Trt, hair transplants and hair loss medications.

[Etownone]

I wish I knew then what I know now.  

I was always under the impression that transplanted hair won't fall out.   Had my first HT in late 2008,  and then 2015, 2016,  2018, 2020, and my last one in 2022.   

My thing is, I was on my own prescribed trt regimen at 200 mg a week for the longest time. 

I'm 2020 I went legit and got it prescribed to me and started taking the hair loss medications serious.  But I still had hair loss happening.    I lowed my dosage over the last couple years.  

Fast forward to today...   

I take 0.5 dutasteride 2x a week,  1mg finasteride the other 5 days.   I also take 5 mg oral minoxidil daily.    And I also apply RU58841 daily.   I just lowered my trt from 130 to 120 ml a week now split up every 3.5 days.   

And I'm still losing hair,   losing transplanted hair.   In total I've had over 12k grafts transplanted but you wouldn't tell.   

I can't stop trt,  and I'm pretty much depleted in my donor region.   I'd like to find a way to stabilize hair loss and live with what I have now.    

Any recommendations?     I'm considering taking DUT everyday and stopping finesteride completely,  but I heard for some the switch was not worth it and they ended up losing more hair.  

[A_4_Archan]

@Etownone

For some it is worth and for others it is worthless ...so imo this is all about trial and error kind of thing ..what works for you might not work for others and vice versa ...

Your regime is at par but taking dutasteride everyday can make it more powerful....this is the last weapon left in your armoury...but i would like to tell you one thing that general health is more important than hairs so please do take care of that and it should be the priority....evryone is not good responder to medication and will keep on loosing ground slowly and steadily even with all the medication and nothing can help with this and you should accept that thing at some point in life and move on...

Though i wish 0.5 mg dutasteride a day  works on you and you can halt the hairloss progression...but whatever you do please do it under your doctor's observation and with his consultations ...Best of luck...

[GoliGoliGoli]

I've always been suspicious of the idea that transplanted hair is "as permanent as it would be had you left it in the donor". 

If you take 100 people from town A where it is very clean and move them to down B where it is polluted with toxic waste, don't be surprised if they get sick.

If you take 100 hair follicles from the donor where maybe there isn't as much DHT activity, and move it to the scalp where there is a lot of DHT, I guess you can't be surprised if those hairs minitarize. But this is just speculation, maybe the hair follicles in the donor are just not as susceptible to DHT due to some physiological/genetic reason compared to the rest of the scalp, and it isn't about DHT concentrations varying at all. 

[Grouse]

2 minutes ago, GoliGoliGoli said:

I've always been suspicious of the idea that transplanted hair is "as permanent as it would be had you left it in the donor". 

If you take 100 people from town A where it is very clean and move them to down B where it is polluted with toxic waste, don't be surprised if they get sick.

If you take 100 hair follicles from the donor where maybe there isn't as much DHT activity, and move it to the scalp where there is a lot of DHT, I guess you can't be surprised if those hairs minitarize. But this is just speculation, maybe the hair follicles in the donor are just not as susceptible to DHT due to some physiological/genetic reason compared to the rest of the scalp, and it isn't about DHT concentrations varying at all. 

Is there more DHT in the scalp? Any studies to confirm that? I don't actually know why hair on top falls out, but sides often don't. I always assumed it was that hair on the side wasn't sensitive to DHT as much as top hair.

[Grouse]

@Etownone do you have any pictures? I'm sorry to hear this is happening to you. I don't know what to do - I always thought donor was more or less permanent (may thin over time, but wouldn't fully fall out). Do you think you have DUPA maybe?

 

Worst case, I suppose you could always shave and rock the bald look? Easier to say than do, but I'd imagine if you're on TRT you're pretty buff, which makes bald look pretty good most of the time. 

[Grouse]

@Etownone I'm also looking into DUT mesotherapy, which seems to have clinical results. Could be another supplementary option to look into

[Etownone]

12 minutes ago, A_4_Archan said:

@Etownone

For some it is worth and for others it is worthless ...so imo this is all about trial and error kind of thing ..what works for you might not work for others and vice versa ...

Your regime is at par but taking dutasteride everyday can make it more powerful....this is the last weapon left in your armoury...but i would like to tell you one thing that general health is more important than hairs so please do take care of that and it should be the priority....evryone is not good responder to medication and will keep on loosing ground slowly and steadily even with all the medication and nothing can help with this and you should accept that thing at some point in life and move on...

