Somehow in my consciousness over the winter and spring, I developed a plan (if you can call it that) to begin doing something about my hair, or more precisely, my lack of a full head of hair on top. As a man, I had always just borne the burden, as it was typical of my sex. But as I began to contemplate an alternate reality (still awfully imaginary at the time), I realized I might need to do something. I wrote to Bosley on their website, and soon I was deluged with print packets, DVD’s, emails, and helpful phone calls, all following up on the sales lead. I studied the materials and weighed the pros and cons. The pros were these: I would benefit from the hair whether I decided to transition or not, the procedure was financeable at 0% through Capital One Healthcare, and the timing was such that I could do it and pretty much be through the ugly part of it in the slow time right after the spring semester ended. The cons were these: I would be giving in to pride and buying in to the cult of transparent beauty (something I had resisted in so many ways over the years), I might simply be wasting my time and money because I have so much hair loss that I would be chasing a dream of a full head of female hair.
So I took the middle path and did nothing, opting instead to dig deeper through an initial consultation at a Bosley clinic. I flew to Dallas on June 19th and got a ride over to the clinic, which is only 5 minutes from Love Field and very, very convenient. I was quite nervous and ambivalent about being there. On the one hand, the visit was necessary to either prove the folly of a hair transplant or to convince me that it was something I wanted to do. On the other hand, the visit would necessitate disclosure of my medications to the doctor, and I really wasn’t ready to reveal this secret to just anyone (only my doctor and my wife knew at the time).
Since almost everyone who goes to this clinic is a man in his 30’s or 40’s, everything about the clinic was designed to make such a person feel right at home. Televisions all around the waiting rooms, consultation rooms, and surgical rooms played ESPN highlights, CNN news, or Wall Street tickers. The front waiting room’s coffee table had sports magazines, sports sections from the Dallas Morning News, men’s health magazines, and GQ-like men’s life/leisure magazines. Suffice to say it’s not necessarily the environment that makes me feel right at home.
I was called in to talk with Alfonso, a hispanic “consultant” who I understood to be a salesman, a gentleman whose job it was to provide me with information, but also to close the deal. He drew on a giant piece of paper that had various views of a head on it to illustrate what the doctor might do when he arrived in a little bit. He showed me pictures from the brochures I had been sent, as if I had not seen them before. He talked about how easy the procedure is and how easy it was to set up a schedule. Finally, he talked about finance options.
One of the things he focused on during the finance discussion was the scope of the transplant. If you get 600 hairs transplanted, the cost per hair is $9.50. If you get 1200 hairs, the cost per hair drops to $8, and if you get 2200 or more hairs, the price flattens out at $5.50 per hair. In other words, while offering various clients various options, the pricing structure is designed as a flat fee around 2000 hairs. “After the doctor gives you his opinion,” he said, “I’ll be back to discuss what you’d like to do.”
I filled out a medical history, fully disclosing my use of estradiol and spironolactone, and waited for the doctor to arrive.
Dr. Bruce Hubert (who has since moved to the Bosley clinic in Phoenix), came in, studied my chart and the big paper that the consultant had drawn on. We chatted in a cordial but cold way for a few minutes. He came to the part in the medical questionnaire that said I was taking estrogen and anti-androgens and asked why I was taking these things. I said, steeling myself for rejection, that I had gender identity disorder and that I was investigating the possibility of fixing my baldness for the possible transition from male to female. All things being equal, I said, I’d like to have more hair. He said he understood, but said bluntly that I would never have a full head of female hair and that I would continue to lose hair and that there wouldn’t be enough donor hair to achieve what I was talking about. If I wanted to look fully female, he continued, I probably shouldn’t get the hair transplant, save my money, and wear a wig; however, if I wasn’t going to transition, then I’d be able to achieve certain things like the front filled in and some of the middle around the back. I was nodding rationally at this diagnosis while inwardly sinking lower and lower, feeling foolish for coming to the clinic, for having dreams of looking pretty, for even giving in to my transgender feelings.
