Terrified of Fin, the side effects, and the serious implications it has

[Hairtroubles]

The more I am starting to learn more about a Hair Transplant, the more I am realizing that you can't seem to have a successful one unless you are on Fin? Is this true?

I went to the Belgravia center in the UK once and took Minoxidil with Finasteride and it terrified me. The side effects were very real and I felt anxious, faint, and super light headed.  If you research the side effects, people are saying they had irreversible side effects of erectile dysfunction and there is a whole subreddit group on it, so any of you who say, this is 2-3%, go look at the group and read the stories, they are terrifying.  People have been off Fin for 5+ years and still cannot get a boner...

 

I thought the whole point of a Hair Transplant was to avoid medication like this, and now you are telling me I need Fin!? Seriously? What are my options, nothing?

[asterix0]

Welcome to the fun world of male pattern baldness.

As a general rule of thumb, before doing anything, try shaving your head. It's the simplest, healthiest, most cost-effective way to "deal" with this condition. 

[Hairtroubles]

I do not want to shave my head to be honest, I miss my hair.  I know I sound like a kid, but there has to be a way to go about this.  In my other post, I have posted pictures, but I am starting to become super disheartened when I see that a successful Hair Transplant needs Fin - it makes me just want to give up.

Surely there are people here who have regrown their hair or done a HT and not touched the stuff - anyone?!

[asterix0]

Just now, Hairtroubles said:

I do not want to shave my head to be honest, I miss my hair.  I know I sound like a kid, but there has to be a way to go about this.  In my other post, I have posted pictures, but I am starting to become super disheartened when I see that a successful Hair Transplant needs Fin - it makes me just want to give up.

Surely there are people here who have regrown their hair or done a HT and not touched the stuff - anyone?!

There are many such cases of transplants without finasteride. It all depends on your own particular androgen sensitivity, the sensitivity in your donor etc. 

Finasteride provides you another layer of protection, of peace of mind so to speak, to ensure the best chance of success for your transplant. Is it necessary for everyone? No. Like I said, it's case by case dependent.

I saw your pictures in your other thread, you have quite a lot of native hair to save. So you would benefit quite a bit from using it. For one, if you don't use it, then almost certainly your non transplanted hair will continue to thin and fall out, and you will be left with an awkward looking hair pattern. Then you will have to go for a follow up surgery. So this will be a lot of time and money committed to getting back maybe to where you are right now, or maybe even slightly worse hair-loss wise.

 

[Hairtroubles]

Thanks for your reply.  In serious terms, how many people do you think take Fin on this forum, how many have ever reported side effects? Has their ever been someone who did report side effects?

Looking at my pics, what do you think my state is and what do you think I could get it to, honestly.  What are your thoughts? Taking Fin, doesn't it lower Testosterone?

 

 

[asterix0]

Suppose we could look into a crystal ball and see the future. Maybe 20 years from now, your hair loss is the same. Well in this case, you wouldn't need finasteride, as your native hair would hold up, and your donor hair would remain strong. In this case all is good.

Let's look at the alternative. Maybe you lose everything on top. People think, oh well it can't happen to me, but before they know it there is nothing left but the horseshoe. Maybe you have miniaturization in your donor and are now a complicated transplant candidate. All of this is on the table.

Think of finasteride as an alternative to minimize scenario (b), while giving you a fighting chance for scenario (a). 

[asterix0]

Of course there are people who claim side effects. It is hard to say. I have been taking it for over 4 years, along with minoxidil, and have not had any side effects. At least none that I can notice. I try to eat and live healthy, exercise often, maybe this helps minimize the chance of side effects. Or maybe it has no effect at all, who knows.

Likely the incidence of side effects is higher than what Merck initially reported in their studies. However, I don't think everyone is necessarily a candidate for finasteride, nor would I recommend it for everyone. Someone who is on pace to maybe lose 1 Norwood every 10 years, in my opinion, should not take it. If you start at Norwood 1 at 20, go to Norwood 2 at 30, maybe 2.5 at 40, etc., the risk of sides isn't worth it. 

In your case, it is hard to say. If I had to place a bet, I bet you progress towards the higher Norwood range sooner than stay stable by doing nothing. I know it may not be the opinion you want to hear, of course I could be wrong. But you have diffusion throughout the entire top, this is usually a sign that higher Norwood progression is likely. 

