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

[Portugal25]

5 hours ago, Cristero said:

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.

@Cristero you are wrong because the safe area is not immune to DHT.

I had FUT with one of the best Doctors in the world for FUT and I experienced hairloss in my implanted grafts that were taken from a strip located in the safe zone.

Dr Lorenzo is the world authority  on successful surgeries to patients with DUPA and he states it’s mandatory for them to be on Finasteride 6 months prior to their surgery exactly to strengthen the donor area and assure its not affected throughout the years.

Sadly Finasteride has a high risk of nasty side effects but it’s proven that a lower dosage of 3mg/week is more than enough to stop hairloss and with this smaller dosage the chance for side effects is reduced.

I’m taking Finasteride because I want to maintain my donor area (and strengthen my crown something Finasteride is know for) so that I can have enough grafts for a third surgery to rebuild the hairline and increase overall density.

Edited August 30, 2020 by Portugal25

[Cristero]

12 minutes ago, Portugal25 said:

@Cristero you are wrong because the safe area is not immune to DHT.

I had FUT with one of the best Doctors in the world for FUT and I experienced hairloss in my implanted grafts that were taken from a strip located in the safe zone.

Dr Lorenzo is the world authority  on successful surgeries to patients with DUPA and he states it’s mandatory for them to be on Finasteride 6 months prior to their surgery exactly to strengthen the donor area and assure its not affected throughout the years.

Sadly Finasteride has a high risk of nasty side effects but it’s proven that a lower dosage of 3mg/week is more than enough to stop hairloss and with this smaller dosage the chance for side effects is reduced.

I’m taking Finasteride because I want to maintain my donor area and strengthen my crown so that I can have enough grafts for a third surgery to rebuild the hairline and increase overall density.

Which means vast majority of surgeons in the world have fooled us saying the donor area is immune to DHT. The very same doctors you took your finasteride dosage from (the ones from The Hairloss Show) says the transplanted hairs are permanent and refuses to do juveniles hairlines on a big chunk of their patients, because they say they will keep their hairs on the hairline while keep receding in the mid and crown. 

Out of curiosity, can you share a picture of your scar during your first FUT? I'm curios to see where they harvested.

Regarding Dr. Lorenzo, being a good surgeon doesn't make you an experienced endocrinologist or dermatologist. He just says what he thinks it could work, but there's no literature on donor hairs and finasteride (or at least I'm not aware of it). Dr. Rassman, the one who labeled DUPA 20 years ago, says there's no treatment for it and refuses to proceed to surgery. So once again, 2 surgeons contradicting themselves. There are studies and articles done by SITRI, the Italian dermatologists society, which demonstrated how the female diffuse alopecia pattern is due to lack of tissue estrogens, in particular estriol. That could be a field to investigate for DUPA for example. In any case, how many men have you seen going diffuse thinning or completely bald in the donor area? Personally, no one. So, even if your logic would be correct and finasteride will improve your donor, how much would you expect to gain from that? 10% more hairs? Is it worth it the side effects, especially because you're not in your 20s anymore and your HPTA is slowing down by itself already, exposing you to a lower androgen index in your body?

To conclude, I can tell you by experience there is no proven dosage for any hormonal inhibitor. I've seen many blood works in these years by people taking aromatase inhibitors (which works the same way as 5-ar inhibitors) and the very same dose produced completely different outcomes in terms of serum levels. They are both paracrine hormones and their serum levels are irrelevant. You would need to do a scalp biopsy before and after to see how much that dose is lowering your scalp DHT.

[Rolandas]

1 hour ago, Cristero said:

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.

 

Actually I'm not bluntly following Dr. Ferreira's advice, but rather i find our opinions very very similar. He is of course a Dr. who is quite crazy about hair, so I would assume he should know better than me, just a regular "Joe". Although I like to triple source my information to draw any conclusions.

Of course I would agree on the fact that lots of people are delusional which goes both ways. But according to research potential of sides is so low it would be stupid to neglect benefits of it's medication. I do believe people are overthinking negative part, thus creating this fear of it which is blown out of proportion.
I will tell you why I'm so defensive on this. I knew about Finasteride around 6 years ago, but I was put off by comments like yours to even TRY take it. Fast forward form NW2-3 to NW5a and I'm here, using fin for over a year with no problems what so ever + enjoying it's benefits. My biggest regret is not to start using it earlier, as it could have saved me a ton of hair!

