Need help to evaluate side effects

[Viper1991]

Hello All,

I have had an FUE around 1.5 years back. Growth is good. Not many complaints regarding the HT, other than few doubles here and there in my HairLine. I have gone through a dark phase for the last 8 months, when few people pointed my hairline HT, and since then i have become a slave to my mind and went through all kinds of negative loops and since 2-3 months, i have been doing much better. Been doing cardio, dancing, yoga, and trying to be positive most of the time, and learning to accept it and live with it. Came off finasteride after taking for 6 months straight. Even now i do have mood swings on and off, which i am able to manage. I am on topical minoxidil plus finasteride solution which i use Monday, Tuesday, and Friday, and other days i use plain minoxidil. The finasteride content in it is 0.1% percent. So it is totally 0.3 MG per week. My doctor has suggested that i be completely off on Saturday and Sunday, to keep tolerance in check. So the medication is only Monday to Friday. 
Wanted to understand from you guys, on how to evaluate if i am getting any of the side effects with the topical solutions that i am using? How do i understand if my libido is low? I dont get morning wood though. Its been a long time, close to an year since i got morning wood. May be this is also because of the stress that i take around all of this, along with my work. 

Shall i go for any lab tests to check my condition?
Should i switch to plain minoxidil, and stick to keto shampoo and multivitamins or should i still stick with Topical MInFin Solution? Current condition shown in the photos below.

 

@Melvin- Moderator  @ciaus @Gatsby @Eugenix Hair Sciences @gillenator @NARMAK @Eugenix Hair Sciences @DrTBarghouthi @pkipling @folicallychallenged

@asterix0 @Berba11

 

Edited June 22, 2022 by Viper1991

[GaryStruthers]

Can we see a picture of your hairline? The one on display just shows a good head of hair. I would like to see the issue with “pluggy” etc. 

[Viper1991]

11 minutes ago, GaryStruthers said:

Can we see a picture of your hairline? The one on display just shows a good head of hair. I would like to see the issue with “pluggy” etc. 

 

[GaryStruthers]

Cool! Thanks for those images. Are you able to share which clinic you went to? This seems like many cases where the patient just needs a second surgery. But, there are also many cases where a single surgery produces a higher density as to what you have received. I look forward to hearing more about your procedure. 

[Viper1991]

13 minutes ago, GaryStruthers said:

Cool! Thanks for those images. Are you able to share which clinic you went to? This seems like many cases where the patient just needs a second surgery. But, there are also many cases where a single surgery produces a higher density as to what you have received. I look forward to hearing more about your procedure. 

I am learning to live with it. It does not look all that bad when i wear a comb down hair style with longer hair.

Edited June 21, 2022 by Viper1991

[GaryStruthers]

Yeah, your hair is of great quality! But you should be able to wear it the way you want (outside of standard transplant limitations) I’m interested to hear from others about your case. I’m assuming it wasn’t at a top notch clinic? Also, do you have any pre surgery pictures? Would love to get an idea as to where your hairline sat. 

[Gatsby]

How old are you can I ask? You actually don't really look to me by those photos that you are suffering from MPB. It appears that you had your hairline lowered. How many grafts did you have transplanted and who did the surgery? If you can get away with styling your hair forward you look fine. It really depends upon how much this interferes with your mental health. You can have the doubles removed by a surgeon to repair the hairline. As to medication I would leave this to your doctor. However personally I would just stick with 5% topical minoxidil daily and finasteride 1mg a day (max). From what you have described I would cease the finsteride with your doctor and see how your sex drive/mood responds once the drug is out of your system. All the best!

[Viper1991]

34 minutes ago, Gatsby said:

How old are you can I ask? You actually don't really look to me by those photos that you are suffering from MPB. It appears that you had your hairline lowered. How many grafts did you have transplanted and who did the surgery? If you can get away with styling your hair forward you look fine. It really depends upon how much this interferes with your mental health. You can have the doubles removed by a surgeon to repair the hairline. As to medication I would leave this to your doctor. However personally I would just stick with 5% topical minoxidil daily and finasteride 1mg a day (max). From what you have described I would cease the finsteride with your doctor and see how your sex drive/mood responds once the drug is out of your system. All the best!