[Hairtroubles]

Thanks for the reply, makes sense, but I feel like you are just looking at it through the lens of Finasteride.  It is the.. only option... whilst I am looking for that other option, albeit slim.  

I presume to do a succesful hair transplant you need some hair right, I am not too sure about the whole process I am still researching, so what you are saying is Fin will help save the hair and also give me a fighting change in the future.

 

All of this scares me, the fact that I over think things, knowing me, I will be a mess on Fin.  It terrifies me.

[Hairtroubles]

Okay thanks, makes sense.  What Norwood do you think I am now currently, and what Norwood do you think I am progressing to?  

 

If you were me, in all honesty, what would you do, knowing everything available in options, what would you do, Fin, Minoxidil, Hair Transplant, what?

[asterix0]

I am only looking at it through that lens because unfortunately, it is the only thing that works. You can try alternative treatments like RU, dutasteride (a stronger finasteride), maybe CB if you are into the experimental route.

But anti-androgen drugs are the only tools we have against aggressive hair loss. Minoxidil, for mild patients, can actually do quite well for a very long time. But for aggressive loss it simply isn't enough. 

 

[Hair4Days]

If you don’t want to take fin, that’s fine. Some doctors don’t like to rely on a medication for life to maintain a desirable cosmetic appearance. Honestly if you really think about it, you should only start a hair transplant with the expectation of losing all your hair up top, unless it’s pretty apparent that you won’t become an advanced pattern. Planning for the worst and using your donor wisely, and not relying on a little pill is the best way to approach this stuff. You really never know if you’ll ever want to stop the medication for whatever reason. Signing off on committing to it for life doesn’t sound attractive. I rather just see a surgeon that can utilize   every graft possible and commit to 2-3 surgeries if you become an advanced balding pattern.

[asterix0]

1 minute ago, Hairtroubles said:

Okay thanks, makes sense.  What Norwood do you think I am now currently, and what Norwood do you think I am progressing to?  

 

If you were me, in all honesty, what would you do, knowing everything available in options, what would you do, Fin, Minoxidil, Hair Transplant, what?

If I were you I would definitely start both finasteride and minoxidil. You are a Norwood 2.5 diffuse but in my opinion on the road to Norwood 5 or 6. Norwood 7 is unlikely, but again one never knows.

Here is the kicker though, you may think well if Im already Norwood 5, who cares if I go Norwood 7, I'll be shaving my head anyway. Well actually, its a huge difference, Norwood 5 gives you much more potential donor for a transplant than a Norwood 7. You can achieve significant cosmetic results from a Norwood 5 that a Norwood 7 simply does not have the donor supply for.

I believe a healthy lifestyle can reduce the risks of finasteride. If you are really worried, start by microdosing it. Start off with monday-wednesday-friday at 0.5mg per day. Then after 2 weeks add Sunday. Then replace one of those days with 1 mg, and slowly incorporate another day until you can take the daily 1mg dose used in the studies. 

You will be surprised how well your hair will hold up, and minoxidil may regrow a significant amount of hair as well. 

[Hairtroubles]

3 minutes ago, asterix0 said:

I am only looking at it through that lens because unfortunately, it is the only thing that works. You can try alternative treatments like RU, dutasteride (a stronger finasteride), maybe CB if you are into the experimental route.

But anti-androgen drugs are the only tools we have against aggressive hair loss. Minoxidil, for mild patients, can actually do quite well for a very long time. But for aggressive loss it simply isn't enough. 

 

Okay, thank you for the reply.  So if you were me, in all honesty, what would your path be, what route, if you were me right now.  Can you plan it out if you were me so I can write it out myself and research all options? Would appreciate it.  

 

How do I handle the fear of Fin?

[Hairtroubles]

5 minutes ago, James C said:

If you don’t want to take fin, that’s fine. Some doctors don’t like to rely on a medication for life to maintain a desirable cosmetic appearance. Honestly if you really think about it, you should only start a hair transplant with the expectation of losing all your hair up top, unless it’s pretty apparent that you won’t become an advanced pattern. Planning for the worst and using your donor wisely, and not relying on a little pill is the best way to approach this stuff. You really never know if you’ll ever want to stop the medication for whatever reason. Signing off on committing to it for life doesn’t sound attractive. I rather just see a surgeon that can utilize   every graft possible and commit to 2-3 surgeries if you become an advanced balding pattern.

