You are someone who has the manifestations of male pattern hair loss. The onset of your male pattern hair loss has been early in your life and it is progressing very fast. Those two factors are very important in your decision about undergoing transplant. From a pharmaceutical perspective, there are only two drugs that are used and approved for male pattern hair loss: minoxidil (Rogaine)and finasteride (Propecia). Finasteride is a drug that is used to block an enzyme called 5-alpha reductase which converts testosterone to dihydrotestosterone. Dihydrotestosterone has been identified as a factor to cause susceptible hair follicles to become thinner. Hair thinning doesn’t mean that existing hair goes from thick to thin. Rather, during the normal growth cycle as the hair is shed, the hair that comes back is thinner. Finasteride has been shown to help people with male pattern hair loss reverse the thinning process, but there are some limitations to the use of finasteride that you should also be aware of. From my clinical experience, I have been prescribing finasteride since 1997 and 1998 when it was first approved. Younger males who have aggressive hair loss typically don’t respond as well as males who are in their mid to late 30s who are starting to have a slow ad progressive expansion of the bald spot area. Even on those medications, people still do progress. There has also been a concern about the long-term sexual side effects. Interestingly in our practice, we have patients who have been taking finasteride for 20 years and they are fine and even patients in their 50s who are coming in for prescription renewals. At the same time, we have patients who are coming in their 20s and 30s who won’t take finasteride because of its side effects. When you first noticed hair loss you’ve already lost 50% of your hair. The rule of the thumb for hair loss is the Rule of Decades - in your 20s, about 20% of your contemporaries have hair loss. That means 80% of your contemporaries have lots of hair. As you get to your 40s and 50s, 40 to 50% of men have significant hair loss. I’ve seen so many patients who got hair transplants in their 20s who continue to lose hair because they were not able to take medical treatment like Propecia. What are left in their scalp are the transplanted hair. When I first trained in hair transplant surgery over 20 years ago, I learned from my teachers to avoid doing transplants on younger males like you. Men in their 20s who are losing hair, with a rapid rate of loss, combined with the unexpected results, are unfortunately too many unfavorable variables. Unfortunately in the modern world, with aggressive internet advertising and television commercials, medical procedures are sold and overhyped. You are only shown the benefits and given very compelling testimonials that make you want their products. However, the reality is that the area where the transplants are taken from called the permanent zone or the donor area is very limited. That limited area is at the back of the scalp where the hair won’t fall out. In hair transplant surgery, the strategy is to take those hairs physically as units and place them in areas in the scalp. In my practice, I developed Hair Regeneration which is a method and a procedure that combines a material called extracellular matrix which is derived from pig bladder and originally designed for wound healing, with platelet-rich plasma - a byproduct of your own blood that has growth factors. Platelet-rich plasma is commonly used to help hair loss but on its own, it doesn’t reverse hair thinning. We reverse hair thinning with our Hair Regeneration treatment. This is something that we have developed for several years and we can boast close to a 100% success rate for male pattern hair loss. This is a onetime injection and literally reverses the thinning of hair and thickens the hair. There is a lot that is yet to be understood about the causes of hair loss as well as the ways to reverse hair loss. For 30 years, several biotech companies have tried to get some kind of solution and for my perspective, this use of extracellular matrix, which happens to be an accidental discovery, has resulted in greater benefit to patients with hair loss than the work that hundreds of millions of dollars has been invested in the goal of hair cloning or trying to grow hair in the lab and implant those hairs. I would love for this stuff to materialize because it would give one more tool to help surgeons like me to help people like you. At this time, the material we are using is only FDA approved for wound healing. It isn’t approved specifically for hair loss but as a surgeon and physician, it is common to have off label use of materials as long as it is clinically appropriate. I would recommend Hair Regeneration as a treatment for you. We follow our patients very closely and see people at one month, 3 months and even up to 2-3 years. Once a patient is in our practice, the door is always open. I would just like to remind you to be mindful of the limitations and expectations of a hair transplant procedure and learn about this extracellular matrix technology and Hair Regeneration and see if you could find a provider that would be right for you. I hope that was helpful, I wish you the best of luck, and thank you for your question.