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Advice re. topical finasteride


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Hi all, apologies if I’m posting this in the wrong place (or if it’s something that’s been posted loads of times before), and sorry for the long post, but I would really appreciate any advice or tips. FYI I’m 32 and located in the UK.

Long story short, I’ve had recurrent episodes of diffuse hair shedding since 2020, with the remission periods between them becoming shorter and shorter. I’ve been applying minoxidil consistently for the past six months and have used ketoconazole shampoo for a good few years, way before the shedding started. Blood tests have come back clear, apart from low vitamin D and borderline underactive thyroid, but these have been followed up with normal results. Two specialists have said that it’s likely chronic telogen effluvium, with no known cause. I agree with this because the shedding has also at times been from the back and sides of my head, as well as my facial hair.

But the most worrying part for me is they said chronic TE can accelerate androgenetic alopecia, if you were always genetically predisposed to it, which I think is what is now happening to me. My hair has gradually become thinner (which I think is to be expected with chronic TE), but the main issue is that I’m noticing a lot of the hairs that are falling out now are short and thin, which I understand is miniaturisation and representative of permanent hair loss. Also the first cm of my hairline suddenly looks really thin and see-through (there are some tiny hairs coming through, but I predict they’re going to fall out like the other new growth has).

In terms of the chronic TE, I’m not sure there’s a lot more I can do. But what I do want to try and do is not permanently lose any of the hair I’m shedding through AGA, which is why I’m considering topical finasteride. I appreciate even if it works, I could continue shedding that hair because of the TE, but at least I’d be keeping the follicle ‘alive’ for the periods of remission, as well as for if/when the condition might stop.

I’m going down the topical route as I, like many others, am worried about the potential side effects. I realise there can be some systemic absorption over time, even with topical application.

I was going to order a 60ml bottle of topical 0.05% finasteride + 5% minoxidil (without alcohol) from Hims, which they recommend applying twice a day. From my understanding, this can be excessive, so my plan is to mix this with a 60ml bottle of 5% minoxidil (again without alcohol) to make a 120ml bottle of 0.025% finasteride + 5% minoxidil (please someone let me know if it doesn’t work like that!).

What I’m unsure of is how often to apply it – I’ve read that the half-life is three days, so would it be best to start with one application every three days and see how that goes? Or two applications (on the same day) every three days? It’s so hard to judge, because I want to minimise the risk of side effects, but I also don’t want to waste time continuing to lose hair because the dosage is too low. I was also thinking I could initially prioritise application at my hairline, rather than the entire top of my scalp, as this is where the main loss seems to be at the moment, and see how that goes first?

I’m also planning to get blood tests done before I start any treatment, and to monitor this semi-regularly (pricey, but I’d rather be safe than sorry). The clinic I’ve found offers blood tests for: DHT, androstenedione, LH, oestradiol, testosterone, FSH, prolactin, free androgen index, and free testosterone (calc.). Do you think that covers most bases?

Again, sorry for this being so long, but I’d be grateful for any help. Needless to say, it’s been a really stressful experience…

I’m be happy to share progress and updates on here if that would be useful.

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12 hours ago, silo said:

What I’m unsure of is how often to apply it – I’ve read that the half-life is three days, so would it be best to start with one application every three days and see how that goes? Or two applications (on the same day) every three days? It’s so hard to judge, because I want to minimise the risk of side effects, but I also don’t want to waste time continuing to lose hair because the dosage is too low. I was also thinking I could initially prioritise application at my hairline, rather than the entire top of my scalp, as this is where the main loss seems to be at the moment, and see how that goes first?

Please apply it on your entire scalp and use it once everyday. The probability of side effects with topical finasteride are 0.01%. If you do feel the side effects then you can reduce the usage to once every two days. You can also share some pictures of your scalp for a detailed evaluation.

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it's alright man, i feel ya, i'm on the same thing probably and i'm younger than you. meds is still the best bet, you can try to use lower dose on the meds first, if youre using the minoxidil-finasteride mix, why not try using it less than reccomended? for example, you said per 3 days, meanwhile the days you're not applying that one, use normal minoxidil. finas "arrests" the hairloss, and minox "thickens" the existing hair. unless you are sensitive to minox as well, which is rarer compared to finas, i think you can apply it like that, and if you don't have any side effect and think that it's not effective enough, you can increase the frequency / dose.

i usually apply it 2x a day, once in the morning minox+finas topical, then once at night with normal minoxidil.
i'm stopping it at the moment though to prepare for HT

 

regarding blood test, it's good for you to have it. you record the test result, then after a month or maybe 3 months, you compare the blood test, that will be the difference pre - and post 3 month of meds use.

