Cristero

2 minutes ago, LonelyGraft said:

So a randomized study with 19000 patients over 7 years is something we should overlook? Ok 👍🏼 

You clearly have a bias and failing to understand how the research and studies works.

Just for your information, a metanalisys is a collection of several studies and it's considered superior to a single study, as it collects data from several sources throughout the years.

The source you cited is still doing a connection between DHT and prostate cancer, which has been found to be obsolete in the second metanalisys I've sent you. I guess you didn't even open it. That doesn't invalidte all it says there, but clearly shows the doctor you quoted is failing to keep himself updated.

In any case, there's no point on keeping discussing it. It's the usual self-defensive attitude of finasteride users. They don't want to hear the fact that they are possibly jeopardizing their health for the sake of a band aid that won't prevent them to eventually get bald anyway.

24 minutes ago, LonelyGraft said:

Not sure where you got your info from but finasteride helped prevent prostate cancer in over 25% of men over 55 who were in it over 7 years. That’s significant.

 

the doctor provides a very good explanation in terms of why higher grade prostate cancer was detected. It likely wasn’t finasteride that caused it directly. Take a read:

 

https://www.cancer.gov/news-events/cancer-currents-blog/2019/prostate-cancer-prevention-finasteride-parnes

You are using just one source.

This metanalisys contradict your source:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358277/#:~:text=The role of 5α-reductase,risk in high-grade disease.

Ypu may want to read the biggest metanalisys of studies on DHT I'm aware of, that shed light on the role of DHT in prostate cancer, which is dubious by now:

https://academic.oup.com/edrv/article/38/3/220/3788611

12 minutes ago, Melvin-Moderator said:

That’s true, I believe the main reason they aren’t effective is because DHT is not the cause for prostate cancer, early onset dementia or possible prostate cancer detection, to keep higher sides on an already bald scalp seems insane to me.

As another user said, people are ignoring senile alopecia. Your donor won't be the same at 40 as it was at 20. Hairs are organs and they age like all the rest of the body.

I've personally asked Dr. Rassman because I saw with a microscope some miniaturized hairs on my occipital area (mostly one hair on a double graft). He told me he sees it quite frequently when "guys turn into men" and not to be worried about it. Donor miniaturization could be due to other causes, like lack of iron, low vitamin D levels, hypothyroidism etc. But yeah, let's ingest an anti-androgen like if it was a candy to thicken 200 hairs on the donor.

33 minutes ago, Melvin-Moderator said:

My father was diagnosed with prostate cancer 4 years ago at 59. Thank god he caught it early and is now cancer free, another fear of mine and why I won’t take fin. I would strongly urge you to discuss with your urologist. There is a misconception that DHT causes prostate cancer, but that’s not true, it is testosterone. In some cases, dutasteride and finasteride can cause spikes in testosterone. The only thing fin and dut do is prevent early detection, from what I understand.

I'm glad you brought up the matter and mentioned that the issue with finasteride is not only sexual side effects. 5-ar is rich in some tissues for a reason.

Not many people knows that 5-ar inhibitors have been trialed as treatment fro prostate cancer, in order to try to target the androgens in the prostate in the early 2000s. We now know that prostate cancer is way more complex than just saying androgens is the cause. There are prostate cancers that are resistant to complete prostate androgens deprivation. In any case, finasteride and dutasteride didn't get approved for the treatment of prostate cancer, because not only they were ineffective, but they actually showed to be possibly trigerring a far more aggressive cancer prostate than the one they were supposed to treat. I've seen a recent study done to try to debunk that, but it didn't convince me at all.

40 minutes ago, Curious25 said:

In contrast to what someone mentioned on here or perhaps another thread in regards to age being a consideration whilst assessing ones likelihood to experience unwanted side effects, 

I believe it was the user @Cristero - anyway, he mentioned the older one gets, the more susceptible they are to experiencing negative side effects due to the combination of forced inhibition alongside the natural decline in their androgens. 

To me, that logic makes sense.  

However at my recent consultation with the urological consultant, he had observed side effects to be less severe with age, something which he attributed to be potentially down to a more 'experienced' endocrine system, one that is perhaps more in tune with the body (similar to as wisdom comes with age), and able to tolerate attacks and tampering with 'a more mature approach'.  

