What The f*** Happened To Me. I Need Some Advice.

[Giiizmo]

First of, congrats on your successful dieting. Although anarchic, you've soldiered through and got results.

Now about your hair loss, there are a few things to keep in mind.

Any kind of severe stress (psychological distress, heavy surgery, extreme dieting) can trigger hair loss. Usually it manifests itself by telogen effluvium alone. However, such an episode of hair loss can greatly accelerate any underlying male pattern baldness that would have otherwise taken years if not decades to declare itself.

You should try to get a solid understanding of what's happening to you before even thinking about taking meds, let alone undergoing a hair transplant. Get some bloodwork done and check your thyroid function, your iron levels and DHT levels (although DHT is a poor indicator of what's happening since it could just be your androgen receptors kicking into overdrive).

If nothing pans out, get a small biopsy to rule out any other cause of hair loss (e.g. cicatricial alopecia). Male pattern baldness presents some unmistakable histological features that are easy to recognize with a biopsy.

Then, if it's really male pattern baldness, start thinking about a solution. Monitor its progression while taking enough time to weigh the pros and cons of each potential "solution" (several months at least).

Good luck.

 

[seanvandamme]

You can never predict the future with hair loss 100%, but I feel like it would thin further just not aggressive. My dad pretty much had a full set of hair norwood 2ish at 60.

Finasteride was to help thicken it up. If I did not care about thickening the thinner hairs, I would not get on Finasteride as I also was not shedding/thinning aggressively. Just know that most here would get on Finasteride to be on the safe side. To them the possibility of a low chance of side effects is worth it. Whether or not that's worth it to you is for you to decide.

I myself haven't exeperienced major side effects.

I haven't consulted for Hair transplant, but yes class A are good candidates.

So it's really a tradeoff then. Thank you so much for your advice. I think I'll skip finasteride until the slightest symptom manifests again. Spending money on something that isn't actively treating an active condition doesn't sit well on me. What's preventing you from getting a hair transplant if you consider yourself to be a good candidate though? Costs? Would you consider one if your hair loss stabilises a few years down the road?

 

[seanvandamme]

I'll retract my statement, but the fact that meds regrow temples still stands. I, myself, experienced this.

https://www.hairlosstalk.com/intera...ma-possibly-finasteride-in-the-future.110774/

Somebody Alex is another member that has regrown his temples. Google him.

Have a look at the success stories, alot of members have grown out their temples.

I agree that temples are harder to recover but it isn't impossible.

Woah wtf, both are insane results! Does everyone respond this well though? What determines if you'll be a good responder or not?

Also, minoxidil is for life isn't it? Even if my male pattern baldness doesn't come back forever, I'd still have to be on the regime to maintain any hair I've grown. I've read stories about Minoxidil worsening hair loss when discontinued and that really freaks the f*** out of me.

 

[Alphalete]

Woah wtf, both are insane results! Does everyone respond this well though? What determines if you'll be a good responder or not?

Also, minoxidil is for life isn't it? Even if my male pattern baldness doesn't come back forever, I'd still have to be on the regime to maintain any hair I've grown. I've read stories about Minoxidil worsening hair loss when discontinued and that really freaks the f*** out of me.

Unfortunately, not everyone responds as good. Some might respond better/worse. Minoxidil is a lifetime regime and dropping it, will obviously drop you below baseline. The reason is very simple: As I earlier stated, minoxidil is only a growth stimulant. When applied without an anti-androgen (such as finasteride), it doesn't stop the balding process!

The stories you've read about minoxidil worsening hair can be understood logically. You see, without preventing DHT from further ''damaging'' your hair, the hair loss continues, and at the same time is stimulated by the Minoxidil. I hope my explanation makes sense.

The first link I posted, was of me. I'm only on Minoxidil, Ketoconazole 2% and dermaroller 1.5 mm + 0.5 mm. But my gains will not last forever if I don't add an anti-androgen. There's sadly no other way of keeping your hair...

 

[seanvandamme]

First of, congrats on your successful dieting. Although anarchic, you've soldiered through and got results.

Now about your hair loss, there are a few things to keep in mind.

Any kind of severe stress (psychological distress, heavy surgery, extreme dieting) can trigger hair loss. Usually it manifests itself by telogen effluvium alone. However, such an episode of hair loss can greatly accelerate any underlying male pattern baldness that would have otherwise taken years if not decades to declare itself.

