What's the consensus on transplants without fin?

[Grouse]

Hey all. I've spent the last 6 months learning about HT from this amazing forum, and it seems there's a general consensus on things like doctors, scarring, illusion of density, etc.

 

However - it seems like opinions are split about doing transplants without medications. Dr. Pittella and a few others seem to not require it, while some like Dr. Lorenzo 100% require it.

 

Similarly - some members here seem to say meds are always required for an acceptable outcome. Others like @Melvin- Moderatorseem to have absolutely perfect, knockout results without finasteride / dutasteride.

 

Curious what everyone's thoughts are about this. Is requiring meds case dependent? I've had bad sides on fin before, and feel like I'm a borderline case that will go to NW6 (pics attached). Consults with top clinics have been split - some told me no without meds, others have said no problem at all without meds. For those without meds - how did you get comfortable booking surgery when some say its a very bad idea?

[Z--]

Full Disclosure: I'm a NW6 and I'm not taking Fin. 

The general consensus is that if you undergo a transplant without Fin, you'll very likely need an additional surgery, as non-transplanted hair (and possibly some transplanted hairs which were on the border and impacted by DHT) will thin with time. This only poses issues if (i) you lack donor or (ii) you lack the desire (e.g. lack of funds, time, motivation) for future transplants. If you are okay with (ii) and a reputable doctor believes you have the requisite donor per (i), I don't see why undergoing a transplant without Fin is an issue. 

Keep in mind that hair from the safe zone within the donor region are susceptible to falling out in the future, but this seems to happen very late in life. Fin may also lose efficacy with time (and side effects, some possibly permanent) may appear in the future as well, though they are uncommon. 

The folks like Tao, Melvin, etc. who succeeded, typically have had 3+ transplants to achieve that level of density - at least in the case of the former two. If that doesn't deter you, I'd say speak to your doctor to get a sense of your donor zone and make that personal judgement. Like I mentioned above, I'd rather do additional transplants and go through 8+ months of ugly duckling phases/surgery costs, than having to medicate for the rest of my life and deal with the potential side effects. Either decision should be respected. 

EDIT: Noticed that you mentioned having sides before. If I were you, I wouldn't bother, but I can also understand folks telling you to use lower doses or take the dose every other day. Eh. I think if you're susceptible to the sides, there's no point risking your physical and mental well-being to save some hair.

Best of luck!

Edited May 21, 2022 by Z--

[NARMAK]

Short answer = bad idea. 

Longer answer, is you can try to go down that route without medication (Topical versions or otherwise) but it's truly a guessing game as to how your personal hair loss will shake out and as a result, you'll need to be very conservative and accept further limitations in your hair restoration goals and attempts than perhaps others. 

By now, it's become much more apparent that the role of medication like Finasteride etc. also helps in the donor area by helping to thicken hair up. It's a misconception people have that the donor are is 100% DHT resistant and nothing happens to it. What actually happens is it can weaken with age as the DHT affects it but at a significantly reduced rate whereas Finasteride etc. can help restore the much stronger thicker hair you may have had there. 

Generally speaking, i would urge people to do thorough blood work to establish if there's anything wrong with them elsewhere and this then allows you to exclude or scapegoat Finasteride as the culprit as some do imo. However, there's also the "Nocebo" effect some think themselves into when expecting sides to happen. 

I think a hair transplants entirely possible without meds. You just need a bit of luck too. 

[Rahal Hair Transplant]

Grouse,

Edit - I’m a firm believer that some patients ARE candidates for surgical hair restoration without having to take finasteride. See below for my answer. But I wanted to include this first because some people seem pretty adamant that it’s a bad idea for anyone to undergo surgery without finasteride and I disagree entirely.

I doubt there would be an actual consensus because in my opinion at least, it simply depends. Some individuals are simply better candidates for surgical hair restoration without finasteride than others.

Those with aggressive hair loss who’ve only just started losing hair are likely not the best candidate especially if they are younger in general let alone without finasteride.  But slightly older men whose hair loss is either not so aggressive or pretty much at their genetic capacity (The point at which the individual will no longer lose hair) are likely good candidates for hair transplant surgery even without taking finasteride.  And then of course there are cases in between.

So long story short, it really depends on the individual as to whether or not they would be a good candidate for hair transplant surgery without taking finasteride. I don’t really believe there is one overall consensus on this topic. At least there shouldn’t be.

Best Wishes 

Rahal Hair Transplant 

Edited May 21, 2022 by Rahal Hair Transplant

[Rahal Hair Transplant]

Because a lot of people seem to sell the statement that an individual should not undergo hair transplant surgery without taking finasteride as a dogma, I’m going to emphatically disagree and point out candidates who I think would be able to undergo hair transplant surgery without taking finasteride. This is not an exclusive list, this is just a few examples of patients who would potentially be a good candidate for surgery without medication.