Though i wish 0.5 mg dutasteride a day  works on you and you can halt the hairloss progression...but whatever you do please do it under your doctor's observation and with his consultations ...Best of luck...

Thanks bud..

Everything is prescribed by doctors.   I do blood work every 4 months.   I would say my trt regimen is now on the low side.  

I'm 48 now,   I just want to be healthy.    I wish I could just shave all my hair off but my donor area would look like a war zone after 2 FUTs and 4 FUEs.     

 

 

[Etownone]

8 minutes ago, Grouse said:

@Etownone do you have any pictures? I'm sorry to hear this is happening to you. I don't know what to do - I always thought donor was more or less permanent (may thin over time, but wouldn't fully fall out). Do you think you have DUPA maybe?

 

Worst case, I suppose you could always shave and rock the bald look? Easier to say than do, but I'd imagine if you're on TRT you're pretty buff, which makes bald look pretty good most of the time. 

Def not big/buff anymore...    I was when I was taking 200 ml a week,   but cutting it down to 120 ml has me looking more normal/healthy.   

And I WISH I could shave it all off, but like a responded to an earlier comment...  After 2 FUTs, and 4 FUEs,  my donor area must looked horribly scarred.   Doubt even smp could save it.   

I honestly think it was the high dose of trt and lack of meds that made my transplanted hairs fall out over the years....  But it's still falling out even with the meds and low trt dosage.  

 

It's not DUPA.    

Edited August 16, 2023 by Etownone

[GoliGoliGoli]

28 minutes ago, Grouse said:

Is there more DHT in the scalp? Any studies to confirm that? I don't actually know why hair on top falls out, but sides often don't. I always assumed it was that hair on the side wasn't sensitive to DHT as much as top hair.

No idea if certain areas have more DHT, just kind of espousing my general suspicion that "donor dominance" is 100% true as a concept. There is lots about balding we don't understand. 

Edited August 16, 2023 by GoliGoliGoli

[Grouse]

1 hour ago, GoliGoliGoli said:

No idea if certain areas have more DHT, just kind of espousing my general suspicion that "donor dominance" is 100% true as a concept. There is lots about balding we don't understand. 

What is donor dominance? Donor takes on characteristics of whatever hair it is transplanted in?

[Grouse]

1 hour ago, Etownone said:

Def not big/buff anymore...    I was when I was taking 200 ml a week,   but cutting it down to 120 ml has me looking more normal/healthy.   

And I WISH I could shave it all off, but like a responded to an earlier comment...  After 2 FUTs, and 4 FUEs,  my donor area must looked horribly scarred.   Doubt even smp could save it.   

I honestly think it was the high dose of trt and lack of meds that made my transplanted hairs fall out over the years....  But it's still falling out even with the meds and low trt dosage.  

 

It's not DUPA.    

I wish I had more advice man. I've wondered how many hair transplants we'll see eventually thin out over time and result in having to shave anyway. My suspicion is there is more than we think.

 

Not trying to diminish a crap situation, but it may not be as bad as you think. If it is, hair system is always an option. It's a terrible feeling being self conscious all the time - I hope you're able to still carry on without too much mental burden (easier said than done).

 

You could also look into "Fit Farming" from beard / body hair that I think @mustang has talked about to add hair over the FUT scars and make the donor look homogenous and then keep everything buzzed down + SMP? I think Dr. Mwamba and several other top docs do this. 

[Etownone]

42 minutes ago, Grouse said:

I wish I had more advice man. I've wondered how many hair transplants we'll see eventually thin out over time and result in having to shave anyway. My suspicion is there is more than we think.

 

Not trying to diminish a crap situation, but it may not be as bad as you think. If it is, hair system is always an option. It's a terrible feeling being self conscious all the time - I hope you're able to still carry on without too much mental burden (easier said than done).

 

You could also look into "Fit Farming" from beard / body hair that I think @mustang has talked about to add hair over the FUT scars and make the donor look homogenous and then keep everything buzzed down + SMP? I think Dr. Mwamba and several other top docs do this. 

You're right about Mwamba..  

He actually did my last surgery.   And he repaired some over harvested areas on my donor area with beard.    

