Advice wanted on hair transplant

[tiktok]

I am a 36 year old who is considering a hair transplant. The photos attached probably put me in the NW 3-4 range.

My hairline is a few cm higher and there is some thinning in the crown area.

I initially used finasteride between the ages of 28 and 30. It did very well in maintaining my hair and the hair loss in the crown region halted and perhaps even reversed as it wasn't really visible when I stopped. I stopped due to side effects.

I switched to minoxidil foam and have been using it for the past 6 years. During this period there has been gradual thinning of the crown and hairline. It seems to have slowed but not halted the hair loss. There is a big history of hair loss in my family and usually people are a NW 6-7 by my age.

I am now considering a hair transplant. I am also considering post transplant to go back on to finasteride alongside minoxidil foam. 

What do you think in terms of hair transplant strategy? Should I thicken my hairline only? My crown is thinning but has further to go - should I pack it with a HT now as well?

I know that I was a good responder to fin but I stopped when I was getting married due to side effects. Now that I have kids I am willing to try it again but what if I have the same issues and have to stop fin. I may continue to lose hair in the future so need to consider what is the best way. I wouldn't want to focus on hairline only as I want the HT to sort out all bald areas out now. Therefore, my idea is to go FUE on both the hairline and crown. Later if fin is unsuccessful and there is future hair loss I would consider another HT. If my donor area runs out there is no shortage of beard or body hair as backup.

Would welcome your thoughts?

On a side note I have started reaching out to HT doctors and the ones of interest are these ones in Turkey based on upcoming availability (I am keen to do it this year): Dr Gur, Dermirsoy, Keser, Pekiner. I have also reached out to some of the EU Drs so waiting to see what they say. But my main concern right now is on the HT strategy itself rather than Dr choice.

Thank you for your help.

Edited August 29, 2022 by tiktok

[NARMAK]

Number 1 is for you to get back in Finasteride. I don't mean any disrespect but your situations just a very bizarre example for me to understand. You successfully used Finasteride and saw a benefit from 28 to 30, but then stopped without experiencing side affects but just thinking you might get them. It's just an unusual response to me when people do this. 

Hopefully the Finasteride can help you save what it can, but the Minoxodil was just masking the loss you experienced since stopping Finasteride and that's why you will need to indefinitely stay on both again if you start but especially Minoxodil as they both run on different mechanisms of action. 

Your age is well, the hair loss doesn't seem extensive but Finasteride to help with the crown, continued use of Minoxodil and maybe adding in Microneedling with a derma pen once a week to boost results would also be good for you. You need a procedure to restore your frontal hairline. Depending on design, i'd say maybe 2-2.5k grafts depending on design/density. 

I would say not to touch the crown yet, let medication help and then use hair fibres for now to plump the thinning look up. 

[tiktok]

18 minutes ago, NARMAK said:

Number 1 is for you to get back in Finasteride. I don't mean any disrespect but your situations just a very bizarre example for me to understand. You successfully used Finasteride and saw a benefit from 28 to 30, but then stopped without experiencing side affects but just thinking you might get them. It's just an unusual response to me when people do this. 

Hopefully the Finasteride can help you save what it can, but the Minoxodil was just masking the loss you experienced since stopping Finasteride and that's why you will need to indefinitely stay on both again if you start but especially Minoxodil as they both run on different mechanisms of action. 

Your age is well, the hair loss doesn't seem extensive but Finasteride to help with the crown, continued use of Minoxodil and maybe adding in Microneedling with a derma pen once a week to boost results would also be good for you. You need a procedure to restore your frontal hairline. Depending on design, i'd say maybe 2-2.5k grafts depending on design/density. 

I would say not to touch the crown yet, let medication help and then use hair fibres for now to plump the thinning look up. 

I stopped fin because I had side effects. Maybe my post wasn't clear so I have edited it to clarify.

Edited August 29, 2022 by tiktok

[NARMAK]

32 minutes ago, tiktok said:

I stopped fin because I had side effects. Maybe my post wasn't clear so I have edited it to clarify.

Thanks for clarifying. I would say some people do recommend trying to microdose Finasteride or if that still isn't an option, quite often switching to the topical version helps. 

If you cannot use Finasteride period  then you just need to have a long term plan of action for any further progress and perhaps may benefit from oral Minoxidil. 

[LookMaxx]

In my opinion, you don’t need to use finasteride at all and pointless given your age and level of hairloss. Seems like you will only progress to nw3 or 4 and not a severe Norwood level. 
 

Get a small ht with any good doctor and you should be set for a decade at the least. 
 

