Hair transplantation without medication? Or what to do in my case...

[Mark]

Hi,

I am 32 years old. My hair loss started 2 years ago. In the last time the speed of loss increased, unfortunately. I did not take any medication so far.

I have several questions and the answers to my question in my other thread were good, thanks for this again, so I think it is a good idea to ask them here.

Disclaimer: I am aware that my case is not the worst. That there are some people who would be happy if they have what I have. However, for me this is a severe problem. Reason is that people see it and it was different a short time ago. So like 1 year ago my hairline was way better and for these people it is really a significant visual difference. It disturbs me quite a lot and I definitely want to have it fixed / get rid of it. So please don't answer that my loss is not that severe and I shouldn't worry and just ignore it. (That is also why I am very ok with going for a hair transplant. I contacted some clinics and they estimated more or less around 2.000-2.500 grafts to be needed). Furthermore as you can see it will very likely progress in the future. So it just started.

I did not take any medication so far. Especially I did not take finasterid. Reason is that I am unsecure about the side effects. Like loss of sexual ability, depression. Of course, I would like to avoid them as any other person. I cannot say if I would be affected, because I haven't taken it yet. But actually I wouldn't like to test it and then see that I have these side effects and then I have problems to get rid of them, even if I stop taking it.

I have no problems with having a second ht in the future.

At the moment the hair loss is mostly in the hairline. I have a small loss starting at the crown / top, but it is not severe (but it likely will increase in the future). My donor area is super. Lot's of hair available at the back and in the sides.

Questions:

1. If I had a hair transplant and have my frontline corrected and the complete front area supported: These hair will never fall out again, even if there is inheriated hair loss in other regions. Or does a ht just fix it for a moment and if I do not take any medication the frontline will be destroyed again?

2. As far as I can see and as a result of my research, I would actually be a quite good candidate for finasterid. Is this correct?

3. Should I take just finasterid or take something else instead or finasterid and additionally other things?

4. If I decided to go for a ht, does this ht definitely mean that I also have to take medication (finasterid), even if just for a certain time after the surgery, because without medication a ht would not make any sense? Or can I got for an ht and not take any medication? (As far as I know this would be possible, see question 1. That means I correct my frontline with an ht and this will stay in the future, however the hair loss will continue in other areas and I will have to go for another ht in the future. But that would be ok for me. However, if my frontline would be affected by future hair loss that somehow means that I definitely have to take some medication.)

5. If I take finasterid, will it just stop my hair loss or will the hairs in the frontline and temples actually "come back" again? I don't think so, right? So it will actually just save the current state (yes I know, then I should have taken finasterid already earlier).

 

Thanks for any help!

 

[StillAlive]

Oh man, reading your post is like going back inside my head around 13 years ago, when my hair loss started progressing from NW2 to NW3 and I was horrified that I would go from village stud to 'that sad Larry David lookalike' overnight. 

First things first :

Yes, people around you will notice and they'll register you as balding. They will not really care nor will their perception of you change. I was still able to play village stud even with severe hair loss, so don't worry on that front. Be yourself. Be open. Be the first to joke about your hair loss. It may sound impossible right now, but it's not. The worst thing you can do, is scramble to hide/cover it when everyone who matters, already knows. People who have never met you before, will not care. I could write an essay on this, but the gist is the above three lines. Be yourself. Nobody cares. The chicks you were going to get with full hair, you will get with receding hair. 

Also, finasteride does NOT bring back/regrow your temples/frontal area. At best, it will halt any further loss and strengthen your crown and midscalp.

You do have to marry the drug though, as, even in a best case scenario where you do not have ANY side effects, if you ever stop taking it, you will lose all fin supported hair within 6 months and fast forward to your 'normal' NW for that age. 

Personally, I am 40 and have never taken nor do I aim to take finasteride post hair transplant, because I -personally- do not accept even the slightest risk of its side effects versus benefits.

TL;DR Don't get an HT right now, you will regret it. The hair implanted will be permanent without fin but if it's aggressive and continues, you'll end up with a perfect hairline that has big holes behind it where you've lost more of your original hair. I recommend waiting, hard as it sounds, for it to stabilize. You already know that you are not headed for early NW7 territory, as you are just NW2.5/3 at 32. That's quite normal recession for a very large group of men at your age. Start using Nizoral shampoo once per week, pop some MSM & Biotin for the placebo effect. Observe its progress.

You should only go ahead with HT's once you have your hairloss stabilized so that you can plan for the future with a clear picture. Right now you are pounding on the panic button and that is never a good idea, under any circumstances, no matter the issue. The awful truth is that there are no 'hard and fast' solutions to hair loss and anyone claiming otherwise is a fraud after your money. It's a progressive condition and it requires careful planning to effectively manage. 

