Gaining confidence in my understanding

[Balding_CPA]

Hello everyone, 

I’d really love if some of you kind members could help me confirm my train of thought regarding my treatment plan moving forward. 
 

I originally joined this group completely adamant that I would never take a single medication for hair loss. No fin, no min, and no dut. The hysteria surrounding side effects was too much for me. I also refused to commit to a lifetime drug strictly for the sake of hair loss.
 

 I’m fortunate enough that money was never the issue and I planned on approaching a HT knowing I’d need multiple over the years to maintain a minimal look. My mindset was more “bald gracefully” than to “stop balding”. 

 I have diffuse thinning on my crown and a naturally big forehead that makes the receding line appear worse than it is. I’ve been quoted 3500-4000 grafts to address both.

I’ve educated myself on these drugs and the viability of reducing dosages if side effects present themselves, which eased a lot of my fears. This has me reconsidering my stance and I’d like some advice on my new game plan. 
 

The importance of Fin has been regurgitated to me endless times and it’s starting to get through. This is my first concession. If I can become comfortable with the fact that I’ll be taking this for the rest of my life and work through proper dosing, it will open up all other possibilities in my journey. 
 

After giving Fin a year and calibrating dosage, this is where I get confused. I know Min is typically recommended for hair regrowth but is this a life long drug as well? If fin is holding off hair loss, will Min regrow certain follicles and the Fin keep them? Once I see that regrowth, is there need to maintain the Min regimen?

Additionally, if I plan on a transplant after the Fin, is there even a reason to attempt Min? Would I not just be restoring loss and then staving it off this way?

Im very excited to schedule a hair transplant and am surprised at my own mindset changing towards Fin but would still like to minimize medications where possible. In a perfect world I would just get transplants ever decade and stay off meds but I’ve learned this is a risky way to approach the situation. 
 

I appreciate the help everyone! 

[dronay]

Hello sir,

I can tell you my opinion on whether or not to have a Hair Transplant operation. I understand your detailed story in terms of drugs.

First of all, do you have any age and additional discomfort?

Can you share your photos from a few angles so that we can understand if you need a hair transplant?

 

 

[John1991]

Min (if taken orally or applied to the donor) can strengthen your donor.  While you could say all of these drugs are life-long, perhaps none more so than min.  When you cold-turkey min you will likely shed and end up in a worse spot than you were to begin with (though you'll recover, those 4-5 months won't be enjoyable).  Sure, you may make it 2-3 months before the shed begins, but begin it will.  Min will help overall thicken your hair and will help regrow hair in areas that perhaps are weakened - but it likely won't really bring back "dead-zones" so to speak.

[Balding_CPA]

Well it sounds like Min is out of the question. I really don’t see the utility if you aren’t specifically looking for thicker hair. 
 

So is Fin and transplants enough? I’m looking to marginally cover the crown and slightly lower the hairline. 
 

Dr.- I have pics on my previous post. I’m not sure what you are asking with “age and additional discomfort”?

[Melvin- Admin]

Both drugs have a synergistic effect. Both drugs are lifelong drugs. If you don’t wanna take medication, the best thing to do is nothing. Doing nothing and shaving is never a bad choice. But if you embark on surgery you need to be committed to stopping the progression of further hair loss.

 

 

[John1991]

Everything Melvin said is correct.  When you stop fin you will slowly revert to losing whatever hair you would've lost without fin in the first place.  When you stop min you lose all the gains from min and then some to the point where you end up worse than baseline/before min.  Now, to be sure, you should recover back to baseline after a time, but I think it's safe to say between those two drugs stoping min will have the more drastic "holy sh**, what's happening to my hair!" short term effect.  And, as I stated before, you may stop min for a few months and think you're fine only to notice 3 or so months after stopping that you're shedding like mad.  Once that shed starts, you can't stop it and even when it stops (it can last 4-8 weeks) it will take probably yet another 3-4 months at least to cosmetically recover from its effects.  My cold-turkey shed lasted around 5-6 weeks and while the number of hairs I find in my drain catcher and comb post shower is back to normal, the areas that I applied min to the most still have a ways to go until they're back to pre-shed levels.  Trust me, you're better off not starting then starting and stopping.  It isn't too horrible a commitment, it only takes 3-5 minutes to apply, but it is essential you don't cold-turkey it. lol

As far as its utility, it can definitely be a needle mover for some.  Thicker, fuller hair is the name of the game after all and if you're willing to pony up many thousands of dollars and recover for half a year from a surgical procedure just to improve your hair, it seems hard to justify not also being willing to apply some foam to your scalp for 3-5 minutes every night before bed.  If that sounds like too much, low dose oral min can be a game-changer as well and you'll be more likely to respond well to it.

Edited September 15, 2022 by John1991

[NARMAK]

Personally speaking, oral medication is the easiest to adhere to which is why i've managed to keep on Dutasteride for so long. I think Minoxodil is actually really important in some people and those who are perhaps attempting regrowth of hair that Finasteride usually cannot do by itself. Minoxidil in conjunction with Microneedling using a derma pen is probably the most potent hair regrowth protocol out there once you're using Finasteride/Dutasteride to block the DHT and slow down the further hair loss. 

