My hair transplant

Or how I got something done that I never thought I’d get done.

I’ve talked about my hair-related dysphoria elsewhere. I am bald. At 50+, I have a lot of bald on the top of my head. I hate it, and avoid looking at myself, avoid having pictures taken, avoid thinking about what others see when they look at me. As I began to settle into my identity as nonbinary and transgender, I found I still hated my lack of hair, but on my worst days, me.

Yay, dysphoria.

By the time I got to a hair transplant, I’d already been through several stages of dealing with hair loss. Ignoring it didn’t work. Embracing it didn’t work. Shaving my head didn’t work. Hats didn’t work. Wigs didn’t work (though for various reasons I didn’t give them a real chance). And in the constellation of hair, that leaves transplants.

So I made an appointment with a local doctor. I’d done my research, I’d looked at testimonials, I’d compared my other options locally, and I chose this guy. My free consultation was affirming (he keeps getting my gender wrong and then immediately—but not making a big deal about it—over correcting to “she” which I actually find kind of charming, for some reason). He was very confident about the likelihood of success in my case, and so I made an appointment for a procedure.

I’d like to take this moment, to once again thank insecure old white men for the advances in gender-affirming care they have helped to push. Hair transplant medicine was pioneered and perfected for insecure old white men. I am reaping the benefits. So, my appreciation.

During the last half of the procedure, I got to chat extensively with the two medical technicians who were implanting hair in the top of my head. At one point, they were laughing about what happens when they meet new people, at a party or at a bar. “Once they find out what we do,” they said, “the first question they always ask is, ‘Does it work?’ and then it’s like twenty questions until someone asks ‘How much does it cost?’ and that always stops the conversation.”

A hair transplant is ridiculously expensive. There’s no getting around that fact. Even the cheapest places are still unfathomably expensive. Where I went, a specialist who only does this, it was even more so. I… can’t actually bring myself to write the number down, but the math is easy. The doctor I saw charges $5 per hair moved. In my first of two and a half planned procedures, they moved 3,325 hairs. Yeah. The whole process is about the cost of a mid-sized car. A nice mid-sized car.

I need to acknowledge how far out of reach this is for almost every person on the planet. Insurance rarely will cover this procedure, it’s considered cosmetic, and therefore elective. Facts: hair transplants were developed for rich old white men, and those are still the people who can access it. That was me before my transition, and I am still cloaked in all that privilege.

That said, however you feel about it, I’m writing this particular post so that people who want or need to know more about hair transplants can learn something from my experience. So here goes.

A hair transplant is ridiculously expensive. It bears repeating.

It works. It can be botched. It is not painful while it is happening. It was really painful afterwards. It takes a long time to see results. It is a bit of a miracle. It is not a cure, for baldness, for dysphoria, for any of it.

What to know about hair transplants.

• It’s insanely expensive. Know that, and you’ll still be surprised.
• They will refer to the “donor” area, where they will take the hair from, and the “recipient” area, where they will implant the extracted hair.
• There are two ways to do it. In one process, they cut small strips out of the donor area, then extract the hair follicles under a microscope. This is called Follicular Unit Transplantation, or FUT. It is cheaper and faster, requires sutures to close up the scalp where the strips are removed, and can cause scarring that is often covered by remaining hair, especially if you keep it longish. The second type of procedure is called Follicular Unit Extraction, or FUE. In FUE, follicles are removed one at a time via a “punch” that felt more like a drill to me when it was being done. The follicles are then implanted in the bald areas. This is more expensive, less invasive, takes longer, and usually does not lead to any scarring. Learn more here about FUT and FUE.
• In all cases, you can expect the transplanted tiny hairs to fall out soon after, and it can take four months to a year for the implanted follicles to generate new hairs.
• As with many of the gender affirming processes I have explored, testosterone will fuck you over here. T will make sure your male pattern baldness keeps happening, and you should counteract it if this is important to you.

My procedure, in more detail than you want.

