Jump to content

Advice for my hair loss case ?


Recommended Posts

  • Regular Member

Quick Background:

  • Male, 30. Started losing hair around age 18-19. Now I have frontal loss and the mid scalp is starting to go as well (hard to tell from the pics)
  • Slow, gradual process over 10+ years. Family history of Norwood 6 (dad and both grandfathers).
  • Dad, now 65, has thin donor hair.

Attempts to Address Hair Loss:

  1. Shaving: Developed some body dysmorphia from hair loss, hate seeing myself in mirrors/pictures. Tried shaving twice; I can pull it off but feel it doesn’t look like "me." Due to facial features and beard I have a feeling that I end up looking much like a person with a ethnic background very far away from my own, which I don't like. I have no issues with other ethnicities, just to be clear.  

  2. Finasteride: Tried oral finasteride at 24 and 27, but stopped due to side effects (low libido, brain fog, prostate pain). Tried topical finasteride but still experienced side effects. Fluridil also caused testicular ache.

  3. Dutasteride: Using "mesodut" topical dutasteride (0.025%) from anagenica with microneedling since May (following a study:https://smj.journals.ekb.eg/article_42083_24b61cbba4be9982db23c318414034c0.pdf). Unsure if it’s helping, but shedding continues, and may cause mild side effects post-application 4-5 days. 

  4. Minoxidil: No improvement on topical; tried oral but experienced chest pain/tightness, so stopped.

Next Steps:

  • Considering low-dose oral dutasteride (0.5 mg every 5 days), topical dutasteride gel 1-2 times a week, and topical anti-androgens (KX826 1% or CB0301).

Future Plans:

  • Saving for a transplant (3-5k grafts was suggested by clinics). Have good donor hair, as well as beard/body hair, though I’ve heard body hair survival rates are low?

Question: Would it be best to find an effective treatment to slow the loss first, then proceed with a transplant? Or should I just shave it off and try to work with the look? - maybe get other procedures done to help. Dr. Felipe Pittella’s work with beard/body hair is promising, but I’m concerned about aesthetics (maybe look like pupic hair on the scalp?). 

I am aware that some of the issues comes from within myself as I also suffer from depression/anxiety and am very self critical. I am in theraphy, but somtimes I wonder what comes first - if the hair loss is causing/contributing to my mental health issues or if it is my mental health issues that is exacerbating/making hair loss such a big deal... I am a bit tired of thinking about my hair so much...


I have attached photos. Any input would be greatly appreciated !

 

Thank you all



 

 

bald igen.png

bald side.png

front.png

crown top oktober 2024.png

crown oktober 2024.png

doner oktober 2024.png

side 2 oktober 2024.png

top oktober 2024.png

top part oktober 2024.png

side 1 oktober 2024.png

Link to comment
Share on other sites

  • Regular Member

For what it's worth you can rock the shaved look very well, the beard suits you and your facial features complement the look.

As for your current situation and to answer your question, you are doing the right thing by exploring medical intervention first. This will allow you to maximise chances of hair loss recovery and minimise the amount of surgical intervention. Usually an ethical surgeon will advise you to stabilise your hair loss first for at least 6 months.

Given what you said I would recommend you try oral dutasteride a couple of days a week, and also look at introducing oral or topical minoxidil, this will help with regrowth and further reinforce your donor region (EDIT: nvm I see you tried this and stopped, that's too bad!). Personally I would not bother with topical androgens if you are already going to start on something like oral dustasteride which is very potent and effective at inhibiting DHT conversion.

Lastly, your donor looks good, the sides are not as strong as the back but your hairloss is not that advanced, I would say you are a NW3/NW4 so about 3000-3500 grafts would restore your look, but remember you will need to stay on medication for life (or as long as you want hair) because genetically you are very likely to follow in your father's footsteps (NW6). Also you may need some temple work done, so it is crucial you pick a doctor that can create a natural look, temples point are notoriously hard to get right as they require finer single grafts to be used.

