Which Doctors Can I Consult Virtually To Decide Donor Zone Stability

[Fox243]

Hey everyone, as a brief background, I’m a 20 year old male who is a NW4. I’ve been losing hair since I was 16, and since then have taken rogaine and nizoral. I added LLT and fin 10 months ago, and micro needling 6 weeks ago. It seems that I’ve maintained though I may have worsened slightly. 
 

Unfortunately, finasteride has given me minor side effects such as low libido and watery semen. Therefore, I’m considering hopping off; however, I’d still like a transplant in 5 years or so.

 

Currently, my donor is thick, dark, and wavy, but my grandfather had a NW7, so I might end up there as well.

 

Which doctors would be best at assessing donor capacity and whether I’d still be able to have a decent transplant using scalp/beard/chest hair, even if I ended up as a NW7? I was thinking Eugenix, but would love to consult with a couple of others before deciding whether to pull the plug on finasteride.

Edited May 26, 2021 by Fox243

[InTheSix]

sorry that you have been experiencing hair loss since 16. Could imagine it wasnt fun at such a young age.. You seem to be given yourself a decent shot by your current regimen.. You will find a lot of admirers for Eugenix here, and although I havent personally dealt with them, they are definitely one of the clinic you should consult with at some point, especially since they have a lot of experience with high NW (in case you end up being one). Not sure where you are located, but personally I didnt find a lot of clinic big on BHT in North America. Mostly Europe and Eugenix in India... I did however personally meet with  Dr Nadimi in Chicago, and she mentioend she performs BHT also (she came across as honest, and good at what she does)

The other school of thought will tell you to not go for FUE, but instead go the FUT route first, to maximize your potential lifetime grafts, especially if you are concerned you may end up at NW7.... In that case, you should at some point, consult with H&W. (they do not perform BHT).. you can of course go for FUE/BHT in your 2nd procedure, if it come to that, which for most NW7, it will...

 

[deeznuts]

Wouldn't stability be something that the doctor looks at through a microscope? I.e. they want to look for miniaturization

[Gatsby]

At your age and stage of hair loss I would certainly only consult with those surgeons on our recommendation list who specialize in high Norwood cases. That being said, without having a DHT blocker such as Finasteride in your arsenal I personally wouldn’t recommend surgery. Have you tried topical versions of Finasteride or Dutasteride, etc? Eugenix would be a good clinic to consider having a consultation with. An in person consultation is really best and at your young age your donor region will change in time. Have you considered shaving your head or any other options?

[Fox243]

@GatsbyCan you please link that list for those who specify in high Norwood cases?

 

I haven’t tried topical versions for two main reasons: 1) there isn’t much evidence on efficacy and safety, 2) my derm suggested that it would be pretty useless for my level of balding. 

 

And yeah, I think about either just accepting my hair loss or wearing a hair system. It’s just hard to deal with it at such a young age, but it may be a route I take. 

[Gatsby]

37 minutes ago, Fox243 said:

@GatsbyCan you please link that list for those who specify in high Norwood cases?

 

I haven’t tried topical versions for two main reasons: 1) there isn’t much evidence on efficacy and safety, 2) my derm suggested that it would be pretty useless for my level of balding. 

 

And yeah, I think about either just accepting my hair loss or wearing a hair system. It’s just hard to deal with it at such a young age, but it may be a route I take. 

@Fox243if you have any thoughts of accepting hair loss and/or wearing a hair piece in the future I highly recommend dismissing a hair transplant (at the least for now). At 20 and NW4 you need to realize that not everyone is a candidate for a hair transplant. Statistically the younger you are and the earlier you have surgery the higher the outcome that you will regret it. An ethical surgeon will tell you not to have a hair transplant if you have any thoughts at all of reconsidering this. At your age they will (should) knock you back. At 18 I had two hair transplants and it destroyed not only my scalp but my life for a long time. Once you are cut their is no going back. 

[Fox243]

@qui bonoI’m not sure what you mean by slick bald vs diffuse, but I’ve attached two pictures if that helps.

@GatsbyYeah, I completely agree. These consultations are more about whether it’s okay for me to stop fin and still have a chance at a decent HT in 5-10 years, if I decide to go for a HT then. If I’m not on fin, I’ll definitely wait till my late 20s.
 

If they say that I can get a transplant without fin, that would be ideal. But if they say fin is the only way I can get a transplant, I would need to think more about whether to continue fin. 

Edited May 26, 2021 by Fox243

[Fox243]

And maybe I’m being too harsh on myself in terms of lack of progress, so here is a photo two months into fin. 

[Fox243]

Yeah, @qui bono, I was really hoping that the crown and mid scalp and hopefully even the hairline would have thickened up during my 10 months on fin, but it didn’t appear to do so. So I believe fin will either maintain what I have right now or slow down loss over the next couple decades, but I’m not expecting any regrowth at this point. Thanks for your advice.

[aaron1234]

@Fox243 Have you tried a half dose of fin at all?  Or taking it every other day?  

With a pattern this aggressive at a young age you should be very careful with HT's.  One bad procedure without having much in reserve to repair it with is not something you'll want to experience.  There are worse things than being bald.  