 

[mustang]

12 hours ago, GoliGoliGoli said:

I've always been suspicious of the idea that transplanted hair is "as permanent as it would be had you left it in the donor". 

If you take 100 people from town A where it is very clean and move them to down B where it is polluted with toxic waste, don't be surprised if they get sick.

If you take 100 hair follicles from the donor where maybe there isn't as much DHT activity, and move it to the scalp where there is a lot of DHT, I guess you can't be surprised if those hairs minitarize. But this is just speculation, maybe the hair follicles in the donor are just not as susceptible to DHT due to some physiological/genetic reason compared to the rest of the scalp, and it isn't about DHT concentrations varying at all. 

This is not how it works. There is DHT present in your entire body, including your door area. They are not genetically predisposed to androgenic miniaturization, just like there is DHT in your face and your beard is not affected. 

Edited August 17, 2023 by mustang

[Emiry]

If your genetics are of a Norwood 7, there is very small safe zone and that small safe zone also isn’t so healthy, the hairs don’t fall out but appear wispy and weak and thin.

So many young people freak out with initial hairloss at nw2/3/4, get hair transplants, ignore medication and advice of clinics. Their hairloss progresses all over.

Then they start questioning established facts like donor dominance and hair transplants aren’t permanent. 

 

[Gatsby]

TRT will definitely accelerate MPB for those who are genetically predisposed to it. 

[mustang]

If I hope back on TRT again I'll be using alfa estradiol with fin topically and either CB or mesotherapy.

[Etownone]

12 minutes ago, mustang said:

If I hope back on TRT again I'll be using alfa estradiol with fin topically and either CB or mesotherapy.

Hey Mustang...   What was your dosage of Trt?      

[mustang]

140 mg a week (40 EOD) , 100iu HCG daily and 10mg topical progesterone

[Etownone]

26 minutes ago, mustang said:

140 mg a week (40 EOD) , 100iu HCG daily and 10mg topical progesterone

Pretty similar to mine.   Expect no top prog. 

I dropped the test down to 120 last week,   I hope that makes a difference.    I'm pretty sure my continued hair loss is related to the high test.   

 So why did you stop?  So many benifits being on trt.   

[GoliGoliGoli]

9 hours ago, mustang said:

This is not how it works. There is DHT present in your entire body, including your door area. They are not genetically predisposed to androgenic miniaturization, just like there is DHT in your face and your beard is not affected. 

So your theory is that the hair follicle in the donor is genetically dissimilar to the hair follicles in the areas an individual is balding in? Do you have anything that supports this theory? Not saying this theory is wrong, but I can guarantee you there has been no evidence found that shows the hair follicle in the donor is genetically dissimilar to the hair follicle in the rest of the scalp. 

Of course absence of evidence is not evidence of absence, but when it comes to hair loss you should stay away from definitive claims like "This is not how it works". There is much we don't know, and at best you're just making an educated guess by claiming some genetic dissimilarity. 

What you mention about DHT in the face/beard actually supports my point - this is what's known as the "DHT paradox". AKA, why does DHT promote hair growth in every part of the body except for the scalp? One possible theory is the one you mentioned, that there is something genetic in the scalp hair follicles that makes them miniaturize from DHT. But such a "gene" or "cluster of genes" has not been found so it's at best theoretical. 

[sunsurfhair]

I’m on 50mg E4D, so 100 total a week. I’m early 40s so my MPB (NW 3V) was well established and had essentially stopped. Hair and frontal third HT super healthy and stable. Oral Minox 5mg daily. My donor was / is very strong so that helps. Did not do well on any anti androgens, so I stay away from that. Do everything else I can. I believe vascular health to the scalp is super critical. Please be cautious with any anti androgens especially oral forms. 
 

Monitor labs every 6 weeks (full profile). Test usually sits around 750 on trough with great free t and e2 counts. DHT sits around 45-50 which I’m very content with. Good mix of positive effects of DHT without the negatives (acne, hair loss, prostate enlargement etc). 
 

I would possibly consider mesotherapy PRP w DUT but I don’t need it at all now. 

Do you know where your DHT level sits at? 

Bottom line - it’s all genetics. There’s guys on heavy TRT who don’t lose a strand. Or high T guys in general who don’t. In the absence of an androgen blocker, I do what I can do ensure good vascular scalp health, which is good for my body and brain regardless. 
 

