Thoughts on my situation?

[Mat16]

Hello lads, 

I am almost 24 and my current and past hair situation can be seen in photos below. First 5 photos were taken today (red shirt) and other photos were taken 2-3 years ago.
 

I would like to know your opinion on how much time you think I have before my crown goes away (also other parts but I just recently noticed the crown is thinner). I tried taking finasteride three times but every time I got unbearable sides so I stopped pursuing. I have been taking oral minoxidil for over a year now (2.5mg 5x a week) but I am thinking about stopping because I have not noticed any improvement (I believe the noticeable difference in my front is due to a new barber who cuts it in a way for it to be even) and it is quite expensive. 
 

What are your opinions guys? When could I have a little procedure done? How much time do you think I have left with my crown and temples?

 

any insights are gratefully welcome.

 

cheers

Edited December 19, 2022 by Mat16

[Lego123]

What sides did you get on fin?

[Mat16]

2 minutes ago, Lego123 said:

What sides did you get on fin?

Well to be honest my erections were so much softer than before. Even after taking just 0.5mg 

[Lego123]

O.5 mg reduces dht as much as 1mg tbh maybe try 0.25 every other day . I

[Mat16]

18 minutes ago, Lego123 said:

O.5 mg reduces dht as much as 1mg tbh maybe try 0.25 every other day . I

I tried it at last but I still thought something was wrong

[WhereIsMyMind]

Well no offense, no surprise you haven't seen much results because I see a perfect non-balding head 😅

[JayLDD]

18 minutes ago, WhereIsMyMind said:

Well no offense, no surprise you haven't seen much results because I see a perfect non-balding head 😅

If you see an eaten away, non symmetrical frontal area with miniaturisation throughout and think it is a "non-balding" head no offense but you should reconsider whether you have enough experience with this to comment. 

Obviously not the most extreme balding in the world, but its very clearly occurring.

Lack of finasteride and seemingly thinning crown towards a 3V pattern makes a transplant at this stage too risky. Potentially in a few years go for a full hairline reconstruction and crown work when both have opened up a bit more. If you can't achieve meaningful coverage you'll end up with visible holes behind the transplant. 

[WhereIsMyMind]

I have a lot of experience actually. Im involved in hairloss research. No need to get into personal things. Most hair loss drugs don't work well for temple maturation, an the rest of your head is definetely not balding (at least enough to expect any results from medication). So again, it is to be expected you had "no results"

In your situation most sensible approach would be to keep using fin for manteinence and restore hairline in future with HT, we agree w that 👌

Edited December 19, 2022 by WhereIsMyMind

[Curious25]

2 minutes ago, WhereIsMyMind said:

Most hair loss drugs don't work well for temple maturation,

This myth is out of control. 
 

Hair loss medication works on responders when there is enough hair left to work with. 
 

If someone has been balding for 10 years, starting with frontal loss, and as a result has slick bald temples and a diffusing crown, medication is more likely to regrow the crown (because the hairs here are thinning and not gone) as opposed to regrow temple areas where there is literally no hair present. 
 

If someone has miniaturised hair at the front or in the temples, there is just as much chance they get strengthening in this area as it is if they were to have miniaturising at the vertex or crown. 

[WhereIsMyMind]

5 minutes ago, Curious25 said:

This myth is out of control. 
 

Hair loss medication works on responders when there is enough hair left to work with. 
 

If someone has been balding for 10 years, starting with frontal loss, and as a result has slick bald temples and a diffusing crown, medication is more likely to regrow the crown (because the hairs here are thinning and not gone) as opposed to regrow temple areas where there is literally no hair present. 
 

If someone has miniaturised hair at the front or in the temples, there is just as much chance they get strengthening in this area as it is if they were to have miniaturising at the vertex or crown. 

It is not a "myth". FDA hair loss drugs work very poorly at restoring very minituarized hairs (you-acted-too-late ones), but they are really good for manteinence or slight recovery.

