At a Loss for What to Do - The Genetics are Strong

[Scrags]

30 y/o here. I've been on finastride for about 10 months at 0.5mg, I was originally on it for 18 months but stopped for a couple of months after I tried shaving my head, was sick of the side effects but just braving them out now. I get bad gyno at 1mg, but 0.5mg is manageable, also get decent sexual sides.

Been on minoxidil for about 4 years with a small break which caused a shed. Both times stopping these meds was of course a bad idea, but also thought each time I could come to terms with the loss.

I've typically been able to just live with the level of loss and get faded haircuts to accommodate it - but recently the hair has been too bad to style, i'm constantly thinking about it and my appearance, and always on video calls seeing myself and my terrible hairline. I have started to rely on Toppik but even then it doesn't look good because of my hairline.

I could tolerate being on finastride and minoxidil if I looked good, and I also know without them I would be in full NW5 territory already. I've looked into transplants, but feel terrified of being trapped by Finastride forever as I do get gyno and other side effects.

It feels like my self confidence is destroyed, I can't date, I can't go out and have a good time without thinking about it, I always feel inferior and like theres something wrong with me. I'm bordering on feeling like a recluse who wont have a good time or go out with my friends because of it.

Theres 2 photos that were sent to Eugenix where they advised 3000 grafts, this was about 6 months ago and i've added another photo from today to show the potential crown difference versus 6 months ago.

What do I do here.. do I go for a reputable hair transplant place and stay on finastride with the sides, will it even look that good with my donor and progression? I have such dark hair and light skin i'm not sure it can be pulled off, and my temple recession is really abnormal.

Do I go for a hair system? Do I stay with this current hair and brave it out? Does it look better just to shave it then I can just stop the meds?

Let me know if I missed anything, appreciate the input.

 

Edited November 4, 2021 by Scrags

[hairman22]

use fibers or smp for density.

 

Then in 5+ years maybe look to get a transplant.

No point as hairs in midcalp may go.

 

get a 0 fade around the sides as well

Edited November 4, 2021 by hairman22

[JDEE0]

Hey,

In your case, honestly, I think it would look better if you shaved it down short rather than keeping it the length in the pictures due to the diffused nature of your loss. Some types of balding, such as a receding hairline with minimal loss elsewhere, can generally go unnoticed to a large degree by most people who don't think about hair loss as we do here, but with loss like yours, I think it's probably going to be one of the first thoughts that enter peoples minds when they see you (at least from certain angles).

To be fair, it doesn't look as bad in your 3rd photo as your last, so it depends which one is more representative of reality, and ultimately what you feel most comfortable with. But I think bald always wins over very clearly and quite severely balding, especially when someone is younger. 

I'm a big advocate of fin, but not if it's causing you issues, you really don't want to stay on it long-term if it's making your life worse.... I would try topical finasteride as good evidence has recently emerged from a study that shows it to go less systemic than oral, yet still has a similar efficacy. You could try oral minoxidil on top of this and perhaps try dutasteride mesotherapy in conjunction.

As for should you get a transplant, well, it's hard to judge your donor from these pics, but I think it's probably average at best, which might be being generous. Do you have a good beard supply? You're destined to go NW6 and so you're going to need 6-7000 grafts at least for reasonable coverage across your whole head. 

[Britanium]

This looks like its going to progress to a Norwood 6 without the meds. If you can tolerate the lower dose of Fin that’s going to really help. You do have a lot of hair to save at present. Have you considered/consulted with anyone else apart from Eugenix ? Always good to get at least a few done. But Eugenix are particularly good with your level of loss. Is it FUE your looking at, or would you also consider FUT ? 

[Britanium]

You mentioned you tried shaving down, did you not like the look ? It does take some getting used to. But it’s definitely not for everyone. 

