Losing my hair rapidly at the age of 21, when can a hair transplant be safe for me? (photos)

Started losing my hair at 19. Since then I've been googling everything about hair loss including minoxidil and finasteride. I didn't want to go on either because I want a less chemical solution. However, the loss is becoming extreme and my self esteem has tanked. I'm pretty sure I've missed the train to preserve what I had then. My dad and his father both have good hair genes. The males on my mom's side of the family are mostly bald. How will this further proceed, and what can I do to resolve?

Doctor Answers 9

Hair transplants are not right for your age, but hair loss can be stopped at your age without finasteride or minoxidil

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Thank you for your question. You’re 21-years-old and I understand you’ve been losing hair since you were 19. You are wondering when is best to have a hair transplant, and you say you’d rather not take minoxidil or finasteride because you want a less chemical solution.

To first give you a little information about myself — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I am the founder of TrichoStem™ Hair Regeneration centers, which offer an alternative non-surgical treatment for male and female pattern hair loss. As a hair specialist, I’ve had a lot of experience with hair transplants and hair loss treatment over the years, so I can certainly give you some guidance on this matter.

It seems there is a genetic pattern with your hair loss, particularly since you stated that the men in your mom’s side of the family are mostly bald. It’s important to understand that there are limitations to hair transplants, especially when you have earlier and more aggressive onset of hair loss. The technology of hair transplant surgery is based on the donor area, which is a strip of hair situated at the back of the scalp that is genetically resistant to hair loss. These hairs can be extracted surgically and then transplanted to the skin at the front part of the scalp. The limitations lie in the geometric mismatch between the donor area and the transplant area, regardless of the method used (strip method or follicular unit extraction).

One also needs to consider what is socially acceptable in one’s age range. For example, if a man starts losing hair in his early to mid-30s and then opts for a hair transplant in his 40s, it will be acceptable to get a limited amount of hair placed in a specific area because most of his contemporaries will be experiencing hair loss to some degree. However, for a younger man in his early 20s, more than 80% of his contemporaries still have lots of hair. You will need to think about where you will be 10 years from now in terms of hair loss and you have to ask yourself, as far as the timing of the hair transplant is concerned, when you will be able to have satisfactory coverage and not keep losing hair.

In our practice, we developed the hair loss treatment system called Hair Regeneration, under the company TrichoStem™ Hair Regeneration. The treatment makes use of a combination of Acellular matrix, which is a wound-healing material, and platelet-rich plasma, which is a concentration derived from your own blood and is made up of essential growth and healing factors.

This combination enables us to stop hair loss progression, reactivate the hair growth cycle in existing hairs that have stopped growing, and reverse the hair thinning process by inducing the eventual shedding of thinning hair and the replacement of that with thicker hair. Unfortunately, the treatment only works on people with existing hair follicles, which means it will not work on someone who is totally bald. Over the years of using this treatment on our patients, some of which are as young as 18-years-old, we have learned that the earlier we catch someone, the better the results are.

Hair Regeneration works for both male and female pattern hair loss, and has more than a 99% success rate. We have also been able to prove that Hair Regeneration can be extremely effective and successful even without the support of hair loss drugs like finasteride or minoxidil.

I suggest that you hold off on having a hair transplant for now, and learn more about treatments like Hair Regeneration in order to stabilize your hair loss progression. You could also get additional opinions about finasteride, since the drug does work for about 60% of men. In the meantime, meet with a hair specialist and discuss your options.

I hope that was helpful and I wish you the best of luck!

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Losing my hair rapidly at the age of 21, when can a hair transplant be safe for me?

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Thank you for posting your question. Hair restoration can definitely be an option you may have at this age. This all depends on the strength of your donor region. You may also consider using Minoxidil, Topical Finasteride (you would need a compounding pharmacy) and highly consider PRP as well. Glad you are doing research. Hope this helps.

Matt Tahsini, MD
Pasadena Hair Restoration Surgeon
5.0 out of 5 stars 16 reviews

If you are losing hair and you want treatment options, it is best to see a doctor first before thinking about surgery.

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If you are losing hair and you want treatment options, it is best to see a doctor first before thinking about surgery.  There may be other issues and surgery may not be your best option.

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 102 reviews

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Dr Alba Reyes

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You are definitely in the situation that a Hair transplant can resolve the hair loss in th frontal/central area. It is very important to think about stabilizing the crown area for as long as you can with the use of Propecia ans Minoxidil. Best of luck

Alba Reyes, MD
Dominican Republic Hair Restoration Surgeon

Seek Competant Hair Loss Advice

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Hair loss at your age and with your family history can be traumatic. You should continue to educate yourself and take measures to try to slow your hair loss. I understand your concern about not wanting a chemical solution like Minoxidil or Finasteride, however you should not just relegate your investigation of these medications to the Internet. Seek the counsel of a full time hair restoration specialist that will develop a diagnosis and a comprehensive approach to combating your hair loss, not a surgical approach. You may benefit from surgery in the future but please understand that you may never be a good surgical candidate. What you should not do is see a hair transplant salesperson or consultant. Sales people are a problem in the hair restoration industry. Sales people should not be involved in any practice of medicine. See a real expert physician (doctor) for advice. You may want to continue some research at the International Society of Hair Restoration Surgery. Please also review link below so you will not become prey to someone who just wants to perform surgery on you.

