Am I an OK candidate? Which steps to take? 32 years old male.

[Blaexe]

Hey,

So I'm an 32 years old male and have been experienced hair loss probably since the very early 20s. I'd say I'm somewhere around Nordwood 2/3 and there's also some thinning going on at the tonsure. I haven't been on any medicamentation. The donor area looks pretty good I think but since I'm relatively young I don't know whether a HT would be the right way - although I would love to have the full hair back.

The hair loss has been going pretty slowly overall (so over around ~10years). So what are my options, what do you suggest? I'll attach some images. Thank you.

[Gatsby]

It's a little hard to tell from those pics but going by them your donor looks good. I would look at surgery as a last resort and although I'm not a doctor I would be considering looking at finsteride and minoxidil first. If you can post some better pics with your eyes blacked out, etc it would help to get a better idea of your situation. All the best!

[Blaexe]

So I'm not 100% sure what kind of images you need, but here are some more.

After reading up on Fin a bit, I'm not sure I'm willing to take the (very small) chance of a permanent erectile disfunction problem though.

Thanks!

Edited April 20, 2022 by Blaexe

[DrTBarghouthi]

It does seem your loss is fairly limited to some frontal/ midscalp and crown areas. I would suggest some sort of maintenance. If finasteride is not within your plan, then maybe consider topical finasteride and oral or topical minoxidil. I believe your donor looks favourable and you can certainly do a limited HT especially in the front and  Midscalp region. 

[Curious25]

2 hours ago, DrTBarghouthi said:

It does seem your loss is fairly limited to some frontal/ midscalp and crown areas. I would suggest some sort of maintenance. If finasteride is not within your plan, then maybe consider topical finasteride and oral or topical minoxidil. I believe your donor looks favourable and you can certainly do a limited HT especially in the front and  Midscalp region. 

Good advice 

[Mike10]

Frankly you are not a good candidate. I can understand your concerns regarding Fin. It is not rare to see sides in the long term. I woould suggest you get on alternative hair loss prevention treatment then: Minox, PRP (good quality), maybe Laser Cap

Edited April 20, 2022 by Mike10

[Blaexe]

@DrTBarghouthi I had a look at topical fin. Seems like the side effects are basically the same, it just happens less often. Might be worth a try. It's just that these permanent or semi-permanent side effects people talk about are kind of frightening. Everything else is just fine. Minoxidil could be an alternative, I'll look into it.

@Mike10 Can you elaborate on why exactly you think I'm not a good candidate? I'm just trying to understand the reasoning behind that statement. Or is it just if I don't take any medication?

 

[NARMAK]

OP, i was once you. I also thought as a guy i don't want permanent ED just for taking a pill to try save my hair. 

The hard true fact however is that millions of men globally use it each year and the ones with serious side affects are circa 2% and even then  with stopping Finasteride they usually go back to their prior state. You would have to be one of the unluckiest people ever imo to get permanent impotence. 

If you are actually scared you might have an increased side affect risk, do a through blood test analysis to see your vitamin, hormone etc. levels and see if anything needs to be addressed. 

I personally had a Vitamin D deficiency which i addressed whilst taking my medication and i actually went even more nuclear than Finasteride by hopping straight to Dutasteride 0.5mg everyday off the bat. 

I personally think it has saved my hair and i levelled out within a few months of taking it to where the side affects that were imo mild anyway and tolerable disappeared or reduced down. That said, i have to be completely honest and say that i am saying side affects for some stuff that actually could have been unrelated to the medication but other things going on in my life such as stress etc. 

If you try Finasteride and it's working for you as it does for the vast majority of men imo, you're gonna be in a significantly better position than most. You actually have really solid looking temple points. So with 12 months worth of medication to do some hair restoration on the thinning frontal, mid and crown area whilst you research and save up for a hair transplant. I think you could get a fantastic result. 

[Mike10]

6 hours ago, Blaexe said:

@DrTBarghouthi I had a look at topical fin. Seems like the side effects are basically the same, it just happens less often. Might be worth a try. It's just that these permanent or semi-permanent side effects people talk about are kind of frightening. Everything else is just fine. Minoxidil could be an alternative, I'll look into it.

@Mike10 Can you elaborate on why exactly you think I'm not a good candidate? I'm just trying to understand the reasoning behind that statement. Or is it just if I don't take any medication?

 

Even though your donor is good, the fact that you are only 32, have visible thinning in the crown region and are not on a DHT blocker (Fin, Duta) for at least 12 montsh with good effect and  without sides does not make you a good candidate in my view. As mentioned, I  respect your decision with Fin though. I think it is not that rare to have sides with Fin in the long term (the 2% is very doubtful in my view). 

