Propecia Losing Its Efficiency

[SugarHighs]

Hi Folks,

 

I am noticing that after using Propecia 1mg for about 10 years now, it is beginning to use its efficacy. Any suggestions? I have heard Dut is a good next move, but I've also heard some *horror* stories.

 

I have no sides from Fin that I am aware of (although I lift weights at the gym, so the added testosterone may be masking any sexual sides.)

 

Some background and experience:

 

a) I am nearly 38 yo.

b) began having a receding hairline around 22 yo

c) Began Propecia around age 26-27 (1999)

d) I never took any other treatments

 

The last year:

 

a) hair loss at the hairline has been consistent over the last 10 years or so, but slow

b) I am around NW 2-3

c) I have no hair loss at the crown (that I can notice)

d) In the last 1.5 years the speed of hair loss at the hair line has gotten faster. Maybe 1.5 - 2X faster than it was before.

 

 

Could this be from aging? Propecia stopped working? Too much weight lifting?

 

Nothing dramatic has really changed in my lifestyle in the last 1.5 years. If anything, I have had less stress. The only minor changes are:

 

a) I began working from home from a laptop (I'm less active during the day, but still lift weights at night)

 

b) I have worked out with heavier weights (more testosterone = more DHT?)

 

(I do not use any steroids or any workout supplements - once in a blue moon I have a protein shake)

 

c) I began getting lazy about taking propecia at the same time each day. I have not missed any days, but sometimes I take it in the morning, and sometimes at night.

 

d) No other lifestyle changes that I can think of.

 

e) Beginning two weeks ago, I started using Kirkland Minox 5% and S5 Sprio (once/day, at hair line and temples only)

 

Thanks,

Sugar

Edited October 16, 2011 by SugarHighs

[SugarHighs]

Oops, this should be filed under "non-surgical." I am retarded. Trying to move it now.

[zenmunk]

Hey Sugar,

 

It's very difficult to pin-point why the propecia is not working as well for you lately. I doubt it has anything to do with your lifestyle (as described), but who can say for sure? If I had to put money on it, I'd say it's simply genetics.

 

Those of us with the MPB gene(s) will probably eventually lose whatever hair we were programmed to lose even if we're on finasteride. It just takes longer. How much longer varies from person-to-person. Actually 10 years is a pretty good stretch on fin. without much hair loss.

 

I'm in a similar boat. Just turned 39. I lift weights regularly, too. Similar hair loss (Norwood 2.5ish). No crown loss. I've been on propecia (1mg/day) for 13 years. Little-to-no observable sides. It's pretty much halted further hair loss. Been pretty lucky in that regard so far. But for how long? Who can say?

 

I've always been a little paranoid about the possible non-observable side effects of long-term fin. use. I'm actually seeing a Urologist on Tuesday to do a battery of tests to see how things are going in the semen, prostate and hormone dept. I already did a blood test to gauge liver function. Granted, I'm being ultra-cautious, but it's only because it's serious stuff, and I've been on fin. for a long time. I don't think I'd ever consider dutasteride as it's a much more powerful drug. Bottom line - I suggest you seriously research dut. before starting it. In the meantime, you may consider getting at least your hormone levels checked for testosterone (serum & free), dht, etc. Couldn't hurt.

 

z

[mahhong]

I can't imagine anything in your lifestyle would have triggered the increase in hairloss. Propecia works by lowering the DHT in your system but it doesn't eradicate it (for very good reason) and it doesn't alter your genetic sensitivity to hairloss. As a result, over time you're still likely to end up experiencing increased hairloss but at a much slower rate than somebody not on propecia.

 

Dutasteride is the next step in terms of DHT blocking, but the jury is still out on how much more effective it is and issues like increased side effects etc. In addition, DHT blockers have never really been brilliant for most people's hairlines, so the loss you're experiencing might not necessarily slow further even if you did move to a stronger drug.

 

I think the options really boil down to moving to dutasteride and/or considering a HT to reverse the loss in the hairline. Most men on propecia have to consider this stage eventually because the hairline is rarely safe from MPB - but you're lucky you still have a good crown and no sides from fin!

 

Also, though I'm sure you know, don't stop taking the fin as this will just cause catch up loss, and your hair could very well fall out very quickly and very badly (not definitely, but possibly).

 

Hope you find a suitable solution!

[Gish]

Sugarhighs, I am always very excited to see posters who have been on finasteride for a decade. Do you by chance have any pictures that document baseline to now? Or, even just a baseline picture and a current one?

