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Post HT shock loss and medication for diffuse thinners

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Hello all,

So I am a 44 y.o male who just had a HT a couple days ago and had some questions. I think I have been slowly balding since I was probably 20. Around 2015 (36y) I decided to do something about it and got an (expensive) consultation interview with a very famous new york city specialist and ask him what my options were in regards to operations and medications etc. It was then that I first learnt that I was what they call a 'diffuse thinner'. The doctor did not want to operate saying I was not a good candidate and asked me to go on Finasteride. Within a month of taking that medication I was getting serious depression and things downstairs started getting a little iffy, if you know what I mean. The whole experience soured me a bit on the hair restoration industry - what with this very leading specialist saying I was a no hope case for transplants and his prescribed medications turning my world ... soft. In any case my balding had always been fairly slow so I pretty much did nothing about it anymore frustrated with that episode(took no medications anymore) till recently. 

Over the past year I got the itch again to fight this battle so I decided to visit a few other doctors to see what their opinions on my case would be. I consulted with three other well known guys (well recognized on this forum as well). All three of them roughly said the same thing - yes I was a diffuse thinner, BUT, given my poor experience with Fin previously, yes they could do a transplant on me. My donor zone was pretty limited in all their individual views - it would only have to be a FUE as I had no more than a supply of approximately 4000 grafts lifetime. All three of them basically suggested the same conservative number - 1200 for the first procedure to reconstruct some of the hairline carefully and to add some density where possible in the frontal areas. All three of these guys have a pretty decent reputation so based on convenience and timing and general gut feel, I chose one of them and 5 days ago I had my first hair transplant with 1200 grafts and got a PRP injection to boot as well! 

So with all that back story, here is my question to all the knowledgeable folk on this awesome forum. At some point over the coming weeks I suppose I will go into shock loss. Here is my worry now - It is my understanding that shock loss can hit us diffused cases a bit harder. While I feel that my general balding had slowed down a lot since turning 40 I am kind of worried that this shock loss phase could kick start a renewed phase of permanent loss especially since I have never been on medication.

So should I go in on Oral Minoxidil now? Since I only have about 2500 or less bullets left for future procedures I cannot risk a seriously depletive permanent shock loss. But then Minoxidil is supposed to cause some loss too initially right? For a new user going through shock loss, would the compounded loss from the new medication throw off my remaining at risk hair. Should I wait to get on the Oral Minox till the shock period is over? I am kind of only considering the oral because of the know itchy scalp issues of the topical and since  Ihave an extremely sensitive scalp I am pretty sure the topical would trigger me. What would be the ideal time for me to get on this? 


Thank you for reading my essay.  


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Oral Minoxodil is something Dr Bisanga recently discussed and said he saw good response with for those who had issues with Finasteride, so it may be worth looking into. 

That said, it is definitely a good thing to come here to be warned of the diffuse thinning issues and shock loss. I know that some people choose to use topical Minoxodil too but if you're going to use the oral version, i don't think it's wise to use both, but there are users here who have chosen to use other supplements and things like Argan Oil  Castor Oil etc. and said it can help with some of the health of the hair and maybe anecdotally help it be a better spot to help 

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On 8/6/2022 at 7:09 PM, MAIZE1694 said:

What dose of fin did you start at when you had sides?

Since it's been 8 years since, maybe try again at the lowest .25mg dose?

Honestly, the side effects of oral minoxidil scare me a LOT more than those of finasteride.

Oh gosh, its been so long. I am 90% sure it was a 1mg dosage. I am actually considering now if I should re-take a stab with some of the new topical Fin solutions around nowadays that weren't there before. I think the dosage is lower in them, and the side effects I read about are not sexual in nature (though correct me if wrong). Specifically looking at the (1) HappyHead Fin+Minox spray and the (2) Hims Fin+minox spray. Both of these products seem to have other additions in them they say help to avoid the scalp sensitivity issue of usual topical minox. The (3) Xyon topical Fin solution is also on my radar.

Would love to hear anyone's opinion on one or all of them. All three of them have different compositions etc and almost feel like I need a pharma degree to sort out which one to try lol.   

10 hours ago, NARMAK said:

Oral Minoxodil is something Dr Bisanga recently discussed and said he saw good response with for those who had issues with Finasteride, so it may be worth looking into. 

That said, it is definitely a good thing to come here to be warned of the diffuse thinning issues and shock loss. I know that some people choose to use topical Minoxodil too but if you're going to use the oral version, i don't think it's wise to use both, but there are users here who have chosen to use other supplements and things like Argan Oil  Castor Oil etc. and said it can help with some of the health of the hair and maybe anecdotally help it be a better spot to help 

As mentioned, I was only thinking about oral Min because I have always had a sensitive dry scalp, prone to flakiness etc. But as I responded to @Maize1694  above maybe one of the products above which are marketed as being more gentle on the scalp can help. In any case I am psyching myself out thinking about shock loss nowadays. Can't seem to decide whats right - (1) wait out the shock period of the HT and see how it goes before introducing new medication into system after 2-3 months or (2) get into medication right away (in another 7-10 days or so) and ride out the shock loss and medicine shed period together aarrggh! 

