Finasteride

[Cmike]

Hey guys, coming back to you for some advice. I’ve been on finasteride for a year now, and it seems as if my hairline has gotten worse. I still have good density, but it’s defintely receded a bit more. I really want to get a hair transplant, I’m just worried that if finasteride can’t atleast stop the hair loss, than a transplant will be a waste of money. Should I try dutasteride? Or are there any other suggestions. Thanks to all!

Edited May 11, 2022 by Cmike

[Dillpickle123]

It could be that those hair were too far gone my hairline has also receded more even on finasteride could be that those hairs were bound to fall off finasteride can only slow down hairloss how old are you? As long as most of the mid scalp and crown are good then it’s probably working only way too tell is blood tests to see if it’s lowering dht 

[Cmike]

31 minutes ago, Dillpickle123 said:

It could be that those hair were too far gone my hairline has also receded more even on finasteride could be that those hairs were bound to fall off finasteride can only slow down hairloss how old are you? As long as most of the mid scalp and crown are good then it’s probably working only way too tell is blood tests to see if it’s lowering dht 

23 about to turn 24. Defintely going to look into getting a blood test for dht levels. And I’ve done a pretty good job documenting. Up until a month or two ago, those hairs were still there and pretty dense. Not sure if stress or something else has played a factor but

[Mike10]

Finansteride usually does not work in the hairline area. It is taken for the middle and the crown! I am repeating myself over and over with this. They all want to keep believing it is this miracle drug while it is not.

At 23 you are too young for a HT in my opinion.  

[mafpe]

finasteride doesnt "STOP" hair loss, it simply slows down the progress by a big margin, for example, if it's about to take you 6 years to go to nw6, using finas might delay that progression slowly to the point it take perhaps 24 years. *some claim that it arrest their hair loss totally but these are rare.

my hairloss progress constantly even when i take the meds, but i'm pretty sure that i'd be around 2 norwood higher than i am now should i have not taken them.

[NARMAK]

Finasteride helps to slow down hair loss. Usually the hair that recedes does so in a pattern from front to back. So the hair you described could have been weaker and past the point of saving if they had become weak and miniaturised however, there's also a chance that Finasteride could be causing them to shed and starting a regrowth cycle. A hair cycle can take around 3 months though, so it's also a reason you may look bad at times and better in others. 

The medication will definitely help but its not a miracle. Very few manage to block enough scalp DHT to completely block hair loss in its tracks. Finasteride blocks 41% scalp DHT at 1mg everyday. To block 100% of your scalp DHT, your native hairs resistance in all areas would need to be a minimum of 59% and then you could argue you might still lose out if something or other increased your DHT levels on the scalp. 

Even Dutasteride that blocks 51% scalp DHT, if your native scalp DHT resistance was 30%, would mean you still are getting affected but it's still going to be significantly slower than not using it. 

Until there's something better out there we can add on top, just trust the process and at 23, you are way too young imo unless you can show stability till around 25 for a few years to consider a hair transplant. It would probably lead to further hair loss into your 30s you'd be chasing to cover up. 

Edited May 11, 2022 by NARMAK
Spelling

[Cmike]

4 hours ago, NARMAK said:

Finasteride helps to slow down hair loss. Usually the hair that recedes does so in a pattern from front to back. So the hair you described could have been weaker and past the point of saving if they had become weak and miniaturised however, there's also a chance that Finasteride could be causing them to shed and starting a regrowth cycle. A hair cycle can take around 3 months though, so it's also a reason you may look bad at times and better in others. 

The medication will definitely help but its not a miracle. Very few manage to block enough scalp DHT to completely block hair loss in its tracks. Finasteride blocks 41% scalp DHT at 1mg everyday. To block 100% of your scalp DHT, your native hairs resistance in all areas would need to be a minimum of 59% and then you could argue you might still lose out if something or other increased your DHT levels on the scalp. 

Even Dutasteride that blocks 51% scalp DHT, if your native scalp DHT resistance was 30%, would mean you still are getting affected but it's still going to be significantly slower than not using it. 

Until there's something better out there we can add on top, just trust the process and at 23, you are way too young imo unless you can show stability till around 25 for a few years to consider a hair transplant. It would probably lead to further hair loss into your 30s you'd be chasing to cover up. 

