balding 21 year old. Should i change from propecia to dutasteride? (with pics)

[nocombover123]

Hi everyone- new member here. I've been taking propecia for just over 9 months. I shed badly in the first 3 months of using propecia, but that isn't so much of a prob anymore. However I'm concerned that I have aggressive male pattern baldness. Literally all my uncles, grandfathers and both my dad and brother went bald when they were in mid twenties. I've always had a more pronounced forehead, but that doesn't both me so much. What bothers me is that the hairs on the front are so thin and the hair in the middle is almost see through.

 

So: Should i increase from 1mg of propecia to 2.5mg (if this is possible).

Or should i change to dutasteride? Am i likely to suffer shedding again on this new treatment?

Or should I do nothing until after 12 months use of propecia before re-assessing my situation?

 

It's really difficult because I'm keen to address the problem as early as I possibly. I looked through the pictures of my brother. He lost most of his hair quickly within the space of just a few years (between the ages of 21 and 24).

[Rachmunas4life]

Check out the Norwood Hair Loss Progression Pattern's on this website. What would you say your relatives get to? NW 6 or 7? Can someone post a link to the Norwood Scale? Thanks!

[Dan72]

Hi there,

 

I'm no expert, but as far as I am aware, Propecia is only effective around the crown area, and doesn't really touch the frontal portion. Do you use Minoxidil too? It may be worth including that into your regime to help keep/regrow the front area.

[nocombover123]

Thanks for the replies guys. My dad is a norwood 6. My brother is probably between a norwood 5 and 6 at the moment. I had a haircut today- I think I'm moving from a 2a to 3 fairly rapidly so I think this is an important time for me to think about changes in regime. Minoxidil is a tough one- it seems both expensive and is only effective for around 40% of users I believe. Could give it a go I guess. Do you know where i could buy it cheaply? s there a tablet form for minoxidil as well? Thanks.

[mattj]

A switch to Dut could trigger a new shed. You shouldn't necessarily write-off Propecia just yet. After the shedding you experienced it could be a matter of waiting a few more months before potentially seeing some re-growth in the thinning area. There are no guarantees though, unfortunately.

 

Sometimes it can be hard to tell from someone's description of their experience with the treatments whether they're frustrated that their re-growth hopes weren't to be, and ignoring the benefits of preventing further loss.

Now that the shedding phase has been over for a while, would you say that your hair is continuing to get worse? For many users, maintaining hair is the best that the drug can offer.

Edited March 14, 2011 by mattj

[Dan72]

There is a tablet, but I believe it can do more harm to your health than good and is not recommended.

 

I'm sure one of our more clued up members can help further with details. Where are you based? There are places you can get these things cheaper, I'm just not sure of the link since my laptop died on Sunday with all my favourites :-/

[nocombover123]

Thanks again for replies- much appreciated. Yes Matt it is very difficult to tell if the situation is worse or whether the hair loss has stabilised. I find myself looking it mirrors all the time trying to figure it out I guess. I think the hair at the front is thinner than 9 months ago. But the rest may have simply stabilised.

 

I'm based in the UK. Minoxidil seems really expensive and annoying to apply. Maybe I'll do it in the summer when I'm not uni. Can't face anymore shedding whilst I'm still at uni. Thanks for the info on the pill as well!

[RCWest]

The oral form of Minoxidil is bad for you in high doses, but the dose for helping hair loss is extremely small (5 mg.) Dr. Pathomvanich is the resident expert on here. Here is his post about it:

 

Thanks for allowing me to share my experience for the use of Oral Minoxidil in the treatment of Androgenic Alopecia.

 

Minoxidil is a peripheral vasodilator used officially as an antihypertensive. It occurs as a white crystalline powder and is soluble in alcohol, propylene glycol and slightly soluble in water.

 

The chemical name is 2, 4, - pyrimidine-diamine, 6-(1- piperidinyl), 3-oxide with molecular wt. 209.25.

 

More than 90% of drug is absorbed from gastrointestinal tract, reaching the maximum plasma level within first hour and declining rapidly thereafter. The average half-life in humans is 4.2 hours. Approximately 90% is metabolized predominantly in Liver by conjugation with glucuronic acid, with some by conversion to more polar products. All metabolites are excreted in urine.

