little as the damage is done already so the longer you can benefit from dut the better in theory, thoughts?

 

I agree in theory. Problem is dut isn't fda approved for hair loss and your taking more potential risk getting on dut for 40 years.

[TrixGlendevon]

There is not a single study we are aware of that shows that finasteride "wears off". The reason that some people believe this is because finasteride only slowed their loss and it took time for them to notice that the progression is much slower rather than completely halted.

 

This is good to know, actually. Although, if hairloss continues then surely it wouldn't make much difference if I took medication or not? I really need to speak to a doctor about this but I can't get enough time off work now. I thought I had a week in July but something has come up! My hairloss does appear to have become more stable though.

[TrixGlendevon]

I agree in theory. Problem is dut isn't fda approved for hair loss and your taking more potential risk getting on dut for 40 years.

 

I agree with this. I do not like the idea of taking any drug for 50 years much less one that hasn't been approved by a first world country's medical council/authority.

[TrixGlendevon]

Well, it's always many times better to take medication. AGA is unpredictable and you can't foresee the future. You can map for current miniaturization, but nobody in this world can map for future miniaturization.

 

Deviating from SDA only makes things riskier, I think that is where FUT shines anyway.

 

What is AGA and SDA?

[Justin77]

The Merk study shows hair count peaks at a few years and starts to drop, but the decline is much less steep than the placebo group. To me, this is showing that it is always working, just that the follicles can still be overcome by the amount of dht that is left.

 

Can you please post a link to the Merck study you're referring to? I Googled it but cannot find the information about the peak hair count declining. Which year did it peak, and which year did it start to decline?

 

I'm more familiar with the Rossi 10-year study of finasteride users which concluded:

 

After 10 years, the patients with an improvement at the first year (54 of 113, one less than in respect to the previous analysis because one treatment discontinuation) have an empirical probability of 0.04 to have worse results; otherwise, they tend to maintain the hair growth (with a probability equals to 0.28), or more probably, to improve (with a probability equals to 0.68).

 

http://www.bernsteinmedical.com/downloads/Rossi_Finasteride_10Yr_%202011.pdf

[mikeyhwk]

This is good to know, actually. Although, if hairloss continues then surely it wouldn't make much difference if I took medication or not? I really need to speak to a doctor about this but I can't get enough time off work now. I thought I had a week in July but something has come up! My hairloss does appear to have become more stable though.

 

Sure it makes a difference. Hairloss continues if you're genetically predisposed to it but you can slow it with meds, it's like saying we're all going to die so why eat well and exercise when I can just eat garbage and sit on my butt all day...one way buys you time and the other just leads you to the end faster.

[Speegs]

 

The Merk study shows hair count peaks at a few years and starts to drop, but the decline is much less steep than the placebo group. To me, this is showing that it is always working, just that the follicles can still be overcome by the amount of dht that is left.

I think it's an educated conjecture to think also that the aging process causes a certain amount of hair loss that strictly limiting the conversion of DHT will not deter.