I love castor oil btw! I assume most people on here are probably skeptical of it, and maybe its all placebo, but I do notice when I am regular (every other day) with castor oil my hair seems to be thicker. Not saying it reverses or grows new hair but definitely gives me a thicker, fuller feeling and better texture. I do intend to go back to applying that after the scabs heal.

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to be honest, it’s really difficult to give you any real advice without seeing what your hair looks like before surgery and what it looks like immediately after surgery.

The primary reason hair transplant patients, especially diffuse thinners are strongly encouraged to use finasteride is to prevent the possibility of permanent shock loss to those miniaturized hairs that are already on their way out due to the effects of male pattern baldness. 

Androgenetic alopecia a.k.a. genetic hair loss is a progressive condition that ultimately shortens and quickens the natural hair growth cycle causing hairs affected by the condition to miniaturize and ultimately shrivel until the hair follicle can no longer grow hair.   DHT or dihydrotestosterone is the agent used by this genetic condition to carry out the demolition work of these hairs.  Since not every hair is susceptible to DHT, only those that are will ultimately shrivel and die.  because this is different for everyone, levels of hair loss/thinning will vary from person to person.

Finasterise works because it inhibits the production of DHT by blocking type 2 5-alpha reductase enzymes. DHT is created by the combination of these enzymes and testosterone.  As you are aware, sexual side effects can occur in a small percentage of finasteride consumers.

All that to say, your risks of permanent shock loss will ultimately depend on how far along any of the natural hairs on top of your scalp are in the miniaturization process.  Then you have to consider your established hair loss pattern, future risks of hair loss and your family history of hair loss.

I just point, you’ve had your hair transplant and as long as you select the reptile surgeon, at the very least, you should have a natural looking hair transplant. Now as far as whether or not you will end up with more hair or just the same amount of hair where transplanted hair in a sense replaced the natural hair that was falling out anyway, is yet to be determined.

As far as non-surgical treatments, it certainly wouldn’t hurt to try oral minoxidil although I don’t know how effective that will be for you.  Have you considered trying topical finasteride since oral finasteride clearly produces side effects for you?

Believe me when I say I am a firm believer that Men who don’t take or can’t take finasteride can be candidates for hair transplant surgery but they also have to be aware of the additional risks that go along with it. For example, if you only have 4000 follicular units that can be used for transplanting over the course of a lifetime, you run the risk of having a very thin looking head of hair if you lose all the hair on top of your scalp. Now most people don’t lose every single hair so hopefully some of those are not susceptible to DHT and those that are, hopefully you can use topical finasteride or either topical or oral minoxidil to help save them to give yourself more overall hair which will aid your parents of density.

so I’ve said a lot at this point which is all pretty general. So hopefully you can apply this to your case. If you resent some photos of your hair prior to an immediately after surgery, individuals will be able to give you some more specific input based on what they see.  I hope this helps.

Rahal Hair Transplant 

Rahal Hair Transplant Institute - Answers to questions, posts or any comments from this account should not be taken or construed as medical advice.    All comments are the personal opinions of the poster.  

Dr. Rahal is a member of the Coalition of Independent of Hair Restoration Physicians.

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Thank you for your considerate reply Doctor.

 I think I will be getting on topical Minox soon as scalp clears up (yes I know I said oral min in my OP but in last 72 hours this is where i am headed) while I continue to debate internally if I should get on topical Fin. My whole life I have been almost medication free and with other ailments often if you have side effects you can drop the drug. But with hair loss meds decision making always seems so terminal whether it be Min or Fin or any other. Cross the rubicon for a second and there's no coming back your whole life.

A kind of - 'start the drug once and you can never leave it else you will lose all your gains and slightly more as punishment from the gods of hair if you do" - kind of feel. For example if I have X number of hairs and am supposed to lose 60% of it in my lifetime without intervention and with meds the loss is only 40%. But if I take meds for only, lets say 5 years, will I just go back to that original 60% loss number? Or do I now end up with 75% loss for the "sin" of starting Fin and stopping!!

Of course its just a rhetorical question. I understand the science and doctors cannot predict that to a certainty but the mind certainly wonders such questions when making  a decision...

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Like everything, it is a gamble that you need to decide if it's worth the risk.

You may or may not lose all the hairs on the top of your head, maybe your loss accelerates in the next 5 years, maybe it doesn't. You can use your family history as an approximate guideline.

The question is, how important is having good hair to you? For some, it is worth the risk of finasteride, for making sure the investment of their transplant looks good, etc.

Hair loss is actually difficult to predict. 

For myself, I knew that losing from an early age, I was destined to lose everything on top pretty early. So I planned my transplant with the assumption I would need:

1) finasteride to keep my donor in good shape and suitable for the long haul.

2) multiple transplants because finasteride and minoxidil will only slow down my loss, not stop it.


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Pics of 1 day prior op and 4 days post op for those interested. As mentioned in OP my donor is not supposedly the best so went with some very defensive hairline and a bit of mid scalp(?). Saving some ammo for later depending on how this goes. 

Any takes on my Norwood level btw? 



Edited by BigApple
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