I am 30 Years Old. The photos after being on meds on 1.5 years. First six months 1 mg finasteride, and post that it has been topical MinFin solution. I had got it done from a below par clinic in India, around 1500 grafts. Not sure, if i would ever be happy with repair/additional work. I am slowly learning to live with it, and it is working for me. Current medication, only Topical MinFin alternate days, and Plain Minoxidil 5% rest of the days. Even with topical solutions, i am worried about my morning erections as to why they are happening. I do get turned on by looking at few chicks on the street these days though.

Should i also stop the topical finasteride the alternate days as well to see if my morning wood improves? 
This is the picture from pre-surgery. @Gatsby

 

Edited June 22, 2022 by Viper1991

[Gatsby]

Ok this gives a better indication of your situation. If it were me, I would cease finasteride (topical or otherwise) and see how my libido responds. It could take a month or more but I wouldn't worry. It will still be working in your scalp DHT receptors for at least a month. Stick with the minoxidil (again topical or otherwise). You want to isolate what one drug is doing otherwise you won't know what is doing what. I have done this myself twice and I found between two to four weeks my libido rebounded back to normal both times. Wishing you all the best @Viper1991.

[ciaus]

Sounds like you've been on a stress rollercoaster in recent years, probably in the lead up to getting the hair transplant as well like alot of us. And you're turning 30, which is still relatively young, but you're no longer the indestructible teenager/20something so you need to start paying closer attention to that as well. Its good that you are focusing on exercise and other activities that help to focus and calm your mind. Don't forget about having a good diet and getting good sleep, very important as well. And I wouldn't put much worry or effort into morning wood, as long as it works good for the main events is what matters.

Assuming you have no lifestyle issues or side effect-like symptoms because you are afraid of getting the actual side effects, there is blood work that you can do to make sure your overall health is optimized in terms of being able to take DHT blocker medication like finasteride. There's a company in the USA called Marek Health that offers testing services for stuff like this. I can't post the direct link here on the forum, but you can google their name. I'm pasting the test packages below for general reference, even if you don't go to them your doctor can order them for you. Perhaps something will be identified in the testing that can be addressed so that you'll be able to handle finasteride.

Finasteride is the foundation for non-hair transplant ways of addressing hair loss. If you can't take it, there's not much benefit to the other treatments. Keto shampoo doesn't hurt but also doesn't help much. Same with vitamins, better to just eat nutritious food. Minoxidil long term without finasteride is going to be less valuable, it will just make your vulnerable hair look better until the DHT completely finishes it off. 

 

BASIC HAIR PANEL
$450.00 
Basic Pre-Finasteride Panel Includes:

Total & Free Testosterone (LC/MS-MS) (Equilibrium Ultrafiltration)
Estradiol, Total and Free (MS)
DHT (High-pressure liquid chromatography (HPLC) with tandem mass spectrometry) & Free DHT (Equilibrium dialysis, high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS)
Sex Hormone-Binding Globulin (SHBG)

 

COMPREHENSIVE MALE HAIR PANEL
$700.00 
Total & Free Testosterone (LC/MS-MS)(Equilibrium Ultrafiltration)
Estradiol Sensitive (LC/MS-MS)
Total & Free DHT (Equilibrium dialysis, high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS)
Sex Hormone-Binding Globulin (SHBG)
Progesterone
Prolactin
Prostate Specific Antigen (PSA)
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Thyroid Peroxidase (TPO) Ab
Dehydroepiandrosterone Sulfate (DHEA-S)
Pregnenolone
Cortisol
Lipid Panel – LDL, HDL, Triglycerides, Total Cholesterol, Ratio hdl/ldl
Apolipoprotein B
IGF-1
CBC with differential
Comprehensive Metabolic Panel (14)
Vit D, 25 Hydroxy
Iron serum + TIBC
Ferritin
HBa1c
TSH, Free T4
Free T3
Reverse T3
Lipoprotein (a)
Insulin
Magnesium
C-Reactive Protein, Cardiac
γ-Glutamyl Transferase (GGT)
Urinalysis, Routine