For most humans, the pattern of balding makes temples go thinner faster than other areas. This is why temple hairs are harder to restore, because they have been minituarized for much longer than other areas. There is no scientific reason why temples or vertex is worse, we agree with that. But in practice, you can say, when someone has very minituarized temples, the chance of recovering them to full terminal with Minox and 5ARI is almost 0%. People who manage it are outliers. Microneedling along with minox increases the chances though.

Edited December 19, 2022 by WhereIsMyMind

[Curious25]

8 minutes ago, WhereIsMyMind said:

It is not a "myth". FDA hair loss drugs work very poorly at restoring very minituarized hairs (you-acted-too-late ones), but they are really good for manteinence or slight recovery.

For most humans, the pattern of balding makes temples go thinner faster than other areas. This is why temple hairs are harder to restore, because they have been minituarized for much longer than other areas. There is no scientific reason why temples or vertex is worse, we agree with that. But in practice, you can say, when someone has very minituarized temples, the chance of recovering them to full terminal with Minox and 5ARI is almost 0%. People who manage it are outliers. Microneedling along with minox increases the chances though.

Well that was a load of mumble jumble. 
 

9 minutes ago, WhereIsMyMind said:

FDA hair loss drugs work very poorly at restoring very minituarized hairs (you-acted-too-late ones), but they are really good for manteinence or slight recovery.

This first of all, is not what we were talking about, and I actually alluded to the fact that there’s only so much medication can do. 
 

In response to your very scientific observation that ‘in humans temples bald quicker and thinner’ 

it has been generally acknowledged for years that this is because these hairs are usually the most sensitive to androgens in people susceptible to MPB, in the same light that traditional donor areas are the least susceptible. 
 

My point was it was a myth to blanket state say that hair loss meds don’t work on the temples yet they work on the vertex or crown. 
It all depends on the timing of medical intervention,  and the remaining state of miniaturisation of the hairs - regardless of where they are on the scalp. 
 

Is it fair to say that typically people begin to experience hair loss from front to back - as it is equally typical for people start medication many years after this initial frontal hair loss has occurred, hence hair in this region of the head being is in a far less capable state of being ‘restored’ as opposed to perhaps their crown regions which have only recently experienced an onset of miniaturisation ? Yes, I would agree with that. 
 

Your argument is all over the place. If you really are involved in hair loss research, it comes as no surprise to me how there hasn’t been any major advancements in 25 years. 

[WhereIsMyMind]

You are missing the point. I am focusing on the actual drugs we have to combat hairloss, there is only 2 FDA approved drugs (+breezula), because people who start medication usually do it after they already lost hair. This is exactly why FDA hairloss drugs don't restore temples for most people, because the hairs that have minituarized past a certain threshold can't be recovered into full terminal with actual drugs. There is no argument over the place... it is a pretty simple concept in fact. We are just talking about two different things. There is no scientific data proving why we develop the NW pattern even today, i'm not into that debate.

 

Quote

If you really are involved in hair loss research, it comes as no surprise to me how there hasn’t been any major advancements in 25 years. 

There are many promising treatments in the pipeline im excited about, so we don't agree about that either.

Edited December 19, 2022 by WhereIsMyMind

[Mat16]

I mean you don’t have to tell me you see a non-balding head. I have been living with this hair for quite a long time and I could see parts of it just go away so😂. However, I would like to know how much time (at least approximately) I have in this current state. And if it is wise to stop oral minoxidil even if I can’t take finasteride.

maybe some advice how to overcome the sides and go on it again

[Al - Moderator]

2 hours ago, Mat16 said:

maybe some advice how to overcome the sides and go on it again

Have you tried topical finasteride?

 

[Mat16]

30 minutes ago, BeHappy said:

Have you tried topical finasteride?