You should try to get a solid understanding of what's happening to you before even thinking about taking meds, let alone undergoing a hair transplant. Get some bloodwork done and check your thyroid function, your iron levels and DHT levels (although DHT is a poor indicator of what's happening since it could just be your androgen receptors kicking into overdrive).

If nothing pans out, get a small biopsy to rule out any other cause of hair loss (e.g. cicatricial alopecia). Male pattern baldness presents some unmistakable histological features that are easy to recognize with a biopsy.

Then, if it's really male pattern baldness, start thinking about a solution. Monitor its progression while taking enough time to weigh the pros and cons of each potential "solution" (several months at least).

Good luck.

What a well-thought answer.

Thank you for the compliment on my dieting efforts. The journey from skinny-fat to lean was harrowing and I paid a heavy price for it.

So you're saying the onset of male pattern baldness can be accelerated by severe physiological or psychological stress? Well, going 1300 calories under my maintenance requirement would constitute as pretty severe f*****g stress to my body, would it? Add strength training 4x a week where I try and hit PR's every workout and it begins to add up.

Went for a septoplasty surgery a month ago and had preliminary blood tests done, so iron shouldn't be an issue. Thyroid I have yet to check, but if there is any issue with mine at all, it ought to have resolved, seeing as how my male pattern baldness has freezed for quite a while. About androgen receptors kicking into overdrive.. Can you elaborate? Isn't DHT the primary cause of male pattern baldness in all men?

Cicatrical alopecia. You've given me something new to look at. I might request for my derm to run a few extensive tests for me.

Thanks.

 

[Mushu]

So it's really a tradeoff then. Thank you so much for your advice. I think I'll skip finasteride until the slightest symptom manifests again. Spending money on something that isn't actively treating an active condition doesn't sit well on me. What's preventing you from getting a hair transplant if you consider yourself to be a good candidate though? Costs? Would you consider one if your hair loss stabilises a few years down the road?

For me it's not cost, but also risk/reward realative to my current situation. Hair transplant is not a guarantee success. I'd be okay with my hair if it stay this way. I can still style it and besides norwood spotters, won't be considered balding. If it get worse, I'd consider it again. Finasteride is also giving me good results.

 

[seanvandamme]

Unfortunately, not everyone responds as good. Some might respond better/worse. Minoxidil is a lifetime regime and dropping it, will obviously drop you below baseline. The reason is very simple: As I earlier stated, minoxidil is only a growth stimulant. When applied without an anti-androgen (such as finasteride), it doesn't stop the balding process!

The stories you've read about minoxidil worsening hair can be understood logically. You see, without preventing DHT from further ''damaging'' your hair, the hair loss continues, and at the same time is stimulated by the Minoxidil. I hope my explanation makes sense.

The first link I posted, was of me. I'm only on Minoxidil, Ketoconazole 2% and dermaroller 1.5 mm + 0.5 mm. But my gains will not last forever if I don't add an anti-androgen. There's sadly no other way of keeping your hair...

That's what bugs me: having to keep it up for the rest of my life. Honestly, I'm seriously considering going all in with a hair transplant. It's a serious gamble I know, but evidence I observed from my extended family just doesn't point to very aggressive balding (anything beyond a Norwood 3) in future. I have really dense donor area so I'm not completely fucked if things happen to go south in future.

I'm desperate and can't stay in this limbo for much longer anymore. I'd take a calculated risk over having to stay on meds my whole life.

 

[Mushu]

What a well-thought answer.

Thank you for the compliment on my dieting efforts. The journey from skinny-fat to lean was harrowing and I paid a heavy price for it.

So you're saying the onset of male pattern baldness can be accelerated by severe physiological or psychological stress? Well, going 1300 calories under my maintenance requirement would constitute as pretty severe f*****g stress to my body, would it? Add strength training 4x a week where I try and hit PR's every workout and it begins to add up.

Went for a septoplasty surgery a month ago and had preliminary blood tests done, so iron shouldn't be an issue. Thyroid I have yet to check, but if there is any issue with mine at all, it ought to have resolved, seeing as how my male pattern baldness has freezed for quite a while. About androgen receptors kicking into overdrive.. Can you elaborate? Isn't DHT the primary cause of male pattern baldness in all men?

Cicatrical alopecia. You've given me something new to look at. I might request for my derm to run a few extensive tests for me.

Thanks.

The truth is somewhere in between. If it was only DHT related, we'd have a cure now. You'll realize after doing some research, there's alot of anecdotal information regarding hairloss.

