Hair Transplant at 20: A Comprehensive Guide for Young Men

According to researchers, alopecia in young people is a more widespread socio-cultural issue than it might seem: it’s appearing earlier and earlier. In a society dominated by social media where physical appearance has become paramount, this early baldness is a source of insecurity and discomfort for many young men. While certain medicinal and herbal treatments can help slow the progression of hair loss, they can never stop it entirely. Hair transplants remain the only way to regain one’s hair. But is it sensible to opt for a hair transplant at 20, when all evidence suggests that baldness typically stabilises only after 30-40?

Identifying the Causes of Premature Alopecia: The First Step in Treatment

The first step in treating early-onset alopecia, which can sometimes begin as early as 15, is to identify its causes. It may be due to genetic, hereditary, hormonal, or external factors such as intense stress or poor nutrition.

• Androgenetic alopecia: The most common cause of early hair loss is androgenetic alopecia, resulting from hormonal disorders. Increased production of dihydrotestosterone (DHT), a byproduct of testosterone, disrupts proper hair production by attacking the hair follicle, causing hair to become progressively thinner and eventually fall out. This hormonal dysfunction isn’t, in itself, a serious physiological problem: many of these ‘virile’ men, who produce more testosterone than average, aren’t necessarily bothered by their hair loss from an aesthetic point of view. If they have a well-shaped head, their lack of hair can even be attractive to some. Androgenetic alopecia tends to stabilise between the ages of 30 and 50, coinciding with a reduction in DHT production due to ageing.

• Alopecia Areata: Also known simply as ‘alopecia’, this type is an autoimmune condition manifested by sudden hair loss, which may fall out in clumps from certain areas of the scalp. This sudden alopecia can also result from psychological states of anxiety, stress, or unease, which temporarily affect the immune system. Once the sources of stress have been identified and addressed with psychological support, the alopecia can be temporary, and the hair follicles, still alive and active, can resume normal growth. Certain medications can also cause alopecia areata, such as an overdose of antibiotics, contraceptives, or vitamin A-rich nutrients. With proper medical treatment, hair can regrow in the areas affected by alopecia areata.
• Nutritional, vitamin, or mineral deficiencies: Poor diet can severely disrupt the bodies of many young people. Some may embark on an excessively strict diet that causes a significant drop in nutritional intake, leading to premature hair loss. A lack of vitamins A or B and minerals (iron, zinc), which play a crucial role in hair growth, can cause unusual hair loss. A visit to a dietitian to correct a poor diet and restore balanced nutrition in terms of vitamins, proteins, carbohydrates, and minerals will enable the body to return to normal and the hair system to function as usual.
• Thyroid disorders: Pathological dysfunction of the thyroid gland, located at the base of the neck, can cause sudden hair loss in some adolescents. The thyroid plays a crucial role in hair growth.

How to Treat Premature Alopecia

When a young man notices his hairline receding and a decrease in hair density, the first step is to consult a specialist. The doctor will prescribe a number of medical tests, including blood tests, to try to identify the causes of this premature alopecia. If left untreated, within a few years the patient can develop noticeable baldness, leading to discomfort and insecurity which, psychologically, is equivalent to premature ageing.

Why Hair Transplants Are Not Generally Recommended Before Age 25

Once the cause of premature alopecia has been identified, the doctor can prescribe appropriate treatments. However, no herbal or medicinal treatment is currently available to halt the inexorable advance of baldness: they can only slow it down. The only definitive and certain treatment today is a hair transplant. Moreover, hair transplants are primarily intended for patients whose alopecia has stabilised: most specialists recommend hair transplants from age 30 onwards, when hormonal activity begins to stabilise.

Depending on the severity of the baldness and its psychological impact on the patient, it is possible to undertake a hair transplant before 30. However, the baldness will continue to progress, so the patient will likely need to repeat the operation to maintain an aesthetic balance. A premature transplant can also leave visible and frustrating traces: the progression of baldness around the hair implantation areas can give an unnatural appearance to the hair. Furthermore, the success of hair implantation also depends on the quality and quantity of grafts available in the donor area of the scalp where the hair follicles are most vigorous and numerous. Repeated graft renewal involves renewed extraction of follicles from the donor area, prematurely depleting the follicular potential and compromising the long-term success of future grafts.

