Dr. Kaan Pekiner FUE+BHT 3895 (2007 FUE + 1888 BHT) 28/12/2019

[Scars and Stripes]

Honestly - this looks good. The vertex is a black hole eating thousands of grafts and it is a waiting game. Considering your starting point this looks really, really good! Stay away from Finasterid!

Edited August 9, 2020 by Scars and Stripes

[Cristero]

On 8/8/2020 at 10:05 PM, Namsak said:

I have a question guys: how will finasteride be any helpful if the quasi totality of Portugal25's hairs are implanted hairs. I thought finasteride was useful to preserve native scalp hairs.

This.

Portugal, you know me and we spoke in PM several times, but I have to tell you that your choice to jump on finasteride was dictated by panic rather than logic.

There is no need for you to stay on finasteride, since your native hairs were all gone. It may actually be counter-productive since you had beard grafts implanted.

[rhstoned]

Portugal. I think it looks great so far considering where you were.  And you still have more time for growth. Perhaps minoxidil can help you more in the vertex? 

[Portugal25]

Hello everyone,

I have reached 8 months post surgery and noticed a very slight improvement over the last month. 

Kepping my fingers crossed hoping these gaps will fill in over the course of the next few months as I understood that the crown can take up to 18 months to reach 100% growth.

Following Dr. Pekiner and Dr. Bruno Ferreira reccomendation I I started taking Finasteride last month and hope to start reaping its benefits by the end of the year. 

Even though I’m a Norwood 6 (with 7325 implanted grafts to hide this fact) I was informed by Dr. Bruno that my hairloss will progress and that it would be counterproductive having spent over 14k on my hair (2 surgeries/7320 grafts) and then losing it again for not taking Finasteride. 

Looking forward to your comments.

Edited September 4, 2020 by Portugal25

[Rolandas]

Holy cow! I wouldn't say you're NW7 at all! Donor looks great and the density on the top is incredible! Home run. Happy for you mate!

[HTP1]

Not sure what much more you can ask for given where you've come from. 

Looks really good to me. 

[Melvin- Admin]

Not sure I agree with Dr. Ferreira, there’s no point in using finasteride if you’re a Norwood 7 with an established pattern. I do not think the risks are worth the pros. 

At best, you stay the same. At worst, you suffer cognitive issues and sexual dysfunction, and you still look the same. 

[ITA]

@Portugal25 wow, great, congratulations, could you show us the effect even under the sunlight in the next pics? 

[Rolandas]

1 minute ago, Melvin-Moderator said:

Not sure I agree with Dr. Ferreira, there’s no point in using finasteride if you’re a Norwood 7 with an established pattern. I do not think the risks are worth the pros. 

At best, you stay the same. At worst, you suffer cognitive issues and sexual dysfunction, and you still look the same. 

Joe Tillman is NW7 for ages and still takes Finasteride. Most of people have some degree of miniaturization in donor as well, so Fin would prevent this. If not, he would risk his transplanted hair just like Dr. Ferreira said.

[Melvin- Admin]

2 minutes ago, Rolandas said:

Joe Tillman is NW7 for ages and still takes Finasteride. Most of people have some degree of miniaturization in donor as well, so Fin would prevent this. If not, he would risk his transplanted hair just like Dr. Ferreira said.

I honestly don’t think it makes a difference for Norwood 7s. I would be more worried about the potential long-term side effects than the transplant slightly thinning. That’s my opinion though, everyone’s different. 

[Rolandas]

2 minutes ago, Melvin-Moderator said:

I honestly don’t think it makes a difference for Norwood 7s. I would be more worried about the potential long-term side effects than the transplant slightly thinning. That’s my opinion though, everyone’s different. 

You might not think, but sad reality is, it can decrease density of your HT dramatically. I've seen a guy who had HT and was on fin. Everything was fine until he decided to drop it after many years of use (got married, family, decided ehh, don't care about slight miniaturization). He got NW17 in few years and his HT looks almost non-existent. He said it's his biggest regret. Now he had another one with loads of BHT to catch up and it will never look the way it was looking before.

[HTP1]

I wouldn't be concerned about fin with beard hair. How many people take fin and have issues with their beard or other hair where it's meant to have a growth effect? 

