HT - age 23

[gingerfrombk]

hi everyone - thank you in advance for your help and responses. I am currently a 22 year old that is contemplating getting a HT, I would be ~23 at the age of the procedure. I spoke with two surgeons (Dr. 1 and Dr. 2). Dr. 1 mentioned that surgery is possible and quoted me at 2500-3000 grafts FUT ("closer to 3000 to lower hairline, add temporal peaks, and strengthen the vertex") Dr. 2 mentioned that it is too early to do a HT yet and suggested different alternatives (Fina and PRP) I am hesitant on Fina based on the side effects. 

From my research online almost everyone online says that the earliest that an HT should be pursued is at 25 y/o based on "how hair will move / change and grow later on", however, Dr. 1 is the only one that said that it is fine that he has performed HT on younger patients before (he is well reputable, charges almost double what another doctor would charge and has been posted on this site many times). Important to note both surgeons are in America (NYC and SF) 

My question is and this is based on logic I have deducted, friends and doctors that I have spoken to. Although yes, it is difficult for a doctor to predict how much further hairloss will happen in the following years and that is why they ask to wait past 25 years old, if the doctor is providing a hairline (which mine is almost gone and providing support for the vertex). Does it make sense to wait until I'm 25? I believe that adding these 3k grafts would provide me with a better look for at least 5-10 years and in that time if I see further hair thinning / recession then I can go for different treatments such as PRP. 
 

Let me know your thoughts / experiences especially if anyone here has gotten HT at an earlier than suggested age. 

[ciaus]

I'd go with the doctor #2, the one wanting you to wait and consider finasteride. I'd stay away from any doctor willing to 'strengthen the vertex' on a 23 yr old. Your crown area is the most difficult to address with procedures and usually saved for last after getting your front/middle areas addressed and stabilized.

 

[1978matt]

 

[Flash10]

i was in your shoes.. best thing you can do is get on fin for a year and then reassess.

i would highly recommend doing this with your family doctor. he will monitor your testosterone and other levels through blood work prior to and after starting fin to make sure you are not being adversely affected.  furthermore what i did was i attempted doing nofap.. i found it physically and psychologically helped me.. i found my sex drive to shoot through the roof among other sexual benefits.. havent gotten past day 15.. but knowing all those horrible side effects aren't currently an issue literally removes every shred of anxiety associated with using fin based on the horror stories that i have read about.. 

the only reason i did not have a hair transplant sooner was the top doctors in canada refused to perform a HT on me, only less predominate doctors said they would do it no problem. and credit to them my donor was strong and thus they knew they could make me happy.. but then within 5 years i would definitely be unhappy again.. only now with less money and less donor hair for my future.

best of luck whatever you decide bro. the ultimate goal is happiness and i know my advice delays that but its better to be patient and attain it rather than chase it relentlessly, unable to ever hold onto it..

Edited September 8, 2020 by Flash10

[LonelyGraft]

You’ve gotten a bunch of great advice on this thread. Just to add my experience, Had I gotten a transplant at 23 (even tho I was on fin) I would have a gap between my transplanted and native areas because I still slowly receeded. Imo 23 is too young especially if ur not doing anything to prevent loss. Crown work is a HUGE no at ur age bc of the possibility of having a crown halo if u continue to have a crown that expands with loss.

[Curious25]

It's circumstantial - however generally speaking 25 tends to be the golden age. 

There was a very clued up member on here a few years back who had 2x quite large FUE procedures with ASMED at an age similar to where you are just now, and it was very hard to fault his rationales - he had good donor, a pretty clear pattern forming which coincided with his family history in terms of loss, and he was generally very well versed when it came to hair restoration, so he knew enough IMO to weigh up the risk reward factor for himself. 

Tried tagging him so you could read his cases and posts, but appears he's not a member anymore - think he was called JeanLuc or something along those lines. 

 

[ItHasToLookNatural]

1 hour ago, Curious25 said:

It's circumstantial - however generally speaking 25 tends to be the golden age. 

There was a very clued up member on here a few years back who had 2x quite large FUE procedures with ASMED at an age similar to where you are just now, and it was very hard to fault his rationales - he had good donor, a pretty clear pattern forming which coincided with his family history in terms of loss, and he was generally very well versed when it came to hair restoration, so he knew enough IMO to weigh up the risk reward factor for himself. 