 

No I have not but I’ve heard that if someone gets sides on oral there’s I high probability the same happens with topical. And also my living situation would not allow me to put it on my hair every day 

[JayLDD]

6 hours ago, Mat16 said:

I mean you don’t have to tell me you see a non-balding head. I have been living with this hair for quite a long time and I could see parts of it just go away so😂. However, I would like to know how much time (at least approximately) I have in this current state. And if it is wise to stop oral minoxidil even if I can’t take finasteride.

maybe some advice how to overcome the sides and go on it again

If you’ve had sides already it would be stupid to continue messing with the drug. Avoid it entirely and accept that you’re likely to need multiple surgeries over time and will continue to lose hair.

Consider ketoconazole shampoo as a mild anti-androgen. Hardly going to replace Finasteride but potentially can slow the process. 

Minoxidil has an extremely low success rate and some people aren’t responders period, it’s possible you’re in this category if you’ve never noticed any growth at all. 

in terms of how much longer you have, we’ll there’s no point asking people on the forum that because you’re the one living with it. The best you can do is take photographs, in my opinion it’s likely you’ll be in a position for surgery within 3-5 years and likely need two surgeries over the next decade or so. But that’s extremely vague guessing, you’d know better than anyone from your own experience and family history with balding. 
 

[Mat16]

And are there any other opinions on when at soonest could I get a small restoration done? Just to strengthen my hairline and temples. I have heard and read everywhere that the threshold is around 25yo and now I’m already 24…

[Z--]

Highly advise you wait. You aren’t on meds and you’re losing hair. 25 is usually a baseline and only good if you’ve stabilized. Not the response you’ll want to hear, but any doctor worth their salt will probably advise you to wait until 30.

[Spring15]

2 hours ago, Mat16 said:

And are there any other opinions on when at soonest could I get a small restoration done? Just to strengthen my hairline and temples. I have heard and read everywhere that the threshold is around 25yo and now I’m already 24…

I was in the same position as you, unable to take finasteride due to side effects. Regardless I got a hair transplant in 2017 at age 25. I don't regret getting it, I wish I went with a better surgeon however. Your hair loss doesn't appear to be too aggressive so restoring a NW1 hairline wouldn't be too difficult & it should be maintainable until you're nearly 30 or possibly into your 30s. I just got my second transplant at 31, this was more to add density from my first transplant/ I've probably lost between a quarter and half a norwood between transplants. I would highly recommend adding weekly microneedling along with topical minoxidil as well 

Your 20s are the prime years of your life, you don't want to be hindered by hair loss. I say go for it, with a reputable surgeon of coarse

[Rafael Manelli]

You're a Norwood 2 with receded temple points. Your hair looks straight and fine. You're receding young, and it might be aggressive. Finasteride has been ruled out. 

None of these are good signs. 

Diagnosis complete. That'll be $99 thanks. Jk

Try topical dutasteride. It might restore those shrinkers at the front. 

People telling you to wait until some arbitrary age to get an HT are just regurgitating what they've heard, to be honest. It's not that they're wrong, strictly speaking, but it's not a bit lazy in terms of advice. 

What's the point of waiting? So you can see how bad it'll get in ten years? It could still get worse even in 20 years. And if you wait to become a Norwood 5 and then get 5000 grafts, how is that any different from getting 5000 grafts now and then eventually becoming nw5 (but with transplants)? It's the same end result but you don't have to deal with many years of highly visible baldness if you get the transplant upfront. This isn't the advice most people will give you but take it or leave it. 

Your hair is falling out. It will continue to fall out without DHT meds. Topical finasteride or dutasteride is your best bet. Personally I'd suggest dut. It's stronger and apparently less systemic, so fewer sides. 

Your hair still looks pretty good. But I understand wanting back a wicked Norwood 1. You could get it, you know. It could be done. If you keep your hair that short, you probably want a fue rather than a fut. If you lock yourself into a Norwood 1 hairline, you're going to have to risk the possibility you'll need to keep getting surgeries to recoup any further loss you experience, and eventually you may run out of grafts have to settle for a bald crown. 

My opinion is it's worth settling for a bald crown in ten or twenty years, while maintaining a great hairline until then and after. I'd rather have that, than tolerate balding for ten years, only to restore a modest nw3 hairline and dense crown afterwards. But that's just me. 