[Scrags]

31 minutes ago, JDEE0 said:

Hey,

In your case, honestly, I think it would look better if you shaved it down short rather than keeping it the length in the pictures due to the diffused nature of your loss. Some types of balding, such as a receding hairline with minimal loss elsewhere, can generally go unnoticed to a large degree by most people who don't think about hair loss as we do here, but with loss like yours, I think it's probably going to be one of the first thoughts that enter peoples minds when they see you (at least from certain angles).

To be fair, it doesn't look as bad in your 3rd photo as your last, so it depends which one is more representative of reality, and ultimately what you feel most comfortable with. But I think bald always wins over very clearly and quite severely balding, especially when someone is younger. 

I'm a big advocate of fin, but not if it's causing you issues, you really don't want to stay on it long-term if it's making your life worse.... I would try topical finasteride as good evidence has recently emerged from a study that shows it to go less systemic than oral, yet still has a similar efficacy. You could try oral minoxidil on top of this and perhaps try dutasteride mesotherapy in conjunction.

As for should you get a transplant, well, it's hard to judge your donor from these pics, but I think it's probably average at best, which might be being generous. Do you have a good beard supply? You're destined to go NW6 and so you're going to need 6-7000 grafts at least for reasonable coverage across your whole head. 

Yeah it wasn't as bad until I stopped fin those few months, then thats when those Eugenix photos occurred. Its a bit better now like the 3rd photo, even donor hairs get darker - but the contrast between my skin and dark hair just looks different between photos.

I tried topical fin and actually got worse sides than the 0.5mg, its actually why I stopped fin - I thought topical might be good but my gyno got severe and scans showed development lol.. I tried oral minoxidil and got super dizzy spills, its not feasible long term and if I go dut and already have issues on half dose fin..

Decent beard supply, and thats what has me thinking Eugenix for maybe 2 hits over my lifetime - just don't know if this chase or path is worth it.

[Scrags]

19 minutes ago, JC71 said:

This looks like its going to progress to a Norwood 6 without the meds. If you can tolerate the lower dose of Fin that’s going to really help. You do have a lot of hair to save at present. Have you considered/consulted with anyone else apart from Eugenix ? Always good to get at least a few done. But Eugenix are particularly good with your level of loss. Is it FUE your looking at, or would you also consider FUT ? 

I've consulted with several in Australia but Gatsby recommends against them lol for fair reasons, DHI pretty much went blank when I asked about a long term plan, and other ones told me they would do it if I told them to. Knudsen from the hair loss show was just smug, I wouldn't let him touch my hair.

The shaved down look is okay.. but it triggers this inferiority complex in me that I can't shake, I do wish I went for more girls before with it shaved to see if I had success - but when out with my friend i'd just be in my head negatively the whole time - I have a bit of a baby face and its just not in my personality.

[Britanium]

@DrTBarghouthi (Vertex clinic), Dr Bisanga (BHR), Hattingen and Dr Zarev are some other good choices for the higher Norwood Levels. Just to name a few. 
 

Edited November 4, 2021 by JC71

[JDEE0]

22 minutes ago, Scrags said:

Yeah it wasn't as bad until I stopped fin those few months, then thats when those Eugenix photos occurred. Its a bit better now like the 3rd photo, even donor hairs get darker - but the contrast between my skin and dark hair just looks different between photos.

I tried topical fin and actually got worse sides than the 0.5mg, its actually why I stopped fin - I thought topical might be good but my gyno got severe and scans showed development lol.. I tried oral minoxidil and got super dizzy spills, its not feasible long term and if I go dut and already have issues on half dose fin..

Decent beard supply, and thats what has me thinking Eugenix for maybe 2 hits over my lifetime - just don't know if this chase or path is worth it.

Yeah, but what dose were you using it at? For some reason, and god knows why, most clinics offering topical fin offer it in a 1, 2 or 2.5 percent solution, which is the equivalent of 10, 20 or 25 mg of finasteride per ml (or pump) of application. So potentially up to 100 times the daily dose of fin depending on how much is used...