Tried tagging him so you could read his cases and posts, but appears he's not a member anymore - think he was called JeanLuc or something along those lines. 

 

@JayLDD

[Briguy]

I agree 23 is very young but you should post some pics for people to see how advanced your hair loss is or isn't at this stage.

[Curious25]

21 hours ago, ItHasToLookNatural said:

@JayLDD

There we go! 

@JayLDD - your presence is required! 

[TommyLucchese]

I was 23 when I had my HT but it was a conservative new hair line and I'd been on the meds for 2 years. 8 years later it's continued to be a good decision thankfully, hoping to get the crown addressed in 5 years or so. 

Be cautious and don't rush in to anything - you only have one chance to get it right. You don't know how much hair you'll lose in the next 10 years.

You can always add to a conservative hair line later on. I'd say my new hair line is halfway between a V and a U when pushed back - certainly no temples or anything drastic like that. You'd be surprised how good that is in reality. 

I'm not sure having 3k grafts including rebuilt temples is the way to go at 23, unless your donor is ridiculously good etc. 

Edited September 10, 2020 by TommyLucchese

[Gatsby]

Not much to add except from own experience. If I could go back in time and I was given one wish it would be to not have had hair transplants at 18!! It's true why so many hair transplant surgeon's won't operate until you are 25. The reason is quite simply because it's not until 25 until you are able to establish the pattern of loss as well as the best use of finite grafts that you possess. I know this is not the answer you want hear but I have lost count of the number of young people (apart from myself) that have posted stating that they wish that they never had a hair transplant in the first place. I know a few years away feels like you are 'wasting' those years by not having surgery. The reality is you do not want to waste the rest of your life with scars and a procedure that leaves a hair transplant marooned from the rest of your native hair. If your losing hair as much as you say you are then that's even more reason to wait. Get on the meds both finasteride and minoxidil and see if you can stabilize your hair loss now for the future. Doing something like this will make you feel like you are taking things back in your control. All the best.

[Curious25]

To be honest, if you are conservative in your approach - there's no difference giving a 23 year old a hair transplant, than there is a high NW in his late 40's/50's, other than the fact that the younger patient is likely to reap many more years of benefit, as opposed to the older patient who will have lived a substantiative period of time throughout his life balding, or bald. 

Balding at an early age tends to signal towards a higher probability of that individual reaching a higher level on the NW scale. That's literally the only reason (and rightly so) there is caution when dealing with younger patients.

In terms of their health, healing and physiology, I'd argue the younger the age the potentially better the candidacy.  

So there is a credible argument IMO that if the doctor is ethical, takes into account and presumes a high eventual NW pattern, intervention will benefit at an early age, and give the guy life in his 20's. 

Long term planning - essential 
Ethical doctor - essential 
Good donor management - essential
Realistic expectations - essential 
Understanding of the limitations and requirements for future surgery - essential 
Preventative Medication - advisory 

I hold a preference for smaller 'top up' sessions over the years, as opposed to mega sessions, because I think it's a better method for donor preservation, and graft survival, (albeit at the expense of higher costs, and the inconvenience of multiple surgeries - shaving head, down time etc) - 

But it seems a bit of a stone age mentality to wait until you've lost more hair, or all of it is gone - then bite the bullet and transplant. You're essentially just extending the years you have balding and unhappy with your image. I would also argue that for the majority of men - the phases of life that are experienced in the 20's and 30's are a lot more reliant on ones personal image and their self confidence , ie. meeting spouse, graduating and starting a career, socialising in groups where statistically hair loss is a lot less common. This isn't to discredit the importance of personal image after life in your 30's - as it equally isn't to dismiss the ability to have self confidence without a full head of hair, however I think you will get my drift. 

This is obviously where there is a strong argument to consider medication, to hopefully slow this process down and buy yourself more time, however, a life long commitment to medication equally isn't everybody's preference. Whilst being the optimum recommendation in terms of dealing with hair loss, it may be outweighed by other factors personal to OP or anyone else in a similar situation. 