An interesting approach on custom dosing of Fin you may wish to consider: 

 

 

[Portugal25]

@HTP1 actually @Dr. Bruno Ferreira reccomended taking Finasteride 3x/week which is the dosage I’m taking.

@Melvin-Moderator I also believed a NW7 wouldn’t need Finasteride but I don’t want to risk losing transplanted hairs again so I’m giving Finasteride another chance with a lower weekly dosage of 3mg.

@Rolandas what happened to your friend also happened to me as I had a full head of hair after my FUT with Dr. Rahal that gave me 70fu/cm2 density in the front but after 12 years without taking Finasteride I now have 30fu/cm2 density in the front. 

I will probably need a third surgery to rebuild the front (without beard grafts)  and increase overall density which is why I’m in touch with @Dr. Bruno Ferreira

Edited August 29, 2020 by Portugal25

[Rolandas]

35 minutes ago, Portugal25 said:

@HTP1 actually @Dr. Bruno Ferreira reccomended taking Finasteride 3x/week which is the dosage I’m taking.

@Melvin-Moderator I also believed a NW7 wouldn’t need Finasteride but I don’t want to risk losing transplanted hairs again so I’m giving Finasteride another chance with a lower weekly dosage of 3mg.

@Rolandas what happened to your friend also happened to me as I had a full head of hair after my FUT with Dr. Rahal that gave me 70fu/cm2 density in the front but after 12 years without taking Finasteride I now have 30fu/cm2 density in the front. 

I will probably need a third surgery to rebuild the front (without beard grafts)  and increase overall density which is why I’m in touch with @Dr. Bruno Ferreira

It actually sounds and looks exactly like you

Well, you still have quite good donor which is obviously great for you. That person had much worse donor with more miniaturization in there. 

I'm sure it's possible to extract more  grafts from your donor. It looks really really good to me!

[Melvin- Admin]

40 minutes ago, Rolandas said:

You might not think, but sad reality is, it can decrease density of your HT dramatically. I've seen a guy who had HT and was on fin. Everything was fine until he decided to drop it after many years of use (got married, family, decided ehh, don't care about slight miniaturization). He got NW17 in few years and his HT looks almost non-existent. He said it's his biggest regret. Now he had another one with loads of BHT to catch up and it will never look the way it was looking before.

@Pat - Community Publisher

I met up with him two weeks ago, he had his hair transplant over 20 year ago, and he’s now in his late 50s. He hasn’t taken finasteride in years, and his hair looks just as good if not better than it did in the late 90s. 

There will always be cases that you can pull from, I’m just saying when you look at the best and worst case scenario. It’s not worth it. At best, your sides stay intact and your transplant stays the same. At worst, cognitive and sexual problems for a long period of time, possibly permanent. That’s extreme, not likely, but can happen.

I would rather go bald 10x over, but again, that’s just me, so everyone will think differently. Now, finasteride makes sense and is definitely worth taking if your a Norwood 2-4, beyond that, the cons start to outweigh the pros for me personally.

[aaron1234]

@Portugal25 This is nothing short of incredible. I know in the 7 month pics it looked thin, but you said it was right after a haircut.  In fact, my hair always looks thinner after a haircut for a couple weeks.  It is interesting that just a half inch difference in length can make a head of hair look much thicker.  Regardless, your 8 month photos show a big improvement.  Good call to get back on Fin.  Your donor region is actually quite thick and healthy.  You don't want DHT to attack that area and it most certainly can. 

[Cristero]

I agree with @Melvin-Moderator. Both your friend @Rolandas and @Portugal25 would have lost their transplanted hairs anyway, because they were extracted too high in the occipital area.

Especially with @Portugal25, it's clear his occipital area baldness went pretty low on what you would see on many men. I saw pictures of extractions in several patients and a good amount of surgeons extract very high.

You're describing finasteride like if it's the Holy Grail. Many people can't even maintain with finasteride, as the oral version inhibits DHT a roughly average of 40% in the scalp. Without even mentioning that testosterone miniaturises as well, around 5 fold less than DHT. And, as shown by studies done years ago by Italian thricologists, the androgen receptors are more sensible to testosterone than DHT on the hairline.

