Younger patients and donor projections.

[Greg_Swanson]

This is something I've always wondered, but it is sort-of glossed over in the transplant world.

After reading some knowledgeable posts by certain members, and reading many stories, I really think patients should be advised more heavily that their donor hair won't necessarily last "forever".

For example, my family comprises of NW 6/7's, all who had only a NW2 recession in their late 20's, only to lose virtually all of their hair by mid-thirties with sparse donor regions. I've been told that my donor can facilitate a transplant, but if I follow my family trajectory, it definitely wouldn't in a few years. I.e. those hairs would begin to thin. 

I've read stories of people who have had their donor assessed as fine, only to have it think 3-4 years later. 

Some folk say to wait it out, and see where your hair loss will end up - but then again, not a lot of people want to spend 5-10 years covering up their hair loss in anticipation.

Just thinking out loud, any thoughts welcome : )

[AssaultedByDHT]

Yeah. That's why I believe transplant without meds is way too risky.  If I ever get off my meds, I won't bother with caring about my hair anymore because I know for certain my future is NW6/NW7 (diffuse thinning).

[hairman22]

6 hours ago, AssaultedByDHT said:

Yeah. That's why I believe transplant without meds is way too risky.  If I ever get off my meds, I won't bother with caring about my hair anymore because I know for certain my future is NW6/NW7 (diffuse thinning).

meds slow down hair loss. Dont stop it especially not someone heading for nowood 6 or 7

 

 

[AssaultedByDHT]

10 hours ago, hairman22 said:

meds slow down hair loss. Dont stop it especially not someone heading for nowood 6 or 7

 

 

If I can get just a decade of maintenance out of dutasteride and finasteride, in addition to a 2500 grafts to add density to the midscalp and the front, I will be very glad. I'm sure that some better treatment will be out there in 10 years.

[harry_potter1]

35 minutes ago, AssaultedByDHT said:

If I can get just a decade of maintenance out of dutasteride and finasteride, in addition to a 2500 grafts to add density to the midscalp and the front, I will be very glad. I'm sure that some better treatment will be out there in 10 years.

That is a bit naive

 

Regarding original post. I agree with you. 

That was one of the reasons I didn't go for HT at younger age -though not sure it was right decision- as I wanted to see how much I am gonna lose before that.

Didn't want to be someone who had 5K grafts implanted for NW3 and then I end up NW 5/6 and don't find enough grafts lefts

That is why selecting surgeon is important too. A relatively conservative approach could help to preserve your donour are

[bonkling]

20 hours ago, AssaultedByDHT said:

Yeah. That's why I believe transplant without meds is way too risky.  If I ever get off my meds, I won't bother with caring about my hair anymore because I know for certain my future is NW6/NW7 (diffuse thinning).

How long have you been on them, do you mind me asking? Do you think they've successfully kept the loss at bay?

[Greg_Swanson]

1 hour ago, harry_potter1 said:

That is a bit naive

 

Regarding original post. I agree with you. 

That was one of the reasons I didn't go for HT at younger age -though not sure it was right decision- as I wanted to see how much I am gonna lose before that.

Didn't want to be someone who had 5K grafts implanted for NW3 and then I end up NW 5/6 and don't find enough grafts lefts

That is why selecting surgeon is important too. A relatively conservative approach could help to preserve your donour are

These are my concerns exactly.

How come you say you're not sure it was the right decision?

Did you end up committing to a transplant?

I suppose it's that old decision of: wait it out, but live a few years under a hat - or, get a transplant, and risk it ending up worse than when you started.

[Greg_Swanson]

2 hours ago, AssaultedByDHT said:

If I can get just a decade of maintenance out of dutasteride and finasteride, in addition to a 2500 grafts to add density to the midscalp and the front, I will be very glad. I'm sure that some better treatment will be out there in 10 years.

I've been thinking that too. If I can tough it out for a decade or so, hopefully things have advanced by then

[harry_potter1]

9 hours ago, Greg_Swanson said:

 These are my concerns exactly.

How come you say you're not sure it was the right decision?

Did you end up committing to a transplant?

I suppose it's that old decision of: wait it out, but live a few years under a hat - or, get a transplant, and risk it ending up worse than when you started.

Didn't commit to HT yet. Thinking about going for it between 2020-2022

 

Not sure due to couple of reasons:

1- I didn't take medications and now it is probably too late. I am diffused NW5. Should have at least gave it a go. 

2- I think I shouldn't have waited till it was very advanced, up to 2016 or 2017 I had enough thickness to  camouflage my scalp. Still looked good with my hair. But it was clear which direction I was headed too. I think I should have started at that point ( I was around 28-30)

 

That said I am not regretting anything. I am more knowledgeable now than I was few years ago. If I had done a surgery back then I would have gone to local doctor. There is a couple of decent one here but nothing "impressive" tbh 

[Greg_Swanson]

On 8/4/2019 at 9:29 PM, harry_potter1 said:

Didn't commit to HT yet. Thinking about going for it between 2020-2022

 

Not sure due to couple of reasons:

1- I didn't take medications and now it is probably too late. I am diffused NW5. Should have at least gave it a go. 

