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  1. #1
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    Default Opinions on HT without finasteride

    I'll save you the long-winded story and just present the facts.

    - Age 37, NW 2, hairline a bit choppy (see explanation below), otherwise very good head of hair with no detectible loss

    - family history mixed, no slick baldies, brother, uncles, and cousins all have perfect hair, dad is thin on top but with no crown recession, one grandpa had good hair, another had very receded hairline

    - been OFF finasteride and minox for four years due to a neurological problem, have seen minor thinning in the hairline over that period but nothing on the top or back of the head (*knock on wood*)

    - getting PRP treatments with Dr Greco every six months, using laser therapy 3 times per week, and also some natural stuff - don't know if it's working but my hair looks pretty good and loss is very slow right now

    - got roped into a bad HT when I was a kid when my hairline matured, looked bad as I got older, had Dr. Feller and Dr Cole remove the hairline grafts via FUE punch over several sessions a couple years ago

    So, after my HT reversal, I look pretty good considering everything, but my hairline is a little choppy and seems to be very slowly thinning. There is also a little bit of white scarring which doesn't look terrible but may become more evident if I continue to recede. So, I am thinking of getting a small procedure to refine my hairline, but have always felt like doing any HT surgery without finasteride was a bad idea. I wouldn't have even considered it 10 years ago, but given my age and my rate of loss, I'm thinking maybe I should just go for it.

    Any thoughts or opinions?

  2. #2
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    Default

    Also, money is not an issue and I can afford as many additional procedures as I might need.

  3. #3
    Doctor Representative 35YrsAfter's Avatar
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    Quote Originally Posted by ryan555 View Post
    Also, money is not an issue and I can afford as many additional procedures as I might need.
    ryan555, when were you last in to see Dr. Cole? At 37, Norwood 2, with little hair loss in you family, you should be able to accomplish your goals without any issues. Is your donor hair in good shape?

    A wild stab at the percentage of our patients who don't use oral hair medication like Finasteride is somewhere around 60-70%. Dr. Cole told me a while back that a patient who has a reaction to Finasteride may not necessarily have the same adverse reaction to Avodart. Avodart is more powerful but most guys I have talked with only use a fraction of the capsule. Just a thought.

    I see great results with patients who don't even use Rogaine. Finasteride should support the longevity of the grafted hair. The "permanent zone" is not so permanent in some men. For instance my donor was very thick when I was in my late twenties. It thinned a bit since then. In 2003, I used Allegra, Ibuprofen and glucosamine + chondroitin. Not a good combination for me. Made my hair look bad to the extreme.

    Less potent but natural alternatives to Finasteride may be of benefit.
    Last edited by 35YrsAfter; 02-22-2015 at 05:09 PM.

  4. #4
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    Quote Originally Posted by 35YrsAfter View Post
    ryan555, when were you last in to see Dr. Cole? At 37, Norwood 2, with little hair loss in you family, you should be able to accomplish your goals without any issues. Is your donor hair in good shape?

    A wild stab at the percentage of our patients who don't use oral hair medication like Finasteride is somewhere around 60-70%. Dr. Cole told me a while back that a patient who has a reaction to Finasteride may not necessarily have the same adverse reaction to Avodart. Avodart is more powerful but most guys I have talked with only use a fraction of the capsule. Just a thought.

    I see great results with patients who don't even use Rogaine. Finasteride should support the longevity of the grafted hair. The "permanent zone" is not so permanent in some men. For instance my donor was very thick when I was in my late twenties. It thinned a bit since then. In 2003, I used Allegra, Ibuprofen and glucosamine + chondroitin. Not a good combination for me. Made my hair look bad to the extreme.

    Less potent but natural alternatives to Finasteride may be of benefit.