Edited April 21, 2022 by Mike10

[Blaexe]

@NARMAKSeems like it all comes down to whether I'm willing to go down the Fin route...good advice with getting a blood check, I'll consult my doctor. Thanks.

@Mike10So you're not saying I'm not a good candidate per se but because I'm not on medication. Or the other way around: I would be a good candidate if I had been on Fin for 12 months without significant side effects, right? That seems like the consensus here.

[NARMAK]

1 hour ago, Blaexe said:

@NARMAKSeems like it all comes down to whether I'm willing to go down the Fin route...good advice with getting a blood check, I'll consult my doctor. Thanks.

@Mike10So you're not saying I'm not a good candidate per se but because I'm not on medication. Or the other way around: I would be a good candidate if I had been on Fin for 12 months without significant side effects, right? That seems like the consensus here.

Definitely give the blood test a go and try also seeing how you respond to Finasteride. Usually people can also Nocebo themselves because what they anticipate will happen mentally manifests. So do be wary of that aspect itself. 

If you are taking it and as i mentioned are doing well over 12 months, you should still benefit from it over a longer term too. Japanese 10 year study of Finasteride showed people still responding to the medication for example. 

[Mike10]

6 hours ago, Blaexe said:

@NARMAKSeems like it all comes down to whether I'm willing to go down the Fin route...good advice with getting a blood check, I'll consult my doctor. Thanks.

@Mike10So you're not saying I'm not a good candidate per se but because I'm not on medication. Or the other way around: I would be a good candidate if I had been on Fin for 12 months without significant side effects, right? That seems like the consensus here.

And if Fin works, keep in mind that it does not work for about 10% of users.  Yes in that case you would be an OK candidate. However I still urge you not too hurry, take that full year to inform yourself about the surgery and then take a fully informed decision. HT surgery is a lifelong commitment. Also, if Fin works very well you may not want anymore surgery.

[Blaexe]

I'm debating on doing some blood tests and if all is okay starting with something along the line of 1mg 3x per week. But since I'll have to wait around a year for the results there is still plenty of time to do research, that's true.

As far as I understand the crown might become thicker again but there's basically a zero chance of the temples region recovering so that would need an HT surgery, albeit a (relatively) small-ish one. And of course I'd choose some well respected surgeons, even if it's more expensive.

Edited April 21, 2022 by Blaexe

[Mike10]

5 minutes ago, Blaexe said:

I'm debating on doing some blood tests and if all is okay starting with something along the line of 1mg 3x per week. But since I'll have to wait around a year for the results there is still plenty of time to do research, that's true.

As far as I understand the crown might become thicker again but there's basically a zero chance of the temples region recovering so that would need an HT surgery, albeit a (relatively) small-ish one. And of course I'd choose some well respected surgeons, even if it's more expensive.

your understanding what Fin can do is correct. As for taking Finansteride, that is your decision. 

[Eugenix Hair Sciences]

33 minutes ago, Blaexe said:

I'm debating on doing some blood tests and if all is okay starting with something along the line of 1mg 3x per week. But since I'll have to wait around a year for the results there is still plenty of time to do research, that's true.

As far as I understand the crown might become thicker again but there's basically a zero chance of the temples region recovering so that would need an HT surgery, albeit a (relatively) small-ish one. And of course I'd choose some well respected surgeons, even if it's more expensive.

It is true that the crown and mid scalp will get thicker if you use Fiansteride. The frontal zone will remain more or less the same. If it bothers you a lot then you can go for a transplant.

We would highly recommend taking finasteride as it will help you to a great extent in the maintainable of your pre existing hair.

[Curious25]

If you’re concerned about side effects - starting with a topical formulation from a credible source is a no brainer IMO. 
 

Avoiding liver metabolisation has been proposed countless times now as being a, if not the, fundamental aspect to limiting the systemic absorption. 

[DrTBarghouthi]

On 4/20/2022 at 9:46 PM, Blaexe said:

@DrTBarghouthi I had a look at topical fin. Seems like the side effects are basically the same, it just happens less often. Might be worth a try. It's just that these permanent or semi-permanent side effects people talk about are kind of frightening. Everything else is just fine. Minoxidil could be an alternative, I'll look into it.

@Mike10 Can you elaborate on why exactly you think I'm not a good candidate? I'm just trying to understand the reasoning behind that statement. Or is it just if I don't take any medication?

 

Yes some sort of medication is definitely worth it.