This theory is not scientifically proven or researched at all, and was simply an observation from his experience over the years, and an offering of a potential explanation, when I probed him as to why this was. 

 

The reason is because your body experiences a really slow androgens decrease with time. In a healthy male, the avreage is a decline of 1% of testosterone every year, one you reach your 30s.

Older men are accustomed to live with lower androgens and may suffer less the introduction of an anti-androgen at later stage, especially because they don't expect to perform as a guy in his 20s in every field of their life (not just sexually). 

5 minutes ago, elduterino said:

Suppression of the stress or HPA axis results in inadequate cortisol production. Cortisol is the natural stress hormone found in humans. When this hormone is produced insufficiently, response to stressors (e.g. trauma, surgery, inflammation) may be impaired and defence against infections may be inadequate. 

>Does not mention sexual hormones. This affects cortisol not male hormones

According to research, chronically elevated cortisol levels can produce impotence and loss of libido by inhibiting testosterone production in men. 

>so how having low cortisol does seem to lead to impotence 

 

Dude you are confused to say the least. I'm not gonna get into a discussion on this topic, because this is seriously endocrinology 101. Cortisol doesn't suppress the HPTA and doesn't require any induced restart of the axis.

If you want to know how the HPTA works and what happens when it gets suppressed, google "secondary hypogonadism in men".

As I said before, I'm done with this conversation until we will get the Breezula phase 3 data from Cassiopea. What came out from the Winlevi trials on young adults is alarming to say the least for now.

15 minutes ago, elduterino said:

sexual side effect have a very strong fear effect for guys, imagine spending all this money and effort on looks and hair, finally getting the girl of your dreams in bed and struggling to getting it up..a nightmare for most guys. Some even killed themselves over this.

HPA suppression, most older guys have no idea how this translates to practice.. and this is a lot more prevalent in children than older adults. Again, this was not reported in the hair loss age studies, 95 to 99% of guys will be just fine and EVERYONE will have rock hard erections

HPTA suppression is way worse than any sexual side effects. It seems you don't know much about it and I'm glad for you that you didn't experienced it, but that basically means you don't have any considerable amount of sexual hormones running in your body anymore, both androgens and estrogens.

Not only you will be unable to perform sexually, but you will experience a terrible depression and sometimes even suicidal thoughts. Try to ask any bodybuilder who failed to do a proper PCT protocol after a steroid cycle.

In any case, we will discuss again when we will have the data from the completed phase 3 of the hairloss topical.

35 minutes ago, Portugal25 said:

Totally false!

I most certainly lost several of my transplanted hairs over the course of the last 12 years!

@PT#31 knows me for over 15 years and can tell you that my frontal area that had 3425 grafts implanted in 2008 looked amazingly dense in 2009 and today not even 50% of the transplanted grafts have survived due to not taking Finasteride.

No it’s was not due to losing my frontal native hairs because Dr. Rahal assumed the hairs I had in the frontal area would be gone in under 5 years so he rebuilt the whole frontal area. 

Dude, I don't want to sound harsh, but the pictures you provided and the numbers you posted are telling a different story.

In any case, I wish you the best and I guess we have given you our opinion regarding your choice of jumping on finasteride. You are a grown up and you can do an informed decision. Hopefully you will be able to achieve the density you are after with or without finasteride.

Good luck for everything.

33 minutes ago, Portugal25 said:

@Cristero that’s not true.Transplanted hairs may thin out over time regardless if you have family with totally bald heads. This is why people take Finasteride and it still might not prevent hairloss by 100%.

Finasteride won't prevent your hairloss for sure. Period. It will give you some more years, but if you don't target all the other pathways, you will lose them eventually.

Finasteride is only a band aid.

A quick look at hairlosstalk forum will prove you that.

14 minutes ago, Rolandas said:

There's no reason to even continue this debate. If you think your donor is completely immune, good for you and best of luck in the future. I guess we are trying to be proactive and looking at evidence rather than waiting for it to happen and be "oh shit, I was wrong".

Look, I'm not trying to say I know the answer and you don't. Completely the opposite actually. I'm saying we BOTH don't know the answer. 