 

[JayLDD]

I had my first transplant at 22 and it was absolutely the right decision.  I ended up having to get off finasteride due to side effects but even that has not changed my considerations for the most part. The benefits massively outweigh the risks with a high-level surgeon.  For someone in their early twenties I would likely recommend FUT to maximise graft numbers and suggest to anyone in that position to accept the scarring, for the vast majority a clinic like Hasson and Wong will leave you able to leave your back and sides relatively short regardless. ASMED for myself was a great choice although I'm less convinced over time that FUE is the safest choice.

Curious gave what is basically a really intelligent comment overall.  I think its often slightly overstated how conservative one needs to be however. By the time you are NW3 your overall balding pattern is typically very apparent. If it is a NW5 depending on donor quality there is a good chance even if you went completely bald that you have the capacity to basically create a youthful hairline with a thinner crown that is overall the appearance of a full head of hair. FUT is likely the better option in terms of maximising donor however. 

The main questions I would ask are do you have the money do afford multiple surgeries, including potential top-ups over the decade and beyond, and especially what you will do if the procedures don't turn out the way you hope. How will you cope in regards to future actions, emotionally and financially. Honestly, I think the biggest questions are whether or not you are a NW5 or a NW6 pattern, the quality of your donor, your finances and choice of surgeon. 

Does it make sense to wait until I'm 25? I believe that adding these 3k grafts would provide me with a better look for at least 5-10 years and in that time if I see further hair thinning / recession then I can go for different treatments such as PRP. 

In regards to this, PRP is in my opinion largely unproven as a serious means of combating hairloss. I would personally avoid surgeons that push PRP as a treatment.  I would also say as MUST you should post photos of your current situation and say who the surgeons are that you've been to to get a second opinion. There are plenty of posters here that are quite frankly more knowledgeable about optimal strategies and the top surgeons than a lot of doctors are. If your hairline is almost completely gone 3000 grafts is a fairly standard and common amount to rebuild it but serious work in both the crown and hairline would likely be closer to 5000.

If you're worried about finasteride sides, I would say avoid it and focus on transplants. Finasteride might save you a lot of money in the short term however.

 

 

 

 

 

[ItHasToLookNatural]

On 9/15/2020 at 1:26 PM, JayLDD said:

 ASMED for myself was a great choice although I'm less convinced over time that FUE is the safest choice.

 

 

 

 

 

 

What makes you say this now? You used to be the biggest FUE advocate on the forum. 

[JayLDD]

1 hour ago, ItHasToLookNatural said:

What makes you say this now? You used to be the biggest FUE advocate on the forum. 

You’re right, partly on the basis of the fact that I had finasteride sides and it became clearer over time that the early studies on the drug and the FDA trials were farcical from what I saw elsewhere. I think if you assume that they’re legitimate and the sides are genuinely in the range of 1-3% then the majority of patients can achieve their long term goals with FUE and finasteride.

But as I said, I no longer am confident that those early studies are even remotely accurate in regards to side effects. So particularly for a younger patient that is probably going to lose a lot of hair and lose it quickly, I’d recommend or at least suggest the method that will maximize grafts long term. Before I would have said finasteride and FUE.

I do think the overall risk of severe damage to the donor is higher with FUT on average and scars stretching is a possibility but I at this point I’d take trade off of having longer short and sides for the sake of more hair on top. For the vast majority of cases they will have have significantly less scarring magnitude with FUT and be able to have their hair not that much longer than with FUE. 

It really comes down to trade offs with probabilities and what you make of them. Without finasteride in the equation FUT looks much more valid than otherwise. 

 

[Curious25]

4 hours ago, JayLDD said:

You’re right, partly on the basis of the fact that I had finasteride sides and it became clearer over time that the early studies on the drug and the FDA trials were farcical from what I saw elsewhere. I think if you assume that they’re legitimate and the sides are genuinely in the range of 1-3% then the majority of patients can achieve their long term goals with FUE and finasteride.

But as I said, I no longer am confident that those early studies are even remotely accurate in regards to side effects. So particularly for a younger patient that is probably going to lose a lot of hair and lose it quickly, I’d recommend or at least suggest the method that will maximize grafts long term. Before I would have said finasteride and FUE.

I do think the overall risk of severe damage to the donor is higher with FUT on average and scars stretching is a possibility but I at this point I’d take trade off of having longer short and sides for the sake of more hair on top. For the vast majority of cases they will have have significantly less scarring magnitude with FUT and be able to have their hair not that much longer than with FUE. 