I explained that I really didn’t know what my future held regarding transition and that I would have to balance all possible futures with the hair procedure. I asked, “what about T-blockers? Wouldn’t they prevent further hair loss if my testosterone levels fall to female levels?” He looked at me dismissively and said “Women’s testosterone levels are something like 15 and yours is probably 400-600. Spironolactone isn’t going to do anything about your male pattern baldness.” That wasn’t exactly the most informed answer, but I assumed that he was not informed about GID and the possibility of a patient having reduced (or eliminated) testosterone via drugs or orchies.
In any case, we plowed ahead with the medical portion of the consultation, which picked up pace because it was a more normal script. He examined my head, drew on a new piece of paper, and announced after about 60 seconds that I was a Hairloss Class 6, and that I was a candidate for hair transplant if I didn’t expect too much. He estimated that I had around 5000-6000 hairs to donate and that we could use around 2000 of them this summer to create a new hairline and fill in the thinning spots behind it, and if i wanted thicker hair, we’d have a few more hairs for round 2 in a year or so.
The doctor left and the salesman came back in and talked concretely about timing and cost, and I said I’d opt for 2000 hairs if I did the procedure, but I’d have to think it over. That was ok with him, so I returned home to mull it over.
I was a bit depressed by the whole experience for a week or so, but the more I thought about the costs versus the benefits, and as a window of opportunity was closing (i.e. getting it done and healed by the start of the fall semester), I rationalized it thusly. It’s relatively inexpensive, given my situation, and if I get any benefit whatsoever, then I’ll benefit as a man or a woman. If it’s not feminine, then I’m still going to be wearing a wig, which is precisely what I’d have to do if I did nothing. But if there was any chance of minimizing the baldness and perhaps making passing more of a reality, then why not do the procedure? If I skip the procedure and wait a year, then I’ll be one year behind. So I took the plunge and did it, just before our family vacation.
Flew down to Love Field Sunday night, stayed across the street at the Hilton. Checked out and walked around the corner to the Bosley office at 7:30 Monday morning, July 23rd, and we dove right in. The first stop was the paperwork waiting room, in which I signed a lot of waivers, studied the financing sheets again, and stowed my suitcase and other belongings. Then it was off to the procedure room, where I would remain all day long (when they say it will take all day, they mean it).
The room is hospital-room sized with something like a barber chair right in the middle, facing away from the doorway and towards a television mounted up near the ceiling. A window was on one wall, but the other three walls had work counters with under-cabinet lighting and probably 6-8 microscopes distributed around the room.
The first thing that happened was a great deal of combing and tying back the hair on the back of my head, or the “donor area.” Then they shaved very carefully around the edges, presumably establishing a very clean and clear area for working. They had told me that it would be better if I had some length in my hair, and since I was growing my hair, anyway, it was no big deal. After the graft was taken out, the rest of the hair would just fall over it and no one would be the wiser. When the preparation was all done, Dr. Hubert showed up, took some pictures, drew some lines on my head, and then left to let the technicians do their work.
First a woman (they’re all women except for the doctor) went to work numbing on the back of my head, where she used something like a tattoo gun to give me lots of numbing drugs really fast (really painfully, I might add). By the time I could react to the sound of the buzzing and the forceful way she and her assistant were manipulating my skull, the medicine was working. After I was comfortably numb, the doctor came in and began injecting cold water under the skin, which (I assume) was to separate the skin from the underlying tissue. It sounded really odd, crunchy, the sound transmitted both through the air and through my skull to my inner ear. Visualizing the procedure was very odd and I came close to getting the willies a couple of times, as I imagined my skin being inflated to rise above my skull and the crunching sound being the tearing of whatever holds the skin to the bone.
Once this whole strip, which runs from ear to ear in a ribbon-like strip, was injected with water, next came the scalpel, and a couple of women physically moved my head back and forth as the doctor cut the top of the ribbon, cut, cut, cut, turn head, cut, cut, cut. Then the bottom of this 3/8″ ribbon, reversing the technique. I didn’t feel when he cut the ends of the ribbon, but with little fanfare, the doctor grasped the skin and simply pulled the skin right off the scalp. I had visions of American Indians scalping their victims. With the strip removed like a trophy, the girls took it over to the tables where, vulture-like, 6-8 workers (all women) began to tear it apart in 1/2″ segments to take back to their microscopes, where they would harvest the hair follicles one by one. I had no idea how labor intensive this procedure would be, and I found myself absolutely fascinated by the workflow and the labor costs that must go into this business.
