Contrasting evaluation done by Dr Pekiner & Eugenix

[Viking360]

Hello Forum,

This is my first post on this forum and I am really grateful for all the information I have obtained from this forum.  I am a 32-year-old male facing hair loss since the age of 22. I recently got my initial evaluation done from Dr. Pekiner and Eugenix for HT. I have received a contrasting evaluation from both the clinics. I haven't consulted the doctors directly but it is through their representatives. 

Eugenix Evaluation:

Your pictures have been evaluated by our doctors. Their assessment is mentioned below:

Currently, you seem to have Norwood Grade VI of baldness but this may progress in future

The marked area could require: 5500

Proposed Harvest from Scalp: 3500

Proposed Harvest from Beard: 2000

The above evaluation of the Grade of baldness and graft assessment is tentative as it's a preliminary (and pictorial) evaluation. However, the final evaluation may vary during Face-to-Face assessment by a doctor.

The “miniaturized hair” might improve with the help of medications.

You will also require finasteride for the preservation of your pre-existing hair. 

Finasteride is a US FDA-approved medication which is known to stop and reverse progressive thinning (miniaturization of the hair in most cases).

Duration of post-transplant Finasteride: Lifelong (but we can take breaks of 2 to 3 months in between). The dosage can also be revised periodically.

The progress in the mid-scalp and crown can be assessed with Finasteride for 1 year. Further the medication will help in increasing the density in these areas.
 
 
For Androgenetic Alopecia, it progresses with the following acceleration in different age groups:
The 20s to 30s: very aggressively 
The 30s to 40s: slows down
The 40s onward: starts stabilizing 
 
 
Side effects: The Dose of 1mg daily is approved by USFDA and side effects are rare.

What if you don't take Finasteride after the transplant?
 
The transplanted hair will grow normally. However, there may be some damage/acceleration of hair loss of the pre-existing native hair due to competition in blood supply. They may undergo physiological shock loss and the process of the natural progression of male patterned baldness may continue. In that case, the pre-and post-operative pictures may look the same. So, there may not be much visual enhancement of hair density which you are aiming at. We take each step to reduce the chances of post-operative shock loss. However, if you are continuing to take Finasteride then you can achieve your goal of enhancing the density in the sparse zones.

We advise all androgenetic alopecia patients to consider taking finasteride (Only After Doctor’s Prescription) before and after the hair transplant, to slow down the progression of baldness.

Dr. Pekiner's Evaluation:

Dr. Pekiner analyzed your case and thinks your current situation is not ideal for a FUE hair transplantation.

He noticed that you have diffused thinning on all the androgenetic areas (front mid scalp and crown).

You are currently around Norwood 4 class of male pattern baldness but ongoing miniaturization is clearly pushing towards 5 to 6.
A hair transplant is safe and logic to be planned only on a stable situation, otherwise you will lose more hair behind and around the transplanted one after some time.

Pharmaceuticals such as oral Finasteride (staple medication) and Minoxidil are the preferred treatments in these cases, as well as supplements integration. Obviously you will not regain a full head of hair but you will hopefully strengthen your miniaturized hairs and avoid further worsening of your androgenetic alopecia pattern.

So if you agree to start a therapy to treat AndroGenetic Alopecia, dr. Pekiner would prefer to wait 6 to 8 months of full therapy (ORAL Finasteride and Minoxidil + Biotin supplements) to see therapeutic response and then do a new evaluation. 

Finasteride is the only prescription drug, you must visit a doctor and have a diagnosis of androgenetic alopecia to get a prescription for it.
Minoxidil and supplements don't need prescription. You can take Kirkland, Rogaine, Foligain etc. as Minoxidil.
A good supplement is a high concentration Biotin.

We should wait at least 6 months from the beginning of the therapy to check the first improvements. Full and stable results can be accomplished after 1 to 1.5 year. Cures are effective as long as you take them but a lower dose consumption can be planned for long term maintaining.

As you may have probably already figured out, a hair transplantation surgery without using Finasteride is not recommended in your case.

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Do you guys think I should start taking finasteride for a year before opting for a hair transplant? I was planning to get my surgery done by the end of this year but Dr. Pekiner's response is making me think if I should push it to maybe after a year. Also, I read this on one of the hair restoration clinic's website where they discourage using finasteride before hair transplant. "The Donor Site is Carefully Selected to Ensure We Relocate DHT Resistant Grafts. If you start the DHT blocker medication (most commonly Finasteride or Dutasteride) before surgery there is a chance that it will artificially strengthen the hair near the donor site that is not naturally resistant to DHT."

