Medical therapy recommendations from elite surgeons - analysis of their differences

[Kraki77]

FIrst of all, I would like to openly say that I've already booked surgery with dr. Freitas for the end of next year. In my consultations with many elite surgeons it became evident that there are slight differences in the way they are recommending medical treatment. It would be nice to create some kind of database based upon your experiences also.

De Freitas - 0.5 mg Dutasteride (Monday and Friday), 1mg Finasteride (Tuesday,Wednesday, Thursday, Saturday, Sunday), 5mg oral minoxidil (every single day)

Pinto - 0.5 mg Dutasteride (from Monday to Friday), 5mg oral minoxidil (every single day)

Ferreira - 1 mg Finasteride (every single day) - insisted that it's more than enough for my case.

I'm interested to hear other comments and perhaps valid discussion about which approach makes more sense or what kind of arguments are out there to support that.

[Mike10]

We do not have any pictures so it is difficult to assess for us. I would generally agree with Dr Ferreira that 1mg  Finansteride is enough. Oral Minox also potentially  has some serious side effects, so if you do not need it do not  take it. 

[Robbert]

What's the benefit of oral minox? For what I understood how minox works is that it increases blood flow locally, so how would it be beneficial for your scalp hair if you take it orally? Wouldn't hair start to grow basically everywhere on your body?

I also believe that dutasteride block both types (I and II) of 5alpha-reductase. Where finasteride only blocks type II. So I'm very confused why doctor Freitas would subscribe both and the strongest one only twice a week.. I'm not a doctor but research states that 0.5 grams a day would block >90% DHT where fin blocks ~70%. So why take the risk to just get a little over 70% with the 2 Dustasteride pills swap a week with possibly more side effects? I'm confused.

[HappyMan2021]

7 hours ago, Kraki77 said:

I've already booked surgery with dr. Freitas for the end of next year

hopefully a Monkeypox pandemic or WW3 won't occur before then

[Robbert]

1 hour ago, HappyMan2021 said:

hopefully a Monkeypox pandemic or WW3 won't occur before then

I'm still rooting for a genetic hairloss treatment breakthrough in months (nuclear war has become possible within weeks, so why not a cure for hair loss within months). A few companies are extremely close (Korean one I believe), one with the same results as finasteride. There was a Harvard study about Gas6 in 2021 that a lot of people are rooting for as well which would be a topical cream, contender for minox.

But maybe these things would cause a zombie apocalypse.

[Gatsby]

14 hours ago, Kraki77 said:

FIrst of all, I would like to openly say that I've already booked surgery with dr. Freitas for the end of next year. In my consultations with many elite surgeons it became evident that there are slight differences in the way they are recommending medical treatment. It would be nice to create some kind of database based upon your experiences also.

De Freitas - 0.5 mg Dutasteride (Monday and Friday), 1mg Finasteride (Tuesday,Wednesday, Thursday, Saturday, Sunday), 5mg oral minoxidil (every single day)

Pinto - 0.5 mg Dutasteride (from Monday to Friday), 5mg oral minoxidil (every single day)

Ferreira - 1 mg Finasteride (every single day) - insisted that it's more than enough for my case.

I'm interested to hear other comments and perhaps valid discussion about which approach makes more sense or what kind of arguments are out there to support that.

Personally I would go with the advise that your treating surgeon suggests. I don't believe that there is one universal treatment for everyone. Each surgeon will have enough feedback from there results over the years to know what works best from there own experience. That's if they are an excellent surgeon of course. No doubt the majority will give the same advice but some do vary but do so for good reason. All the best!

[Rahal Hair Transplant]

Kraki77,

Every doctor has their own opinions and will provide you with what they think are the best medical options based on their assessment of your case.

Personally (and keep in mind that this is my input not necessarily Dr. Rahal’s), I think it’s better to start with the recommended dose of finasteride and inky increase it if you feel it’s not working in 6 months to a year.

Greater amounts and/or more potent medication means a higher risk of side effects.  So unless you’ve already tried finasteride with minimal success, I would try that first before adding dutasteride into the mix.

Keep in mind that finasteride and dutasteride both work by minimizing the production of DHT (dihydrotestosterone) in the body.

DHT is the hormone responsible in carrying out the demolition work to the follicles as directed by genetics. Everyone has a genetic limit (genetic programming that dictates just how much hair will be lost). This is why not everyone with androgenetic alopecia advanced to a Norwood class 6 or 7.  

The difference between finasteride and dutasteride is that finasteride only blocks type II 5-alpha re-educates enzymes whereas dutasteride blocks both type I and II.  This enzyme assists in producing DHT when it is combined with testosterone in the body.  Thus, blocking both type I and II would further reduce the amount of DHT in the body and further minimize DHT’s attack on the hair follicles susceptible to it. But this also means a greater risk of more extreme side effects.

