Finasteride concerns

[hairyharry]

I'm about ready to pull the trigger and schedule a HT procedure but I have concerns about using finasteride and minoxidil. I took a med similar to finasteride a few years ago and had a bad reaction psychologically. I've also ready of the negative effects of minoxidil as well. Although I realize the percent of people with issues is relatively small, I still don't want to risk side affects of ingesting these meds for the rest of my life. 

My hairline is mostly gone and very little hair left on the crown so I wonder if there is much more I could loose anyway. That said, I don't think it would be wise to invest all this money in a HT if I don't protect the little existing hair I have left.

I've read (and been told) that there are other alternatives, such as regular PRP and laser hats. Are these valid alternatives to finasteride and minoxidil? 

[TorontoMan]

23 minutes ago, hairyharry said:

I'm about ready to pull the trigger and schedule a HT procedure but I have concerns about using finasteride and minoxidil. I took a med similar to finasteride a few years ago and had a bad reaction psychologically. I've also ready of the negative effects of minoxidil as well. Although I realize the percent of people with issues is relatively small, I still don't want to risk side affects of ingesting these meds for the rest of my life. 

My hairline is mostly gone and very little hair left on the crown so I wonder if there is much more I could loose anyway. That said, I don't think it would be wise to invest all this money in a HT if I don't protect the little existing hair I have left.

I've read (and been told) that there are other alternatives, such as regular PRP and laser hats. Are these valid alternatives to finasteride and minoxidil? 

You need to understand the problem is with androgens. Prp without managing androgens is a complete waste of money. 
 

If you don’t want to ingest orally, your options are a topical AA like fluridil or CB. These are known to metabolize in the body when they come in contact with your blood stream and break down to harmless byproducts. There is also a new product on the horizon from a Chinese company called Kintor, I wouldn’t hold my breath until then, I’m just suggesting you take a look at it and keep tabs on it. 
 

Your other option is topical dutasteride. I’ve seen blood work from a handful of guys now that show that the inhibition of systemic dht is only approx 30% due it’s molecular weight and vehicle. 
 

I would advise against a hair transplant until you’ve at least taken some risk and tried something. Otherwise the loss will slowly progress and you’ll be chasing with further transplants until some point you’ll be tapped out of donor 

[JDEE0]

Hi,

What meds were they if you don't mind me asking that you took in the past that were similar? Because unless it was Dutasteride, I doubt it was similar in any way to finasteride; these are medications that block the 5-alpha reductase enzyme (to different extents, finasteride to a substantially lower degree and Dutasteride to a higher degree whilst also blocking an additional isoform of 5a reductase that is found in different tissues that shouldn't really be relevant to hair loss). 

If you look at my post history, I left a comment for another user regarding finasteride yesterday, I don't want to repeat myself, so check it out. But essentially, the simple answer is: try them and stop if you feel you need to, there's not much more to it than that.

The only caveat I would have to say is that if you are a particularly neurotic type of person, for lack of a better word, who worries non-stop about things then I wouldn't even bother for obvious reasons. 

PRP and laser therapy aren't valid alternatives to fin unfortunately, neither is minoxidil alone. The only way to tackle the root of the problem is to reduce the amount of overall androgens (DHT in particular) available to reach the androgen receptors in your hair follicles. Minoxidil may aid growth for some people, for others it doesn't do anything due to the lack of the required sulfotransferase enzyme that some people naturally are missing in comparison to others (this is necessary for monoxide to work essentially, although it can be negated somewhat by taking oral minoxidil). But even If it does work, it's not going to prevent further loss. 

