1st timer....advice requested

[samiam]

HI there. I'm 41, based in US, and honestly just started thinking about remediation, so I don't know the lingo or much really. Both mom and dad's side have male pattern baldness and I started noticing mine for the first time at 25. I've never taken any meds - honestly don't really want to be on meds forever and don't want to deal with any side effects like loss of libido, etc. So I'd rather not ever have to use that. I don't notice my hair falling out, it's more of a surprise so I honestly don't know to what degree I'm shedding. If I grasp a handful of hair from my top and pull, 0-3 hairs come out. I have had an extremely stressful professional career that started about 20, so to the extent that stress exacerbates hair loss, I would attribute a great deal of my loss to that. I don't foressee much accelerated loss due to anything other than naturally on a go-forward basis. 

I am researching physicians for my case - I'd like the ability to have a thick head of hair again, wear my hair short and spikey/messy or long (chin length or shoulder length) and not see my scalp unless I'm really trying (or not at all). I feel like my hairline and temples are fine and that I have thick donor area? - I am not under the impression that those areas have changed at all, though I'm sure they have. I've been here researching doctors Bicer, Pinto, Ferriera, Feitas, Zarev, Courto. I'm willing to wait, if I can get ahold of them. Any other suggestions to this list? I'd prefer only one procedure and would prefer to stay under $5. I'm under the impression I'll likely need 3k-4k grafts. Any suggestions around this information, would be helpful - thanks! Sorry about the upside down photos - I tried to rotate them but the forum keeps forcing them to updside down no matter what rotation I save them. 

Edited June 30, 2022 by samiam

[samiam]

some shorter hair pics...

[THE TRUTH]

This looks like an agressive case of diffuse thinning although considering the fact that you are over 40 now and it started when you were 25 you didn't lose that much. 

Getting a hair transplant as a diffuse thinner who is not on medication is a huge risk and really not recommended. 

I've seen many failed surgeries over the years. 

Sometimes it can fail because the surgeon tries to implant too many grafts in a a particular area which later result in either permanent destruction of native hairs or zero survival of the implanted hairs. 

A hair transplant will ruin the back of your head leaving thousands of white dots scars that will look weird once shaven...

You may have very poor survival rate of your grafts and hence you may waste your limited donor resources forever. Be careful  things can go wrong even with a top surgeon. 

Diffuse thinners are very delicate. 

You really need to be on medication for at least 6 months and preferably a year before any surgery. Not only will it thicken the existing miniaturized hairs on the midscalp and 

I highly recommend you get on Dutasteride 0.5mg daily, oral minoxidil 2.5mg daily and optionnal a topical anti androgen of your choice such as RU58841 or fluridil. 

Actually oral 5AR inhibitors raise your free testosterone levels....

Some diffuse thinners are hyper responders to medication (in some rare cases) and you could even avoid surgery. Definitely give a try. 

SURGERY IS ALWAYS LAST RESORT 

It's a big risk and lottery even with the best surgeons. 

Now all the surgeons you mentionned are legit. They are all good choices and I'm sure they would all do good work in your case. 

However, the "one and done" hair transplant is a myth my friend...

If you browse through the forum you will see that most patients require at least 2 sometimes even 3-4 surgeries to get to where they wanna be. 

And remember transplants will NEVER look like your native hairs. It'll always look weak and seethrough and you may still look like you are thinning even after multiples surgeries especially under harsh lighting. I don't wanna sound pessimitic or negative but this is the reality.

That's why they ar roften refered to as "illusion of density". 

It's important to accept several things before you ever decide to move forward and  get surgery. 

1. Hair transplant will never look as dense  as the hair you had before Androgenic Alopecia happened. 

2. You will require several procedures. At least 2 in your case. 

3. A hair transplant can fail even in the hands of the best surgeon in the world. It's very rare thanks God but the truth is it does happen...It's a lottery no matter if you go to Konior, Zarev or a hairmill such as SmileHair, Nowhairtime Cinik, Serkan, Koray...All reputable doctors and turkish hairmills have bad results. Only difference is that bad results are statistically minimal with good surgeons.  You gotta be mentally ready for this. 

4. A hair transplant on a diffuse thinner who is not medicated is a big risk. Poor survival risk is increased as well as permanent shockloss. 

5. Medication post transplant is highly recommended. Your hairloss will progress on the non transplanted areas and you will require more surgeries down the road if you refuse medication while your donor area at the back of your head is limited...

Last but no least: I always recommend doing a small test surgery first in order to evaluate the survival rate of the grafts and then continue if you are happy. Never go all at once since you risk wasting your limited grafts forever. 

All the best and good luck.  

 

[samiam]

2 hours ago, The Mann is the GOAT said:

This looks like an agressive case of diffuse thinning although considering the fact that you are over 40 now and it started when you were 25 you didn't lose that much. 

