Losing Ground on Oral Minoxidil and Oral Dutasteride. What next?

[jim1973]

As the title states, I'm on oral Min (5mg/day) and oral Dut (.5mg/day) since May 2023 and am still losing ground.  Hair continues miniaturize, fall out, and becomes noticeably thinner as the weeks/months pass.  My hair got thicker initially on both products but after a year, continues to fall out.  Although I have no side effects, I'm not seeing any positive results so I'm considering any of the following (below) but would love to get valuable input before I make any changes.  Should I switch to any of the following? 

• Oral brand name Propecia (brand Dut too expensive) 6 days/week, continue oral Minoxidil 5mg, continue oral Dut 1 day/week?
• Topical Finasteride (with Tretinoin), continue oral Minoxidil 5mg, add micro-needling?
• Topical Finasteride (with Tretinoin), switch to topical Minoxidil (either combined with Hims/Keeps, or separate with Rogaine), add micro-needling?
• Low dose oral Finasteride, low dose oral Minoxidil (mornings) AND low dose topical Finasteride and low dose topical Minoxidil (evenings)?
• Stop oral versions of everything and begin Dutasteride Mesotherapy injections along with topical Minoxidil?

History….From 2013-2020, I was on generic oral Fin (1mg/day) and topical Min (5% foam once/day), which really helped me stabilize my hair.  I had  decrease in libido during that time but it was manageable so I pushed through.  I lost my frontal hair at age 18 so haven't had a hairline in over 25 years but everything else remained relatively thick.  End of 2020, after a bout with Covid, I began to lose ground quickly with no other changes to diet, medication, exercise, etc. I continued Fin/Min until late 2022 when I switched to my current protocol as the hair loss never stopped.  Ironically I felt my libido come back on generic Dutasteride.  I get my bloodwork done every 6 months and have shored up any gaps and everything in normal range.  My DHT is low at only 7. 

So as my post states, I'm considering to switching to either brand name oral Propecia (oral) or topical formulation (For Minoxidil, I could also do oral or topical).  Have you heard of someone not responding to oral Finasteride but responding well to topical?  Is it possible that although my serum DHT is really low, that my scalp DHT isn't responding to the oral products?  I really don't want to initiate a shed unless I feel its going to only return (currently hair "sheds" but hasn'tt returned for 1 year and counting).  Or should I simply go back to brand name Propecia to have best chance of maintaining existing hair?  I'd love any input, thank you.

[jjsrader]

Genetics are a bad bad bitch.  Avodart (brand-name dut) daily should be used for your donor hair to stay healthy if you wanna do hair restoration in the future.  Get better insurance or pay up.

Could maybe titrate up to 10mg of oral minox per day (5mg in the a.m. - 5mg in the p.m.).

If genetics are strongly against you - you'll still lose all your hair - just slower - but your donor will be stronger as you age.

You're balding now & as you've written - sometimes it just keeps getting worse regardless. 

Cheers! 

 

Edited June 6 by jjsrader

[Al - Moderator]

You've been on meds for 11 years. When you have aggressive hair loss it may not be possible to stop the progression forever. This happened to me. I was on finasteride for 11 years. The first few years it seemed to be helping and I maybe gaining a bit. The next few years I was probably stable, not gaining, but not losing. The last few years I was definitely losing hair again. While you may be able to tweak a few of the meds to stop losing hair for a little while longer, it may be inevitable that you will eventually lose more hair. For me personally I stopped finasteride because it was thinning my body hair which I needed for further transplants, but you may want to keep using whatever meds you are on if you want to keep your donor area thick. It will probably continue working for that area since hair loss is much less aggressive there.

 

[SWoodberry]

What did you end up doing? 

I'm dealing with a similar issue when it comes to losing ground with oral min / dut...

[jim1973]

3 hours ago, SWoodberry said:

What did you end up doing? 

I'm dealing with a similar issue when it comes to losing ground with oral min / dut...

Haven't made any changes yet.  Still staying course.  But I'm considering adding in a topical treatment of low dose Min and Fin/Dut, while also adding microneedling.  

[jim1973]

On 6/6/2024 at 7:29 AM, Al - Moderator said:

You've been on meds for 11 years. When you have aggressive hair loss it may not be possible to stop the progression forever. This happened to me. I was on finasteride for 11 years. The first few years it seemed to be helping and I maybe gaining a bit. The next few years I was probably stable, not gaining, but not losing. The last few years I was definitely losing hair again. While you may be able to tweak a few of the meds to stop losing hair for a little while longer, it may be inevitable that you will eventually lose more hair. For me personally I stopped finasteride because it was thinning my body hair which I needed for further transplants, but you may want to keep using whatever meds you are on if you want to keep your donor area thick. It will probably continue working for that area since hair loss is much less aggressive there.

 

Interesting that your body hair thinned on Fin (mine did also).  But when I started Dut and oral Min, body hair grew twice as much and thicker.  Unfortunately not on scalp though.

[SWoodberry]

Did a doctor put together this plan for you?

I was on oral fin and topical min for a few years through Keeps and it helped grow some back on my crown but didn't stop my hairline so I contacted a HT surgeon and he suggested switching to oral dut and oral min...

