Try oral + topical finasteride as a combo?

[alopie]

I have been on 1mg oral finasteride for 5 years. Last year I started having some testicular pain, and, after stopping for a month the discomfort went away.

Now I want to find the sweet spot. So I am thinking of doing the following:
 

0.25mg oral fin: every Monday, Wednesday and Friday

0.1% topical fin 1ml: every Tuesday, Thursday, Saturday and Sunday

 

Would that be more effective than 0.1% topical fin daily?

[Eli_Avdikian]

It would defintely be more effective than topical fin on its own. You'll have to monitor the side effects though.

[12345]

more than likely the sides will return.

[alopie]

13 hours ago, Eli_Avdikian said:

It would defintely be more effective than topical fin on its own. You'll have to monitor the side effects though.

Are we sure about it? 0.1% topical finasteride (1ml) means roughly 1mg of finasteride daily on the scalp. The net amount of finasteride is more with the topical solution. 

So are we saying that 0.25mg orally will be more effective than 0.1% 1ml topical?

 

9 hours ago, 12345 said:

more than likely the sides will return.

My urologist said it is very unlikely that finasteride is causing testicular pain, especially at the low dose of 1mg orally. He does not want me to use finasteride beyond 10 years as there are no solid studies about its effects. He is optimistic and says that the overall safety profile is good, but he would not want to risk it on me. (I saw high-grade prostate cancer, gyno and male breast cancer mentioned, that is due to the imbalance of estrogens to androgens in the long run) -- so topical is good

[12345]

3 hours ago, alopie said:

Are we sure about it? 0.1% topical finasteride (1ml) means roughly 1mg of finasteride daily on the scalp. The net amount of finasteride is more with the topical solution. 

So are we saying that 0.25mg orally will be more effective than 0.1% 1ml topical?

 

My urologist said it is very unlikely that finasteride is causing testicular pain, especially at the low dose of 1mg orally. He does not want me to use finasteride beyond 10 years as there are no solid studies about its effects. He is optimistic and says that the overall safety profile is good, but he would not want to risk it on me. (I saw high-grade prostate cancer, gyno and male breast cancer mentioned, that is due to the imbalance of estrogens to androgens in the long run) -- so topical is good

if your physician told you that finasteride does not cause testicular pain you need to see a better doctor. Just google it, and you will find that finasteride can cause testicular pain from mild in severe depending on the person. 

Listen if you want to keep the faith that you wont have sides on a reduced dosage 3 days week regimen compounded with topical fin in between, then i wish you all the best. 

[alopie]

9 minutes ago, 12345 said:

if your physician told you that finasteride does not cause testicular pain you need to see a better doctor. Just google it, and you will find that finasteride can cause testicular pain from mild in severe depending on the person. 

Listen if you want to keep the faith that you wont have sides on a reduced dosage 3 days week regimen compounded with topical fin in between, then i wish you all the best. 

I was on finasteride for 4.5 years, 1mg oral daily, no side effects. It is my assumption that testicular pain is now caused due to accumulation of finasteride in my system. But it is position dependent, and it might be irrelevant, it does not happen when I stand up, or walk. "Just google it" is by no means better than a professional urologist. I visited three urologists in the last year, they all prescribed urological tests, but no one reported in their practice the side effect of testicular pain, even when prescribing higher doses for bhp.
Are you using topical or oral?

[Eli_Avdikian]

11 hours ago, alopie said:

Are we sure about it? 0.1% topical finasteride (1ml) means roughly 1mg of finasteride daily on the scalp. The net amount of finasteride is more with the topical solution. 

So are we saying that 0.25mg orally will be more effective than 0.1% 1ml topical?

 

My urologist said it is very unlikely that finasteride is causing testicular pain, especially at the low dose of 1mg orally. He does not want me to use finasteride beyond 10 years as there are no solid studies about its effects. He is optimistic and says that the overall safety profile is good, but he would not want to risk it on me. (I saw high-grade prostate cancer, gyno and male breast cancer mentioned, that is due to the imbalance of estrogens to androgens in the long run) -- so topical is good

It's true that you are applying the equivalent of 1mg of finasteride topically on your scalp, but only roughly 20% of it is absorped in the dermis (depending on the vehicle and some other variables such as the size of the drug molecule). We already know this from topical minoxidil : when we apply 5% minox, it's not like 50g of the drug is absorbed by the scalp, but only a small portion of it.

