How to proceed - pics attached

[jakos]

30 y.o. diffuse thinning all over scalp, with hairline still intact. I started Fin 5 months ago, haven´t seen improvement visually. I don´t use any other medication.

Do you think i should go with this regimen, do see what "only Fin" can achieve? Or do you think Fin only is not likely to provide satisfactory regrowth and I should start Min + dermarolling ASAP?

I can also get a HT, but my hairloss pattern doesnt really favor a HT afaik. Maybe I can have one after some more time on Fin to avoid shock loss

But the main question for me now is: Add Minoxidil or stay on Fin until 1 year is over

What do you guys recommend?

Edited November 4, 2022 by jakos

[NARMAK]

1 hour ago, jakos said:

30 y.o. diffuse thinning all over scalp, with hairline still intact. I started Fin 5 months ago, haven´t seen improvement visually. I don´t use any other medication.

Do you think i should go with this regimen, do see what "only Fin" can achieve? Or do you think Fin only is not likely to provide satisfactory regrowth and I should start Min + dermarolling ASAP?

I can also get a HT, but my hairloss pattern doesnt really favor a HT afaik. Maybe I can have one after some more time on Fin to avoid shock loss

But the main question for me now is: Add Minoxidil or stay on Fin until 1 year is over

What do you guys recommend?

At only 5 months, you're at nothing more than a baby step to helping your existing hair. The question i think personally is more about how much patience you have or how aggressive you are willing to be with keeping your hair. 

Finasteride actually works for many years more for those that respond positively to it and a 10 year Japanese study showed how regrowth is possible but most will tell you to realistically expect little to none. That's what they'll say Minoxodil is for. 

OP, if you want my honest opinion, and this is probably going to go a little against others. I would take 1mg Oral Finasteride everyday and start Oral Minoxodil or Topical Minoxodil if you feel like you are able to commit to taking it 2x a day like that. Personally i think a pill is easier for adherence. You also should Microneedle 1mm to 1.5mm once a week and use Nizoral as a little extra small boost. 

The "problem" with this approach will be that you will not know exactly how much effect comes from Finasteride, how much from Minoxodil and Microneedling. However, you're a diffuse thinner and imo, the longer you wait, its an even bigger uphill battle for you. Attacking it aggressively and indefinitely if you're truly willing to fight tooth and nail to keep your hair looking good is going to require the kitchen sink approach. 

Waiting another 7+months to see what ground Finasteride helps you with is fine, but in that 7 months there could have been hair Minoxodil might have helped save that due to delay were lost. At least that's how i felt when i started Dutasteride at 31 and felt like i'd already been losing enough ground and probably thinning out in ways that was visually hidden amongst the healthier surrounding hair. 

Of course, i have no evidence for this, but given examples like yours of diffuse thinning, we 100% know its possible to lose hair amongst the healthy all over the scalp and only when it gets visually sparse enough do we realise. I looked at my shaved head pictures post op and i still noticed what i feel are miniaturised hairs and hope Dutasteride can help me recover ground there. 

[GoliGoliGoli]

How long have you been losing hair for? I almost think in a situation like yours it's better to kind of start from scratch if your plan is to get a HT. What I mean by that is like, it seems like your native hair is basically on the way out. You say your hairline is intact but really it's hanging on by a thread and hard to say for how much longer. So if I were you I would basically plan to get a HT to fully re-construct your hairline and frontal area without incorporating what native hair you have left, and then plan to do a 2nd one later on to cover the crown and maybe some more of the front area if needed. Basically blow through whatever hair is left in the hairline and vertex and upper crown. Whatever native hair remains and isn't lost to shock loss will also help with illusion of density, but you wont be relying on native hair for coverage in any part. 

 

The benefit of this plan is that you're not constantly working around your remaining hair and constantly chasing your loss with more HT's. You get one soon, a 2nd 12 months later and then you're good for years. Down the road years later you might need a 3rd to chase whatever loss has happened but this way you're at least set after the 2nd one for many years

 

 

Edited November 4, 2022 by GoliGoliGoli

[HappyMan2021]

Very very very very few people get full and complete NW1 regrowth from meds and alternative treatment. 

