Need advice/a lot of help with HT as a curly haired male

[Eremita]

Hello hair restoration community! I've been looking at this site for a few days and some of you all's posts have really encouraged me, to the point where I think my next best step might be to get a hair transplant. I have a ton of questions about the process though, and I also wondered if you could take a look at my photos and my hair loss and help me with what to expect a bit. Actually my most burning question is am I even well-positioned, i.e. is my thinning too bad given my potential donor area? If so, what compromises could I make?

As a bit of background, I am a fresh 24 year old, which I know is a bit young, but unfortunately I've been battling this for a little while now. I noticed some recession June/July of '21 so I started taking finasteride that October or November. My hairline was definitely receded then and my top had thinned, but it was workable, and I was ok with where it was at as I didn't notice any thinning of the crown or back-top (although I do now looking back at the pictures). The finasteride was holding me steady, though I didn't see any regrowth. However, spring 22 I was not able to get back for a follow up appointment so I started taking it more intermittently. I got a prescription again this May, and took it regularly until July when I moved abroad and haven't been able to get finasteride until a few days ago. I've been on topical Minoxidil for a little over two weeks now, but my balding has accelerated very rapidly to the point where I really could use some corrective action beyond just these tools in the not too distant future.
Ideally, I would love to aim for February or March to get a transplant, as that would give me 6 or so months on the Minoxidil and Finasteride for my balding to stabilize a bit, and to allow for some potential regrowth. However, I wonder if realistically I should wait until next summer.

I know 24 is quite young, but unfortunately having the hair that I do it deceived even me into thinking there was more than there was. It is just miniaturizing and thinning so fast now, and it is of noticeably poorer quality than it was even just a month or two ago. I didn't realize quite how bad it had gotten, but it is driving me to the edge just watching it all evacuate. Thankfully, I never experienced side effects from finasteride, so taking it for essentially the rest of my life doesn't bother me, though I would not mind swapping out topical min for oral min.

So here are my questions for you all:

1. First of all, the basics that everyone asks: how many grafts do you think I would need, and would it even work in my case? I acknowledge that I won't be able to get to my original thickness, but I would love to have a hairline, repopulate the obviously thinned areas, and just in general feel some dimension/fluffiness on top again. Looking back on my older pictures, I have always had a decently high hairline, and my hair has never even been that thick to begin with so I don't need anything super crazy. My concern is that my back and sides are too thin. It has always been a bit cowlick-y, especially on my right side, so I don't know that it's quite as thin as the pictures may show (these are not great images, so if you need better lighting conditions feel free to let me know and I would be happy to provide them.

2. Are there any particularly gifted curly hair practitioners in the US or Anglosphere? I would love if I could do this without completely shaving my head, but I acknowledge that might be a tougher ask. My family is based in the Southeastern US, and I live in Japan right now, but I'm not super confident that even the most gifted surgeons in this part of the world would be completely familiar with how to best deal with my hair type. I would love if you have recommendations for someone in the Southeast US but this isn't a must. I won't completely rule out somewhere like Turkey since I know some of you all have great results, but would prefer if I could do it without travelling too far/too unfamiliar a place as I would be better positioned for any follow-up that might be necessary. I'm not ruling anywhere out, as I have heard you all praise doctors like Bisanga and Mwamba in Belgium, but I would love to know if anyone has some first hand experience elsewhere.
If it helps, I am willing to pay a little more to stay stateside/NA. 

3. If I need multiple sessions, what are the logistics of this? My hope is that I could do it just in one, since I would need to take off of work and travel so far, but I fear that I might need more than one and I wondered if you all had any experience with this - what was the timeline between sessions? For anyone who went to somewhere really far away, did you have to go back after a few months? And as far as follow-up appointments go, how does that work? Do places usually offer online sessions?

4. Also, I'm not totally sure about the consultation process... Once again, being in Japan I worry that many doctors here or in South Korea would not be familiar enough with my hair type to quote me properly. Is it a good idea to get a consultation/quote and then go to another doctor? Basically, as with everyone, I'm trying to minimize trips abroad, but I don't really want to fly somewhere and feel like I can't walk away if I don't like their treatment plan. Alternatively, I will be visiting the states in December, and places like Anderson Center for Hair Restoration in Atlanta are within driving distance - could I go for a consultation then, and then come back a few months later for the actual procedure? I apologize that these are kind of silly questions, and I'm sure they often depend on the individual office, but if anyone has experience I would love to hear it. Researching all of this has been a bit overwhelming. 

