The good hair conundrum

[hairofthedog]

So basically, here's my situation. I'm 27 years old and first noticed signs of balding about 4 years ago. I usually have my hair long and had cut it short for once. I can actually remember seeing my reflection in the mirror behind a bar and thinking that my hairline had changed a bit. After that it took me over a year to accept that I was actually at the early stages of MPB. For that first year the loss was negligible enough for me to convince myself that I wasn't.

Since then I've always had my hair long (how I prefer it) and no one is really any the wiser that I'm in the norwood 2.5ish sort of territory. To paint a picture, my hair is similar to that kid from One Direction, Harry Styles. The problem is that- and I know this might sound like a bit of an arsey thing to say to people who are much more advanced than me- it's not just a cover up job I'm doing, people actually compliment my hair all the time. Great, you may think, but it's not such a great thing when you know that the amount of time you will be able to have your hair styled this way is a lot more limited than you'd like it to be. I don't know how long it will be before this style will start to look like some ridiculous comb over. As you all know, a lot of the mental stress caused by MPB is not just the current state of your hair but the fact you know it will only get worse.

Meds are my solution, you say. Unfortunately I'm already on them. Been on propecia for almost a year now. Side effects, much to my relief, have been minimal but it also seems primary effects have been as well. Just to clarify, I have no baldness on my crown and still have none. Maybe the propecia is stopping me from being bald there already, I don't know. For my hairline though, things have progressed pretty much at the same speed as they were before. Slowly but surely getting worse. I'm also using rogaine on my hairline and even the combination of the two seems to, as of yet, be ineffective.

Anyway, what should I do? I'm slowly but surely coming around to the idea that I may have to have a hair transplant in the future. I can accept that, though the mammoth cost is pretty off-putting. What I don't want is to have a transplant then to carry on losing more hair and need another one a couple of years later. I can't afford that and also don't want it to dominate my life in that way.

Someone, please give me some advice! HELP!

[Pboy101]

Do you have pictures of before photos? I'm talking about the times when you were NW0 -> NW1 -> where you are now. Our memories and intuitions are not to be trusted because we are naturally pessimists once we realize we have hair loss; trust only photos. While Rogaine will help regrow some hair, finasteride usually will do the trick in stopping hair loss. If it doesn't upgrade to Dustasteride and that will almost guarantee stoppage of hair loss as it's much stronger then fin. Good luck.

[ParanoiaDestroya]

You and I are in very similar situations, my friend. In two weeks I will be 26, and I've been on finasteride going on 7 months. I have no idea if it's helping, nor do I have an actual diagnosis of genetic alopecia. My doctor gave it to me on the basis of my family history alone. I asked to see a dermatologist, but he wanted to skip that step. That was a bad idea. But I too went through the phase where I could half-plausibly deny it in my mind. I may still be there, though I feel like that's not the case at this point - hence the medical intervention.

In terms of advice, I am not quite sure what you should do. Some have increased their dose of finasteride while others have gone on dutasteride (which is off-label, so it may or may not be trickier to get a doctor to prescribe it for genetic alopecia), and dutasteride is more effective, but the risk of adverse reactions is higher. Personally, I'd like to give finasteride a complete year, and if things seem to have gotten worse, I will consider dutasteride. I just hope a doctor would prescribe it for me.

But back to increasing the dose of finasteride. I know that Bernstein does this in his practice. After 3-5 years he will increase the dose to maintain his patients. Last I checked, there was no clinical data showing increased efficacy, but some showing no increased efficacy. I'm not aware if that's been contradicted up to here. Bernstein is generally very conservative, which is why I trust him more than any other doctor (that I know of) on this subject, and I imagine he increases the dose because anecdotal evidence from his practice shows increased efficacy. I would try it, personally. If that doesn't work, then dutasteride would be the last line in terms of medications if and until something else comes along.

If I were to get surgery, I would go to Hasson and Wong here in British Columbia, Canada. As you said, the cost is prohibitive, so I am hoping I don't go downhill, or at least too downhill, by the time I can get transplants. Then again, as you said, depending on your trajectory, effective medical therapy plus transplants is the ideal, to say the least.

The worst case scenario is that you would need a hair piece or hair system, which comes with its own issues and of course it's not your own hair. The idea is pretty depressing, even though I know that a decent piece is virtually undetectable. But at least you know that you never have to present to the world as bald. That's never the inevitable.

[hairofthedog]

Thanks for taking the time to reply, Guys.

I do have photos, though not keen to post, and there has definitely been some recession over the last couple of years. It will be a year in December since I started on Propecia. My plan is to keep taking Propecia and Rogaine for another year. If deterioration continues at the same speed I may consider just sacking it in and going for the buzzed head look. Although the thought of giving up on my hair does fill me with dread I think there is a part of me that would be greatly relieved to not have to worry about it any more. In a way it's not so much that I will look worse with my hair buzzed that worries me, it's that I fear I'll look boring. So many guys out there who are balding with their hair like that. I might compensate with a bunch of tattoos and muscles. Pretty transparent but oh well.

Not really considering Dutasteride or increased dosages as an option. The reason being I fear it's a slippery slope. If that doesn't work, what other crazy concoction will I go on to next? A lot of people out there seem to playing with fire with untested and unproven medication. I can feel the temptation myself to do whatever it takes at whatever the cost and feel that's a demon that shouldn't be fed.

[35YrsAfter]

Meds are my solution, you say. Unfortunately I'm already on them. Been on propecia for almost a year now. Side effects, much to my relief, have been minimal but it also seems primary effects have been as well. Just to clarify, I have no baldness on my crown and still have none. Maybe the propecia is stopping me from being bald there already, I don't know. For my hairline though, things have progressed pretty much at the same speed as they were before. Slowly but surely getting worse. I'm also using rogaine on my hairline and even the combination of the two seems to, as of yet, be ineffective.

Anyway, what should I do? I'm slowly but surely coming around to the idea that I may have to have a hair transplant in the future. I can accept that, though the mammoth cost is pretty off-putting. What I don't want is to have a transplant then to carry on losing more hair and need another one a couple of years later. I can't afford that and also don't want it to dominate my life in that way.

Someone, please give me some advice! HELP!

Since you can tolerate finasteride, I would stay on it. Just make sure you're getting finasteride from a reputable source as opposed to online without a prescription. Hair transplants usually aren't a one-shot deal. Hair loss is progressive so a good hair transplant of say 2,500 grafts should give you some relief for several years. If your hair continues to thin around the grafts, it will seem like you're back to square one, but that is an illusion because without a good transplant you would be much balder looking after several years of progressive hair loss.

35YrsAfter also posts as CITNews and works at Dr. Cole's office - forhair.com - Cole Hair Transplant, 1045 Powers Place, Alpharetta, Georgia 30009 - Phone 678-566-1011 - email 35YrsAfter at chuck@forhair.com
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