2- I think I shouldn't have waited till it was very advanced, up to 2016 or 2017 I had enough thickness to  camouflage my scalp. Still looked good with my hair. But it was clear which direction I was headed too. I think I should have started at that point ( I was around 28-30)

 

That said I am not regretting anything. I am more knowledgeable now than I was few years ago. If I had done a surgery back then I would have gone to local doctor. There is a couple of decent one here but nothing "impressive" tbh 

Perhaps waiting is indeed better in your instance. 

The difference a good surgeon/clinic can make is enormous, so I feel as though waiting, but choosing a good option will definitely serve you better in the long run.

I suppose once a transplant is done, you can see if medication is the right course to help it along.

[gillenator]

On ‎8‎/‎3‎/‎2019 at 8:31 AM, hairman22 said:

meds slow down hair loss. Dont stop it especially not someone heading for nowood 6 or 7

 

 

 

 

Very true.

Edited August 6, 2019 by gillenator

[gillenator]

This is why considering family history is an important part of the equation, meaning if there is a family history of pronounced donor thinning, it will probably continue to the next generation.

Yet we must also remember that most if not all of the older men did not have low dose finasteride nor did they take any other meds that are effective for slowing down MPB.

[LaserCap]

It happens.  The problem is, you just don't know. 

Consider there are millions of people on this earth.  We are all similar but yet so different.  When speaking specifically about hair, some may loose early, some very late, some non at all.  I've met with 16 YOs with little to no hair left.  I've also met with patients in their 60s who recently started thinning. 

But, as Gillenator points out, family history does play into this considerably.  If the writing is on the wall, get ready.

I think it would be smart to start a medical regimen.  The fact you are thinning diffusely should prompt you to get going.  And, if you have a lot of hair that has not left the building - even more so.  You still have the opportunity to reverse some of this miniaturization.  Give it a year, which is the time it takes to find out if the meds are effective.  Three things may happen.  You may end up staying as you are, which means the medication is working.  You may end up worse...Meaning the medication did nothing and you continued experiencing loss, (at that point just get off the meds and do nothing). Or, you'll get some enhancement, (the shaft of the hair improved)..At that point, by all means, continue the medication.

I'll tell you about my own son.  My grandfather was totally bald.  My dad only has the front forelock and nothing behind it.  My case is very similar.  My son is now 26, never experienced loss.  At 20 he started taking Propecia.  Has not had any loss.  What we don't know is...would he have had any loss in the interim?  Don't know.  Most of my loss occurred at 26.  Regardless, we both know it's going to happen so we agreed to be proactive.  (He does not want to look like me).

My suggestion is to consider the meds until you get some kind of proof you are experiencing retention. If you do, you will continue doing so for as long as you take the medication.

Lastly, I'll tell you....Many doctors do take this into consideration.  Many are not willing to do transplants until the patient is in his 30s.  They want to have an idea what the pattern will be.

[Melvin- Admin]

1 hour ago, LaserCap said:

It happens.  The problem is, you just don't know. 

Consider there are millions of people on this earth.  We are all similar but yet so different.  When speaking specifically about hair, some may loose early, some very late, some non at all.  I've met with 16 YOs with little to no hair left.  I've also met with patients in their 60s who recently started thinning. 

But, as Gillenator points out, family history does play into this considerably.  If the writing is on the wall, get ready.

I think it would be smart to start a medical regimen.  The fact you are thinning diffusely should prompt you to get going.  And, if you have a lot of hair that has not left the building - even more so.  You still have the opportunity to reverse some of this miniaturization.  Give it a year, which is the time it takes to find out if the meds are effective.  Three things may happen.  You may end up staying as you are, which means the medication is working.  You may end up worse...Meaning the medication did nothing and you continued experiencing loss, (at that point just get off the meds and do nothing). Or, you'll get some enhancement, (the shaft of the hair improved)..At that point, by all means, continue the medication.

I'll tell you about my own son.  My grandfather was totally bald.  My dad only has the front forelock and nothing behind it.  My case is very similar.  My son is now 26, never experienced loss.  At 20 he started taking Propecia.  Has not had any loss.  What we don't know is...would he have had any loss in the interim?  Don't know.  Most of my loss occurred at 26.  Regardless, we both know it's going to happen so we agreed to be proactive.  (He does not want to look like me).

My suggestion is to consider the meds until you get some kind of proof you are experiencing retention. If you do, you will continue doing so for as long as you take the medication.

Lastly, I'll tell you....Many doctors do take this into consideration.  Many are not willing to do transplants until the patient is in his 30s.  They want to have an idea what the pattern will be.