During my consultation, the doctor was super pleased with the thickness of my hair in the donor area, the back of my head. Apparently I am blessed with a lot of hair where I actually have hair. He said I was a great candidate for the FUE procedure, and I said that sounded great. He basically clucked over my head like a protective hen, and sounded well pleased with himself. It was endearing.

I showed up at 7 am the morning of my procedure. I was the only patient getting a procedure that day, which is standard process for this practice. The first thing the nurse did was go over the after care packet (which I had received at my consultation, four months earlier).

The doctor then drew on my head. For this particular procedure, he was going to lower the hairline on my forehead, then fill backwards until they ran out of hair. When I say “lower” the hairline, let’s be clear that I mean “create” a hairline, because all I had was a tuft in the middle. He got my permission, then took a few photos.

Then I met the person who runs the… extraction machine? He lives three states away, and gets flown in by the doctor several times a month to run the machine. According to the doctor, this guy is the best in the nation. I spent six hours with him that day, and he was delightful, funny, respectful, and seemed good at his job. When he’s not doing this, he hangs out with family. He gets paid well.

He had me sit and shaved my hair down to a short buzz. Then he had me lay face down on a comfortable table, and the doctor proceeded to numb my head with local anesthetic. He used some sort of machine that felt like a scalp massager with needles instead of rubbery nubbins. That hurt like a motherfucker, let me tell you, but it was the last pain I felt that day.

Throughout the day, they kept telling me to let them know if I felt any pain. I would do that, and they’d numb it up and keep going. What I’m saying is, don’t be afraid of the pain.

Then, the extraction guy started drilling. Of course, I couldn’t feel any pain, but could definitely feel the pressure, and very occasionally, a sound through my skull that reminded me of ripping a seam. That memory doesn’t bother me because it was replaced by a different sound later in the day that I can’t quite shake. 🙂

This took four hours. Yeah, extracting 3,325 hairs took four hours. I was prepared for this. I’m a pretty gregarious person, and so was the guy extracting the hair. We chatted about our lives, we got into some pretty deep topics (politics, even), we chatted about our respective Latine heritage, it was actually kind of fun.

In the background, two technicians were taking the grafts he removed and looking at them under microscopes, checking for viability, and… whatever. I guess some of the follicles can be cut in half during the extraction, and those need to be removed. The doctor had boasted that the industry rate of this “resection” is 10%, but that his guy had a rate of 3%. I did get a chance to look in the microscope once, and it was kind of cool.

I took breaks to pee and to stretch, about every hour. They had snacks and drinks. It was a pretty pleasant experience.

About noon, they wrapped up the extraction and the doctor came back in. He had popped in several times during the morning to check on me and my follicles, but this time had me lie on my back and tapped around on my head in the recipient area (my forehead and backwards from there) for any sensation, re-applied local anesthetic where needed, and then proceeded to cut into my scalp.

He showed me the tool he was using, which looked like a long, flat piece of metal maybe three or four millimeters on the short end, which was sharp like a really small knife blade. He proceeded to stab my head with this, cutting tiny incisions by pushing straight down. I gather it bled a lot, because there was a lot of mopping.

This is where I still get a little fluttery. The sound of this process is like the sound of cutting an apple: that combination of slicing and crunch. I still can’t shake it. To boot, once he had cleared the area where I still had some hair (remember the tuft?), where he had to go carefully, he started moving quickly across my scalp. Some of those cuts ended with a solid thunk on what I can only imagine was my skull. That’s also hard to forget.

This process lasted about an hour. Then he wrapped up my head and I ate lunch, a sandwich provided by the doctor’s wife. It was nice.

The afternoon was for implanting. I lay down on my back again, and the two technicians and the extraction guy started putting grafts into the holes the doctor had made. I gather there is an art to this, and the doctor popped in several times to look at how it was going, talking about angle and color a little bit. I know that hairs are implanted at angles designed to mimic natural hair (which does not necessarily come out perpendicular to the scalp). It also appears, from my own examination in the mirror, that they implanted more gray hairs along my temples, where I already had gray hairs, and more dark hairs along my hairline. I’m curious to see what color is where when it grows out.