My personal problem with topical Minoxidil was the formula left my hair feeling greasy and i guess i was very impatient and didn't understand it enough at the time when i was maybe 18/19 trying to use it. I'm a little more educated but applying it topically 2x a day is imo what kills it for most. However, IF you personally can be diligent and fit it into your routine and perhaps pay for a better quality Minoxodil if going topical like say a foam for the morning and the cheap stuff for night is one suggestion i read but you will still have to ensure you wash out the Minoxodil from the night before every morning. As well as the fact if your skins like mine you'll probably end up with more dry flaky skin/dandruff as a result of the alcohol in the PG mix of the cheap stuff. 

That's why perhaps Oral Minoxidil is gaining more popularity. I know it has an increased side affect profile and needs to be monitored properly but its definitely effective for hair loss and i had concerns around the extra unwanted hair growth over the topical but i figured you could use laser hair removal to keep it at bay. 

Overall for myself, i'm trying to keep Minoxodil for long term use in my back pocket. I only started using some older topical Minoxodil i had laying around to help promote my hair transplant growth which as far as i'm aware won't disappear with stopping. Merely helps accelerate their growth. However under normal circumstances, hair regrown exclusively via Minoxodil has to be indefinitely maintained with that. Finasteride unfortunately cannot. I don't know why exactly and even the makers really don't truly know how it works in terms of the true mechanism of action. I guess this is what happens when you get accidental hair loss treatments. 

I made a thread on Pyrilutamide recently and if it can do what it says, there's a chance people might be able to replace Minoxodil with that and it might be the golden bullet in regrowing hair like Minoxodil but let them be maintained with just Finasteride if you stop. 

[mister_25]

If you quit finasteride after a year of using it, you will lose the benefits of finasteride (preventing balding). If you quit minoxidil after a year of using it, you will lose the benefits of minoxidil (regrowth/strengthening of hair)

The best way to think of hair loss medication is think of it as treatment and not a cure. Treatments are ongoing and once stopped you will lose the benefits of said treatment. Whilst a cure for hair loss does not exist because there is no "one and done" pill/therapy that you can do.

[Balding_CPA]

I appreciate all the replies. Very informative. I do think I may not have asked clearly enough or conversation strayed a bit. 
 

Min doesn’t seem like a fit for me as density isn’t really a concern of mine and I doubt I could be consistent with the routine if I’m not taking it orally. 
 

Ive made piece with Fin but I guess my question remain, if I’m diligent with Fin and have a transplant, what can I expect from a treatment perspective. 
 

I still need to watch Melvin’s video above but I had hoped that Fin and a transplant would be sufficient for my specific situation. 

[mister_25]

1 minute ago, Balding_CPA said:

I appreciate all the replies. Very informative. I do think I may not have asked clearly enough or conversation strayed a bit. 
 

Min doesn’t seem like a fit for me as density isn’t really a concern of mine and I doubt I could be consistent with the routine if I’m not taking it orally. 
 

Ive made piece with Fin but I guess my question remain, if I’m diligent with Fin and have a transplant, what can I expect from a treatment perspective. 
 

I still need to watch Melvin’s video above but I had hoped that Fin and a transplant would be sufficient for my specific situation. 

Simply put, Finasteride + HT is a viable solution and strategy for most people. If you add minoxidil you might be able to strengthen some weaker miniaturized hairs and can get away with less grafts but its doesn't have the same crucial impact a DHT blocker like Finasteride/Dutasteride has because they don't address further hair loss.

Best case scenario if you start Finasteride and have a transplant is that you will get a bit of regrowth and stabilize your hair loss. Meaning that there will be less required grafts in total and wont need to worry too much about regression and further thinning in the future. You could describe this as a "win" against hair loss.

What's more likely to happen is you will slow down your hair loss to a much more negligible point where its much slower and you will only notice it by comparing photos decades apart rather than years. You might need a touchup around 10-20 years later but should be good. You could also describe this a "win" against hair loss buts its not out of your mind forever, its still something you will need to be consciously aware of for your future.

Worst case scenario is that finasteride doesn't do anything for you, or you cant tolerate it due to numerous side effects. You will continue to regress into your "final pattern". Everyone's final pattern is different, some are lucky and only end up Norwood 2. Most end up Norwood 5 or 6 and some are very unlucky and end up Norwood 7. Depending on Quality of donor and final pattern, you might need to accept that you will have to have weakspots/thin patches even if you have a good result. Your donor supply might not be able to meet your demand that is your recipient area.

DHT Blockers if you can tolerate them are the most important drug in my opinion against battling hair loss. If you can stop it dead in its tracks that means its a simple "fix your frontal region, fix your crown" in your lifetime rather playing a game of "allocating X amount for the front and X amount for the crown, have X amount in the donor for the possibility of further hair loss in the midscalp"

 

[Balding_CPA]

Hey. Thanks Mister

 

This is the exact mindset I had coming into the conversation and I’m happy to hear I wasn’t to far off. I know the name of the game is getting lucky with genetics and settling in to a final pattern. I’m sure everyone else here, myself included, would love to know what that looks like ahead of time but that’s the challenge. 
 

I’ve compared photos from a decade ago to today and although I have subtle thinning it really hasn’t progressed much at all. Who knows what the next decade will bring but it makes me optimistic that Fin could be enough to pair with my HT.