Agressive hair loss, is a transplant worth it for me without medication?

[Zoobz]

Hi all

Pretty silent lurker on these forums for years. I have what I would consider to be pretty aggressive hair loss as per pics. 

I have tried finasteride in various doses in the past, but suffer from side effects even down to 0.25mg twice a week, so obviously a no go for me. 

I have been using minoxidil for past 1.5years although not sure if it's doing anything as it looks pretty much the same as before.

Considering my young age. I'm 32 and inability to use finasteride, along with family history of hairloss, both sides Norwood 6/7 for dad and maternal uncle, although my brothers are Norwood 0 and probably 3 at ages 34 and 38 respectively and grandfather's had minimal hairloss. is it possible to do a transplant or not worthwhile, I would like to consider options over the next 2 years. 

All pics were taken under direct spotlight and my phone tends to overexpose so not as bad as it looks, but fairly close.

What I would like is good density on frontal and midscalp, with reduced density on crown as probably not realistic to think I can have illusion of full density everywhere as I won't be on med

Also how's my donor look, I think is might be sparse but not sure.

[HappyMan2021]

Your hairline and front of scalp look like run of the mill hairloss. Crown loss is significant. Doubly so bc the crown is a black hole for grafts and needs way more grafts than youd think just by visually looking at it. 

Its a shame you cant take Fin bc if you could take it your patient profile wouldnt be too challenging really.

But i agree with you that being only 32, aggressive loss and no dht blocker, you are likely to lose more hair. 

Only pursue a transplant under these conditions if you like gambling. 

I encourage you to try topical fin or literally any other variation of a dht blocker that is out there. 

Please also be absolutely certain and honest with yourself that your fin sides are real and not due to a different condition or placebo effect. 

Edited June 19, 2022 by HappyMan2021

[NARMAK]

I would also second trying to use a topical Finasteride if the oral version has been causing you issues. 

Overall though, the problem is that you referred to it as aggressive hair loss and are 32. So if you do get any hair transplant at all, even at this age it would need to be pretty conservative and take into account potential future hair loss. 

[civic]

You still have great coverage, use all possible remedies if you can't take fin, dermaroll 1x a week, minox, vitamins. Use hair fibers. The only time you should entertain notion of ht is when Toppik no longer binds to hair & falls on scalp.

[Gatsby]

I would be consulting with top tier surgeons who specialize in higher Norwood patients such as Eugenix, etc. All the best.

[BurnieBurns]

If I was in your position I'd see how I respond to all other modalities of treatment including oral minoxidil, microneedling, laser, and ketoconazole shampoo. A good surgeon would likely want you to be stable before they start tampering with what's there. Without finasteride there will always be the change of future loss despite the other modalities. There are new topical formulations on the horizon worth trying. Of course you can't base any firm decision around those though

 

[THE TRUTH]

Your hairloss on the crown is significant. 

Although at 32 with a decent hairline and midscalp, I've seen much worse in terms of agressivness.

Get on oral Finasteride/Dutasteride immediately. Give yourself 6 months at least. 

Add oral minoxidil + a topical anti androgen if you want. 

Do your research. Take your time. Spend time on this forum. Research, research, research, look for bad reviews, look for who you think has the best crown work. 

In my opinion Zarev is by far the best when it comes to crown work. Even better than Eugenix. His ability to close bald spots is incredible. He excels where 99% of other surgeons struggle...

Pitella seems very solid too especially when it comes to crown.

I've seen some good vertex work from Ximena Vila too.

The vertex is a black hole for grafts so you always need a lot more grafts than you think...

I believe 3000 grafts will do the trick. 

 

Edited June 19, 2022 by The GOAT of botched jobs

[sukh123]

2 hours ago, The GOAT of botched jobs said:

Your hairloss on the crown is significant. 

Although at 32 with a decent hairline and midscalp, I've seen much worse in terms of agressivness.

Get on oral Finasteride/Dutasteride immediately. Give yourself 6 months at least. 

Add oral minoxidil + a topical anti androgen if you want. 

