Spent a while reasearching transplants, now discouraged

[Balding Lee]

So I'm 36, been on finasteride/dutasteride for about 4 years (started when I first noticed thinning).  I guess you would classify it as mature NW2-ish, but I'm not in a big rush to transplant it now, it looks better than average for my age.  I have however been using this site and others to research transpants, so when the time comes later on, I can restore the hairline if needed, and I have always felt good knowing the option is there especially since my hairline seems to have stopped receding in the last few years.

However something horrible happened - I cut my hair short for the first time in a few years, and realized the crown is starting to go.  It looks good when dry, but when wet you can really see the NW5/6 pattern emerging.  What worries me the most is that I don't think it was this bad when I started meds.

1. Basically, now that the crown is going, even when on meds, is it pretty much game over for a transplant? 

2. Is there a chance it will stabilize in the current diffuse state? 

3. Is it worth trying the snake oils (minox, lazers, PRP) if dutasteride isn't working? 

4. [added] I have always had my hair longer styled slick back since I was a kid.  I do not think my crown will ever be completely bald based on my family history, or if it does, it will be a very long ways off.  Is it advisable to still transplant the front 3rd densely, and rely on my traditional hairstyle to cover continued thinning in the crown and vertex?

Thank you,

Edited October 28, 2020 by Balding Lee
added question

[longjonsilver]

Hi Lee. I would give minoxidil foam a go. The combination of that and fin thickened up my crown a bit and I was in my late forties. Have to persevere for at least a year though. 

[TorontoMan]

You may have been in that condition before you started meds, and cutting your hair down just revealed to you some thinning. Similar thing happened to me after a buzz. You could likely be getting good maintenance from your medications so I wouldn't stop that. Consider adding a topical anti-androgen.. unfortunately not a lot of research but the idea is that it fights for androgens at the scalp (RU, CB). Minoxidil will do you some good to thicken things up. 

[Balding Lee]

1 hour ago, longjonsilver said:

Hi Lee. I would give minoxidil foam a go. The combination of that and fin thickened up my crown a bit and I was in my late forties. Have to persevere for at least a year though. 

I did try minox for about 16 months a few years ago.  Seemed to really burn my scalp, very irritating.  Never grew a single new hair during that time, and never really had significant shedding when I stopped.  Perhaps the foam would be different.

39 minutes ago, TorontoMan said:

You may have been in that condition before you started meds, and cutting your hair down just revealed to you some thinning. Similar thing happened to me after a buzz. You could likely be getting good maintenance from your medications so I wouldn't stop that. Consider adding a topical anti-androgen.. unfortunately not a lot of research but the idea is that it fights for androgens at the scalp (RU, CB). Minoxidil will do you some good to thicken things up. 

I am 80% certain my crown was not that bad.  I do believe that I have been getting decent maintenance in the front though, which is weird because most people report the opposite.  For RU and CB, year I just not have seen consistent results on the forums.

[Melvin- Admin]

Whether hair transplants are worth it depends on your expectations. The good news is you’re 36 and it doesn’t sound like the hair loss is that bad. The meds can maintain your hair for the next 20 years, will it be the end of the world if your crown is a little thin at 56? Doubt it.

The meds probably have stabilized it, doesn’t stop it, but sounds like it’s stopped it to a slow pace.

I wouldn’t say minoxidil is snake oil, it’s proven to work by scientific data, if you’re not on it, get on it asap.

My hair style currently is basically a slick back hair with a thin crown, it works well. 

[Balding Lee]

41 minutes ago, Melvin-Moderator said:

Whether hair transplants are worth it depends on your expectations. The good news is you’re 36 and it doesn’t sound like the hair loss is that bad. The meds can maintain your hair for the next 20 years, will it be the end of the world if your crown is a little thin at 56? Doubt it.

The meds probably have stabilized it, doesn’t stop it, but sounds like it’s stopped it to a slow pace.

I wouldn’t say minoxidil is snake oil, it’s proven to work by scientific data, if you’re not on it, get on it asap.

My hair style currently is basically a slick back hair with a thin crown, it works well. 

I have seen your videos on concealer usage, and yes you do sort of have the same style.  My hair seems to be finer than yours, but I have a more favorable hair/scalp color contrast. 

I have a question for you: If your hair loss was 10 years less aggressive and the contrast was better, would you have gone for a more aggressive hairline position or shape?

BTW I appreciate what you do here.

[Melvin- Admin]

32 minutes ago, Balding Lee said:

 

I have a question for you: If your hair loss was 10 years less aggressive and the contrast was better, would you have gone for a more aggressive hairline position or shape?

BTW I appreciate what you do here.

Knowing what I know now, No. It’s all about supply and demand. I like the analogy of building a house, you don’t want to waste all of your supply on a beautiful front entrance, knowing that you will eventually need a roof.

Everything you do should be done with the future in mind, by your own admission you’ll need the crown done eventually, so why on earth would you be aggressive with the hairline, not the smart thing to do.

[Al - Moderator]

12 hours ago, Balding Lee said:

Basically, now that the crown is going, even when on meds, is it pretty much game over for a transplant? 