 

 

COMPREHENSIVE THYROID PANEL
$300.00 
TSH + FT4
Thiiodothyronine (T3), Free
T3 Uptake
Thyroid Peroxidase (TPO) Ab
TgAb + Thyroglobulin, IMA or LCMS
Reverse T3
Iron and TIBC
Ferritin
Vitamin B12
Vitamin D
, 25-Hydroxy
Cortisol
Magnesium
γ-Glutamyl Transferase (GGT)
Thyroxine Binding Globulin (TBG)
Venipuncture

[asterix0]

The only way you can test this is have a control group of sugar pills and finasteride pills, and do it blindly. Take each for some months and then you'll probably have your answer.

I can't speak for finasteride side effects as I've taken it for 5 years+ without side effects.

[Viper1991]

16 hours ago, ciaus said:

Sounds like you've been on a stress rollercoaster in recent years, probably in the lead up to getting the hair transplant as well like alot of us. And you're turning 30, which is still relatively young, but you're no longer the indestructible teenager/20something so you need to start paying closer attention to that as well. Its good that you are focusing on exercise and other activities that help to focus and calm your mind. Don't forget about having a good diet and getting good sleep, very important as well. And I wouldn't put much worry or effort into morning wood, as long as it works good for the main events is what matters.

Assuming you have no lifestyle issues or side effect-like symptoms because you are afraid of getting the actual side effects, there is blood work that you can do to make sure your overall health is optimized in terms of being able to take DHT blocker medication like finasteride. There's a company in the USA called Marek Health that offers testing services for stuff like this. I can't post the direct link here on the forum, but you can google their name. I'm pasting the test packages below for general reference, even if you don't go to them your doctor can order them for you. Perhaps something will be identified in the testing that can be addressed so that you'll be able to handle finasteride.

Finasteride is the foundation for non-hair transplant ways of addressing hair loss. If you can't take it, there's not much benefit to the other treatments. Keto shampoo doesn't hurt but also doesn't help much. Same with vitamins, better to just eat nutritious food. Minoxidil long term without finasteride is going to be less valuable, it will just make your vulnerable hair look better until the DHT completely finishes it off. 

 

BASIC HAIR PANEL
$450.00 
Basic Pre-Finasteride Panel Includes:

Total & Free Testosterone (LC/MS-MS) (Equilibrium Ultrafiltration)
Estradiol, Total and Free (MS)
DHT (High-pressure liquid chromatography (HPLC) with tandem mass spectrometry) & Free DHT (Equilibrium dialysis, high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS)
Sex Hormone-Binding Globulin (SHBG)

 

COMPREHENSIVE MALE HAIR PANEL
$700.00 
Total & Free Testosterone (LC/MS-MS)(Equilibrium Ultrafiltration)
Estradiol Sensitive (LC/MS-MS)
Total & Free DHT (Equilibrium dialysis, high-performance liquid chromatography/tandem mass spectrometry (HPLC/MS-MS)
Sex Hormone-Binding Globulin (SHBG)
Progesterone
Prolactin
Prostate Specific Antigen (PSA)
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Thyroid Peroxidase (TPO) Ab
Dehydroepiandrosterone Sulfate (DHEA-S)
Pregnenolone
Cortisol
Lipid Panel – LDL, HDL, Triglycerides, Total Cholesterol, Ratio hdl/ldl
Apolipoprotein B
IGF-1
CBC with differential
Comprehensive Metabolic Panel (14)
Vit D, 25 Hydroxy
Iron serum + TIBC
Ferritin
HBa1c
TSH, Free T4
Free T3
Reverse T3
Lipoprotein (a)
Insulin
Magnesium
C-Reactive Protein, Cardiac
γ-Glutamyl Transferase (GGT)
Urinalysis, Routine