Do you think it’s possible to see a shed phase even after a year? I’m not too sure, but I always thought the shed phase happened earlier on, which I never really noticed. Do you add any other alpha 5 reductase inhibitors with finasteride? Thanks for your reply!

Edited May 11, 2022 by Cmike

[Cmike]

5 hours ago, Mike10 said:

Finansteride usually does not work in the hairline area. It is taken for the middle and the crown! I am repeating myself over and over with this. They all want to keep believing it is this miracle drug while it is not.

At 23 you are too young for a HT in my opinion.  

Man you’re not kidding. No one in my family that I remember is even bald haha. Both my grandpas had a thick head of hair, and same with my dad. Do you add any other alpha 5 reductase inhibitors to the oral finasteride? I wanted to try and take as little as possible at first, but now I feel like I might need to add something else in here. Thanks!

Edited May 11, 2022 by Cmike

[NARMAK]

6 minutes ago, Cmike said:

Do you think it’s possible to see a shed phase even after a year? I’m not too sure, but I always thought the shed phase happened earlier on, which I never really noticed. Do you add any other alpha 5 inductase inhibitors with finasteride? Thanks for your reply!

I personally am on Dutasteride 0.5mg everyday and i do think it is possible for your hair to go through multiple shed phases. Sometimes small ones but at other times there could be other factors and a higher shed. 

I think there's some people that take topical Finasteride as well as Oral Finasteride but right now, i think that mixing those two is probably too extreme. Some people like to try and also add other things to help like Nizoral with 2% ketoconazole or perhaps sometimes you might even see people using research chemicals like RU58841 (?) or similar for apparently an Anti-Androgen boost. 

I use Dutasteride, Nizoral 2% keto and occasionally try to make sure i microneedle with a derma pen at 1mm to 1.5mm once a week but haven't been very diligent with Microneedling as much lately. 

I'd say what you should do is entirely based on your individual hair loss situation. 

[Mike10]

48 minutes ago, Cmike said:

Man you’re not kidding. No one in my family that I remember is even bald haha. Both my grandpas had a thick head of hair, and same with my dad. Do you add any other alpha 5 reductase inhibitors to the oral finasteride? I wanted to try and take as little as possible at first, but now I feel like I might need to add something else in here. Thanks!

Nor at all. If you do not have the MPB genes, I would not have recommended Finansteride to begin with. That is not the way I would have approached this based on personal experience. 

[Dillpickle123]

Depends how bad your hairloss is you could get a small ht if it really really bothers you 

[Rahal Hair Transplant]

Cmike,

To give you some advice, it would be helpful if you could provide a bit more information. For example how old are you? Also, do you have any photos you can show of the top of your scalp?  

Unfortunately, finasteride doesn’t work for everybody. And for those it works for, sometimes it only works in the crown area. That said, although it’s only proven to work in the crown, it does sometimes work in the hairline and sometimes stops hairline recession. Unfortunately, this may not be the case for you.

Keep in mind also that not everybody who experiences male pattern baldness will advance to a Norwood class 6 or 7.   Unfortunately however, there’s no way to determine with certainty how far your hair loss will advance.  But, family history and your current hair loss pattern can be a guide for both you and your surgeon.

To address your original concern and question, many people who don’t use nonsurgeal treatments can and do proceed with hair transplant surgery.  That said, an experienced and skilled surgeon will take a more conservative approach and discuss not only the short term goals of a single hair transplant, but long-term strategy which may involve subsequent procedures if necessary.

In my opinion, consult a few leading hair transplant surgeons recommended by this community and garner their professional input on the best course of action for you both short and long-term.

Best wishes,

Rahal Hair Transplant

[Mike10]

I gotta hand it to the Rahal representative, he is giving consistently good advice. 

[ciaus]

9 hours ago, NARMAK said:

Finasteride blocks 41% scalp DHT at 1mg everyday. To block 100% of your scalp DHT, your native hairs resistance in all areas would need to be a minimum of 59% and then you could argue you might still lose out if something or other increased your DHT levels on the scalp. 

Even Dutasteride that blocks 51% scalp DHT, if your native scalp DHT resistance was 30%, would mean you still are getting affected but it's still going to be significantly slower than not using it. 