I agree with @Portugal25 about Dr. Lorenzo. I was about to write it down as well. He has lots of success with DUPA and he always puts his patients on Finasteride in order to recover and maintain integrity of donor area. So this proves my point even further, that all scalp is susceptible to DHT, but most of hair follicles in the donor are not as sensitive as top of the scalp. Furthermore it looks like highly depends on individual. Some people have higher sensitivity to DHT in donor than others, so you will see mixed reviews. Some are NW7 with strong donor for years, but some have more miniaturisation.
I remember Dr. Bisanga checked my hair with magnification and said I've got less than 10% miniaturisation in my donor. That's when I got interested in this topic and realized not everything is black and white. Donor dominance is legit theory, but it's not as black & white as well.

Edited August 30, 2020 by Rolandas

[Portugal25]

19 minutes ago, Cristero said:

Out of curiosity, can you share a picture of your scar during your first FUT? I'm curios to see where they harvested.

HRN lost all my photos from my first HT. These are the ones still available in the Italian forum. 
The scar is truly perfectly made. 

[Cristero]

10 minutes ago, Rolandas said:

Actually I'm not bluntly following Dr. Ferreira's advice, but rather i find our opinions very very similar. He is of course a Dr. who is quite crazy about hair, so I would assume he should know better than me, just a regular "Joe". Although I like to triple source my information to draw any conclusions.

Of course I would agree on the fact that lots of people are delusional which goes both ways. But according to research potential of sides is so low it would be stupid to neglect benefits of it's medication. I do believe people are overthinking negative part, thus creating this fear of it which is blown out of proportion.
I will tell you why I'm so defensive on this. I knew about Finasteride around 6 years ago, but I was put off by comments like yours to even TRY take it. Fast forward form NW2-3 to NW5a and I'm here, using fin for over a year with no problems what so ever + enjoying it's benefits. My biggest regret is not to start using it earlier, as it could have saved me a ton of hair!

I agree with @Portugal25 about Dr. Lorenzo. I was about to write it down as well. He has lots of success with DUPA and he always puts his patients on Finasteride in order to recover and maintain integrity of donor area. So this proves my point even further, that all scalp is susceptible to DHT, but most of hair follicles in the donor are not as sensitive as top of the scalp. Furthermore it looks like highly depends on individual. Some people have higher sensitivity to DHT in donor than others, so you will see mixed reviews. Some are NW7 with strong donor for years, but some have more miniaturisation.
I remember Dr. Bisanga checked my hair with magnification and said I've got less than 10% miniaturisation in my donor. That's when I got interested in this topic and realized not everything is black and white. Donor dominance is legit theory, but it's not as black & white as well.

Well, I guess you didn't read my comments then. I never said no one should ever take finasteride for hair loss. I said there's no point for a NW7, because no one that doesn't have DUPA will ever go bald or visibly thinning out on the donor. I think we can at least agree on it. He's exposing himself to an anti androgen for what would mostly be a minimal gain. Then obviously it's his call.

Just as a word of advice, in the first years taking finasteride, was like ingesting a placebo pill. No side effects whatsoever. The problem is when you're exposing yourself to the drug for the rest of your life, considering, as I've already said, that your hormonal profile will be completely different in your 40s than your 50s.

[Portugal25]

6 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.

According to the below presentation Dr. Lorenzo gave about DUPA it states that actually it was O’Tar Norwood in 1975 that named DUPA along with the Norwood scale.
He also states that Bernstein and Rassman wrote again about DUPA in 2002. 
Nowadays Lorenzo is the foremost authority on DUPA. 

 

Edited August 30, 2020 by Portugal25

[Rolandas]

2 minutes ago, Cristero said:

Well, I guess you didn't read my comments then. I never said no one should ever take finasteride for hair loss. I said there's no point for a NW7, because no one that doesn't have DUPA will ever go bald or visibly thinning out on the donor. I think we can at least agree on it. He's exposing himself to an anti androgen for what would mostly be a minimal gain. Then obviously it's his call.

