Hey guys,

As a younger guy on this forum (28), who had his first HT at the ripe old age of 20, I thought I'd share some insight.

I see the same question asked a lot: "what age is best to consider a hair transplant." It's been asked of me by editors, friends, and the occasional e-buddy. So, I thought I'd do a lot of research, talk to some people and add my two cents.

Firstly, I'd like to thank Falc for his great post, "Am I too young for a transplant." I suggest that you read that post even before reading this one.

Secondly, I must reiterate that there really can be no definitive answer on the matter as it is highly subjective, so I thought I'd give some considerations and a range of possible factors that might influence your decision.

1) Genetics - Keep in mind that genetics are just as unpredictable as everything else in life, so nothing is 100% percent certain. Sure, your dad and your dad's dad and your dad's dad's dad may have had manes like Samson, but that doesn't guarantee that you will be so lucky.

The best thing to do in considering your genetics is to find an older family member with hair loss (if possible) and discover if he started losing his hair around the same time and with the same or similar pattern of loss. In my family, this happens to be my dad - no surprises there as I look almost exactly like him too, which may be another factor you wish to consider: if your the "spittin' image" of this man, you'll probably continue to be the spittin' image of him at all stages of life. Still, there are no guaranties. Take into account that no one is 100% certain of what causes MPB. Sure, we know some of the details, but we still have only maybe 75% of all the details. There are just so many factors.

2) Age - How young is too young? Well, from the research I've done, it seems that the acceptable range for most ethical doctors to consider performing an typical medium-sized to medium mega session HT session is 26-28. Why? Well, it is believed that this is the age when the pattern will form. Most surgeons that I have researched or spoken with believe that this is a very important age as they can get as accurate a picture as possible as to how aggressive your hair loss is, where it will likely progress in the coming years, and the size and strength of your donor area. Again, though, nothing is 100% certain.

That being said, the best candidate is, of course, the older candidate with minimal hair loss and good mitigating factors.

3) Drug therapy - If you are on Propecia or Minoxidil, this may affect your rate of loss. It is important to get on and stay on these treatments for at least one year to judge there efficacy. If they are effective, you may stave off more hair loss for years to come which will make you a better candidate.

4) Other factors:

- Donor density - Some of us naturally have more dense hair in all areas, even those not effected by hair loss. It is important to know how dense this area is and how much of said area is covered in hair that is genetically balding resistant. You could be a better candidate if you have a remarkably dense donor area.

- Scalp lacity - Try, if you, cupping your head by interlocking your fingers as in doing a classic sit-up. Now move with a medium force, your joined hands. Feel the movement of the scalp skin? The more you can move the skin, the better. This will allow the surgeon to take more donor area. If you have good laxiety in combination with a good density, you may make a good candidate.

- Hair characteristics - People with lighter or blonde hair make better candidates as there is less contrast to the skin and it will look like they have more hair present than they actually do: the appearance of fullness. Those with thicker hair shafts and those with a wavy or slight to medium curl also seem to have a better appearance of fullness.

- How long have you been loosing you hair? This factor seem to be overlooked in lieu of the question of the age at which you started to loose your hair. I think both are important. Someone that has been loosing their hair for 2 years is bound to loose a lot more and should most likely give drug therapy a good long test drive before jumping into an HT. If you have been loosing your hair for anything over 10 years, you may be a better candidate for an HT. As hair loss can speed-up and even stabilize at certain periods in your life this is also not 100% certain, but it may be a good consideration in determining just how aggressive you hair loss has been and may continue to be in the future. Along with this factor, however, you must also weigh in any drug therapies you have undergone. It may be the Propecia that has held you hair loss so long - which is still a good sign and would be considered a good factor to making you a better HT candidate because you have been shown to respond to treatment and you will most likely continue to respond to treatment, which will keep you will a fuller head of hair for longer than if you are not on a treatment. And yes, studies of Propecia do suggest that it looses some efficacy after a time, however, it still shows to be somewhat effective for up to and beyond five years. Plus, there are new therapies all the time. I've gotten wind that GSK may be re-entering Phase III FDA trials for Avodart as a DHT inhibitor... So, doctors may soon start prescribing en masse. If Propecia looses its effect on you, your doctor may also switch you to Proscar or Avodart - contrary to what I have read on many boards, off-label prescribing is perfectly within a doctor's authority and is not illegal, though some doctor's do not practice this measure as it may leave them open to questioning by insurance companies and possible ramification from the AMA (although chances of this are quite slim).