As for oral minoxidil, I just posted about this in another thread.  I’ll copy and paste it in a reply below just so you can read my thoughts on it.

Best Wishes,

Rahal Hair Transplant 

[Rahal Hair Transplant]

Kraki77,

I posted the below in another topic regarding my thoughts on oral vs topical minoxidil.  These are just my personal opinions not necessarily that of Dr. Rahal’s. So keep that in mind when you read it.

—-

In theory, yes oral minoxidil will work everywhere you have hair so it’s the equivalent of applying topical minoxidil to your entire scalp (and body for that matter - more on that below).  That said, and I’ve said this before but I’m not really convinced that oral minoxidil is really all that effective.

Don’t get me wrong, I’m not suggesting it’s not worth a try.  But the exact mechanism that makes minoxidil effective in regrowing hair is still unknown.  We know it’s a vasodilator and the fact that it can “stimulate hair regrowth” was accidentally discovered.

The question of how minoxidil stimulates hair growth still remains.  If in fact the solution must make contact with the follicle by absorbing into the skin then I can’t imagine oral minoxidil would be overly effective.

Moreover potential side effects include unwanted hair growth in areas the solution is accidentally applied to. That’s why individuals (especially women) are encouraged to wash their hands after application and are usually careful not to get it onto their face and other areas of the body.  

Taking minoxidil orally means that there is no application control.  For us to think it only works on miniaturizing hair that’s impacted by DHT would be a bit naive.  So if it works, it may also thicken facial and body hair since no specific hair follicles are being targeted by an applicator. This may be a benefit to some and a hindrance to others  

Of course, the above are just my thoughts and something to think about. I’m not trying to persuade anyone not to take it, I just think people should be aware that there are additional things to consider if they are looking into taking minoxidil orally.

Best wishes,

Rahal Hair Transplant 

Edited May 23, 2022 by Rahal Hair Transplant

[Etownone]

On 5/23/2022 at 8:37 AM, Rahal Hair Transplant said:

Kraki77,

I posted the below in another topic regarding my thoughts on oral vs topical minoxidil.  These are just my personal opinions not necessarily that of Dr. Rahal’s. So keep that in mind when you read it.

—-

In theory, yes oral minoxidil will work everywhere you have hair so it’s the equivalent of applying topical minoxidil to your entire scalp (and body for that matter - more on that below).  That said, and I’ve said this before but I’m not really convinced that oral minoxidil is really all that effective.

Don’t get me wrong, I’m not suggesting it’s not worth a try.  But the exact mechanism that makes minoxidil effective in regrowing hair is still unknown.  We know it’s a vasodilator and the fact that it can “stimulate hair regrowth” was accidentally discovered.

The question of how minoxidil stimulates hair growth still remains.  If in fact the solution must make contact with the follicle by absorbing into the skin then I can’t imagine oral minoxidil would be overly effective.

Moreover potential side effects include unwanted hair growth in areas the solution is accidentally applied to. That’s why individuals (especially women) are encouraged to wash their hands after application and are usually careful not to get it onto their face and other areas of the body.  

Taking minoxidil orally means that there is no application control.  For us to think it only works on miniaturizing hair that’s impacted by DHT would be a bit naive.  So if it works, it may also thicken facial and body hair since no specific hair follicles are being targeted by an applicator. This may be a benefit to some and a hindrance to others  

Of course, the above are just my thoughts and something to think about. I’m not trying to persuade anyone not to take it, I just think people should be aware that there are additional things to consider if they are looking into taking minoxidil orally.

Best wishes,

Rahal Hair Transplant 

I've switched over to oral minoxidil and have been in it for a little over 6 months..    I feel topical worked better for me.  I still have some shedding...     I was given a prescription of 10mgs of oral minoxidil a day.   (I know it seems high, but that is what Dr Mwamba prescribed) 

I'm thinking of doing 5 MG oral a day and go back to adding topical ....   

Want to help me out...  You Thoughts?

[Rahal Hair Transplant]

@Etownone,

If topical minoxidil was more effective and worked better for you, why did you switch to oral?  As I described above, I have my own personal doubts about the efficacy of oral minoxidil since the regrowth mechanism is largely unknown amd there’s no direct contact between oral minoxidil and the follicles.  By your own admission, topical minoxidil was more effective so why switch?

So if you want my honest opinion, instead of continuing down the path of using oral minoxidil, switch back to topical minoxidil. Of course, if there is some reason you can’t continue using it, let me know and maybe I can provide you with additional advice.

Best wishes,

Rahal Hair Transplant