 

Minoxidil is a direct acting peripheral vasodilator capable of reducing both elevated systolic and diastolic blood pressure. It does not interfere with the vasomotor reflux and is therefore unlikely to produce orthostatic hypotension. The primary use is for the treatment of hypertension.

 

Dosage is usually 2.5 to 100 mg per day as a single dose for adults.

 

The side effect is salt and water retention, with swelling of hands and feet, face, lower legs; rapid weight gain can occur.

 

Cardiovascular effects including chest pain, hypotension, and fast and irregular heart beat are possible effects. Hypertrichiosis without virilism as elongation, thickening and increased pigmentation of fine body hair are seen in about 80% of users, developing within 3-6 weeks after starting the therapy. Hypertrichosis is usually first noticed on the temples, glabella, forehead or along the sideburns. Later it may extend to a back, arms, legs, and scalp. Upon discontinuation of minoxidil the growth of new hair is arrested, but 1- 6 months may be required to resume pretreatment appearance. No endocrine abnormalities have been found to explain to this abnormal hair growth.

 

Other effects like thrombocytopenia, nausea, vomiting are uncommon. Breast tenderness occurs in less than 1%. Allergic rashes, blurred vision; flushing of the skin; headache; decreased sexual desire or impotence; numbness or tingling in the hands, feet or face have all been reported.

 

Contraindication

Minoxidil should not be used in Pheochromocytoma or those who are sensitive to the components of the preparations. It may produce pericardial effusion and occasional tamponade. Angina pectoris may be exacerbated. Full details of the drug usage and side effects may be found in the PDR.

 

Minoxidil may pass from mother to the child through breast milk. Therefore, women who are pregnant and breast feeding should not use minoxidil.

 

When I started my private practice 20 years ago, I have seen a large number of patients who were taking oral minoxidil other than minoxidil lotion from other physicians and some patients even took on their own. I was entirely against taking oral minoxidil since it is not approved by the FDA and encouraged those patients to change to minoxidil lotion only, in fear of the side effects from oral minoxidil. After many years of practice, I have realized the remarkable effect on hair growth from oral minoxidil compared with the lotion. In many patients the result has changed from minimal hair over the scalp i.e. miniaturized hair to the cosmetic fullness of hair i.e. more terminal hair growth over both the front and the crown areas. Some have responded only at the crown but not at the front; also, there were patients who did not respond other than hypertrichosis. I have a few patients, whom I turned them down for hair transplantation surgery since they were poor candidates’ i.e. poor donor and severe degree of hair loss. One of them took oral minoxidil on his own and I was amazed when he returned to see me in four months, his temples hair was full with moderate hair growth at the crown but not at the front and made him a candidate for hair transplantation. Please see the attached photograph below. I did two sessions of hair transplant surgery on him and he was happy with the final results.

 

I prescribed oral minoxidil for hair loss treatment in less than 1% of patients in my practice over past 20 years. These are those hopeless patients who have the hair loss problem with no response from finasteride, dutasteride and minoxidil lotion but the patient wants to have some treatment option to treat the hair loss. I use it with caution, since there is no study regarding the dosage and safety in treating androgenic alopecia.

I do not prescribe this medicine to patients who are known to have cardiovascular disease, history of deranged blood pressure, liver and kidney dysfunction.

 

What is the optimal dose of oral minoxidil for the hair growth with minimal side effects?

 

I have learned from other physicians, who have prescribed minoxidil extensively to treat androgenic alopecia and was informed that 5 mg daily was enough to stimulate the hair growth without any effect on blood pressure and heart rate. One of my patients, who took oral minoxidil tablet and lives close by the clinic, came to the clinic twice a day for blood pressure monitoring for one month and all the reading were within the normal limits of his baseline; therefore, I am no longer monitoring the blood pressure as often as I did in the past. I have been using 5 mg daily for years and in some patient taken a low dose such as 2.5 mg tab per day or 5mg every other day still reported significant hair growth and stopped the hair loss to his satisfaction.

 

The most common side effect in my practice was puffy eyelids, leg swelling. Similar to any other forms of hair growth product, the gain hair will shed in 3-4 months on stopping the pill. This oral form should not be used in women due to hypertrichosis, it may persist in cases even on discontinuing the drug.

