Agree on sticking with finasteride. It is heartening to know med based periodic sheds are also a thing. I faced the same periodic behavior with min alone and got through it, so I will not stop using it.
Thanks for the pointe on lipogaine, keen on getting rid of the dandruff because when it started last time I was only on minoxidil (pre HT) it aligned perfectly with the best result I got. The absorption ingredients appear similar but different to the Kirkland liquid and foam, with propelyne glycol in the regular (also in Kirkland liquid) and glycerin (vs butane for the Kirkland foam) in the sensitive scalp versions. Hopefully the lipogaine sensitive scalp will be easier on my scalp than the Kirkland foam, I may give it a try.
Just got back from my doctor for the 6 month checkup. Overall, my doc is very happy with my progress so far, mentioning that growth is looking robust considering where I started and I already look a lot younger. After looking over my scalp (both with naked eye and microscope), doc found many new hairs starting to poke through, and many 2s/3s beginning to grow their extra hairs, so we're hopeful that more growth is coming. Additionally, thickening still has a ways to go. Donor area is doing great. After that I asked a ton of questions and got some good info.
Shedding starting month 5: we are not sure of the cause but doc doesn't think it's from delayed shock loss or med/fin shedding. Never had a patient have it this late in the game. Doc said most likely cause is seasonal shedding, which after going through my old minoxidil diary I did notice my hair 'peaked' in fullness early October '19 and '20, and bottomed out the following Januaries, to begin improving into the spring and summer. Hopefully, it is just seasonal.
Sees seasonal shedding in many of their patients.
Nonetheless, doc prescribed me some blood work to get done. Iron, Vitamins A/D, and thyroid.
Scalp looked healthy, no evidence of problems. Did not recommend me to go to a derm at this point.
Dandruff: I asked about oral minoxidil. Doc highly supported, has several patients on it seeing positive results and no sides, but could not prescribe due to impacts on blood pressure and monitoring it, suggests having my GP prescribe. Until then, recommends that I do one minoxidil per day instead of 2, with fin it is enough to get most of the benefits.
Graft density: I got 30 grafts/cm^2 on average, with lower densities on the crown and higher densities in the hairline. Doc tells me that, since I never had taken fin before, the goal of the first surgery was not a 'home run' but rather solid coverage, and seeing how my scalp takes the grafts and whether my native balding pattern holds or improves over the next year. Additionally, planting at this density apparently maximizes yield; going significantly more dense in a single surgery will increase overall density at the expense of yield due to limited blood supply. For cases like me that start meds after HT, doc tells me that a touch up procedure was common to really dial in the density and fill in the weak areas after stabilization. Even coverage was provided in case I progress either way to maintain my natural balding pattern.
Doc said I had very very good hair quality - lots of curl and thick caliber, so 30 grafts/cm^2 just might be enough for satisfaction too, possibly with some styling.
Overall, I am pretty happy with my meeting, and was reassured that things should improve. I have a shed that should eventually turn around, more sprouting and thickening coming. Cheers for the next 6 months!
I don’t think your hair looks any thinner at 6 months. If it were a seasonal shed, it will return. It’s good that the doctor is happy with the progress and that new grafts were visibly pushing through. At 6 months some patients are just seeing their first growth. You’ve had quite a bit so far, especially when looking at your pre op picture, the transplanted area was practically bald.
It will be interesting to hear what your blood results are.
Good luck with the oral minoxidil. Your blood tests and blood pressure will help your GP when making his recommendations.
I don’t agree with the doctors graft density statement. I believe you could have received more grafts that would have been sufficient to accomplish your goal with one surgery. Many doctors regularly do larger surgeries with great success. However, if you get optimal growth from this procedure and happy to accept you’ll need a second, then that’s what matters. I believe your doctor has been very cautious which it sounds like that’s his surgery protocols.
Hopefully, the meds work well for you.
All the best for the next 6 months of growth.
Thanks Bigmac and Kevboy. I didn't plan on multiple surgeries at the start but have come to realize that many or most people need multiple surgeries / touch ups anyway, and conserving the donor area is important in the long run. Hopefully the doctor's conservative approach pays off in the end.
I noticed that the dandruff has reduced quite a lot over the last week, finally. I tried that Pura d'or gold label anti-thinning shampoo 4x a week and changed Ketoconazole 2% to 2x a week, while keeping 1x a day topical minoxidil (will also try a switch to lipogaine if I can't find someone to prescribe me oral over the next couple months) and 1mg finasteride daily. It's great to be mostly free of the minoxidandruff, thank you for that suggestion! The shedding is still elevated, have to stay patient on that.