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If you transplant now, what will the next 20+ years look like?

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Benign prostatic hyperplasia occurs when the cells of the prostate glad begin to multiply.  These additional cells cause the prostate glad to swell which squeezes the urethra and limits flow of urine.  Most believe the main culprit is an imbalance of hormones.  It is my understanding alpha blockers do not reduce the size of the prostate but can help relive symptoms.  It would be interesting to learn from the doctors in the forum how much DHT is still active in older gentlemen.  Propecia, which I learned from the rep is an alpha reductase inhibitor can partially shrink the prostate by reducing DHT levels....

Doctors....help!

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3 hours ago, LaserCap said:

Benign prostatic hyperplasia occurs when the cells of the prostate glad begin to multiply.  These additional cells cause the prostate glad to swell which squeezes the urethra and limits flow of urine.  Most believe the main culprit is an imbalance of hormones.  It is my understanding alpha blockers do not reduce the size of the prostate but can help relive symptoms.  It would be interesting to learn from the doctors in the forum how much DHT is still active in older gentlemen.  Propecia, which I learned from the rep is an alpha reductase inhibitor can partially shrink the prostate by reducing DHT levels....

Doctors....help!

Exactly....but what triggers the hyperplasia.....? SENSITIVITY TO DHT. You don’t need a doctor when there are likely hundreds of studies online that have studied this.

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Posted (edited)
On 3/16/2020 at 2:09 PM, LonelyGraft said:

If what you’re saying is true then why do Prostates enlarge in older men? And fin/dut is used to reduce its size? It’s exactly what the other poster is claiming...our genes make us more sensitive to dht. It’s not entirely about the levels of dht 

1) Prostate glands are not hair follicles. If they were then we would get hairier as we grew older (or our prostates would fall out of our rectums if you want to go the other direction). There is a lot more smooth muscle and glandular tissue, that's why the alpha blocker mentioned above works for difficulty urinating. In addition, an enlargening prostate is not all healthy tissue. It under goes necrosis, cystic degenerative change and can frequently evolve into cancer. It really looks like hell internally. The part of your scalp that looks like this is the subcutaneous fascia -- if you don't believe this, just feel the evidence. Try probing  the skin where you've lost hair and the skin where you still have hair. Do they feel different?  A similar process of poorly restricted cell turnover, scar tissue and death has occurred in both, just the prostate is in a less restricted space.

2) Yes, it is not entirely about DHT, it is about something called the dermal papilla, where the stem cell resides. The follicles at the front and dome of your scalp seem to be androgen sensitive, while those in back less so. This sensitivity is impacted by a combination of genetics and environment, but the contribution of environment becomes greater with time. Akin to putting high octane fuel into an old jalopy. Having a healthy dermal papillae is why you can transplant follicles into this fibrosed scalp tissue where you've lost hair and it usually doesn't die. Though it certainly can have difficulty growing, particularly depending on the surgical technique and how much of the bulb was removed without damage.

This is a very big discussion and I'm not going to get into it and hijack the thread. The only point I had was that I appreciate TS's original comment about not being able to anticipate future hair loss.

Statistically, the majority of men are high Norwoods when they are old, so it stands to reason that the transplanted hairs will be retained to a greater degree while the native hairs fall out around them. For many, by the time you reach old age you will be left with only the transplanted hairs in your reconstructed scalp. So sure, think short term, spots to fill in, etc. But also keep in mind your long term game. Don't fuck your later years up to have a slightly better youth. Life gets a lot harder as you get older.

The cost of this trend towards follicle burning with low yield aggressive surgeries will become more apparent in the decades to come. I am sure transplant surgeons and early patients are already well aware of it. A low frontal hairline with a bald top looks bizarre as most men recede to some degree before they lose the hair at the dome of their scalp.

That's why guys like Lorenzo start so high; they know where things usually end up. Lorenzo style clinics are sacrificing a slightly more aesthetic short term to save those guys in the long term. The low hairline obsession is getting patients into the door of aggressive clinics, but these guys are really putting themselves at risk of a "Julius Caesar crown" of transplanted hair as things progress with time. Especially if you blow your wad by doing something silly like 4500 FUE to your frontal hairline when you're 22. How many times can you realistically go back into that scalp to fill the dome as it continues to shed? Yes, there are old guys with hair, but it is a small minority. The long term data on finasteride/dutasteride is not complete, but suggests that even with medication, things will get worse for most. This is due to the increasing fragility of hormone sensitive follicles with aging due to mutation accumulation.

