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Ht/hair loss advice needed!

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Hi there,


First time poster here. I was just hoping to get a little bit of feedback from some other users as to my current hair loss situation and my maintenance/HT options.


I’m 26 and in January (2018) I noticed that my hair in the temporal region looked a little thin. All the men on my Dad’s side of the family have gone completely bald so I’ve always been very obsessive about checking my hair for potential loss. Anyhow, I decided to go see a hair loss specialist here in Sydney Australia who recommended I get on Finasteride (1mg) three times a week (MWF) for 3 months and see how I respond. I took fin for two weeks in March and in that time I experienced a bunch of sexual sides (a lot of which I didn’t even realise you could even get until I read about them in forums after the fact). I experienced penile numbness, watery semen, loss of morning wood, loss of libido and weaker erections. I could still get it up and I was sexually active during that time but I’d say my erection quality was at about 80%. I also noticed that the sensation of orgasm was dulled. To make matters worse I experienced a pretty hefty shed in my right temporal region and my hair line definitely took a hit.


Naturally, I was pretty freaked out. My Doc had assured me that he rarely sees patients with side effects and that it was very unlikely I would experience any. So, I stopped taking fin and contacted my Doc again. He recommended I try fin again at 0.5mg once a week for a month and then increase 0.5 mg twice a week and so on until I reach a desirable dosage. He also said that because I was only thinning at the hairline and temples (and had no noticeable thinning/ miniaturisation in the crown or mid-scalp a lower dose would probably be appropriate). I was reluctant to get back on the meds but my hair situation seemed to be worsening and after a month of researching low dosage fin use and etc I decided to give it another go. But once again I got sides after two weeks. They were way less severe (obviously) as I was taking such a low dosage but I did lose my morning erections (although one morning I did have a semi) and spontaneous erections and I felt that my erection quality wasn’t quite there. Thankfully I didn’t experience any numbness or loss of sensation. As for libido I can’t really say because I stopped after two weeks which really isn’t long enough to tell. But it seemed to me that at such a low dose I really shouldn’t have been experiencing any side effects at all. So again I stopped the meds and spoke with my doc. He suggested that if I was that sensitive to the drug then I probably shouldn’t be taking it. However, he also emphasised to me that it would be worth trying it again and sticking it out for at least two months to see if the sides dissipate with continued use. He then rehashed that statistic about 50% of patients having their side effects subside after a year etc.


To my surprise though he then suggested that I could opt for a hair transplant and just fill in my temples and strengthen the hairline. He showed me some before/after results of patients around my age who couldn’t take meds due to sides but who he had completed an FUT and FUE on. I hadn’t even considered this an option because I thought that without meds an HT was a terrible idea.


I then began researching the HT route which lead to me discovering the Dr Rahal Clinic. I was blown away by the results I saw. I eventually had a Skype consultation with a patient advisor at Dr. Rahal. They said that they could easily fix my hair line/temples with an FUT. They recommended FUT because I wear my hair a little longer and it would also ensure I had plenty of hair left in my donor area for future procedures. They estimated I would need around 2000 – 2500 grafts to fix/reinforce my frontal third. They also recommended that I give fin another go and stick it out for longer this time to see if the sides go away, but they emphasised to me that I didn’t need to take fin to get great results and that I would likely be very happy with any work they did regardless of whether I’m on the meds.


Anyhow, I guess my main questions are as follows:


- Have any of you had a hair transplant without meds and if so how did it turn out? My understanding is that fin has no effect on the actual growth of the implanted grafts, it’s really just about preventing further loss of native hairs.


- Has anyone had any initial side effects on fin (specifically loss of morning wood) that eventually went away with continued use?


- Would it be worth trying 0.25 mg? At the moment my hair seems unstable. I’m constantly shedding. I can easily run my hand through my hair and come out with 8-10 hairs.


- And I guess ultimately I would love to know if you think it’s wise to get a hair transplant given my current situation? I thought this would be something I would be dealing with/considering in my late thirties but alas ‘twas not to be. Also, I honestly don’t think it’s worth going the HT route if all I can do are small conservative transplants that leave my hairline/temples looking thin. The appeal of Dr Rahal is that his hairlines are dense.


Any advice or feedback you would be willing to provide would be greatly appreciated.


I’ve also included some pictures for reference. There are photos of my hairline prior to any loss dating back to 2013 and then some recent shots so you can see the recession. My temples have definitely gotten worse since March. I have been very stressed about my hair loss so that may have contributed to this.


Cheers legends!













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I can see the changes in your hairline. It doesn't appear that your hairloss is very aggressive.


I had stopped the meds by the time of my HT. Fin can strengthen miniaturised hairs and that is beneficial whether you're having an HT or not. Being on the meds isn't essential to having a transplant, though. Getting a great result doesn't require Finasteride use.