Whilst you wait for the meds to stabilise your hairloss over the next few months, you can start reaching out to doctors for consultations, the best doctors usually have a wait list so it is advisable to start this process early. Expect to wait 6-9 months for a consultation with a good surgeon, and 1 - 2 years for surgery. This of course depends on your budget but you would rather do it once and do it right, than risk going to a hairmill.

Edited by Ccd99
  • Like 1
  • Consultation with Dr Bruno Ferreira - Nov 2023 - - see link below for more info
  • First surgery with Dr Bruno Ferreira - Sept 2024 -  - 3200 grafts to frontal third and partial mid-scalp - link to thread
  • Second surgery with Dr Bruno Ferreira - May 2025 -  - 2500-3000 grafts to remainder of mid-scalp and crown + touch-up

 

Link to comment
Share on other sites

  • Regular Member
17 minutes ago, Ccd99 said:

For what it's worth you can rock the shaved look very well, the beard suits you and your facial features complement the look.

As for your current situation and to answer your question, you are doing the right thing by exploring medical intervention first. This will allow you to maximise chances of hair loss recovery and minimise the amount of surgical intervention. Usually an ethical surgeon will advise you to stabilise your hair loss first for at least 6 months.

Given what you said I would recommend you try oral dutasteride a couple of days a week, and also look at introducing oral or topical minoxidil, this will help with regrowth and further reinforce your donor region (EDIT: nvm I see you tried this and stopped, that's too bad!). Personally I would not bother with topical androgens if you are already going to start on something like oral dustasteride which is very potent and effective at inhibiting DHT conversion.

Lastly, your donor looks good, the sides are not as strong as the back but your hairloss is not that advanced, I would say you are a NW3/NW4 so about 3000-3500 grafts would restore your look, but remember you will need to stay on medication for life (or as long as you want hair) because genetically you are very likely to follow in your father's footsteps (NW6). Also you may need some temple work done, so it is crucial you pick a doctor that can create a natural look, temples point are notoriously hard to get right as they require finer single grafts to be used.

Whilst you wait for the meds to stabilise your hairloss over the next few months, you can start reaching out to doctors for consultations, the best doctors usually have a wait list so it is advisable to start this process early. Expect to wait 6-9 months for a consultation with a good surgeon, and 1 - 2 years for surgery. This of course depends on your budget but you would rather do it once and do it right, than risk going to a hairmill.

Thank you very much for the reply. 

You are right, I have retrograde alopecia on the sides. I actually usually keep the sides very short (6 mm), that way it looks better. 

I have one question for you. Do you know anyone who had success on topical dutasteride gel ? - I ask because if the oral low dose dutasteride gives me sides, then that would be my last shot. 

Link to comment
Share on other sites

  • Regular Member
15 minutes ago, Rapunzel2024 said:

Thank you very much for the reply. 

You are right, I have retrograde alopecia on the sides. I actually usually keep the sides very short (6 mm), that way it looks better. 

I have one question for you. Do you know anyone who had success on topical dutasteride gel ? - I ask because if the oral low dose dutasteride gives me sides, then that would be my last shot. 

I believe @Melvin- Admin has had success with dutasteride gel, I don't really have experience on it so can't comment. If you are not able to tolerate oral dutasteride due to side effects, then it might be worth including an anti-androgen (like you mentioned) also in addition to topical dutasteride.

I have also heard about anectodal evidence of people not tolerating finasteride, but able to tolerate dutasteride, even though the latter is more potent. Lastly even if you do experience side effects, it is worth trying it out for 3 months or so, your body may need time to adapt and adjust to the side effects - again I have read from others' experiences that this can happen, so don't give up straight away.

Personally I have had huge success with oral minoxidl and oral dutasteride with no side effects and good stabilisation and regrowth of hair, so these medicines do work if you give it time.