As for having to take fin for the rest of your life, if you don't have sides, which is overwhelmingly likely to be the case statistically speaking, there is really no issue. But in any case, I'm pretty confident that there will be a number of alternative treatments available in the next 5-10 years that will be just as, and I would argue likely more so, effective than fin and should hopefully come with a very minimal side effect profile (finasteride already is minimal, but hopefully the things I'm talking about won't have systemic absorption, that is the plan). None of that is guaranteed of course, maybe no treatments will come out (although I think that is unlikely) but my point is that I don't think you'll have to take it for the rest of your life if you don't want to, but until alternatives are available, its wise to hold on to what you have. 

also, the fin may drastically improve your hairs current state, and on top of that, it will protect your donor hairs too. Additionally, unless you are a Norwood 7, trust me you can lose more hair, even if you're a NW5 now and you feel you're pretty much as bald as you can get, your sides can drop an inch, and your crown can dip two inches at the back and then you're pretty much screwed - this is particularly relevant if you're still young/showing the potential for this to happen (you'll need to be examined with a dermiscope or something similar by a competent dr). 

[TorontoMan]

13 minutes ago, JDEE0 said:

Hi,

What meds were they if you don't mind me asking that you took in the past that were similar? Because unless it was Dutasteride, I doubt it was similar in any way to finasteride; these are medications that block the 5-alpha reductase enzyme (to different extents, finasteride to a substantially lower degree and Dutasteride to a higher degree whilst also blocking an additional isoform of 5a reductase that is found in different tissues that shouldn't really be relevant to hair loss). 

If you look at my post history, I left a comment for another user regarding finasteride yesterday, I don't want to repeat myself, so check it out. But essentially, the simple answer is: try them and stop if you feel you need to, there's not much more to it than that.

The only caveat I would have to say is that if you are a particularly neurotic type of person, for lack of a better word, who worries non-stop about things then I wouldn't even bother for obvious reasons. 

PRP and laser therapy aren't valid alternatives to fin unfortunately, neither is minoxidil alone. The only way to tackle the root of the problem is to reduce the amount of overall androgens (DHT in particular) available to reach the androgen receptors in your hair follicles. Minoxidil may aid growth for some people, for others it doesn't do anything due to the lack of the required sulfotransferase enzyme that some people naturally are missing in comparison to others (this is necessary for monoxide to work essentially, although it can be negated somewhat by taking oral minoxidil). But even If it does work, it's not going to prevent further loss. 

As for having to take fin for the rest of your life, if you don't have sides, which is overwhelmingly likely to be the case statistically speaking, there is really no issue. But in any case, I'm pretty confident that there will be a number of alternative treatments available in the next 5-10 years that will be just as, and I would argue likely more so, effective than fin and should hopefully come with a very minimal side effect profile (finasteride already is minimal, but hopefully the things I'm talking about won't have systemic absorption, that is the plan). None of that is guaranteed of course, maybe no treatments will come out (although I think that is unlikely) but my point is that I don't think you'll have to take it for the rest of your life if you don't want to, but until alternatives are available, its wise to hold on to what you have. 

also, the fin may drastically improve your hairs current state, and on top of that, it will protect your donor hairs too. Additionally, unless you are a Norwood 7, trust me you can lose more hair, even if you're a NW5 now and you feel you're pretty much as bald as you can get, your sides can drop an inch, and your crown can dip two inches at the back and then you're pretty much screwed - this is particularly relevant if you're still young/showing the potential for this to happen (you'll need to be examined with a dermiscope or something similar by a competent dr). 

^ the best answer I’ve seen yet when ppl ask this type of question 

[hairyharry]

2 hours ago, JDEE0 said:

Hi,

What meds were they if you don't mind me asking that you took in the past that were similar? Because unless it was Dutasteride, I doubt it was similar in any way to finasteride; these are medications that block the 5-alpha reductase enzyme (to different extents, finasteride to a substantially lower degree and Dutasteride to a higher degree whilst also blocking an additional isoform of 5a reductase that is found in different tissues that shouldn't really be relevant to hair loss). 

If you look at my post history, I left a comment for another user regarding finasteride yesterday, I don't want to repeat myself, so check it out. But essentially, the simple answer is: try them and stop if you feel you need to, there's not much more to it than that.

The only caveat I would have to say is that if you are a particularly neurotic type of person, for lack of a better word, who worries non-stop about things then I wouldn't even bother for obvious reasons. 