Okay you see this is interesting, in comparison to the posts above you are saying it's okay to not take Fin, so what would be my route here.  The more I read about Fin, the more terrified I get, I want to do anything to save my hair but not compromise my body... 

[Hairtroubles]

3 minutes ago, asterix0 said:

If I were you I would definitely start both finasteride and minoxidil. You are a Norwood 2.5 diffuse but in my opinion on the road to Norwood 5 or 6. Norwood 7 is unlikely, but again one never knows.

Here is the kicker though, you may think well if Im already Norwood 5, who cares if I go Norwood 7, I'll be shaving my head anyway. Well actually, its a huge difference, Norwood 5 gives you much more potential donor for a transplant than a Norwood 7. You can achieve significant cosmetic results from a Norwood 5 that a Norwood 7 simply does not have the donor supply for.

I believe a healthy lifestyle can reduce the risks of finasteride. If you are really worried, start by microdosing it. Start off with monday-wednesday-friday at 0.5mg per day. Then after 2 weeks add Sunday. Then replace one of those days with 1 mg, and slowly incorporate another day until you can take the daily 1mg dose used in the studies. 

You will be surprised how well your hair will hold up, and minoxidil may regrow a significant amount of hair as well. 

Thanks, I just read this after I posted my last reply.  Okay, 2.5 - interesting.  I understand preserving my hair is the best route, I just want to do it the best way. I do not want to compromise my body.  On reddit, I see people talk about Fin and it just terrifies me, genuinely.

Will it ever be okay for me to not use any pills, and in 2 years get a HT? Hopefully that would save the top?  What do you think/

[Hair4Days]

1 minute ago, Hairtroubles said:

Okay you see this is interesting, in comparison to the posts above you are saying it's okay to not take Fin, so what would be my route here.  The more I read about Fin, the more terrified I get, I want to do anything to save my hair but not compromise my body... 

i don’t take Fin for the exact same reasons. I’m not risking permanent side effects. I’m also not taking a pill for life just to save my crown. I rather just get additional surgeries if i bald out completely. If i were you, i wouldn’t take meds. Maybe just rogaine. And when the time comes where your front third which is your hairline and a few inches beyond that get thin enough to need a transplant, then just  do the surgery. And then once your mid scalp and crown get bad then do another surgery. It takes on average 5-6k grafts to get coverege from hairline to crown so you’d be looking at 2 fut surgeries for that. And then you can do a 3rd fue session to fill in any touch ups. No point in relying on fin. In the end your genetics will always win. Keeping your donor in the best shape possible is more important here 

[asterix0]

2 minutes ago, Hairtroubles said:

Thanks, I just read this after I posted my last reply.  Okay, 2.5 - interesting.  I understand preserving my hair is the best route, I just want to do it the best way. I do not want to compromise my body.  On reddit, I see people talk about Fin and it just terrifies me, genuinely.

Will it ever be okay for me to not use any pills, and in 2 years get a HT? Hopefully that would save the top?  What do you think/

Without any medication I don't know who can predict how your hair loss will progress. Given the current state, for sure you will lose more hair. 

[asterix0]

Just now, James C said:

i don’t take Fin for the exact same reasons. I’m not risking permanent side effects. I’m also not taking a pill for life just to save my crown. I rather just get additional surgeries if i bald out completely. If i were you, i wouldn’t take meds. Maybe just rogaine. And when the time comes where your front third which is your hairline and a few inches beyond that get thin enough to need a transplant, then just  do the surgery. And then once your mid scalp and crown get bad then do another surgery. It takes on average 5-6k grafts to get coverege from hairline to crown so you’d be looking at 2 fut surgeries for that. And then you can do a 3rd fue session to fill in any touch ups. No point in relying on fin. In the end your genetics will always win. Keeping your donor in the best shape possible is more important here 

That strategy can work as long as you don't go slick bald, and go either Norwood 6 or 7. 

And also if your androgen sensitivity is not high enough that your donor gets compromised. 