  • Consultation with Dr Bruno Ferreira - Nov 2023 - - see link below for more info
  • First surgery with Dr Bruno Ferreira - Sept 2024 -  - 3200 grafts to frontal third and partial mid-scalp - link to thread
  • Second surgery with Dr Bruno Ferreira - May 2025 -  - 2500-3000 grafts to remainder of mid-scalp and crown + touch-up

 

Link to comment
Share on other sites

  • Senior Member

I also suffered side effects from oral Finasteride, but now I am using topical formula over 3 years without any side effects, rarely I get complaints about the topical formula, have you tried?

Donor looks mostly good, your crown is in amazing shape, frontal area needs about 3000-3000+ grafts, pretty straight forward case.

Doron Harati - Patient consultant coordinator for HDC Hair Clinic.

For consultation, WhatsApp: +972526542654

Maildoronhdc@gmail.com

HDC Instegram: https://instagram.com/doronhairadvisor_hdc?igshid=YmMyMTA2M2Y=

* All comments from this account should not be taken or construed as medical advice, all comments are only the personal opinions of the poster.

Link to comment
Share on other sites

  • Regular Member
4 hours ago, Doron Harati said:

I also suffered side effects from oral Finasteride, but now I am using topical formula over 3 years without any side effects, rarely I get complaints about the topical formula, have you tried?

Donor looks mostly good, your crown is in amazing shape, frontal area needs about 3000-3000+ grafts, pretty straight forward case.

As mentioned in my post I did try topical fiansteride formular. Twice actually, I tried  both a 0.25% solution and a low 0.005 % solution and unfortunatly it gives me sides. 

I am however intrested in dutasteride because it seems the side effect profile is slightly lower than with fin. Maybe because of the iso enzyme balance or drug properties. 

I guess my case is straight forward only if I can tolerate medications ? and thus stabalize ?

Edited by Rapunzel2024
Link to comment
Share on other sites

  • Valued Contributor

@Rapunzel2024 my biggest concern is that being a sufferer of anxiety/depression and being hyper self critical that you may not be happy with the results of a transplant/s. You will need at least more than one over the life span. Hair transplants are not perfect. They aim is to best give the illusion of having your own hair. Overtime balding continues as it is genetic, thus requiring more surgery. It’s a question of supply versus demand. As we age so too do our donors and they thin naturally. Without a 5ari that is working then you need to be aware that you will be chasing this with surgery. The other option is to buzz your head. Once you buzz your head everyday you no longer think about hair. If it weren’t for the scars from surgery when I was young I would never have had my recent hair restoration. All the best. 

  • Like 1
Link to comment
Share on other sites

  • Regular Member
6 minutes ago, Gatsby said:

@Rapunzel2024 my biggest concern is that being a sufferer of anxiety/depression and being hyper self critical that you may not be happy with the results of a transplant/s. You will need at least more than one over the life span. Hair transplants are not perfect. They aim is to best give the illusion of having your own hair. Overtime balding continues as it is genetic, thus requiring more surgery. It’s a question of supply versus demand. As we age so too do our donors and they thin naturally. Without a 5ari that is working then you need to be aware that you will be chasing this with surgery. The other option is to buzz your head. Once you buzz your head everyday you no longer think about hair. If it weren’t for the scars from surgery when I was young I would never have had my recent hair restoration. All the best. 

Do you think I would be chasing it with surgery even while on 5ari's ? or only if I dont medicate/stop the loss ? - I do often see posts, but also real life examples of this, where people had the front done but was not on meds and it looks very off.

Just to understand what you say - you would just have shaved/buzzed if it was not because you have scars from surgery ? 

I do agree with you on the part about not being happy with a transplant. As part of a vacation I actually did meet up with a clinic in Istanbul (Cosmedica - and yes I know it is a hair mill). But they did draw a line of where the hair could be transplanted and it seemed quite high to be honest. He said it has something to do with a certain muscle in the scalp. At that time I was put off a bit and thought it was not worth it. 

My mind has since changed, as I just really dislike my pictures and look when I am bald... I just dont dig it much and feel like I am someone else. 

