New Here, Advice Sought

[SlowlySurely]

Hi all.

Apologies for what may be a typical initial post. Will try to be as brief as I can while offering the relevant info.

I've done the required reading, still I'm of the "never hurts to ask" mindset and any feedback is welcome.

I'm male, pushing 50, very fit living a fantastic life. I have what most would call long and awesome hair for a man. About 20 years ago I was starting to thin in the crown, and that went away with finasteride. I'd taken finasteride on and off since then, as well as 5% minoxidil. Sometimes skipping days or weeks, even a couple months between prescriptions, generally using the products every other day. I do think it helped. Never any side effects.

Four years ago through summer I experienced severe shedding and obvious thinning overall. Not just less hair, but the hair follicles had thinned. Typically I had at least average, probably thick follicles. The ones falling out, and much of what remained, was very thin.

Once I realized this wasn't typical shedding, in the fall I went to a top hair clinic and after nearly laughing me out of there - most of the nurses would probably have traded hair with me - I was prescribed Apo-Dutasteride in the lowest .5mg dosage. I asked for this since I'd read it's better (more comprehensive) and was already taking finasteride.

Like magic it worked! Or so I thought. I went from the symptoms you're all probably familiar with - pillows and sinks and shirts of hair - to nothing. For 6 months or so, into the spring, I couldn't shed a hair if I tugged on it. Not one hair when vigorously shampooing, not one hair on white sheets in bed, etc.

Springtime it started again through summer. Worse this time. End of summer - by October or so - it tapered off and went back to zero. This coinsided with me trying platelet injections in the scalp. I just wanted to try to so something/anything that might help. Following year the same.

I'm taking the right vitamins, etc. etc. I do participate in very rigorous sports in summer, in a lot of sunlight (which I love). I thought maybe I'm shocking my system - lot of impact, odd meal times, hot sun - and figured this year I'd scale it back. Due to an injury I took most of the winter off serious sports and ...

This year it's starting again, and I'm only one more summer's shedding away from making it very obvious and maybe having to consider head shaving, or surgery.

I still look great - probably the fact that I have longer hair covers up some of the thinning - and I still get compliments from women specifically on my hair ... though I'm tall so they might not see or know the obvious signs. But it's getting to the point where if it gets worse it'd be obvious if I reversed it with surgery - if that's even possible - and if it's obvious in my world-view then it's not something I'd want to do.

May hair line is unchanged, and I think I described and have this - https://www.americanhairloss.org/typ...ffluviums.html - Telogen Effluvium.

This part especially hit me: "This temporary increase in the number of telogen hair follicles and shed hair is probably due to changes in hormones in response to changes in daylight exposure."

Thing is though, I've barely had any sunlight exposure or much physical training/sports so far this year, yet about two weeks ago shedding started again out-of-the-blue ...I'd swear I hadn't shed a hair in 5 months... and what's more the hair follicles are exceptionally thin.

So ... any thoughts, comments, etc.? Is this even balding?

If considering surgery, does anyone have an opinion or preferably experience with the robotic machines vs. humans? I can easily visit a top surgeon, but the robotics seem more bang-for-the-buck.

Also, can surgery be performed with long-ish hair or is shaving the head part of the procedure? I'm partly of the mind that if I had to shave it once I might as well stick with it, though I generally don't like to shave.

Much thanks.