 

Unfortunately, it is likely that what you are experiencing in terms of perceived decreased effectiveness from finasteride is the same kind of decrease that is seen in the literature after 10 years of use.

 

Take a look at the graph I uploaded, It shows a quick mean increase in hair count within the first year of use, a considerable slow down in the rate of hair gain between first and second year of use, and a drop in hair count between year two and year 5. If the graph was to continue on in that fashion you would end up back at baseline at around 10 years of use, after which point the average person would continue to loose hair and be below baseline.

 

This is just averages, some men may start to go below baseline much sooner, some much later, but the majority right around the 10 year mark.

 

It is striking just how much finasteride slows down the progression of MPB. Look at the difference between the experimental group and the placebo group at year 5. That is a lot of hair!.

 

As far as your speculations go...

 

I very much doubt that normal weight lifting will effect your hairloss. More testosterone does not exactly equal more DHT. The amount of DHT in our bodies relies on the amount of 5alpha reductase, both isophorms, that are present....In our case, the amount of 5alpha reductase type 1 and 5alpha reducaste type 2 not inhibited by finasteride.

 

Men on finasteride experience a roughly 5-15% increase in testosterone levels due to non-converted T "lingering around", yet we have ~85% less DHT. Its a complicated issue and not black and white, but I think your safe.

 

Doesn't really matter when you take finasteride during the course of the day. The time it takes for your body to make more 5AR type 2 can be over a day.

 

I think at this point you should ask yourself exactly what kind of goals you have, and how important those goals are to you. If preventing any further progression of hairloss is your goal you basically have to reduce the androgen stimuli to the hair follicles. Whether you do this by taking a stronger internal anti androgen like dutasteride, or a topical anti androgen, like spiro, fluridil, flutimide etc, is your call. You have options, but they are less conventional and more experimental then finasteride.

 

It is important to remember that, to best of our knowledge, finasteride is still working as effectively as it always has, its just over the years the remaining androgen stimuli has been slowly damaging the follicles.

 

The S5 cream is a good start, if it wasn't such a pain to apply to the whole head it would be quite a good adjacent treatment. I would recommend getting a bottle of Nizoral 2% shampoo, it is commonly used as another side kick treatment for MPB. One study showed it effectiveness to be greater or equal to that of a 2% minoxidil solution.

 

A hair transplant is also another option to consider, perhaps even experiment with some PRP injections as well if you have some extra money kicking around.

 

Best of luck to you, if you have any other questions I'll be happy to anser them to the best of my knowledge.

[SugarHighs]

Hey Gish,

 

I was excited to read your reply, as you seem very knowledgeable about the chemistry of DHT and DHT-blocking.

 

I am working on putting up some photos, unfortunately I'm of an age that there weren't really many digital cameras when I was 25, so most photos from then back will have to dug up and scanned.

 

In short, I was born with a high hairline, that began to recede around 21-22. I was able to brush my hair back and style with gel until around age 26-27.

 

Was able to wear the hair forward while short on the sides and back without the appearance of loss until I was around 29-30. Even in my early 30s, if it was long enough, I could cover my forehead with hair pushed forward and some creative styling with paste. I think I had to abandon heavy products like paste due to thinness around age 35.

 

I'm now 38 and wear my hair forward with a very close crop #2 on the sides and back, and pretty short on the top. My higher hairline is now much more apparent, but thank goodness that hair goes forward, because other wise I would be showing off at least 2cm more scalp.

 

I will see what I can do about some photos hopefully soon.

[Gish]

Sounds good! I look forward to the possibility of seeing some pictures.

 

If/when you decide what your next course of action is please update us.

[mattj]

Mahong makes a good point re. DHT blockers and hairlines. It's possible that Fin will continue to work for the areas of your scalp that benefit the most from the drug, even if it has ceased to hold on to your hairline.

 

 

It would be interesting to see the results of blood tests for testosterone and DHT levels taken before and after the observed loss of Propecia efficacy, to see if DHT levels rise in conjunction with the reduced effectiveness of the drug. (Too late for you to try that but I'm just thinking out loud).

[SugarHighs]

Thanks for all the great thoughts on this gents.

 

I did not realize that DHT blockers such as Finasteride and Dutasteride were not really that helpful to the hair line. Learning this kind of makes me want to avoid Dut, especially if "the jury is out," as it were, with regard to how much difference it might make. Or maybe it's worth a try in the short term?

 

Has anyone experimented with taking Fin and Dut at the same time - or is that ill-advised?