 

[seanvandamme]

For me it's not cost, but also risk/reward realative to my current situation. Hair transplant is not a guarantee success. I'd be okay with my hair if it stay this way. I can still style it and besides norwood spotters, won't be considered balding. If it get worse, I'd consider it again. Finasteride is also giving me good results.

Hahaha! f*** norwood spotters! You wouldn't feel confident even when you consider yourself a good candidate eh?

 

[Giiizmo]

[...] About androgen receptors kicking into overdrive.. Can you elaborate? Isn't DHT the primary cause of male pattern baldness in all men?

DHT is one of many factors in what we deem to be nowadays an inflammatory process. Ultimately, what's more important than DHT itself is the affinity of the androgen receptor to androgens in general, DHT in particular since it's more potent than testosterone for instance, all things being equal. That is, you'll get an equivalent response to testosterone with only about a tenth of DHT although they usually interact with different kinds of androgen receptors (which is why, for instance, bodybuilders don't inject themselves with DHT analogs even though DHT is technically a stronger androgen).

What this means is that you could have a normal or even negligible concentration of DHT affecting the follicles but if the androgen receptors either have a high affinity (e.g. because the DHT molecule fits *just right* in the receptor) or are present in a greater amount than usual, the follicles cells will be subject to a big amount of stimulation. This will in turn further the inflammatory cascade towards, for instance, producing inflammatory signalling molecules (such as prostaglandin D2, or PGD2 in short, which is hypothesized to be a primary factor) that contribute to make the overall hair follicle shrink until it cannot create a new hair shaft.

One of the main effects of DHT is an overall increase in body hair, yet there are some very hairy individuals who also sport a glorious mane. Others can have little body hair but have a massive beard. Why? Because it depends on the affinity of the androgen receptors for a given tissue. The curse of people who suffer from male pattern baldness is essentially that their specific sub-type of androgen receptors that is expressed in the skin of their scalp is too sensitive to DHT, which explains the role genes play in the disease.

Cicatrical alopecia. You've given me something new to look at. I might request for my derm to run a few extensive tests for me.

I'm not saying you have cicatricial alopecia per se but that your type of hair loss may not be that obvious, especially when taking into account your health history and that there seems to be no case of male pattern baldness in your family. There may be other factors in play that may be glossed over in favor of what is seemingly the most obvious answer. In your case, it might be better to be sure before trying anything.

 

[seanvandamme]

DHT is one of many factors in what we deem to be nowadays an inflammatory process. Ultimately, what's more important than DHT itself is the affinity of the androgen receptor to androgens in general, DHT in particular since it's more potent than testosterone for instance, all things being equal. That is, you'll get an equivalent response to testosterone with only about a tenth of DHT although they usually interact with different kinds of androgen receptors (which is why, for instance, bodybuilders don't inject themselves with DHT analogs even though DHT is technically a stronger androgen).

What this means is that you could have a normal or even negligible concentration of DHT affecting the follicles but if the androgen receptors either have a high affinity (e.g. because the DHT molecule fits *just right* in the receptor) or are present in a greater amount than usual, the follicles cells will be subject to a big amount of stimulation. This will in turn further the inflammatory cascade towards, for instance, producing inflammatory signalling molecules (such as prostaglandin D2, or PGD2 in short, which is hypothesized to be a primary factor) that contribute to make the overall hair follicle shrink until it cannot create a new hair shaft.

One of the main effects of DHT is an overall increase in body hair, yet there are some very hairy individuals who also sport a glorious mane. Others can have little body hair but have a massive beard. Why? Because it depends on the affinity of the androgen receptors for a given tissue. The curse of people who suffer from male pattern baldness is essentially that their specific sub-type of androgen receptors that is expressed in the skin of their scalp is too sensitive to DHT, which explains the role genes play in the disease.



I'm not saying you have cicatricial alopecia per se but that your type of hair loss may not be that obvious, especially when taking into account your health history and that there seems to be no case of male pattern baldness in your family. There may be other factors in play that may be glossed over in favor of what is seemingly the most obvious answer. In your case, it might be better to be sure before trying anything.

That was enlightening, thank you. Are there any evidence of androgen receptors kicking into overdrive because of physiological or psychological stress? I'm trying to put 1 and 2 together here.. An informed guess about what exactly caused my predicament.

Yeah, I'm definitely going to run a thyroid test to be sure. Also, I'm never doing a cut more than 500 calories below maintenance again. I hope my story is a lesson to anyone who tries and push their body too hard for gains.