 

 

COMPREHENSIVE THYROID PANEL
$300.00 
TSH + FT4
Thiiodothyronine (T3), Free
T3 Uptake
Thyroid Peroxidase (TPO) Ab
TgAb + Thyroglobulin, IMA or LCMS
Reverse T3
Iron and TIBC
Ferritin
Vitamin B12
Vitamin D
, 25-Hydroxy
Cortisol
Magnesium
γ-Glutamyl Transferase (GGT)
Thyroxine Binding Globulin (TBG)
Venipuncture

Thanks for such detailed response. What exactly do you mean by saying? "but you're no longer the indestructible teenager/20something so you need to start paying closer attention to that as well. ". Did not really understand the context. Regarding the tests, are these all different tests. I am from India. Not sure, if these will be available. Shall i go to my dermatologist and ask to order for all of the above tests. @ciaus

 

Edited June 23, 2022 by Viper1991

[Viper1991]

20 hours ago, Gatsby said:

Ok this gives a better indication of your situation. If it were me, I would cease finasteride (topical or otherwise) and see how my libido responds. It could take a month or more but I wouldn't worry. It will still be working in your scalp DHT receptors for at least a month. Stick with the minoxidil (again topical or otherwise). You want to isolate what one drug is doing otherwise you won't know what is doing what. I have done this myself twice and I found between two to four weeks my libido rebounded back to normal both times. Wishing you all the best @Viper1991.

Thanks @Gatsby. Will start with slowly tapering down the topical finasteride, before cutting it down completely (May be from thrice a week, to first twice a week). Just worried, if it makes a lot of difference and i might thin a lot, at this time, i am looking to get married, and dont want to experiment and screw up things.

[Gatsby]

8 minutes ago, Viper1991 said:

Thanks @Gatsby. Will start with slowly tapering down the topical finasteride, before cutting it down completely (May be from thrice a week, to first twice a week). Just worried, if it makes a lot of difference and i might thin a lot, at this time, i am looking to get married, and dont want to experiment and screw up things.

Once you establish your normal baseline libido (even though it varies at different times) you could always titrate up to a low does. Building up to 0.5mg three times a week is still effective for many. This is what I think I will do in the future again but I will stay at this dose this time and wait to see if side effects do not emerge. All the best!

[ciaus]

6 hours ago, Viper1991 said:

Thanks for such detailed response. What exactly do you mean by saying? "but you're no longer the indestructible teenager/20something so you need to start paying closer attention to that as well. ". Did not really understand the context. Regarding the tests, are these all different tests. I am from India. Not sure, if these will be available. Shall i go to my dermatologist and ask to order for all of the above tests. @ciaus

 

I was just referring to getting older in general, because the older we get the more likely we are to have health issues and performance decline with our bodies. Regarding those lists of tests, its broken down into three 'packages' of tests and there is some overlap. I wouldn't worry about getting tested for everything on that list, just maybe print that post out on a sheet of paper and go over it with your doctor about the best ones. -And I wouldn't go to a dermatologist for recommendations on those tests, you want to go to a doctor that has training and experience with hormones (like an endocrinologist) and general health, not just skin and hair that dermatology covers.

[gillenator]

6 hours ago, Gatsby said:

Once you establish your normal baseline libido (even though it varies at different times) you could always titrate up to a low does. Building up to 0.5mg three times a week is still effective for many. This is what I think I will do in the future again but I will stay at this dose this time and wait to see if side effects do not emerge. All the best!

I have been on this same low dose finasteride regimen for a number of years now and it has worked well with no side-effects.