Do your research. Take your time. Spend time on this forum. Research, research, research, look for bad reviews, look for who you think has the best crown work. 

In my opinion Zarev is by far the best when it comes to crown work. Even better than Eugenix. His ability to close bald spots is incredible. He excels where 99% of other surgeons struggle...

Pitella seems very solid too especially when it comes to crown.

I've seen some good vertex work from Ximena Vila too.

The vertex is a black hole for grafts so you always need a lot more grafts than you think...

I believe 3000 grafts will do the trick. 

 

you keep telling people to hop on to an anti androgen which is irresponsible as there are no FDA-approved ones out or licensed by a well-known health administrations. And I'm not sure taking advice from someone who is called "GOAT of Botched jobs" provides assurance to people lol

[Eugenix Hair Sciences]

16 hours ago, Zoobz said:

Hi all

Pretty silent lurker on these forums for years. I have what I would consider to be pretty aggressive hair loss as per pics. 

I have tried finasteride in various doses in the past, but suffer from side effects even down to 0.25mg twice a week, so obviously a no go for me. 

I have been using minoxidil for past 1.5years although not sure if it's doing anything as it looks pretty much the same as before.

Considering my young age. I'm 32 and inability to use finasteride, along with family history of hairloss, both sides Norwood 6/7 for dad and maternal uncle, although my brothers are Norwood 0 and probably 3 at ages 34 and 38 respectively and grandfather's had minimal hairloss. is it possible to do a transplant or not worthwhile, I would like to consider options over the next 2 years. 

All pics were taken under direct spotlight and my phone tends to overexpose so not as bad as it looks, but fairly close.

What I would like is good density on frontal and midscalp, with reduced density on crown as probably not realistic to think I can have illusion of full density everywhere as I won't be on med

Also how's my donor look, I think is might be sparse but not sure.

Since you cannot take finasteride, future hair loss is inevitable. Even if you go for a transplant, you will lose hair in new areas in your scalp. You will have to go for more hair transplants in the future to fill in those new areas.

The best thing you can do is try topical finasteride. If it does not give you side effects then you can continue with it. However, it will take 10 to 12 months to see the results of the medication.

[Zoobz]

Yes

7 hours ago, Eugenix Hair Sciences said:

Since you cannot take finasteride, future hair loss is inevitable. Even if you go for a transplant, you will lose hair in new areas in your scalp. You will have to go for more hair transplants in the future to fill in those new areas.

The best thing you can do is try topical finasteride. If it does not give you side effects then you can continue with it. However, it will take 10 to 12 months to see the results of the medication.

Yes I'm aware this will probably be 2 possibly 3 over a lifetime. My question is more whether it's doable and if I could get the density I'm after without Meds

Have tried topical, same issue just takes.longer

 

 

 

[Zoobz]

21 hours ago, HappyMan2021 said:

Your hairline and front of scalp look like run of the mill hairloss. Crown loss is significant. Doubly so bc the crown is a black hole for grafts and needs way more grafts than youd think just by visually looking at it. 

Its a shame you cant take Fin bc if you could take it your patient profile wouldnt be too challenging really.

But i agree with you that being only 32, aggressive loss and no dht blocker, you are likely to lose more hair. 

Only pursue a transplant under these conditions if you like gambling. 

I encourage you to try topical fin or literally any other variation of a dht blocker that is out there. 

Please also be absolutely certain and honest with yourself that your fin sides are real and not due to a different condition or placebo effect. 