The cosmetic medical industry is a very bizarre cocktail. "Freedom of choice" and doctor shopping come up against "do no harm" for essentially every patient-surgeon encounter. And there is a constant background of body dysmorphic disorder that has become profound with the influence of social media, though certainly it has always been there. I mean, we live in a society where women are allowed to get breast implants so large they can't walk upright and Michael Jackson was allowed to get nose jobs till he had to pick his nose with a Q-tip.

There's a surgeon for every patient if you have the money and a poor instinct for self-preservation. Hair restoration may be a science and an art, but we must keep in mind that it is also a business. And as with any business, there is a tendency to glorify the more extreme results -- availability heuristics are a real problem in this industry. You gotta play like Belichick not Bradshaw.

Edited by bismarck
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Our genetic disposition has more to do with it than any other factor IMHO...having said that, my father who did not have MPB hasd the thickest head of hair until approximately the age of 70 and older...he started thinning everywhere and rapidly.

Also, finasteride is used primarily to reduce the swelling of the prostrate, not to reduce the size of it.


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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Posted (edited)
On 3/17/2020 at 1:34 PM, gillenator said:

Our genetic disposition has more to do with it than any other factor IMHO...having said that, my father who did not have MPB hasd the thickest head of hair until approximately the age of 70 and older...he started thinning everywhere and rapidly.

Also, finasteride is used primarily to reduce the swelling of the prostrate, not to reduce the size of it.

Gillenator, not quite. Finasteride works to to slow the development of something called benign prostatic hyperplasia. There is no swelling or edema unless it's infected.

Edited by bismarck

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On 3/16/2020 at 1:05 PM, LaserCap said:

If you do find cases of older gentlemen with hair in the front and crown only, (and had transplants), we can assume a couple of things.  1, poor planning - perhaps by both the doctor and the patient.  2nd, little to no use of medical therapy.

 

I don't necessarily agree with this.

1. Every NW 6 and NW 7 person had a full head of hair at some point in their life. If a NW 7 is not a candidate for a hair transplant and you don't know who will be a NW 7 before hand then how can you plan for that when the patient is at a NW 3 and getting a hair transplant. I sometimes see Drs write that they always take future balding into consideration and plan for the worst. This is obviously not true because the worst would be that the patient is not a good candidate. Any Dr who actually planned for the worst with all patients would never do a single hair transplant. Then there are some NW 5s who have thinning in the donor area, but they didn't have that when they were NW 4 or NW 3. What if you did a transplant on them when they were NW 3 even if it was very conservative? They would still be losing transplanted hair and as their area increases to NW 5 or greater then they will absolutely end up with a bald rim between the native side and back hair and the transplanted hair and it would be very hard to do much about it because the donor area is losing hair as well, so you can't transplant any more of that.

2. I took finisteride for 11 years. I think it may have increased my hair very slightly for the few few years, kept it the same for the next couple of years and then I lost hair the last 3 or 4 years. After 11 years of using it I ended up with less hair than than when I started.

 

 

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16 hours ago, BeHappy said:

 

I don't necessarily agree with this.

1. Every NW 6 and NW 7 person had a full head of hair at some point in their life. If a NW 7 is not a candidate for a hair transplant and you don't know who will be a NW 7 before hand then how can you plan for that when the patient is at a NW 3 and getting a hair transplant. I sometimes see Drs write that they always take future balding into consideration and plan for the worst. This is obviously not true because the worst would be that the patient is not a good candidate. Any Dr who actually planned for the worst with all patients would never do a single hair transplant. Then there are some NW 5s who have thinning in the donor area, but they didn't have that when they were NW 4 or NW 3. What if you did a transplant on them when they were NW 3 even if it was very conservative? They would still be losing transplanted hair and as their area increases to NW 5 or greater then they will absolutely end up with a bald rim between the native side and back hair and the transplanted hair and it would be very hard to do much about it because the donor area is losing hair as well, so you can't transplant any more of that.