Lower dosages of Finasteride have been shown to work while limiting the side effects. If you are especially sensitive to the drug (and it appears that you are) then it's possible that the 0.25mg dose will not give you the side effects. Yes it's true that side effects can subside over time and remember that Fin can cause some shedding within the first months of starting it.


Your hairline reminds me of what mine was like when I was your age or a bit younger. Your hair is thicker than mine (you're lucky) but the hairline shape is very similar. My hairloss didn't progress very much and I haven't lost a noticeable amount of hair since my procedure five years ago.


Bottom line is that you still have a great head of hair, but your hairline has taken a hit. It could be restored with surgery and you are a good candidate for a dense hairline procedure. If you were on meds then that would be better, but meds aren't essential. Lots of patients shun the meds due to what they read or have had direct experience with them which is negative. Surgery i still possible and still lead to phenomenal results.

I am a patient and representative of Dr Rahal.


My FUE Procedure With Dr Rahal - Awesome Hairline Result


I can be contacted for advice: matt@rahalhairline.com

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Hi Mattj,


Thanks for the reply mate. I really appreciate it.


It’s funny because the change in my hairline was very subtle (i.e. very minor thinning) before I took finasteride a few months ago. Prior to that if I was losing hair it was at a very slow rate. The finasteride seemed to kick things into overdrive and expedited the process. I worry now that things will continue to go south very quickly.


How old were you when you had your HT? Looks great btw. Very natural. I would be stoked with a head of hair like that in my 30s. My dad’s hair was always pretty damn thick but he went completely bald in his mid-late 30s. On my mum’s side the men have thick Norwood 1 hairlines pretty much their entire life! Lucky bastards. Also, do you use rogaine? I wonder if that’s worth giving a shot. I’ve just had so many conflicting opinions thrown at me about hair rogaine and finasteride that I’m somewhat paralysed.


In any case, I’m definitely leaning towards booking a procedure with Dr Rahal but there are some lingering uncertainties which are making it hard to make a decision.


- I see you went with FUE. Do you think FUE would be a better option? I believe it’s more ideal to have the option to shave your head if things continue to get worse etc and for whatever reason further HTs are no longer an option. There are plenty of bad FUT scars around that make me wary of the procedure. Both seem to leave scars but the FUE scars are far less detectable.


- Also in your experience, how long do patients usually wait in between procedures? Like if I were to get undergo an HT would I then have a good 5-10 years before I might need another procedure? I guess that’s all dependent on my rate of hair loss (which can’t really be predicted). But I’m still interested in hearing about what you have noticed whilst working as a rep for Dr. Rahal. I imagine you’ve also seen plenty of younger patients (i.e. mid to late twenties). Are these patients usually happy with the results and do they tend to need follow up procedures?


- Also, what’s your plan if you encounter further loss? Will you opt for another procedure? Another concern of mine is that we only have a limited amount of donor hair and so without meds to maintain native hair we won’t be able to get enough coverage for the entire head.


Sorry for bombarding you with questions. As always, any info you can share would be awesome.


Cheers mate.

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If you do go the HT route it's best to do a couple of things:


1. Get a real assessment of how much hair loss you have. ie. you have coverage but you might be undergoing miniaturization of hairs that will be gone sooner than later. Buzz it down and have a hairloss surgeon find out where you are at.

2. Project which NW you will end up at.

3. After the first two, understand how much donor hair you have for any and all future HT's. There's no use overdoing a receding hairline and then not having much else left over to fill what will go bald in the future.


It seems like a lot of patients are using up too much donor to fix a problem that will only get worse over time. That's why all the recommendations for younger people to try and stabilize the loss and to see where they are going to be down the line, then act more conservatively which the resources at hand.


In my case since my NW is higher I have had to tap into my beard for more grafts. But if you're going for the drop then there is only so much you can do.

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Hey AB2000,


Thanks for the reply mate.


The hairloss surgeon that I had my consultation with (I was referring to him as my “doc” in the post above) did analyze my hair with a microscopic camera and concluded that the only miniaturization he could see was in my hairline. That said, in a year from now things could well change so I think you’re right that shaving down or getting another check up is wise. Having long hair also does make it hard to tell. As I said the men on my Dad’s side of the family all reached full Norwood 6-7 by the time they were in their late 30s - 40. I would assume i’m heading in the same direction.


Ultimately, i’m very aware of the pitfalls of getting a procedure done to address loss in my frontal third when there’s a strong possibility of further loss behind the hair line. That’s my main concern really. Particularly considering that finasteride May not be an option for me. It’s certainly a risky move and whilst I am leaning towards getting a HT, i’m Not going to pull the trigger until I’m a little confident that there’s a viable plan in place to stabilize loss. Although, again without Fin I don’t know what that plan looks like.


Cheers for the advice.

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