Just as a word of advice, in the first years taking finasteride, was like ingesting a placebo pill. No side effects whatsoever. The problem is when you're exposing yourself to the drug for the rest of your life, considering, as I've already said, that your hormonal profile will be completely different in your 40s than your 50s.

Apologies if that came this way. I do agree there's little evidence on long term use, however we are all here trying to combat something natural which is Hair Loss. Of course we are trying different things with all it's risks. Everything has it's risk. You can get hit by a car tomorrow morning on your way to a grocery shop, yet this doesn't stop you from going out? Just an example.

 

[Portugal25]

16 minutes ago, transplantedphil said:

Not trying to sound insulting or anything, but given your pre-existing hair, i dont believe your result from Rahal represents 70FU per cm growth. 

Actually Dr. Rahal said I should expect a density of 75fu/cm2 given the area I covered and the amount of grafts that were used.
I never did mesured after the 12 month growth cycle to make sure because I was super happy. 

[Cristero]

1 hour ago, Portugal25 said:

According to the below presentation Dr. Lorenzo gave about DUPA it states that actually it was O’Tar Norwood in 1975 that named DUPA along with the Norwood scale.
He also states that Bernstein and Rassman wrote again about DUPA in 2002. 
Nowadays Lorenzo is the foremost authority on DUPA. 

 

So one of the two is lying, tertium non datur (as the Romans were saying):

https://www.realself.com/question/california-md-dupa-hair-loss

Thanks for showing your pictures, but as the other user said, there's no chance that was 70 grafts per cm2. You would have looked really dense. I don't know what happened really, but I think you just kept losing your native hairs.

In any case, let's assume what they told you was correct. You said you started from 70 hairs per cm2 after the first HT and ended up with 30 hairs per cm2 before Pekiner's HT. That would have meant that you lost almost 60% of your hairs you used to have. This means you lost all the native plus more than 20% of your transplanted. As you can see from the link posted above, that would have implied you had DUPA, since more than 20% of the occipital hairs miniaturised. But we know for sure you don't have DUPA, so something else must have happened.

From what I can grasp at the moment, there are 2 possibilities then: either Rob English's theory about scalp tissue is correct, implying that even hairs in the donor area when implanted in fibrotic tissues start miniaturising, or you just retained your transplanted hairs and lost all your native hairs, which means you were quite far from having 70 hairs per cm2.

I tend to lean towards the second option.

 

Edited August 30, 2020 by Cristero

[Melvin- Admin]

3 hours ago, Cristero said:

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.

 

I think the same way, when you’re a Norwood 2 you’d be crazy not to try it. But when you’re a Norwood 7, you’d be crazy to try it. 

I look at it like this, imagine letting all of your grass die, and then buying fertilizer, it’s too late at that point. 

[Cristero]

2 hours ago, Melvin-Moderator said:

I think the same way, when you’re a Norwood 2 you’d be crazy not to try it. But when you’re a Norwood 7, you’d be crazy to try it. 

I look at it like this, imagine letting all of your grass die, and then buying fertilizer, it’s too late at that point. 

Amen

[Curious25]

On 8/29/2020 at 3:26 PM, HTP1 said:

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: 

 

 

I don’t think passive observations that finasteride users still have beard growth to be a sufficient answer to this. 
 

For me the question for the doctor would, 

Doctor a substantial amount of beard hair grafts have been transplanted to my scalp, that have now provided a dramatic transition in my appearance on top. Why do you recommend to suppress a hormone that is scientifically proven to stimulate the growth of these said grafts, in favour of potentially minimising miniaturisation of my (already strong looking, despite two ht’s) donor hair region?

[Melvin- Admin]

2 minutes ago, Curious25 said:

I don’t think passive observations that finasteride users still have beard growth to be a sufficient answer to this. 
 

For me the question for the doctor would, 

Doctor a substantial amount of beard hair grafts have been transplanted to my scalp, that have now provided a dramatic transition in my appearance on top. Why do you recommend to suppress a hormone that is scientifically proven to stimulate the growth of these said grafts, in favour of potentially minimising miniaturisation of my (already strong looking, despite two ht’s) donor hair region?