2. I took finisteride for 11 years. I think it may have increased my hair very slightly for the few few years, kept it the same for the next couple of years and then I lost hair the last 3 or 4 years. After 11 years of using it I ended up with less hair than than when I started.

 

 

The whole idea of the site is for everyone to share their point of view, I am glad you're sharing your opinion.

Let's break this one up.....Every class 6, 7 .....had hair at one point or another....agree.  How did they get there?  Either they never became aware of medical therapies, took the meds at one time or another and stopped, never took or did anything.....The combinations are endless but in the end he has an advanced pattern.

Who will be a class 7? You've hit the $10,000 question.  We don't know.  If we had a hair crystal ball - that would be amazing.  That's why medical therapies are discussed during a consultation.  Mind you, the medications are not for everyone.  Some will experience nothing, some may experience side effects...Again, the combinations are endless. But say the meds work, now you can move forward with a hair transplant procedure.  If not, you can now search for other alternatives. 

Some patients are adamant about a transplant procedure regardless of medical therapy outcome.  This is when disaster hits.  And, if the patient does end up being a class 7, he'll have no recourse.

During a consultation we plan for the worse but hope for the best.  A conservative approach is always best, (in my opinion).  Depending on the situation at the time of the consultation, why not suggest medical therapy first?  If it works, you can not move forward knowing you will not be taking 3 steps back. If the medication works, it will work for as long as you take the medication.  (throughout my career how many times I have heard, "I was on finasteride for 10 years and stopped because it wasn't working any more." People tend to get confused with shedding and loss.  Other times, and it does happen, the patient was not supposed to lose any hair in that specific time period.  Unfortunately we just don't know.  In my view getting on medical therapy is the best approach.

With the millions and millions of people on this earth, you'll always find people that match your criteria and sometimes you'll find people that match my brief explanation.  Regardless, it is the responsibility of the doctor, staff, (even the industry), to look out for the best interest of the patient.  Naturalness is what we're all trying to achieve.  The recommendation will be based on what the patient looks like at the time of the consultation, (regardless of what the future might bring).  If things do change for the better or for worse, he can then schedule another consultation.  These are stand along consults.  A doctor can not be held liable for what happens to the patient.  (He could have stopped the medication, etc).  

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1 hour ago, LaserCap said:

The whole idea of the site is for everyone to share their point of view, I am glad you're sharing your opinion.

Right. I don't get into calling people names when they don't agree with me. I try to have normal conversations. Everyone's experience with hair loss, transplants, and medical therapy is different, so it's good to listen. Just because one persons experience is one thing doesn't mean it's the same for everyone. Some guys don't get hair loss at all and others end up at NW 7 before age 30, so there's going to be a big range of what and how well different treatments work on everyone.

I agree with most of what you are saying. I think a lot of guys should try medication first especially if they are in the earlier stages. There's been a few people on here that have had excellent growth with a combination of micro needling, rogaine, finisteride, etc who end up, in my opinion, not even needing a hair transplant.... or at least a much smaller session. But I think the men who have extremely aggressive balding are probably going to end up NW 7 anyway over time.

 

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Posted (edited)

Well, 

4 hours ago, LaserCap said:

Who will be a class 7? You've hit the $10,000 question.  We don't know. 

The answer is: Your age roughly parallels the percentage of people who have significant male pattern baldness.

At age 50, half of men have significant baldness. Maybe you'll be very lucky and be the 1 out 5 guys that still has his hair at 80, or maybe you'll be very unlucky and die young, but the most likely scenario is that you (and everyone here) will be old with only transplant hairs left. In light of that possibility, I think planning the frontal hairline should be done very carefully.

I accept VenMo.

Edited by bismarck

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Posted (edited)
19 hours ago, bismarck said:

Well, 

The answer is: Your age roughly parallels the percentage of people who have significant male pattern baldness.

At age 50, half of men have significant baldness. Maybe you'll be very lucky and be the 1 out 5 guys that still has his hair at 80, or maybe you'll be very unlucky and die young, but the most likely scenario is that you (and everyone here) will be old with only transplant hairs left. In light of that possibility, I think planning the frontal hairline should be done very carefully.

I accept VenMo.