This process took about five hours? Maybe just four. We watched TV, and the four of us chatted about the movie, and about other things. Again, it was entirely pleasant, and I couldn’t feel a thing.

After all of this, they wrapped up the donor area with a bandage, gave me a gift bag with bandages, ointments, instructions, cornbread (again from the doctor’s wife), and a colander, and took a few pictures (again, with permission). Finally, I wrote a big ass personal check.

One thing about the check. It was for a lot of money. I had to make special arrangements with my investment professional to have it available. I asked the doctor, and the doctor’s office, for a number several times leading up to the procedure, and they were very consistent with that number. I secured more than that, because I am cautious that way. On the day of the procedure, they were able to extract (and implant) more hair than predicted, which is a Good Thing. That means less time later. But it also means the price was higher than they had been telling me. $5 a hair, remember? I am glad I had secured more money than they had said, because my regular cash flow would not have been able to cover the difference.

After almost twelve hours, I drove myself home. I was not in any pain. I had been instructed to sleep on my back, so as not to rub on the newly implanted hair. I sleep on my side, but I had a sleeping wedge I used to use, and I got it out. I managed to stay on my back (ended up doing that for five nights, they asked me to do it for three). But I did not sleep well, my subconscious kept waking me up, nervous about whether I was still on my back.

The second day I took the bandage off the donor site, the back of my head. It had bled a lot more than they told me it would, but by morning it was not actively bleeding. I had put down one of the waterproof surgical pads they had given me on my pillow overnight, and there was a fair amount of blood on it.

I followed their very detailed care and showering instructions, which taper off over the course of ten days, and begin with “don’t touch the recipient area” to “shower as you normally would, no restrictions”. The most amusing part is that for five days in the middle there, I was using the provided colander to interrupt the shower flow to lessen the force as it hit my head.

There’s not much to say about the recovery process except this: the donor area hurt like a motherfucker. Almost three weeks later, as I write this, it is still tender. I had to sleep on it however, as I was sleeping on my back, and I took a lot of over the counter pain meds for this. During the day, for the first few days, the pain would build until I could not really think straight, and I would take some pain meds.

Oh, and the scabs. At first, the recipient area (the top of my head) was pretty bloody. As I began moving into being able to wash it, the general color of my scalp faded from red-brown to just a little flushed, but the scabs lasted for almost two weeks. At one point, people clearly thought I had colored my head or my scalp. I have to think that anyone who got close could tell that no, that was blood and I was suffering from some sort of horrible something, but nobody ever said anything.

Eventually the scabs came off, mostly on their own, some of them assisted by me. Don’t do that. If you possibly can, don’t pick your scabs off. I couldn’t resist early on, and I pulled out what I am sure were a few follicles along with the scabs. The horror of that helped me avoid doing it (much) more.

This is getting long.

I’ve been to my two-week post op appointment, and the doctor was very pleased with himself and with me. He told me to expect all the little hairs to fall out, but for them to begin regrowing within a few months.

The procedure did not take care of all of my baldness. There is a significant area at the crown of my head that did not get any implants, so I will go in for (at least) one more procedure. They will take more hair from the same donor area (remember, I have thick hair, at least there), and use it to cover that spot, and to fill in where this first procedure may have missed. There may be a third procedure, we will see after the regrowth following the second one. And yes, each time will require separate payment, this was not all up front.

How am I feeling about it? I am definitely trying not to make any decisions about it yet. I have months before this first procedure can really be evaluated for success. But it does work. I’ve met people (hello cis men) who have had it done, and been pleased.

Looking at myself in the mirror, even with just baby hairs, even still looking bald-ish, it’s better. I am excited. I still look like a balding man. But I am hopeful that someday I won’t.

Ask me questions. I’m sure I have forgotten something, and I expect I will edit this later, as I remember.