37yo, probably a NW3, starting recovery

[xapato]

Hi all,

My hairline started receding around 16 or so. It didn't bother me much at the time, and it progressed very slowly. My hairline isn't drastically different from when I was 27:

But in the past 5-7 years or so, the hairline did move up, especially along the temples. I think I'm about a NW3 now, but I'm not sure. I did notice that my hairs are a bit thinner on top than on the sides, but not much less dense. In the regions near the bald temples, the hair is less dense. In the front middle, it is much less dense for the first cm or so. I don't notice any density loss on the crown, although like the entire top, the hairs there are not as thick as those on the sides.

- I've started taking dutasteride 0.5mg / day, and using ketoconazole 2% gel twice per week. I'm considering increasing my dutasteride dose for some days, for loading. But I'm wondering if that would lead to lots of hair shedding at once.
- I would like to get on an androgen antagonist.
- I've read about some very aggressive approaches involving managing levels of prostaglandins with castor oil, etc. I'm not that patient, but I'm open to anything that works.
- If I can't achieve what I want, I'll do a hair transplant. I definitely want to fill in the temples.

What I'm wondering is, how much can I recover with non surgical treatment? I would like to be NW1. Should I go aggressive, buy all sorts of stuff and get a dermapen? Or should I just maintain with Dutasteride then get a hair transplant?
My plan is to try to gain as much as I can in the next 12-18 months, then get a FUE hair transplant. I'm hoping to minimize the number of grafts needed by getting as much regrowth as possible beforehand.

Below are some pictures of my hair now:



It's hard to see but the left temple is especially receded and thin:


Please excuse the low quality photography.

Here is a picture of my dad's hair at around age 70:
My grandfathers both lost hair late in life. By around 80, they had lost a lot of hair. But not in the crown. They both had slow receding hairlines, like mine and my dad's.

What do you think? Should I just say fuggit and get a hair transplant right away?

 

[checkbienca]

if you have the funds to get a hair transplant and it'll make you more confident and stress-free then go for it. However, I think your hair looks fine.

 

[ren01]

get on minoxidil, keto and finasteride or dutasteride asap.

 

[xapato]

I've already started dutasteride, and I think I'll probably go for a hair transplant eventually. But do you think at 37 I can recover much with treatment?

Does minoxidil suck? I imagine that my confidence would feel lower on min, because I would always have this substance in my hair. If a girl puts her fingers in my hair and rubs her face, will she grow facial hair? Then again, if min will really bring me back to a NW1, then that's probably worth it.

To me, it sounds like the experience of being on minoxidil sucks. What does it feel like to be on min? If I'm going to do something that sucks, then I'm thinking I should at least try some experimental stuff like setipiprant first.

By the way, I already notice some loss of libido on dutasteride one week in. I don't know if it's all in my head or actual, but so far it seems acceptable. I really wish I would have gone for finasteride when I was younger. I can't remember when it came out, but I remember being aware of it in my lower 20s. Dammit.

 

[xapato]

I'm on dutasteride + nizoral. If I can maintain with dutasteride + nizoral + (something other than min), then if I'm going to get a hair transplant anyway I don't want to use min.
I appreciate the advice, and I know that minoxidil would work. But let me just say that I have avoided it because I don't want to have some sticky stuff in my hair every day.
Is min not that bad ? Is the thickness it would (be likely to) add unparalleled?

 

[Pequod]

If you want a lower hairline I think a hair transplant is the only way to go. minoxidil can give you about 10% more growth but it doesn't stop loss due to male pattern baldness. Dutasteride does but it takes about 6 months up to one year to see results. You look like you have excellent donor hair for a hair transplant.

 

[xapato]

So it sounds like I'll need a hair transplant to get where I want. And I guess the disciplined thing to do would be to wait up to 18 months to see how well I maintain / regrow on dutasteride.

Now I am weighing the pros and cons of minoxidil. What would sway me is information pertaining to potential cumulative benefits. On minoxidil, maybe hairs that would otherwise die would stay alive. Looking at cases like zeroheat's gives me hope that there are cumulative benefits to minoxidil. If he never used minoxidil, maybe those little hairs would never have grown and died by now. What do you think? Side effects are less of an issue, because I could just stop using it and they would subside.

Lastly, I'm looking into other tools: setipiprant, RU58841, topical spironolactone, wounding