[Fox243]

@aaron1234Yeah, I've tried taking it every other day. And again, the side effects aren't super severe, but it's more the thought of being on this drug lifelong at an age where I'm not really sure how much hair matters to me. I initially got onto it hoping I would have good thickening, given my very young age and diffuse pattern. But when I only found maintenance, I wasn't sure if that was worth staying on the drug, especially since I was hoping that I wouldn't have to get a HT if I got on fin (and LLLT, microneedling, minoxidil, and nizoral).

Edited May 26, 2021 by Fox243

[Fox243]

@aaron1234  @qui bono @GatsbyIn case you were interested, I consulted with Eugenix and unfortunately they mentioned that I basically have to take finasteride to get a transplant. Despite me having a good donor area, because I'm so young, they aren't sure whether I'll develop DUPA or if my donor will thin. And they said after 10 months on fin, if I'm not having major side effects, they would recommend I continue it as it is unlikely any severe side effects will develop. I'm still uncomfortable with this, but I guess I'll have to think about it.

[Gatsby]

Yes Eugenix recommend that all of their patient's commence finasteride for surgery. So too do a lot of top tier surgeons for good reason. If you can tolerate it then you 'may' be a candidate for surgery down the track but you must take this drug for life for the benefits to continue. It can take up to two years to see the full benefits but often the benefits can commence after 4/5 months. I feel in your case the greatest benefit in taking finasteride is for your donor area and lower crown. Finasteride has been shown to raise the bottom half of the crown in Norwood 6/7 patients and can strengthen the donor hair and hair all over the scalp in general. Eugenix will probably augment your surgery with beard grafts. Regardless of the level of hair loss you have to always assume that as a hair transplant patient you will eventually end up a Norwood 6 so surgery becomes a life long strategy in planning for the future. Finasteride will delay the need for future hair transplants. It is only one part of the hair restoration process just as surgery is. At your age you have a lot of time ahead of you to think about what your options are and to do as much research as you can. Don't be in a rush. With your level of hair loss at such a young age a hair transplant without finasteride (that works without side effects) would be a foolish endeavor. Trust me on this! You will be for ever trying to chase your hair loss with beard grafts, chest hair grafts and the goal that you have now will never look natural. You do not want to be in a position whereby in ten years from now you regret ever having gone down this path and wish you just had your scalp back the way it was in the beginning. This is a common wish of many young guys when they pull the trigger too early (myself being one of them). Consult with Hasson and Wong and others and be honest with how you feel and what your goals are. Wishing you all the best.

[Fox243]

I think I'm going to end up shaving my head. I can grow a decent beard. There's just too much uncertainty -- even if I continue taking fin, I may end up still balding and be constantly chasing my hair loss. I've let it define me for so many years, and I just want to move on with my life.

Edited May 27, 2021 by Fox243

[Britanium]

6 minutes ago, Fox243 said:

I think I'm going to end up shaving my head. I can grow a decent beard. There's just too much uncertainty -- even if I take fin, I may end up still balding and be constantly chasing my hair loss. I've let it define me for so many years, and I just want to move on with my life.

Very wise ! You will be free of years of hts and/or meds as well as keeping your head scar free, and would have saved yourself a small fortune 🙏

Edited May 27, 2021 by JohnAC71

[Forty Six & 2]

I agree. With this grade of balding at this young age, I would not recommend the hair transplant route. It would be super expensive and unsure, if the available amount of grafts is sufficient for the whole head.

[Melvin- Admin]

Unfortunately, I’m almost certain you will be a Norwood 7. I can see the signs now. Getting a hair transplant at this stage could be disastrous, especially without medication. Try to stabilize on some form of medication. Doing nothing is never a bad choice. You could opt for smp. I don’t think any ethical doctor would choose to perform surgery on a 20 year old with that level of hair loss and Norwood 7s in the family.

[Doron Harati]

As a consultant center of HDC clinic I wouldn't recommend you for HT, it looks you'll be NW7 in a few years, it's very rare that NW7 is barely acceptable candidate, even more unethical to accept paitents under age 24.

[gillenator]

On 5/26/2021 at 2:16 AM, deeznuts said:

Wouldn't stability be something that the doctor looks at through a microscope? I.e. they want to look for miniaturization

Absolutely true...it takes a microscopic in-person exam to determine donor suitability.

[Gatsby]

On 5/28/2021 at 1:59 AM, Fox243 said:

I think I'm going to end up shaving my head. I can grow a decent beard. There's just too much uncertainty -- even if I continue taking fin, I may end up still balding and be constantly chasing my hair loss. I've let it define me for so many years, and I just want to move on with my life.

I think you have made a decision that will not only save you thousands of dollars, but more importantly a life of regret and wishing you never had surgery in the first place. I wish when I was your age I was able to be as mature in my decision making as you are. Have a look at Bald Cafe on YouTube with Harry James. I've done a podcast with him about the pit falls of living with scars. Watch a few of his videos where he chats with young men exactly like you who shave their head. Wishing you all the best!

[gillenator]

We all have to make decisions that we feel are in our best interest...as long as we are well informed.