34 Year Old Asian-American Male - Thoughts on My Balding / Donor Area?

[Balding Bad]

Hi all -- I'm relatively new to this specific forum, but I've been on another forum since 2013. So just want to put out a disclaimer that I'm not a complete newb when it comes to this stuff. 😄

As the title suggests I'm a 34 year old Asian-American male and if I had to diagnose my balding I'd say I'm probably a NW3A or NW4A. My front hairline is thinning pretty bad and I recently just noticed that my crown seems to be going too. (ugh!)

CURRENT HAIR LOSS PREVENTION REGIMENT:

I've been only on Minoxidil for nearly 6 years (started on January 2016 when I was 28 years old). I only apply it once per day as opposed to the recommended twice daily. The reason is because it's just too much of a hassle for me to apply it every morning so it's only a night time routine. Moreover I've never had dry scalp/dandruff before and ever since I've been on Minoxidil I've been flakey AF. I contemplated taking Finasteride and in fact got a prescription for it and even picked up the bottle from the pharmacy, but I ultimately decided it wasn't worth it due to the potential sexual side effects. So it'll only ever be Minoxidil for me in terms of medical intervention.

MY HAIR LOSS / FAMILY HAIR LOSS HISTORY:

I started noticing my hair was thinning back in college when I was 20. At the time I wore a lot of hats so the precise age of when I started balding is unknown, but it's possible I started thinning out when I was 18 or 19, but 20 was when I definitively noticed it for the first time.

My father is pretty much completely bald now. He's a NW7, but then again he's also 70 years old, so that's not much of a surprise. I did peruse some of our old family photos recently and it seems to me by the time he was 31 years old he was essentially at the same balding pattern as where I am now (if not worse). My father has about 4 other brothers and unfortunately he's the only that's bald... 🙄

My older brother (39 years old) is bald too and based on old family photos it seems he started thinning out really aggressively at around 19/20. Compared to my brother, his balding was definitely wayyyyy worse than mine. It was so bad that he started shaving his head by the time he was 23 or 24. Even though he continues to keep it shaved, based on his stubble pattern I would say he's also a firm NW7 now.

MY CURRENT HAIR SITUATION:

Luckily for me, I've been able to style my hair in a way that conceals my balding/thinning in the front hairline for all these years. Everyone I've ever confessed that I'm balding to are always genuinely surprised and shocked to hear that and claim they can't even tell.. That usually makes me feel good about my hair loss situation, but there's really no way of telling if they are being genuine or not. I always wonder if they actually CAN TELL but just choose not to tell me in order to make me feel better... 🤔

The idea of a hair transplant was already on my mind back in my early 20s, but I always felt that I was too young to go down that path. For me, surgery was a very extreme measure and it should only an absolute last resort. In my opinion, as long as I could continue to conceal the thinning/balding then I was winning. However recently I started to notice that it has been becoming more difficult to style my hair to conceal my frontal thinning/balding. Now that I'm upon my mid-30s I feel like now is the right time to seriously explore the hair transplant route. Moreover my company is still allowing us to "Work For Home" so it'd be a wasted opportunity if I didn't take advantage of this time to get it done.

Anyways, sorry for the rambling...back on topic! Just wanted to get some opinion and insight on what you fine folks think of my hair situation.

MY QUESTIONS TO ALL OF YOU:

1. How would you rate my current hair loss and what do you think my future outlook is?

2. How many grafts do you think it would take to restore my front hairline? (I'm pretty realistic and not trying to restore it to my teenage years, ideally looking to retain a mature/proper hairline for my age. Ideally I'd like to be able to slick my front back.)

3. How is my donor area? Am I an ideal candidate for a hair transplant? I'm only considering FUE. (I never noticed, but I've kinda got a weird Nightwing logo (the DC Comics character) on the back of my head, which kinda worries me...)

PHOTOS BELOW: (They were all taken WITHOUT flash, except the final 3 on the bottom. These photos were also taken the day after I just got a haircut.)

Here is a baseline photo of myself. This was back in May 2021. As you can see, to the untrained eye my hair seems fine.

