27, NW3, on medication; Is it rational to consider a HT?

[Mars11]

Hi everyone,

I would like to introduce my situation shortly - I'd highly appreciate any kind of feedback. 

Age: 27
NW: 2,5-3
Family history: my maternal grandfather was NW5-6; besides him no one in my family experienced noticeable hairloss
Rate of hairloss: moderate, probably not fully stoppet at this point; started when I was about 18 years old
Medicine: Fin (1mg/eod since 1 month), Minoxidil (daily since 6 years), KET-Shampoo (2-3x weekly)
Recommended Grafts: 1800-2200

I'll post pictures of my current hair status below. So what I would like to know is the following:

1) Is it rational to tackle a HT next year? While most of the clinics I contacted didn't advised me against and recommended a HT since I started Fin. There were one famous which advised me to wait longer because the risk of further receding of my hairline which could result in a 2nd and 3rd (...) HT in the future.

2) I experience some kind of more shedding atm. I use a higher amount of Minox than before and as written above I just started Fin - could that explain a increase in shedding?

 

Thank you and have a good one!



 

 

[Melvin- Admin]

Personally, I think next year would be okay, as long as you’re committed to the medicine. How much do you plan to lower the hairline?

[Doron Harati]

You can do HT now, but you can wait another year, on the photos you look like NW2.5, I guess in a year you will be NW3 which 1 procedure can surely cover it, your donor looks great above average!

[Mars11]

2 hours ago, Melvin-Moderator said:

Personally, I think next year would be okay, as long as you’re committed to the medicine. How much do you plan to lower the hairline?

Hi Melvin,

thanks for your reply! Yes, I'm aware that I need to stick to medicine for the rest of my life then. As far as I can tell, it feels like I could tolerate it very well. 
I just want to lower the hairline very little and keep it conservative.
Of course nothing can be determined a for absolute certainty, but do you have a recommendation from your experience regarding the haitline? Is the risk very high that i would need a second operation in the next 5-10 years?
 

[Mars11]

Dear Doron, 

thanks for your answer as well. How confident are you with your prediction that I'll be a NW3 in 1 year? Considering this kind of progress of my hairloss - I'd surely end up being a NW3.5 - NW4 in a couple of years and so on. Sounds like an endless loop of HTs. 
I got a rather spongy measurement of my donor area. It's suppose to be around 70-80 grafts/cm^2

[giegnosiganoe]

You look like a simple case with a great donor. I'd go for it.

[TorontoMan]

Great donor, you could def get it done and get a good result. Research a doctor and I’m sure by the time you make a decision on who to choose you’ll be closer to a year on fin and you’ll see the rate of progress on it 

[Melvin- Admin]

6 hours ago, Mars11 said:

Hi Melvin,

thanks for your reply! Yes, I'm aware that I need to stick to medicine for the rest of my life then. As far as I can tell, it feels like I could tolerate it very well. 
I just want to lower the hairline very little and keep it conservative.
Of course nothing can be determined a for absolute certainty, but do you have a recommendation from your experience regarding the haitline? Is the risk very high that i would need a second operation in the next 5-10 years?
 

No one has a crystal ball unfortunately, you should plan to have another procedure, will it be in 10 years, 20, no one knows. As long as you’re committed to this lifelong journey, it’s fine to proceed.

[Gabreille Nelson Mukhia]

10 hours ago, Mars11 said:

Hi everyone,

I would like to introduce my situation shortly - I'd highly appreciate any kind of feedback. 

Age: 27
NW: 2,5-3
Family history: my maternal grandfather was NW5-6; besides him no one in my family experienced noticeable hairloss
Rate of hairloss: moderate, probably not fully stoppet at this point; started when I was about 18 years old
Medicine: Fin (1mg/eod since 1 month), Minoxidil (daily since 6 years), KET-Shampoo (2-3x weekly)
Recommended Grafts: 1800-2200

I'll post pictures of my current hair status below. So what I would like to know is the following:

1) Is it rational to tackle a HT next year? While most of the clinics I contacted didn't advised me against and recommended a HT since I started Fin. There were one famous which advised me to wait longer because the risk of further receding of my hairline which could result in a 2nd and 3rd (...) HT in the future.

2) I experience some kind of more shedding atm. I use a higher amount of Minox than before and as written above I just started Fin - could that explain a increase in shedding?

 

Thank you and have a good one!



 

 

 

You can go for the frontal zone reconstruction. And finasteride can help retain the pre existing hair. 

You can go for the hairline reconstruction if it bothers you a lot. If it doesn't bother you the you can forego the transplant.