I was considering the case of @Portugal25. He's losing hairs in a standard horse shoe pattern. We are not talking about the donor getting thinner overall, we are talking about areas going completely bald, while the rest of the donor staying thick. So, to stay in topic, he just needs a surgeon to harvest in the safe area in HIS case and he won't need to take finasteride. His hairs when transplanted will stay thick, unless we are embracing the fibrosis/scalp tension theory.

You have surgeons on one side telling you the result are permanent, while some people claiming they lost their transplanted hairs. As you saw from Portugal pictures though, his own case judgement was biased. He didn't even lose transplanted hairs, at least from what we can assume from the pictures and the numbers he gave us. 

Do we have studies where they followed people with a hair transplant for more than 10 years?

32 minutes ago, Portugal25 said:

I asked Dr. Pekiner and he warned me that if I don’t take Finasteride my hairloss will progress to the green zone. This is something I see also in my 68 year old uncle that lacks any hair in that area and is fully bald. 
Sent a email to @Dr. Bruno Ferreira to also get his opinion on the comments made by Melvin and others.

So this demonstrates that what you and @Rolandas were saying is basically false. Transplanted hairs, taken from the safe part of the donor area, are immune to miniaturisation. The reason why Pekiner advise you to take finasteride is because you have a precedent on your family which had an AGA progressing quite extensively in the occipital area. This doesn't mean that transplanted hairs are not immune to DHT, but simply that your AGA is progressing quite aggressively in the occipital area. Which is what I've been trying to tell you since the beginning. Dr. Rahal harvested too high in YOUR case. If you showed him a picture of your uncle, he did a big mistake then.

2 hours ago, Melvin-Moderator said:

I think the same way, when you’re a Norwood 2 you’d be crazy not to try it. But when you’re a Norwood 7, you’d be crazy to try it. 

I look at it like this, imagine letting all of your grass die, and then buying fertilizer, it’s too late at that point. 

Amen

1 hour ago, Portugal25 said:

According to the below presentation Dr. Lorenzo gave about DUPA it states that actually it was O’Tar Norwood in 1975 that named DUPA along with the Norwood scale.
He also states that Bernstein and Rassman wrote again about DUPA in 2002. 
Nowadays Lorenzo is the foremost authority on DUPA. 

 

So one of the two is lying, tertium non datur (as the Romans were saying):

https://www.realself.com/question/california-md-dupa-hair-loss

Thanks for showing your pictures, but as the other user said, there's no chance that was 70 grafts per cm2. You would have looked really dense. I don't know what happened really, but I think you just kept losing your native hairs.

In any case, let's assume what they told you was correct. You said you started from 70 hairs per cm2 after the first HT and ended up with 30 hairs per cm2 before Pekiner's HT. That would have meant that you lost almost 60% of your hairs you used to have. This means you lost all the native plus more than 20% of your transplanted. As you can see from the link posted above, that would have implied you had DUPA, since more than 20% of the occipital hairs miniaturised. But we know for sure you don't have DUPA, so something else must have happened.

From what I can grasp at the moment, there are 2 possibilities then: either Rob English's theory about scalp tissue is correct, implying that even hairs in the donor area when implanted in fibrotic tissues start miniaturising, or you just retained your transplanted hairs and lost all your native hairs, which means you were quite far from having 70 hairs per cm2.

I tend to lean towards the second option.

10 minutes ago, Rolandas said:

Actually I'm not bluntly following Dr. Ferreira's advice, but rather i find our opinions very very similar. He is of course a Dr. who is quite crazy about hair, so I would assume he should know better than me, just a regular "Joe". Although I like to triple source my information to draw any conclusions.

Of course I would agree on the fact that lots of people are delusional which goes both ways. But according to research potential of sides is so low it would be stupid to neglect benefits of it's medication. I do believe people are overthinking negative part, thus creating this fear of it which is blown out of proportion.
I will tell you why I'm so defensive on this. I knew about Finasteride around 6 years ago, but I was put off by comments like yours to even TRY take it. Fast forward form NW2-3 to NW5a and I'm here, using fin for over a year with no problems what so ever + enjoying it's benefits. My biggest regret is not to start using it earlier, as it could have saved me a ton of hair!