    35YrsAfter also posts as CITNews and works at Dr. Cole's office
    forhair.com
    Cole Hair Transplant
    1070 Powers Place
    Alpharetta, Georgia 30009
    Phone 678-566-1011
    email 35YrsAfter at chuck@forhair.com
    The contents of my posts are my opinions and not medical advice
    Please feel free to call or email me with any questions. Ask for Chuck
    Thanks for the info. It's probably been about 3 or even 4 years since I saw Dr Cole. After I had to stop taking fin, I assumed that I'd be bald in a year and decided to just have the crappy old grafts removed and own it. To my surprise, the thinning was very slow and not very severe, though I am still glad I had Drs Cole and Feller reverse it as I now have an age appropriate hairline and not that of a 12 year old Asian girl.

    It's very interesting that so many of your patients don't take meds. Do you tend to see a lot of shock loss with these guys? Also, would the fact that I had no shock loss following the FUE removals predict less shock loss from a transplant in the same area?

    Maybe I'll head out to Atlanta soon and let Dr Cole give me his two cents. My donor is still very good minus the shitty scar left from the first surgery (though Dr Cole re implanted the extracted hairs and it looks much better now). I honestly have seen no difference in any part of my scalp since I stopped taking fin, except for about the first centimeter of my hairline. I've even had the microscope placed on there and been told things look pretty good. Still, I want to be very conservative after what I went through before, and because I've already lost about 1,000 grafts to my prior mistake.

  5. #5
    Doctor Representative 35YrsAfter's Avatar
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    Quote Originally Posted by ryan555 View Post
    It's very interesting that so many of your patients don't take meds. Do you tend to see a lot of shock loss with these guys? Also, would the fact that I had no shock loss following the FUE removals predict less shock loss from a transplant in the same area?
    During the time I have been a patient and have worked at Dr. Cole's, I can't recall any patient experiencing shock loss. Minimal depth FUE doesn't appear to impact the hair cycles of the surrounding hair in any noticeable way. I did meet a young man who was in for a strip scar repair consultation several months ago who experienced shock loss. His shock loss was temporary. Shock loss is seldom permanent but I know it's a pain. When I was in my twenties, I had an MPR (Male Pattern Reduction - scalp reduction) and the miniaturized surrounding hair disappeared for about a year.
    Last edited by 35YrsAfter; 02-22-2015 at 05:08 PM.

  6. #6
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    ryan,

    A fair number of docs would ideally like to see their mature male patients start finasteride well ahead of any planned HT procedure in order for the active ingredient to have the full benefit of inhibition of DHT.

    At least six months of ingestion as prescribed should in most men demonstrate whether or not the progression of MPB is stabilized. And even without long term clinical substantiation by competent medical professionals, not necessarily the manufacturers, I have observed a higher percent of men that do experience success with stabilization including post-op shock loss.

    Even so, shock loss can still occur and is unpredictable even to those men who are having good success with the drug.

    I am still of the opinion however that the correlating trauma from the countless extractions and incisions along with the fluids injected into the scalp are the source of the accompanying post-op shock loss.

    Your case IMHO is more favorable because your planned procedure is not large and being that you are going with one of the best FUE surgeons world-wide, your potential success is optimal both in terms of post-op shock loss and the end result of enhancing your hairline.

    Obviously many of the grafts will be single hair FUs so you may not get as much visual gain in coverage yet at your present age and educated mind, your expectations will no doubt be in sync with your goals.

    Best wishes to you and enjoy the transformation that awaits you...
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Bob True & Dr. Bob Dorin

  7. #7
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    Thanks for the replies. So my next question would be the old FUE vs FUT debate. I already have a strip scar so I can't cut my hair super short anyway. Won't going FUT give me a slightly higher yield and allow for more future grafts if I need them? I want to be very careful in conserving as many grafts as possible since I'm already down about a thousand grafts from the chain store surgery I had in the 90's. I need to prepare for the worst case - I end up a NW 5 at some point and no future treatments become available.

  8. #8
    Senior Member gillenator's Avatar
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    It really comes down to the competence of the surgeon and the adequate amount of scalp laxity to accommodate another strip if you elect to go that route.

    I'm not suggesting that you do another FUHT but if you do go with FUE, go with the proven surgeon that you are already considering...
    "Gillenator"
    Independent Patient Advocate
    more.hair@verizon.net

    NOTE: I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice nor are they the opinions of the following endorsing physicians: Dr. Bob True & Dr. Bob Dorin

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