Settling the debate on Hair Transplants for Young Patients

[Adier]

@trynagetaHTYou started too late honestly. At NW4 there is much medications can do. Also if you progressed to NW5 in two years even after taking medications and still considering a HT then definitely wait and try dutasteride may be. Getting a HT when your hairloss isn't getting controlled by DHT blockers is only adding to the injury. 

[mafpe]

16 minutes ago, Melvin- Moderator said:

I would say that meme is better suited for this:

”I’m not gonna care what I look like when I’m 40”

40 comes

”I won’t care what I look like when I’m 50”

50 comes “ I won’t care what I look like when I’m 60” 

It never stops. The analogy is also not true about being in good shape when you’re young and not caring once you’re older and married. Fitness is a lifestyle, not a phase. Take a look at @MazAB he’s almost 50, married with kids. He stays in amazing shape, and STILL cares about his hair! Nothing has changed, and will not change. 

This idea is very common amongst unmarried, younger men. They have this narrative that once they get married, they can just forget about looks and let themselves go completely. But I guarantee these are the same guys who will expect their wives to maintain their figure and looks. You can’t have your cake and eat it too. Marriage is work, and let’s face it, looks do matter! Married or not. 

The fact is that if you care about your hair at 20, you will care about your hair at 40,50,60 and so on. Life doesn’t stop at 30. Priorities change, yes, but if looks are important enough for you to consider getting surgery, looks are likely to always be on that list. There’s nothing more foolish than this YOLO mentality, especially with surgery. 

That is not the line i was meaning ti convey with the picture, and there are more to the post after the picture that i addressed the concern and i think that it's best planned, but if that's your take on my post, that's alright.

Your examples and points are all true.

And for the example and analogy, of course it's just an example, not everyone will be like that. We humans all have varying degree of difference, we're not programming codes made up of only 0 or 1.

One important thing i expressed exist in this paragraph i had in the post before.

"consider your options, what NW are you gonna be, how good of a candidate you are, are you using medication to prolong your time? do you have body hair to use? make a good plan, so you don't regret it later on the line."

[John1991]

The "not caring about hair at 40" attitude is short-sighted, but the "wait until 40" view fails to take into account that you only live once.  It's understandable that people would want to improve their hair situation when they're younger and still on the dating market.  That said, it's probably a bad idea to get a transplant when you're hemorrhaging loss in your early 20s.  

Edited June 25, 2022 by Melvin- Moderator
Removed cultural remarks

[Gatsby]

Guys I’m 55! I want hair the same now as I did at 18 (which caused the biggest mistake in my life this far). I wasted a lot of grafts, mental health and collected a lot of scars. Hindsight is a wonderful thing and I should have done nothing and gone straight to a hair system until Norwood 7 surgeons like Dr Pitella, Dr Zarev and Eugenix arrived on the scene. Even if I shaved my head, surgery would have always been on the table. You can always go forward but you can never go back. 

[NARMAK]

I don't have as severe hair loss visually as some do, but what i can say is that by my mid to late teens, my temple points were completely gone. Now it may not seem like a big deal, but most people do not lose those until they are much older and in some cases ever to the point i did. It aged me. I only realise that in hindsight and i would almost create pseudo temple points by having the sideburns shaved back to make that illusion of a temple point when i didn't have any. Even then, i would also have hairstyles that were longer as i got older to cover that area. So i was pretty conscious of hair loss very, very early on because i saw a family member that had suffered from Alopecia Totalis not just general hair loss. 

As i got older and educated myself again, i realise some of my viewpoints on hair transplants were not anywhere close to accurate back when i was looking at things in my late teens and 20s. The science had evolved to become better at meta studies on hair loss medication and patient education when FUE surgery began to boom in Turkey. I genuinely didn't even know what a hair mill was back then or the hallmarks of what a good doctor and clinic has when choosing them for your personal situation. 

Hypothetically even if unlimited grafts became a reality tomorrow, i would argue that the fundamentals of choosing a surgeon that's suited best for your needs isn't going to change. What will change is the idea of "chasing future hair loss" as a younger patient because finite donor areas no longer a concern. 

Right now, the fact that out donor area is finite is what gives rise to the idea that younger patients have to either wait for themselves to be near the end (NW 6/7) or be on medication and stable in their hair loss for quite a while post-25 to really show they're a good candidate and slowed/stopped their hairloss as much as possible so they're not chasing it. 