Edited August 17, 2023 by sunsurfhair

[Etownone]

2 hours ago, sunsurfhair said:

I’m on 50mg E4D, so 100 total a week. I’m early 40s so my MPB (NW 3V) was well established and had essentially stopped. Hair and frontal third HT super healthy and stable. Oral Minox 5mg daily. My donor was / is very strong so that helps. Did not do well on any anti androgens, so I stay away from that. Do everything else I can. I believe vascular health to the scalp is super critical. Please be cautious with any anti androgens especially oral forms. 
 

Monitor labs every 6 weeks (full profile). Test usually sits around 750 on trough with great free t and e2 counts. DHT sits around 45-50 which I’m very content with. Good mix of positive effects of DHT without the negatives (acne, hair loss, prostate enlargement etc). 
 

I would possibly consider mesotherapy PRP w DUT but I don’t need it at all now. 

Do you know where your DHT level sits at? 

Bottom line - it’s all genetics. There’s guys on heavy TRT who don’t lose a strand. Or high T guys in general who don’t. In the absence of an androgen blocker, I do what I can do ensure good vascular scalp health, which is good for my body and brain regardless. 
 

Thanks bud, great info. 

 

So, Good vascular health to the scalp ...   What do you mean by that?      By just taking oral minoxidil?     Or do you mean dermaroll or prp.     I feel like prp would help, but it's mostly negative reviews about it being too expensive for little resutls. 

I did blood work for my DHT like 6 months and it was like super low....  12.   Which I thought was good.   

Edited August 17, 2023 by Etownone

[sunsurfhair]

1 hour ago, Etownone said:

Thanks bud, great info. 

 

So, Good vascular health to the scalp ...   What do you mean by that?      By just taking oral minoxidil?     Or do you mean dermaroll or prp.     I feel like prp would help, but it's mostly negative reviews about it being too expensive for little resutls. 

I did blood work for my DHT like 6 months and it was like super low....  12.   Which I thought was good.   

Wow glad you got that checked. So clearly a great example of despite having a below value DHT (quite low), you’re still losing. This is why this is so much more complicated then just lowering DHT. Have you been to the derm to check your scalp make sure nothing else is going on? Might be worth it as well. 
 

Vascular Health -

Minox 5mg (best med we have at the moment)

Fish Oil (I like Nordic Naturals)

Arginine/Citruline (amino acids that encourage blood flow)

high quality laser cap (good for anti inflammatory effects as well)

healthy diet lots of clean whole foods 

exercise with good hydration and electrolytes 

Good collagen supplement I like Vital Proteins

Coq-10 or Ubiquonol (great for heart health as well)

I don’t derma roll because I am concerned with damage to the scalp and it’s painful as all hell 

PRP I’m not totally sold - I haven’t done it but I trust Konior and he still feels strongly it’s a waste of money - that being said some people swear by it since it technically should do just that - enhance scalp vascular health with your own platelets and growth factors. I would consider if I needed it.

 

 

Edited August 17, 2023 by sunsurfhair

[Melvin- Admin]

Are you being seen by an endocrinologist? Your hormones may be imbalanced, which could lead to telogen effluvium. 

If I were you I would stick to 0.5mg dutasteride daily with oral minoxidil daily. It might also be worth trying CosmeRNA or Pyrilutamide. 

[Etownone]

3 hours ago, Melvin- Moderator said:

Are you being seen by an endocrinologist? Your hormones may be imbalanced, which could lead to telogen effluvium. 

If I were you I would stick to 0.5mg dutasteride daily with oral minoxidil daily. It might also be worth trying CosmeRNA or Pyrilutamide. 

Whoa...    THANKS Melvin 

I gotta look up all this stuff.    I've been Googling for months, trying to find a different approach.   Not sure what telogen effluvium,  CosmeRNA, or Pyrilutamide is,  But I'm going to look into it and schedule a visit with an endocrinologist.    Never thought about that.  An endocrinologist can do a hormone check up and maybe help me.   Thx.   

I'm a little nervous of stopping finesteride compeltely and doing only dutasteride cause I heard some people had bad experiences.   I think I'll bump it up to 3 times a week and finesteride the other 4 days.