(By the way, I grow the top part of my hair out pretty long in order to use it for the 'ol snazzy Trump combover effect. 😅)

But here is the reality of my hairline...

 

THESE PHOTOS BELOW ARE TAKEN WITH FLASH***

Edited October 13, 2021 by Balding Bad

[Britanium]

With the highest of Norwoods in your family, I would be considering topical fin maybe ? Just a thought as you have got so much hair still at present.

Its difficult to tell with your donor area, looks like it’s ok I’m some pics but not so great in others.

I reckon 2 -2.5k upfront would do wonders in the right Drs/Clinics hands 😊

[Britanium]

As your experienced already, which clinics would you be considering? 

[Balding Bad]

12 minutes ago, JohnAC71 said:

With the highest of Norwoods in your family, I would be considering topical fin maybe ? Just a thought as you have got so much hair still at present.

Its difficult to tell with your donor area, looks like it’s ok I’m some pics but not so great in others.

I reckon 2 -2.5k upfront would do wonders in the right Drs/Clinics hands 😊

I would like to have a family one day and don't want to risk any potential complications with Fin. I would probably be open to the idea of Fin once I have my kids though...but in the meantime it's simply not a viable option for me.

I have a colleague who is currently on topical Fin and he says he's got some mild sexual side effects, so that's kinda scary to me...

That's great that you think 2-2.5k grafts would be sufficient for my front. That's what I was thinking myself. 😁

11 minutes ago, JohnAC71 said:

As your experienced already, which clinics would you be considering? 

Strongly considering Dr. Ron Shapiro with Shapiro Medical Group in Minnesota since they've got a stellar reputation with natural looking frontal hairlines. My consultation is scheduled for next month. I'm kinda pumped and that's honestly why I have these pics. So I figured it'd be a good opportunity to get some additional feedback from this forum! 😎

Edited October 13, 2021 by Balding Bad

[Britanium]

Exciting times ! Great you have a face to face consultation booked up 👍🏽 Be really interesting to hear what he thinks 🤔

[Balding Bad]

Just now, JohnAC71 said:

Exciting times ! Great you have a face to face consultation booked up 👍🏽 Be really interesting to hear what he thinks 🤔

I'm sorry, I should have clarified. My consultation is going to be over the phone since I am located on the East Coast of the US... 😞

[Britanium]

4 minutes ago, Balding Bad said:

I'm sorry, I should have clarified. My consultation is going to be over the phone since I am located on the East Coast of the US... 😞

Ah ok 👌 

[Future Hair Doc]

Hi Heisenberg, I strongly suggest you at least attempt finasteride. You should switch to the liquid minoxidil without alcohol and propylene glycol. If you're getting side effects from oral finasteride, which about 5% of people get, then switch to topical finasteride. Feel free to reach out anytime

[Curious25]

7 hours ago, Balding Bad said:

1. How would you rate my current hair loss and what do you think my future outlook is?

2. How many grafts do you think it would take to restore my front hairline? (I'm pretty realistic and not trying to restore it to my teenage years, ideally looking to retain a mature/proper hairline for my age. Ideally I'd like to be able to slick my front back.)

3. How is my donor area? Am I an ideal candidate for a hair transplant? I'm only considering FUE. (I never noticed, but I've kinda got a weird Nightwing logo (the DC Comics character) on the back of my head, which kinda worries me...)

 

1) Considering what you have told us with regards to your father and brother, you are doing very well. Either minoxidil is doing wonders for you, or you aren't genetically as predisposed to MPB as your father and brother - I would probably steer more towards this answer, as opposed to crediting it all on minoxidil, as you haven't been addressing the route course. 

2) I would follow the outline of your hairline that you still have, and assuming you have characteristics similar to other asian patients, I would roughly guess that between 2000-3000 would sit you well, depending how far into your native hair the surgeon chooses to go. 

3) Very hard to tell from your pictures - you really need a microscopic examination for the answer to this, however, visually it looks ok. 

It'll be interesting to see how you get on with some in person consultations, if you are able to get them booked in! 