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Thanks @mafpe, that’s really helpful. Can I ask what concentration of finasteride you’re applying?

And did you see any results/side effects before you stopped?

Good luck with the ht!

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0.05%, that means 0.5mg per application. nowadays i'm doing half dose like the earlier post, but if you want to start, you can try 0.25 which means half ml (half the usual dose of minox), each day which should have minimal systemic exposure compared to the effect on DHT. theoritically 0.1 have very very low systemic absorption that you won't experience side effect, but the DHT effect is small compared to minimum 0.25mg daily.

to be honest, i didn't know if it affects me much because i was depressed at the time i started, but as far as sexual side effect one, i didn't notice any by the time i get out of my rut. i can't say it doesnt affect me however, there are times where i don't have the drive, but functionally speaking, i'm able to get it functioning when i want or need to. some also said that to those affected, some doesn't experience the side anymore after 3 months. although in my opinion you should lower the dose or stop if it is affecting you, unless you don't mind having sides over hairs.

thank you!

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Posted (edited)

Topical finasteride goes systematic and depending on concentration from studies can be anything from 70-30 percent dht serum reduction , and some people get sides with even a little disruption from the dht reduction due to their free t not making up for the reduction. I saw that there is a new one coming out that been mentioned here from dr hasson which he claims to hardly reduce dht serum but a few people who have tried this on the forum experienced side effects. I really don’t understand why people don’t get blood work prior to fin to see their hormonal profile which would shed light on why you get sides

Edited by sukh123
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11 hours ago, sukh123 said:

Topical finasteride goes systematic and depending on concentration from studies can be anything from 70-30 percent dht serum reduction , and some people get sides with even a little disruption from the dht reduction due to their free t not making up for the reduction. I saw that there is a new one coming out that been mentioned here from dr hasson which he claims to hardly reduce dht serum but a few people who have tried this on the forum experienced side effects. I really don’t understand why people don’t get blood work prior to fin to see their hormonal profile which would shed light on why you get sides

what should one look at in the hormonal profile in order to understand if he is prone to sides?

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Posted (edited)
5 hours ago, jakos said:

what should one look at in the hormonal profile in order to understand if he is prone to sides?

Testerone, free testerone, dht, estrogeon , LH and FSH. Fin alters all of these hormones so you want.A baseline of where your at before starting fin. If you have low free t to start with, chances are crushing your dht is going to mean your more likely to get sides.

Edited by sukh123
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  • 4 weeks later...

Thanks for the replies.

I had my pre-treatment blood tests done and everything was in normal range, apart from FSH, which was slightly low, and DHT which was high (3.23 nmol/L – normal range is 0.33 to 3.01).

I guess that explains the recent more permanent thinning then! Though I was expecting my testosterone levels and Free T to also be high if my DHT is, but they’re both fine – is that normal?

Anyway, going to start this week with 0.025% topical finasteride + minoxidil once every other day (minoxidil on its own outside of this) and see how I go. 

 

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1 hour ago, silo said:

Thanks for the replies.

I had my pre-treatment blood tests done and everything was in normal range, apart from FSH, which was slightly low, and DHT which was high (3.23 nmol/L – normal range is 0.33 to 3.01).

I guess that explains the recent more permanent thinning then! Though I was expecting my testosterone levels and Free T to also be high if my DHT is, but they’re both fine – is that normal?

Anyway, going to start this week with 0.025% topical finasteride + minoxidil once every other day (minoxidil on its own outside of this) and see how I go. 

 

Hi, I'm guessing your are from the UK like myself if you're using these ranges,  I had my bloodwork done prior to fin so I could get a baseline. MY dht was 3.7 which was really high like yourself, but testosterone was also really high like 33( ( range is 8-30) which makes sense since 10 percent roughly of testosterone is converted to DHT, and my free test was high too at 0.6 which given the range is (0.20-0.62) is very high, my estrogen was 118 which is also well within range. What was your testosterone and free t, as well as your oestradiol number, that would help make more of a judgement.  

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Posted (edited)

Yep, from the UK. My testosterone is 19.7, free T is 0.4, and oestradiol 96, so all well within the normal range. Not sure if it’s something that needs more investigation, but I also really want to start treatment asap because my hair’s thinning a lot now.

Are you still using fin? If so, at what dosage and for how long?

 

Edited by silo
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