If you actually used it at a lower dose such as 0. whatever per ml, and still had worse sides than oral fin, are you sure you're not experiencing nocebo? You also say 0.5 of finasteride gives you no gyno issues (and less sides in general) than 1mg (which you think definitely does), which to be honest makes no sense scientifically. 1mg of finasteride and 0.5mg of finasteride daily inhibit pretty much the exact same amount of DHT, maybe a percentage point or 2 less. As such, the amount of T that isn't able to convert to DHT is probably the exact same, and the extra T that aromatases to Estrogen (which is what causes gyno) will again be the exact same. 

To be honest, it makes little sense in general - not just in relation to gyno - that 0.5 would cause less issues than 1mg if someone was truly getting legitimate sides from fin as, like I say, they inhibit nearly the exact same amount of T - DHT conversion. Not trying to argue that you don't have real sides by the way, just some thoughts. 

Also, I said dutasteride mesotherapy, not regular dut, it's not the same thing.

Edited November 4, 2021 by JDEE0

[Britanium]

Oh and Dr Bicer is another good consideration. Eugenix are pretty amazing but it’s always good to consider others. Medispa is someone else who do good work, and in particular the combo cases. Sometimes they combine FUT/FUE/BHT in one ht which is certainly one way of maximising all sources ! 

[follically challenged]

Is it worth trying topical? topical Fin or Dut? Worth a shot maybe?

[Z--]

Honestly, you're headed to a high Norwood and it looks like a tad bit of thinning in the donor. I'd really recommend not trying to push the hairline too far down. You have limited donor and a large area to cover.

Personally, I don't think surgery is a bad idea. Most of the balding is behind the frontal third and there isn't much to save back there. At most you could lose some hair in the front without medication. 

I'd look into H&W/Eugenix. I've seen them provide great results for higher NWs.

[SLA]

Hi @Scrags- I feel you...I am dealing with similar minor gyno issue myself. Been on fina 1.25mg for close to 1.5 years and had minor swelling, but got a bit worse recently.

Here is what I have learned about finasteride...

In the original Merck study .2mg daily of oral finasteride performed only about 10-20% worse than 1mg daily, so that certainly may be something to try. In Japan, they prescribe .25mg tabs (you could cut the 1mg into quarters). Dr. Vikram and Knudsen from Australia typically prescribe 1.25mg and have patients take 3x per week and said in their 20 years of practice that this has stabilized the hair loss of most of their patients. They also said one can stop finasteride for 1 month and not lose any ground- while finasteride leaves the blood stream in ~24 hours, it remains in tissue a lot longer and the enzyme has a half life of 30 days so it will still block DHT for 90 days (although less DHT). Another doctor (well known) says in his practice, he has patients on finasteride stop for 15 days every 3 months to let excess flush from the system.

As for topical finasteride, companies selling it online typically sell in higher doses (as mentioned in this thread) which can be as systemic as the oral version. There was a study done which showed that .025% concentration of topical finasteride showed only 24% serum DHT suppression yet had a 50+% suppression of scalp DHT compared with close to 70% in oral! Check out link here from Matt Dominance explaining this well and how to compound it yourself. I also think FUEClinic (Dr. Mwamba) sells the .025% concentration.

https://mattdominance.com/topical-finasteride-2/   

Here is another good article about finasteride and gyno prevention- I would talk to your doctor about this and arranging a treatment plan.

https://moreplatesmoredates.com/finasteride-gynecomastia/

Finally, in regards to gyno, it sucks, BUT worse case it can be reversed permanently through surgery- may cost ~$5k in the US, ~$1k in India.

I hope this helps...my personal plan is stopping oral finasteride for up to 30 days. I have an appointment with my doctor in 10 days to talk about a strategy. Likely, will try a MWF 1.25mg strategy with oral. If that doesn't work, try a topical solution- maybe at .025%.