For the record, I think it’s actually downright harmful to suggest that nobody should undergo surgery without taking finasteride.  Yes, this does apply to certain candidates but not all. Again, here’s a list of those who I feel would be good candidates:

1. Older young adults (late 20’s) or middle age men who’ve reached their genetic capacity (the point at which an individual stops losing hair due to genetic programming)

2. Individuals with realistic expectations who’ve tried finasteride but for one reason or another, can’t continue most likely due to extreme side effects.  I could elaborate on this however, to suggest that these men are out of luck and have no options would be detrimental to their mental health.

3. Men 25 plus with minimal hair loss and who are only slowly losing their hair and whose family history only showcases lower Norwood patterns

4. Norwood level 5A plus candidates with exceptional donor hair and realistic expectations 

Now, The above are simply categories on each individual possesses specific circumstances where one could technically argue for or against this. But for the most part, many men in the above categories would be good candidates for hair transplant surgery without taking finasteride. It really comes down to informed consent. Not everybody will agree but as long as individual understands the risks and what can realistically be achieved, then I don’t think it’s fair to tell them that they are not candidates - unless of course reputable surgeons agree that they are not candidates for one reason or another.

Best Wishes 

Rahal Hair Transplant 

 

[BaldDude]

54 minutes ago, Rahal Hair Transplant said:

Grouse,

Edit - I’m a firm believer that some patients ARE candidates for surgical hair restoration without having to take finasteride. See below for my answer. But I wanted to include this first because some people seem pretty adamant that it’s a bad idea for anyone to undergo surgery without finasteride and I disagree entirely.

I doubt there would be an actual consensus because in my opinion at least, it simply depends. Some individuals are simply better candidates for surgical hair restoration without finasteride than others.

Those with aggressive hair loss who’ve only just started losing hair are likely not the best candidate especially if they are younger in general let alone without finasteride.  But slightly older men whose hair loss is either not so aggressive or pretty much at their genetic capacity (The point at which the individual will no longer lose hair) are likely good candidates for hair transplant surgery even without taking finasteride.  And then of course there are cases in between.

So long story short, it really depends on the individual as to whether or not they would be a good candidate for hair transplant surgery without taking finasteride. I don’t really believe there is one overall consensus on this topic. At least there shouldn’t be.

Best Wishes 

Rahal Hair Transplant 

those with aggressive AA usually slow down in their mid to late 30's right?

[mafpe]

most agree that it's not a good idea due to longevity of the HT and that you would continue to lose your hair, it's like filling a leaking bucket, you have finite water to fill it, yet the bucket keeps leaking so it will never be filled enough. unless you're likely to end up only with lower NW and is not on the bad side of baldness, it's generally a no go.

i'm not good at assessing people's hair loss but you might want to have expert to asses you. it seems to me your thinning diffusely, and i don't know if your donor is just shown in harsh light or if it is also thinning. if your donor is thinning... most good doctor wouldn't recommend you for an HT

[Grouse]

3 hours ago, Rahal Hair Transplant said:

Because a lot of people seem to sell the statement that an individual should not undergo hair transplant surgery without taking finasteride as a dogma, I’m going to emphatically disagree and point out candidates who I think would be able to undergo hair transplant surgery without taking finasteride. This is not an exclusive list, this is just a few examples of patients who would potentially be a good candidate for surgery without medication.

For the record, I think it’s actually downright harmful to suggest that nobody should undergo surgery without taking finasteride.  Yes, this does apply to certain candidates but not all. Again, here’s a list of those who I feel would be good candidates:

1. Older young adults (late 20’s) or middle age men who’ve reached their genetic capacity (the point at which an individual stops losing hair due to genetic programming)

2. Individuals with realistic expectations who’ve tried finasteride but for one reason or another, can’t continue most likely due to extreme side effects.  I could elaborate on this however, to suggest that these men are out of luck and have no options would be detrimental to their mental health.

3. Men 25 plus with minimal hair loss and who are only slowly losing their hair and whose family history only showcases lower Norwood patterns

4. Norwood level 5A plus candidates with exceptional donor hair and realistic expectations 

Now, The above are simply categories on each individual possesses specific circumstances where one could technically argue for or against this. But for the most part, many men in the above categories would be good candidates for hair transplant surgery without taking finasteride. It really comes down to informed consent. Not everybody will agree but as long as individual understands the risks and what can realistically be achieved, then I don’t think it’s fair to tell them that they are not candidates - unless of course reputable surgeons agree that they are not candidates for one reason or another.