I agree with @Portugal25 about Dr. Lorenzo. I was about to write it down as well. He has lots of success with DUPA and he always puts his patients on Finasteride in order to recover and maintain integrity of donor area. So this proves my point even further, that all scalp is susceptible to DHT, but most of hair follicles in the donor are not as sensitive as top of the scalp. Furthermore it looks like highly depends on individual. Some people have higher sensitivity to DHT in donor than others, so you will see mixed reviews. Some are NW7 with strong donor for years, but some have more miniaturisation.
I remember Dr. Bisanga checked my hair with magnification and said I've got less than 10% miniaturisation in my donor. That's when I got interested in this topic and realized not everything is black and white. Donor dominance is legit theory, but it's not as black & white as well.

Well, I guess you didn't read my comments then. I never said no one should ever take finasteride for hair loss. I said there's no point for a NW7, because no one that doesn't have DUPA will ever go bald or visibly thinning out on the donor. I think we can at least agree on it. He's exposing himself to an anti androgen for what would mostly be a minimal gain. Then obviously it's his call.

Just as a word of advice, in the first years taking finasteride, was like ingesting a placebo pill. No side effects whatsoever. The problem is when you're exposing yourself to the drug for the rest of your life, considering, as I've already said, that your hormonal profile will be completely different in your 40s than your 50s.

12 minutes ago, Portugal25 said:

@Cristero you are wrong because the safe area is not immune to DHT.

I had FUT with one of the best Doctors in the world for FUT and I experienced hairloss in my implanted grafts that were taken from a strip located in the safe zone.

Dr Lorenzo is the world authority  on successful surgeries to patients with DUPA and he states it’s mandatory for them to be on Finasteride 6 months prior to their surgery exactly to strengthen the donor area and assure its not affected throughout the years.

Sadly Finasteride has a high risk of nasty side effects but it’s proven that a lower dosage of 3mg/week is more than enough to stop hairloss and with this smaller dosage the chance for side effects is reduced.

I’m taking Finasteride because I want to maintain my donor area and strengthen my crown so that I can have enough grafts for a third surgery to rebuild the hairline and increase overall density.

Which means vast majority of surgeons in the world have fooled us saying the donor area is immune to DHT. The very same doctors you took your finasteride dosage from (the ones from The Hairloss Show) says the transplanted hairs are permanent and refuses to do juveniles hairlines on a big chunk of their patients, because they say they will keep their hairs on the hairline while keep receding in the mid and crown. 

Out of curiosity, can you share a picture of your scar during your first FUT? I'm curios to see where they harvested.

Regarding Dr. Lorenzo, being a good surgeon doesn't make you an experienced endocrinologist or dermatologist. He just says what he thinks it could work, but there's no literature on donor hairs and finasteride (or at least I'm not aware of it). Dr. Rassman, the one who labeled DUPA 20 years ago, says there's no treatment for it and refuses to proceed to surgery. So once again, 2 surgeons contradicting themselves. There are studies and articles done by SITRI, the Italian dermatologists society, which demonstrated how the female diffuse alopecia pattern is due to lack of tissue estrogens, in particular estriol. That could be a field to investigate for DUPA for example. In any case, how many men have you seen going diffuse thinning or completely bald in the donor area? Personally, no one. So, even if your logic would be correct and finasteride will improve your donor, how much would you expect to gain from that? 10% more hairs? Is it worth it the side effects, especially because you're not in your 20s anymore and your HPTA is slowing down by itself already, exposing you to a lower androgen index in your body?

To conclude, I can tell you by experience there is no proven dosage for any hormonal inhibitor. I've seen many blood works in these years by people taking aromatase inhibitors (which works the same way as 5-ar inhibitors) and the very same dose produced completely different outcomes in terms of serum levels. They are both paracrine hormones and their serum levels are irrelevant. You would need to do a scalp biopsy before and after to see how much that dose is lowering your scalp DHT.

37 minutes ago, Rolandas said:

Ok I get it now, it's because you had a bad experience. Your position is completely understandable. It's a human psychology to try to find negatives in something you don't like.

That being said, I'm still curious to what do you think about Portugal situation with his first strip as "extracted not from the safe zone" is invalid here.