The guys I see who do get regrowth (mainly on Reddit) are very young (early 20s), are still a low norwood, and begin treatment within months of the first sign of hairloss. 

Id wager that for 95% of guys who are a NW3 or worse, a hair transplant is the solution if you want to revert back to a NW1 again

[Jayson1361]

You look like you have decent donors. With meds like Finasteride or Dutasteride and minoxidil coupled with a hair transplant into diffuse areas i think you could dramatically improve your standing. As I understand it diffuse thinning across the entire scalp includes your donor area and sides, which is not your situation. You have hair in your safe zones and could be transplanted, it seems. Clearly there may or may not be some shock loss after transplant in recipient areas, but I think the meds approach with the transplant would put you in the category of having some hair thicker than where your are at now for most if not the rest of your life. 

[SeanT1]

You should wait until the one year mark minimum, with any good transplant doctor they expect you to be on finasteride for a least a year before surgery.

5 months is too early to decide the effectiveness of finasteride. 

[Gatsby]

17 hours ago, jakos said:

30 y.o. diffuse thinning all over scalp, with hairline still intact. I started Fin 5 months ago, haven´t seen improvement visually. I don´t use any other medication.

Do you think i should go with this regimen, do see what "only Fin" can achieve? Or do you think Fin only is not likely to provide satisfactory regrowth and I should start Min + dermarolling ASAP?

I can also get a HT, but my hairloss pattern doesnt really favor a HT afaik. Maybe I can have one after some more time on Fin to avoid shock loss

But the main question for me now is: Add Minoxidil or stay on Fin until 1 year is over

What do you guys recommend?

Do not have surgery unless you have given finasteride a good year to give it a fair trial. Then I would add minoxidil (preferably oral) if you don't respond to the finasteride. Surgery is always a last resort. All the best!

[jakos]

On 11/5/2022 at 10:34 AM, SeanToman said:

You should wait until the one year mark minimum, with any good transplant doctor they expect you to be on finasteride for a least a year before surgery.

5 months is too early to decide the effectiveness of finasteride. 

yes, definitely not rushing for the surgery! especially since without having used fin around 1 year my existing hair could be very prone to shockloss from the operation...

[jakos]

On 11/4/2022 at 7:39 PM, HappyMan2021 said:

Very very very very few people get full and complete NW1 regrowth from meds and alternative treatment. 

The guys I see who do get regrowth (mainly on Reddit) are very young (early 20s), are still a low norwood, and begin treatment within months of the first sign of hairloss. 

Id wager that for 95% of guys who are a NW3 or worse, a hair transplant is the solution if you want to revert back to a NW1 again

Indeed, my goal is not to achieve full recovery with meds only, i know that is not very likely. My goal is to recover as much density as possible, especially in the crown area where HT doesnt work very well. 

Maybe combine that with a HT in the frontal scalp

[jakos]

On 11/4/2022 at 6:42 PM, GoliGoliGoli said:

How long have you been losing hair for? I almost think in a situation like yours it's better to kind of start from scratch if your plan is to get a HT. What I mean by that is like, it seems like your native hair is basically on the way out. You say your hairline is intact but really it's hanging on by a thread and hard to say for how much longer. So if I were you I would basically plan to get a HT to fully re-construct your hairline and frontal area without incorporating what native hair you have left, and then plan to do a 2nd one later on to cover the crown and maybe some more of the front area if needed. Basically blow through whatever hair is left in the hairline and vertex and upper crown. Whatever native hair remains and isn't lost to shock loss will also help with illusion of density, but you wont be relying on native hair for coverage in any part. 

 

The benefit of this plan is that you're not constantly working around your remaining hair and constantly chasing your loss with more HT's. You get one soon, a 2nd 12 months later and then you're good for years. Down the road years later you might need a 3rd to chase whatever loss has happened but this way you're at least set after the 2nd one for many years

 

 

I think it´s hard to tell for diffuse thinners like myself. I´ve had plenty of hairs in my pillow ever since i can remember. But my head was full of hair so i didn´t care. And you know, once it´s visible that means hairloss has significantly progressed But i guess i´ve been losing hair since i was 20 years old.