 

I always say this depends on whether you want to shave your head or not once you lose a certain amount of hair. If you plan to shave your head if you had a bald crown and thin hair in the front half then you may be better off not getting a hair transplant if you think you are going to be that bald in a few years.

However if you can't imagine yourself sporting the shaved head look then a hair transplant is certainly not out of the picture because then your options are (1) Don't have a hair transplant and have a bald crown with thin hair (or no hair) in the front half or (2) Have a hair transplant and still end up with a bald crown, but with much thicker hair in the front half.  If you are lucky and don't lose the crown entirely then you end up with a thick front half and just some thinning in the crown.

 

[Al - Moderator]

8 hours ago, Balding Lee said:

I have a question for you: If your hair loss was 10 years less aggressive and the contrast was better, would you have gone for a more aggressive hairline position or shape?

 

I don't want to answer for Melvin, but I think he had his first hair transplant at 29 years old (correct me if I'm wring, Melvin). If he was 10 years older when he had the transplant he would be 39. At that age he may not have felt the need for a more aggressive hairline. Age really plays a big role in hair transplants. Younger men are usually going to want lower, thicker hairlines to look their age and feel like the money spent was worth it, but at the same time the younger men are the ones who need to be more conservative due to the amount of loss at a young age and so many years left for their hair loss to worsen.

[Gatsby]

It may be a case that you need to tweak your meds. Our DNA is always fighting what we continually put in our system. If you consult with your doctor and it's ok I would suggest trying to increase your dosage. I would definitely look at this before considering a hair transplant. Especially for your age and how well you have maintained what you have so well for so long. All the best!

[fito88]

Why don't you guys think of rebuilding the hairline/midscalp via hair transplant with a good density/coverage, and if the crown starts going and there isn't enough donor to cover it then may be wear a synthetic hair piece for the crown only that matches the hair texture/colour?

I mean that way you won't worry about the hairline looking fake if you have a hairpiece on it?

What's your thoughts on that guys

Edited October 29, 2020 by fito88

[Al - Moderator]

11 minutes ago, fito88 said:

Why don't you guys think of rebuilding the hairline/midscalp via hair transplant with a good density/coverage, and if the crown starts going and there isn't enough donor to cover it then may be wear a synthetic hair piece for the crown only that matches the hair texture/colour?

I mean that way you won't worry about the hairline looking fake if you have a hairpiece on it?

What's your thoughts on that guys

There is nothing wrong with that. A few guys have done it. Actor Ted Danson did that for years, although I think his frontal hair was real (not a hair transplant) and he was just bald in the crown.

 

[Balding Lee]

7 hours ago, fito88 said:

Why don't you guys think of rebuilding the hairline/midscalp via hair transplant with a good density/coverage, and if the crown starts going and there isn't enough donor to cover it then may be wear a synthetic hair piece for the crown only that matches the hair texture/colour?

I mean that way you won't worry about the hairline looking fake if you have a hairpiece on it?

What's your thoughts on that guys

This was the worst case scenario and ultimate solution I was thinking of.  Getting a transplant in the front and ending up with a thin or receded hairline for the sake of saving grafts is just not worth it, I'm not living my life in 2nd place, its dense NW1.5 or nothing for me.  I am sure that with my hair style and use of concealers (I don't even need concealers on my crown yet) will get me by for years to come until I gotta integrate a system back there.

BTW, I am convinced that our 'cure' for hair loss in the next 15 years will be the advancement of hair systems.  I am sure we will look back at systems today the same way we look at systems from the 80s now.

[Melvin- Admin]

1 hour ago, Balding Lee said:

This was the worst case scenario and ultimate solution I was thinking of.  Getting a transplant in the front and ending up with a thin or receded hairline for the sake of saving grafts is just not worth it, I'm not living my life in 2nd place, its dense NW1.5 or nothing for me.  I am sure that with my hair style and use of concealers (I don't even need concealers on my crown yet) will get me by for years to come until I gotta integrate a system back there.

BTW, I am convinced that our 'cure' for hair loss in the next 15 years will be the advancement of hair systems.  I am sure we will look back at systems today the same way we look at systems from the 80s now.

There’s a case here from @DrTBarghouthi where he did the hairline and custom fitted a hair system, it actually looks really good.

[DrTBarghouthi]

4 hours ago, Balding Lee said:

This was the worst case scenario and ultimate solution I was thinking of.  Getting a transplant in the front and ending up with a thin or receded hairline for the sake of saving grafts is just not worth it, I'm not living my life in 2nd place, its dense NW1.5 or nothing for me.  I am sure that with my hair style and use of concealers (I don't even need concealers on my crown yet) will get me by for years to come until I gotta integrate a system back there.

BTW, I am convinced that our 'cure' for hair loss in the next 15 years will be the advancement of hair systems.  I am sure we will look back at systems today the same way we look at systems from the 80s now.

I do agree that hair systems are advancing a lot. They are utilizing 3D printing nowadays to make a perfect customized fit of the client’s scalp. I do believe that they cater to clients with higher expectations or those who need a full dense coverage or even in then unfortunate event of depleted donors with unsatisfactory results. I certainly like them for the crown at a younger age when a HT is not yet advised. Saves you grafts and at the same time gives that fullness.