Dr. Robert Bernstein has put together a terrific group of before and after photos from people who used medications such as finasteride, without surgery. Look at this link: https://www.bernsteinmedical.com/medical-treatment/patient-photos/
These are great pictures. You have not developed a mature hairline yet as you have maintained much of your juvenile hairline, but there is a suggestion in the corners that you may be moving your hairline up in the direction of a mature hairline so this may not be balding as you may be transitioning into a more mature hairline. A hand microscope will help to see if you have miniaturization in these corner areas but wait this out as time is the best way to know. I rarely see men in this transition stage, so thanks for sharing these photos with me. Contact me in a year and repeat the photos, then we might know the answer to what is happening to you. The arrows show both the juvenile center of your hairline and the changing corners.
50% of men develop genetic balding at some point in their lives. Based upon age, the older you are without any evidence of balding, the less likely you will be in the 50% group of balding men but the genes for balding can start expressing this trait at any age. Rarely, I have seen men start balding at age 50 or greater.
It looks like the recipient wounds were larger than most surgeons use today and the wounds are further spaced out. There is some pitting reflecting some abnormal healing that may get better over time. These surgical techniques may cause increased healing time and they may not completely heal. When the grafts grow in, take a look at what it looks like. You can do another hair transplant with a doctor who does not use such large instruments in the recipient area and can pack in the grafts enough to hide any abnormality that is present.
I have been itching and trying to avoid scratching my head. I use minoxidil and various lotions but without effect. Suggestions??
Minoxidil is an irritant and it can cause problems, but itching can be a sign of healing. I recommend that you never scratch the graft area as it will cause grafts to come out and introduce the possibility of infection. The medications HPR + HydroGel work well for itching and you can get the reference from your doctor or call 1-844-genRx2u to get the medications.
If your hair is fine, the part looks more see-through than when your hair is coarse. It does not mean that something is wrong unless you believe you are losing hair. I always tell people that when I was young, the grown-ups would rub my short hair for luck when they saw me. They did this because my hair was coarse and there was no see-through to the scalp. If I asked you, I’l bet nobody ever did that for you and you agreed, that means that your hair is fine and fine hair never looks very full and the scalp is often seen through the hair.
Both topical and oral finasteride seem to drop the DHT levels. At the 0.25% topical dose, the drop in DHT was less than the oral; nevertheless, reports from some doctors in the field suggest that the sexual side effects still appear with the topical dose
Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27. doi: 10.5414/CP202467.Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia.
Abstract
OBJECTIVE:
The effects on scalp and serum dihydrotestosterone (DHT) of different doses of a novel topical solution of 0.25% finasteride (P-3074), a type 2 5?-reductase, were investigated in men with androgenetic alopecia.
METHODS:
Two randomized, parallel-group studies were conducted. Study I: 18 men received 1 mL (2.275 mg) P-3074, applied to the scalp once a day (o.d.) or twice a day (b.i.d), or 1 mg oral tablet o.d. for 1 week. Study II: 32 men received P-3074 at the dose of 100 (0.2275 mg), 200 (0.455 mg), 300 (0.6285 mg), or 400 (0.91 mg) ?L or the vehicle o.d. for 1 week. Scalp and serum DHT and serum testosterone were evaluated at baseline and treatment end.
RESULTS:
Change from baseline in scalp DHT was -70% for P-3074 o.d. and approx. -50% for P-3074 b.i.d. and the tablet. Serum DHT decreased by 60 – 70%. The doses of 100 and 200 ?L P-3074 resulted in a -47/-52% scalp DHT reduction, similar to the 300 and 400 ?L doses (i.e., -37/-54%). A -5.6% inhibition was observed for the vehicle. Serum DHT was reduced by only -24/-26% with 100 and 200 ?L P-3074 and by -44/-48% with 300 and 400 ?L P-3074. No relevant changes occurred for serum testosterone.
CONCLUSIONS:
The novel finasteride 0.25% solution applied o.d. at the doses of 100 and 200 ?L results in an appropriate inhibition of scalp DHT potentially minimizing the untoward sexual side-effects linked to a systemic DHT reduction.
Chest pain should always be evaluated by a doctor. Minoxidil, induces low blood pressure and that could bring on Angina, a heart problem that reflects limited blood flow to heart muscles. See a doctor as this drug may have saved your life if I am correct about your heart problem
Setting realistic expectations is critical when undergoing a hair transplant. This is a responsibility of both you and your doctor. Make sure that your doctor did not promise you are full head of hair as the picture shows a very thin look. Go back and speak with him about your pre-operative discussions and the results you have now. I always want my patients to be happy so I rarely promise them the world.
At 18, if you have a hair transplant, you will almost certainly accelerate the loss that you see and get a much larger area. Then you will transplant it again, and more hair loss will follow with then a 3rd transplant and on and on. At your age, the best treatment is the drug finasteride which may very well reverse this without surgery and slow down the development of more hair loss. Doesn’t that make more sense?
This is a complex treatment that involves both balloon expanders and hair transplants. It will take some time to expand the existing scalp and you should look for a surgeon with considerable experience in this type of repair. Everything is not hopeless as I am optimistic that you can make the entire balding area normal again.
I am 21 years old, what does this mean for my future?
This is a sign that you will probably continue to bald in the crown. The drug finasteride, can be applied and maybe reverse this. Try it as you can buy it in the pharmacy, Keep on it for a year at a minimum to get any benefits. IF it does not solve your problem, see a doctor
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