 

[Giiizmo]

That was enlightening, thank you. Are there any evidence of androgen receptors kicking into overdrive because of physiological or psychological stress? I'm trying to put 1 and 2 together here.. An informed guess about what exactly caused my predicament.

Not that I know of but it's a good guess. One could even hypothesize that since 5-alpha-reductase catalyzes testosterone into many different compounds, notably DHT but also others being implicated in mental health - especially anxiety management -, that the body would over-express that very enzyme to a point where the concentration of DHT might be too much for the hair follicle to bear.

Science is still trying to fully understand the exact ethiology of male pattern baldness. It's a multi-headed beast that is comprised of multiple signalling cascades each affecting different metabolic pathways. In essence, each hair follicle is a very small organ by itself which explains the complexity in actually trying to regrow any amount of hair.

 

[seanvandamme]

That was enlightening, thank you. Are there any evidence of androgen receptors kicking into overdrive because of physiological or psychological stress? I'm trying to put 1 and 2 together here.. An informed guess about what exactly caused my predicament.

Yeah, I'm definitely going to run a thyroid test to be sure. Also, I'm never doing a cut more than 500 calories below maintenance again. I hope my story is a lesson to anyone who tries and push their body too hard for gains.

You seem to be a rather knowledgeable member in the forum, so I'll just pop a question at you. Hope you are able to shed some light on this.

I've read about hair transplants and the consensus is that the frontal area is best limited to half of the original density for an illusion of coverage. However, I see here that Dr Hasson has really pushed through that and transplanted at a density of close to 100% for this particular patient:

Original post:http://forum.hairsite.com/t/true-density-dr-hasson-1750-grafts-one-year-strip/3910?page=2
Before and after video:

This is an insanely good result that flies in the face of current hair transplant literature. Are ultra high densities like these actually reproducible? Will surgeons feel more comfortable implanting at such densities if hair loss is minimal and has stablized? This really shocks me not because of the implanted density, but because the grafts actually survived and grew. Wasn't there a study showing that grafts above 40cm^2 would yield poor growth?

Will be excited to hear your view on this. Cases like these gives me hope.

 

[Giiizmo]

I've read about hair transplants and the consensus is that the frontal area is best limited to half of the original density for an illusion of coverage. However, I see here that Dr Hasson has really pushed through that and transplanted at a density of close to 100% for this particular patient:

Original post:http://forum.hairsite.com/t/true-density-dr-hasson-1750-grafts-one-year-strip/3910?page=2
Before and after video:

This is an insanely good result that flies in the face of current hair transplant literature. Are ultra high densities like these actually reproducible? Will surgeons feel more comfortable implanting at such densities if hair loss is minimal and has stablized? This really shocks me not because of the implanted density, but because the grafts actually survived and grew. Wasn't there a study showing that grafts above 40cm^2 would yield poor growth?

I'm no real expert on hair transplants (or really in anything related to hair loss to be honest) but here's my view.

Density above 40cm^2 is possible but the higher you go, the more you run the risk of poor yields, be it due to shock loss, graft transsection, poor neovascularization or what have you. The quoted density is also a good trade-off between creating the illusion of having hair and keeping some for any future losses. After all, male pattern baldness can keep progressing, even with meds.

About that particular example, although it's a great result, it doesn't strike me as something with huge density. For an example, have a look at results from notorious Turkish surgeons like Erdogan who routinely use dense-packing to create some very thick hairlines.

Those kind of results can look very good but you also have to keep in mind the fine balance between spending all your available donor hair on a small surface while you could lose more hair and wishing for a very dense hairline. Also do be mindful of dense-packing itself since even though the result might look great - for now - some surgeons are very keen on it because they charge by the graft...

 

[JeanLucBB]

You seem to be a rather knowledgeable member in the forum, so I'll just pop a question at you. Hope you are able to shed some light on this.

I've read about hair transplants and the consensus is that the frontal area is best limited to half of the original density for an illusion of coverage. However, I see here that Dr Hasson has really pushed through that and transplanted at a density of close to 100% for this particular patient:

Original post:http://forum.hairsite.com/t/true-density-dr-hasson-1750-grafts-one-year-strip/3910?page=2
Before and after video:

This is an insanely good result that flies in the face of current hair transplant literature. Are ultra high densities like these actually reproducible? Will surgeons feel more comfortable implanting at such densities if hair loss is minimal and has stablized? This really shocks me not because of the implanted density, but because the grafts actually survived and grew. Wasn't there a study showing that grafts above 40cm^2 would yield poor growth?

Will be excited to hear your view on this. Cases like these gives me hope.