PRP and laser therapy aren't valid alternatives to fin unfortunately, neither is minoxidil alone. The only way to tackle the root of the problem is to reduce the amount of overall androgens (DHT in particular) available to reach the androgen receptors in your hair follicles. Minoxidil may aid growth for some people, for others it doesn't do anything due to the lack of the required sulfotransferase enzyme that some people naturally are missing in comparison to others (this is necessary for monoxide to work essentially, although it can be negated somewhat by taking oral minoxidil). But even If it does work, it's not going to prevent further loss. 

As for having to take fin for the rest of your life, if you don't have sides, which is overwhelmingly likely to be the case statistically speaking, there is really no issue. But in any case, I'm pretty confident that there will be a number of alternative treatments available in the next 5-10 years that will be just as, and I would argue likely more so, effective than fin and should hopefully come with a very minimal side effect profile (finasteride already is minimal, but hopefully the things I'm talking about won't have systemic absorption, that is the plan). None of that is guaranteed of course, maybe no treatments will come out (although I think that is unlikely) but my point is that I don't think you'll have to take it for the rest of your life if you don't want to, but until alternatives are available, its wise to hold on to what you have. 

also, the fin may drastically improve your hairs current state, and on top of that, it will protect your donor hairs too. Additionally, unless you are a Norwood 7, trust me you can lose more hair, even if you're a NW5 now and you feel you're pretty much as bald as you can get, your sides can drop an inch, and your crown can dip two inches at the back and then you're pretty much screwed - this is particularly relevant if you're still young/showing the potential for this to happen (you'll need to be examined with a dermiscope or something similar by a competent dr). 

Thanks for the informative response. Regarding the other med I took, it wasn't equivalent to finasteride but it did warn of potential phycological side effects, like finasteride warns of possible impotence, depression, etc. Since I already know I'm susceptible to those symptoms I don't want to risk potentially years of post symptoms like I experienced in the past. I wouldn't call myself neurotic, just had a very bad experience with medication that was supposed to be "safe" but caused years of side effects so I'm very cautious not to repeat that experience. I'd also just generally prefer an natural alternative to drugs. 

I'm 55 years old and have attached a pic of my crown. Seems like I don't have much more to lose. If I only have the equivalent of a couple HT treatments, couldn't I go without finasteride treatment and instead have a couple HT treatments instead? If there is little to lose, seems to me the health risk considerations and low return on investment might not justify taking the drug. I'm not good at estimating number of follicles by looking at a picture, but I can't imagine there'd be more than 3k left on the crown?

 

Edited July 4, 2021 by hairyharry

[JDEE0]

11 minutes ago, hairyharry said:

Thanks for the informative response. Regarding the other med I took, it wasn't equivalent to finasteride but it did warn of potential phycological side effects, like finasteride warns of possible impotence, depression, etc. Since I already know I'm susceptible to those symptoms I don't want to risk potentially years of post symptoms like I experienced in the past. I wouldn't call myself neurotic, just had a very bad experience with medication that was supposed to be "safe" but caused years of side effects so I'm very cautious not to repeat that experience. I'd also just generally prefer an natural alternative to drugs. 

I'm 55 years old and have attached a pic of my crown. Seems like I don't have much more to lose. If I only have the equivalent of a couple HT treatments, couldn't I go without finasteride treatment and instead have a couple HT treatments instead? If there is little to lose, seems to me the health risk considerations and low return on investment might not justify taking the drug. I'm not good at estimating number of follicles by looking at a picture, but I can't imagine there'd be more than 3k left on the crown?

I understand your concerns - and by the way, I wasn't suggesting you were neurotic or anything, I was just saying if you happen to be the overly anxious, paranoid sort of type then it's probably best to steer clear and not nocebo yourself into a bad state as people like this generally always tend to convince themselves of the worst, even when there's nothing actually physically wrong.

Anyway, as I say, I can understand your position after reading that you've had bad experiences in the past. If you don't want to take it then that's completely up to you of course. You don't have to, you just have to accept that you're much more likely to experience further loss than if you did take it.