 

Actually the studies indicate finasteride blocks up to around 70% and dutasteride in the 90s% range. But the general point that it doesn't block all DHT is true and important for guys to realize. Because even if you do continue to lose ground, as long as its at a significantly slower rate, then finasteride or dutasteride can still be a very valuable tool for minimizing the number and size of hair transplants you need down the road. 

I wouldn't get too stressed about continuing to lose the frontal area hair, try to appreciate that you are holding on to it longer than you would otherwise. That area is usually the most DHT sensitive for guys. But if you start dramatically losing hair in the mid-scalp and crown areas too, that's when you need to start thinking about whether its worthwhile to continue taking it. It all comes down to your individual genetics, there is a very unlucky minority of guys whose hair is just too sensitive to DHT for the blockers to have a worthwhile long term impact. 

 

 

https://pubmed.ncbi.nlm.nih.gov/10495374/

Methods: Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days.

Results: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.

 

https://donovanmedical.com/hair-blog/dutasteride-dht

 

[NARMAK]

31 minutes ago, ciaus said:

 

Actually the studies indicate finasteride blocks up to around 70% and dutasteride in the 90s% range. But the general point that it doesn't block all DHT is true and important for guys to realize. Because even if you do continue to lose ground, as long as its at a significantly slower rate, then finasteride or dutasteride can still be a very valuable tool for minimizing the number and size of hair transplants you need down the road. 

I wouldn't get too stressed about continuing to lose the frontal area hair, try to appreciate that you are holding on to it longer than you would otherwise. That area is usually the most DHT sensitive for guys. But if you start dramatically losing hair in the mid-scalp and crown areas too, that's when you need to start thinking about whether its worthwhile to continue taking it. It all comes down to your individual genetics, there is a very unlucky minority of guys whose hair is just too sensitive to DHT for the blockers to have a worthwhile long term impact. 

 

 

https://pubmed.ncbi.nlm.nih.gov/10495374/

Methods: Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days.

Results: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.

 

https://donovanmedical.com/hair-blog/dutasteride-dht

 

I'm sorry,  i wasn't able to locate it but my understanding is that Finasteride blocks 70% serum body DHT levels but only 41% scalp DHT levels. Which is what would explain why men still lose hair because if Finasteride blocked 70% or so of DHT on the scalp, combined with the natural DHT resistance of the average man, i'm almost certain it would stop hair loss in its tracks. That doesn't happen however and that's likely due to the amount of scalp DHT being blocked sitting around 41%.

Last i checked, Dutasteride blocked 90% of serum body DHT but sata round 51% for scalp DHT blocked. 

I can't recall exactly which source this was but it was when i began to look into it a lot more closely to see why people were still losing hair if Finasteride was blocking 70% DHT and they should have some natural DHT resistance too. 

[Cmike]

9 hours ago, Rahal Hair Transplant said:

Cmike,

To give you some advice, it would be helpful if you could provide a bit more information. For example how old are you? Also, do you have any photos you can show of the top of your scalp?  

Unfortunately, finasteride doesn’t work for everybody. And for those it works for, sometimes it only works in the crown area. That said, although it’s only proven to work in the crown, it does sometimes work in the hairline and sometimes stops hairline recession. Unfortunately, this may not be the case for you.

Keep in mind also that not everybody who experiences male pattern baldness will advance to a Norwood class 6 or 7.   Unfortunately however, there’s no way to determine with certainty how far your hair loss will advance.  But, family history and your current hair loss pattern can be a guide for both you and your surgeon.

To address your original concern and question, many people who don’t use nonsurgeal treatments can and do proceed with hair transplant surgery.  That said, an experienced and skilled surgeon will take a more conservative approach and discuss not only the short term goals of a single hair transplant, but long-term strategy which may involve subsequent procedures if necessary.

In my opinion, consult a few leading hair transplant surgeons recommended by this community and garner their professional input on the best course of action for you both short and long-term.

Best wishes,

Rahal Hair Transplant

The first picture is a month into finasteride (about a year and 2 months ago) and the second picture was taken today. I’ll take your opinion if it’s recessed as you know quite a bit more than I do. I initially thought it was recessed but upon looking more it seems like the second picture (current) has a lot more density around the hairline