I would say maybe half of men have very noticible hairloss at age 50 depending on ethnic background. But at age 50 85 percent or so men have some form of hairloss.

Edited by Phillyman1996

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On 3/18/2020 at 3:36 PM, BeHappy said:

 

I don't necessarily agree with this.

1. Every NW 6 and NW 7 person had a full head of hair at some point in their life. If a NW 7 is not a candidate for a hair transplant and you don't know who will be a NW 7 before hand then how can you plan for that when the patient is at a NW 3 and getting a hair transplant. I sometimes see Drs write that they always take future balding into consideration and plan for the worst. This is obviously not true because the worst would be that the patient is not a good candidate. Any Dr who actually planned for the worst with all patients would never do a single hair transplant. Then there are some NW 5s who have thinning in the donor area, but they didn't have that when they were NW 4 or NW 3. What if you did a transplant on them when they were NW 3 even if it was very conservative? They would still be losing transplanted hair and as their area increases to NW 5 or greater then they will absolutely end up with a bald rim between the native side and back hair and the transplanted hair and it would be very hard to do much about it because the donor area is losing hair as well, so you can't transplant any more of that.

2. I took finisteride for 11 years. I think it may have increased my hair very slightly for the few few years, kept it the same for the next couple of years and then I lost hair the last 3 or 4 years. After 11 years of using it I ended up with less hair than than when I started.

 

 

You bring up a valid point, I truly believe DHT sensitivity is different every person. That’s why some are norwood 2 and others are norwood 7. Medication works better on those with less sensitivity, that’s why despite taking finasteride for 11 years, you still lost your hair.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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When out in public, take inventory of the men over 50 and take note how many are affected by MPB...you will be shocked....😬

Of course you will have to wait until the Virus calms down....😯


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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4 hours ago, gillenator said:

When out in public, take inventory of the men over 50 and take note how many are affected by MPB...you will be shocked....😬

Of course you will have to wait until the Virus calms down....😯

Gillenator, you have a gentle way of making insightful comments. It's a fair point. I'll keep an eye out.

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8 hours ago, gillenator said:

When out in public, take inventory of the men over 50 and take note how many are affected by MPB...you will be shocked....😬

Of course you will have to wait until the Virus calms down....😯

Would you consider it mpb if the guy only has slight crown thinning and a noorwood 2.5 at age 60?

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There are couple of different ways to think about. 

Some guys have more of a live fast die attitutude and want the aggressive and dense hairline at a relative early age as it will provide them with a stronger level of confidence and self esteem (perhaps) at a younger age. 

 

Some other guys will have a longer term goal and will want to conserve their donor and perhaps take a less aggressive approach. This may turnout bettwr and more natural and balanced in the long run. But then again, there is no guarantee how long you live to. 

I guess the world is a colourful place and people have a choice on what's suitable for them, at a certain point in time. The doctors just need to have a consideration for their patients needs and desires and be flexible enough to accommodate or advice against their patients wishes. 

 

We all know hair loss is a life long battle. Once mpb starts marching, it's almost impossible to stop it in its tracks. It's just about managing to the best of what you can, with meds, regimes and choosing the righy surgeon and approach if you choose to do so 

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Posted (edited)

Castrated men, who have almost no testosterone, may retain their hair, but men with low testosterone levels can still go bald. That's because it is not the amount of testosterone circulating in the bloodstream that dictates baldness, it's down to genetics. That's it. So if you are lucky and you have good genetics then maybe after having a treatment with testosterone booster supplements, by the way here is a good article about medicines docarzt.com, you will succeed and have your hair back, but if not, then you will have to transplant it from other parts of your body.

Edited by DupeDupex
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The one impact that seems to be ignored is the fattening of the face.  Perhaps hair transplant is only part of the solution to achieve the overall look you want.  Alec Baldwin is a perfect example of a good hairline, but fullness in his face and specifically his eyes give him a haggared look.  He has aged 40 years in the last 20 years.


"Imagination frames events unknown in wild fantastic shapes of hideous ruin, and what it fears, creates." Hannah More

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This is a great topic, and it's my main speed bump in pulling the trigger.

I'm 30, NW3, have been on meds for years, but I'm slowly still losing ground.

