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I am a NW2 and aged 28. No sign of rapid baldness or hair loss. I have very slow progression of hair loss. I am planning for HT to lower my hairline little bit. I DONT WANT TO TAKE FINASTERIDE after transplant. My queries are..

  1. Will all the transplanted hairs grow even if don't take finasteride after surgery?
  2. Does transplanted hair fall after sometime? or is it permanent? I have read the transplant hair also undergoes miniaturisation and eventually fall off. I comfortable being bald in my late 40s. But I am skeptical about whether my hairline will look bad if only surrounding native hairs fall out.
Edited by Gokul Krishnan
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1) Yes 

2) Hair follicles that are DHT resistant, remain DHT resistant wherever they are on the scalp. So if your transplanted hairs are extracted from a zone on your scalp that is genetically programmed to remain DHT resistant, they will stay. 
 

Two points;

All hair is susceptible to thinning due to the body’s natural ageing process, 

Chances are you won’t be comfortable being bald in your 40’s. I agree that relativity plays a huge role in this, in the sense that suffering hair loss in your 20’s is likely to be a great deal more physically and emotionally destroying, however I believe you will likely still care about your appearance somewhat in your 40’s. It’s only 12 years away after all. 

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I have done some research into this and have even made a thread about it.

It seems to be a combination of things. Senile alopecia is just the generalized reduction in overall density as we age, which is different than male pattern baldness. This plays a part in it potentially.

However, donor dominance, where the donor hair maintains its characteristics when moved to the recipient area, is still inconclusive. Actually, you will see that beard hair and body hair transplants will have the hair change in texture and type when it is transplanted. So complete donor dominance has already been refuted.

In some patients though, even completely healthy hair in the donor area will become thin and begin to fall out if the patient is not on finasteride or other anti androgen. Each individual patients threshold is different in this case.

If you want to be sure and protect your transplanted hair and your donor hair, finasteride should give you that peace of mind, assuming you can tolerate it.

It is important to note that you don't need to have DUPA to have this happen. Your recipient zones just need to be sufficiently androgen sensitive such that they even overload the more resistant donor hairs.

Because your hair loss is not aggressive, it is unlikely that this will happen to you. It can still happen in a small minority of patients though.

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So, I have found one recent study published just a month ago showing some skepticism:

https://www.jcasonline.com/article.asp?issn=0974-2077;year=2020;volume=13;issue=4;spage=292;epage=297;aulast=Kumaresan

Abstract    

Background: The longevity of the grafted hair follicles is still debated and there are limited literature available on this topic. Aim: To assess the longevity of transplanted hairs after follicular unit transfer (FUT). Materials and Methods: A total of 112 patients who had undergone FUT were included in the study and their results at the end of 4 years were compared with the 1 year post surgery results by standardized images. The reduction in the density of the grafted hair follicles was graded by a blinded observer in a grading scale. Results: Among 112 subjects 50.89% had grade 4, 46.42% had grade 5, 2.67% had grade 6 alopecia respectfully. The 4 year follow up grading of hair loss showed moderate reduction in transplanted hair density in 55.35%, slightly reduced density in 27.67% greatly reduced in 8.03% and no change in the density in 8.92% subjects. Conclusion: The hair grafts transplanted may not last permanently for all the subjects. Recipient site influence might affect the growth and long-term survival of the transplanted hairs.

 

Here are some more examples:

https://pubmed.ncbi.nlm.nih.gov/16931898/

Abstract

Pathogenetic mechanisms in androgenetic alopecia are not yet fully understood; however, it is commonly accepted that androgens like testosterone (T) and 5alpha-dihydrotestosterone (5alpha-DHT) inhibit hair follicle activity with early induction of the catagen. Thus, we investigated the influence of T and 5alpha-DHT on proliferation, cell death and bcl-2/bax expression in cultured dermal papilla cells (DPC) from nonbalding scalp regions of healthy volunteers. T and 5alpha-DHT induced apoptosis in DPC in a dose-dependent and time-related manner; in addition a necrotic effect due to T at 10(-5) M was found. Interestingly, bcl-2 protein expression was decreased in T- and 5alpha-DHT-treated cells, leading to an increase in the bax/bcl-2 ratio. In addition, T and 5alpha-DHT induced proteolytic cleavage of caspase 8 and inhibited proliferation of DPC at 10(-5) M. High concentrations of T and 5alpha-DHT were needed to induce apoptotic effects in DPC. These data suggest that DPC from nonbalding scalp regions do have the capacity to undergo apoptosis, but need a high androgen stimulus. The present study provides an interesting new pathogenetic approach in androgenetic alopeci

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20 hours ago, asterix0 said:

So, I have found one recent study published just a month ago showing some skepticism:

https://www.jcasonline.com/article.asp?issn=0974-2077;year=2020;volume=13;issue=4;spage=292;epage=297;aulast=Kumaresan

Abstract    

Background: The longevity of the grafted hair follicles is still debated and there are limited literature available on this topic. Aim: To assess the longevity of transplanted hairs after follicular unit transfer (FUT). Materials and Methods: A total of 112 patients who had undergone FUT were included in the study and their results at the end of 4 years were compared with the 1 year post surgery results by standardized images. The reduction in the density of the grafted hair follicles was graded by a blinded observer in a grading scale. Results: Among 112 subjects 50.89% had grade 4, 46.42% had grade 5, 2.67% had grade 6 alopecia respectfully. The 4 year follow up grading of hair loss showed moderate reduction in transplanted hair density in 55.35%, slightly reduced density in 27.67% greatly reduced in 8.03% and no change in the density in 8.92% subjects. Conclusion: The hair grafts transplanted may not last permanently for all the subjects. Recipient site influence might affect the growth and long-term survival of the transplanted hairs.

 

Here are some more examples:

https://pubmed.ncbi.nlm.nih.gov/16931898/

Abstract

Pathogenetic mechanisms in androgenetic alopecia are not yet fully understood; however, it is commonly accepted that androgens like testosterone (T) and 5alpha-dihydrotestosterone (5alpha-DHT) inhibit hair follicle activity with early induction of the catagen. Thus, we investigated the influence of T and 5alpha-DHT on proliferation, cell death and bcl-2/bax expression in cultured dermal papilla cells (DPC) from nonbalding scalp regions of healthy volunteers. T and 5alpha-DHT induced apoptosis in DPC in a dose-dependent and time-related manner; in addition a necrotic effect due to T at 10(-5) M was found. Interestingly, bcl-2 protein expression was decreased in T- and 5alpha-DHT-treated cells, leading to an increase in the bax/bcl-2 ratio. In addition, T and 5alpha-DHT induced proteolytic cleavage of caspase 8 and inhibited proliferation of DPC at 10(-5) M. High concentrations of T and 5alpha-DHT were needed to induce apoptotic effects in DPC. These data suggest that DPC from nonbalding scalp regions do have the capacity to undergo apoptosis, but need a high androgen stimulus. The present study provides an interesting new pathogenetic approach in androgenetic alopeci

wow man.. appreciate your effort.

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

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