Yea, I don’t think there’s any way to rule out that your beard may slightly be affected, beard hair is thick. If you lose some beard hair, it’ll be hard to spot. I’d be interested to see a study where this is actually studied.

[HTP1]

30 minutes ago, Curious25 said:

I don’t think passive observations that finasteride users still have beard growth to be a sufficient answer to this. 
 

For me the question for the doctor would, 

Doctor a substantial amount of beard hair grafts have been transplanted to my scalp, that have now provided a dramatic transition in my appearance on top. Why do you recommend to suppress a hormone that is scientifically proven to stimulate the growth of these said grafts, in favour of potentially minimising miniaturisation of my (already strong looking, despite two ht’s) donor hair region?

Of course it's not scientific, but I'd expect there to be some anecdotal evidence and it 'be known' given there millions of people who use it. 

 

[Portugal25]

3 hours ago, Melvin-Moderator said:

I think the same way, when you’re a Norwood 2 you’d be crazy not to try it. But when you’re a Norwood 7, you’d be crazy to try it. 

I look at it like this, imagine letting all of your grass die, and then buying fertilizer, it’s too late at that point. 

@Melvin-Moderator according to Dr. Pekiner if I don’t take Finasteride I will probably lose the hair on the green area and recommends I keep taking 3mg per week.

[Curious25]

5 minutes ago, HTP1 said:

Of course it's not scientific, but I'd expect there to be some anecdotal evidence and it 'be known' given there millions of people who use it. 

 

But given that it is already recognised, and has been for decades, that beard hair growth occurs as a result of the follicles sensitivity to DHT, I’m failing to see the logic in suppressing their ‘fertiliser’ as Melvin earlier put it. 
 

What benefits can result from trying to inhibit the hormone they are dependant upon? 

[Curious25]

4 minutes ago, Portugal25 said:

@Melvin-Moderator according to Dr. Pekiner if I don’t take Finasteride I will probably lose the hair on the green area and recommends I keep taking 3mg per week.

@Portugal25 I just want to start by saying your 8 months progress pic is fantastic. 
 

Secondly, what has Dr BF picked up to suggest your safe zone is at risk to the miniaturisation? Have you been diagnosed with DUPA?

[Portugal25]

2 minutes ago, Curious25 said:

@Portugal25 I just want to start by saying your 8 months progress pic is fantastic. 
 

Secondly, what has Dr BF picked up to suggest your safe zone is at risk to the miniaturisation? Have you been diagnosed with DUPA?

I asked Dr. Pekiner and he warned me that if I don’t take Finasteride my hairloss will progress to the green zone. This is something I see also in my 68 year old uncle that lacks any hair in that area and is fully bald. 
Sent a email to @Dr. Bruno Ferreira to also get his opinion on the comments made by Melvin and others.

[Cristero]

32 minutes ago, Portugal25 said:

I asked Dr. Pekiner and he warned me that if I don’t take Finasteride my hairloss will progress to the green zone. This is something I see also in my 68 year old uncle that lacks any hair in that area and is fully bald. 
Sent a email to @Dr. Bruno Ferreira to also get his opinion on the comments made by Melvin and others.

So this demonstrates that what you and @Rolandas were saying is basically false. Transplanted hairs, taken from the safe part of the donor area, are immune to miniaturisation. The reason why Pekiner advise you to take finasteride is because you have a precedent on your family which had an AGA progressing quite extensively in the occipital area. This doesn't mean that transplanted hairs are not immune to DHT, but simply that your AGA is progressing quite aggressively in the occipital area. Which is what I've been trying to tell you since the beginning. Dr. Rahal harvested too high in YOUR case. If you showed him a picture of your uncle, he did a big mistake then.

[Portugal25]

@Cristero that’s not true.Transplanted hairs may thin out over time regardless if you have family with totally bald heads. This is why people take Finasteride and it still might not prevent hairloss by 100%.