Recommended Alternatives Before Considering a Transplant

While waiting to reach the recommended age, young patients can start treatments to help stabilise hair loss and slow the progression of alopecia. In cases of nutritional deficiencies, food supplements and nutritional support can be effective. For autoimmune diseases, medical support to strengthen the immune system can help. In cases of androgenetic alopecia – the most common form of early-onset alopecia – several types of treatment can be prescribed to regulate hormone production. Depending on the case, all of these treatments are generally prescribed over several years, before the ideal age for hair transplantation is reached. For natural and/or nutritional treatments, they may be continued after the hair transplant to continue giving hair follicles greater strength and resistance. Finally, meso hair transplant is a new regenerative medicine technique, based on the injection of one’s own stem cells, with particularly promising results. Unlike hair transplants, meso-transplants can be applied at the first signs of early alopecia, without the need to repeat the treatment several times.

Allopathic Treatments (Medications)

There are currently only two medications available that can help slow the progression of androgenetic alopecia (AGA), but not stop it: Minoxidil and Finasteride (marketed under the name Propecia). These drugs must be taken for life, and as soon as the treatment is stopped, androgenetic alopecia resumes its course. Due to the lack of data concerning the simultaneous prescription of finasteride and minoxidil, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) does not recommend this combination in the treatment of androgenetic alopecia. If a doctor prescribes them together, it’s best to seek a second opinion! The risks and unknowns are too significant to consider taking such a combination. Particularly in the case of Finasteride, certain serious adverse reactions have been observed.

• Minoxidil: Available in two dosages (2% for men and women, 5% for men), Minoxidil should be applied daily to the scalp in the form of a lotion or foam, without exceeding a dose of 2ml per day. A slowdown in hair loss has been observed, but according to medical literature, effluvium (sudden, diffuse hair loss) may occur at the start of treatment, ‘which is a marker of a good response’. The active compound is a ‘repurposed’ drug, originally developed to relieve gastric ulcers, which acts on the vascularisation of hair follicles. The main side effects caused by Minoxidil in patients with AGA are irritation, itching, and dryness of the scalp. Low blood pressure, dizziness, and headaches have also been observed.
• Finasteride: Prescribed under the name Propecia for early-onset AGA in men aged between 18 and 41, this compound is thought to be able to block the conversion of testosterone into dihydrotestosterone (DHT). Like Minoxidil, Finasteride is a ‘repurposed’ drug, originally used to treat urinary problems caused by benign prostatic hyperplasia. However, some medical journals consider that Propecia and its generics are ‘not very effective’ and have so many adverse effects that they have been classified as ‘more dangerous than useful’. Finasteride is said to have a number of serious side effects, including allergic skin reactions (itching, hives), reduced libido, erectile dysfunction and reduced ejaculation, cases of gynaecomastia (excessive development of the mammary glands), the appearance of blood in the sperm (haematospermia) and, on a psychological level, mood changes, anxiety and psychological disorders such as depression or suicidal thoughts. Moreover, according to patient advocacy groups, these side effects may persist after treatment has been stopped. In the UK, the patient information leaflet for Propecia and its generics includes warnings about these risks of sexual and psychiatric disorders.

Natural Treatments and Herbal Remedies

Natural treatments, particularly those based on essential oils, can also be beneficial for hair and may help slow alopecia. Unlike allopathic medicines, they have no side effects, and while their effectiveness varies from patient to patient, they are generally harmless. It has now been proven that rosemary, nettle root, and nasturtium are good for hair health. Combined, cedar, Tea Tree, and Palmarosa essential oils also help to slow hair loss and restore tone to the scalp. For greater effectiveness, these essential oils can be diluted in sesame, almond, olive, or coconut oil and massaged into the scalp regularly (at least once a week).

Mesotherapy with Mesenchymal Stem Cells

In recent years, medical research has made considerable progress in the field of stem cells. Present in the bodies of all multicellular living beings, stem cells can generate specialised cells through cellular differentiation, playing a crucial role in the development of organisms and keeping them alive, whether in muscle, bone, or organ tissue. While embryonic cells, present in the human embryo, ensure the growth of the foetus and the constitution of the human being, mesenchymal stem cells are present in certain parts of the adult organism and can, in an undifferentiated manner (multipotent), generate any type of cell. Induced pluripotent stem cells (iPSCs) can replicate indefinitely and give rise to all cell types present in the human body, playing a crucial role in regenerative medicine.

In the field of meso hair transplantation, it is now possible to generate new dermal papillae from mesenchymal stem cells harvested from the scalp. This revolutionary treatment has shown very convincing results, with highly satisfactory patient feedback. Present in hair follicles, these dermal papillae, which ensure hair growth, length, and thickness, can generate new follicles, stopping inflammation and reactivating damaged stem cells, particularly in cases of androgenetic alopecia.