I'd like to say it again, just to drive the point home: nothing in MPB is 100% certain, so you need to be educated! I think you'd do yourself a huge favor by reading a sales and marketing book or too before going to a clinic for a consult. Why? Because, you'll get to see first hand what their sales platform is... Now, I'm not saying that sales and sales people are bad. Far from it! We are all in sales, after all. But there are people that will sell something, not because they believe in it, but because it will put a lot of money in their pockets in a short time with minimual work. So ask a lot of questions. Demand that they supply you with the information and education that you need to make the most informed decision necessary. If you think you are being scammed at any point, you probably are. The best thing you can do at that point is ask, honestly if what they are offering is a scam. They will deny it, I'm sure. Then, ask for proof. If they promise you proof and make a bunch of excuses as to why they cannot deliver, then run and don't walk as far away from there as possible. If they respond, honestly, that they are asked that question a lot - I can guaranty that they are - and offer you any proof you need: meeting patients, photos of patients, etc. Then you can feel more comfortable in moving forward, but not until you have spoken, face-to-face with these patients. You are also, I might add, doing a good thing by reading these forums. There is a lot of good advice here, so keep reading and post questions.

For those of you that say, I don't care about having hair when I'm 40, I just want a full head of hair now! Let me tell you that I know how you feel and I'm sure there are others here that do as well; however, while you may not care if you have hair at 40, you will still want to have hair at 25 and 30 and 35. Also, you won't want to look like you had a run in with one of those buzzsaw robots from the robot battle shows going on with your scalp. If you're not educated and make a quick, foolish decision, that is a possibility. Hair loss sucks at any age and I don't know anyone that every really wanted to go bald.

So, that is about it. If anyone has any question, feel free to contact me. If you disagree with anything here or you have something you want to add, feel free to do that as well. A little healthy criticism is always a good thing. I would, after all, rather have a brilliant enemy than a stupid friend; a brilliant enemy would at least be more conducive to personal and professional growth.

HLBD-

Very, very common sense post, my friend. I whole-heartedly agree.

I like what you're saying about Genetics..........I think too many times guys get hung up on looking to family hair loss history to determine their case. From personal experience, I have found even if you are the "spittin image" of a relative, your loss can be vastly different. This was evidenced for me by my father...............we look quite a bit alike and started losing our hair about the same age (23). However, his loss started in the hairline/temples and finally moved back to his crown, my loss started in the crown and crept forward.

Also, your point about drug therapy is well taken. Those who have only been experiencing loss for a couple of years shouldn't consider a HT. Given the meds a chance to work and give it a little time to see exactly how much hair you will lose.

Great thread!

HLBD,

Great post! I think this is a great addition to what I've already written. Obviously there are many things to consider. Education is power.

I like how you've stated many important factors yet still noted that there is no 100% guarantee. Sadly, hair loss is still unpredictable.

If anyone wants a link to my original post, it's here: http://hair-restoration-info.com/eve/forums/a/tpc/f/3466060861/m/7701076213

Cheers,

Falc

P.S. I linked this thread to my original post!

Thanks guys! Thought I'd help out a bit with my own two cents. I am always hungy for knowledge and I like to put it together and share it.

I think you and I are a lot alike when it comes to a scientific and analytical way of weighing the facts and presenting them while limiting any personal bias, Falc. Thanks for the great work!

You are right, hairbank, even if you are the spittin image of one of your realitives, you may take a different course. I wish I could take credit for the idea of looking for someone in your family with the same history and pattern of loss, but this was a recommendation of quite a few dermatologist I have had the pleasure of speking with over the years. Basically, I think you call into argument two very good points about the genetics factor: 1) as sttated before, nothing is 100% certain, and 2) You need to look for someone that not only has the same history (started balding at the same time and looks similar to you in other regards), but also a family member with the same pattern of loss. If you don't follow their patter, there is a good chance that you cannot go by their example.

I happen to follow the pattern and history of my father exactly, which is a slight comfort to me as both my grandfathers were NW 7. My father, now in his late 50s is still a NW 4 or 5. Given that I have nearly 12 years of loss and I am still a NW 3 with good scalp laxiety and donor density - I'm also lucky in that my hair, while straight, is at least medium in thickness so I can expect a bit better coverage with less grafts - I count my blessings. Still, we all want more hair, right?

Oh, there is one other thing I think young guys (indeed all of us) need to watch out for as a factor: stress. Now, I'm not saying that stress causes you to have MPB, but it certainly cannot help! I've seen stress do some pretty nasty things to the human body: triggering strokes, stopping natural growth in children, premature aging... The list goes on and on. There is one factor linked to every major illness (even obesity): stress. I think the worst thing anybody with MPB or any other illness, for that matter, is stress too much about it. If it is an issue for you, then deal with it head on and start on a treatment or two, start saving for an transplant, draw out a plan and set goals. Action defeats fear.

Thanks again guys!

H.L.B.D - Hair loss be damned!