It really comes down to trade offs with probabilities and what you make of them. Without finasteride in the equation FUT looks much more valid than otherwise. 

 

Where do you stand on finasteride now? If i remember correctly, you were never keen on jumping on it in the first place, and when you did, took a very low dosage? Do you believe it to have had a cumulative affect on you?

[JayLDD]

1 hour ago, Curious25 said:

Where do you stand on finasteride now? If i remember correctly, you were never keen on jumping on it in the first place, and when you did, took a very low dosage? Do you believe it to have had a cumulative affect on you?

I was mildly concerned with side effects to begin with but thought it was unlikely they would occur, I took 0.25mg the entire time. In terms of DHT reduction the result between 0.25mg and 1mg is very similar, although the exact effect on side effects is unknown so I was hoping it would drastically lower the chances. For the first year I had absolutely no sides, in the first month of useage my sex drive went up drastically and my lifts went up fairly drastically overnight, almost in a way that was steroidal. Things leveled out after that.  I can't remember the exact time span but after about 2 years I had minor issues with holding a boner in one experience and and maybe a month after that where it was clearly a problem. After getting off it took about 6 months to get roughly back to baseline. 

My unverified assumption off the basis with my experience in the first month and up to the point of 2 years (and I would have needed to test hormone levels to do so) is that to counter the reduction of DHT my testosterone production rocketed up in the first month, drifted down a bit subsequently and by 2 years or so was back to baseline. There isn't a huge amount of good information on side effects for fina over a long period of time. There's also plenty of other information on effects of finasteride on another of other variables and downstream effects that aren't well understood on top of this. If I had any specific reason to recommend against using the drug and doing so long term it would be how utterly terrible the lack of information on broader effects on the body are regarding a number of variables and how contradictory many studies appear, particularly older ones in comparison to newer.

Even in my experience with a NW5 pattern I think FUE was acceptable and ASMED did a great job, however because finasteride failed it drastically increased the overall risk factor. If my growth had been 30% worse for example I'd be in a very bad position, FUT with surgeons at the level of Hasson/Wong would have been safer in regards to yield even if it may have meant I needed to have my back and sides a little longer. Hair transplants are a permanent solution, finasteride is temporary and just seems to complicate things. It can however save you a lot of money in the short term.

[Curious25]

I'm sorry to hear your experience with that, but glad all is well now. You make some very valid points regarding your outlook on all things hair loss tbh - and I enjoy conversing with people who are able to change their mind and avoid tunnel vision mentality in regards to anything in life, not just hair restoration.

RE. FUT first then FUE later, I myself too, had an FUE procedure, I quite frankly didn't want the risk of a scar gone wrong or the downtime, and I didn't buy into the whole FUT maximises graft numbers long term argument, because no one I spoke to could give me a good enough argument as to why you couldn't have FUT after an FUE procedure. I also liked the idea of eventual homogenous placement of hair across the scalp, as my back and sides have always been a lot denser than up top. Now I'm more read up and wise to hair restoration, I have come round to the idea somewhat of FUT, after seeing and hearing some great testimonials - but I'm finding it difficult to weigh up whether the shift in trend of clinics now favouring FUE is driven by consumer demand, or the additional money they can make . . probably a combination of both, although I do think techniques have come on leaps and bounds now, which under the right hands can provide graft survival rates akin to FUT. 

RE. Finasteride - the lower dosing to reduce side effects is something I've never understood either - if the studies suggest that lower dosing still more or less reduces DHT levels by the same amount as a daily 1mg dose does, why would this miraculously reduce the chances of side effects, when its the reduction in DHT that causes these very side effects?! lol? Anyway - despite my strong views on it, I will never deliberately try and put people off, what I think is important is to advise every single guy to consult with doctors (and I mean urologists, endocrinologists etc, not HT doctors) read up and study, talk to users, talk to former users, consult with their partners/family, and then make an accurate and informed decision which is personal to you and only you can do that. There's too many idiots who jump on these boards and demand people to start a daily 1mg prescription of it the next morning as though its like sprinkling an extra bit of sugar on your weetabix, as there are too many idiots who will jump on these boards and tell people they'll never have an erection in their life again (which for the vast majority I also don't believe is true). 