As for topical dutasteride, it will be interesting to see more research come out on it. I know Drs. Hasson & Wong sell it and are studying it and Dr. Wong said in an interview with @Melvin- Moderatorsomething like it only has 5% absorption (I don't remember the exact details) and works every bit as well as oral without sides. Might have something to do with the molecular weight of dutasteride with is above 500. However, at this point, you can only get in Vancouver or Italy. 

Just a small set back in the journey! Hang in there!

 

[Scrags]

6 hours ago, JDEE0 said:

Yeah, but what dose were you using it at? For some reason, and god knows why, most clinics offering topical fin offer it in a 1, 2 or 2.5 percent solution, which is the equivalent of 10, 20 or 25 mg of finasteride per ml (or pump) of application. So potentially up to 100 times the daily dose of fin depending on how much is used...

If you actually used it at a lower dose such as 0. whatever per ml, and still had worse sides than oral fin, are you sure you're not experiencing nocebo? You also say 0.5 of finasteride gives you no gyno issues (and less sides in general) than 1mg (which you think definitely does), which to be honest makes no sense scientifically. 1mg of finasteride and 0.5mg of finasteride daily inhibit pretty much the exact same amount of DHT, maybe a percentage point or 2 less. As such, the amount of T that isn't able to convert to DHT is probably the exact same, and the extra T that aromatases to Estrogen (which is what causes gyno) will again be the exact same. 

To be honest, it makes little sense in general - not just in relation to gyno - that 0.5 would cause less issues than 1mg if someone was truly getting legitimate sides from fin as, like I say, they inhibit nearly the exact same amount of T - DHT conversion. Not trying to argue that you don't have real sides by the way, just some thoughts. 

Also, I said dutasteride mesotherapy, not regular dut, it's not the same thing.

So the topical finastride was 0.1mg combined with 7% min and when I started using it I had a stinging pain for gyno and a worse drive, I actually kept using it, but went to a doctor who did a scan and agreed they were swelling. I went to the beach with my friends and man did it look bad, the scan showed a small bit of tissue developing. Jumped off it after the doctor said should stop to see and it went down, then tried 1mg finastride again and sides returned, so back on 0.5mg. Literally every time I go 1mg it goes bad then 0.5mg is still there but just not as bad, looks manageable.

 

I've done the 1mg test about 3 times because I know it worked so well for me when I did it for 6 months. Oral is probably better too as my sides seem to get healthier on it. I get your point, they are the same blockage, I can do with reduced sex drive on 1mg but the gyno evidence is there visually every time I bump it up.

[Scrags]

1 hour ago, SLA said:

Hi @Scrags- I feel you...I am dealing with similar minor gyno issue myself. Been on fina 1.25mg for close to 1.5 years and had minor swelling, but got a bit worse recently.

Here is what I have learned about finasteride...

In the original Merck study .2mg daily of oral finasteride performed only about 10-20% worse than 1mg daily, so that certainly may be something to try. In Japan, they prescribe .25mg tabs (you could cut the 1mg into quarters). Dr. Vikram and Knudsen from Australia typically prescribe 1.25mg and have patients take 3x per week and said in their 20 years of practice that this has stabilized the hair loss of most of their patients. They also said one can stop finasteride for 1 month and not lose any ground- while finasteride leaves the blood stream in ~24 hours, it remains in tissue a lot longer and the enzyme has a half life of 30 days so it will still block DHT for 90 days (although less DHT). Another doctor (well known) says in his practice, he has patients on finasteride stop for 15 days every 3 months to let excess flush from the system.