Will the meds and a conservative transplant keep me satisfied for years to come? Maybe. Will I suddenly lose a lot of hair quickly and not have the donor to facilitate a restoration? Also maybe.

Not knowing where we will end up is terrible, and not knowing how effective any one thing will be is just difficult in general.

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3 hours ago, DupeDupex said:

Castrated men, who have almost no testosterone, may retain their hair, but men with low testosterone levels can still go bald. That's because it is not the amount of testosterone circulating in the bloodstream that dictates baldness, it's down to genetics. That's it.

Well, the observation is accurate but the conclusion not so much. It's something called a diathesis stress model.

Regarding the comment above on Alec Baldwin, I suspect the fact that he is a smoker and years of alcohol.

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3 hours ago, bismarck said:

 

Regarding the comment above on Alec Baldwin, I suspect the fact that he is a smoker and years of alcohol.

I fear you are dismissing an almost universal issue. People are not looking at the overall picture..  If your eyes look like George Soros no amount of hair is going to do any good.  We have all seen women with young hair, but a face like Maxine Waters.  Maintaining a natural appearance is vital, and should be a prime consideration when planning your hair goals.  One other thing is why would a man get a transplant and then shave his head.  I can't think of anything more counter productive than shaving your head.  There is more to reaching your goals than just your hair.  You need to speak to Plastic Surgeons other than Hair Transplant.  You have goals that you may not talk about, but you know they are there.  Women are lucky in that they usually don't have that much trouble with hair loss.  I don't need somebody to chime in with 'women lose hair also'.  I am talking about average woman, whereas the average man loses hair.  Women can concentrate on their face whether through cosmetics or surgery.  I know of a highly regarded surgeon in Costa Rica and a full facelift will cost about the same as your average transplant .  LOOK AT THE WHOLE PICTURE.


"Imagination frames events unknown in wild fantastic shapes of hideous ruin, and what it fears, creates." Hannah More

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On 3/19/2020 at 4:08 PM, bismarck said:

Well, 

The answer is: Your age roughly parallels the percentage of people who have significant male pattern baldness.

At age 50, half of men have significant baldness. Maybe you'll be very lucky and be the 1 out 5 guys that still has his hair at 80, or maybe you'll be very unlucky and die young, but the most likely scenario is that you (and everyone here) will be old with only transplant hairs left. In light of that possibility, I think planning the frontal hairline should be done very carefully.

I accept VenMo.

Well said!...😉


Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians:  Dr. Robert True & Dr. Robert Dorin, New York, NY

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OP here - I appreciate everyone's thoughts so far.  This fear of the unknown is scary.  I had no reservations at all back when I did my crown transplant 5 years ago - but i hadn't had any noticeable loss anywhere else (and at 38, I thought I might be in the clear).  Now, my thoughts are:

  • If I use more grafts for my crown (which likely only has the 1500 grafts from the previous transplant), am I wasting them? I mean - if I have just 2500 grafts there at the end of the day, I'd still need Toppik I suspect.
  • I have thick donor, so maybe the above doesn't matter - but I keep going back and forth on that....
  • What if I lose all the frontal hair (like Mike and Micky in my first post) - if I only have transplants, won't it look bizarre? How many would I need to not look bizarre?
  • Am I risking permanent loss of native hairs in the front (and the previously transplanted hairs in the crown) by doing a new procedure?
  • So, maybe I should never touch the front and let if be natural?
  • Why don't we ever see many people 10, 20 years later from having their transplant?

I guess the fear boils down to - if I start touching the front, it's permanent - though it might look great the next 5 - 10 years. Heck, it might look great the rest of my life - but it also might look like Joe Biden's.  Sigh - how do others get around this in their head? Just say YOLO and take the plunge?  

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3 hours ago, indymusician said:

I guess the fear boils down to - if I start touching the front, it's permanent - though it might look great the next 5 - 10 years. Heck, it might look great the rest of my life - but it also might look like Joe Biden's.  Sigh - how do others get around this in their head? Just say YOLO and take the plunge?  

Looking at Joe Biden and Trump has made me legitimately reconsider my whole transplant philosophy. What a pair of Bosley disasters.

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guys... guys... all of you scared what it will look like in 10-15 years, just remember.. we will have a cure by then :D

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