I will probably care about my hair into my 70s or beyond if lucky to live long enough but the social importance of hair loss to a teen and man into their 30s isn't the same as perhaps somebody generally in the 40+ range as some of you have pointed out. Having a great head of hair is almost expected in this modern hyper image focused age of social media. People on dating apps for example are ridiculously so picky that you have to be literally perfect in appearance to stand a chance (PSA - Stay off them guys! They'll just make you feel worse imo and try real life meetings). 

A guy settled into his life with a solid job, marriage and kids in his late 30s won't have the same appearance sensitivity on average as a guy looking for a partner. Whether we like it or not, we're all competing for the best we can get and for most guys, it seems hair loss is a negative attribute to be presenting. 

The recommendations of hair systems here are all fine and well, but i think they're a negative. We've seen how having a hair system ruin the hair below and in some cases appear to accelerate hair loss alongside DHT because they further starve follicles of oxygen and the likely environment of glue etc. plays a part. Not only that, once you take it off,  quite a few people end up being told to get on medication like Finasteride to try strengthen the hair back up and wait a year without using a system. So you're literally right back to square 1 imo. 

That's why i emphasise taking medication so strongly to younger guys. Don't wait to lose it all or worry about side affects that you haven't even seen manifest because you didn't bother trying the medication. It could have potentially saved you a lot of emotional distress had you started and loads of hair. Maybe even helped you achieve a much better hairline when you went for a hair transplant. My own personal regret is not starting Finasteride 10+ years ago. The fact i had slow hair loss i'll take as a compensation for having my temple points stolen in my youth though and i still hope i didn't start the medication too late and can perhaps strengthen my crown area with it. 

Every person, young or old suffering with hair loss needs to be treated on a case by case basis, but we're unfortunately in a time where finite donor areas mean we HAVE to go on what have been generally proven outcomes, which is a younger person loses hair sooner and an older person is more stable and why younger patients are more risky HT candidates until they can prove otherwise. 

Sorry for the dissertation, thanks to those reading/skim reading to the end

[Bb111]

Hey Fox,

I too am of the same background. I am married and about 40. I still care about my hair. I don't know where you live now and where you grew up. For me I grew up in the US. My advice to you is don't rush and certainly don't do something because your relatives (especially the older generation) are making you feel bad or a certain way. For better or worse I find my views to be the polar opposite of my older relatives. Take your time and do your research. As others have said this is a journey and for almost all of us it won't end at 40. Hope that helps.

[deeznuts]

14 hours ago, Fox243 said:

That’s why I’m suggesting we plan for being a NW7 when getting a HT. I still think NW7 can get a very conservative hairline with light full coverage if using FUT + BHT based on my research.

Would you really be happy with a NW7 hairline? NW7s often end up as NW3s after they're done transplanting... Have you even lost enough hair to be NW3?

Edited June 25, 2022 by deeznuts

[NARMAK]

3 hours ago, deeznuts said:

Would you really be happy with a NW7 hairline? NW7s often end up as NW3s after they're done transplanting... Have you even lost enough hair to be NW3?

The rule of thumb that we should go on what our mothers and fathers male relatives ended up at in their 70s or so is carried over from a bygone era imo that never properly updated. 

For one thing, FUE has improved to even where Hasson & Wong, practically pioneering the best FUT in the world say FUE is now as good or better. 

Then, factor in that we have access to Finasteride/Dutasteride and Minoxodil alongside treatments like Microneedling and Nizoral with ketoconazole 2% to also help. Not to mention the somewhat untested but anecdotal off label topicals like RU5 whatever it is. 

My point is that for the vast majority of people, when we now take into account the fact we can inhibit DHT, there's a good chance that had say a grandfather been NW7, but say a father gone on medication when available, he went no further than a Norwood 4 and a son started almost pre-emptively at 18, he never goes past a NW2. 

There's never ever been a genuine long term study of that kind to see the impact of DHT inhibition by Finasteride over such a generational study. So it's guessing but look at people on this very forum who have been on Finasteride for 15+ years. They will tell you themselves how their relatives were NW7 but they inhibited to the point they maybe didn't get past NW5. That's 2 classes of baldness saved against and having to use more grafts to cover. 