[Curious25]

3 hours ago, Dr. Suhail Khokhar said:

Hi Heisenberg, I strongly suggest you at least attempt finasteride. You should switch to the liquid minoxidil without alcohol and propylene glycol. If you're getting side effects from oral finasteride, which about 5% of people get, then switch to topical finasteride. Feel free to reach out anytime

By the sounds of it, he's pretty well read up on hair loss - I imagine he's gone through his own personal risk v reward analysis hundreds of time in his head, so this is a pretty unhelpful input if you have read through his original post. 

[Balding Bad]

6 hours ago, Dr. Suhail Khokhar said:

Hi Heisenberg, I strongly suggest you at least attempt finasteride. You should switch to the liquid minoxidil without alcohol and propylene glycol. If you're getting side effects from oral finasteride, which about 5% of people get, then switch to topical finasteride. Feel free to reach out anytime

Hi Dr. Khokhar -- appreciate the suggestion.

Where would I be able to find some alcohol and propylene glycol free minoxidil? I am currently using the generic Kirkland brand.

[Future Hair Doc]

Just now, Balding Bad said:

Hi Dr. Khokhar -- appreciate the suggestion.

Where would I be able to find some alcohol and propylene glycol free minoxidil? I am currently using the generic Kirkland brand.

Happy to help. I believe minoxidilmax offers topical finasteride/minoxidil without alcohol or propylene glycol:

https://www.minoxidilmax.com/

[Balding Bad]

3 minutes ago, Dr. Suhail Khokhar said:

Happy to help. I believe minoxidilmax offers topical finasteride/minoxidil without alcohol or propylene glycol:

https://www.minoxidilmax.com/

Appreciate the prompt reply. I'll definitely look into this. Thanks Doc!

[Balding Bad]

3 hours ago, Curious25 said:

1) Considering what you have told us with regards to your father and brother, you are doing very well. Either minoxidil is doing wonders for you, or you aren't genetically as predisposed to MPB as your father and brother - I would probably steer more towards this answer, as opposed to crediting it all on minoxidil, as you haven't been addressing the route course. 

2) I would follow the outline of your hairline that you still have, and assuming you have characteristics similar to other asian patients, I would roughly guess that between 2000-3000 would sit you well, depending how far into your native hair the surgeon chooses to go. 

3) Very hard to tell from your pictures - you really need a microscopic examination for the answer to this, however, visually it looks ok. 

It'll be interesting to see how you get on with some in person consultations, if you are able to get them booked in! 

Yeah to be completely honest, even though my front hairline is clearly in bad shape I am still overall grateful I have as much hair as I do and that I'm able to use the existing hair that I have for a nice concealer effect. Part of me feels like it's a mixture of having slightly better genes and minoxidil doing it's thing. The two together are providing a good synergy in at least slowing down my hair loss.

The goal is to rebuild the current hairline. I would not dare try to lower it or try to fill in the temples. I'm very realistic and I don't want to exhaust my precious donor area when there's no telling where I'll be in 10 years from now.

Yeah, the photos of my donor area were kinda hard to take since I'm taking them by myself. It's been kinda muggy where I live recently, but I'd like to try to take photos again of my donor area when I have some pretty solid lighting.

Anyways appreciate your insight/feedback @Curious25! 😎

[Balding Bad]

Howdy gang -- it's been just almost a week since I started this topic, but wanted to do a follow up now that my hair is 1 week longer.

My main question is about my donor area. We rarely see the back of our heads and because of that I recently only discovered this weird shape in the back.

1.) Wanted to get some insight on whether or not my donor area would make me a suitable/ideal candidate for an FUE HT and if this "pattern" is of any concern?

2.) Any thoughts on my crown? Does it look okay or is it thinning out?

The image below highlights what I'm referring to. Not too sure if this particular photo best illustrates it, but I've got kind of a Nightwing logo going on (or I guess it looks like a thong based on how I highlighted it 🤣). The hairs in that area just seem notably thinner... It seems more notable in the photo where I tilt my head down.

For reference, all these photos were taken with no flash under natural lighting and the overhead bulb in the bathroom. I had just woken up so my hair is technically in "bed head" mode. I didn't style it or anything.