Getting a hair transplant as a diffuse thinner who is not on medication is a huge risk and really not recommended. 

I've seen many failed surgeries over the years. 

Sometimes it can fail because the surgeon tries to implant too many grafts in a a particular area which later result in either permanent destruction of native hairs or zero survival of the implanted hairs. 

A hair transplant will ruin the back of your head leaving thousands of white dots scars that will look weird once shaven...

You may have very poor survival rate of your grafts and hence you may waste your limited donor resources forever. Be careful  things can go wrong even with a top surgeon. 

Diffuse thinners are very delicate. 

You really need to be on medication for at least 6 months and preferably a year before any surgery. Not only will it thicken the existing miniaturized hairs on the midscalp and 

I highly recommend you get on Dutasteride 0.5mg daily, oral minoxidil 2.5mg daily and optionnal a topical anti androgen of your choice such as RU58841 or fluridil. 

Actually oral 5AR inhibitors raise your free testosterone levels....

Some diffuse thinners are hyper responders to medication (in some rare cases) and you could even avoid surgery. Definitely give a try. 

SURGERY IS ALWAYS LAST RESORT 

It's a big risk and lottery even with the best surgeons. 

Now all the surgeons you mentionned are legit. They are all good choices and I'm sure they would all do good work in your case. 

However, the "one and done" hair transplant is a myth my friend...

If you browse through the forum you will see that most patients require at least 2 sometimes even 3-4 surgeries to get to where they wanna be. 

And remember transplants will NEVER look like your native hairs. It'll always look weak and seethrough and you may still look like you are thinning even after multiples surgeries especially under harsh lighting. I don't wanna sound pessimitic or negative but this is the reality.

That's why they ar roften refered to as "illusion of density". 

It's important to accept several things before you ever decide to move forward and  get surgery. 

1. Hair transplant will never look as dense  as the hair you had before Androgenic Alopecia happened. 

2. You will require several procedures. At least 2 in your case. 

3. A hair transplant can fail even in the hands of the best surgeon in the world. It's very rare thanks God but the truth is it does happen...It's a lottery no matter if you go to Konior, Zarev or a hairmill such as SmileHair, Nowhairtime Cinik, Serkan, Koray...All reputable doctors and turkish hairmills have bad results. Only difference is that bad results are statistically minimal with good surgeons.  You gotta be mentally ready for this. 

4. A hair transplant on a diffuse thinner who is not medicated is a big risk. Poor survival risk is increased as well as permanent shockloss. 

5. Medication post transplant is highly recommended. Your hairloss will progress on the non transplanted areas and you will require more surgeries down the road if you refuse medication while your donor area at the back of your head is limited...

Last but no least: I always recommend doing a small test surgery first in order to evaluate the survival rate of the grafts and then continue if you are happy. Never go all at once since you risk wasting your limited grafts forever. 

All the best and good luck.  

 

appreciate the robust info and for managing expectations. I suppose I need to re-think medication and give a regimen a try before committing to a surgery and the worst that happens is that I expeirence unwanted side effects and I can stop, then re visit the transplant option. I'll try the oral Dutasteride and Minxoidil but I'll keep researching the topical anti-androgens you suggested - they seem iffy at best upon initial research, but I appreciate the option nonetheless!

Edited June 30, 2022 by samiam

[Eugenix Hair Sciences]

You have Androgenetic Alopecia involving the frontal zone and mid scalo with sparring hairline. Your crown is also thinning.

You can go for 2000 to 2400 grafts for the frontal zone and mid scalp.

Without the use of finasteride, your baldness will progress and you will require more transplants in the newly emptied areas.

[samiam]

9 hours ago, Eugenix Hair Sciences said:

You have Androgenetic Alopecia involving the frontal zone and mid scalo with sparring hairline. Your crown is also thinning.

You can go for 2000 to 2400 grafts for the frontal zone and mid scalp.

Without the use of finasteride, your baldness will progress and you will require more transplants in the newly emptied areas.

Thanks for the analysis.

[samiam]

Any recommendations on where to obtain oral minoxidil in the US? I s able to get oral Dut online. I've spoken to two dermatologists who won't prescribe oral Minoidil orally for anyone. 

[THE TRUTH]

4 hours ago, samiam said:

Any recommendations on where to obtain oral minoxidil in the US? I s able to get oral Dut online. I've spoken to two dermatologists who won't prescribe oral Minoidil orally for anyone. 

Dr. Daniel McGrath in Texas prescribes it. 

You could also ask any other hair transplant surgeon. 

[Eugenix Hair Sciences]

You are grade 3 on the Norwood Hamilton scale of baldness. You shall require 2000 grafts approximately for your procedure. You can also use finasteride to prolong baldness on your scalp and to maintain the pre existing hair as well as the transplanted hair.