How long after beginning finasteride should a HT be considered?

[FluffyPanda]

Hey everyone! So big thank you to this forum for really helping me get the confidence to start treating my hair loss, and to the people last time who helped give their opinions. Long story short, I'm almost 33 and have been thinning over the last 8ish years. I started 0.5mg finasteride a few weeks ago and since i had no side effects, I'm now on 1mg finasteride (for a grand total of ~1 month). I've included pics of my current hair situation.

Following the suggestions of many posters here, I've been getting numerous consults with recommended hair transplant surgeons on this forum. I've also been getting a variety of opinions over where or not a HT now would be of benefit or I should be waiting nearly a year right now. Pretty much everyone agrees that I should be on finasteride 1mg and my first HT should be to rebuild the hairline + mid/frontal scalp region. I'm perfectly fine and on board with that. The differences seems to be how long to wait.

Dr. Pinto recommended not getting a HT at this time and waiting 12 months to see how the finasteride does for the hairgrowth (also recommended switching to dutasteride + oral minox).

Similarly, HLC recommended sticking with finasteride 1mg and waiting 6-12 months to see the effects and then re-evaluate.

Both Eugenix and Dr Camacho (in Bogota) recommended staying on finasteride 1mg but that I would benefit from a HT now because finasteride won't really do anything for the hairline (but would do more for the crown). Both are estimating ~2500-2800 grafts and both felt I would get really excellent results.

Dr. Bisanga was indeterminate and said an in-person consult is necessary because he felt the donor area had some weaker areas.

This isn't to throw anyone under the bus, and I'm very grateful to all of these surgeons for providing their opinions, but rather I just wanted to illustrate the range of opinions I've gotten. Certainly I want to make sure I make the correct choice for me and do this right the first time, especially before flying to a different continent to have this done, and mostly wanted to gauge if I should be waiting to consider a HT or should be trying to get one sooner rather than later (although I suppose with how far out these surgeons get booked, I'll probably end up having to wait at least 6-12 months for a HT anyway.)

[NARMAK]

Hey bud, glad to hear you were able to start medication and going 1 month strong with Finasteride. 

I personally think you should wait a full 12 months on the Finasteride to get a better idea of how it can help with your hair loss and in the meantime, save up and pick the best surgeon you feel is able to deliver your hair transplant objectives. 

If you do need to, get on the wait lists of the people you feel are the one and just educate yourself on hair transplants in general and set out what you would like in terms of the hairline design, density etc. 

[devnull]

I would also recommend waiting 12 months before jump on any hair transplant. It will thicken your native hair, which reduces shock loss. 
 

And most important: you really need to figure out m, that you can really imagine taking it until the rest of your life. 

[Mike10]

at least 1 year

[JoeMan]

I agree with waiting but nothing wrong with booking with a surgeon that's about a year out. Personally I didn't wait quite a year but I'm also 44 and hair was fairly stable. I think that is the most important thing. You want your hair to be stable before moving forward and it will take about a year to assess whether it is. At least you are looking at good surgeons which is half the battle. 

If you can afford it, an in person consultation with Dr. Bisanga might be worth it in about 6 months. He's definitely one of the best. 

Edited March 31, 2022 by JoeMan

[Melvin- Admin]

I would say 6 months to a year.

[LaserCaps]

As long as it takes for you to confirm the medication is working.  If the med does not work, which does happen in a very small percentage of patients, (and say you worked the crown, for example), you would then end up with an island of hair and nothing around it.  Better to be certain before moving fwd.

[Mike10]

1 hour ago, LaserCaps said:

As long as it takes for you to confirm the medication is working.  If the med does not work, which does happen in a very small percentage of patients, (and say you worked the crown, for example), you would then end up with an island of hair and nothing around it.  Better to be certain before moving fwd.

It does not work for 10 %. Not that small

[NARMAK]

45 minutes ago, Mike10 said:

It does not work for 10 %. Not that small

Hell, give me something with a 90% chance of success and show me a statistic that says most wouldn't go for it lol. 

I do know it's probably one of the few options though that anybody really has and had until we get new FDA or similar approved treatments. 

Well, at least we know we're always 5 years out from the next miracle, and then another 5 years on review 😂

[Vann]

Finasteride 1mg works to reduce 70% of DHT so 0.5mg would take a lot longer to process (vs 1mg) in your body since the half life of the drug would take longer to kick in for you. Ordinarily a doctor would recommend 5mg to a patient to cut in half or into thirds to save money (in the US). This isnt a big issue but the amount is not necessary. From what I have read the average amount of finasteride a dermatologist gives to patients, between the ages of 20-35, would be 3-7mg weekly.

Dutasteride 0.5mg works 90% (20% more effective than fin 1mg). However, most people say for dutasteride you can see growth and hair thickening, clinically speaking this would probably be because some hairs grew out in the hair cycle -- may not actually have regrown hair (telogen/anagen phases). There could have been a shedding period for those who have never taken dutasteride/finasteride (usually the first few months there is a temporary shed). And for those who were on finasteride then switched to dutasteride would probably experience more hair "density" (thickness) because the drug is already blocking dht but within a few months also blocks another 5 alpha reductase.

Given your age, I would say your alopecia was slowly progressing. You may have had aggressive hair loss in your early-mid twenties but you may see some more density with derma rolling, minox, dutasteride over the next year. However, keep in mind, these are not permanent and once you stop you lose the progression it has built up.  

Some of the surgeons you picked have a year waiting list which could serve as a good measure as to whether or not you wish to proceed with a HT. This gives you time to think about all options whether medical/surgical.

Personally... I would consider giving yourself 1.5-2 years to see if you can stabilize your hair loss and see if you can potentially regrow with the medical therapy. But, (I can understand) if you are confident that you can get results from a HT why not get your hair back while you are young and put the mental struggle behind.

[sfarfals2]

I had a hair transplant more 14months ago, I started using finasteride 7.5mg per week(2.5mg Monday/Wednesday/Friday) and minoxidil 1x day.

Last November I stopped using Minixodil and the the last month I noticed some hair loss and density decreasing...
 

Shouldnt the finasteride keep the hair going? Or it is expected that the hair lose some density after stopping Minoxidil, 

Recently I bought a dermastamp and I am applying it daily for 5/10 minutes

 

Any advice?