[Rolandas]

17 minutes ago, Cristero said:

So this demonstrates that what you and @Rolandas were saying is basically false. Transplanted hairs, taken from the safe part of the donor area, are immune to miniaturisation. The reason why Pekiner advise you to take finasteride is because you have a precedent on your family which had an AGA progressing quite extensively in the occipital area. This doesn't mean that transplanted hairs are not immune to DHT, but simply that your AGA is progressing quite aggressively in the occipital area. Which is what I've been trying to tell you since the beginning. Dr. Rahal harvested too high in YOUR case. If you showed him a picture of your uncle, he did a big mistake then.

There's no reason to even continue this debate. If you think your donor is completely immune, good for you and best of luck in the future. I guess we are trying to be proactive and looking at evidence rather than waiting for it to happen and be "oh shit, I was wrong".

[asterix0]

I have yet to see any source claim definitively, with the appropriate evidence, that hair transplants are truly permanent. I have seen cases on forums where patients had thinning of their transplanted hair. 

Most reputable hair loss doctor's website will say it is usually the case that it is permanent, but you never know. I have a Norwood 7 guy at work who's donor hair thinned to the point where a transplant would be impossible. He has very fine hair by default, he was unfortunately likely predisposed for that to happen. Had he gotten a hair transplant earlier, perhaps the doctor could not have properly assessed his donor miniaturization when he was younger, and the procedure would have eventually failed.

I don't think anyone can give a one size fits all answer for all patients. You may be lucky enough that your donor hair's genetic programming will keep it strong enough to thrive in your weakened mpb recipient site. Another person may not be lucky. Taking finasteride minimizes the risk factor of this occurring. 

We know that male pattern baldness has more factors than just your hair follicles susceptibility to DHT. Poor blood flow, scalp calcification, and other things all contribute. This is why one of the reasons why minoxidil works as well. So it is not, intuitively speaking, shocking to see that transplanted hair may not grow properly in "poor soil", so to speak, even if it is much stronger than your original hair on top.

Edited August 30, 2020 by asterix0

[Cristero]

14 minutes ago, Rolandas said:

There's no reason to even continue this debate. If you think your donor is completely immune, good for you and best of luck in the future. I guess we are trying to be proactive and looking at evidence rather than waiting for it to happen and be "oh shit, I was wrong".

Look, I'm not trying to say I know the answer and you don't. Completely the opposite actually. I'm saying we BOTH don't know the answer. 

I was considering the case of @Portugal25. He's losing hairs in a standard horse shoe pattern. We are not talking about the donor getting thinner overall, we are talking about areas going completely bald, while the rest of the donor staying thick. So, to stay in topic, he just needs a surgeon to harvest in the safe area in HIS case and he won't need to take finasteride. His hairs when transplanted will stay thick, unless we are embracing the fibrosis/scalp tension theory.

You have surgeons on one side telling you the result are permanent, while some people claiming they lost their transplanted hairs. As you saw from Portugal pictures though, his own case judgement was biased. He didn't even lose transplanted hairs, at least from what we can assume from the pictures and the numbers he gave us. 

Do we have studies where they followed people with a hair transplant for more than 10 years?

[Cristero]

33 minutes ago, Portugal25 said:

@Cristero that’s not true.Transplanted hairs may thin out over time regardless if you have family with totally bald heads. This is why people take Finasteride and it still might not prevent hairloss by 100%.

Finasteride won't prevent your hairloss for sure. Period. It will give you some more years, but if you don't target all the other pathways, you will lose them eventually.

Finasteride is only a band aid.

A quick look at hairlosstalk forum will prove you that.

[Portugal25]

14 minutes ago, Cristero said:

As you saw from Portugal pictures though, his own case judgement was biased. He didn't even lose transplanted hairs, at least from what we can assume from the pictures and the numbers he gave us. 

Totally false!

I most certainly lost several of my transplanted hairs over the course of the last 12 years!

@PT#31 knows me for over 15 years and can tell you that my frontal area that had 3425 grafts implanted in 2008 looked amazingly dense in 2009 and today not even 50% of the transplanted grafts have survived due to not taking Finasteride.

No it’s was not due to losing my frontal native hairs because Dr. Rahal assumed the hairs I had in the frontal area would be gone in under 5 years so he rebuilt the whole frontal area. 

Edited August 30, 2020 by Portugal25