Thanks, have tried topical and have the same results, side effects are definitely real as I get gyno from it which is visible

[sukh123]

You got gyno from it , that means your oestrogen was more dominant than your testosterone . This is why bloodwork before taking this drug is essential . If your hormones are already out of whack, high chance you will develop sides from a Dht blocker like fin. Dht help Modulate estrogeon and keep it in check. I guess you didn’t get any bloodwork done prior  because gyno is pretty messed up

Edited June 19, 2022 by sukh123

[ML488]

1 hour ago, Zoobz said:

 

Yes I'm aware this will probably be 2 possibly 3 over a lifetime. My question is more whether it's doable and if I could get the density I'm after without Meds

 

 

 

 

You would get mediocre density. This is a hair transplant after all. If you are motivated and understand what the future will undoubtedly hold for you (i.e. at least 2 more transplants down the road, or 1 if you don't care about your crown) then  sure, of course its all possible. If and only if your results end up being ok and don't experience poor survival which is always an unfortunate possibility. Personally though if I had all the hair you still have I would use fibers or dermatch and ride that wave until I couldn't anymore, even if its for years, and only after your hair loss has progressed then and only then go for your first surgery. That's how I would play it if Finasteride is off the table.

Edited June 20, 2022 by ML488

[Mountinvan]

I believe that in the hands of a skilled surgeon you would be amazed at your transformation. I think you would look like a new person-younger, more confident and more attractive. Medications would stop further hair loss but if they are not in the cards with the present offerings then so be it because new ones are in the pipeline and might not give you sides. There is a whole process to researching surgeons, getting on their wait list, etc. I wouldn't delay. You will be amazed by what a talented HT surgeon can do. If you are interested enough to post on this forum, you already taking the first steps. I know you are motivated to do something that will be a life changer. It has been for me and countless others.

[Antlor]

@ZoobzPerhaps you should have a consultation with Dr. Felipe Pittella of Brazil. Melvin just did a podcast with him on Friday. Dr Pitella does not require his patients to be on finasteride because the drug requires lifetime committment and the doctor himself does not take finasteride. He does request his patients to be on minoxidil though.

[Gatsby]

For what's it's worth I no longer take finasteride due to side effects (I may challenge the drug later and stay at a lower dose) and I now just take minoxidil. I'm a Norwood 7 and although I'm only 5 months post op, I don't in anyway feel that not being on finasteride now is compromising my hair. I realize you have a lot of native hair still compared to me. However seeing results today by surgeons like Dr Pitella shows what is possible even without finasteride. All the best!

[Zoobz]

On 6/20/2022 at 2:02 AM, Antlor said:

@ZoobzPerhaps you should have a consultation with Dr. Felipe Pittella of Brazil. Melvin just did a podcast with him on Friday. Dr Pitella does not require his patients to be on finasteride because the drug requires lifetime committment and the doctor himself does not take finasteride. He does request his patients to be on minoxidil though.

Very interesting, I will check that out as I have recently started minoxidil and it's not too much of a hassle

[Zoobz]

On 6/20/2022 at 2:57 AM, Gatsby said:

For what's it's worth I no longer take finasteride due to side effects (I may challenge the drug later and stay at a lower dose) and I now just take minoxidil. I'm a Norwood 7 and although I'm only 5 months post op, I don't in anyway feel that not being on finasteride now is compromising my hair. I realize you have a lot of native hair still compared to me. However seeing results today by surgeons like Dr Pitella shows what is possible even without finasteride. All the best!

Thanks food for thought. Hope yours is going well 

[Zoobz]

On 6/20/2022 at 1:03 AM, ML488 said:

You would get mediocre density. This is a hair transplant after all. If you are motivated and understand what the future will undoubtedly hold for you (i.e. at least 2 more transplants down the road, or 1 if you don't care about your crown) then  sure, of course its all possible. If and only if your results end up being ok and don't experience poor survival which is always an unfortunate possibility. Personally though if I had all the hair you still have I would use fibers or dermatch and ride that wave until I couldn't anymore, even if its for years, and only after your hair loss has progressed then and only then go for your first surgery. That's how I would play it if Finasteride is off the table.

In terms of mediocre density, what would that be any pictures you could refer me to, I appreciate transplants are a illusion and I won't have a full head of hair, but if it's so sparse that it looks like I'm obviously still balding seems a bit pointless.

 

Thanks for opinion on fibers but it's not for me its something I purposely have opted to not use, I don't want to use it like a security blanket i.e like some guys who always wear hats to cover balding. I would like to regain my confidence and I don't think fibers will help me, but great for those who it does.