Best Wishes 

Rahal Hair Transplant 

 

Thanks Rahal. I'd say I fall into #2 here, open to very mature hairline, BHT, SMP, and complete donor depletion / fit farming. This is a helpful framework.

4 hours ago, NARMAK said:

Short answer = bad idea. 

Longer answer, is you can try to go down that route without medication (Topical versions or otherwise) but it's truly a guessing game as to how your personal hair loss will shake out and as a result, you'll need to be very conservative and accept further limitations in your hair restoration goals and attempts than perhaps others. 

By now, it's become much more apparent that the role of medication like Finasteride etc. also helps in the donor area by helping to thicken hair up. It's a misconception people have that the donor are is 100% DHT resistant and nothing happens to it. What actually happens is it can weaken with age as the DHT affects it but at a significantly reduced rate whereas Finasteride etc. can help restore the much stronger thicker hair you may have had there. 

Generally speaking, i would urge people to do thorough blood work to establish if there's anything wrong with them elsewhere and this then allows you to exclude or scapegoat Finasteride as the culprit as some do imo. However, there's also the "Nocebo" effect some think themselves into when expecting sides to happen. 

I think a hair transplants entirely possible without meds. You just need a bit of luck too. 

Yeah I've wondered about that. In my instance - I'm wondering if I'm ok with getting a transplant knowing it'll eventually thin out to the point of looking not good in my late 40's and beyond. The only reason I want a transplant is to help with my dating life - hair is far, far more valuable when you're dating and in your 20s / 30s than when you're married with kids in your 40s / 50s IMO.

1 minute ago, mafpe said:

most agree that it's not a good idea due to longevity of the HT and that you would continue to lose your hair, it's like filling a leaking bucket, you have finite water to fill it, yet the bucket keeps leaking so it will never be filled enough. unless you're likely to end up only with lower NW and is not on the bad side of baldness, it's generally a no go.

i'm not good at assessing people's hair loss but you might want to have expert to asses you. it seems to me your thinning diffusely, and i don't know if your donor is just shown in harsh light or if it is also thinning. if your donor is thinning... most good doctor wouldn't recommend you for an HT

Yeah I can't tell either. Donor looks great long, not so great short. Lighting on the shorter picture was with a direct flashlight essentially, so as harsh as it gets. Still looks sparse tho idk.

[MAIZE1694]

Transplant or no transplant - your hair, including the donor will thin considerably faster than without fin.

Your donor looks pretty thin, thinner than mine. I put my surgery on pause with Eugenix for this reason, even with taking fin for 2 years. 

My hair rarely gets longer than 1.5 inches, so in my case, surgery would be very tricky.

If you're comfortable wearing your hair 2-3 inches long go for it.

Or if the peaky blinders look doesn't bother you, even better.

Good luck.

[NARMAK]

5 hours ago, Grouse said:

Yeah I've wondered about that. In my instance - I'm wondering if I'm ok with getting a transplant knowing it'll eventually thin out to the point of looking not good in my late 40's and beyond. The only reason I want a transplant is to help with my dating life - hair is far, far more valuable when you're dating and in your 20s / 30s than when you're married with kids in your 40s / 50s IMO.

I feel every sympathy for any guy in today's world trying to date/start a relationship. The advent of social media has fuelled a complete nightmare for males to adhere to certain images and that includes typically impeccable hair. 

Personally i would say whilst it's ideal to be able to have your own hair, there's absolutely nothing wrong with wearing a hair system either. 

There's pros and cons to all things and you just have to figure out what's best for you. 

[Grouse]

36 minutes ago, MAIZE1694 said:

Transplant or no transplant - your hair, including the donor will thin considerably faster than without fin.

Your donor looks pretty thin, thinner than mine. I put my surgery on pause with Eugenix for this reason, even with taking fin for 2 years. 

My hair rarely gets longer than 1.5 inches, so in my case, surgery would be very tricky.

If you're comfortable wearing your hair 2-3 inches long go for it.

Or if the peaky blinders look doesn't bother you, even better.

Good luck.

What's the peaky blinders look?

 

Did Eugenix say you were a candidate, or was that your call? They've said they could operate on me no problem, but I'm wary...

26 minutes ago, NARMAK said:

I feel every sympathy for any guy in today's world trying to date/start a relationship. The advent of social media has fuelled a complete nightmare for males to adhere to certain images and that includes typically impeccable hair. 

Personally i would say whilst it's ideal to be able to have your own hair, there's absolutely nothing wrong with wearing a hair system either. 

There's pros and cons to all things and you just have to figure out what's best for you. 

