FUT VS FUE? Doctor Suggestions? Any other advice.

[tkmoney]

Hello, long time lurker of the forum here, as I really looked hard into getting a hair transplant a few years ago, but ultimately decided not to do anything and just live with what I had. I'm 49 yrs old, and have always had very thick hair up until the age of 40. Around the age of 40 I also got on testosterone replacement therapy, and that's when I noticed my hair starting to thin. Things remain pretty good still up until my 45th birthday, and that's when I noticed the biggest drop off in my opinion. Started Finnasteride 3 yrs ago, stayed on it for 2 years but didn't see any real benefit, so I discontinued use last year, but no side effects were present. So now I'm back and ready to go through with the hair transplant, but so many choices of doctor and what type of transplant, fut vs fue, so just looking for any comments or suggestions. I live in St Louis, but have pretty much ruled out anything out of the country, and will be seeing someone here in the US. Here are my Top 5 in no particular order......

 

1) Blake Bloxham

2) Sahar Nadimi

3) Jerry Cooley 

4) Shapiro Medical Group 

5) Vladimir Panine

 

 

 

[Future Hair Doc]

Did your hair loss at least stabilize on finasteride and minoxidil? It’s especially important for you to be on medications since you’re on testosterone replacement therapy

[tkmoney]

It's really hard to say, I thought maybe it did and I kind of even noticed a improvement at what point after taking it for a year, but I look at my photos now and they look very similar to what I saw a couple years ago, maybe only a slight regression. I have no problem getting back on Finnasteride before I get my surgery.

[Future Hair Doc]

You might want to try dutasteride if you didn’t respond to finasteride. Feel free to reach out

[Melvin- Admin]

All very solid names have you personally consulted with any?

[BDK081522]

Definitely get back on finasteride as soon as possible. You had no sides and even though you may not think it helped grow hair it was retaining what you have. You have a great deal of miniaturization that could be halted or even reversed slightly. Being on testosterone is akin to shooting yourself in the foot when it comes to androgenic alopecia. You need to be on a dht blocker especially if you're considering hair restoration. 

[tkmoney]

12 minutes ago, Melvin- Moderator said:

All very solid names have you personally consulted with any?

I have reached out to all of them just recently with my information and photos, but only response so far was from Dr Nadimi. She responded very quickly so I was kinda surprised. Here was her response just seeing my photos and without a consultation.....The photos you sent show an intermediate phase miniaturization in the crown and frontal scalp regions.  You appear to be a good candidate based on the nature of your hair loss pattern and what appears to be a good donor supply.  The exact number of grafts needed will depend on the precise size of the zone you want filled and on your overall density expectations.  High density grafting requires a "dense-pack" approach in which approximately 40-50 follicular units per square centimeter are placed to achieve maximum filling of the zone.  The great majority of patients are very satisfied with this density.  Depending on the hairline marked on the morning of surgery, I believe you will need about 2000 grafts for a high-density frontal hairline restoration.  Strip or FUE harvesting can be used with FUE being recommended should you opt to wear a very short hair style in the future.

 

I was a little surprised she recommended only 2000 grafts, because a few years ago when I was thinking about going to Turkey, they all recommended 4500-5000 grafts for me. I now can afford pretty much any doctor here in the states so going to Turkey is not really an option for me fortunately.

[tkmoney]

7 minutes ago, BDK081522 said:

Definitely get back on finasteride as soon as possible. You had no sides and even though you may not think it helped grow hair it was retaining what you have. You have a great deal of miniaturization that could be halted or even reversed slightly. Being on testosterone is akin to shooting yourself in the foot when it comes to androgenic alopecia. You need to be on a dht blocker especially if you're considering hair restoration. 

I agree I definitely need to get back on Finnasteride or something similar. I do monitor all my levels regularly though with frequent blood work. It definitely probably was helping me even though I didn't see it at the time. 

[tkmoney]

What sucks for me is since my Dad was bald by the time he was in his late twenties, I thought I was good since I still had a very thick head of hair well into my late 30's. It wasn't until my mid 40's when things really went south for me in my opinion. These photos are from 37, 44, 45 years old.

[JDEE0]

36 minutes ago, tkmoney said:

What sucks for me is since my Dad was bald by the time he was in his late twenties, I thought I was good since I still had a very thick head of hair well into my late 30's. It wasn't until my mid 40's when things really went south for me in my opinion. These photos are from 37, 44, 45 years old.