Also, take into account that the 10 year study on Finasteride from Japan for example found that NW3 and above who started, kept the most hair and recovered the most ground but almost all classes fared better than placebo which continues to get worse. 

So genuinely we need a slightly modified approach towards younger patients but ONLY if they imo are following a medication regimen of say Finasteride for a couple years beforehand and show they have stopped/stabilised hairloss till around 25 in order to be deemed suitable for more aggressive hairlines. That said, they also need to assume the onus of future hair loss and what it would mean if they did slip on medication which does happen. 

Very few lucky people never bald another hair by inhibition of DHT and a very few unlucky people still reach NW7 with aggressive hair loss even on the highest dose. Everybody else should assume an average in the middle result. 

Edited June 25, 2022 by NARMAK
Spelling

[Mike10]

On 6/24/2022 at 8:06 PM, Melvin- Moderator said:

I would say that meme is better suited for this:

”I’m not gonna care what I look like when I’m 40”

40 comes

”I won’t care what I look like when I’m 50”

50 comes “ I won’t care what I look like when I’m 60” 

It never stops. The analogy is also not true about being in good shape when you’re young and not caring once you’re older and married. Fitness is a lifestyle, not a phase. Take a look at @MazAB he’s almost 50, married with kids. He stays in amazing shape, and STILL cares about his hair! Nothing has changed, and will not change. 

This idea is very common amongst unmarried, younger men. They have this narrative that once they get married, they can just forget about looks and let themselves go completely. But I guarantee these are the same guys who will expect their wives to maintain their figure and looks. You can’t have your cake and eat it too. Marriage is work, and let’s face it, looks do matter! Married or not. 

The fact is that if you care about your hair at 20, you will care about your hair at 40,50,60 and so on. Life doesn’t stop at 30. Priorities change, yes, but if looks are important enough for you to consider getting surgery, looks are likely to always be on that list. There’s nothing more foolish than this YOLO mentality, especially with surgery. 

I think you 're probably right Melvin

[Mike10]

17 hours ago, bbq111 said:

Hey Fox,

I too am of the same background. I am married and about 40. I still care about my hair. I don't know where you live now and where you grew up. For me I grew up in the US. My advice to you is don't rush and certainly don't do something because your relatives (especially the older generation) are making you feel bad or a certain way. For better or worse I find my views to be the polar opposite of my older relatives. Take your time and do your research. As others have said this is a journey and for almost all of us it won't end at 40. Hope that helps.

At 40 we are old but not that old. One thing I realize is that hair loss tends to stabilize around age 40. It will pick up at a higher age though that is for sure.

[Mike10]

18 hours ago, John1991 said:

The "not caring about hair at 40" attitude is short-sighted, but the "wait until 40" view fails to take into account that you only live once.  It's understandable that people would want to improve their hair situation when they're younger and still on the dating market.  That said, it's probably a bad idea to get a transplant when you're hemorrhaging loss in your early 20s.  

have you looked at he divorce rate? Lots of folks get divorced around 40

[Savemyhairline]

My almost 90 year old grandpa still absolutely cared about his hair, two months before he passed away he had me give him a haircut in the hospital since it was during covid lockdowns and he couldn’t get to a barber. RIP pa love you.

 

Now with that said, I strongly disagree that it is “best” to wait until 40 for a transplant. Best as in more efficient course for your entire life? Sure. Best as in you will be the happiest overall? I doubt it. I argue hair is more important/detrimental to your confidence in your 20s and 30s. I am not saying you stop caring about it later on in life, though objectively it becomes more normal by the time you’re in your 40s/50s to be noticeably balding than when you are 25. It is much harder to not feel bad when all of your peers have full heads of hair and you’re aggressively balding. When you’re 50, way more of your peers are similar to you when you are balding. Plus there have been many studies that show older women do not find balding to be as detrimental to the attractiveness of a man compared to women in their 20s. 
 

So like everything in life, it’s all about balance. Don’t rush to get a HT when you’re 19 and noticing the first signs, but also don’t neglect your confidence and attractiveness when you are in your prime mating years.

[Mountinvan]

People get married and get divorced at all different ages--even into their 90's. People worry about looks and sex at all different ages. The "I won't care so much at age___" is BS and just justification for instant gratification. The author of this thread made a good point about waiting for the hair loss pattern to become more stabilized and known. Melvin and others made good points about age being relative and hair loss being important to those who suffer from it at varying ages. Baldness is more prevalent at later ages so maybe easier to accept or rationalize----but who among us would not like flowing locks of hair at 60, 70 or beyond?