All the nw6-7 guys I seen get that level before 30, your loss isn’t severe and you’re past the danger age. So yeah pointless to use medication, you’re not going to use it for life anyway and your loss isn’t severe so you can enjoy the good years without it

[Hairgrowpro]

Inhibiting DHT is it essential for reducing the rate of future hair receding. If you do not tolerate 1 mg of finasteride due to side effects, I have had patients still benefit from half a tablet (0.5 mg) daily with less significant side effects. Alternatively you can try every other day dosing which spaces out the interval between doses. Another option would be to use topical finasteride which would likely experience less side effects and still have some benefit. Finally a finasteride is not an option for you you can try and alternative DHT inhibiting compound such as saw palmetto. A substantial population does not respond with positive results from minoxidil so it is not surprising to hear that you have noticed continued receding despite the topical minoxidil foam. I agree with you that it is wise to find an optimal maintenance regimen that you are able to tolerate prior to committing to a hair transplant. Best of luck to you!

[tiktok]

1 minute ago, Hairgrowpro said:

Inhibiting DHT is it essential for reducing the rate of future hair receding. If you do not tolerate 1 mg of finasteride due to side effects, I have had patients still benefit from half a tablet (0.5 mg) daily with less significant side effects. Alternatively you can try every other day dosing which spaces out the interval between doses. Another option would be to use topical finasteride which would likely experience less side effects and still have some benefit. Finally a finasteride is not an option for you you can try and alternative DHT inhibiting compound such as saw palmetto. A substantial population does not respond with positive results from minoxidil so it is not surprising to hear that you have noticed continued receding despite the topical minoxidil foam. I agree with you that it is wise to find an optimal maintenance regimen that you are able to tolerate prior to committing to a hair transplant. Best of luck to you!

Thank you. Based on my family history I think minoxidil has done a decent job in slowing down hair loss. No way to prove it of course as it may be the baseline anyway for me. 

I used to use 0.5mg daily before. I have heard about your strategy of every other day or also taking short breaks when you feel side effects to clear out the system. 

Topical fin interests me as I already use minoxidil foam so am used to putting things on my head daily. Just need a reliable and cost effective supply. 

[tiktok]

1 hour ago, LookMaxx said:

In my opinion, you don’t need to use finasteride at all and pointless given your age and level of hairloss. Seems like you will only progress to nw3 or 4 and not a severe Norwood level. 
 

Get a small ht with any good doctor and you should be set for a decade at the least. 
 

All the nw6-7 guys I seen get that level before 30, your loss isn’t severe and you’re past the danger age. So yeah pointless to use medication, you’re not going to use it for life anyway and your loss isn’t severe so you can enjoy the good years without it

Interesting perspective thanks alot. As I said in the post above either minoxidil has slowed down loss or my natural baseline isn't too aggressive. Your idea that I may not progress to NW6+ is interesting. So maybe your option could work. Do an HT and enjoy hair with minoxidil only for a decade and think about another HT if needed near my 50s. 

And no worries about fin side effects reappearing that way. 

[tiktok]

11 hours ago, NARMAK said:

Thanks for clarifying. I would say some people do recommend trying to microdose Finasteride or if that still isn't an option, quite often switching to the topical version helps. 

If you cannot use Finasteride period  then you just need to have a long term plan of action for any further progress and perhaps may benefit from oral Minoxidil. 

Thank you. Any pros or cons of oral minoxidil over the existing foam that I use? 

[Gatsby]

12 hours ago, tiktok said:

I initially used finasteride between the ages of 28 and 30. It did very well in maintaining my hair and the hair loss in the crown region halted and perhaps even reversed as it wasn't really visible when I stopped. I stopped due to side effects.

@tiktok how long after you started finasteride did begin to develop side effects? Was it after two years at the age of 30? Many thanks in advance.

[Hairgrowpro]

There is a trend for using oral minoxidil instead of topical these days which is largely due to convenience factors as well as to reduce the scalp sensitivity that can occur with the topical formulations. Oral minoxidil was originally a blood pressure medication so typically lowers blood pressure a few points and some people can feel lightheaded with this. It can also cause lower extremity edema which usually gradually develops. In contrast to finasteride which mostly exerts its influence on the DHT sensitive hairs, the minoxidil is more capable of increasing total body hair when consumed systemically. This tends to be more of a problem for females developing hirsutism when hair develops on less traditional or less desirable areas. I have  prescribed oral minoxidil in some of my patients experiencing hair loss with concomitant hypertension or for those who benefited from minoxidil but weren't able to tolerate topically due to side effects. Your best option might be checking with a local compounding pharmacy for a hair loss product that has both topical minoxidil and topical finasteride

[Gatsby]

45 minutes ago, tiktok said:

Thank you. Any pros or cons of oral minoxidil over the existing foam that I use? 

Topical minoxidil will benefit the area that it is applied to. Oral finasteride will benefit your hair all over.

[jr1986]

2 hours ago, LookMaxx said:

In my opinion, you don’t need to use finasteride at all and pointless given your age and level of hairloss. Seems like you will only progress to nw3 or 4 and not a severe Norwood level. 
 