As for topical finasteride, companies selling it online typically sell in higher doses (as mentioned in this thread) which can be as systemic as the oral version. There was a study done which showed that .025% concentration of topical finasteride showed only 24% serum DHT suppression yet had a 50+% suppression of scalp DHT compared with close to 70% in oral! Check out link here from Matt Dominance explaining this well and how to compound it yourself. I also think FUEClinic (Dr. Mwamba) sells the .025% concentration.

https://mattdominance.com/topical-finasteride-2/   

Here is another good article about finasteride and gyno prevention- I would talk to your doctor about this and arranging a treatment plan.

https://moreplatesmoredates.com/finasteride-gynecomastia/

Finally, in regards to gyno, it sucks, BUT worse case it can be reversed permanently through surgery- may cost ~$5k in the US, ~$1k in India.

I hope this helps...my personal plan is stopping oral finasteride for up to 30 days. I have an appointment with my doctor in 10 days to talk about a strategy. Likely, will try a MWF 1.25mg strategy with oral. If that doesn't work, try a topical solution- maybe at .025%.

As for topical dutasteride, it will be interesting to see more research come out on it. I know Drs. Hasson & Wong sell it and are studying it and Dr. Wong said in an interview with @Melvin- Moderatorsomething like it only has 5% absorption (I don't remember the exact details) and works every bit as well as oral without sides. Might have something to do with the molecular weight of dutasteride with is above 500. However, at this point, you can only get in Vancouver or Italy. 

Just a small set back in the journey! Hang in there!

 

The good thing is, if I stop the swelling generally goes, like my chest went good generally which makes me confident - and agreed it's easier to do 5k for gyno surgery than 15k and a potentially unsuccessful transplant and losing irreplaceable hair. I'd potentially even brave out the gyno it's just that my hair still looks like shit.

I may have gotten sides on the topical fin because it was combined with the minoxidil and absorbed like crazy I'm not sure, doctor also said it could have just been from the oral already. It also gave me severe nausea which I only now just remembered.

Will go talk to my doctor tomorrow about getting some blood work done for hormones - thanks for the links will look into trying to manage it more

[RandoBrando517]

You should consider topical fin and dut 

[Gokuhairline]

can anyone tell me what gyno side is ? lol i think i know but maybe i am wrong...

[Britanium]

2 minutes ago, Gokuhairline said:

can anyone tell me what gyno side is ? lol i think i know but maybe i am wrong...

Enlarging of the breasts. 

[SLA]

14 hours ago, RandoBrando517 said:

You should consider topical fin and dut 

Does topical fin and/or dut actually cause fewer side effects? At the doses most are selling, the research I have seen seems to show that is has the same effect on serum DHT levels so in theory, I would think it would produce the same sides as oral.

Would love to hear experiences around this....

The only data I saw of lower serum DHT levels with efficacy was topical finasteride at .025% which lowered serum DHT levels by only 24% yet lowered scalp DHT by 50+%.

 

[MazAB]

I think a hybrid approach of oral and topical finasteride would probably do the trick here. Microdose what you can tolerate for oral, and use topical to fill the gap. 

Maybe 0.25 mg daily and also apply topical daily. My best friend crushes the finasteride pills, puts in a blender and mixes it with minoxidil. Then applies daily with a dropper, as well as orally taking 0.25mg daily and the sides disappeared.

Might be an approach to consider...

Follow my Journey with Eugenix and Dr Arika Bansal!

 

Edited November 5, 2021 by MazAB

[JDEE0]

4 hours ago, SLA said:

Does topical fin and/or dut actually cause fewer side effects? At the doses most are selling, the research I have seen seems to show that is has the same effect on serum DHT levels so in theory, I would think it would produce the same sides as oral.

Would love to hear experiences around this....

The only data I saw of lower serum DHT levels with efficacy was topical finasteride at .025% which lowered serum DHT levels by only 24% yet lowered scalp DHT by 50+%.

 

Problem with that study you're referring to is that it only lasted a week.

Luckily, a pretty good study recently was published re topical fin, I made a thread about it here: 

 

Edited November 5, 2021 by JDEE0

[Scrags]

@Gatsby are you able to comment what you think of the pics, would going ahead with eugenix be okay?