I hear people say "just shave it and bulk up and work out more, get big". But then I feel it becomes this vicious cycle of trying to fix the issue/compensate via. other means. I am considering shaving and try to accept it, but then maybe get a small beard transplant, as a part of my beard is sparse (not the sides in the pictures). And I could go to the gym 5 times a week and I could also get a nosejob to correct the issue I feel from being bald (I feel my nose becomes much bigger when the frame of hair is gone - it does make sense). I could also get a tattoo sleeve as it fits bald dudes...

But I feel a bit stuck with the idea. Then why not just fix the first problem = hair loss ? instead of speanding money and time on compensating. 

Sorry for the rant, and once again, thank you for your reply ! 

Link to comment
Share on other sites

  • Valued Contributor

If you take a 5ari and it stabilizes your hair loss then yes you are in a good position for surgery. My concern moreso is will you be happy though? Will you be then focusing on the hairline height, the density (or lack of it)? Will it lead you to wanting more surgery? I only mention this because you said that you suffer from anxiety and that you are self critical. Being a candidate for surgery is more than just having an excellent donor, etc. It’s being informed of all the things that can go wrong and making an informed and educated decision. All the best. 👍

  • Like 1
Link to comment
Share on other sites

  • Regular Member

 

2 hours ago, Gatsby said:

If you take a 5ari and it stabilizes your hair loss then yes you are in a good position for surgery. My concern moreso is will you be happy though? Will you be then focusing on the hairline height, the density (or lack of it)? Will it lead you to wanting more surgery? I only mention this because you said that you suffer from anxiety and that you are self critical. Being a candidate for surgery is more than just having an excellent donor, etc. It’s being informed of all the things that can go wrong and making an informed and educated decision. All the best. 👍

I do see your points for sure. I guess I will have to try the meds and see what happens !

Thank your for the answers

  • Like 1
Link to comment
Share on other sites

  • Moderators
On 10/31/2024 at 7:55 AM, Rapunzel2024 said:

I hear people say "just shave it and bulk up and work out more, get big". But then I feel it becomes this vicious cycle of trying to fix the issue/compensate via. other means. I am considering shaving and try to accept it, but then maybe get a small beard transplant, as a part of my beard is sparse (not the sides in the pictures). And I could go to the gym 5 times a week and I could also get a nosejob to correct the issue I feel from being bald (I feel my nose becomes much bigger when the frame of hair is gone - it does make sense). I could also get a tattoo sleeve as it fits bald dudes...

 

This makes me think you won't be happy with a hair transplant. I mean your beard is totally full. If you feel like you need to improve that then I wonder if you'll ever feel like you like the way you look. You are talking about a nose job, tattoos, beard issues. If your problem was just your hair then I'd say go ahead and get a hair transplant, but it sounds like anything you do, you'll want to change something else because you don't feel like any of it fits together. A hair transplant is not perfect. You sound like someone who would definitely be focusing on each hair strand and why you feel like it's out of place. Then if you remove that hair you'll feel lopsided and want other surrounding hairs removed or some added, etc etc.

Maybe I'm wrong, but if I were you I'd do some serious thinking about what is actually bothering you.

 

  • Like 2

Al

Forum Moderator

(formerly BeHappy)

I am a paid forum moderator for hairrestorationnetwork.com. I am not a Dr. and I do not work for any particular Dr. My opinions are my own and may not reflect the opinions of other moderators or the owner of this site. I am also a hair transplant patient and repair patient. You can view some of my repair journey here.

Link to comment
Share on other sites

  • Regular Member
2 hours ago, Al - Moderator said:

 

This makes me think you won't be happy with a hair transplant. I mean your beard is totally full. If you feel like you need to improve that then I wonder if you'll ever feel like you like the way you look. You are talking about a nose job, tattoos, beard issues. If your problem was just your hair then I'd say go ahead and get a hair transplant, but it sounds like anything you do, you'll want to change something else because you don't feel like any of it fits together. A hair transplant is not perfect. You sound like someone who would definitely be focusing on each hair strand and why you feel like it's out of place. Then if you remove that hair you'll feel lopsided and want other surrounding hairs removed or some added, etc etc.