That would apply to you as well, since you're using it after Dr. Ferreira suggestion. It's human psychology to defend something your are putting your faith on. I hope you did your extensive research at least before ingesting an anti-androgen. Don't trust whatever a doctor will tell you.

Hair loss forums are full of delusional trying to defend finasteride even when faced with evidences and basic endocrinology and pharmacology knowledge. On the other side you have people who got bad experiences that blame everything on finasteride, even if it's completely unrelated.

My stance is in the middle: if you're losing your mind after your hair loss, then definitely try. If you don't get side effects, it will retain your hairs for a decade, maybe 15 years.

But for a NW7, I seriously don't understand. If @Portugal25did FUT I don't know then. I would assume could be something related to how the surgery has been performed, but I don't really know. It is out of my field of expertise.

3 hours ago, PizzaWolf said:

No.

Believe what you want, I couldn't care less. You won't believe it even if I show you the blood tests before and after.

Juts for the record, look for the user Mustang on hair loss talk. Same experience as mine and other users on Italian forums.

Because I've been doing blood tests since I was in my early 20s and I'm in my 30s now. Until last year I was doing extensive blood work every month. Find me anyone else spending so much money on lab works. Is that enough as an evidence?

7 hours ago, Rolandas said:

@Portugal25 If I recall correctly your first surgery was FUT with strip taken from the sweet spot? If so, how Mr. @Cristero would explain such phenomenon.

Also not sure why you say that a doctor told you there's a frequent miniaturisation going on in the donor in men in their 30's, but then you say it's totally nonsense to take Finasteride on NW7? I'm a bit confused as to where do you stand. Also interesting where do you take information on scalp DHT being reduced by 40% only? https://pubmed.ncbi.nlm.nih.gov/10495374/  "Results: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively". To me it looks like it's above 60%. Also the fact that androgens are more sensible in the hairline by T (which I'm not sure it's true), this doesn't mean anything as OP had hairline transplanted.

From what I understand Fin can help to maintain integrity of donor area as much as top of the scalp. Even if it's not 100% efficacy, it's still way better than nothing. Besides risking side effects is just a nonsense. Take it and you will see sides, if they appear, discontinue. Now you know you can't take it. But by living in a fear whole life is not the best solution.

It means that miniaturization in the donor is something that even people without AGA sometimes have. It's a normal aging process, unrelated to what's happening on top of your head. Just to be clear, Dr. Rassman is the surgeon who invented the word DUPA, so not really the last surgeon on earth.

You quoted just one study. I saw several during the years and the numbers are all over the place. DHT is a paracrine hormone, you will see different reductions according to the time of the day the sample is drawn, the age and the health situation of the patient. That's why I said 40% on average.

About the efficacy of finasteride on the donor area, is complete speculation. We have been told for years the hairs on the safe area are immune to DHT, so why bothering with finasteride? The options are 2 then: they either lied to us and they are not immune, so HT is a not long term option, or the people who lost their hairs extracted from the safe area have or developed DUPA afterwards, so a HT should have not performed in any case.

Discontinuation of 5-ar inhibitors doesn't mean complete recovery in several guys and we know it quite well by now. I personally became hypogonadal after 7 years of the drug and I'm on TRT for life. So it's not that easy as you are describing it and chances of side effects are higher and higher the more you age, since the androgens load in the body goes lower and lower due to aging.

I agree with @Melvin-Moderator. Both your friend @Rolandas and @Portugal25 would have lost their transplanted hairs anyway, because they were extracted too high in the occipital area.

Especially with @Portugal25, it's clear his occipital area baldness went pretty low on what you would see on many men. I saw pictures of extractions in several patients and a good amount of surgeons extract very high.

You're describing finasteride like if it's the Holy Grail. Many people can't even maintain with finasteride, as the oral version inhibits DHT a roughly average of 40% in the scalp. Without even mentioning that testosterone miniaturises as well, around 5 fold less than DHT. And, as shown by studies done years ago by Italian thricologists, the androgen receptors are more sensible to testosterone than DHT on the hairline.

Dr. Rassman told me personally that he sees miniaturised hairs in the donor quite frequently in men in their 30s, as it's a normal aging process. Taking finasteride on a former NW7 is totally non-sense, especially if he had beard grafts transplanted.