Personally I'm a techno optimist. I'd be surprised if any of this matters in twenty years. Better/more solutions will be available. People will say don't rely on future technology, but that's just me. 

If all else fails you can just get a prosthesis. 

[Rafael Manelli]

I find it funny that curious25 and whereismymind are arguing 

They clearly agree 

[Mat16]

6 hours ago, Rafael Manelli said:

You're a Norwood 2 with receded temple points. Your hair looks straight and fine. You're receding young, and it might be aggressive. Finasteride has been ruled out. 

None of these are good signs. 

Diagnosis complete. That'll be $99 thanks. Jk

Try topical dutasteride. It might restore those shrinkers at the front. 

People telling you to wait until some arbitrary age to get an HT are just regurgitating what they've heard, to be honest. It's not that they're wrong, strictly speaking, but it's not a bit lazy in terms of advice. 

What's the point of waiting? So you can see how bad it'll get in ten years? It could still get worse even in 20 years. And if you wait to become a Norwood 5 and then get 5000 grafts, how is that any different from getting 5000 grafts now and then eventually becoming nw5 (but with transplants)? It's the same end result but you don't have to deal with many years of highly visible baldness if you get the transplant upfront. This isn't the advice most people will give you but take it or leave it. 

Your hair is falling out. It will continue to fall out without DHT meds. Topical finasteride or dutasteride is your best bet. Personally I'd suggest dut. It's stronger and apparently less systemic, so fewer sides. 

Your hair still looks pretty good. But I understand wanting back a wicked Norwood 1. You could get it, you know. It could be done. If you keep your hair that short, you probably want a fue rather than a fut. If you lock yourself into a Norwood 1 hairline, you're going to have to risk the possibility you'll need to keep getting surgeries to recoup any further loss you experience, and eventually you may run out of grafts have to settle for a bald crown. 

My opinion is it's worth settling for a bald crown in ten or twenty years, while maintaining a great hairline until then and after. I'd rather have that, than tolerate balding for ten years, only to restore a modest nw3 hairline and dense crown afterwards. But that's just me. 

Personally I'm a techno optimist. I'd be surprised if any of this matters in twenty years. Better/more solutions will be available. People will say don't rely on future technology, but that's just me. 

If all else fails you can just get a prosthesis. 

I’d be very happy to be able to take finasteride. I have tried three times and it just didn’t work for me. 
Where do you think I could get topical dut in Europe for a good price. Oral minoxidil is very expensive so I cant really add something that expensive to my portfolio right now  I really like your take on having the nice hairline now and to settle for a worse condition in 10-20 years but majority of this forum doesn’t agree with that so I’m on the verge here

[Rafael Manelli]

3 hours ago, Mat16 said:

I’d be very happy to be able to take finasteride. I have tried three times and it just didn’t work for me. 
Where do you think I could get topical dut in Europe for a good price. Oral minoxidil is very expensive so I cant really add something that expensive to my portfolio right now  I really like your take on having the nice hairline now and to settle for a worse condition in 10-20 years but majority of this forum doesn’t agree with that so I’m on the verge here

The majority of the forum act like life will be the same in 50 years as it is now. When was the last time in history that was true? Not any time in the last two hundred years at least. We barely even had smartphones fifteen years ago. 

Most of their gameplans for young guys is to tell them to just sacrifice their youth to the Norwood devil so they'll be able to get a high JT type hairline when they're 40 and nw7. It makes little sense to me. 

Not entirely sure how you can get topical dut. I think Dr Lupanzula sells it. Maybe your regular family doctor can help. 

[JayLDD]

13 hours ago, Rafael Manelli said:

You're a Norwood 2 with receded temple points. Your hair looks straight and fine. You're receding young, and it might be aggressive. Finasteride has been ruled out. 

None of these are good signs. 

Diagnosis complete. That'll be $99 thanks. Jk

Try topical dutasteride. It might restore those shrinkers at the front. 