I see the point of your suggestion, my only concern is that transplanted hair may not be enough to cover entire upper scalp. So, every native hair there would be crucial to create some sort of density. That´s why i´ve been a bit reluctant to jump on a HT. But definitely thinking how to incorporate a HT in the best way possible...

 

[jakos]

On 11/4/2022 at 6:33 PM, NARMAK said:

At only 5 months, you're at nothing more than a baby step to helping your existing hair. The question i think personally is more about how much patience you have or how aggressive you are willing to be with keeping your hair. 

Finasteride actually works for many years more for those that respond positively to it and a 10 year Japanese study showed how regrowth is possible but most will tell you to realistically expect little to none. That's what they'll say Minoxodil is for. 

OP, if you want my honest opinion, and this is probably going to go a little against others. I would take 1mg Oral Finasteride everyday and start Oral Minoxodil or Topical Minoxodil if you feel like you are able to commit to taking it 2x a day like that. Personally i think a pill is easier for adherence. You also should Microneedle 1mm to 1.5mm once a week and use Nizoral as a little extra small boost. 

The "problem" with this approach will be that you will not know exactly how much effect comes from Finasteride, how much from Minoxodil and Microneedling. However, you're a diffuse thinner and imo, the longer you wait, its an even bigger uphill battle for you. Attacking it aggressively and indefinitely if you're truly willing to fight tooth and nail to keep your hair looking good is going to require the kitchen sink approach. 

Waiting another 7+months to see what ground Finasteride helps you with is fine, but in that 7 months there could have been hair Minoxodil might have helped save that due to delay were lost. At least that's how i felt when i started Dutasteride at 31 and felt like i'd already been losing enough ground and probably thinning out in ways that was visually hidden amongst the healthier surrounding hair. 

Of course, i have no evidence for this, but given examples like yours of diffuse thinning, we 100% know its possible to lose hair amongst the healthy all over the scalp and only when it gets visually sparse enough do we realise. I looked at my shaved head pictures post op and i still noticed what i feel are miniaturised hairs and hope Dutasteride can help me recover ground there. 

Thanks for the detailed response!

I am weighing exactly like you said just adding minoxidil for the sake of "pressing every button available" vs waiting to isolate the effects so that i can understand which one helps the most.

I am hesitant about oral minoxidil, a cardiologist family friend strictly warned me against it. And topical minoxidil is a significant commitment (and i´m not the most self disciplined person when it comes to those things), so it´d be a shame to start applying it without knowing how much it helps...

Maybe if I try topical minoxidil, and see if i´m a good responder to it, that would be an easier choice. I mean some people are hyper responders and would be great to know I am one. Do you know how much time is required to see the effect from topical Minoxidil?

 

 

[NARMAK]

15 minutes ago, jakos said:

Thanks for the detailed response!

I am weighing exactly like you said just adding minoxidil for the sake of "pressing every button available" vs waiting to isolate the effects so that i can understand which one helps the most.

I am hesitant about oral minoxidil, a cardiologist family friend strictly warned me against it. And topical minoxidil is a significant commitment (and i´m not the most self disciplined person when it comes to those things), so it´d be a shame to start applying it without knowing how much it helps...

Maybe if I try topical minoxidil, and see if i´m a good responder to it, that would be an easier choice. I mean some people are hyper responders and would be great to know I am one. Do you know how much time is required to see the effect from topical Minoxidil?

 

 

Personally i wouldn't like to put a timescale on things because as you said, an extremely small group are hyper responders, whilst some are even non-responders to topical, but if you are going to consider yourself as a possible average responder, my personal recommendation to everybody who tries medication is give it a minimum of 12 months, take progress pictures under repeatable lighting and then stay on top of things. 

It seems like adherence is an issue you struggle with which is where oral Minoxodil is usually easier to stick with imo but i can understand obviously somebody you trust is warning you against oral versions but generally the science studies have been done enough it seems to determine 2.5-5mg are tolerated well enough for hair loss purposes. However as with everything, you have to make that decision for yourself. You could start off with topical and see how you go. Using the cheaper brand for night applications and foam for morning is a routine some use, but ultimately you'd have to regularly wash your hair to get rid of the night application it seems. 