So first batch is dry hair and then 2nd batch is immediately after I showered, so it's wet.

**THIS IMAGE BELOW WAS TAKEN WITH PARTIAL NATURAL LIGHTING COMING IN FROM THE LEFTHAND SIDE.

**THE REST OF THE IMAGES BELOW ARE TAKEN WITH NATURAL LIGHTING DIRECTLY ON THE BACK OF MY HEAD.

**THESE PHOTOS BELOW ARE TAKEN AFTER SHOWER, SO HAIR IS WET.

Edited October 19, 2021 by Balding Bad

[Balding Bad]

No one responded to my previous post, that's fine I suppose. 

I'm just gonna use this thread to chronicle my hair growth so far and if any of you fine folks wanna chime in then feel free.

Anyways  I usually get a haircut every 3 weeks, but I've decided to forego my usual haircut and grow it out a little more to see how my donor area looks like when there's more growth. It's been 1 month since my last haircut, so the donor area is more filled in now.

I dunno if it's because my head was laying flat on a chair/pillow and therefore may have caused my hair to flatten in an odd way, but I've noticed there seems to be less density in the bottom part of my hair, specifically the center part on the bottom. Does anyone think that's any signs for concern?

Also what do you guys think of my donor area now that there's more hair there?

[Gatsby]

I think that their is really no perfect donor in truth as we cannot be guaranteed how our donor will be in say 40 years from now (assuming you are 34). You will care about your hair when you are 74. That said at 34 you have minimal hair loss compared to many others and you seem very well versed in MPB. I understand your concerns (and I am not a doctor) but I would recommend seeing your doctor and think about micro dosing finasteride. I took 1mg a day and after a few months I developed sexual side effects and ceased taking the drug for six months. I have since gone back on the drug at 0.5mg's on Monday, Wednesday and Friday and I have had zero side effects. I have since upped my Friday dose to 1mg (to cover both Saturday and Sunday) and so far so good. I will monitor this for another couple of months then up my Monday dose and then continue to monitor this also for several months. Already I can feel my hair feels more thicker and bristly if that makes sense and my lateral humps feel higher and my lower crown feels like it has risen slightly. Finasteride isn't just about retaining hair but also improving the quality of the hair (most importantly the donor). In terms of surgery have you looked at Dr John Diep even for just a consultation? My estimation is that between 2K -2.5K grafts would be a good number. I would at the very least continue with your minoxidil and seriously think about micro dosing finasteride or trying topical finasteride. Wishing you all the best! 

[Balding Bad]

5 hours ago, Gatsby said:

I think that their is really no perfect donor in truth as we cannot be guaranteed how our donor will be in say 40 years from now (assuming you are 34). You will care about your hair when you are 74. That said at 34 you have minimal hair loss compared to many others and you seem very well versed in MPB. I understand your concerns (and I am not a doctor) but I would recommend seeing your doctor and think about micro dosing finasteride. I took 1mg a day and after a few months I developed sexual side effects and ceased taking the drug for six months. I have since gone back on the drug at 0.5mg's on Monday, Wednesday and Friday and I have had zero side effects. I have since upped my Friday dose to 1mg (to cover both Saturday and Sunday) and so far so good. I will monitor this for another couple of months then up my Monday dose and then continue to monitor this also for several months. Already I can feel my hair feels more thicker and bristly if that makes sense and my lateral humps feel higher and my lower crown feels like it has risen slightly. Finasteride isn't just about retaining hair but also improving the quality of the hair (most importantly the donor). In terms of surgery have you looked at Dr John Diep even for just a consultation? My estimation is that between 2K -2.5K grafts would be a good number. I would at the very least continue with your minoxidil and seriously think about micro dosing finasteride or trying topical finasteride. Wishing you all the best! 

Hey Gatsby -- thanks for taking the time to respond!

And yes, I am indeed 34. I wish I could say I was younger, but the truth is the truth haha.

Yeah, I'm pretty obsessed with my hair and not having full density at the front has been one of my biggest insecurities in life. It's been over a decade since I first noticed my thinning so for all these years now I've always been pondering that glorious thought of "what if my hair line was restored and I could style my hair the way I actually wanted to..?" I'm sure you know the feeling.