Get a small ht with any good doctor and you should be set for a decade at the least. 
 

All the nw6-7 guys I seen get that level before 30, your loss isn’t severe and you’re past the danger age. So yeah pointless to use medication, you’re not going to use it for life anyway and your loss isn’t severe so you can enjoy the good years without it

Why do you say its pointless taking fin at 36? 

I often read posts and articles on hairloss that state that hairloss slows after 35. Or if you make it to 35 with most of your hair your probably not going fully bald. I'd really like to believe that as like the op, I've at lot of hair at 36 without meds. 

Yet you also read posts by guys who say their dad was nw1 at 40 and all hell broke loose, and they were bald by 50.

Is it really true that by 35 you are past the danger point?

Edited August 30, 2022 by jr1986

[LookMaxx]

12 minutes ago, jr1986 said:

Why do you say its pointless taking fin at 36? 

I often read posts and articles on hairloss that state that hairloss slows after 35. Or if you make it to 35 with most of your hair your probably not going fully bald. I'd really like to believe that as like the op, I've at lot of hair at 36 without meds. 

Yet you also read posts by guys who say their dad was nw1 at 40 and all hell broke loose, and they were bald by 50.

Is it really true that by 35 you are past the danger point?

In my case I was nw1 then progressed rapidly to nw6 after 30. 

The years hairs are really important are 20 until 50 for most people, if you’ve made it to mid-30s without severe hairloss, I feel like fin is pointless as the hairloss clearly isn’t severe enough. You can get amazing results from HTs if you’re less than nw5 which op clearly is.

Finasteride I think makes more sense for the progressing to nw7 in early 20s to enjoy the good years

 

Edited August 30, 2022 by LookMaxx

[tiktok]

47 minutes ago, Gatsby said:

Topical minoxidil will benefit the area that it is applied to. Oral finasteride will benefit your hair all over.

This is a tricky one to answer. I used fin for 18 months at 0.5mg daily and then got married. It was when I got married I realised that I was struggling to perform and noticed other things like lack of morning wood. I honestly don't know if the sides kicked in before or coincided with that period.

That is when I made the decision to drop fin and it all sorted itself out and everything quickly went back to normal. 

Was it all in the head, nerves or build up of fin? Can't answer definitively but lack of morning wood was certainly persuasive evidence at the time. 

 

Edited August 30, 2022 by tiktok

[StillAlive]

You can always consider taking Saw Palmetto & Multivits. Given your age and low degree of loss, they may be enough to maintain your existing hair and boost the transplant. 

[Gatsby]

55 minutes ago, LookMaxx said:

In my case I was nw1 then progressed rapidly to nw6 after 30. 

The years hairs are really important are 20 until 50 for most people, if you’ve made it to mid-30s without severe hairloss, I feel like fin is pointless as the hairloss clearly isn’t severe enough. You can get amazing results from HTs if you’re less than nw5 which op clearly is.

Finasteride I think makes more sense for the progressing to nw7 in early 20s to enjoy the good years

 

Finasteride has a role to play over the life span as hair continually miniaturizes as you age, especially in your 50's, 60's and above in the donor area. The donor area of a 70 year old compared to a 30 year old are worlds apart.

[NARMAK]

8 hours ago, tiktok said:

Thank you. Any pros or cons of oral minoxidil over the existing foam that I use? 

Cons are possibly more side affects such as trichosis (unwanted hair) and all over the body in some cases. However the pro is that its usually more effective at regrowing hair that the topical version. 

[KooKazoo]

Oral minox is also not great for women. Hair growth everywhere.

[tiktok]

Just for an update. I had a transplant in November 2022 and also restarted on fin at 0.5mg every other day 2 months after the transplant. My post discussing this is here

 

[Dr. Guncel Ozturk]

I can understand your concerns about hair loss and your desire to find the best strategy for addressing it. Based on the information you have provided, here are my thoughts and recommendations:

Hair transplant strategy: Given that you ar e experiencing thinning in both the hairline and crown areas, it may be beneficial to consider a comprehensive hair transplant strategy that addresses both areas. This can help to create a more natural-looking result and provide better overall coverage. It is also important to consider the long-term implications of future hair loss anpotential donor area depletion.

1. Finasteride and Minoxidil: Based on your previous experience with finasteride and the gradual thinning you have experienced despite using minoxidil, it may be beneficial to consider going back on finasteride after the hair transplant surgery. Minoxidil can also be continued post-transplant to help maintain hair growth.
2. Backup donor hair: While beard and body hair can be used as backup donor hair if needed, it is important to keep in mind that these hairs may not always have the same characteristics as scalp hair, and may require additional expertise to extract and transplant effectively.
3. Ultimately, the best course of action will depend on your individual situation and goals. I recommend scheduling a consultation with a qualified hair transplant surgeon to discuss your options and develop a personalized treatment plan.