So what happens if you jump the gun and get an HT right now? Impossible to predict, but a likely scenario would be that you'd be pleased for a few years with your restored NW1 hairline, then, depending on your situation, you'd observe your mid-scalp thin out and just go and get another procedure done, rinse repeat, until your donor is depleted. 

TL;DR No HT right now. 

[THE TRUTH]

You don't seem to have very agressive hairloss. 

You remind me of Kevin Mann who had only a Nw 2 to Nw 3 at exactly the same age as you. 

That said, I would play if safe and better get on oral Finasteride. 

Even a lowdose such as 0.25mg daily can prevent or at least slow down potential future thinning on the midscalp and crown. 

This is what I would do in cases like yours in which hairloss seems to be moderate. 

Hairloss is progressive and you may thin on the crown and midscalp later in life although it's probably not gonna be a Norwood 7 but rather a moderate Norwood 4-5 pattern by the time you turn 50. 

Now let me answer your questions more specifically. 

A. Transplanted hairs are much more DHT-resistant but not totally immune. 95% of men which androgenic alopecia will bald in a classic Norwood 7 horseshoe pattern in which case the horseshoe hair have embriologically less 5ar type 2 isoenzyme expression as well as less than Androgen Receptor density. These hairs continue to behave the same way once they are transplanted on the balding regions and keep their genetic characteristics. This is the principle of donor dominance. 

However, around 5% of men show DUPA in the donor area. That means that because of their unusual genetic makeup the donor area is also prone to DHT-caused thinning and these patient should NEVER get any transplant without long term commitment to oral Finasteride/Dutasteride. Otherwise they risk thinning or loss of the transplanted hairs. 

Loss of transplanted hairs can also occur due to poor harvesting being performed outside the true safe zone (for example too high on the crown) which can later result of miniaturization and eventually loss. This often happens in lowcost turkish hairmills. 

Last but not least, scenile alopecia will inevitably affect all hairs on the scalp to a certain a degree because cells progressively degenerate and we have no control over it. Of course it's not nearly as bad as androgenic alopecia but your hairs WILL thin out. Oral minoxidl might help to some extent but you can't expect your transplanted hairlone to have the same density 20-30 years down the road. 

2. Yes you should consider Finasteride. Your hairloss isn't very agressive but you never know when and how your crown/midscalp could start thinning. Try a lowdose. It is 10000 times easier to prevent hairloss than playing catch-up with multiples surgeries especially with vertex baldness that is extremely hard to recover even with multiple surgeries. 

3. Based on your degree of hairloss and agressivness, I think Finasteride is all you need in order to stabilize it. I don't think you need Dutasteride or stronger pharmaceuticals. 

4. You should check with a very skilled and experienced hair transplant surgeon if you are showing signs of DUPA in the donor. If that's the case then you must use finasteride for the rest of your life to maintain your transplant. In case you have no DUPA Finasteride is highly recommended to prevent further thinning on the midscalp and crown. Better play it safe like I said. Even a lowdose such as 0.25mg daily can do wonders to mimize further thinning. 

5. Finasteride/Dutasteride are great drugs  that both work incredibly well in most men for stopping or at worst slowing down significantly genetic hairloss but it is total crap when it comes to regrowth. Finasteride absolutely doesn't regrow any hair at all. It'll never regrow a hairline or a bald spot on the vertex. In some cases it might thicken up a little but the existing miniaturized hairs. This is definitely the exception, not the rule. 

Hope this clarifies things for you. 

All the best. 

 

[mr_peanutbutter]

@StillAlive

 

„ if you ever stop taking it, you will lose all fin supported hair within 6 months and fast forward to your 'normal' NW for that age."

 

based on which study do you make this assumption?  

 

[mr_peanutbutter]

@mark do you have first signs of thinning at your crown?

[Mike10]

You are still quite young and also have some thinning in the crown. So I would be wary of going ahead with a HT without Finansteride at this point. 

I understand you dilemmna with Propecia though. Personally, I also do not take medication and will not take any post op. But I am 40 and the middle and crown is strong.  I am also on preventive treatment in PRP.

 

[Eugenix Hair Sciences]

On 6/19/2022 at 3:41 PM, Mark said:

1. If I had a hair transplant and have my frontline corrected and the complete front area supported: These hair will never fall out again, even if there is inheriated hair loss in other regions. Or does a ht just fix it for a moment and if I do not take any medication the frontline will be destroyed again?

The hair in the transplanted area might notice miniaturization in the future if you do not take finasteride.

 

On 6/19/2022 at 3:41 PM, Mark said:

2. As far as I can see and as a result of my research, I would actually be a quite good candidate for finasterid. Is this correct?