[Gatsby]

You could go for a hair transplant if you have done all of your research and have chosen the best surgeon who meets your needs. The only thing though is that you have only been on Finasteride for 4 weeks. I developed side effects at 8 weeks and stopped the drug. I strongly recommend that you give yourself a good 6 months as a minimum on Finasteride before proceeding. If you cannot tolerate it then your plan of attack will change dramatically. All the best!

[Curious25]

2 hours ago, Gatsby said:

You could go for a hair transplant if you have done all of your research and have chosen the best surgeon who meets your needs. The only thing though is that you have only been on Finasteride for 4 weeks. I developed side effects at 8 weeks and stopped the drug. I strongly recommend that you give yourself a good 6 months as a minimum on Finasteride before proceeding. If you cannot tolerate it then your plan of attack will change dramatically. All the best!

+1. 
 

Reasses in 11 months time, when you have been on medication for 12 months, for two reasons. 
 

1) you may have visually strengthened or regrown some areas, making your ht needs less so, or maybe even non so depending on how you feel. 

2) you may not be able to tolerate continuous use of the drug/it may not have the desirable affects . . Therefore despite still being possible, your hair restoration course of action will follow a considerably different plan without using medication aimed to slow the hair loss process. 
 

 

Edited October 1, 2020 by Curious25

[Mars11]

7 hours ago, Melvin-Moderator said:

No one has a crystal ball unfortunately, you should plan to have another procedure, will it be in 10 years, 20, no one knows. As long as you’re committed to this lifelong journey, it’s fine to proceed.

You are absolutely right of course. I was just wondering if someone like you, who obviously has seen a lot in this forum, could make a (approximate) prediction. But I mean every case may be different and I understand nobody is able to really quantify the risks.
Thanks.

Do you know whether it’s normal to observe a little increase in shedding when starting Fin?

[Mars11]

6 hours ago, Gabreille Nelson Mukhia said:

 

You can go for the frontal zone reconstruction. And finasteride can help retain the pre existing hair. 

You can go for the hairline reconstruction if it bothers you a lot. If it doesn't bother you the you can forego the transplant.

Hi Gabreille,

Thanks for reply to my post. Maybe it’s due to the fact I’m not a native English speaker. But I do struggle with one of the parts which you have mentioned. What is the difference between frontal zone and hairline? 

[Mars11]

4 hours ago, Gatsby said:

You could go for a hair transplant if you have done all of your research and have chosen the best surgeon who meets your needs. The only thing though is that you have only been on Finasteride for 4 weeks. I developed side effects at 8 weeks and stopped the drug. I strongly recommend that you give yourself a good 6 months as a minimum on Finasteride before proceeding. If you cannot tolerate it then your plan of attack will change dramatically. All the best!

Hi Gatsby,

thank you for throw in a different aspect to my situation. So far I rather experience a maintain or even positive increase of functions that are associated with Fin side effects.
Nevertheless I think it is a good idea to watch the effect (either way) till next year before diving on into an operation.
All the best for you too!

[Mars11]

2 hours ago, Curious25 said:

+1. 
 

Reasses in 11 months time, when you have been on medication for 12 months, for two reasons. 
 

1) you may have visually strengthened or regrown some areas, making your ht needs less so, or maybe even non so depending on how you feel. 

2) you may not be able to tolerate continuous use of the drug/it may not have the desirable affects . . Therefore despite still being possible, your hair restoration course of action will follow a considerably different plan without using medication aimed to slow the hair loss process. 
 

 

Thanks for the clarification!

2) ok, I understand that it may take some time for Fin to accumulate and side effect might build up over time. May I ask why is it reasonable to observe affects until one year? Is it very unlikely for side effect to appear after 1 year (if those didn’t appear before)? 

[Curious25]

15 minutes ago, Mars11 said:

Thanks for the clarification!

2) ok, I understand that it may take some time for Fin to accumulate and side effect might build up over time. May I ask why is it reasonable to observe affects until one year? Is it very unlikely for side effect to appear after 1 year (if those didn’t appear before)? 

It’s a drug that can have a cumulative effect on people. Initial DHT suppression in the short term may not have too many negative consequences as the body may be able to counter act the short fall by compensating for its reduction in androgens through the potentially higher level of free testosterone. However continuous suppression of DHT may in some cases change, or have changed the natural equilibrium of the body’s endocrine system so much so, that androgen receptors start shutting down, and in a worst case scenario no level of testosterone therapy is able to re-stimulate the body to returning back to its baseline level. Again, worst case scenario. 
 

There are so many variables and factors that go into the equation, but the broad fact of the matter is that physiologically we are all unique .. therefore everybody’s sensitivity levels are different - some people may experience negative side effects within the first few weeks - others after years, others seemingly non at all... I’ve seen plenty of cases for each scenario. The same goes for positive effects , people have varying levels of success using the medication (Just from passing observation the people who tend to have the most positive side effects, also unfortunately tend to have the most severe negative side effects). 