Thanks

[Melvin- Admin]

You’re definitely not a Norwood 4. You are 100% a Norwood 6/7. Taking medication for a year is the smart thing to do, but I don’t think it’s totally necessary. You are basically bald on top, with little to no hair on top. You might see a small improvement, but I don’t think it would make a huge difference. But you could be an outlier. I think a good compromise is using meds for 6 months before getting surgery.

[Rafael Manelli]

This is a Norwood 6.

[mr_peanutbutter]

contact dr pittella if you dont want to take fin. he recommends oral minox though i heard. 

[ThePerseverantWarrior]

Both are partly right. 

You're certainly not NW4. NW 5-6 probably in diffused pattern. 

However, you should still try medication before surgery. You've got nothing to lose, and potentially a fair bit to gain should you go that way

[Eli_Avdikian]

That's Norwood 6 for me 

[A_4_Archan]

Yeh as evry1 mentioned ..you are definitely nw 5/6..you have very less hair on top so medication won't be of any use for that..but through medication you can make your donor strong and that would help to make you a better candidate for a surgey ..you can even consult a good local surgeon for your scalp checkup and see if you have retrograde alopecia or not....you can continue medication for 6/8 months and than cn go for a surgey but please set your goals accordingly ....

Eugenix is good in high nw cases and specially when it comes to bht..But Imo you can even consult dr pittela as he is also producing good results in high nw cases...and if you can wait longer thn imho dr zarev would be the best bet....

Edited April 11, 2023 by Archan

[Gramatik]

Pekiner's response seems to be an ethical doctor's response. He said that you should start finasteride before surgery, which is the best plan for your case. You should start treatment firstly, as some hair may regrow and become thicker which should be done before your surgery.

[Gatsby]

To maximize your results in all areas taking Finasteride would be the only option prior to surgery. If you discover that you develop sides you may then want to think seriously about going ahead. 

[Rawkerboi]

Always start  Medications especially Finasteride before Hair Transplant. 

You need to stay on medications for Atleast a year and then start researching for Hair Transplant. 

Dr Pekiner response is quite ethical and it's better you start medications first. 

But given your situation a highly doubt you will see any regrowth but yes some thickness can be expected. 

Minoxidil and Finasteride combo works great for some. 

You can also add Dutasteride 

[FUEtile]

Both said you need to take finasteride the only difference is Pekiner gave you the wrong norwood classification is that what you mean by contrasting?

[Viking360]

44 minutes ago, FUEtile said:

Both said you need to take finasteride the only difference is Pekiner gave you the wrong norwood classification is that what you mean by contrasting?

Euginex is ready to do surgery without prior medication while Pekiner wants me to be on med for at least 6-8 months and do another evaluation.

[FUEtile]

10 hours ago, Viking360 said:

You will also require finasteride for the preservation of your pre-existing hair. 

Finasteride is a US FDA-approved medication which is known to stop and reverse progressive thinning (miniaturization of the hair in most cases).

Duration of post-transplant Finasteride: Lifelong (but we can take breaks of 2 to 3 months in between). The dosage can also be revised periodically.

 

4 minutes ago, Viking360 said:

Euginex is ready to do surgery without prior medication while Pekiner wants me to be on med for at least 6-8 months and do another evaluation.

So the only difference is taking meds after surgery and waiting 6-8 months? I don’t see the point in waiting your still gonna be bald in 6-8 months. 

[duckling]

I would suggest going on meds for 6 months (if no sides), then re-assess your scalp situation. 2 situations are possible:

1) Incase you didn't get much re-growth / any re-growth but atleast got your existing hair to thicken up then those little amount can also help in increasing density when thicker. 

2) You might be an outlier / hyper-responder and you get a lot of growth. (you never know until you try). 

In both cases eventually you will need a transplant because with this much grade of baldness there is only so much even the point number 2 can do for you. Transplant will be needed and both doctors can then give you a appointment date for surgery if they want to take your case. (eugenix already does but pekiner might also come around ).

If you don't choose to take meds then go ahead with surgery (for which some surgeons and clinics might still take your case) but you will not know if meds could have worked for you. Just surgery might also give you a good result but great results always come with meds doing wonder for your existing hair.

Edited April 12, 2023 by duckling