[SugarHighs]

Regarding lifestyle changes, it seems to be the consensus that they don't make much difference.

 

I agree mostly, but I do strongly believe that bodybuilding might affect my follicles more than it does others - as I've seen higher rates of loss coincide with periods of more (and heavier) weightlifting. (Interestingly, this also deepens my voice!)

 

I've "tested" this in practice over the last 8 years, and the incidence is just too consistent to be coincidental. It's kind of a cruel irony of life - in that being physically stronger causes me to be more physically attractive in that way, but at the same time, it might be taking away from my looks up above. I'm trying Spiro 5% to see if it helps any with that.

 

 

Matt, you've inadvertently given me a great idea - I'm going to have my Testosterone and DHT rates tested at a period of peak weightlifting (~185-190 lbs), and again at a down time (170-175 lbs). It should be interesting to see. I'll post the results here, although they may take some weeks to gather.

[SugarHighs]

I think at this point you should ask yourself exactly what kind of goals you have, and how important those goals are to you. If preventing any further progression of hairloss is your goal you basically have to reduce the androgen stimuli to the hair follicles. Whether you do this by taking a stronger internal anti androgen like dutasteride, or a topical anti androgen, like spiro, fluridil, flutimide etc, is your call. You have options, but they are less conventional and more experimental then finasteride.

 

It is important to remember that, to best of our knowledge, finasteride is still working as effectively as it always has, its just over the years the remaining androgen stimuli has been slowly damaging the follicles.

 

The S5 cream is a good start, if it wasn't such a pain to apply to the whole head it would be quite a good adjacent treatment. I would recommend getting a bottle of Nizoral 2% shampoo, it is commonly used as another side kick treatment for MPB. One study showed it effectiveness to be greater or equal to that of a 2% minoxidil solution.

 

A hair transplant is also another option to consider, perhaps even experiment with some PRP injections as well if you have some extra money kicking around.

 

Best of luck to you, if you have any other questions I'll be happy to anser them to the best of my knowledge.

 

Gish, thanks again for sharing so much detail.

 

I neglected to mention that I do use Nizoral 1% (in the blue bottle). I found that my hair looked like quite crap with Nizoral 2% sadly.

 

I've heard that flutamide is dangerously powerful for men, any thoughts on this?

 

Can't find much information correlating PRP injections to hair maintenance - is there more reference about this somewhere?

 

I'm considering FUE HT, particularly with a surgeon who has a strong reputation for working on hairlines, and the experience to work with someone who has wavy/curly hair.

 

Thanks,

Sugar

[mahhong]

Thanks for all the great thoughts on this gents.

 

I did not realize that DHT blockers such as Finasteride and Dutasteride were not really that helpful to the hair line. Learning this kind of makes me want to avoid Dut, especially if "the jury is out," as it were, with regard to how much difference it might make. Or maybe it's worth a try in the short term?

 

Has anyone experimented with taking Fin and Dut at the same time - or is that ill-advised?

 

Yeah I think most doctors will tell you there's really little you can medically for the hairline. Some men do see growth or stabilisation using DHT blockers and/or minoxidil, but that's very much the exception.

 

I'm not particularly educated on DHT blockers but I believe Dut is essentially just a stronger Fin, so I don't imagine taking both will be of much help and probably not recommended purely for use against hairloss. That having been said I have seen a few men switch from Fin to Dut and receive prescriptions from their hair doctors for that, so it's worth discussing it with a doctor if you're interested.

 

The main thing with Dut is just that it's more potent than Fin, so whilst it's possibly more effective on hair there is the chance of increased likelihood of side effects etc. That increase in risk is still statistically very small though; it's very much thought of as a safe drug.

 

This is to some extent unfortunately the limitation with DHT blocking though. It does not work forever because you cannot safely remove DHT from your body, and so you have to find the dosage that offers the best compromise between lack of side effects and improvement in hairloss. You will always end up losing the battle but, if you can hold on to that hair for 10 or 20 years and then lose it at a much slower rate, that's very likely a battle worth having! But transplantation will probably have to come into the equation somewhere and now could be the time perhaps.

[Gish]

Thanks for all the great thoughts on this gents.

 

I did not realize that DHT blockers such as Finasteride and Dutasteride were not really that helpful to the hair line. Learning this kind of makes me want to avoid Dut, especially if "the jury is out," as it were, with regard to how much difference it might make. Or maybe it's worth a try in the short term?

 

Has anyone experimented with taking Fin and Dut at the same time - or is that ill-advised?