People telling you to wait until some arbitrary age to get an HT are just regurgitating what they've heard, to be honest. It's not that they're wrong, strictly speaking, but it's not a bit lazy in terms of advice. 

What's the point of waiting? So you can see how bad it'll get in ten years? It could still get worse even in 20 years. And if you wait to become a Norwood 5 and then get 5000 grafts, how is that any different from getting 5000 grafts now and then eventually becoming nw5 (but with transplants)? It's the same end result but you don't have to deal with many years of highly visible baldness if you get the transplant upfront. This isn't the advice most people will give you but take it or leave it. 

Your hair is falling out. It will continue to fall out without DHT meds. Topical finasteride or dutasteride is your best bet. Personally I'd suggest dut. It's stronger and apparently less systemic, so fewer sides. 

Your hair still looks pretty good. But I understand wanting back a wicked Norwood 1. You could get it, you know. It could be done. If you keep your hair that short, you probably want a fue rather than a fut. If you lock yourself into a Norwood 1 hairline, you're going to have to risk the possibility you'll need to keep getting surgeries to recoup any further loss you experience, and eventually you may run out of grafts have to settle for a bald crown. 

My opinion is it's worth settling for a bald crown in ten or twenty years, while maintaining a great hairline until then and after. I'd rather have that, than tolerate balding for ten years, only to restore a modest nw3 hairline and dense crown afterwards. But that's just me. 

Personally I'm a techno optimist. I'd be surprised if any of this matters in twenty years. Better/more solutions will be available. People will say don't rely on future technology, but that's just me. 

If all else fails you can just get a prosthesis. 

If he has an endless budget, I would certainly agree. 

If he's a regular person being on the hook for a surgery with a high level surgeon every 2-3 years at 24 years this isn't particularly realistic. 

There's risk of a poor result too which would further the requirement of chasing losses. You should always have money for both the procedure AND a backup in my opinion, higher order for someone at his age. 

A "great hairline" with a bald crown doesn't work. No one has a black hole at the back with a dense NW1 hairline. If he goes for a high density NW1 for it to appear natural he will have to at least provide thin but relatively complete coverage in the midscalp and crown. Certainly the midscalp as well.

I think your techo-optimism is doing a lot of heavy lifting. But again, if he has the money (his parents happy to shell out 50k no questions asked for example) I would personally go for it. 

Currently the science in this area is an embarrassment when it comes to the future, the only promising treatments involve essentially cloning grafts and transplanting them. Which of course would be wildly expensive. Same goes for any wildcards that arrive, even if they eventually exist you have no idea whether or not they'll be affordable. 

[Rafael Manelli]

8 minutes ago, JayLDD said:

If he has an endless budget, I would certainly agree. 

If he's a regular person being on the hook for a surgery with a high level surgeon every 2-3 years at 24 years this isn't particularly realistic. 

There's risk of a poor result too which would further the requirement of chasing losses. You should always have money for both the procedure AND a backup in my opinion, higher order for someone at his age. 

A "great hairline" with a bald crown doesn't work. No one has a black hole at the back with a dense NW1 hairline. If he goes for a high density NW1 for it to appear natural he will have to at least provide thin but relatively complete coverage in the midscalp and crown. Certainly the midscalp as well.

I think your techo-optimism is doing a lot of heavy lifting. But again, if he has the money (his parents happy to shell out 50k no questions asked for example) I would personally go for it. 

Currently the science in this area is an embarrassment when it comes to the future, the only promising treatments involve essentially cloning grafts and transplanting them. Which of course would be wildly expensive. Same goes for any wildcards that arrive, even if they eventually exist you have no idea whether or not they'll be affordable. 

You've got some good points but I beg to differ on the matter that I've seen plenty of guys who bald at the crown first. In other words, they develop a big bald spot before the hairline recedes. Ergo, a strong front with a bald crown can look natural, as it occurs in nature. It looks natural but it doesn't look particularly good. Obviously. None of us think balding looks particularly good otherwise we wouldn't be here.