How to determine if Finasteride is working, or causing issues?

[Peladophobia]

I'm a 53 yo male. I have been taking Finasteride, 1mg orally daily, Since April 2018. 
At the time I began, I had a bald spot on the top back of my head that seemed to be getting larger. If you pinch above my scalp at the bald spot, there is hair, but not thick enough to notice visually in the mirror. I attempted to keep a photographic record of my hair thickness since then, but it seems anecdotal because of variation in how long my hair was at the time of each set of pictures. Right now, the top middle-section appears thinner to me than it did in 2018, but the bald spot itself is close to the same size. In short, it has been four years, and my hair is definitely not thickening.

For six months or so in 2020, I tried a 1.5mm micro needle roller regimen on my bald spot without a topical other than lidocaine, with no noticeable hair growth. (Perhaps a few thin hairs that don't help visually.) It might be worth mentioning that I have been dying my hair for over a decade, perhaps 20 times a year, since I doubt that is helping the hair loss. 

A few days ago, I began reading through this forum, and it is a hypochondriac's dream/nightmare regarding how many people report Finasteride side effects and nocebo effects. People mentioned testicular pain close to the time they started taking it... well, I had a vasectomy that same month, so I wasn't blaming that sort of thing on the pills. I had also started taking viagra / cialis within the year before, so I'm not blaming anything there on the pills, although that dosage seems to be increasing. I became inactive and lost muscle tone- first due to a motorcycle accident, then the pandemic. My social behavior reduced, which resulted in mild depression-like symptoms. I can account for why all of these things took place without pointing to the pill, but I have no way to know if the pills could be contributing to anything.

Before I started taking the pills, my doctor advised me that if I decide to stop taking the pills, there is a strong possibility that allowing my hormones to return to normal will cause rapid shedding of all the hair that the pills managed to help retain. I took that as a lifelong decision. This lifelong decision thing is also the reason I never tried minoxidil. Who wants to be dedicated to that regimen for the rest of their life, not knowing if it will even thicken their hair? (I'm sure many made that decision with good results.

I'm already at the point where I am considering doing a medical tourism trip for FUE, which is why I sought out this forum. My girlfriend is "supportive" because she will take any excuse for a vacation. She has gone the extra mile by pointing out how much thicker my hair is in my old pictures.

Now I have questions, and I am faced with new decisions.

I'm very interested in finding out which blood tests can detect issues that Finasteride could be causing. One person here reported their prolactin being extremely high, and I don't even see that in any of the blood panels I have done.
I'm also curious if the 1 mg daily dose helps to protect from the prostate from enlarging.

Does it make sense to keep taking the Finasteride for the rest of my life, not knowing if it is negatively impacting my health or lifestyle?
Should I discontinue it, wait a few months to allow the potential shedding to take place, then do the FUE trip? 




 

[LookMaxx]

I always say nobody does finasteride for life, it’s just not a feasible plan. You can only take for a few years.

If you aren’t experiencing any sides then there’s nothing wrong. Simple as that. Don’t read more into it. At your age, fin might be helping with prostate but if you don’t have prostate enlargement then no reason to take it. 

I would advise stopping finasteride and getting a hair transplant especially at your age. For the simple reason that drugs suck and when you can have alternative drug free life, go for it. At your age your Norwood level must be apparent now and hairloss slowed or stabilised for the most part.

 

[Gatsby]

If I can speak plainly, I wouldn’t go ahead with a hair transplant. If part of the reason is to keep your girlfriend happy with a holiday then you would be having surgery for all the wrong reasons. If you are not experiencing clinical depression, gymomastia, sexual dysfunction, etc then Finasteride may not be the cause of any of the issues that you have gone through (especially after being on the drug for over four years). I could be wrong. I would speak to your dermatologist and I wish you all the best.