The longer you take the drug the more you’l be able to make an informed decision on whether you want to commit to it for life - which like I previously mentioned will determine your hair restoration  strategy. 
 

There is no size fits all answer for these types of questions because 

a) everybody’s physiology is unique 

b) everybody’s hairloss rate and pattern differs 

c) it’s subjective to what you classify as being important to you - hair vs other functions that may take a hit as a result of medication 

 

There are genuinely people I’ve came across who deem their hair so important to them they would sacrifice sexual/cognitive function, gyno, cardiac issues, excessive hair growth, (these two are related to oral minoxidil) in return for maintaining their hair, and fair play to them it’s their life and their choices. 
 

Equally there are people who care about their hair, however even the slightest chance of experiencing one of the aforementioned adverse effects wouldn’t quantify as a worthy sacrifice  to risk. 
 

All personal - just research as much as you can and be as well informed as is possible. 

 

[Sean]

The longer you can go without one, the better it is.  I didnt have a pleasant experience and i had similar hair and concerns.  It has set me back and im still looking for an ethical repair.  

medications can help quite a bit -  once your cut, you are cut.

Best of luck to you

[win200]

I would do a relatively small procedure to marginally lower your hairline--around 1,500.  Then sit tight for a few years.  If the work is holding up well and your loss is stabilized, you can lower the hairline some more.  Five to six more years should give you a better picture as to what your loss will look like.  I got 1,500 grafts at 29, 2,200 at 33, and then 1,200 (I think) at 36.  I'm now 38, the work has held up beautifully, and I'm glad I spaced the procedures out to make sure that I wasn't going to hit 30 and get hit by a ton of hair loss.  It's unusual that someone who's destined to have very heavy loss can't see it coming by the time they're 35-38.

[Mars11]

16 hours ago, Sean said:

The longer you can go without one, the better it is.  I didnt have a pleasant experience and i had similar hair and concerns.  It has set me back and im still looking for an ethical repair.  

medications can help quite a bit -  once your cut, you are cut.

Best of luck to you

Thanks a lot for your input. What is your story of I may ask? 

[Mars11]

1 hour ago, win200 said:

I would do a relatively small procedure to marginally lower your hairline--around 1,500.  Then sit tight for a few years.  If the work is holding up well and your loss is stabilized, you can lower the hairline some more.  Five to six more years should give you a better picture as to what your loss will look like.  I got 1,500 grafts at 29, 2,200 at 33, and then 1,200 (I think) at 36.  I'm now 38, the work has held up beautifully, and I'm glad I spaced the procedures out to make sure that I wasn't going to hit 30 and get hit by a ton of hair loss.  It's unusual that someone who's destined to have very heavy loss can't see it coming by the time they're 35-38.

Thanks, sounds resealable! My plan is max 2000 grafts for the first one. I’m going to have a consultation with Feriduni in December. I guess that’ll might point me in a certain direction graft-wise. 

Wasn’t  it hard to perform that many operations? Are you in fin?

[win200]

1 hour ago, Mars11 said:

Thanks, sounds resealable! My plan is max 2000 grafts for the first one. I’m going to have a consultation with Feriduni in December. I guess that’ll might point me in a certain direction graft-wise. 

Wasn’t  it hard to perform that many operations? Are you in fin?

I'd go closer to 1,200 to 1,500 grafts, if I were you--just leaves more in the tank for later, and it's better to start conservative.

I didn't think three procedures was a big deal.  Hair transplant isn't major surgery, and the second one is MUCH easier because you know what to expect.

I'm on Avodart--.5mg/week.  Doesn't take much for me to keep the shedding under control.

[Gabreille Nelson Mukhia]

On 9/30/2020 at 10:38 PM, Mars11 said:

Hi everyone,

I would like to introduce my situation shortly - I'd highly appreciate any kind of feedback. 

Age: 27
NW: 2,5-3
Family history: my maternal grandfather was NW5-6; besides him no one in my family experienced noticeable hairloss
Rate of hairloss: moderate, probably not fully stoppet at this point; started when I was about 18 years old
Medicine: Fin (1mg/eod since 1 month), Minoxidil (daily since 6 years), KET-Shampoo (2-3x weekly)
Recommended Grafts: 1800-2200

I'll post pictures of my current hair status below. So what I would like to know is the following:

1) Is it rational to tackle a HT next year? While most of the clinics I contacted didn't advised me against and recommended a HT since I started Fin. There were one famous which advised me to wait longer because the risk of further receding of my hairline which could result in a 2nd and 3rd (...) HT in the future.

