Yes, 21 is too young for a hair transplant because you will not know what is your eventual balding pattern at 21. If, for example, you transplant a receding hairline at 21, and then should develop significant balding by the time you are 26, you will have hair where the transplant was done and nothing behind it (looking weird). IF for example, you have crown balding at 21, and transplant the bald area in the crown, by the time you are 26, you might have an island of hair surrounded by a ‘bald sea’ and then you would really look weird and everyone would know what you did. Everyone needs a Master Plan for balding created by you with a good doctor who thinks ahead to anticipate what you and he might do as it reflects the progressive nature of your balding that is the consequence of ‘genetic male patterned balding’. I have seen too many freaky looking transplanted men who never created such a Master Plan with their doctors. I have written about this here:

Hairs in the frontal part of the hairline show slightly more vellus hairs which appear small and fine and this is what you may be looking at. Miniaturization throughout the head and scalp is less than 20% of the hair population, something I have published in medical journals. See Here:

Your family experience is just that, your family experience; however this has been well studied that inheritance is approximately 50/50 from the mothers and fathers side. This has been studied across a large population to determine this. It actually may favor the female side of the family by a little less than 1%. The is the story that I tell:

‘A bald man who sees his son balding, lectures his wife about the poor genes that she gave him and blames her for her son’s balding’. This is a male chauvinistic view of some men in some cultures

I don’t know for sure but I suspect that you are correct. We know that females generally do not get the receded mature ‘male hairlines’ that men do. Could this be caused by genes related to our sex alone or is it that two X chromosomes with the high estrogen levels in females protected against the mature hairlines. No one has been able to study this. These hairs in the zone between the juvenile and mature hairline certainly have an ingrained number of hair cycles which then produce ‘apoptosis’ (cell death) of these hair cells possibly triggered by testosterne,

“I am almost 1 year since my hair transplant and I am very disappointed with the results”. I have heard this before. Setting proper expectation that are realistic is critical between the doctor and the patient. From what this patient told me in his email, he did not elaborate why he was disappointed so I would assume that either he did not get the growth of the transplants (reflecting some time of procedural error) or that his expectations were not realistic and his result may have been what the doctor promised but not what he expected. I always recommend that the patient return to the doctor who did the work and discuss the result, the expectations, etc… If there was a failure of the procedure to any significant degree, the doctor should be honorable and MAKE IT RIGHT to the patient’s satisfaction. I would do that if I were the doctor.

This is a terrible question as it reflects a doctor who is not ethical and a patient who is naive. A 21 year old might have early crown hair loss and frontal hairline loss along the hairline (Called a Norwood Class 3 Vertex pattern) which is not uncommon in a young man under 23 years old. Most of these men can stop their hair loss on the drug finasteride, but of course the doctor can’t make money that way, so this poor fellow had a hair transplant and will be destined to continue having hair transplants until is final balding pattern is evident (about 26 years old). If he does not have the donor density for this, he will look freaky as he runs out of hair chasing possibly the impossible. Ethical doctors are in the business so if you are under 25 and have hair loss, see on of the ethical doctor who does not rush you into surgery to pay for his new car.

Norwood Class 3

These are the problems that you may not be aware of. Please be cutious when asking your doctor for Testosterone replacement which many more men seem to be taking today.
1- Thromboembolisms from deep vein thrombosis can not only impact the circulation to your legs, but also kill you if a clot is dislodged into your lung.

2- Increases your risk of heart attack and stroke with a poor outcome for those men on this drug. For men over 65, the risk doubles or triples for such complications

3- Increases your hair loss in every man with genetic hair loss

4- Decreases the size of your testicles and may impact your other glands including pituitary gland (master gland for the body).

5- Possibly increases the risk for developing hypoxia and sleep apnea

The indications for use is known clinically significant low testosterone possibly caused by hypogonadism (small poorly-working testicles) and it should be done under a doctor’s management.

In Medscape today, there is an article with the warning of the above title. “There are a number of pitfalls for patients, noted study co-author Douglas Sipp of Keio University School of Medicine in Tokyo.

“It is a problem for patients because there are inevitable risks in any invasive procedure, the vast majority of stem cell treatments being advertised online show exceedingly poor evidence of efficacy, they are costly and not reimbursed by most insurance, and more generally, the waste of time and resources on over-promoted quack remedies diverts these away from investment and use of in scientifically credible medicine,” Sipp said by email.”

In the hair industry, more and more such clinics are appearing almost weekly. There are two important issue: (1) the risks may not be inconsequential to your overall health and the health of your scalp and hair, and (2) they will be fleecing you for the money in your pockets.

This is my math: 6000 donor follicles available. Average head has 100000 hairs. Can lose 50% of hair density before it’s visible. Say a norwood 6 loses 60% of their hair (40% left on sides) that’s 60000 hairs. Need 30000 hairs replaced to reach 50% density and look like a full head. Average graft 2 hairs. 15000 grafts = 30000 hairs would look like a full head. Could sides be over harvested from 6000 to 10000 to replace 20000 hairs? 2/3 of full apperance. Sides clipped to no1 with SMP to cover overharvest?

Answer: ?Your math is partly right. The donor area is always determined on the Class 7 scale not the Class 6 scale, which essentially reduces the donor area to about 20,000 hairs or 10,000 grafts, which can be harvested at say 60% assuming that you have an average donor density. Graft numbers are adjusted according to hair weight (coarse vs fine), color and contract between hair and scalp and hair character. The artistic judgment of the surgeon manages the multi-variant analysis as everything is not by the numbers alone.

?The law in most states forbid a surgeon from a guarantee for any surgery. Think about it, if you had cancer and your surgeon guaranteed that he would cure you, that is impossible and illegal. So a hair transplant is the same thing; however, any good doctor should warrant his work regardless of the fault. If there is some failure of any part of the hair transplant process, or any complication that should arise, I am always good to make it right. I want patient satisfaction 100% of the time

The use of Scalp Micropigmentation with these conditions do not require that the disease is inactive as the depth of the SMP when done correctly in skilled hands, does not penetrate the skin more than .75mm, which is too shallow to impact these diseases. See here:

A good surgeon can keep the recipient making instrument apart from the normal native hairs which he/she should be able to see when the recipient area sites are made.? Magnification and good lighting during the surgery allows the surgeon to see every existing hair without shaving the head. If you have it done with the robot with site making, the head must be shaved and then the robot watches out of the existing native hair, just as a surgeon would do.

Maybe you are one of the lucky 5% that start growing immediately and keep growing without going through the shedding phase. I see this and the patients who have this happen usually have a full head of hair by the 4th month, much earlier than normal.

If you are local to my office in California, visit me so that I can perform a miniaturization analysis of your hair throughout the front, top, crown, back and sides. IF you have miniaturization on the sides and back, then you may have Diffuse Unpatterned Alopecia, something we published about in 1996. This is a difficult problem to have as you are then not a hair transplant candidate. I wrote about how people can find out for themselves in a post where I stated: “Amazon has started to sell a Digital microscope with magnification up to 500 times normal. This allows a person like any reasonable balding person, to examine his own hair and look for miniaturization. I need to give you all some help on how to do this. First purchase a digital microscope on Amazon ($16.95), then look up on Amazon Digital Microscope (the one I purchased can be found here: Look it up to your computer and then you can place it on your scalp and examine your own hair. You don’t have to be a doctor with a good digital microscope in your hand.”

You can send me photos of what you get from this instrument and I will be happy to review them for you if you are not local. Write to me at:

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?