 

All of my patients were informed that the US FDA did not approve the use of oral minoxidil for hair growth and they have to take at their own risk, after understanding the risk and complications of the drug. I believe all the drug have side effects whether they are finasteride, dutasteride, spironolactone or dianee (for female hair loss). The long term treatment with oral minoxidil has more benefit than the chances of over said side effects at the low dose 2.5 - 5 mg once daily needs to be further studied. I advise the patient once the hair loss has stopped and experienced hair gained to stop oral minoxidil and switch back to minoxidil lotion for the long term maintenance usage. However, most of the patients did not want to switch to minoxidil lotion since there was no side effect noted. In some patient who switched to minoxidil lotion reported progressive hair loss.

 

I did not prescribe the diuretic as a routine since most of patients who experience water retention, refused to continue with this drug. Publications from Upjohn explicitly stated that a diuretic "must be" taken in conjunction with Loniten in most cases. The rationale is that while Loniten lowers blood pressure, your body's defense mechanism will automatically return your blood pressure to the original elevated level. Your body accomplishes that by retaining water and salt so that there will be more fluid to pump throughout the body. So in order for Loniten to be safe to consume, it is necessary to use a diuretic medication to remove excess water and salt from your body. Spironolactone is a natural choice for most hair loss sufferers since not only is Spironolactone a diuretic, it is also a potent anti-androgen.

 

In conclusion, only few percentage of the bald population in the world approaches the hair restoration clinics for the solution for hair loss. Of these there are many people who have marked social and emotional impact of hair loss in their lives thus, affecting their psychology. Most of these patients are very well benefited by the treatments like topical minoxidil, oral finasteride and the currently available artistic hair transplant surgeries offered by the clinics.

 

However there are number of patients, who are poor candidates for the hair transplant as they have poor donor area i.e. small donor area, thinning over donor area or have poor quality (more miniaturization at donor site) with large area of baldness NW-Class VII and searching for any possible hope that might improve their hair loss. These patients need to be emphasize regarding the side effects of oral minoxidil and with no FDA approval for hair loss indication. If patient consent's for this treatment, we propose to these terminal hair loss but high hoping patient that they might get benefit from opting to the oral minoxidil as the last sort of therapy till further new drug is available.

 

Best regards,

D. Pathomvanich MD FACS

[Yomommyz]

Just so you know, If you go to minoxidil just for your frontal region , you will shed for 6 months (all over) the earlier you start loosing the faster the rate. Your hair by the lok of your pics is where I am at . I took propecia for a year and half, if anything it stabelized the hair (if anything) never seen any type of positive result such as regrowth or thickeing of the hair density. Remember, hairloss companies bank on you. If you go to minoxidil you chance loosing whats left over your hair. And remember you only get two years with minoxidil before you become immune to it, and have to go to a hair transplant whicxh can cost 10, 000$ and more. The only way to fight off the DHT that has been building up in your body since you hit pubity is to fight it by nutritional supplements and finasteride, however finasteride gives you side effects that dont go away. I would accept your hairloss and start looking for nice caps, save your money , or just do more research. Whatever the case, my advise to myself at the beginning of my hairloss journey would be, dont take minoxidil, and maybe start taking oral supplements early stages of my hair loss, at this point its useless man. You'll just be wasting time, hairs, stress, and money. This would be my advice to myself at age 22 when I started loosing mine. However, I hit puberty late. Comments?

[Yomommyz]

I've spent over 5,000 $ on hairloss products in the last 3.5 years, and it has oly made it progress at a faster rate. Do not take minoxidil if you unless u want your hair to shed lots and lots and lots.

 

I am on lazer therapy at salon once a week, lazer comb at home twice a week. Hair nutritional supplements twice a day, I cleaned my scalp of all the sebum build up, So the minoxidil I'm on would penetrate the scalp better. MY HAIR HAS NEVER LOOKED MORE THIN. ALL MY HAIR SHED, BECAUSE THEY SAY THATS THE PROCESS OF THE NEW HAIRS COMING IN THICKER, BUT I HAVENT GOT THAT FAR YET, AND DOUBT IT WILL EVER HAPPEN. MY SCALP IS SO IRRITATED ALL THE TIME, AND I HAVE TO SOOTH IT BY TAKING SPECIAL CONDITIONERS OR SHAMPOO,S..

 

Hope this helps you , god bless hair loss victims, & I'm just a dumb EXPERIENCED consumer with a civil engineering degree, not a doctor...........

Edited March 18, 2011 by Yomommyz