Maybe I'm wrong, but if I were you I'd do some serious thinking about what is actually bothering you.

 

Hi, as mentioned in my post I am during therapy at the moment. I realize that losing my hair has caused or exacerbated some body dysmorphia. Never really had much issues with my look before losing my hair. I was actually very happy with my look up until my hair loss. And I almost feel that theraphy mostly has led to a recognition that hair matter a lot to me (vain or not, that is just how I feel about it). 

That is why, in the comment your refer to, I try to explain that I think tackling the hair loss would be the best option and the one I would be most happy with, instead of trying to compensate (which I see a lot of bald men do).  

I am in a situation and age where I know it will not be perfect and it will not be as when I was 18 again. That is totally fine for me by now. 

I guess my fear is related mostly to scaring and "failed" hairtransplants. Not so much where the individual hairs are places. I do however see some transplants that looks obvious to the eye, and that would off course be an issue (which I think it would for most). 

That is why I will try medication until all options are tried... it doesn't look so bright by now, as lots of things gives me side effect. But a few more to try out 

 

Link to comment
Share on other sites

  • Regular Member

If you can tolerate the meds, then I would hope you donor and hair characteristics could help to get you a really good outcome.

However, I do worry about it not meeting your expectations.

For high density you'll usually need two passes. Is that something you would consider (12 months apart)?

It's also important your choose a surgeon who can meet your needs. In general, the more experienced surgeons who deliver consistently high quality work cost more money. There are a few surgeons who have a reputation for excellent dense hairlines that I would investigate it your position.

Do you have any surgeons in mind? 

Edited by BackFromTheBrink
  • Like 1
Link to comment
Share on other sites

  • Regular Member
3 hours ago, BackFromTheBrink said:

If you can tolerate the meds, then I would hope you donor and hair characteristics could help to get you a really good outcome.

However, I do worry about it not meeting your expectations.

For high density you'll usually need two passes. Is that something you would consider (12 months apart)?

It's also important your choose a surgeon who can meet your needs. In general, the more experienced surgeons who deliver consistently high quality work cost more money. There are a few surgeons who have a reputation for excellent dense hairlines that I would investigate it your position.

Do you have any surgeons in mind? 

Thank you for the answer ! 

I do think that I can accept less density as In my position (with both dad and gandads being bald) I cannot have such high expectations. For the same reason I understand that I will most likely need more transplants during my lifetime. 

At the moment I am saving up without any specific place in mind and I would use meds for about 1-2 years before any transplant, so I am sure I can tolerate and stay on it long term. I have however been mostly looking at places within the 5-7.000 USD range and I would do it outside my homecountry (northern Europe). 

I have gotten evaluations from Eugenix, Dr. Felipe Pittella, Cosmedica Clinic (istanbul) and Dr. Koray Erdogan (Asmed) just to understand different prices and graft suggestions. 
 

Link to comment
Share on other sites

  • Regular Member
4 hours ago, Justlikeheaven said:

Man, you have the absolute perfect head shape and beard growth to rock the bald look perfectly. I know it's not what you asked, but I'd go with that rather than the long painful road of trying get your hair back. Only reason I did is I can't pull off the look at all. 

Thank you! I am sometimes leaning towards it. I shaved twice now, with approx one year in between. 

My issue is that I end up not liking the look much.... I feel alien, like it is not me and that I guess the "idea" or version of myself, that I have in my head is someone/something else. 


I just find hair more attractive really, but in myself and others. But I see your point of it being a painful and costly process of keeping it. I am mostly concerned with long term use of DHT lowering drugs. But I will give Dutasteride a shot

Link to comment
Share on other sites

  • Valued Contributor

@Rapunzel2024 If you take a 5ari and it stabilizes your hair loss then yes you are in a good position for surgery. My concern moreso is will you be happy though? Will you be then focusing on the hairline height, the density (or lack of it)? Will it lead you to wanting more surgery? I only mention this because you said that you suffer from anxiety and that you are self critical. Being a candidate for surgery is more than just having an excellent donor, etc. It’s being informed of all the things that can go wrong and making an informed and educated decision. All the best. 👍

  • Like 2
Link to comment
Share on other sites

  • Valued Contributor

@Rapunzel2024 I went for therapy when I had my first punch graft botched hair transplants and it was the best thing I could have ever done at the time. It made a huge difference in my self esteem and confidence in my late teens/early twenties. 👍

  • Like 1
Link to comment
Share on other sites

  • Regular Member
1 hour ago, Rapunzel2024 said:

Thank you! I am sometimes leaning towards it. I shaved twice now, with approx one year in between. 