Wow so your son got on propecia just in case? Or was he starting to experience hair loss?

[pkipling]

There are a lot of factors that go into whether or not someone should get a HT at a young age so that the risks are minimized... And family history is definitely one to be highly considered. I would imagine that any credible surgeon made aware of the severity and the timeline of your family history with MPB would really discourage you from moving forward (if they'd even agree to do it at all.) 

[LaserCap]

15 hours ago, Melvin-Moderator said:

Wow so your son got on propecia just in case? Or was he starting to experience hair loss?

Yes he did.  We are both certain he would have lost a lot of hair by now.  Has amazing hair right now and has never experienced side effects.

[Greg_Swanson]

22 hours ago, LaserCap said:

Yes he did.  We are both certain he would have lost a lot of hair by now.  Has amazing hair right now and has never experienced side effects.

Great news for your son! 

Also positive to see that finasteride can potentially stave off aggressive hair loss.

[Melvin- Admin]

On 8/7/2019 at 6:55 AM, LaserCap said:

Yes he did.  We are both certain he would have lost a lot of hair by now.  Has amazing hair right now and has never experienced side effects.

Wow that’s great news he’s very lucky. I wasn’t so lucky at his age 🙁

[LaserCap]

Me being in the industry did help a lot.  If I hadn't been, likely we would both be bald. This brings up a point.  My grandfather was very bald and I wanted to be just like him.  I was then hired by a HR outfit.  Had to have hts do to the nature of the work.  Thus, if you've never been interested or are unaware of hts, like I was, you'll never hear of the process.  Looking in retrospect, I am glad I did it multiple times.  I still look presentable.  

[Dr Blake Bloxham]

Good thread. 

Not to alter it too much or stand on a "soapbox" here, but this is why I often encourage younger patients who are set on surgery to consider FUT. Regardless of how far a patient progresses, an individual with true androgenic alopecia should always keep that safest part of the safe donor region. Even in advanced cases. The very advanced cases (like a NW VII) are often very familial and we see strong signs early, but even these individuals can still be conservatively served with what they have back there. If the entire donor area thins, then the patient likely has some other type of loss and should never have been offered surgery in the first place. But I do find this is pretty rare and typically somewhat obvious from an early stage. If a doctor has global donor concerns, he/she should advise the patient not to move forward now. However, we see too often today doctors taking from "safER" regions in the "expanded donor" on young patients. As mentioned several times here, this area may not be truly safe and only appears that way because the patient is young and early in his journey. So, this thread is a good reminder to act conservatively, treat the donor as finite and sacred, and maximize for the long-term. 

[LonelyGraft]

4 hours ago, Dr Blake Bloxham said:

Good thread. 

Not to alter it too much or stand on a "soapbox" here, but this is why I often encourage younger patients who are set on surgery to consider FUT. Regardless of how far a patient progresses, an individual with true androgenic alopecia should always keep that safest part of the safe donor region. Even in advanced cases. The very advanced cases (like a NW VII) are often very familial and we see strong signs early, but even these individuals can still be conservatively served with what they have back there. If the entire donor area thins, then the patient likely has some other type of loss and should never have been offered surgery in the first place. But I do find this is pretty rare and typically somewhat obvious from an early stage. If a doctor has global donor concerns, he/she should advise the patient not to move forward now. However, we see too often today doctors taking from "safER" regions in the "expanded donor" on young patients. As mentioned several times here, this area may not be truly safe and only appears that way because the patient is young and early in his journey. So, this thread is a good reminder to act conservatively, treat the donor as finite and sacred, and maximize for the long-term. 

Dr. Bloxham

Is there usually a certain age/timeframe where the possibility of donor thinning can be seen?

 

also, how much does the donor thin on average over a lifetime?

[gillenator]

For those individuals who are destined for donor thinning, it usually can be seen by age 40 plus.   It may take using high empowered magnification to confirm miniaturization throughout the donor zone...by age 50 plus it usually becomes more pronounced and visual by the naked eye.

How much can the donor thin over a lifetime?...looking at family history is once again the best indicator IMHO.

[LonelyGraft]

11 hours ago, gillenator said:

For those individuals who are destined for donor thinning, it usually can be seen by age 40 plus.   It may take using high empowered magnification to confirm miniaturization throughout the donor zone...by age 50 plus it usually becomes more pronounced and visual by the naked eye.

How much can the donor thin over a lifetime?...looking at family history is once again the best indicator IMHO.

Thanks. I guess what I’m asking is there a safer age to pursue hair transplants where donor thinning is less likely to occur or identified? For example people say to wait til about age 30 before getting a transplant as your final hair loss pattern can be identified. Is there a similar rule for donor thinning?

[gillenator]

IMHO, between ages 30 - 40 would be ideal...but again it's going to vary somewhat between individuals and why again family history is the best indicator we have to go on.