Advice how to proceed

[le touriste]

Hello everyone,

Although I have read a lot about hair loss and how to treat it over the past few years, I am new to this forum and would appreciate some advice from experts in the field.

My story:

I am 32 and I first noticed some hair loss in my twenties, especially after showering; it was not all the time, there were always two or three months a year when it was worse.

I went to a dermatologist who said I should try Minoxidil, but I stopped after a few months of use when my hair felt greasy and worse than before. Later, I tried the foam, but stopped quickly because it got tangled in my hair and messed it up.

Another dermatologist I visited analyzed that it doesn't look too bad overall, but that my frontal hairline is affected by hair loss. If that was a problem for me, I should consider minoxidil.

Last but not least, a few years ago, I tried Finasteride at another dermatologist's office. As advised, after three months of use I told him as an interim result that I see no difference in hair loss and hair quality and also had some pain in my testicles. He told me that the hair loss should have improved immediately like with all his other patients and told me to stop and come back if my crown started to recede.

So now for several years I am off medication again, but as I am going through another phase of loss, my depression is starting to grow. It should be noted that I already had a deep depressive phase in COVID and hair loss was a part of it.

Looking at my genetics on my mother's side, my grandfather died as NW2, my uncle is also NW2; on my father's side, my father was at NW3 in his 50's, his brother is a NW4 at the end of his 50's, and my grandfather is probably also a late NW4.

As a dermatologist predicted, I am definitely losing my hair at the front now; my left temple has always been strangely receded and much worse than the right one (but is getting worse now), my crown was already weak as a child (very fine hair), I don't see much regression there now (all pictures attached are under strong lightning).

Now I am considering my options and evaluating whether a hair transplant could be an option. To (finally) get an evaluation from an expert, I filled out the form on Dr. Bisangas website and am waiting for an answer. In the meantime, I wanted to take the chance and ask some experts on this topic here what you would advise in my current situation and status. Thank you for your help and time!

 

Edited September 26 by le touriste

[Al - Moderator]

You should think about getting back on finasteride. Taking it for only 3 months is not enough time to know if it stops your loss or not. You could try starting off with a lower dose or take it every other day if you were having side effects. 
 

[Gatsby]

Firstly I am not a doctor. However it takes up to two years to see the full benefits of finasteride. As @Al - Moderator stated three months is not long enough to see results and you could take finasteride in a lower dose and/or take it every other day, etc. You could also take topical finasteride. Personally I would see a new dermatologist. You can also take minoxidil in it's oral form. With minoxidil foam one thing you can do is to fill the cap with the foam. Then lower the cap into hot water. The heat will melt the foam into a liquid that is much less greasy on your hair. All the best.

[Berba11]

Your situation is highly favourable. It's a gross exaggeration to even refer to it as a "situation" to be honest!

First of all, you don't need a HT. You'd get incredibly diminished returns from a HT because you have a really good hairline, really good density and some natural, aesthetically pleasing recession that looks mature and masculine. To add a small number of grafts to the temples won't provide you with much if any aesthetic benefit because your face is already framed just perfectly. You can't better frame an already well-framed face. If it ain't broke...

The second issue is whether to bother with medication in your case. on the one hand, you have a lot of hair to keep and maintain and regular, long-term finasteride use could stop of slow any further hair loss. On the other, you family hair loss history is very good - no higher than a NW4. You could probably just do nothing and let your hair do whatever it's going to do and cross the HT bridge when you actually have enough hair loss to justify a restoration. Higher NW's can't really adopt this approach so easily as every hair is precious! But you probably have to worry about being a NW5/6/7.

The smart choice would be to maintain what you have with a DHT-blocker and move on. The more laid back approach would be do nothing. The really dumb & unnecessary approach (imo of course) would be to get an expensive surgery you don't need for virtually no meaningful aesthetic improvement. Most people would kill to have your head of hair and hairline!

[Melvin- Admin]

5 hours ago, Berba11 said:

Your situation is highly favourable. It's a gross exaggeration to even refer to it as a "situation" to be honest!

First of all, you don't need a HT. You'd get incredibly diminished returns from a HT because you have a really good hairline, really good density and some natural, aesthetically pleasing recession that looks mature and masculine. To add a small number of grafts to the temples won't provide you with much if any aesthetic benefit because your face is already framed just perfectly. You can't better frame an already well-framed face. If it ain't broke...

The second issue is whether to bother with medication in your case. on the one hand, you have a lot of hair to keep and maintain and regular, long-term finasteride use could stop of slow any further hair loss. On the other, you family hair loss history is very good - no higher than a NW4. You could probably just do nothing and let your hair do whatever it's going to do and cross the HT bridge when you actually have enough hair loss to justify a restoration. Higher NW's can't really adopt this approach so easily as every hair is precious! But you probably have to worry about being a NW5/6/7.

The smart choice would be to maintain what you have with a DHT-blocker and move on. The more laid back approach would be do nothing. The really dumb & unnecessary approach (imo of course) would be to get an expensive surgery you don't need for virtually no meaningful aesthetic improvement. Most people would kill to have your head of hair and hairline!

^This. You have a good head of hair. No need to consider surgery at this stage.

[le touriste]

Thank you all for your input! I didn't mean to troll anyone when I posted this, I'm just very sensitive with my hair and fear the worst all the time.

So I understand that I should reconsider finasteride, I was a little afraid because of the sides I experienced first hand and the depressive phase I had before and that it might not be good for me.

Just to understand you correctly: At what point do you think a transplant should really be considered?

[Matthias]

34 minutes ago, le touriste said:

At what point do you think a transplant should really be considered?

Once you reach NW3V stage

[Berba11]

4 hours ago, le touriste said:

At what point do you think a transplant should really be considered?

When you have lost enough hair that you no longer benefit from a framed face. Usually this means the frontal forelock has withered to the extent that it may as well not be there at all. But you’re a long way from that. 
 

Even a deep recession with a decent forelock will still do the job (Jude Law is the classic example).