Regarding your pic, you don't have too much more to lose on the top, no. But, you're essentially a NW5 from what I can see, however it looks like your crown doesn't dip down the back of your head at all, and your sides aren't too low, although they are dropping a bit right now by the looks of it. So all in all, based off that pic (would need to see different angles really to judge properly) you're a somewhat less severe NW5 maybe. So, although you might think you don't have much more to lose, go and look up a NW5 vs a NW7, that crown - could - easily drop another few inches deeper into the back of your head. Not saying it will happen, in fact, the fact you're 55 and it hasn't is probably a pretty good sign that you won't go that far, would be best to get examined by a good surgeon. 

You certainly could just go ahead with a couple of Hair Transplants and forego the meds, yes. With your age, you could well be correct that there is little left to lose, and you very well might not lose too much more hair now. But like I say, you could still progress to a NW7 in say the next 10-20 years, I have no way of knowing. If I was you I would consult with some great doctors and get their take. And get scalp examined for miniaturisation to predict future loss. 

A good doctor is probably going to advise two procedures a year apart; the frontal third first at probably 3 to 3500 ish grafts, followed by the crown/midscalp at around 2-2500 grafts. After this, you might have anywhere from 0-2000 grafts left for any future procedures. depends on your donor, but you'll probably be looking at being close to your limit (if you go straight FUE anyway).

I don't think it is the most irresponsible decision in your case to go ahead without fin considering your age, and I imagine as long as your donor is decent and you're not clearly miniaturising into a nw7 pattern upon examination, most doctors will consider you to be an ok candidate without the fin. I would get in touch with Dr. Bisanga, Dr Bruno Pinto, Dr Ximena Villa, Dr Ferudini, Dr. Bruno Ferreira and Dr. Rafael De Freitas and get their take, but that's just my personal list of my current favourite doctors. Do your own research and come to your own conclusions of course. 

If you're in the States, and don't want to travel (all of those options will be considerably cheaper than US docs and just as good/better than some, but it is a long way) then look at Hasson and Wong, Dr. Konior, Dr. Shapiro, Dr. Cooley - there's more but that's just off the top of my head as I've never considered doctors over the pond. 

[TorontoMan]

You could get a hair transplant if you have some more realistic expectations. Your best bet is to see a reputable doctor to try to estimate the placement and number of grafts that would be required. 

[Britanium]

At 55 it is possible to get a transplant without the use of Fin although you could always try the topical version ? Just another option to think about. 
If you’re willing to accept you may need more than procedure and it’s still possible to lose more hair then yes go for it ! 
@Melvin- Moderatordoes not take Fin, I don’t either as I was always willing to accept my Norwood 6 and that all the hair on my scalp would be grafted. 
Out of curiosity are you thinking FUT or FUE ? 

[aaron1234]

On 7/4/2021 at 8:59 AM, hairyharry said:

I've read (and been told) that there are other alternatives, such as regular PRP and laser hats. Are these valid alternatives to finasteride and minoxidil? 

Absolutely not.  

On 7/4/2021 at 8:59 AM, hairyharry said:

My hairline is mostly gone and very little hair left on the crown so I wonder if there is much more I could loose anyway. 

If you think it can't ever get worse, think again.  Your crown doesn't appear to have dropped and you still have your lateral humps.  Don't underestimate the importance of maintaining the native hair in these areas if you go down the HT route. 

[hairyharry]

4 minutes ago, aaron1234 said:

Absolutely not.  

If you think it can't ever get worse, think again.  Your crown doesn't appear to have dropped and you still have your lateral humps.  Don't underestimate the importance of maintaining the native hair in these areas if you go down the HT route. 

So are you saying don't get a HT unless I'm willing to take finasteride or equivalent? Is that really the only option? I was hoping there was a natural and healthier alternative.

[aaron1234]

24 minutes ago, hairyharry said:

I was hoping there was a natural and healthier alternative.

Same, but there isn't.  I remember trying Saw Palmetto years ago before jumping on fin 🤦‍♂️what a waste of time (which is invaluable when trying to fight hair loss) and money.

Of course you can get a HT without fin, it's just a more risky endeavor.  The enjoyment of a successful transplant could possibly be more fleeting without it.

[gillenator]

I have never seen anyone get good efficiency with saw palmetto.