Am I a good candidate for a hair transplant?

[warmachine007]

Hi guys, would I be a good candidate for a HT? 29 yo and been on oral finasteride 1 mg every day and topical minoxidil 5% once a day for 2 years now.

 

TL;DR: Hair still thin and scalp shows despite 2 years of treatment. Huge bald patch at crown and diffuse thinning on midscalp. Thinking of HT to fix it up. How many grafts would I need, and should I leave the hairline untouched?

 

First three pics are before I started any treatment, next 3 pics are after a year on fin and min, next 3 pics are very recent and after 2 years on fin and min, and the last pic is also very recent and shows my current hairline.

 

I suspect I might have DUPA, since my hair loss seems to be all over the scalp including the side of my head (2nd baseline pic for reference). I'm slightly disheartened by the fact that you can still see my scalp through my hair even after 2 years of treatment. Obviously there's been massive improvement since baseline, but my hair's still not where I want it to be.

 

I'm unwilling to take dutasteride and oral minoxidil. Only thing I haven't implemented yet is microneedling. Bought a 1.5 mm dermaroller recently and thinking about giving it a good shot for 6-12 months before deciding whether I need a transplant.

 

If I were to get a HT in the future, I'd ideally want it to thicken up my midscalp and crown and fix my temple recession. How many grafts do you reckon I'd need? Would I be better off leaving my hairline untouched, since it's already pretty decent and the hairline is apparently one of the toughest things to get right? Looking forward to hearing your opinions and advice. Thanks for reading!

P.S. Excuse the corny emojis, just wanted to hide my eyes for the sake of privacy

[NARMAK]

Firstly, great job sticking  to the routine, i definitely think there's a noticeable improvement between Year 1 & Year 2 in the photos BUT your hair looks much more wet/greasy in Year 1 pics and dry in Year 2, so it could be similar. 

I would honestly say to give Microneedling a shot at 12 months on top of the routine. Add Nizoral or similar with a 2% ketoconazole shampoo to your routine to help block a bit more Anti-Androgen. 

Also, i would say that you never mentioned why you would be unwilling to take Dutasteride or Oral Minoxidil. I know Oral Minoxidil some people avoid due to some systemic side affects, but mainly i'm interested in your reason for not using Dutasteride. 

People who are just maintaining on Finasteride/Minoxidil tend to start introducing Dutasteride on a 1-2x weekly basis on some days like Wednesday/Friday instead of their regular Finasteride to boost their DHT being blocked.

[1978matt]

I don't think a HT is worth the risk at this stage.  The amount of hair you have on top is pretty much what a HT would aim to achieve.  If you try to graft in between those hairs you may just permanently shock them out, and end up looking exactly the same.

From the front you cant really tell there's much of an issue.

[warmachine007]

6 hours ago, NARMAK said:

Firstly, great job sticking  to the routine, i definitely think there's a noticeable improvement between Year 1 & Year 2 in the photos BUT your hair looks much more wet/greasy in Year 1 pics and dry in Year 2, so it could be similar. 

I would honestly say to give Microneedling a shot at 12 months on top of the routine. Add Nizoral or similar with a 2% ketoconazole shampoo to your routine to help block a bit more Anti-Androgen. 

Also, i would say that you never mentioned why you would be unwilling to take Dutasteride or Oral Minoxidil. I know Oral Minoxidil some people avoid due to some systemic side affects, but mainly i'm interested in your reason for not using Dutasteride. 

People who are just maintaining on Finasteride/Minoxidil tend to start introducing Dutasteride on a 1-2x weekly basis on some days like Wednesday/Friday instead of their regular Finasteride to boost their DHT being blocked.

Thanks, yeah my hair was greasy/unwashed in the Year 1 photos but there’s still a massive, noticeable difference between the Year 1 and Year 2 pics. So the treatment has definitely been doing it’s job, but it may have reached its peak since I’ve hit the 2 year mark already.

Yeah I’m think I’m going to give microneedling a shot for 12 months before evaluating further. I already use ketoconazole 2% shampoo sporadically but think it’s only mildly effective, as I was using it regularly during my Year 1 pics but you can see the results for yourself. Plus I’ve been diagnosed with seborrheic dermatitis of the scalp and face and have been using a specially medicated shampoo to combat that, and don’t really have room for ketoconazole in my routine for now.

As for dutasteride, I just don’t want to risk the sexual sides. In fact, I’ll be switching to 0.1% topical fin + 5% min (and ditching the oral fin) as soon as my shipment arrives in a few days to further mitigate the risk of sexual side effects down the line. But who knows, my willingness to use dutasteride might change over the years if/when my hair loss progresses even further.

Edited March 5, 2022 by warmachine007

[warmachine007]

3 hours ago, 1978matt said:

I don't think a HT is worth the risk at this stage.  The amount of hair you have on top is pretty much what a HT would aim to achieve.  If you try to graft in between those hairs you may just permanently shock them out, and end up looking exactly the same.

From the front you cant really tell there's much of an issue.

Thanks for the insight, I think you’re definitely right about a hair transplant being a risky proposition at this stage. I think I’m just going to continue my current treatment regimen (swapping out the oral fin for topical fin though, and adding microneedling 1.5 mm once a week) and let my hair loss ride out its course for the next few years and evaluate again at the appropriate time.

[NARMAK]

10 minutes ago, warmachine007 said:

Thanks, yeah my hair was greasy/unwashed in the Year 1 photos but there’s still a massive, noticeable difference between the Year 1 and Year 2 pics. So the treatment has definitely been doing it’s job, but it may have reached its peak since I’ve hit the 2 year mark already.

Yeah I’m think I’m going to give microneedling a shot for 12 months before evaluating further. I already use ketoconazole 2% shampoo sporadically but think it’s only mildly effective, as I was using it regularly during my Year 1 pics but you can see the results for yourself. Plus I’ve been diagnosed with seborrheic dermatitis of the scalp and face and have been using a specially medicated shampoo to combat that, and don’t really have room for ketoconazole in my routine for now.

As for dutasteride, I just don’t want to risk the sexual sides. In fact, I’ll be switching to 0.1% topical fin + 5% min (and ditching the oral fin) as soon as my shipment arrives in a few days to further mitigate the risk of sexual side effects down the line. But who knows, my willingness to use dutasteride might change over the years if/when my hair loss progresses even further.

I personally am on Dutasteride 0.5mg everyday and feel like that situation seems fine from a normal function to reach form PoV lol. 

You can slowly introduce it into your regimen and if there's any issues reduce or get rid of it. Until you actually try, you will not know unless Finasteride already gave you side affects. 

[civic]

At this stage i absolutely would not even entertain idea of getting HT. You have a lot of native hair, try everything to save it & use toppik when needed. 

[gillenator]

I also concur that the apparent risk with surgery would be shockoss as you definitely have a progressive diffused thinning pattern.