My issue is that I end up not liking the look much.... I feel alien, like it is not me and that I guess the "idea" or version of myself, that I have in my head is someone/something else. 


I just find hair more attractive really, but in myself and others. But I see your point of it being a painful and costly process of keeping it. I am mostly concerned with long term use of DHT lowering drugs. But I will give Dutasteride a shot

You're welcome. I personally think you'd look better bald and with a beard than a hair transplant, especially if you bulked up. But I get it, not everyone likes or wants the shaved head look, at least for themselves. 

It seems you have a decent crown area so you'd have to just fix the hairline, easily doable and you could have great results, but you should decide on what meds you are able to take if any before you go through with it. 

  • Like 1
Link to comment
Share on other sites

  • Regular Member
On 10/30/2024 at 3:03 AM, Rapunzel2024 said:

Using "mesodut" topical dutasteride (0.025%) from anagenica with microneedling since May (following a study:https://smj.journals.ekb.eg/article_42083_24b61cbba4be9982db23c318414034c0.pdf). Unsure if it’s helping, but shedding continues, and may cause mild side effects post-application 4-5 days

I've been told shedding continues for up to a year. 

I've been on it almost 5 months still shedding

Fingers crossed

  • Like 1
Link to comment
Share on other sites

  • Moderators
On 11/2/2024 at 9:55 AM, Rapunzel2024 said:

That is why, in the comment your refer to, I try to explain that I think tackling the hair loss would be the best option and the one I would be most happy with, instead of trying to compensate (which I see a lot of bald men do). 

 

I do understand this part. I always felt the same way. Over the years I had a lot of people telling me to just shave my head or grow a beard, but that's not for me. I know what I look like with hair and without hair. I'd much rather have hair.

 

  • Like 1

Al

Forum Moderator

(formerly BeHappy)

I am a paid forum moderator for hairrestorationnetwork.com. I am not a Dr. and I do not work for any particular Dr. My opinions are my own and may not reflect the opinions of other moderators or the owner of this site. I am also a hair transplant patient and repair patient. You can view some of my repair journey here.

Link to comment
Share on other sites

  • Regular Member
14 hours ago, anon493 said:

I've been told shedding continues for up to a year. 

I've been on it almost 5 months still shedding

Fingers crossed

Do you get actual mesotheraphy dutasteride injections ? or the same as i use -the 0.025% "mesodut" solution from anagenica and do the microneedling electric pen 1-1.5 mm. 

I did not know that shedding could last a whole year on it. 

 

You dont take anything orally ?

Link to comment
Share on other sites

  • Regular Member
16 minutes ago, Al - Moderator said:

 

I do understand this part. I always felt the same way. Over the years I had a lot of people telling me to just shave my head or grow a beard, but that's not for me. I know what I look like with hair and without hair. I'd much rather have hair.

 

Yes.. exactly my point. I actually do think most men would prefer that, however I also see how and why some men just accepts it an roll with the bald look to avoid side effects, money spend etc. - I am mostly debating with myself what I personally want to do. But no doubt having hair again would boost my self confidence and positive feelings about myself

Link to comment
Share on other sites

  • Regular Member
3 hours ago, Rapunzel2024 said:

Do you get actual mesotheraphy dutasteride injections ? or the same as i use -the 0.025% "mesodut" solution from anagenica and do the microneedling electric pen 1-1.5 mm. 

I did not know that shedding could last a whole year on it. 

 

You dont take anything orally ?

I take it orally

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...