Balding Blog

I understand the reason people say you must go on fin, is to stop their hairloss. But I really want to keep my libido. Lets say I get a transplant and don’t go on finasteride. I probably could have a nice hairline for a few years, then I will start to look weird. But I’m pretty much content with shaving it short once I’m older. I don’t care if I have good hair from mid 30s and forward. I feel like its OK to be bald then. I just want the rest of my youth with good hair. What is your thoughts on this? Also my main problem is receding sides. And its been that way a very long time.

Hair transplants should wait until you are at least 25, in some unusual circumstances this timeline can be moved forward. At 25, with a good HAIRCHECK instrument check, I can predict your eventual balding pattern with some degree of accuracy. With this information, I create a MASTER PLAN for your hair loss management and if that management includes surgery, then the plan will address a ‘what if’ you should continue to bald.

Unless you are going to have a very advanced hair loss pattern, the constant hair transplants every two years is not probable and if you are going to develop a very advanced pattern of balding, a totally new discussion must be undertaken with your doctor. The concept of a MASTER PLAN is like everything in life. An architect can’t build a building without a Master Plan, nor can an army wage a war without it. The doctor who builds your MASTER PLAN will be making a commitment with you and that should assuage your fears.

I have been doing such planning with patients for 27 years in this business and I can’t tell you how many of my patients are grateful for the openness and honesty that comes with selecting the right doctor. The good news is that there are many such doctors out in the world who care about people like you. Do your homework and explore the process. I offer monthly open house events where people like you can meet people like you who have been where you are and you can see what has transpired since they made the decisions that are before you now.

The following journal article seems to address this problem: https://onlinelibrary.wiley.com/doi/pdf/10.2164/jandrol.109.009381

In summary, a 1-mg dose of finasteride does not appear to adversely affect spermatogenesis. In addition, the level present in the ejaculate of patients taking 1 mg appears to be negligible. Thus, there does not appear to be any need to stop 1 mg of finasteride in those patients trying to conceive or in those whose partners are pregnant.

The following summary seems to address this issue: https://onlinelibrary.wiley.com/doi/pdf/10.2164/jandrol.109.009381. The conclusion written by the drug company (Merck) is as follows:

In summary, a 1-mg dose of finasteride does not appear to adversely affect spermatogenesis. In addition, the level present in the ejaculate of patients taking 1 mg appears to be negligible. Thus, there does not appear to be any need to stop 1 mg of finasteride in those patients trying to conceive or in those whose partners are pregnant.

Going out of the country for an FUE is not a great idea. The results may not be predictable, there is no accountability for the doctor and the risks of anesthesia may be significant in the wrong hands. Deaths have even happened, even in the US. We have been doing FUE longer than anyone in the world, having invented the FUE procedure and the hair transplant robot. Experience counts. Would you to to the cheapest heart surgeon or brain surgery to save a buck? https://www.youtube.com/watch?v=sisfX3XBmOw

I have been on Finasteride for 4 years and my hair didn’t really change much. I did, however stop the drug for the past two months, but am back on now. 1) could my hair have changed in those two months? 2) what pattern do I appear to be? 3) a reputable IAHRS surgeon consulted me and recommended 1200 graft FUE , what are your opinions on that?

If you trust your doctor then go with it!
The Internet is not a place to receive a second opinion.
If you would like a second opinion it is best to consult with another doctor in person.

Photo(s) are not a good way to determine if you are balding or if you “need” surgery for the following reasons:

1) There is no way to know your history in detail. This involves a dialogue between a doctor and patient. A consultation usually involves 30 minutes or more.
2) There is no way to examine your hair under a microscope to understand how much miniaturization you may have (to plan for a possible surgery). What will you do if you have further recession or balding after the surgery? Are you prepared to have another surgery to fill in the gaps? You need a Master Plan.
3) Photos do not convey your understanding or expectation of a hair transplant surgery. Someone with your hair loss may be happy with 1200 grafts. Another person with the exact same hair loss may not be happy with 1200 grafts.
4) Photos do not convey your goals. Someone with your hair loss may want a drastically low hair line where 1200 may not be enough. Another person with the exact same hair loss may want a very conservative hair line where 1200 may be too much.
5) FUE or Follicular Unit Extraction is just a harvesting technique. It has nothing to do with the end result. In fact FUE may give you a suboptimal result over a FUT (Strip) surgery. Did your doctor tell you this?
6) etc

The question of density by itself makes sense as the size of the balding area dictates the planning. However, density is only one of the considerations. Your donor density relates to the size of your balding area, so a skilled doctor needs to plan the reconstruction of these parameters as well as other factors such as hair thickness, the waviness of your hair, and the color contrast between your hair color and your skin color.

Money is not a problem if I need a hair transplant. Can you transplant me so that I can keep my youthful look which is critical to my acting career if my balding keeps going?

Money may be your greatest enemy as some doctors will want to take your money and not look to your future welfare. What you need is a Master Plan with a good doctor. You can expect to develop a mature hairline in the next few years and this is not balding. I generally recommend that you start off with HAIRCHECK instrument test that will tell you if there is ANY early balding. If the test is positive for early balding that the eye can not see, then you will need a medication protocol to slow or stop the balding. Hair transplants are NOT an option for men of your age as the future balding pattern, if you are balding, does not show up until you get into your 20s and can’t really be predicted until you are at least 25, so a Master Plan for the balding person must take into account the progressive nature of hair loss and how far the balding will go because for hair transplant treatments, the donor supply is finite (limited) and it must be used judiciously so that you never have a half finished look (like running out of paint if you painted your car so that the car will never be normal looking).

https://www.wsj.com/articles/losing-your-hair-why-this-solution-is-no-longer-shameful-11582299915?mod=itp_wsj&mod=&mod=djemITP_h

HAIR UNAPPARENT The celebrities and pop-culture icons to the left have been Photoshopped to remove some or all of their hair. Can you still recognize them?

ILLUSTRATION: SEAN MCCABE; GETTY IMAGES (CELEBRITIES)

Researchers have found that a molecule called «oncostatin m» is what keeps the hair follicles in a dormant stage.

Vixarelimab is a drug that is supposed to be used for a skin condition called Prurigo nodularis. It is a oncostatin m receptor blocker. My theory is that this drug can block the oncostatin m molecule which comes from JAK-stat5 signalling. And thus it may «wake up» the dormant hair follicles.

Oncostatin M blockade with vixarelimab were supposedly well tolerated and no adverse effects were found under clinical trials.