Anyways, I really do appreciate the suggestion regarding microdosing Finasteride and honestly it's an idea I've warmed up to recently. I think ultimately this will be something I do later on in my life once I am settled down and have children. The potential sexual side effects are obviously the main factor that are causing me not to commit to this wonder drug at the moment, but I can see myself on it once I have my family established.

And, nope, I will add Dr. John Diep to my list to look into/research.

Once again, I appreciate your insight Gatsby! 😎

[JDEE0]

Your donor isn't 'ideal', but it's absolutely fine and I would classify it as good. As for your crown, you definitely have some loss going on, yes, but its not too bad at the moment.

I can see that you're going to keep losing hair if you don't use meds due to the nature of your pattern, so I would really consider not just being so blasé about the use of fin. It probably won't be particularly fast, but you might find yourself having lost a similar amount of hair in the next 10 years as the previous 10 up until now. It would be wise to not just find an excuse that allows you to tell yourself you'll pick the issue up in the future as you very well might just end up in the same position you are in now yet again. 

Anyways, you seem like a decent candidate for surgery which becomes a solid candidate if you use meds.

[Balding Bad]

3 hours ago, JDEE0 said:

Your donor isn't 'ideal', but it's absolutely fine and I would classify it as good. As for your crown, you definitely have some loss going on, yes, but its not too bad at the moment.

I can see that you're going to keep losing hair if you don't use meds due to the nature of your pattern, so I would really consider not just being so blasé about the use of fin. It probably won't be particularly fast, but you might find yourself having lost a similar amount of hair in the next 10 years as the previous 10 up until now. It would be wise to not just find an excuse that allows you to tell yourself you'll pick the issue up in the future as you very well might just end up in the same position you are in now yet again. 

Anyways, you seem like a decent candidate for surgery which becomes a solid candidate if you use meds.

Thanks for your input JDEE0.

Honestly, I agree with you 100%. I know for a fact my hair loss will only continue, it's just a matter of how long it'll take and how much I can slow it down by with the use of Finasteride.

You do bring up a valid point that I may be back at square 1 in 10 years even after a HT. Perhaps I am just coming up with excuses for not starting it right away, but my concerns/hesitations regarding the sides are absolutely genuine. Having a family established at some point in my life would kinda put that issue at ease for me to a certain extent, but at the end of the day excuses are excuses I suppose.

[JDEE0]

1 minute ago, Balding Bad said:

Thanks for your input JDEE0.

Honestly, I agree with you 100%. I know for a fact my hair loss will only continue, it's just a matter of how long it'll take and how much I can slow it down by with the use of Finasteride.

You do bring up a valid point that I may be back at square 1 in 10 years even after a HT. Perhaps I am just coming up with excuses for not starting it right away, but my concerns/hesitations regarding the sides are absolutely genuine. Having a family established at some point in my life would kinda put that issue at ease for me to a certain extent, but at the end of the day excuses are excuses I suppose.

No, I understand yours or anyones hesitation to start fin, and it's a personal choice at the end of the day. For some people, I would say don't get a transplant unless you use it as you'll end up worse than before most likely. Others, such as yourself, I would say go for it either way, it may turn out to be a mistake down the line or you may be able to successfully chase the loss for most of your life. Who knows though. 

FYI though, it apart from me just regurgitating what I usually do that all studies pretty much show sides are below 5 percent of users, finasteride has no effect on your ability to start a family. If it's a concern at the time, you can come off for a while.

Maybe look into a low dose of topical fin, it has been recently shown to be nearly as effective with less systemic absorption and less sides reported at about 0.5%.

[Balding Bad]

6 minutes ago, JDEE0 said:

No, I understand yours or anyones hesitation to start fin, and it's a personal choice at the end of the day. For some people, I would say don't get a transplant unless you use it as you'll end up worse than before most likely. Others, such as yourself, I would say go for it either way, it may turn out to be a mistake down the line or you may be able to successfully chase the loss for most of your life. Who knows though. 