[Hair4Days]

Just now, asterix0 said:

That strategy can work as long as you don't go slick bald, and go either Norwood 6 or 7. 

And also if your androgen sensitivity is not high enough that your donor gets compromised. 

If your destined to be a Norwood 7 You’d likely be left with a pretty open crown.. Norwood 6 you should be okay with surgery alone if you started with fut 7k ish grafts would give you enough coverage to satisfy imo 

[asterix0]

Just now, James C said:

If your destined to be a Norwood 7 You’d likely be left with a pretty open crown.. Norwood 6 you should be okay with surgery alone if you started with fut 7k ish grafts would give you enough coverage to satisfy imo 

Yes, even at Norwood 7 recoveries are possible, there are Eugenix cases with beard + body hair that have some pretty amazing transformations. Also other surgeons are quite adept at high Norwood cases, certainly there is still hope.

But there is still a small minority of patients that have their transplanted hair thin out. Does that risk outweigh the risk of finasteride? I can't really say, its an individual decision. For me personally, the side effects of being bald are pretty much worse than the side effects of finasteride, so that's why I take it.

When I was balding heavily without finasteride, I had low libido, depression, brain fog, anxiety. And they weren't going away. 

[Hair4Days]

1 minute ago, asterix0 said:

 

When I was balding heavily without finasteride, I had low libido, depression, brain fog, anxiety. And they weren't going away. 

But are you saying these are self induced effects of not wanting to be bald? 

[asterix0]

1 minute ago, James C said:

But are you saying these are self induced effects of not wanting to be bald? 

I don't know if they were self induced. Certainly I didn't wake up with the goal of being depressed and agonizing about hair loss. I tried everything I could to accept it but I just couldn't mentally. Perhaps I'm an outlier in this regard, I don't know. 

[Hair4Days]

Just now, asterix0 said:

I don't know if they were self induced. Certainly I didn't wake up with the goal of being depressed and agonizing about hair loss. I tried everything I could to accept it but I just couldn't mentally. Perhaps I'm an outlier in this regard, I don't know. 

I understand bro. It makes us all depressed. It’s not easy to accept. But hair transplants are very well done nowadays and can really turn people’s lives around. Have you gotten any surgeries or are you just taking meds to hold on ?

[asterix0]

5 minutes ago, James C said:

I understand bro. It makes us all depressed. It’s not easy to accept. But hair transplants are very well done nowadays and can really turn people’s lives around. Have you gotten any surgeries or are you just taking meds to hold on ?

I have had a few consultations, travel from the US is a challenge to Europe where the best FUE surgeons are in my opinion, but I have some trips planned once the situation with corona settles down.

Another thing is that 7 years ago or so when I started balding, transplants were good but not as good as today's in my opinion. So at the time I didn't really see them as viable as an option as they appear now.

I have signs of retrograde alopecia and minor DUPA, so I can't afford to just go to any surgeon. If I don't go to an elite one who can handle such a complicated case, I think I'd run quite the strong risk of a subpar or failed transplant.

Also, I started balding in college, and considering student loans and the cost in general, I really didn't think I would have had enough money to go to the surgeon I wanted. Years of saving and working post graduation have opened up possibilities that I can now hopefully take advantage of.

So in the meantime I thought it made sense to use treatments to hold onto as much as I can. At least I was able to make it through most of my twenties with hair on my head, I really sympathize with the young guys out there that lose it all super quick. A brutal experience, and the modern world is hard enough already for so many reasons. 

Edited March 23, 2021 by asterix0

[ciaus]

About half of the 4% of guys that reported side effects during the clinical trials were not taking the finasteride, they were in the the placebo group. There are guys that get paranoid about the possibility of side effects and actually psyche themselves out into having sexual performance issues. Reading your posts you sound like one of those guys, and based on that I don't think you should bother with finasteride, you probably torture yourself with worry down the road with what-if(s) even if you don't have immediate side effects.  

And even if 20 or 50 forum members replied to this thread that they experienced side effects, it would be a bad basis for making a decision for yourself. Millions of guys have taken the drug over the decades.

Delay getting a hair transplant as long as possible so you and the doctor can best estimate whether you'll have enough hair in the long run. Or become philosophical and stop caring about superficial stuff like hair.