It's quite hard, especially when most people use apps these days. I've thought about systems, but I'm not sure I'm comfortable with the upkeep. I'd always be self conscious about the edges coming up. I've thought about a strong frontal HT, and a system on the back end maybe.

Edited May 22, 2022 by Grouse

[MAIZE1694]

9 minutes ago, Grouse said:

What's the peaky blinders look?

When the doctor fails to extract grafts in a manner that results in a homogenous appearance. The contrast between the patches/gaps in hair. This can also happen with the best possible extraction methods because the patients donor is simply too thin.

Quote

Did Eugenix say you were a candidate, or was that your call? They've said they could operate on me no problem, but I'm wary...

I'm a diffused NW 3V.

Yes Eugenix accepted my case. Eugenix would operate on just about anyone as long as you agree to take Fin. Oral or topical.

You have to respect Eugenix for that. Not everyone is a suitable candidate. But everyone has a chance at Eugenix.

[NARMAK]

6 hours ago, Grouse said:

What's the peaky blinders look?

 

Did Eugenix say you were a candidate, or was that your call? They've said they could operate on me no problem, but I'm wary...

It's quite hard, especially when most people use apps these days. I've thought about systems, but I'm not sure I'm comfortable with the upkeep. I'd always be self conscious about the edges coming up. I've thought about a strong frontal HT, and a system on the back end maybe.

I have a friend who wants to get a HT but for now whilst he is saving up, and also a person who is not wanting to take any medication at all, he has gone for a frontal hair system. His temporal points were receding and he would style it over in the typical comb to the side to cover the area but eventually he wanted to fix it. 

The problem is that i told him if he wasn't on medication and receded further, you would likely be be chasing the hair loss with multiple procedures and settle for something more conservative. 

Unfortunately we are still very much bound by treatments we came upon by accident to treat hair loss, and until the industry makes a real stride for proper hair loss specific medications without the current side affects, we work with what we have. 

I don't know how long it is going to be, so i've made the decision i made to try medication and luckily it is something i've been able to tolerate and believe works for me. However, i also am now post-op on my first ever hair transplant and will have to wait 12 months to see how things turn out. 

[Mike10]

Well, personally I am going ahead with a HT without any meds as this has been sort of vetted by 2 Top Drs. I am 40, NW2-2,5, Donor density 90/90 follicular units per cm2. For more particularities:  https://www.hairrestorationnetwork.com/topic/63894-is-it-possible-to-predict-hair-loss/. 

This may steer controversity but in all honesty I see myself carrying  a significantly lesser end risk than a young person with more aggressive balding on Finasteride. I would however still expect a couple of additional smaller procedures down the route. 

So I rather tend to agree with the Rahal representative that every case needs to be assessed on its own merits.  Obviously your situation is compleley different than mine though. 

Edited May 22, 2022 by Mike10

[Vertexhairclinic]

Hi @Grouse

This is Hala, working for @DrTBarghouthi
I tagged Dr Taleb so he could give you an advice regarding your case.
 
Kind regards,
Hala
 

Edited May 22, 2022 by Vertexhairclinic

[Robbert]

Fully understand your frustration with dating and thinning hair. My best results where when I just used a buzz cut, it shows that you don't give a beep. Which shows confidence. That with a good attitude and character will get you in front of all others.

For me, my reasoning for a HT was also partly for my dating life. But as I needed to recover and thus stopped dating I found that I'm much happier when I'm simply not chasing women. So I don't date anymore 😂 I also decline offers from ladies who do want to go on a date with me, I simply do not have the time anymore, much more fun things to do then boring dates.

Anyway, do you mind sharing your age? It's an important factor to decide if you should consider a HT or if you should consider fin or minox (before, during and after).

I'm not a hair transplant specialist but if you share your age, the ones who are could help you out much better.

Edited May 23, 2022 by Robbert

[DrTBarghouthi]

Thank you for the mention. I personally think that we as medical providers have a limited role in the overall maintenance regimen of the patient. We can certainly advise using long term maintenance of any sort- minoxidil, finasteride, topical/ oral or any other form or combinations that could help with maintenance and delaying the progression. However, in reality, we can’t control the level of compliance or commitment. If someone is compliant before and shortly after a HT, then that doesn’t mean they will be forever. The main thing is to judge on a case by case basis to the best of our knowledge. Someone with a good track history of maintenance and well in their 30s and 40s with a moderate or limited loss and a great donor will be given a slightly different view from someone in their early 20s with a possible NW7 progression. As long as things are transparent between the provider and the patient and IF the expectations are fairly matched, then there could be a very high chance of offering something. We as doctors know the dynamics of ongoing native hair loss and all these factors play a role on who requires strict vs less strict maintenance.