Sucks indeed, but on the bright side, you made it into your 40's with a pretty good head of hair which is more than most of us here can say by a decade or two!

In all seriousness though, it's the TRT (mainly). You were very likely losing hair extremely slowly before jumping on, as can be seen by your ever so slightly thinning/receding hairline at 37 before you started taking it, so yes you do have the genetic pre-disposition, but the TRT probably just pushed you way over the edge of the required androgenic level/threshold that your body personally needs to really kick off gene expression in the susceptible AR's of your hair follicles. 

As such, I think you really need to get back on Fin as I can't see you stabilising without it. 

[Gatsby]

Even for 50 you have held on to a decent amount of hair compared to the majority of men who suffer MPB. I respect your choice not to fly. If you were willing to though I would definitely recommend Hasson and Wong or Eugenix though. What are your hair result goals? Are you wanting the appearance of full density all over, the frontal area having greater density, the crown, etc? I agree with others on using finasteride if you have no side effects and I think you are an excellent candidate too by the way. All the best!

[tkmoney]

4 hours ago, JDEE0 said:

Sucks indeed, but on the bright side, you made it into your 40's with a pretty good head of hair which is more than most of us here can say by a decade or two!

In all seriousness though, it's the TRT (mainly). You were very likely losing hair extremely slowly before jumping on, as can be seen by your ever so slightly thinning/receding hairline at 37 before you started taking it, so yes you do have the genetic pre-disposition, but the TRT probably just pushed you way over the edge of the required androgenic level/threshold that your body personally needs to really kick off gene expression in the susceptible AR's of your hair follicles. 

As such, I think you really need to get back on Fin as I can't see you stabilising without it. 

Yeah I definitely agree with you and believe that the testosterone just sped up my hair loss a lot faster, a place I would have eventually gotten to but at a much slower rate. I know I have been fortunate or have had it better than most on here, so I didn't want to sound like I was complaining or anything, it was just more of a shock for me, especially the last few years. 

[tkmoney]

2 hours ago, Gatsby said:

Even for 50 you have held on to a decent amount of hair compared to the majority of men who suffer MPB. I respect your choice not to fly. If you were willing to though I would definitely recommend Hasson and Wong or Eugenix though. What are your hair result goals? Are you wanting the appearance of full density all over, the frontal area having greater density, the crown, etc? I agree with others on using finasteride if you have no side effects and I think you are an excellent candidate too by the way. All the best!

That's a good question but yes greater density in the frontal area but mainly coverage all over to give me as close as I can get to even where I was just 4 or 5 years ago. I've actually looked into both of those places a few years ago when I was thinking about getting it done, so nothing is ruled out 100%, but with Covid and all the restrictions and now I can afford just about anyone here in the states, it's just so much more convenient to get it done here. Plus, I would like to have a consultation in person with anyone I eventually choose, something I can also do since I work for an airline and travel is easy from where I leave. Dr Nadimi wants $200 for a 1 hr consultation, first available is Nov 30 and she's booking out about 6-7 months from her consultations.

[Britanium]

I guess you have seen the forums recommended list:

https://www.hairtransplantnetwork.com/Consult-a-Physician/hair-transplant-surgeons.asp?sr=HRN-MOB
 

 

[Britanium]

I would definitely get back on Fin and stay with it. You will definitely benefit in the long term. It’s a good list of Drs/Clinics you have already consulted with. I like Dr Nadimi in particular. 

[JDEE0]

5 hours ago, tkmoney said:

Yeah I definitely agree with you and believe that the testosterone just sped up my hair loss a lot faster, a place I would have eventually gotten to but at a much slower rate. I know I have been fortunate or have had it better than most on here, so I didn't want to sound like I was complaining or anything, it was just more of a shock for me, especially the last few years. 

No need to apologise - was just trying to point out the upside of things to make you feel maybe a tiny bit better about your current situation, not make you feel bad for complaining. Hair loss sucks at any age and you've every right to complain if you want to, especially here.

Also, I noticed your hair looks a little bit sparse in terms of density in the donor area, your calibre looks great as you seem to have coarse hair, don't get me wrong, but when you're holding the comb parting your hair it seems like there is some miniaturisation potentially going on there. I think it would be best to get checked in person before committing to any surgery if you can do so.