5. Realistically, is there any chance that most doctors would even let someone this young do a transplant? I've seen some cases here and on Reddit that would suggest so, and I am already committed to finasteride and minoxidil and am willing to put in the work to stabilize my hair loss for the best long-term results. I am afraid that I would be given the advice just to wait and see what the finasteride/minoxidil does, even though I haven't witnessed any regrowth when I was on finasteride consistently in the past.  I just think I worry that it is hard given my hair type to determine the extent of the hair loss, and I am afraid I would be turned away.

I'm sorry this is such a long post, but if you've gotten this far, thank you so much for reading and for your help. I'm a bit timid about this whole process, but even knowing that this is potentially an option brings me a comfort that I can't even describe, to the point where I really think that this could my best option in the near future. It's so nice to have an encouraging community here, and I appreciate any insight you all can offer!
Thanks!

Here are the pictures. Like I said, my hair is quite fluffy so it can be hard to tell, and I think that's why it took me so long to detect any balding.
1. Hairline on the right. This has taken a drastic hit
2. Hairline on the left. This has been even more noticeable and rapid within the past two months
3-4. Back and back/top. I know you can see this same "crack" in the back in older photos, but I don't sleep on my back anymore like I used to and still the thinning miniaturization is getting bad
5. Top. It feels terrible but I didn't realize how terrible it looked. I would especially love some more density at the front, but I would love to be able to part it and feel some fluff again instead of committing all resources to go to the front
6. The whole top. It's hard to see, but the front is considerably miniaturizing and I'm left with a tuft that has been shedding like crazy these past few days. Hopefully that's the minoxidil doing it's job but I worry still. 

My potential donor sites (Not great photographs, and my hair has clumped together like this quite a bit for a while now)

7. The right

8. The left

9-10. The back (Really hard to photograph so let me know if you need a better idea - I'm a bit unwashed at the moment so my curls are clumping together)

For reference, this is what I used to look like, and what I would like to get close to 
11. 2019. Note that I used to part it on the cowlicky side, so my hairline looks really high, but regardless I generally have showed a decent amount of forehead as I've grown it out.
12. 2020. It's looking especially luxuriant lol but note that the hairline is still quite high, its just that the curls there are a lot fuller. All this is to say, my hairline goals are not that unrealistic I don't think.
13. 2021: This is me on finasteride, with a little bit of thinning in the crown. I had had this bald spot for a while, and I usually sleep on my back, so I wasn't particularly concerned at the time. I would be perfectly fine with having some version of this, i.e. I don't need the back that densely packed.

 

[Eremita]

Ahh a typo, sorry. 5 and 6 aren't separate pictures

[Gatsby]

You need to be on Finasteride and minoxidil for at least 6-12 months everyday as prescribed before making any judgement on the results. At 24 and going by the photos you have shared, I would rule out surgery, at least at this point. In fact surgery could make things a whole lot worse with the risks of shock loss and not knowing what your hair loss pattern will be. With correct use of medication you may be able to rule out the need for surgery altogether. I know this is not what you want to hear but surgery is always a last resort. All the best!

[Rahal Hair Transplant]

Eremita,

honestly, I wrote up an entire post and then went back and looked at your photos. Now I’m starting from scratch.  The reason for this is because I’m seeing signs of thinning on the sides and back of your scalp which could be related to a couple different things. For starters, I notice you have long hair. Your hair is a lot longer than mine but I wear my hair kind of long as well. That said, I know that a lot of people with longer hair often pulled her hair back in a man bun, ponytails, braids and other assorted hairstyles.  My point is, if these hairstyles are too tight, it can cause a type of hair loss known as traction alopecia.

in some cases, traction alopecia can be reversed if you have not damaged the follicles underneath the scalp.  The key to successful regrowth for traction alopecia in this case would be to simply stop wearing your hair in Waze that’s going to pull on the hair. No more braids, no more tight ponytails, dreads or man buns.  That doesn’t mean that you can’t wear your hair up at all, it just can’t be tight. It Hass to be loose.  

secondly, there is a condition known as trichotillomania where an individual pulls on their own hair when they are stressed or feeling a certain type of way. If this is something you are experiencing, again, treatment is similar to what I said above. But since this is considered a disorder, it’s typically very hard to stop so I suggest seeking professional help if this is the case.

