Newbie looking for support, solidarity and advice

[SevenLondon]

I should say thanks before I even start my post, I've been reading the forums over the past month before I joined and appreciate all the advice and openness of sharing stories that happens on the forum, taking my first step in joining into that mix today.

Probably started noticing some receeding and thinning of my hair in my mid 20s, dad had lost everything on the top, went to Belgravia Clinic in London who aggressively messed through my hair in a crowded room full of people and declared I had male-pattern and should start on propecia, the experience left me so uncomfortable that their advice fell on deaf ears.

Over the years it became more noticable, but over the last 5 I think I've been having my hair cut with someone who has done a really flattering job of making me ignore it (apart from on windy days - the worst for me!) and perhaps lulled me into a sense of comfort on good days, where perhaps I should have been taking more action.

I'm just over 40 now. In recent months things have changed, appear to be 3A close to 4A on Norwood, I am finding it harder to style, more noticable, amongst other things that I'll ask about below. I think I'm rapidly approaching needing to take action, and having shaved it once before when I was younger I don't really like that look for the shape of the top of my head.

I have been researching and considering:

• Taking oral finasteride and minoxodil for 6 months - to feel out the side effects and receptiveness / impact
• Aiming for FUE after that, preferably in the quieter months at the beginning of the year (not sure if I'd do it 2024 or maybe 2025 to allow more time to see results of meds)

Have a bunch of questions and would appreciate any insights from the forum:

1. What would you do - People that have been in this situation before, what approach did you take and how did it go?
2. Itching / scabs - I have noticed that my scalp is generally a lot itcher / getting occasional spots that scab over, has anyone else experienced this or is this probably unrelated?
3. Testosterone - I have issues with my energy levels and my sex drive also seems to be low and then appear in bursts for a few days, I have been told to look at supplementing testosterone but am concerned this would only accelerate hair thinning and loss (though it seems to do the opposite in women) - any thoughts?
4. Medication side effects - Done a fair bit of reading on side effects of both finasteride and minoxodil and the two that I keep coming back to are the impact on sexual function given my existing erractic levels of energy there, and also the hair growth elsewhere on the body - wondered if people had experiences with these and how they manage?
5. Talking to GP - I've had a lot of health stuff on in the last few years and I feel... almost guilty talking to my GP about these medications to get their view on what to look out for against my health history - how responsive / considerate have people found GPs?
6. Wearing hats - Mentioned above wind is a source of frustration especially when out running or hiking, does wearing a hat or cap have much impact on hair loss?

P.S.

• I have done research on clinics (with the help of this forum) but am not at that stage of the process yet
• I have done a fair bit of reserach on hair transplants and understand some of the expectation management that I need to do, including the time it takes to see results, that one surgery might not be enough to get ideal results for density, etc, happy to hear advice on this stuff but it's not quite what I'm focused on at the moment
• Trying my best to navigate that space before hand of living with the discomfort, trying to have more self-compassion, and work out if I want to take the leap at least for medication, and maybe also FUE

[A_4_Archan]

@SevenLondon welcome to the forum...your participation would be good for the community...and you will learn many things too..so its a win win situation 😊

Your approach seems to be perfect ..should give at least 10-12 months to the medication ....

 

1 - my approach was kinda same

 

2 - itching can be issue to many people after hair transplant ....you already have the issue so you should clear that first....consult a good dermatologist and start medication for that and once you finalise a doctor for your surgery you should talk to him /her about this issue..

 

3 - if you already have low testosterone than finasteride won't be a good option though you can take a personalised approached after consulting a good surgeon...you can try topical xyon topical dutasteride which doesn't get absorb into body that much and works locally at the scalp level and reduce scalp dht..

 

4 - less percentage of people gets side effects and even if people gets it they can alway stop taking it and they would be fine..its not a permanent side effects from medication ...but in your particular case as you mentioned about low testosterone it can be tricky...

 

5 - if you have existing health issues and specially blood pressure or heart related ones than should be careful in taking minoxidil....

 

6 - wearing hats for too long may cause skin issues as you said you already have one....

 

My advice would be to you is to connect to some top notch hair transplant surgeons who are ethical like dr munib ahmad , dr bisanga ,dr rahal to name a few....do all the reports first ,whatever reports they ask you for and than start your medication and later on think about the surgery ....Wish you all the best...

[Rawkerboi]

1) Be on medications (Finasteride and Minoxidil) for year or two before jumping into Hair Transplant. 

2) Get an appointment with a reputed Dermatologist. If you are suffering from dandruff then try Nizoral shampoo. 

3) Supplementing testosterone may accelerate Hairloss. I would avoid. 

4) Chances of side effects from Finasteride is very rare but it's totally reversible once you stop. My advice start Finasteride, if you experience any side effects quit it. 

5) Please talk openly to your GP. 

6) Wearing Caps doesn't cause Hairloss. 

 

Edited May 8, 2023 by Rawkerboi

[Bucky O Hair]

Get a blood test to check your Endocrine (hormone) levels before starting on any drugs.  This is something that a lot of people don't do, but should always be done.

