Am I responding to finasteride? What does end of anagen phase look like?

[Lightmare]

I am seeing a few shed hairs that look like they are gradually narrowing toward the hair bulb over the nearest ~1-2cm.  I have been on finasteride (generic, from Ascend lab from Costco pharmacy) for a year now and am trying to figure out whether I am responding to it or whether I should switch pharmacies/suppliers or try a stronger 5AR blocker like dutasteride, but I had a HT at the same time so it is hard to tell.  In the crown where I had very few hairs grafted I am not noticing a massive difference from last year, and am undergoing another shedding phase. 

My question is, do normal, healthy hairs (ones that are NOT miniaturizing due to DHT or other effects) shrink gradually during the last month or two of the anagen phase before they reach catagen, or is it a hard cutoff where the diameter stays the same throughout?   I.e. should a healthy, or at least 'constant width' (i.e. not getting any thinner) hair look more like the upper or lower picture?  Apologies for the bad drawing.  

 

 

Edited April 15, 2022 by Lightmare

[NARMAK]

Responding to Finasteride is something you have to keep a track of with progress pictures and maybe a Trichoscopic evaluation. 

That said, the hair shedding people talk about is what always gets me. If it's like over say hundreds a day, then 50-150 hairs is apparently a normal range. Also, if you are shedding thin hairs, it could be because the hair will grow back stronger but it could take a few or more hair cycles. A typical hair cycle is 3 months. That's why Finasteride can and does work for some over a longer period like 10 years and still improving things even slowly. 

[Lightmare]

Yeah, most of the hairs I shed are right in the middle of being the thinnest vellus hairs and thick terminal hairs.  I have been keeping a monthly photo log and keeping track of roughly how many I lose daily when washing/drying my hair.  

It's the shape that I'm wondering about - for hairs that were not cut, shed hairs seem to get thinner toward either end of the hair (both the bulb and the tip when it first pops out of the scalp).  They are darkest/thickest in the middle.  I'm wondering if the shape can give a hint in terms of responsiveness...if a healthy hair ought to be constant thickness before falling out then I'd be concerned that my finasteride is not working or wearing off.

I checked my serum DHT after a few hours of taking a dose of this oral fin and it was sitting at the lower end of normal - not below normal like I would've hoped.  Dividing it by .3 (since fin is supposed to reduce DHT by 70%) put me above the normal range.  Unfortunately I didn't test before starting.

 

Edited April 15, 2022 by Lightmare

[NARMAK]

7 hours ago, Lightmare said:

Yeah, most of the hairs I shed are right in the middle of being the thinnest vellus hairs and thick terminal hairs.  I have been keeping a monthly photo log and keeping track of roughly how many I lose daily when washing/drying my hair.  

It's the shape that I'm wondering about - for hairs that were not cut, shed hairs seem to get thinner toward either end of the hair (both the bulb and the tip when it first pops out of the scalp).  They are darkest/thickest in the middle.  I'm wondering if the shape can give a hint in terms of responsiveness...if a healthy hair ought to be constant thickness before falling out then I'd be concerned that my finasteride is not working or wearing off.

I checked my serum DHT after a few hours of taking a dose of this oral fin and it was sitting at the lower end of normal - not below normal like I would've hoped.  Dividing it by .3 (since fin is supposed to reduce DHT by 70%) put me above the normal range.  Unfortunately I didn't test before starting.

 

I just want to clarify for you and anybody reading. Finasteride blocks 70% of BODY based DHT. Not the scalp. In the scalp, studies show it is around 41% DHT reduction using 1mg everyday as the dosage. For Dutasteride in comparison you block 90% or so of body DHT and around 51% scalp DHT. 

Bear in mind, your scalp and everybody else will naturally block a certain amount but for those that don't block as much and their DHT sensitivities are higher, they will still lose ground. Sometimes even to the point Finasteride etc. looks like it "Isn't doing anything" even though in reality without it, they'd probably have lost ground even quicker. 

If you are in that situation, the only thing you could try imo is to throw the kitchen sink of Dutasteride, Oral Minoxodil and Microneedling with a derma pen at 1.5mm once a week and adding in a 2% Ketoconazole shampoo like Nizoral. Also combining that potentially with some other research based chemicals like RU going by anecdotal evidence of effectiveness. 

The last one you can leave as its not fully supported by studies but also stopping short of near full blown gender changing medication, that above list is the maximum you can do that's got science backed studies. 

Ultimately hair loss is a difficult fight and is multi-factorial so what i listed might need to be done in addition to say treating seborrheic dermatitis, inflammation, Vitamin deficiency etc. too as those might be causing your hair loss too and often are very easily overlooked.