The principle of a meso hair transplant is to perform micro-transplants of mesenchymal stem cells by removing a few hair follicles, together with the fat and mesenchymal tissue surrounding them, from the patient’s scalp. The sample is generally taken from a one-square-centimetre area at the back of the skull, which is a rich donor area and insensitive to the hormonal disturbances caused by androgenetic alopecia. Just three or four grafts are taken, with a fine blade scraping the epidermis, to create a cellular concentrate that will be cultivated and diluted in physiological saline, before being reintroduced, by micro-injections, into the bald areas of the scalp.

A single meso-transplant session is often sufficient to halt hair loss and thicken existing hair, followed by a session every year or two to maintain this growth. Because it acts on the hair bulbs that are still present, meso hair transplantation is well-suited to young men with androgenetic alopecia whose hair loss has not yet reached stage 5 of the Norwood-Hamilton scale. The first results are visible three months after treatment, with accelerated production of new hair follicles and thickening of existing hair. A meso hair transplant is usually combined with a PRP treatment (Platelet Rich Plasma), to boost the growth of the grafts. A hair mesograft can also be carried out prior to an FUE hair transplant, for a more extensive and longer-lasting treatment. Finally, this non-invasive, painless treatment, which holds great therapeutic promise for young patients suffering from baldness, has no known side effects.

PRP Treatment

PRP treatment involves withdrawing a small quantity of the patient’s blood, which is then centrifuged to separate the plasma, platelets, and other blood components. Once enriched with platelets, the blood is reinjected into the patient’s scalp using micro-injections. Carried out under local anaesthetic, the procedure is painless, and the results are rapidly visible. PRP injections can be used to stop hair loss when alopecia is still in its early stages, stimulating regrowth in thinning or balding areas. For optimal treatment, several sessions may be necessary: typically 5 sessions, spaced 5 weeks apart, in the case of early alopecia. PRP treatment can ideally be combined with a hair mesograft and/or an FUE hair transplant.

FUE Hair Transplant: The Best Solution for Early Baldness

Of all the treatments for baldness, FUE hair transplantation is the only safe and definitive treatment. Whatever the cause of premature baldness, a hair transplant is the best way to regain your hair and your confidence. Once the cause of the alopecia has been identified, depending on how advanced the hair loss is and the patient’s age, a hair transplant can be performed at the age that best suits the condition of androgenetic alopecia, the most common cause of early-onset alopecia. However, it is preferable to wait until hormonal activity has stabilised – around the age of 30 in men – before carrying out a hair transplant.

The treatment consists of removing follicular units from the back of the skull, the occiput, where the hair follicles are most active and vigorous, and where they are spared the transformation of testosterone into dihydrotestosterone (DHT), which causes androgenetic alopecia and hair loss. During an operation carried out under local anaesthetic, the hair bulbs are extracted from the donor area and implanted directly, one by one, into the recipient area, generally between the forehead and the crown of the skull. To optimise the results of a hair transplant, the specialist can perform a PRP treatment simultaneously, to ‘boost’ the growth of the newly implanted follicles, and perform hair mesografts on areas that are still not very bald. In this way, regrowth will be more uniform, and the progression of baldness will be halted in areas not covered by hair implantation, but not totally spared by the advance of alopecia.

A Combination of Treatments: Ideal for Early Baldness

The decision to carry out a hair transplant to address early baldness must be carefully considered and accompanied by a strict and comprehensive medical assessment, carried out by a specialist doctor. As baldness rarely stabilises by the age of 20, many young people with premature baldness will have to wait 5 or even 10 years before undergoing hair transplant surgery.

While waiting for the baldness to stabilise, several solutions can be considered. In all cases, a stress-free lifestyle and a balanced diet, with the right nutrients and vitamins, are the pillars of good hair health. The young man can then consider a meso hair transplant, if he can afford it: the treatment remains expensive, and it’s best to consider medical tourism, particularly to Istanbul and Turkey, to access the best treatments at prices often 60 to 80% lower than those charged in the UK, Ireland, US, and Canada. Alongside these meso-transplants, several sessions of PRP micro-injections will help to ensure the success of the regenerative treatment. Finally, once the alopecia has stabilised, all the conditions will be in place for an initial FUE hair transplant, which can be followed, 10-15 years later, by a second FUE hair transplant, to ‘fill in’ newly thinned areas.

Sources

True, R. H. (2021). Is Every Patient of Hair Loss a Candidate for Hair Transplant?—Deciding Surgical Candidacy in Pattern Hair Loss. Indian Journal of Plastic Surgery, 54(4), 435-440. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8719975/