Personally i am not on oral Minoxodil but i have come around to the idea of using it in the future for adherence purposes over topical. I think i'm doing well enough with Dutasteride but hair greed imo isn't only for hair transplants alone but people who might look to maximise their hair regrowth responses too and that's why it's sometimes tempting to use the kitchen sink approach but it's not always suitable for everybody. I would however say if i was in your shoes, Finasteride, Minoxodil and Microneedling with Nizoral shampoo 2% ketoconazole would be my routine. 

[jakos]

On 11/6/2022 at 4:06 PM, NARMAK said:

Personally i wouldn't like to put a timescale on things because as you said, an extremely small group are hyper responders, whilst some are even non-responders to topical, but if you are going to consider yourself as a possible average responder, my personal recommendation to everybody who tries medication is give it a minimum of 12 months, take progress pictures under repeatable lighting and then stay on top of things. 

It seems like adherence is an issue you struggle with which is where oral Minoxodil is usually easier to stick with imo but i can understand obviously somebody you trust is warning you against oral versions but generally the science studies have been done enough it seems to determine 2.5-5mg are tolerated well enough for hair loss purposes. However as with everything, you have to make that decision for yourself. You could start off with topical and see how you go. Using the cheaper brand for night applications and foam for morning is a routine some use, but ultimately you'd have to regularly wash your hair to get rid of the night application it seems. 

Personally i am not on oral Minoxodil but i have come around to the idea of using it in the future for adherence purposes over topical. I think i'm doing well enough with Dutasteride but hair greed imo isn't only for hair transplants alone but people who might look to maximise their hair regrowth responses too and that's why it's sometimes tempting to use the kitchen sink approach but it's not always suitable for everybody. I would however say if i was in your shoes, Finasteride, Minoxodil and Microneedling with Nizoral shampoo 2% ketoconazole would be my routine. 

Alright started Minox a couple of days ago I guess if i see myself responding well to the treatment but not knowing what causes that exactly, that´d be a luxury problem.

Any suggestions about where to apply minox? I am a bit focusing on the mid scalp and vertex as they are hard to attack with a HT and afaik respond better to treatments than frontal 3rd.

What do you think?

[NARMAK]

13 minutes ago, jakos said:

Alright started Minox a couple of days ago I guess if i see myself responding well to the treatment but not knowing what causes that exactly, that´d be a luxury problem.

Any suggestions about where to apply minox? I am a bit focusing on the mid scalp and vertex as they are hard to attack with a HT and afaik respond better to treatments than frontal 3rd.

What do you think?

Apply it to everywhere your hairs thinning or affected and you would like a response. I would strongly urge you to look into Microneedling with a derma pen. Combined with Minoxodil, your results can be greatly boosted. 

[jakos]

On 11/8/2022 at 8:19 PM, NARMAK said:

Apply it to everywhere your hairs thinning or affected and you would like a response. I would strongly urge you to look into Microneedling with a derma pen. Combined with Minoxodil, your results can be greatly boosted. 

Well, responses i received here motivated me to add minoxidil into my routine and i believe that helped my situation significantly. That’s why i want to share an update to show results from combined therapy.
 

I saw noticeable improvements in the appearance of my hair like 1 months after i started  minoxidil, which was september 2022.

 

Attaching a picture that compares where i stood exactly 1 year ago vs now.

 

This week i started putting avodart liquids into my minoxidil solution, to push things a bit more. 

[Gatsby]

That's a night and day improvement @jakos and again why medication should always be the first resort for hair loss.

[mr_peanutbutter]

1 hour ago, jakos said:

Well, responses i received here motivated me to add minoxidil into my routine and i believe that helped my situation significantly. That’s why i want to share an update to show results from combined therapy.
 

I saw noticeable improvements in the appearance of my hair like 1 months after i started  minoxidil, which was september 2022.

 

Attaching a picture that compares where i stood exactly 1 year ago vs now.

 

This week i started putting avodart liquids into my minoxidil solution, to push things a bit more. 

holy moly

1mg fin + topical minox?

[jakos]

5 minutes ago, mr_peanutbutter said:

holy moly

1mg fin + topical minox?

First 6 months was 1mg fin, then i reduced the dosage to 0.5.

 

i believe fin helps me stabilize while min did the heavy lifting.