FYI though, it apart from me just regurgitating what I usually do that all studies pretty much show sides are below 5 percent of users, finasteride has no effect on your ability to start a family. If it's a concern at the time, you can come off for a while.

Maybe look into a low dose of topical fin, it has been recently shown to be nearly as effective with less systemic absorption and less sides reported at about 0.5%.

Finasteride may have no effect on my ability to start a family, but it may potentially make the process of doing so much more difficult lol.

Yeah, low doses/microdosing (as Gatsby suggested) is something I think I am open to.

Moreover a friend of mine who just underwent a HT and is now on topical Finasteride told me there are absolutely 0 sides when applied topically, however I don't believe that's true. I'll need to research more into topical Fin, but have you heard that before? Seems too good to be true.

[JDEE0]

7 minutes ago, Balding Bad said:

Finasteride may have no effect on my ability to start a family, but it may potentially make the process of doing so much more difficult lol.

Yeah, low doses/microdosing (as Gatsby suggested) is something I think I am open to.

Moreover a friend of mine who just underwent a HT and is now on topical Finasteride told me there are absolutely 0 sides when applied topically, however I don't believe that's true. I'll need to research more into topical Fin, but have you heard that before? Seems too good to be true.

Well, if you get sexual/libido related sides, then just stop and you'll be fine. Would be more of an ideal to find this out before you ever get a HT rather than waiting far down the line IMO. In any case, if we go by clinical data, finasteride isn't something to be feared. I've covered the data and my opinion enough already on here, but essentially there's a small risk of side effects to the tune of around 3 percent (placebo is always usually not far behind) which go away on discontinuation. I personally see no logical reason for anybody to be too scared to even give it a go.

As for topical, not true that there will be no sides, no, but a recent study did come out which changed my mind on topical fin in general. There really hasn't been much up until it, and I presumed it would just go systemic to the same degree as oral over time. Turns out not - here it is: https://www.hairrestorationnetwork.com/topic/61390-new-topical-finasteride-study-just-published-might-be-useful-for-some-people/

[Balding Bad]

31 minutes ago, JDEE0 said:

Well, if you get sexual/libido related sides, then just stop and you'll be fine. Would be more of an ideal to find this out before you ever get a HT rather than waiting far down the line IMO. In any case, if we go by clinical data, finasteride isn't something to be feared. I've covered the data and my opinion enough already on here, but essentially there's a small risk of side effects to the tune of around 3 percent (placebo is always usually not far behind) which go away on discontinuation. I personally see no logical reason for anybody to be too scared to even give it a go.

As for topical, not true that there will be no sides, no, but a recent study did come out which changed my mind on topical fin in general. There really hasn't been much up until it, and I presumed it would just go systemic to the same degree as oral over time. Turns out not - here it is: https://www.hairrestorationnetwork.com/topic/61390-new-topical-finasteride-study-just-published-might-be-useful-for-some-people/

Thanks for linking that study, I'll be sure to check it out!

[Gatsby]

2 hours ago, JDEE0 said:

Well, if you get sexual/libido related sides, then just stop and you'll be fine. Would be more of an ideal to find this out before you ever get a HT rather than waiting far down the line IMO. In any case, if we go by clinical data, finasteride isn't something to be feared. I've covered the data and my opinion enough already on here, but essentially there's a small risk of side effects to the tune of around 3 percent (placebo is always usually not far behind) which go away on discontinuation. I personally see no logical reason for anybody to be too scared to even give it a go.

As for topical, not true that there will be no sides, no, but a recent study did come out which changed my mind on topical fin in general. There really hasn't been much up until it, and I presumed it would just go systemic to the same degree as oral over time. Turns out not - here it is: https://www.hairrestorationnetwork.com/topic/61390-new-topical-finasteride-study-just-published-might-be-useful-for-some-people/

@Balding Bad you make an excellent point (for any potential hair transplant candidates). It would be better to trial finasteride prior to surgery for a good 6 months and longer. Why? Because if finasteride is going to be part of your hair restoration plan then you need to be able to rule out finasteride (at least in the oral version) if you do in fact do begin to develop side effects. Once you are cut and you incorporate finasteride later, your plan will in fact quickly go out the window.