Hair Transplant | A Hair Transplant Gift For My Son’s 20th Birthday - Is This A Good Idea?

A Hair Transplant Gift For My Son’s 20th Birthday - Is This A Good Idea?

My 19 year old son has been very depressed about his hair loss. He has been talking to me about taking the drug propecia but I am very uncomfortable about him taking this drug with all of its side effects. I’m also concerned about the long term side effects. I was thinking about just gong him the gift of a hair transplant for his 20th birthday so that he can put this behind him an go on with his life. Do you think this is a good idea and what is the best hair transplant procedure for a young person?

Dealing with hair loss in young men can be very challenging. Most of his friends probably have not started losing hair, so I am sure it makes him self-conscious. The problem with performing a transplant at age 19 is that it is extremely difficult to predict how advanced that man’s hair loss will progress in the future. Frequently, men who begin noticing hair loss in their late teens will bald rapidly through their early 20s. Without having a good idea of future balding patterns, it makes it difficult to judge where to safely place hair (keeping in mind that transplanted hair is permanent hair). Young men seem to invariably want transplants that create low hairlines and that fill in the bald spots in the vertex so that they look the same as most of their friends. Please be warned that if hair is placed too low in the hair line or in the vertex, future balding can lead to a very awkward hair pattern.

I believe you should reconsider your son’s request to use Propecia. Studies of Propecia showed that 90% of men who took Propecia regularly over a 5-year period did not progress in their balding; whereas, most of the men not on Propecia just became balder and balder. If he has already started losing hair at age 19, that should be a warning sign that he may well develop more advanced balding (Norwood 5 to 7 on the balding scale). Why not use a medicine that can prevent that from happening 9 times out of 10? One of the primary reasons men who know about Propecia don’t use it is the same reason you expressed concerns about — side effects. Fortunately, side effects are rare. Approximately 3 to 4% of men may experience sexual dysfunction soon after starting Propecia, but if any such problem did occur, stopping the medication will lead to a quick resolution of the symptoms. Propecia’s official literature includes a long list of possible side effects, but they are uncommon and should resolve once the medicaion is stopped. Please keep in mind that all medications, including everyday medications like Tylenol and Benadryl, have a long laundry list of similar warnings. The only long-term side effect I have noted out of thousands of my patients on Propecia has been the development of enlarged breasts (gynecomastia) in 3 men. Certainly, if your son ever noted such a finding, he could stop taking Propecia before it became embarrassing. If it helps ease your mind, Proscar, which is the exact same medication as Propecia (finasteride), has been prescribed in the United States for prostate enlargement since 1992. In addition to Propecia, I would encourage your son to use Rogaine Foam twice a day to the vertex and frontal scalp. This will improve his odds not only of stabilizing his hair loss, but maybe seeing regrowth.

My preference for a 19-year-old would be for him to use these medicines for a minimum of several years to see their effects before even considering a transplant. If he were part of the unlucky minority of men who do not respond to these medications and if it appeared that his hair loss might ultimately leave him with a Norwood 7 pattern (completely bald on top with only a horseshoe fringe of hair around the sides and back), I believe that he might want to avoid transplants altogether. In nature, it is unusual for a Norwood 7 to have any hair remaining in front or on the top of the scalp. If such a man had a transplant at age 19, he might find his appearance not completely natural even if it were performed with state-of-the-art follicular units. Despite this warning, if you and he decide to pursue a transplant now, I would urge you to be extremely conservative. Do not give in to the temptation to seek to fill in a low hairline or the vertex. Instead, consider only having a high frontal forelock transplnted. Always insist on 100% follicular units. That way, if his hair loss advances significantly, his hair pattern would not look unusual and there would be no “plugginess”. If he does not use Propecia, he will likely have to return for additional transplants as he continues to bald, but if he started with a high conservative frontal forelock, he should have enough hair to keep things looking natural (assuming he does not progress to a Norwood 7).

No matter how much hair is transplanted through the years, it is impossible for man with advanced hair loss to have a full head of hair because we are simply rearranging hair. We are not creating new hair. That is why it is so important, transplant or no transplant, to save as much hair as possible with medications such as Propecia.

Sincerely,
Blaine Lehr M.D
Member, International Alliance of Hair Restoration Surgeons