Is Finasteride Required to Ensure Long Term HT Success?

[Midwestkid0324]

So I’ve been thinking about getting a HT for a while. I’ve always had thick hair throughout my teenage and young adult years. I first noticed a little thinning on my crown when I was 27 in 2015 and immediately began applying Rogaine 2x a day. The results were fantastic as I’ve been able to stave off a lot of potential loss in that area. I’m 32 now and over the last year I’ve started to notice temporal recession that’s drastically impacted my hairline. Luckily, I have bangs and a “messy” hairstyle look that allows me to conceal it. 
 

Im still on Rogaine but the crown is starting to thin more, which isn’t surprising considering the natural aging process. Im extremely hesitant to get on Finasteride because of the potential side effects. While clinical studies point to only a small percentage of men getting these side effects, it’s still impossible to predict if  you’ll be one of the unlucky few. 
 

Ive had a few consults and have been told that a reasonable FUE HT of 1600-1800 grafts would be suitable to fix my hairline. With COVID affording me the opportunity to work from home I’m looking to bite the bullet soon and getting it done. However, as I’m researching I’m seeing lots of posts claiming HTs are a waste of money if you’re not willing to commit to Finasteride for the rest of your life along with it. Is this true? Taking a DHT blocker is helpful, no doubt, but it seems counter intuitive to get a HT and still have to take prescription drugs for the rest of your life to maintain it. I understand the logic behind it because DHT is the root of the problem but the discourse around this topic is super one sided IMO. 
 

I’ve added pics of my hair for reference. What do you all think? Do you think Finasteride is something I absolutely need based off of how my native hairs currently look at 32? 

 

 

Edited December 7, 2020 by Midwestkid0324

[deitel130]

I would recommend that you get started on Finasteride along with the minoxidil you are using. That may do enough to reverse the thinning and you may not really need a HT. Having a HT still requires you to remain on meds if you want to keep your existing native hair. The thing is that although you are adding density in a certain area of your scalp it will do nothing to prevent further loss to the non transplanted hair susceptible to DHT. If your hair loss is not aggressive you may have a HT be ok without meds but that's rarely the case. Without meds you will be chasing hair transplants forever and a certain point you will no longer have enough donor to cover for the loss. Most of the time people start meds when there has been substantial amount of loss and meds would stabilize the loss but then the thin areas bother people and they seek surgery.

 

If I were you I would get on Finasteride. You should benefit from meds. Take it for a year and see how it's working before deciding on a HT. Keep in mind that Finasteride is better and preventive further loss rather than re-growing hair. If your hair is not completely lost but just thinned it should help thicken it back up. 

Edited December 7, 2020 by deitel130

[hairlossPA]

Finasteride is never "required". Finasteride is only encouraged because it will slow down/halt your native hairs from miniaturizing and dying out. It does nothing for the actual transplanted hair. One question to ask is, how will you look if you get a transplant into your hairline and the rest of your hair falls out down the line? Are you able to have more procedures? Do you have the time, money, donor for it? It's all about the long term plan and not the "right now" with finasteride.

You may cover your hairloss OK right now, but I wouldnt be surprised if you head towards a NW5 in the next few years

Edited December 7, 2020 by hairlossPA

[TorontoMan]

This question comes up so often. A lot of guys come on here with hopes that hair will stabilize and that a ht will fill the voids. That is unfortunately naive and wishful thinking. Hair loss is progressive and there is no accurate way to indicate how far you’ll go. So just consider that in the long game you will not get full restoration with a transplant. So you may invest for temporary satisfaction if even that. 

finasteride is going to be everyone’s personal choice and you now have trade offs you have to weigh. Starting the drug is intimidating for every person who has ever started, but just look at it by the numbers Of clinical studies and the percentage of sides in control studies... go by the numbers. Also if you do start and get sides, come off and they are more than likely to subside. 

[Midwestkid0324]

Thanks all. These are valid points. I’m very torn at the moment just because of the potential side effects of Finasteride. I’ve read the clinical studies and data; the science is very reassuring. Again, you just can’t predict if you’ll end up being that unlucky person who has an adverse reaction. At the same time, I def don’t want to spend money on multiple HTs if they’re just temporary fixes and not addressing the cause of hair loss that will continue to occur with native hair 

Edited December 7, 2020 by Midwestkid0324

[deitel130]

Don't be discouraged by reading about side effects. Although there are reported cases it is still quite rare. If they do happen you can always stop. Before I started Finasteride I felt the same way but my doctor explained that it was rare and worthwhile to try. Consult with your doctor and perhaps see if you can start with a few days a week and work your way to the daily dosage. If you were a low norwood case then perhaps you would have been ok without meds. Have you been told what your norwood level is? It's hard to tell as your hair is quite long. 