That particular case isn't out of the norm. I would expect it to be around the 45-50cm^2 mark, certainly nothing out of the ordinary and roughly 60% of original density. Much of the literature on hair transplants is dated, not necessarily formulated by the most talented of surgeons or using a full set of modern protocol and means of achieving the highest standards of results. Particularly the FUE vs FUT literature debate is plagued by US primarily FUT surgeons who stand to gain by maintaining the status quo of FUT as the reigning "gold standard", and thereby presenting poor FUE results in their research. Moral of the story? Do your own research, question motives and look at results across surgeons and those in different countries for yourself. It is certainly accurate that beyond a certain point of density there are diminishing returns in regards to survival rate.

My personal recommendation is that you get on low dose finasteride (0.25mg) as well as ketoconazole shampoo (twice a week) and then research transplants, particularly FUE for your case. The best thing you can do for now is get on finasteride.

 

[seanvandamme]

Not that I know of but it's a good guess. One could even hypothesize that since 5-alpha-reductase catalyzes testosterone into many different compounds, notably DHT but also others being implicated in mental health - especially anxiety management -, that the body would over-express that very enzyme to a point where the concentration of DHT might be too much for the hair follicle to bear.

Science is still trying to fully understand the exact ethiology of male pattern baldness. It's a multi-headed beast that is comprised of multiple signalling cascades each affecting different metabolic pathways. In essence, each hair follicle is a very small organ by itself which explains the complexity in actually trying to regrow any amount of hair.

You theorise like a scientist. Are you perhaps on this forum for research purposes?

About your reply to my hair transplant question. I've looked at Erdogan's transplants on his Norwood 2 and 2A patients, and they're phenomenal. Does he really use a conservative dense packing amount (55cm^2) for those patients? They look really close to original density. It could just be really good 'illusion of coverage' though.

I think I'm going to open this question up with another thread. There's this study done by Nakatsui, Wong and Groot in 2008 that shows a remarkable improvement (98.6% survival rate for density of 72cm^2) from the 2005 study. This could really be helpful for people with mild hair loss.

 

[seanvandamme]

That particular case isn't out of the norm. I would expect it to be around the 45-50cm^2 mark, certainly nothing out of the ordinary and roughly 60% of original density. Much of the literature on hair transplants is dated, not necessarily formulated by the most talented of surgeons or using a full set of modern protocol and means of achieving the highest standards of results. Particularly the FUE vs FUT literature debate is plagued by US primarily FUT surgeons who stand to gain by maintaining the status quo of FUT as the reigning "gold standard", and thereby presenting poor FUE results in their research. Moral of the story? Do your own research, question motives and look at results across surgeons and those in different countries for yourself. It is certainly accurate that beyond a certain point of density there are diminishing returns in regards to survival rate.

My personal recommendation is that you get on low dose finasteride (0.25mg) as well as ketoconazole shampoo (twice a week) and then research transplants, particularly FUE for your case. The best thing you can do for now is get on finasteride.

It is stated explicitly in the link that the implanted density is 90cm^2. Thanks for the advice of sifting through hair transplant literature with a more discerning eye. There is just way too much conflicting information going around.

I am mostly confused by the huge variance of results and opinions regarding ultra high dense packing. Here and there, I see some top doctors push limits and achieve fantastic results. A few google searches later, and you see people going vehemently against these sort of densities. Is there no consensus for when these sort of densities are workable?

Your suggested regime seems reasonable. Do people normally dose at 0.25mg? Last I heard, standard dose is 1mg.

 

[JeanLucBB]

You theorise like a scientist. Are you perhaps on this forum for research purposes?

About your reply to my hair transplant question. I've looked at Erdogan's transplants on his Norwood 2 and 2A patients, and they're phenomenal. Does he really use a conservative dense packing amount (55cm^2) for those patients? They look really close to original density. It could just be really good 'illusion of coverage' though.

I think I'm going to open this question up with another thread. There's this study done by Nakatsui, Wong and Groot in 2008 that shows a remarkable improvement (98.6% survival rate for density of 72cm^2) from the 2005 study. This could really be helpful for people with mild hair loss.

I'd take that study with a grain of salt, there are certainly surgeons who have shown dense packing to around the 70cm^2 mark however in 2008 this would have been incredibly unlikely, particularly as the doctors who conducted the studies in their own work just doing a quick Google are hardly achieving dense packs to begin with which is considered roughly 45cm^2 and above. This is purely ego driven. If no photographic evidence is offered or other means of proof and it's inconsistent with other data I wouldn't take it seriously.