The other possibility is that you’re experiencing diffuse on pattern alopecia which is a type of non-genetic hair loss characterized by thinning in various areas all over the scalp.   Finasteride might work well for the situation so I would certainly consider that if the above two situations are not the case.  However, hair transplant surgery is typically out the window unless this is brought under complete control simply because there is no safe zone.  Hair transplant surgery works because hair on the sides and back of the scalp is DHT resistant and immune to genetic hair loss.  As a result, moving here from the sides and back of the scalp to the top doesn’t change the hairs properties (called donor dominance) so it continues to grow and resist DHT just edited on the sides and back of the scalp.

But ultimately, before considering any treatment, I suggest getting diagnosed by a dermatologist or a trichologist Who specializes in hair.

but if what I’m seeing in the photos is correct, then her transplant surgery will not be an option at this time although non-surgical finasteride might be. But before just jumping into finasteride, I think it’s important to rule out the first two forms of hair loss I discussed above.

I look forward to your response and I hope this helps

Rahal Hair Transplant

 

 

[Rahal Hair Transplant]

I just want to say that it is very difficult to determine what’s going on from the photographs. It’s possible that what I’m seeing is not actual hair loss on the sides and back of the scalp but simply a part from you pulling your hair back so that we can see it coupled with strange lighting that makes it look on the thinner side.  But there are several photos where are the area on the sides and back of the scalp appear to be on the thinner side. I am attaching them here so you know which photos I’m referring to. Perhaps you can give us a little more explanation of what we are seeing here and whether or not you feel those areas are a bit thinner or if that’s just because of lighting and you pulling on your hair in certain ways to show us your donor area.
 

 

[Eremita]

Gatsby,

Thanks so much for replying so promptly! Definitely not exactly what I want to hear but if I don't ever have to get surgery that is perfectly fine with me. If I can at least keep my current level of loss steady, is this something I could still consider in 6-12 months' time?  I guess I'm just trying to keep all options on the table. The idea of having a somewhat decisive "solution" as a goal is a really comforting thought, especially given how fast I'm losing hair and how few people seem to see much significant regrowth with the usual regimen. Thanks for your insight!

 

Dr. Rahal,

Yes, I apologize for the poor photos, especially in the back. I almost never tie it back anymore, and have always preferred to wear it down, though I do wonder if wearing it quite this long is causing a bit of traction alopecia. I've been thinking of cutting it a bit I have just been hesitant as the length is kind of my only saving grace from showing how obvious my balding is. 

I have never exhibited any signs of trichotillomania thankfully. Touching my hair can be a bit of a comfort response but I've never wanted to pull it out or anything, thankfully. 

Ever since it's gotten to be quite this long, I have had trouble getting the hair on the sides to grow out much - they seem to stay that short for whatever reason. However, I have noticed that those patches that you see above the glasses has thinned considerably recently. They were never thick to begin with - my mom noticed a few months ago and said it almost seemed like I had an undercut - but I think I have more recently attributed some of that to wearing a mask for 8-9 hours a day for work, stress from moving abroad (and more recently, hair loss), as well as the potential shock of different water chemistry that came with my location change. Whether any of that could be a factor, I'm not certain, but from what I can tell it doesn't seem like it has gotten progressively worse. Just a recent spike in loss in those side parts. The parts in the back I think are partially due to the fact that I mostly use conditioner back there rather than shampoo, which can make them a bit gummy and draws them together. I haven't noticed any particularly troubling loss back there.  

Thank you so much for the thorough reply and for your concern, and I hope that sheds some light on what might be going on. I know this might be asking a bit much, but given the potentially unusual thinness of my sides, is it possible that what I'm experiencing isn't pattern baldness, but some other condition altogether? No dermatologist I've been to has raised alarm, but these encounters have mostly just looked at my hairline, as I was going for the express purpose of obtaining finasteride. Going bald this young and this fast/aggressively makes me a bit of a genetic outlier in my family (except for my paternal grandpa), so if there is something else I should consider I would be more than happy to pursue some other line of inquiry. Though I'll admit I think I'm still in a bit of denial just how bald I'm getting and still holding on to hope that I might actually have some other sort of solution  I really appreciate your insight though, thank you!