[NARMAK]

2 hours ago, Mountinvan said:

People get married and get divorced at all different ages--even into their 90's. People worry about looks and sex at all different ages. The "I won't care so much at age___" is BS and just justification for instant gratification. The author of this thread made a good point about waiting for the hair loss pattern to become more stabilized and known. Melvin and others made good points about age being relative and hair loss being important to those who suffer from it at varying ages. Baldness is more prevalent at later ages so maybe easier to accept or rationalize----but who among us would not like flowing locks of hair at 60, 70 or beyond?

Whilst you may like flowing locks at 60+, the biggest social and partner finding benefits of great hair are experienced in your 20s and 30s. I'm pretty sure no guy wants to wait till he's in his 40s balding to finally find somebody whilst his peers found relationships in their 20s and now in their 40s hit balding when they already have married, had kids and couldn't care less. 

Say what you guys like, balding hits men significantly harder in their late teens to 30s. Those are prime life ages and the social isolation one could experience is much more immense and negatively shaping a person. 

I hope we can all agree hair loss is a cancer of the soul and it needs eradicating ASAP. 

EDIT

I didn't mean care less as in don't care at all, but it's almost a fact at that age, settled individuals feel much more concerned with other things than hair loss. Your priority is not the same but of course you wish to have a nice head of hair for appearances. 

Edited June 25, 2022 by NARMAK
Additional Details

[deeznuts]

20 hours ago, NARMAK said:

The rule of thumb that we should go on what our mothers and fathers male relatives ended up at in their 70s or so is carried over from a bygone era imo that never properly updated. 

For one thing, FUE has improved to even where Hasson & Wong, practically pioneering the best FUT in the world say FUE is now as good or better. 

Then, factor in that we have access to Finasteride/Dutasteride and Minoxodil alongside treatments like Microneedling and Nizoral with ketoconazole 2% to also help. Not to mention the somewhat untested but anecdotal off label topicals like RU5 whatever it is. 

My point is that for the vast majority of people, when we now take into account the fact we can inhibit DHT, there's a good chance that had say a grandfather been NW7, but say a father gone on medication when available, he went no further than a Norwood 4 and a son started almost pre-emptively at 18, he never goes past a NW2. 

There's never ever been a genuine long term study of that kind to see the impact of DHT inhibition by Finasteride over such a generational study. So it's guessing but look at people on this very forum who have been on Finasteride for 15+ years. They will tell you themselves how their relatives were NW7 but they inhibited to the point they maybe didn't get past NW5. That's 2 classes of baldness saved against and having to use more grafts to cover. 

Also, take into account that the 10 year study on Finasteride from Japan for example found that NW3 and above who started, kept the most hair and recovered the most ground but almost all classes fared better than placebo which continues to get worse. 

So genuinely we need a slightly modified approach towards younger patients but ONLY if they imo are following a medication regimen of say Finasteride for a couple years beforehand and show they have stopped/stabilised hairloss till around 25 in order to be deemed suitable for more aggressive hairlines. That said, they also need to assume the onus of future hair loss and what it would mean if they did slip on medication which does happen. 

Very few lucky people never bald another hair by inhibition of DHT and a very few unlucky people still reach NW7 with aggressive hair loss even on the highest dose. Everybody else should assume an average in the middle result. 

I don't understand how this relates to my post at all

[NARMAK]

2 hours ago, deeznuts said:

I don't understand how this relates to my post at all

Sorry if it didn't seem directly correlated. 

Basically i was trying to take your point that somebody who is Norwood 7, has to settle for a Norwood 3 hairline but a younger patient hypothetically with medications these days getting a transplant isn't guaranteed to end up as a Norwood 7 and that they could potentially get transplants and not end up chasing their hair loss. 

Assuming the hair loss is stable/stopped with the medication regimen i mentioned. 

At the same time, doctors will take the family history almost as a near guarantee of a younger patient progressing to perhaps the same Norwood 6/7 as people that never even took Finasteride and not perform a hair transplant on them till they're older. 

I apologise if you felt the post you made wasn't best linked to the point i was trying to make, it could have also been posted solo i guess. Sorry for the confusion. All the best.