1 hour ago, elduterino said:

yes I was able to maintain with C (Clascoterone is a long name lets just call it C). 20 mg a day is a bit low but that depends on how long your hair is, very short hair will require a lot less. When I had a 1 guard cut all over I also used 20mg a day and it worked fine.

I also use Minox and Stemoxydine and both help lower the C amount as the 3 work in synergy.

In the Breezula studies they used a lot more C but that's also because people did not use anything else

for the HT I switched back to FIN for 1-2 months before I was able to apply topicals again, and used oral minox as well.

I was a Nw2.5 before the two HT

It's crazy you managed to keep your hairs with only 20 mg of clascoterone. I'm using 150 mg everyday in one application at night, along with adenosine as a growth agonist. I also dermastamp once a week and I'll probably add 17-a estradiol and Azelaic Acid after the HT.

It seems your hairloss was pretty mild and maybe it would have stopped by itself after reaching NW 3

4 hours ago, elduterino said:

@Cristero 

so you are taking testosterone and using Clascoterone ,  how does it work for your hair ?

Are your issues due to using FIN  ? I was on FIN for 6 years, never heard of such side effect

I had a terrible shed for 2 months when I started clascoterone which I never had with anything else, but despite the shed, my hairs are looking better.

I'm only taking 140 mg per week, that puts me on high end physiological range. I'm able to maintain with clascoterone at the moment and I'm supposed to have a first hair transplant soon hopefully. We will see how it will behave in the next years.

Did you manage to maintain with clascoterone during the years? What Norwood are you and how aggressive was you AGA?

This was supposed to be a safe alternative  to finasteride finally, especially for young guys wanting to avoid taking finasteride before their 20s. I'm afraid to tell you HPTA axis suppression is way worse than killing 5-ar. 

Just to be clear, HPTA suppression happens with exogenous androgens or several anabolic substances, like nandrolone. After using them, you need to use a post cycle treatment in order to restart your HPTA. Having secondary hypogonadism and being on TRT for the rest of my life thanks to finasteride as well, I can't just shrug my shoulders, pretending this is not alarming. And I don't even believe everyone will be fine after 4 weeks, just stopping the medicatioN. This is a huge disappointment.

That being said, I'm using it since a while to maintain my hair while on TRT, because I can't touch 5-ar inhibitors anymore, and I have 0 side effects. But in my case the HPTA is already suppressed, since I'm using exogenous testosterone.

19 minutes ago, elduterino said:

its not "guy" - they tested it in children aged 12 and over.

5% of those kids got this but this is not a sexual side effect unlike FIN, and the adults tested with the much more concentrated 7% twice a day version did not experience adverse effects.

The Propecia "2% sides" is a lie, a systemic drug which significantly reduces DHT in the whole body is bound to have side effects. The Indian study done later found that about 25% experienced sexual side effects on fin

While I agree with you on finasteride, you're quoting the Cassiopea's press release wrong. Taken from this one:

https://www.cassiopea.com/2020/08/27/cassiopea-receives-fda-approval-for-winlevi-clascoterone-cream-1-first-in-class-topical-acne-treatment-targeting-the-androgen-receptor/

Hypothalamic-pituitary-adrenal (HPA) axis suppression may occur during or after treatment with WINLEVI. In the PK trial, HPA axis suppression was observed in 1/20 (5%) of adult subjects and 2/22 (9%) of adolescent subjects at Day 14. All subjects returned to normal HPA axis function at follow-up 4 weeks after stopping treatment. Conditions which augment systemic absorption include use over large surface areas, prolonged use, and the use of occlusive dressings. Attempt to withdraw use if HPA axis suppression develops.

It clearly says adults and actually it was even worse with teenagers.

3 hours ago, Melvin-Moderator said:

Oh so it’s breezula, I believe it’s already being prescribed in Italy, perhaps @Egy can confirm.

It's not prescribed in Italy, because the drug for hair loss just completed phase 2 and not even started phase 3. If you want it, you have to order it from research labs and it's pretty expensive. I'm doing like that.

I would be cautious with saying that it doesn't have side effects, as Cassiopea clearly stated in their press release that 1 guy out of 20 got HPTA axis shutdown, which is way worse than finasteride. Good news is that it was reverted after 4 weeks.