 

 

[LookMaxx]

You don’t need hair transplant, not at this point anyway.

Seems like fin and min are doing a good job

[Eremita]

LookMaxx,

 

Thanks so much for lending your opinion! I think the fin was doing more heavy lifting than I thought keeping my hair at a level I was ok with, so to see all of that so quickly undone due to not being able to obtain it for a while has been quite discouraging, to say the least. Here's to hoping that I can regain some of that. It's nice to know that I don't need an HT imminently, but am hopeful that I might be eligible eventually.

Thanks again!

[DrMunibAhmad]

I don't think there is thinning of the donor area. These kind of thinner spots are common seen with your type of hair. The hair gets clustered and due to the clustering it looks like there is some thinning. Also due to the lenght of the hair it gets pulled a bit which gives the same effect. 

 

Furthermore the root of this type of hair doesn't have much of a curl so you don't have to worry about that. 

[Gatsby]

23 hours ago, Eremita said:

Gatsby,

Thanks so much for replying so promptly! Definitely not exactly what I want to hear but if I don't ever have to get surgery that is perfectly fine with me. If I can at least keep my current level of loss steady, is this something I could still consider in 6-12 months' time?  I guess I'm just trying to keep all options on the table. The idea of having a somewhat decisive "solution" as a goal is a really comforting thought, especially given how fast I'm losing hair and how few people seem to see much significant regrowth with the usual regimen. Thanks for your insight!

 

Dr. Rahal,

Yes, I apologize for the poor photos, especially in the back. I almost never tie it back anymore, and have always preferred to wear it down, though I do wonder if wearing it quite this long is causing a bit of traction alopecia. I've been thinking of cutting it a bit I have just been hesitant as the length is kind of my only saving grace from showing how obvious my balding is. 

I have never exhibited any signs of trichotillomania thankfully. Touching my hair can be a bit of a comfort response but I've never wanted to pull it out or anything, thankfully. 

Ever since it's gotten to be quite this long, I have had trouble getting the hair on the sides to grow out much - they seem to stay that short for whatever reason. However, I have noticed that those patches that you see above the glasses has thinned considerably recently. They were never thick to begin with - my mom noticed a few months ago and said it almost seemed like I had an undercut - but I think I have more recently attributed some of that to wearing a mask for 8-9 hours a day for work, stress from moving abroad (and more recently, hair loss), as well as the potential shock of different water chemistry that came with my location change. Whether any of that could be a factor, I'm not certain, but from what I can tell it doesn't seem like it has gotten progressively worse. Just a recent spike in loss in those side parts. The parts in the back I think are partially due to the fact that I mostly use conditioner back there rather than shampoo, which can make them a bit gummy and draws them together. I haven't noticed any particularly troubling loss back there.  

Thank you so much for the thorough reply and for your concern, and I hope that sheds some light on what might be going on. I know this might be asking a bit much, but given the potentially unusual thinness of my sides, is it possible that what I'm experiencing isn't pattern baldness, but some other condition altogether? No dermatologist I've been to has raised alarm, but these encounters have mostly just looked at my hairline, as I was going for the express purpose of obtaining finasteride. Going bald this young and this fast/aggressively makes me a bit of a genetic outlier in my family (except for my paternal grandpa), so if there is something else I should consider I would be more than happy to pursue some other line of inquiry. Though I'll admit I think I'm still in a bit of denial just how bald I'm getting and still holding on to hope that I might actually have some other sort of solution  I really appreciate your insight though, thank you!

 

 

@Eremita twelve months of Finasteride and minoxidil can most certainly stop any further hair loss and can even regrow in weak areas that you may have already. All the best! 

[DHT]

On 9/21/2022 at 5:23 PM, Gatsby said:

You need to be on Finasteride and minoxidil for at least 6-12 months everyday as prescribed before making any judgement on the results. At 24 and going by the photos you have shared, I would rule out surgery, at least at this point. In fact surgery could make things a whole lot worse with the risks of shock loss and not knowing what your hair loss pattern will be. With correct use of medication you may be able to rule out the need for surgery altogether. I know this is not what you want to hear but surgery is always a last resort. All the best!

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