Dr. Rassman told me personally that he sees miniaturised hairs in the donor quite frequently in men in their 30s, as it's a normal aging process. Taking finasteride on a former NW7 is totally non-sense, especially if he had beard grafts transplanted.

[Rolandas]

1 hour ago, Cristero said:

I agree with @Melvin-Moderator. Both your friend @Rolandas and @Portugal25 would have lost their transplanted hairs anyway, because they were extracted too high in the occipital area.

Especially with @Portugal25, it's clear his occipital area baldness went pretty low on what you would see on many men. I saw pictures of extractions in several patients and a good amount of surgeons extract very high.

You're describing finasteride like if it's the Holy Grail. Many people can't even maintain with finasteride, as the oral version inhibits DHT a roughly average of 40% in the scalp. Without even mentioning that testosterone miniaturises as well, around 5 fold less than DHT. And, as shown by studies done years ago by Italian thricologists, the androgen receptors are more sensible to testosterone than DHT on the hairline.

Dr. Rassman told me personally that he sees miniaturised hairs in the donor quite frequently in men in their 30s, as it's a normal aging process. Taking finasteride on a former NW7 is totally non-sense, especially if he had beard grafts transplanted.

@Portugal25 If I recall correctly your first surgery was FUT with strip taken from the sweet spot? If so, how Mr. @Cristero would explain such phenomenon.

Also not sure why you say that a doctor told you there's a frequent miniaturisation going on in the donor in men in their 30's, but then you say it's totally nonsense to take Finasteride on NW7? I'm a bit confused as to where do you stand. Also interesting where do you take information on scalp DHT being reduced by 40% only? https://pubmed.ncbi.nlm.nih.gov/10495374/  "Results: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively". To me it looks like it's above 60%. Also the fact that androgens are more sensible in the hairline by T (which I'm not sure it's true), this doesn't mean anything as OP had hairline transplanted.

From what I understand Fin can help to maintain integrity of donor area as much as top of the scalp. Even if it's not 100% efficacy, it's still way better than nothing. Besides risking side effects is just a nonsense. Take it and you will see sides, if they appear, discontinue. Now you know you can't take it. But by living in a fear whole life is not the best solution.

[Cristero]

7 hours ago, Rolandas said:

@Portugal25 If I recall correctly your first surgery was FUT with strip taken from the sweet spot? If so, how Mr. @Cristero would explain such phenomenon.

Also not sure why you say that a doctor told you there's a frequent miniaturisation going on in the donor in men in their 30's, but then you say it's totally nonsense to take Finasteride on NW7? I'm a bit confused as to where do you stand. Also interesting where do you take information on scalp DHT being reduced by 40% only? https://pubmed.ncbi.nlm.nih.gov/10495374/  "Results: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively". To me it looks like it's above 60%. Also the fact that androgens are more sensible in the hairline by T (which I'm not sure it's true), this doesn't mean anything as OP had hairline transplanted.

From what I understand Fin can help to maintain integrity of donor area as much as top of the scalp. Even if it's not 100% efficacy, it's still way better than nothing. Besides risking side effects is just a nonsense. Take it and you will see sides, if they appear, discontinue. Now you know you can't take it. But by living in a fear whole life is not the best solution.

It means that miniaturization in the donor is something that even people without AGA sometimes have. It's a normal aging process, unrelated to what's happening on top of your head. Just to be clear, Dr. Rassman is the surgeon who invented the word DUPA, so not really the last surgeon on earth.

You quoted just one study. I saw several during the years and the numbers are all over the place. DHT is a paracrine hormone, you will see different reductions according to the time of the day the sample is drawn, the age and the health situation of the patient. That's why I said 40% on average.

About the efficacy of finasteride on the donor area, is complete speculation. We have been told for years the hairs on the safe area are immune to DHT, so why bothering with finasteride? The options are 2 then: they either lied to us and they are not immune, so HT is a not long term option, or the people who lost their hairs extracted from the safe area have or developed DUPA afterwards, so a HT should have not performed in any case.

