27 y.o. Male on Triple Therapy hoping to stabilise

[dothestrand]

I am 27 hoping to stabilise my hair loss for a potential future transplant.

I have been on finasteride for 3 years (pre-picture below), Minoxidil for 1 month (some shedding evident on right side below), and ketoconazole for 1 month.

My interpretation is that I am between a Norwood 3V and a NW4. Probably closer to NW4.

I have more advanced hair loss on my right side at the temple and crown compared to my left. Half way through a mild shed currently for Minoxidil.

I have lived with hair loss since I was approximately 20-21. It went through an initial increase when I lost quite a bit of weight at 21. It then increased considerably approx 21-22 (when I was taking Maximuscle protein shakes and going to the gym frequently).

I have further noticed more hair loss during exam periods (I have regular exams due to my career and will continue this through my life).

I can tell when I am losing hair as the scalp is warmer to touch than the surrounding areas and there is an itching sensation.

This past month since on triple therapy rather than just Finasteride have noticed only mild warmth in hair loss areas and no itch.

Aim:

Conservative hair transplant with good future reserve.

Plan:

Review triple therapy results in 6 months with hair transplant surgeon.

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Any help, advice, or suggestions for future treatment would be really appreciated.

Do you feel my hair loss is stable enough for a transplant?
Do you feel I am a good candidate for a transplant?

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Additional information:

Family history: Father Norwood 2/3 at 67 / Mother’s brothers all Norwood 6/7 in mid 40s and 50s.

Diet: Historically poor. Have improved past month with more fruit and vegetables in diet and taking vitamin supplements. No smoking. Drink alcohol socially.

Photos (attached):

1. Wet Hair April 2015 (at start of Finasteride monotherapy)
2. Dry Hair May 2018 (1 month post triple therapy hence slight shed)
3. Birds eye view with crown May 2018 (2.5 months into Minoxidil at crown so anticipate this should improve in 1-2 months)

Apologies the first picture is with wet hair - it’s the only picture I have at the time.

[mrclean]

I would wait and see what happens but it looks like you have stabilized it for now. I would wait as long as possible to have a HT to see how it progresses. Replicel is suppose to be out by the end of the year so that could benefit you if you can wait and travel to Japan.

[dothestrand]

I would wait and see what happens but it looks like you have stabilized it for now. I would wait as long as possible to have a HT to see how it progresses. Replicel is suppose to be out by the end of the year so that could benefit you if you can wait and travel to Japan.

Thank you for your reply!

From looking at the hair, and how it’s shed in response to Minoxidil, I have some clues as to the next 2-3 years. I feel it will likely continue to thin from the right side of the crown. It will also begin to thin across the right half of the widows peak. With some light diffuse thinning on the right side throughout. The left side will follow the same pattern but at a 2-3x slower rate.

Of course I have not seen the true benefits of triple therapy (or indeed if any benefits at all).

I am also 27 so until I’m 30-32 I cannot really begin to fully understand what I’m dealing with. This 2-3 years will be vital to watch and wait.

Living with a NW4 at my age for as long as I have does of course have an impact.

[mrclean]

Making a bad decision now on a HT can ruin your life and financially cripple you. I would wait as long as possible to see if any progression.

[dothestrand]

Making a bad decision now on a HT can ruin your life and financially cripple you. I would wait as long as possible to see if any progression.

Thanks again for the reply.

Financially I should be able to cope. It’s obviously not an ideal way of spending £7500 every 3 years at my age but I could manage it. So I am trying to take money out of the equation and just look at it on merit.

[mrclean]

Everyone is saying replicel will be available by the end of the year so that looks like it would benefit you.

[dothestrand]

Wanted to post some updates on my treatment.

I’ve been using Minoxidil for 4 months and here are my before (blue jumper) and after (yellow) pictures.

Twice a day foam application with ~85% compliance.

[dothestrand]

Having a small, highly conservative hair transplant this week. Will post with results.

Have also switched finasteride to dutasteride due to breakthrough symptoms this year of scalp itching/burning.

Have also loaded myself on vitamin D due to being severely deficient when I had a blood test.

Will post results next summer when everything comes together.