 

Anti androgens do work on the hairline, its just often the hairline is in a much more drastic state of miniaturization compared to the rest of the scalp. Most people notice hair loss via a receding hairline...most men are most bald at/around their hair line.

 

Fin/dut certainly works on the hairline...but you just have to remember what 'working' means.

 

Taking fin/dut is not ill-advised per se, its just there would be no point. Iirc, dut inhibits 99% of 5AR type 2 and a large portion of 5AR type 1. If you were to take dut, do it on its own to save money.

 

Flut is not commonly used and there is some debate over whether or not any benefit is due to systemic absorption. I use RU so there is no point of using Flut.

 

I have said before, on other forums, that if one was really serious a regimen of RU/Dut would very likely halt any further hairloss. Once you reduce the androgen stimuli below a certain level AGA cannot progress.

 

An interesting case is that of pseudo hermaphrodites. These individuals are men who are 5AR type 2 deficient. These guys do not go bald unless they receive DHT.

 

Also, castrates do not continue to loose hair, assuming they were going bald in the first place.

[SugarHighs]

I have read a lot of threads where guys reported really bad hair line results from Dut. Not sure if there's a correlation, but I'm also not sure dut is worth the risk. At least not before hairline surgery.

 

Regarding Spiro 5%, does this stuff have estrogen in it?! Or does it merely convert the androgens in the hair follicle to estrogen?

 

In the two weeks I've been using Sprio cream, I have noticed women seem to be a lot less attracted to me. Since I don't look any different, and I haven't had any other lifestyle changes, I can only assume that the Spiro is emitting some nasty phermones.

 

I'm dumping this stuff if the same results continue, and sticking with Fin internally / 5% minox at the hairline only.

[RCWest]

When a person takes any medication for an extended amount of time their bodies get used to it. You can either up your dose to 1/3 or 1/2 of a 5 mg. Proscar, or jump to Avodart. The hairline is the last area that DHT blockers usually help.

[SugarHighs]

When a person takes any medication for an extended amount of time their bodies get used to it. You can either up your dose to 1/3 or 1/2 of a 5 mg. Proscar, or jump to Avodart. The hairline is the last area that DHT blockers usually help.

 

Has 2mg or 2.5mg Fin shown any better results than 1mg? Medicine doesn't always work that way, but in some cases it does.

 

RC, has Biotin helped you in any way with thickness / hair health, or does it simply make your hair grow faster?

 

Thanks,

Sugar

[Gish]

Spiro doesn't have estrogen in it. It competes for the androgen receptors.

 

I doubt upping your dose will help, if you look at the data the level of 5AR type 2 inhibition is pretty flat with fin.

 

I don't think your body "gets used to it". Any proposed mechanism by which this would happen?

 

Sugar highs decline in effectiveness is a 'text book case'. He needs to reduce the androgen stimuli or continue to loose hair, albeit at a still much slower rate then without fin.

 

If you put Dut and other harsh, or otherwise experimental, topical AA aside this is what your left with.

 

-Topical Spiro

-Minoxidil (not an AA)

-Copper peptides (folligen, Tricomin...mechanism not fully understood...is it a growth stim, an AA, or does it work on some other aspect of MPB?)

-Proxiphen (Dr Proctors prescription version)

-Proxiphen-N (Non-prescription version)

-17a-estradiol topical

-Revivogen

 

I have not personally tried to majority of the treatments listed above, but have seen pictures, and read reports, about the effectiveness of them...all to varying degrees of course.

[SugarHighs]

I would try RU, but there just seems to be no evidence that it's effective. Some have had results, some haven't.

 

I read that the half-life of Fin is 6 hours. Would it make sense to take Fin every 12 hours, then? Rather than every 24 hours?

 

I take propecia now, and I don't really want to get into the proscar cutting business, but maybe cutting proscar into 6 pieces and taking one every 12 hours would make some difference? Probably not.

[rbte11]

hi guys

i have been on propecia for years and i also noticed it was losing its effectiveness.

your options:

 

1) make sure you optimise your regimen - use the big 3 ( Nizoral shampoo, minox, and propecia) and make sure you take propecia every day at the same time.

 

2) exclude other causes of hairloss ( hormones, using some body building supplements, infections of scalp, even stress, allergies to hair products (youll be surprised how often this is a problem) go to a dermatologist to have some bloods taken for this.

 

3) if it still doesnt work, you can try avodart. i would recommend trying it slowly- once a week to start with. avodart IS more effective than propecia but be warned - its long term side effects are not known. there is some evidence that it can affect the brain, as neurrons have receptors to this type of DHT blocking. use this drug with caution.

i tried avodart for 6 months- yes my hair was thicker, and certainly i grew some more, but i had terrible abdomen pain. after a while i gave it up.