2) I experience some kind of more shedding atm. I use a higher amount of Minox than before and as written above I just started Fin - could that explain a increase in shedding?

 

Thank you and have a good one!



 

 

2000 to 2500 grafts for the frontal zone reconstruction.

Finasteride for the preservation of the pre-existing hair and for the prolonging the progression of baldness. 

Age is okay. I got mine done when I was 27 years old. 

[Alex5]

You have similar hair to me, though I'm thinning more at the front middle then you. 

I am 31 and have my HT booked in for a few months time. I can't wait

I think we are great candidates considering our donors and the crown is fine. Just a frontal reconstruction would be a huge difference.

[jolly]

On 10/1/2020 at 4:35 PM, Curious25 said:

It’s a drug that can have a cumulative effect on people. Initial DHT suppression in the short term may not have too many negative consequences as the body may be able to counter act the short fall by compensating for its reduction in androgens through the potentially higher level of free testosterone. However continuous suppression of DHT may in some cases change, or have changed the natural equilibrium of the body’s endocrine system so much so, that androgen receptors start shutting down, and in a worst case scenario no level of testosterone therapy is able to re-stimulate the body to returning back to its baseline level. Again, worst case scenario. 
 

There are so many variables and factors that go into the equation, but the broad fact of the matter is that physiologically we are all unique .. therefore everybody’s sensitivity levels are different - some people may experience negative side effects within the first few weeks - others after years, others seemingly non at all... I’ve seen plenty of cases for each scenario. The same goes for positive effects , people have varying levels of success using the medication (Just from passing observation the people who tend to have the most positive side effects, also unfortunately tend to have the most severe negative side effects). 

The longer you take the drug the more you’l be able to make an informed decision on whether you want to commit to it for life - which like I previously mentioned will determine your hair restoration  strategy. 
 

There is no size fits all answer for these types of questions because 

a) everybody’s physiology is unique 

b) everybody’s hairloss rate and pattern differs 

c) it’s subjective to what you classify as being important to you - hair vs other functions that may take a hit as a result of medication 

 

There are genuinely people I’ve came across who deem their hair so important to them they would sacrifice sexual/cognitive function, gyno, cardiac issues, excessive hair growth, (these two are related to oral minoxidil) in return for maintaining their hair, and fair play to them it’s their life and their choices. 
 

Equally there are people who care about their hair, however even the slightest chance of experiencing one of the aforementioned adverse effects wouldn’t quantify as a worthy sacrifice  to risk. 
 

All personal - just research as much as you can and be as well informed as is possible. 

 

Absolutely agree  with you , you seemed to have researched the effects of finasteride very well ,  I developed sides at 5 months ... prior months were as if all the horror stories I read on google were just a big BS , until at the 5th month sides slowly crept up including ED watery semen and DEPRESSION .... i was forced to quit cold turkey in just after 15 days of the first bout of depression hitting me , i still remember how i was sinking and crying each day . took me about a year to feel normal again , I do consider myself lucky as i have read some ppl  never feel their old self again even after stopping the drug for a good 5-7 years .

on this site i have read a few members posting how they tolerated the drug very well till about 3-4 years and then BANG  the sides  came heavily  and caused them to crash , in my opinion its best to avoid .... but that judgement is purely on the risk taker ..... your life your problem.

 

[Mars11]

Hello everyone,

more than two years have passed since my last post. At this point, I really have to thank the forum for giving me the information and assistance I needed to move forward with my HT.
Brief summary of my current situation:
Since I have been taking Finasteride (5mg/week and Minox) for more than two years without any side effects and my hair loss is more or less stable (see attached photos) I'm pretty confident on doing a HT - would you agree?
There is a (very) slight decrease in the front third, but in the middle and crown area my hair situation seems better than ever. At least that's what my hairdresser (who I've been going to for 15 years) says, and a miniturization mapping by one of the famous Belgian doctors confirmed it. According to his estimation, my donor area offers about 8500 grafts for surgery.

The next steps are that I will fly to Porto in two weeks and have a HT with Bruno Ferreira. The appointment was made more than 1 1/2 years ago. I will have the surgery spread over 2 days. The estimated graft count is 2800. From his first documented cases he was my favorite surgeon, honestly. I really like the way he performs the hairline. Communication started sometime in October 2020 and it was very detailed. Bruno asked for lots of photos and information. His answers were extremely competent and detailed.

So of course I am very excited about the coming weeks. Some things like post-surgery hair situation in combination with work have really been a headache for me, since I work in an area where one have to look somewhat very business-like. But luckily I seem to have a very relaxed boss who doesn't mind me wearing a cap for a few months if necessary.

I plan to post the surgery and my progress here on this forum.