The Hasson+Wong case clearly isn't 90cm^2, it's just factually incorrect. But again this is why you have to look at results for yourself, it isn't particularly relevant if you're a patient what doctors are saying, but rather what they are actually achieving in reality, particularly what you see from a giant sample of patient posted results online. The vast majority doctors aren't doing exact measurements in actual circumstances either, simply a rough calculation. I'd focus more on patient posted results and consistency rather than numbers, a doctor can fake numbers with ease but they can't fake individual results of those who decide to post their transplants on fourms. In saying this Hasson+Wong are still doing some of most densely packed work in the industry, moreso than Erdogan would ever do in a first run through but the numbers are the last thing to worry about.

You'll quickly realise that these density packing numbers are nothing more than a masturbatory distraction when you look into it. Also consider that in the hairline 50-60% of original hairline density will be hard for the eye to distinguish at a reasonable distance to to the real thing, and even 35-40% behind it. In my case (I went to Erdogan) the easiest way to notice the lack of density in comparison to pre-hairloss is simply running my hand through it and feeling the lack of weight and volume, if that makes any sense.

I use 0.25mg because it inhibits roughly 15% less DHT than 1mg. The inflexion point of the efficacy to doseage curve is around the 0.2mg mark. It isn't standard practice but in my case its been hugely helpful and I just followed what the data showed which is that the difference in efficacy is small, and I always have the option to bump it up later on if it didn't prove effective.

 

[KyleTroy]

Get your bloodwork done. You might be deficient, If not, you're prone to male pattern baldness.

Also forgot to mention that hair transplant surgeons usually REQUIRE mandatory usage of finasteride for atleast 1 year in some cases.

The diet thing makes me wonder if you depleted something like magnesium or zink

 

[seanvandamme]

I'd take that study with a grain of salt, there are certainly surgeons who have shown dense packing to around the 70cm^2 mark however in 2008 this would have been incredibly unlikely, particularly as the doctors who conducted the studies in their own work just doing a quick Google are hardly achieving dense packs to begin with which is considered roughly 45cm^2 and above. This is purely ego driven. If no photographic evidence is offered or other means of proof and it's inconsistent with other data I wouldn't take it seriously.

The Hasson+Wong case clearly isn't 90cm^2, it's just factually incorrect. But again this is why you have to look at results for yourself, it isn't particularly relevant if you're a patient what doctors are saying, but rather what they are actually achieving in reality, particularly what you see from a giant sample of patient posted results online. The vast majority doctors aren't doing exact measurements in actual circumstances either, simply a rough calculation. I'd focus more on patient posted results and consistency rather than numbers, a doctor can fake numbers with ease but they can't fake individual results of those who decide to post their transplants on fourms. In saying this Hasson+Wong are still doing some of most densely packed work in the industry, moreso than Erdogan would ever do in a first run through but the numbers are the last thing to worry about.

You'll quickly realise that these density packing numbers are nothing more than a masturbatory distraction when you look into it. Also consider that in the hairline 50-60% of original hairline density will be hard for the eye to distinguish at a reasonable distance to to the real thing, and even 35-40% behind it. In my case (I went to Erdogan) the easiest way to notice the lack of density in comparison to pre-hairloss is simply running my hand through it and feeling the lack of weight and volume, if that makes any sense.

I use 0.25mg because it inhibits roughly 15% less DHT than 1mg. The inflexion point of the efficacy to doseage curve is around the 0.2mg mark. It isn't standard practice but in my case its been hugely helpful and I just followed what the data showed which is that the difference in efficacy is small, and I always have the option to bump it up later on if it didn't prove effective.

Yeah, after looking at Dr Nakatsui's site, it does seem kind of fishy to me. The fact that it was conducted on 1 person only makes it seem less credible too, though I won't dismiss these sort of cases as impossible. So would you agree that dense packing of up to 70% (70 /cm^2 out of 100/cm^2 original density) is a pretty reasonable amount to shoot for in a small area like the frontal zone?

Eh, are there any Hasson+Wong reps around here who can verify the claim? My impression of H+W is that they are a credible clinic with consistent results. Doctoring numbers aren't something I think they would do. And you could tell that wasn't 90/cm^2 just by eyeballing? Impressive.

What was the degree of your hair loss prior to hair transplant and how many grafts did you got? Seems like you have a hairline you could be rather happy about now.

I'll sit on the medications first. Though I'll definitely keep your recommendation in mind.