 

[tkmoney]

21 minutes ago, JohnAC71 said:

I would definitely get back on Fin and stay with it. You will definitely benefit in the long term. It’s a good list of Drs/Clinics you have already consulted with. I like Dr Nadimi in particular. 

Yeah I like that she's trained under the best in the world in Konior, and she seems to be very meticulous herself and getting great results. Probably the most expensive place out of all the ones I'm looking at, but none are really cheap. Distance is great as I can literally drive there or fly.

[Al - Moderator]

I don't know the reason you are on TRT, but if you are able to lower the dose a bit it may help you retain what you still have. Also it looks like you may be getting some thinning all over, so I'm wondering if that's also due to taking TRT. I'd lower the dose if possible and get on finisteride or dutasteride to try to get some improvement.

 

Edited September 21, 2021 by BeHappy

[tkmoney]

7 minutes ago, JDEE0 said:

No need to apologise - was just trying to point out the upside of things to make you feel maybe a tiny bit better about your current situation, not make you feel bad for complaining. Hair loss sucks at any age and you've every right to complain if you want to, especially here.

Also, I noticed your hair looks a little bit sparse in terms of density in the donor area, your calibre looks great as you seem to have coarse hair, don't get me wrong, but when you're holding the comb parting your hair it seems like there is some miniaturisation potentially going on there. I think it would be best to get checked in person before committing to any surgery if you can do so.

 

Thanks and I definitely agree with wanting it to get checked out with at least 1 or 2 surgeons before committing to any surgery. Obviously the donor area hair is the key, and I would want to be an excellent candidate to get the desired results I'm looking for.

[Britanium]

6 minutes ago, tkmoney said:

Yeah I like that she's trained under the best in the world in Konior, and she seems to be very meticulous herself and getting great results. Probably the most expensive place out of all the ones I'm looking at, but none are really cheap. Distance is great as I can literally drive there or fly.

We have seen some very nice results from her in recent times 👍🏽

[tkmoney]

4 minutes ago, BeHappy said:

I don't know the reason you are on TRT, but if you are able to lower the dose a bit it may help you retain what you still have. Also it looks like you may be getting some thinning all over, so I'm wondering if that's also due to taking TRT. I'd lower the dose if possible and get on finisteride or dutasteride to try to get some improvement.

 

I got on TRT around the age of 40, when having my levels checked and experiencing tiredness all the time. Problem with TRT is you also have to incorporate diet and exercise to really feel amazing, which I did. So by eating clean, having my T levels at optimum levels, and a little bit of exercise, my energy and overall feeling was through the roof! Although I've tried to maintain a Paleo diet as best I can, we all know how extremely hard that is, so I have fluctuated with my eating on/off for the last 10 years. But to your pt of cutting back and getting back on something, I think that's a great idea! My levels are at the top range of the scale right now and could definitely be cut back a bit.

[tkmoney]

2 minutes ago, JohnAC71 said:

We have seen some very nice results from her in recent times 👍🏽

The only thing I'm questioning in my mind with her is she's thinking we only need 2000 grafts. Is that because of her technique/skill to densely pack, and get the maximum effect out of only 2000 grafts? Of course she's only seen the photos and I've not had a consultation yet so maybe that could change a little.

[Britanium]

I would be asking her the reason for the quoted grafts, it’s going to be a estimate until they see you in person.

Be interesting when you start to see reply’s from the other Drs/Clincs you mentioned. Let’s see how they compare.

[tkmoney]

3 minutes ago, JohnAC71 said:

I would be asking her the reason for the quoted grafts, it’s going to be a estimate until they see you in person.

Be interesting when you start to see reply’s from the other Drs/Clincs you mentioned. Let’s see how they compare.

Yeah all photos have been sent to all the various doctors, I even included H&W even though they are out of the country and not on the list, they are still some of the best and I wanted their opinion also. I was really against FUT at first and was only thinking FUE, of course because of the scar, but seeing some of the work of Dr Bloxham and other top surgeons, the scar will probably not be an issue for me. I actually just want the best procedure that's going to produce the best results, bottom line. I was just thinking that I needed a high amount of grafts, that FUT might be the way to go. Any opinions/suggestions are always welcomed.....lol

[Britanium]

H&W, Konior will usually feature in most people’s top choices. I like the work Dr Bloxham is doing and yes his FUT scars are pretty invisible usually. With a high level of loss I still think it’s better to maximise our donor area by starting out with FUT.