Oh well, hopefully thread hasn't been hijacked too much and OP gets use out of these conversations in some shape or form, i think in particular with your case it will make for a decent case study to learn from and open up a bit of a pathway he could start to look at taking.

[JayLDD]

12 minutes ago, Curious25 said:

I'm sorry to hear your experience with that, but glad all is well now. You make some very valid points regarding your outlook on all things hair loss tbh - and I enjoy conversing with people who are able to change their mind and avoid tunnel vision mentality in regards to anything in life, not just hair restoration.

RE. FUT first then FUE later, I myself too, had an FUE procedure, I quite frankly didn't want the risk of a scar gone wrong or the downtime, and I didn't buy into the whole FUT maximises graft numbers long term argument, because no one I spoke to could give me a good enough argument as to why you couldn't have FUT after an FUE procedure. I also liked the idea of eventual homogenous placement of hair across the scalp, as my back and sides have always been a lot denser than up top. Now I'm more read up and wise to hair restoration, I have come round to the idea somewhat of FUT, after seeing and hearing some great testimonials - but I'm finding it difficult to weigh up whether the shift in trend of clinics now favouring FUE is driven by consumer demand, or the additional money they can make . . probably a combination of both, although I do think techniques have come on leaps and bounds now, which under the right hands can provide graft survival rates akin to FUT. 

RE. Finasteride - the lower dosing to reduce side effects is something I've never understood either - if the studies suggest that lower dosing still more or less reduces DHT levels by the same amount as a daily 1mg dose does, why would this miraculously reduce the chances of side effects, when its the reduction in DHT that causes these very side effects?! lol? Anyway - despite my strong views on it, I will never deliberately try and put people off, what I think is important is to advise every single guy to consult with doctors (and I mean urologists, endocrinologists etc, not HT doctors) read up and study, talk to users, talk to former users, consult with their partners/family, and then make an accurate and informed decision which is personal to you and only you can do that. There's too many idiots who jump on these boards and demand people to start a daily 1mg prescription of it the next morning as though its like sprinkling an extra bit of sugar on your weetabix, as there are too many idiots who will jump on these boards and tell people they'll never have an erection in their life again (which for the vast majority I also don't believe is true). 

Oh well, hopefully thread hasn't been hijacked too much and OP gets use out of these conversations in some shape or form, i think in particular with your case it will make for a decent case study to learn from and open up a bit of a pathway he could start to look at taking.

"if the studies suggest that lower dosing still more or less reduces DHT levels by the same amount as a daily 1mg dose does, why would this miraculously reduce the chances of side effects, when its the reduction in DHT that causes these very side effects?! lol?"

The problem is the system of variables which are effected by taking the drug are so diverse and understanding the effects of changing them individually are very difficult to test for, even if you could test for them the result might be different from person to person. It also might not simply be DHT reduction that causes side effects, or there might be a very specific level of reduction for which the average person has problems. You're right that its basically wishful thinking and I wouldn't deny its in the realm of broscience, but there's not a lot of legitimate information to actually draw conclusions from to begin with and the original studies are clearly farcical. Its not like Merck or other pharma companies don't have their share of causing massive harm to people off the basis of badly conducted trials.

It definitely still seems logical to take the absolute minimum doseage possible despite similar DHT reduction, its hard to tell exact benefits because I had multiple transplants but it seemed to grow back and strengthen my hair fairly drastically. It absolutely halted 100% of losses, maybe improved my hair and caused growth over baseline at 25% if I was to guess. And I totally agree with you about people having unjustified extreme reactions on both sides,  even in my own case I still probably benefited from a few years of improvement.

"and I didn't buy into the whole FUT maximises graft numbers long term argument, because no one I spoke to could give me a good enough argument as to why you couldn't have FUT after an FUE procedure."

I still haven't necessarily found this either,  it has some basic logic in terms of likely somewhat higher yields and probability of good yield going FUT first. Even a good FUE surgeon will likely have slightly lower yields and a material transection rate. If you do strip after FUE it will have to be a larger strip to have the same amount of grafts than if you'd gone that route to begin. If I have a procedure down the track I will almost definitely look into the FUT option however. I think I've lost the vast majority of my crown natives but if I lose the midscalp too it will probably be 2000 graftsish plus 1k to touchup the frontal third. I could probably go another 1k via FUE too so even 2k strip would be enough.