That way, you can then get a second blood test in the future to confirm the impact it has had on your system.  Judging based on 'side effects' alone is the wrong way to confirm how it has impacted your system.  You should go by the numbers that your blood tests show.  If you do decide to go on drugs, then going with the topical versions first is probably a bit safer.  This is a lifelong commitment, so you should be cautious in your approach.  

Same goes for the testosterone boosting.
You mention you have 'been told' to look at supplementing testosterone.  Was this a doctor that told you this?  If so, then why haven't they ordered a blood test first?  Pretty reckless doctor if they are diagnosing you with potentially low T without even testing you for it. 

Boosting your testosterone will increase your DHT and may accelerate hairloss...but again, this all goes back to testing your current levels and getting a detailed understanding of your current state (so you at least have a baseline).
For all you know, you may already have low DHT and taking finasteride may not have as big an impact to slowing your loss.  Also, taking a DHT blocker and a testosterone booster at the same time could swing your hormones outside the normal ranges. 

Maybe your loss is being accelerated by a skin condition, or by your overall health profile (since you mentioned you've already had a lot of 'health stuff').
You have to also remember that you probably should always be in optimal health before undergoing any sort of surgery, and that includes hair transplants too as it can impact results.

I think you should hold off on any drugs, and start with a full hormone blood test (testing your Test, DHT, Estrogen, TSH, etc.) and check out a dermatologist (since scabbing on your scalp is not normal).

[SevenLondon]

Thanks all for responses so far.

@A_4_Archan - Not so much issues with heart or blood, recovering from surgery to remove cancer last year, and low energy levels

@A_4_Archan - Planning to reach out to Reddy, Bisanga and Mwamba to start with

@Rawkerboi - Understand that side effects are usually reversible, just a bit of fear that if I had a transplant then stopped I could end up with a predicament as remaining hair continues to be affected by DHT, but that said if I follow the suggestion of trying medical route for a longer period first I'd have an idea of side effects before that leap

@Bucky O Hair - GP was commenting as a suggestion but not yet a recommendation after two tests had come back with lower-end testosterone levels, however this was all in the context of my overall energy levels not sexual function so it was all theoretical discussion

@Bucky O Hair - Agree that the stress of cancer surgery and the year that has followed, COVID twice, pandemic, low energy may well be impacting, but yes I totally take your point about being in the right health before surgery, it's not something I'd rush or leap into

Have reached out to GP to start with about scalp issues, have been putting it off hoping it'd resolve itself but agree need to get it looked at.

Once that's out of the way then will arrange another GP chat to talk about hormone testing and discuss medications.

[Bucky O Hair]

Ok.  Sounds like you're doing all the right things.  I'd push for the full hormone profile, just so you can have that full baseline to compare with. 

Also, I wouldn't feel guilty about talking to your GP about hair loss and any steps you want to take to remedy this.  

I felt the same way when I asked my GP to sign off on a doctor consent form from my HT (attesting that I am in good physical and psychological health).  I rolled it all up into my GP appointment and kind of threw the request at her at the end of the appointment.

I was pleasantly surprised at how positive she responded to it, and she mentioned how she gets these requests all the time.  

I threw all kinds of requests at her the previous year (especially during COVID when there were so many rules around visiting docs or getting prescriptions) so this was yet another thing I am requesting, but in the end it's their job and they probably get several of similar requests like these every day.  It probably doesn't even register in their brains half the time.  

 

[SevenLondon]

On 5/9/2023 at 1:59 PM, Bucky O Hair said:

I'd push for the full hormone profile

@Bucky O Hair When you say full hormone profile are there specific things I should be asking for, and do you know of any good private options out there for testing?

I have found some friction and pushback from the GP I saw at my surgery, not to mention complete ignorance about the medications used in preventing hair loss.

[SevenLondon]

Actually found the last tests I had:

• FSH 1.4 IU/L
• LH 3.6 IU/L
• Testosterone 14.8 nmol/L
• Free testosterone 0.325 nmol/L
• Cortisol 266 nmol/L
• Sex binding glob 26 nmol/L
• Prolactin 153 MicroU/L

[Bucky O Hair]

3 hours ago, SevenLondon said:

Actually found the last tests I had:

• FSH 1.4 IU/L
• LH 3.6 IU/L
• Testosterone 14.8 nmol/L
• Free testosterone 0.325 nmol/L
• Cortisol 266 nmol/L
• Sex binding glob 26 nmol/L
• Prolactin 153 MicroU/L

You could probably test for these as well:

 

DHT (Dihydrotestosterone)
Estradiol (17β-estrdiol)
Thyrotropin (sensitive TSH)
Testosterone (Bioavailable)
Albumin
Adiol-G (Androstanediol glucuronid)
PTH (Parathyroid Hormone)
Free T3
Free T4
Thyroid Antibodies
Creatinine
eGFR
Estrone (also oestrone)

 

Mind you, I got a few of these from other recommendations from other sites.  You probably won't get a doc to give you a requisition to get all these tested unless it was for a more serious reason (not an elective one like a HT drug).

I would assume that getting your DHT and Estrogen tested would be very useful though.  Thyroid would be good too.