Finasteride / Minoxidil after HT - how many years?

[HairHereOrThere]

The medication normally given for hair loss is finasteride / minoxidil. When you search on the internet, it is suggested that after the hair transplant ("HT") one must remain on finasteride / minoxidil all one's life, or rather, until you decide to keep your hair. The logic, which I understand and take to be correct, is that after the HT you will have on your scalp a mixture of hair which is not sensitive to DHT (basically the hair transplanted, which comes from donor areas which are not sensitive to DHT) as well as your pre-existing natural hair. This latter hair is still sensitive to DHT, and can potentially fall out. Therefore you must take finasteride /minoxidil to block this from happening. Otherwise, you will need another HT operation down the line to "patch" up the empty spaces.

I am uncomfortable with the idea that I have to take medication all my life. Is there an age hair loss naturally stabilises? I'm 38. Technically, if I want to keep my hair until sixty, I would need to take medication for 21 years. That's way too much. It's ok to take it for a year or two. But 22 years? I know I won't maintain it.

[Turkhair]

52 minutes ago, HairHereOrThere said:

The medication normally given for hair loss is finasteride / minoxidil. When you search on the internet, it is suggested that after the hair transplant ("HT") one must remain on finasteride / minoxidil all one's life, or rather, until you decide to keep your hair. The logic, which I understand and take to be correct, is that after the HT you will have on your scalp a mixture of hair which is not sensitive to DHT (basically the hair transplanted, which comes from donor areas which are not sensitive to DHT) as well as your pre-existing natural hair. This latter hair is still sensitive to DHT, and can potentially fall out. Therefore you must take finasteride /minoxidil to block this from happening. Otherwise, you will need another HT operation down the line to "patch" up the empty spaces.

I am uncomfortable with the idea that I have to take medication all my life. Is there an age hair loss naturally stabilises? I'm 38. Technically, if I want to keep my hair until sixty, I would need to take medication for 21 years. That's way too much. It's ok to take it for a year or two. But 22 years? I know I won't maintain 

Tell me about it man. It sucks 

 

[HairHereOrThere]

So it never settles? Does everyone keep on taking medication until they’re 60?

[djkillab]

Each person's hair loss is different, but you answered it yourself. You need to continue with meds for as long as you want to try and keep your hair

[A_4_Archan]

@HairHereOrThere

If you wanna keep your native hairs than you need to take them...but even with medication you are not 100% sure that you will not loose them in long run..many people keep on loosing at a slow pace even if they are on medication 

While there are many people who's hairloss itself halts at certain age with medication...its not that all the people in the world who are at nw3 at 35 will turn nw6/7 when they are 50/55...without medication you will be at a stage where you are destined to be and no one can predict that...

That's why hairloss is unpredictable thing and there is no way anyone can know what will gonna happen..we can just try things like medication and other non surgical therapies and hope for the best.

I can understand you point and i would say if you aren't a hair greedy person and can live a happy life with fewer or no hair than its always better not to take meds and accept the fate and live happily as this is going to be a tough fight once you are into the battlefield.

[jakos]

Your idea that transplanted hair is not sensitive to DHT is not entirely true, and that is the caveat.

 

We have the “prime” donor area, which is not vulnerable to DHT in many people, that can provide around 2/2.5k grafts. For transplants beyond that number, you have to harvest from areas outside the prime donor, where grafts are more resistant to DHT than are let’s say your temple hairs. But they can be still vulnerable.

 

This is why all cases are different, but i’d say if you require more than 2.5k grafts, than you need to block DHT. 

[Scree]

I would not consider a transplant without taking some sort of preventative indefinitely. If taking oral medication for life makes you uncomfortable, consider topicals form. They are usually more expensive and harder to stay consistent with, but some people swear by them. Finasteride, dutasteride and minoxidil all come in topicals formulations. 

Edited September 7, 2023 by Scree

[hybonix]

If you are not willing to take meds, I personally do not recommend a HT as your hair loss could get worse, which would render your investment useless. It took me almost 3 years to come to terms with this fact, and I wish I would have jumped on medication sooner as I could have saved a ton of my hair...

If you are on the fence, I recommend taking the plunge and taking the meds. If you wait, things can get worse.

[HairHereOrThere]

Hi guys, thank you all for your advice. I decided to go for the compromise suggested by @Scree, where I take the medication in topical form. Psychologically, I feel it's better than popping a pill. I decided to go for a spray, and right now, in my daily routine, I am viewing it as a step similar to when I style my hair (what's left of it anyways 😅). So instead of popping on gel, I pop on a bit of spray. Let's call it a "miraculous hair mousse". 😂 Also, applied topically, it seems to be safer from the pov of side effects. And to me that's kind of a win-win situation. Less messing around with my body. Whilst the pill is a direct hit in the blood stream, this is just hair.

I also kind of see the point of view of @hybonix. Since I am kind of sitting on the fence at the moment, I can start applying this routine. If I can't stick to it, then it kind of rules out the hair op and I gotta accept my hair loss (basically in line with what you all said) because it would be a waste of time, energy and money. Truth is this whole hair thing is messing me up a bit more than I'd like to admit. I had a friend who was going bald. He eliminated it; shaved it. He got heaps of praise ("wow, you look good / cool" etc etc). I shaved off my head thinking, "hey, that's an easy solution". Hell no. I got quite the opposite reaction. Didn't help at all. 

Thanks anyways. 

[Scree]

I am sure you will do great. Consistency is key.

[Turkhair]

2 hours ago, HairHereOrThere said:

Hi guys, thank you all for your advice. I decided to go for the compromise suggested by @Scree, where I take the medication in topical form. Psychologically, I feel it's better than popping a pill. I decided to go for a spray, and right now, in my daily routine, I am viewing it as a step similar to when I style my hair (what's left of it anyways 😅). So instead of popping on gel, I pop on a bit of spray. Let's call it a "miraculous hair mousse". 😂 Also, applied topically, it seems to be safer from the pov of side effects. And to me that's kind of a win-win situation. Less messing around with my body. Whilst the pill is a direct hit in the blood stream, this is just hair.

I also kind of see the point of view of @hybonix. Since I am kind of sitting on the fence at the moment, I can start applying this routine. If I can't stick to it, then it kind of rules out the hair op and I gotta accept my hair loss (basically in line with what you all said) because it would be a waste of time, energy and money. Truth is this whole hair thing is messing me up a bit more than I'd like to admit. I had a friend who was going bald. He eliminated it; shaved it. He got heaps of praise ("wow, you look good / cool" etc etc). I shaved off my head thinking, "hey, that's an easy solution". Hell no. I got quite the opposite reaction. Didn't help at all. 

Thanks anyways. 

You should take oral Finasteride at 38 anyway for prostate health even if low dose. 

Also I think you need to understand something.

The logic of taking medication for life applies to people who have hairs or hair that looks clearly miniaturised looking on the way to disappear. Those people get a HT with miniaturised hair transplanted, without medication these hairs would fall out. But those hairs would fall out even if they didn’t have a HT. 

HTs are also permanent. What happens when you don’t take medication is the DHT indifferent hairs graft will survive while the miniaturised hairs will fall off creating weird looking result. 

You don’t need medication if you’re already NW6/7 with stabilised hairloss for years which it seems you already are. You need medication if you’re a NW3/4/5 with clear miniaturised hairs everywhere in pattern of NW6.