[alopie]

23 hours ago, Eli_Avdikian said:

It's true that you are applying the equivalent of 1mg of finasteride topically on your scalp, but only roughly 20% of it is absorped in the dermis (depending on the vehicle and some other variables such as the size of the drug molecule). We already know this from topical minoxidil : when we apply 5% minox, it's not like 50g of the drug is absorbed by the scalp, but only a small portion of it.

if 20% of finasteride is absorbed, does that mean that using a 0.5% 1ml topically (translates to 5mg of oral finasteride), then 1mg would be absorbed and therefore equivalent to the oral version? That's probably why hims and others choose to go for 0.3% topical finasteride. The issue is that finasteride has a smaller molecular weight, so comparing it to minoxidil in terms of absorption may be incorrect, but this subject is interesting. Regardless, even if I get 0.2mg from it, it's still better than swallowing 0.2mg orally and metabolising it through the liver. It is difficult for me to evaluate the efficacy of topical finasteride since I am also using oral minoxidil 2mg daily, which on its own may postpone the process by decades. 

[Eli_Avdikian]

Yeah roughly speaking.  I agree with you that it's not very accurate to compare it to topical minox, but it was just to illutrate my idea.
0.1% topical fin, unlike lower versions such as 0.025 and 0.01%, largerly goes systemic and lowers serum DHT by about 50% (versus 61% which is the decrease induced by 0.2mg oral fin daily). So why all the hassle of daily topical application to the scalp if you get the same effect by swalloing a pill ? 

Edited January 9 by Eli_Avdikian

[alopie]

11 hours ago, Eli_Avdikian said:

Yeah roughly speaking.  I agree with you that it's not very accurate to compare it to topical minox, but it was just to illutrate my idea.
0.1% topical fin, unlike lower versions such as 0.025 and 0.01%, largerly goes systemic and lowers serum DHT by about 50% (versus 61% which is the decrease induced by 0.2mg oral fin daily). So why all the hassle of daily topical application to the scalp if you get the same effect by swalloing a pill ? 

Honestly, if someone could guarantee that 0.2mg oral fin lowers dht by 61% vs only 50% for 0.1% topical, I would definitely go for the oral version

[Eli_Avdikian]

21 hours ago, alopie said:

if 20% of finasteride is absorbed, does that mean that using a 0.5% 1ml topically (translates to 5mg of oral finasteride), then 1mg would be absorbed and therefore equivalent to the oral version? That's probably why hims and others choose to go for 0.3% topical finasteride. The issue is that finasteride has a smaller molecular weight, so comparing it to minoxidil in terms of absorption may be incorrect, but this subject is interesting. Regardless, even if I get 0.2mg from it, it's still better than swallowing 0.2mg orally and metabolising it through the liver. It is difficult for me to evaluate the efficacy of topical finasteride since I am also using oral minoxidil 2mg daily, which on its own may postpone the process by decades. 

 

8 hours ago, alopie said:

Honestly, if someone could guarantee that 0.2mg oral fin lowers dht by 61% vs only 50% for 0.1% topical, I would definitely go for the oral version

The first graph shows that the 0.2 mg oral dose inhibits dht by 61% on average, while the second graph shows that 0.1% daily of topical finasteride inhibits serum dht by almost 55%

[alopie]

On 1/10/2024 at 9:11 PM, Eli_Avdikian said:

 

The first graph shows that the 0.2 mg oral dose inhibits dht by 61% on average, while the second graph shows that 0.1% daily of topical finasteride inhibits serum dht by almost 55%

That's great, thanks for your time! Do you have the sources of those papers? It looks like a 0.2% concentration would outperform or be equivalent to 1mg orally. Could that be true?

[Eli_Avdikian]

Roberts et al (1999

1 hour ago, alopie said:

That's great, thanks for your time! Do you have the sources of those papers? It looks like a 0.2% concentration would outperform or be equivalent to 1mg orally. Could that be true?

The first graph I believe comes from the Robert et al study (1999), though I'm not sure. The second one is compiled by Rob English of perfect hair health.com. Just type "finasteride DHT inhibition curve" on google, and you'll see a bunch of studies and graphs.