In the midst of my managerial musings, Dr. Hubert grabbed some mighty suture thread and sewed up my ribbon-gap with some forceful tugs, first at two or three major intersections, and then, football-like, across the entire area, and then we were finished. Whew, I thought, pretending that we were all finished. The women told me I had a couple of hours while they harvested the follicles, so I read. They asked me multiple times if I wouldn’t prefer to watch television, to which I replied that I’d really rather read my book, which was some sort of academic theory book, if I remember correctly. It helped transport me away from the room and into the realm of the body-less intellect, where I really preferred to be a that moment.
The technicians took small pieces of my scalp and, under microscopes, counted and separated all these hairs and put them in saline. After a couple of hours, when they were finished, they added up their tallies and said they had 2305 hairs. Since I had paid for 2000 transplants, I got 305 freebies, and they made a point of telling me this. I suspect it’s all a rehearsed part of the experience, allowing the patient to feel like he’s gotten a bit of a break right in the middle of a Frankenstein procedure.
The next step was quite odd (as if the rest of the day was normal. First came the tattoo gun again, all over the top of my head this time, and another run across the back of my head in case it started waking up. It hurts to get shot that many times, let me tell you. When I was good and numb, Dr. Hubert showed up again and said he was going to make the site. First thing he did was to repeat the crunchy, squishy, cold water treatment and I pictured my head blowing up like a balloon as I listened to the otherworldly crunching, both through the air and through my skull. Then came the site preparation, which sounds very pristine and precise, but what it was was 2305 jabs with what felt like a carpet needle or an awl, each one transmitting a distinctive poking sound through the leather of my scalp. One woman held my head and moved it around according to the orientation the doctor desired while another woman standing directly behind the manipulator counted every single jab. It was fast and it sounded the way my kids count to 100 when they want the treat at the end of the counting, taking perhaps 30 seconds to count to 100. Every so often, the doctor would pause and check out his work, then continue poking me, with her counting and yet another woman off to my right keeping track of the hundreds and thousands. Finally, after fighting back the impending feeling of getting the willies again, it was 2301, 2302, 2303, 2304, and a final jab, 2305. “There we go,” he said, and left me in the hands of two women technicians, who promptly began planting the cleaned and separated hairs, one in each hole. They told me this stage would take 4 hours and they tilted my head back so that my brand new scar in back was right up against the headrest. They also draped their arms around my head and face so reading was impossible; therefore, I gave in to the television and found an old Star Trek marathon and watched Captain Kirk in action. This grafting stage took an extraordinarily long time and it was pretty uncomfortable. We stopped for a Caesar Salad at about 1000, and I savored every little bite of lettuce and crouton, half hoping that the meal would never end. When I thought I couldn’t take it any more, I asked how far we were, and they said around half way, at which point I said I had to go to the bathroom. They wrapped my head with something sterile and said that one of them would have to accompany me. A little light-headed, I walked down the hall (no one around, so it was kind of eerie, and I pictured every closed door holding another patient like me) to the bathroom. I noticed that there were no mirrors anywhere, not in the halls and not even in the bathroom. I assume this was a precaution to prevent patients from barfing at the sight of their heads. Another episode of Star Trek and I asked where we were again, and they said only 500 more to go. Finally, it was over, a basketball head, numb and in pain.
A new woman I called the exit nurse gave me instructions, a care package, and medicine. She asked if I had brought a hat, and I said no, so she gave me one of those really large farmer’s caps that could hold a billboard on the front and she said to wear it loose, putting the front band on first, then pulling the back down into place. The hat felt like it sat 18 inches above my head, but I was so dazed I really didn’t care. Then she sent me on my way. Considering how busy the whole day had been, this exit was perfunctory and fairly jolting. I called for a cab and went to the airport, where I had a weather delay of 4 hours. I tried to relax in an airport chair, but the numbness was wearing off and I was in considerable pain. Finally got home just before 10:00.
Epilogue: we went on our family vacation right after this procedure, which was a little uncomfortable, but manageable. I wore a straw hat the whole time, and the 2305 little scabs began forming, then falling off. According to Bosley, all this transplanted hair will fall out because of the shock, and then ought to begin growing in a few months. We will reevaluate the experience around December.