Missed the train at 21?

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The younger one is when hair loss begins, the more distressing it is and the more understandable it is to want to "fix it." But this is rarely the time to have a hair transplant, as you may know if you have been doing your homework. Virtually every experienced, ethical hair transplant surgeon would strongly encourage someone like you to wait until you are older, have made an attempt to stabilize your situation, and it has become possible to plan a hair transplant that will make the best use of your donor hair – a transplant that can provide the foundation for a lasting natural appearance, one that can "go the distance" with you over the decades. The problem is that as you continue losing hair, your scalp doesn't continue to grow more donor hair to keep up with your losses; indeed, what appears to be the donor area today may shrink as you age. It's all about supply vs. demand--and at this point in your life, it is difficult or impossible to predict what either of those will be. An effort to recapture the look you had at 19 could lead you to make a decision you will regret and leave you with a permanently unnatural or undesirable appearance.

That said, you shouldn't conclude that you've missed the train: you still have an opportunity to stabilize or even reverse some of your hair loss. The reason this is so important is that the amount of hair you are at risk for losing in the future far exceeds the amount of hair you have already lost. As you probably know, the most effective solution to ongoing hair loss is a chemical one (finasteride); while you may find a chemical solution objectionable, it has been very well tolerated by millions of men worldwide and the incidence of side effects is extremely low. (BTW, the side effect of not taking finasteride is baldness.) If you are dead set against finasteride, I would strongly recommend a combination of minoxidil and low level laser therapy (LLLT); you could also consider adding platelet rich plasma (PRP) injections, with or without ACell, to that regimen. But it is very important that you do not look at hair transplant surgery as a way to stop your genetically programmed hair loss.

Jonathan Ballon, MD (in memoriam)
Atlanta Hair Restoration Surgeon

21 and losing hair

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I would not rush to do a hair transplant. At your age you have no idea what your final pattern of hair loss will look like.  You need to get a diagnosis. Your biggest enemy is the progressive thinning leading to a balding pattern that is not evident at this point in time. The degree of thinning that you are experiencing would suggest that you should see a doctor who most likely will get Bulk Measurements of your hair to determine the degree of the thinning that you are presently having. If the diagnosis is early genetic hair loss (the most common cause of hair loss in young men), then the best treatment would be the drug finasteride which is highly effective in men of your age and may not only stop the hair loss but possibly reverse it. If you are developing a more advanced balding pattern the best test to get will determine the Bulk Measurements of your hair and this will show, over a one-year time frame, how effective the treatment will be. Once you know this information, then you and your doctor need to develop a MASTER PLAN which will define what you need to do over the years to come.

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 28 reviews

Hair transplant

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Doing a hair transplant at age 21 is early, but not out of the question. If you do a procedure at this age, it should be conservative, focused on the front, and done with long term hair loss in mind. As much risks as you have with minoxidil and finasteride, a transplant at this age carries more- proceed with caution.
You have a limited amount of donor hair for your life and you want to use it wisely.

I would, however, recommend you fully consider finasteride. While there are risks and these should be discussed with a physician, they are limited and infrequent in most physician's opinions and in most studies. The benefit is 90% of men taking finasteride stop losing hair (and many regrow hair)- that is a number that is hard to ignore.In addition, this is something you should consider now- the benefits will decrease as your hair loss continues.

You are wise to take your time in making your decision for a transplant. The train has definitely not left the station for that and you have plenty of time to tackle how and when.

Mark Hamilton, MD
Indianapolis Facial Plastic Surgeon
4.8 out of 5 stars 49 reviews

Have I missed the train?

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You've put alot of thinking into your hair loss and options for treatment. However, a mistake in the reasoning here is that one has missed the train.

You are wise to contemplate the risks and benefits. But also review with your physicians the overall "odds" of these side effects.

At 21, you are too young for a hair transplant. With your history and these photos you are not a good candidate at the present time. Could you be a candidate at some point? Absolutely.

Keep in mind you have a finite number of grafts to transplant in your lifetime. It could be 0 (if you prove to have diffuse unpatterned alopecia) but the maximum in the case presented is probably 3000-5000. Once a graft is removed it does not come back. You need to choose carefully both when and where to put them. 3000 grafts can cover alot if placed in the right area at the right time. Too many patients use up these grafts too early in life and limit their options down the road.

Jeff Donovan, MD, PhD
Vancouver Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.