Discontinuation of 5-ar inhibitors doesn't mean complete recovery in several guys and we know it quite well by now. I personally became hypogonadal after 7 years of the drug and I'm on TRT for life. So it's not that easy as you are describing it and chances of side effects are higher and higher the more you age, since the androgens load in the body goes lower and lower due to aging.

[PizzaWolf]

50 minutes ago, Cristero said:

Discontinuation of 5-ar inhibitors doesn't mean complete recovery in several guys and we know it quite well by now. I personally became hypogonadal after 7 years of the drug and I'm on TRT for life. So it's not that easy as you are describing it and chances of side effects are higher and higher the more you age, since the androgens load in the body goes lower and lower due to aging.

It seems like you're making a correlation/causation fallacy. How do you know it was Finasteride that made you hypogonadal after seven years?

That being said, I have to agree with your other point. If a NW7 with mostly transplanted hair needs to take Finasteride in order to maintain, then we're all screwed long-term no matter what we do.

[Cristero]

Because I've been doing blood tests since I was in my early 20s and I'm in my 30s now. Until last year I was doing extensive blood work every month. Find me anyone else spending so much money on lab works. Is that enough as an evidence?

[PizzaWolf]

3 minutes ago, Cristero said:

Because I've been doing blood tests since I was in my early 20s and I'm in my 30s now. Until last year I was doing extensive blood work every month. Find me anyone else spending so much money on lab works. Is that enough as an evidence?

No.

[Rolandas]

3 hours ago, Cristero said:

It means that miniaturization in the donor is something that even people without AGA sometimes have. It's a normal aging process, unrelated to what's happening on top of your head. Just to be clear, Dr. Rassman is the surgeon who invented the word DUPA, so not really the last surgeon on earth.

You quoted just one study. I saw several during the years and the numbers are all over the place. DHT is a paracrine hormone, you will see different reductions according to the time of the day the sample is drawn, the age and the health situation of the patient. That's why I said 40% on average.

About the efficacy of finasteride on the donor area, is complete speculation. We have been told for years the hairs on the safe area are immune to DHT, so why bothering with finasteride? The options are 2 then: they either lied to us and they are not immune, so HT is a not long term option, or the people who lost their hairs extracted from the safe area have or developed DUPA afterwards, so a HT should have not performed in any case.

Discontinuation of 5-ar inhibitors doesn't mean complete recovery in several guys and we know it quite well by now. I personally became hypogonadal after 7 years of the drug and I'm on TRT for life. So it's not that easy as you are describing it and chances of side effects are higher and higher the more you age, since the androgens load in the body goes lower and lower due to aging.

Ok I get it now, it's because you had a bad experience. Your position is completely understandable. It's a human psychology to try to find negatives in something you don't like.

That being said, I'm still curious to what do you think about Portugal situation with his first strip as "extracted not from the safe zone" is invalid here.

[Cristero]

3 hours ago, PizzaWolf said:

No.

Believe what you want, I couldn't care less. You won't believe it even if I show you the blood tests before and after.

Juts for the record, look for the user Mustang on hair loss talk. Same experience as mine and other users on Italian forums.

[Cristero]

37 minutes ago, Rolandas said:

Ok I get it now, it's because you had a bad experience. Your position is completely understandable. It's a human psychology to try to find negatives in something you don't like.

That being said, I'm still curious to what do you think about Portugal situation with his first strip as "extracted not from the safe zone" is invalid here.

That would apply to you as well, since you're using it after Dr. Ferreira suggestion. It's human psychology to defend something your are putting your faith on. I hope you did your extensive research at least before ingesting an anti-androgen. Don't trust whatever a doctor will tell you.

Hair loss forums are full of delusional trying to defend finasteride even when faced with evidences and basic endocrinology and pharmacology knowledge. On the other side you have people who got bad experiences that blame everything on finasteride, even if it's completely unrelated.

My stance is in the middle: if you're losing your mind after your hair loss, then definitely try. If you don't get side effects, it will retain your hairs for a decade, maybe 15 years.

But for a NW7, I seriously don't understand. If @Portugal25did FUT I don't know then. I would assume could be something related to how the surgery has been performed, but I don't really know. It is out of my field of expertise.