[UnbaldEagle]

OP, your hair loss is very, very similar to mine, I've got the same not fully receded, but patchy and thin temples and similar crown situation. The difference is maybe my crown area is a little bit thicker, however you've got better overall density. 

I'm 34 and I've been on meds for like 11 years or so (1 mg finasteride and 100 mg spironolactone daily with 0.5 mg dutasteride weekly, minox with dermarolling) and just had my 2nd HT so I hope you'll find my example somewhat useful. 

I wouldn't say finasteride is required to ensure long term HT success, I'd rephrase that question in the first place. What I think is absolutely crucial is to halt or slow down the loss of native hair. Getting a hair transplant kind of always signs you up for more, it's just a question of when and how many (..will your donor support). That first HT is embarking you on a journey of playing catch up with your hair loss. I know you probably heard this many times. 

But you also said you don't want to have multiple HTs, and frankly, that's hardly possible even if you're on medication. 😕 At least try some topical antiandrogens if you're worried about side effects. Topical finasteride or dutasteride (you can get the latter from a very reliable source, Dr. Lupanzula), RU58841, oh, and clascoterone 1% has just been approved by the FDA and will be out sometime next year - I'd start with these, minox too, perhaps a PRP or exosome therapy. There's a lot of other options apart from taking oral fin, but imho you absolutely need to make sure you're at least slowing down your hair loss before even thinking of surgery!

[TorontoMan]

I wouldn’t go for surgery if you haven’t tried at least something.. for at least 1-2 years. I think low dose fin or CB could be a good starting point for you. Prp won’t do anything 

[Midwestkid0324]

9 hours ago, deitel130 said:

Don't be discouraged by reading about side effects. Although there are reported cases it is still quite rare. If they do happen you can always stop. Before I started Finasteride I felt the same way but my doctor explained that it was rare and worthwhile to try. Consult with your doctor and perhaps see if you can start with a few days a week and work your way to the daily dosage. If you were a low norwood case then perhaps you would have been ok without meds. Have you been told what your norwood level is? It's hard to tell as your hair is quite long. 

I’ve never been told what my Norwood level is. I’ve had a few HT consults and none of the doctors mentioned anything.

Thanks for the great advice. I actually spoke with a doctor this afternoon who said if I were to experience side effects I’d know in the first two weeks and could stop without any kind of long term or everlasting effects. I think I’m going to give Finasteride a shot and then reassess things later next year  

[Midwestkid0324]

9 hours ago, TorontoMan said:

I wouldn’t go for surgery if you haven’t tried at least something.. for at least 1-2 years. I think low dose fin or CB could be a good starting point for you. Prp won’t do anything 

I was very close to getting PRP done but backed out when I read that there’s very little research that supports it being a viable option for long term hair growth. I think I’m gna give Finasteride a shot 

[Midwestkid0324]

9 hours ago, UnbaldEagle said:

OP, your hair loss is very, very similar to mine, I've got the same not fully receded, but patchy and thin temples and similar crown situation. The difference is maybe my crown area is a little bit thicker, however you've got better overall density. 

I'm 34 and I've been on meds for like 11 years or so (1 mg finasteride and 100 mg spironolactone daily with 0.5 mg dutasteride weekly, minox with dermarolling) and just had my 2nd HT so I hope you'll find my example somewhat useful. 

I wouldn't say finasteride is required to ensure long term HT success, I'd rephrase that question in the first place. What I think is absolutely crucial is to halt or slow down the loss of native hair. Getting a hair transplant kind of always signs you up for more, it's just a question of when and how many (..will your donor support). That first HT is embarking you on a journey of playing catch up with your hair loss. I know you probably heard this many times. 

But you also said you don't want to have multiple HTs, and frankly, that's hardly possible even if you're on medication. 😕 At least try some topical antiandrogens if you're worried about side effects. Topical finasteride or dutasteride (you can get the latter from a very reliable source, Dr. Lupanzula), RU58841, oh, and clascoterone 1% has just been approved by the FDA and will be out sometime next year - I'd start with these, minox too, perhaps a PRP or exosome therapy. There's a lot of other options apart from taking oral fin, but imho you absolutely need to make sure you're at least slowing down your hair loss before even thinking of surgery!

Thanks for sharing your experience! It’s super helpful. I agree with you that embarking on the HT journey probably entails multiple procedures down the line. The way I see it, I just want to preserve my hair through 45ish and then whatever happens, happens lol 

I think I’m going to reassess getting a HT and postponing until late next year or 2022. I’m going to give Finasteride a shot and see what happens