 

4) the best way (IMHO) is to take 0.75 mg of finasteride every 12 hours. so at 8 am and 8 pm.

this gives a more consistant theraputic range, as finasteride only has a half life of 8 hours (+/-)

This really worked for me... i was recommended this by another doctor who called it Dr V's technique. he also recommends taking avodart for 6 months, then trying to maintain the gains after with this regimen. of course it goes without saying you must use minox and niz shampoo.

a healthy diet, NOT smoking, and exercise is always recommended too....

 

hope this helps...

[rbte11]

Has 2mg or 2.5mg Fin shown any better results than 1mg? Medicine doesn't always work that way, but in some cases it does.

 

RC, has Biotin helped you in any way with thickness / hair health, or does it simply make your hair grow faster?

 

Thanks,

Sugar

 

no, there was little evidence in clinical trials that a higher dose of finasteride had significant results. 1 mg was optimal.

Edited October 26, 2011 by rbte11

[SugarHighs]

hi guys

i have been on propecia for years and i also noticed it was losing its effectiveness.

your options:

 

1) make sure you optimise your regimen - use the big 3 ( Nizoral shampoo, minox, and propecia) and make sure you take propecia every day at the same time.

 

2) exclude other causes of hairloss ( hormones, using some body building supplements, infections of scalp, even stress, allergies to hair products (youll be surprised how often this is a problem) go to a dermatologist to have some bloods taken for this.

 

3) if it still doesnt work, you can try avodart. i would recommend trying it slowly- once a week to start with. avodart IS more effective than propecia but be warned - its long term side effects are not known. there is some evidence that it can affect the brain, as neurrons have receptors to this type of DHT blocking. use this drug with caution.

i tried avodart for 6 months- yes my hair was thicker, and certainly i grew some more, but i had terrible abdomen pain. after a while i gave it up.

 

4) the best way (IMHO) is to take 0.75 mg of finasteride every 12 hours. so at 8 am and 8 pm.

this gives a more consistant theraputic range, as finasteride only has a half life of 8 hours (+/-)

This really worked for me... i was recommended this by another doctor who called it Dr V's technique. he also recommends taking avodart for 6 months, then trying to maintain the gains after with this regimen. of course it goes without saying you must use minox and niz shampoo.

a healthy diet, NOT smoking, and exercise is always recommended too....

 

hope this helps...

 

Hi rbte,

 

I've used propecia for more than 10 years, and Nizoral 2-3x per week for somewhere around 6-8 years. Just started 1ML Minox/per day on Oct 1, and I've seen nothing yet. Used at the temples and corners of hairline only.

 

How did you divide finasteride into .75mg effectively? That would be roughly 7 pieces of a 5mg Proscar tablet, which I would think would be almost impossible to do.

 

Even with 1mg propecia, you would have to break one in half, and find a way to break another into quarters, or break 25% off.

 

Thanks,

Sugar

[Gish]

no, there was little evidence in clinical trials that a higher dose of finasteride had significant results. 1 mg was optimal. BUT more regular doses DID help.

of course there was a higher rate of side effects with this.

 

What data showed more regular doses did help?

 

By regular I assume your meaning more then once per day.

 

My understanding is that it is not an issue with half life. The bond formed between 5AR ll and finasteride is so strong that it would take over a day for your body to synthesize new enzymes.

[Kolaios]

Question: Is there anyone here taking more than 1ml of finasteride a day? and is that save? or should we keep it at 1ml?

 

I recall people here taking 2ml and 2.5 a day!

 

thanks a lot!

[Gish]

Question: Is there anyone here taking more than 1ml of finasteride a day? and is that save? or should we keep it at 1ml?

 

I recall people here taking 2ml and 2.5 a day!

 

thanks a lot!

 

Just a quick note, finasteride is measured in mg not ml.

 

I'm sure there are people on here taking more then the recommended 1mg of finasteride. I know of a number of people on HHL and HHT who are. To take more then 1mg is, for all intents and purposes, as safe as taking 1mg. Men who take finasteride for BPH take 5mg. Granted, these men are usually much older.

 

Take a look at some of the figures in this link.

 

No Title

 

It shows that serum DHT levels are reduced by the same amount for all doses above .2mg.

 

BTW. Sugahighs...have you gotten around to digging up those photos yet?

Edited November 5, 2011 by Gish