I can’t take Propecia because of the sexual side effects and after I visited your office, the news as to where my balding might be going (as you said the worst case) could be a Class 6 pattern. I already had two hair transplants and I have a scar on the back of my head so I can not even shave my head. I am 21 years old now, so I get depressed when I think that I am going down the toilet with my hair problems. I don’t want to give up my girlfriend as sex is important to us and the Propecia stopped that cold. What can I do?
There are no easy answers. Your examination in the office showed that you have already lost 61% of the hair in the crown, 26% of the hair on the top, and 32% of the hair in the front. With my naked eye and your blond hair color, one can’t really make out the balding at this time. The crown is fast approaching the point where the balding can be detected in bright light. You are lucky, because if you had dark brown or black hair, the hair loss in the crown would be very evident, but in blond men, the loss may approach 90% with average weight hair before it would show.
If you can not take finasteride because of the sexual side effects, these numbers suggest that you may eventually end up with a Class 6 pattern (worst case). At 21 years old, you have a lot of balding that may show up as you go through your 20s. If you want to shave your head, you might want to consider Scalp MicroPigmentation (SMP), and provided that the area pigmented was in the distribution of your existing hair, you would have the option to keep it long and/or shave it. We can discuss this option at your convenience.
There is no substitute for Propecia (finasteride) on the market. You might get some benefit by taking 25% of the therapeutic dose (0.25 mg) and this might allow you to get some of the benefits of this drug without the sexual side-effects. Young men (20 years old) who start the transplant process without a good Master Plan and have side effects from finasteride, probably should not have started the transplant process at all, as there may not be enough donor hair to complete the process. Your first transplant doctor should have discussed these issues with you before you started this process. Fortunately, there is the SMP option if you get caught between a rock and a hard place.