Questions about my situation and potential transplant in the future.

[LMyR]

Hello. I've been lurking around this forum for the past year and I have to thank the people who are posting as you have saved me from 1-2 wrong choices at least.
My hair loss started at around 19. Ever since then my hairline started to recede with slow, but steady pace. I started finasteride around 23 and a half and it helped me for 7-8 months to stop the receding, but then I've had a major loss in about 1-2 months. I can only guess that it was because the medication was generic as we don't have any branded in my country. I am still taking it as it may help with a potential loss in the crown or the middle.

The things that worry me are:

I'm almost 25 and due to my age I know the risks with an eventual hair transplant below 28-30

My receding doesn't seem to slow down. One of my sides is NW3? and the other is a little bit better. I've also lost a little bit from the base of my hairline.

My family has a history of hair loss. My father is doing well - at almost 50 he is barely NW 1.5, but my grandfathers were/are bald (NW 7/ NW 5)

Finasteride and Minoxidil so far have little visible effect at least on the hairline.

I've managed to book a consultation with Dr. Zarev for the end of March. I want him to evaluate my situation and especially my donor as I have very little knowledge about that.
After that I'm considering to book a consultation with Dr. Bicer, as she is close to me and to my knowledge she still does FUT, which I've heard is better for young patients as it spares the donor more. 
I want to have good hair, but I'm also very conservative and I want to make the best decisions regarding the treatment. That is why I will probably wait at least 2 years before I do anything. Also, I don't have problems to be NW2.5 for the rest of my life, so it's not like I want to get back to my hair when I was 19. 

Any opinions will be appreciated, thanks.

 

[WhiteyUK]

I wouldn’t be having a ht yet, your hair loss is minimal at best

[NARMAK]

OP, your hair looks solid. Not obviously a perfect unreceded Norwood 0 but i mean in a similar sense that its like mine. Your corners are receded but it looks generally strong where it is. 

Regarding medication, are you taking Finasteride 1mg per day, every other day or a smaller dose? Also how often. 

Your temporal areas look like they're holding a few hair on there that might be ripe to help with some Microneedling. I don't think i would recommend Minoxodil for you atm, but Microneedling into the crown area could help you too. Actually kinda reminds me of mine too. Not that it looks massively bald or anything, just a bit thinner. This is something naturally some people even without hair loss can have i guess. Microneedling might just give it a little boost to make sure it's maxed out though. 

Lastly, keep an eye out on further recession and start saving for a HT if you feel strongly to restore the frontal hairline. If you are taking 1mg/day of Finasteride, doesn't always matter if its generic. It could benefit you to maybe start taking a 0.5mg Dutasteride pill 1x a week on a day instead of the 1mg of Finasteride. In some people, this helps block even more DHT and gets you "back on track". 

Edited January 23, 2022 by NARMAK

[LMyR]

Yeah, I don't have problems with the way my hair looks now. Therefore, I am not considering a hair transplant in the next year. But, I can only guess that my recession won't stop and that I will eventually need one in the next few years.

As regarding to the finasteride. I started with 1 mg a day for 7-8 months. It felt as if the medication was working and it stopped my receding for the first 6-7 months, but then it suddenly it stopped working and I've lost a lot in the next 1-2 months. Like, all the hair that it was keeping in the first couple of months was gone. After that, I had to switch to 5mg (breaking it 1.25 mg a day), because they stopped producing 1mg in my country. I can't get dutasteride as we don't have it here either. 
I will consider microneedling, but I know that this is not a long term solution.

As for the crown, when I went to a dermatologist, she said that I don't have loss there, but I'll see what dr. Zarev will say in two months. Its possible that I will start losing ground there too in the future.

[NARMAK]

2 hours ago, LMyR said:

Yeah, I don't have problems with the way my hair looks now. Therefore, I am not considering a hair transplant in the next year. But, I can only guess that my recession won't stop and that I will eventually need one in the next few years.

As regarding to the finasteride. I started with 1 mg a day for 7-8 months. It felt as if the medication was working and it stopped my receding for the first 6-7 months, but then it suddenly it stopped working and I've lost a lot in the next 1-2 months. Like, all the hair that it was keeping in the first couple of months was gone. After that, I had to switch to 5mg (breaking it 1.25 mg a day), because they stopped producing 1mg in my country. I can't get dutasteride as we don't have it here either. 
I will consider microneedling, but I know that this is not a long term solution.

As for the crown, when I went to a dermatologist, she said that I don't have loss there, but I'll see what dr. Zarev will say in two months. Its possible that I will start losing ground there too in the future.

I would continue taking progress pictures and maybe check in with a Trichologist if possible who can properly view the hair and see if it's hair loss due to telogen effluvium or MPB. 

In your circumstances if it turns out it is a further progression and you've been on 1mg/day (now 1.25mg) then you might potentially wish to add Minoxodil into the mix. 

Minoxidil and Microneedling have been shown to be effective and in combination with Finasteride it's the strongest main treatments you could try. There's also a small booster you could try with maybe adding Nizoral shampoo or similar that contains Ketoconazole which has mild Anti-Androgen properties and also helps the scalp clean from certain things that could be impacting you. 

Also, before hopping onto Minoxodil, i strongly suggest you get a blood test done. There is a possibility that something could be imbalanced and contributing to hair loss. 

Good luck and keep us posted. 

[Drish]

It looks like a NW 2A pattern to me. Your hair looks fine at this point. Good hair characteristics as well. Definitely save the transplant for the future. Unless you're completely sure that your hairloss has stabilized it is not worth the plunge. You'd be better off with a NW 3 or 4 pattern than having a rapid recession behind your transplanted area leaving you to chase it for an indefinite period. In the process you'd be compromising with the best possible utilization of your donor over the long run as you'd be utilizing most of the grafts for the frontal part to match the existing density behind the recession and may potentially run out of grafts to address future loss on your crown. The thing with finasteride is it has got shedding cycles associated with it. So, you have to persist with it to maintain the result for a long term. If the hair doesn't come back, you could throw in a bit of minoxidil and microneedling into the mix and see how things go.