You can take finasteride and observe if it suits you or not. Hence, you can be assured of your candidacy for finasteride.

 

On 6/19/2022 at 3:41 PM, Mark said:

3. Should I take just finasterid or take something else instead or finasterid and additionally other things?

Finasteride is sufficient for the prolonging of the progression of baldness. Other medications and supplements such as Minoxidil and multivitamins are optional and could help further the results.

On 6/19/2022 at 3:41 PM, Mark said:

4. If I decided to go for a ht, does this ht definitely mean that I also have to take medication (finasterid), even if just for a certain time after the surgery, because without medication a ht would not make any sense? Or can I got for an ht and not take any medication? (As far as I know this would be possible, see question 1. That means I correct my frontline with an ht and this will stay in the future, however the hair loss will continue in other areas and I will have to go for another ht in the future. But that would be ok for me. However, if my frontline would be affected by future hair loss that somehow means that I definitely have to take some medication.)

You do not have to take finasteride after your transplantation procedure. The transplanted hair will not be affected with the absence of the medication. However, you will lose your pre existing hair in the non transplanted areas as well as expwrience miniaturization in the transplanted areas. You will require more transplants in the future.

On 6/19/2022 at 3:41 PM, Mark said:

5. If I take finasterid, will it just stop my hair loss or will the hairs in the frontline and temples actually "come back" again? I don't think so, right? So it will actually just save the current state (yes I know, then I should have taken finasterid already earlier).

If you take finasteride then you will be able to prolong the progression of baldness. However, you will not get new hair in the frontal zone or the temples.

Edited June 20, 2022 by Eugenix Hair Sciences

[Mike10]

 

28 minutes ago, Eugenix Hair Sciences said:

The transplanted area will not bald again provided the donor grafts are taken from the permanent zone. If you do not take medication then the transplanted area will not bald.

 

You can take finasteride and observe if it suits you or not. Hence, you can be assured of your candidacy for finasteride.

 

Finasteride is sufficient for the prevention of the progression of baldness. Other medications and supplements such as Minoxidil and multivitamins are optional and could help further the results.

You do not have to take finasteride after your transplantation procedure. The transplanted hair will not be affected with the absence of the medication. However, you will lose your pre existing hair in the non transplanted areas. You will require more transplants in the future in the non transplanted areas.

If you take finasteride then your current state of hair will be preserved. However, you will not get new hair in the frontal zone or the temples.

This is not fully accurate. Further work will ususally be required even while on Propecia because most men will progress even while on the medication with time. Also, we now know that there is no such thing as a safe permanent zone- no guarantees should be issued

[Eugenix Hair Sciences]

23 hours ago, Mike10 said:

 

This is not fully accurate. Further work will ususally be required even while on Propecia because most men will progress even while on the medication with time. Also, we now know that there is no such thing as a safe permanent zone- no guarantees should be issue

Apologies for the miscommunication.
It is true that a small percentage of patients do experience further progression of baldness even when on finasteride. However, it is rare. Finasteride seems to work on majority of the population.
There is a permanent donor zone demarkated on the back and sides of the scalp.

[GoliGoliGoli]

I am in a similar boat to you: I don't want to go on Finasteride and I am ok with getting a 2nd HT at some point. This is part of the reason I am going to Dr Nader in Mexico where the price is cheaper but quality is not sacrificed. I will get roughly 4000 grafts in my 1st procedure to cover my hairline/crown, and if/when I need a 2nd HT down the line I will go back to Dr Nader. So my two HT's combined will still cost less than most peoples 1st HT. I started losing my hair at about 25/26 so my loss has been fairly slow even if it hasn't fully "stabilized". 

 

TLDR: As long as you are ok with 2nd HT and have enough donor for it, I would recommend avoiding Finasteride. Different people feel different ways about Fin but for me it just isn't worth the risk. Even Minoxodil I am on the fence about after now having used it for about 3 weeks. 

[Mike10]

22 minutes ago, Eugenix Hair Sciences said:

Apologies for the miscommunication.
It is true that a small percentage of patients do experience further progression of baldness even when on finasteride. However, it is rare. Finasteride seems to work on majority of the population.
There is a permanent donor zone demarkated on the back and sides of the scalp.

Actually, most patients will progress while on Fin over time, even though the progression is slow. That is why any good  HT Dr will tell you that a HT is rarely a one and done. It is a commitment.

[Gokuhairline]

damn idk why but i got a headache right around where you started asking questions 1-5......definitely TL;DR.....just get it done and dont take fin, many of us have done it that way including yours truly, its a risk sure but looks like you are ready for it. Paralysis but analysis here for sure. good luck .