Been on it for a year now and i have never lost so much hair in my life (i started losing it over 20 years ago)

 

[jim1973]

7 hours ago, SWoodberry said:

Did a doctor put together this plan for you?

I was on oral fin and topical min for a few years through Keeps and it helped grow some back on my crown but didn't stop my hairline so I contacted a HT surgeon and he suggested switching to oral dut and oral min...

Been on it for a year now and i have never lost so much hair in my life (i started losing it over 20 years ago)

 

Yea, I started losing over 20 years ago also.  I feel I'm losing faster on oral Min and oral Dut (prescribed by my derm), than I did on topical Min and oral Fin.  It just isn't stabilizing whatsoever.  Weird thing is that my body hair is thicker on this stack and I have no sides with Dut.  When I was on Fin from '13-'20, I had mild sides but it stabilized for roughly 7 years before I started losing again (which is why I switched to this current stack).  I might be a better responder to Fin than Dut (idk). I'm actually considering going to begin a topical treatment (low dose fin, min, and tretinoin) and just add to what I'm already doing.  My derm said he'll prescribe it if I want.  

[SWoodberry]

I am without a doubt losing faster on oral Min and oral Dut than I did on topical Min and oral Fin. 

Not only is it not stabilizing whatsoever, but I've lost more hair on this med stack in the past year than I have in any other year in the past 20. It's almost as if it's accelerating my hair loss.

I'm no doctor, but that makes zero sense to me...

What does your derm have to say about your experience? 

 

[Dragonsphere]

Have you had your DHT levels tested? 

[jim1973]

9 hours ago, SWoodberry said:

I am without a doubt losing faster on oral Min and oral Dut than I did on topical Min and oral Fin. 

Not only is it not stabilizing whatsoever, but I've lost more hair on this med stack in the past year than I have in any other year in the past 20. It's almost as if it's accelerating my hair loss.

I'm no doctor, but that makes zero sense to me...

What does your derm have to say about your experience? 

 

My derm is open to anything I want to try but says my current stack is the best possible stack.  He says my genes are stronger than the meds.  He is willing to up my dosages if I want but I'm not sure.  

[jim1973]

8 hours ago, Dragonsphere said:

Have you had your DHT levels tested? 

My serum DHT is low, below normal. 

[mustang]

17a-estradiol or CB or both 

[SWoodberry]

My doc upped the dut from .5 mg to 1 mg daily about a month ago so it's likely too early to tell, but doesn't seem to be making any difference

He also mentioned upping it to 2.5 mg which is a road I'm not sure I want to go down...

5 pills a day for the rest of my life seems excessive, and that's before taking into consideration the increased risk of sides

[mustang]

DHT is not your problem 

[jim1973]

On 7/18/2024 at 7:19 AM, mustang said:

17a-estradiol or CB or both 

@mustang If after using both oral Dutasteride (.5mg), oral Minoxidil (5mg), and Keto shampoo for over a year (without sides) but is still losing alot of hair and having miniaturization, both visibly and under microscope, how does one know if they should 1.) increase dose of Dut, 2.) add a topical anti-androgen such as Pyralutamide, 3.) a form of Estrogen/Estradiol?  Could these symptoms be related to reflex hyper androgenicity and if so, what should one do?  

In reading various threads and watching various videos, there are various terms that I don't understand such as 1.) high or low androgen activity in scalp, 2.) aromatase, 3.) whether increase in scalp testosterone could be an issue for a small group of individuals, etc.. I'd like to do something in addition to what I'm doing now but don't want to exacerbate the situation. Any input is appreciated.

[mustang]

5 hours ago, jim1973 said:

@mustang If after using both oral Dutasteride (.5mg), oral Minoxidil (5mg), and Keto shampoo for over a year (without sides) but is still losing alot of hair and having miniaturization, both visibly and under microscope, how does one know if they should 1.) increase dose of Dut, 2.) add a topical anti-androgen such as Pyralutamide, 3.) a form of Estrogen/Estradiol?  Could these symptoms be related to reflex hyper androgenicity and if so, what should one do?  

In reading various threads and watching various videos, there are various terms that I don't understand such as 1.) high or low androgen activity in scalp, 2.) aromatase, 3.) whether increase in scalp testosterone could be an issue for a small group of individuals, etc.. I'd like to do something in addition to what I'm doing now but don't want to exacerbate the situation. Any input is appreciated.

It's called androgenic alopecia, not DHT alopecia. That means Estradiol, Testosterone and other androgens cause minituarization as well.

Don't increase your DUT dose. You are already inhibitting 90% of your DHT. It's scalp free testoserone causing further hair loss

You either aromatize it with 17a-Estradiol or block the receptor with CB0301 or RU or add both.

[jim1973]

18 hours ago, mustang said:

It's called androgenic alopecia, not DHT alopecia. That means Estradiol, Testosterone and other androgens cause minituarization as well.

Don't increase your DUT dose. You are already inhibitting 90% of your DHT. It's scalp free testoserone causing further hair loss

You either aromatize it with 17a-Estradiol or block the receptor with CB0301 or RU or add both.

Thanks man, appreciate the additional feedback.  As for 17a-Estradiol/Alfatradiol, I thought that just was another 5α-reductase inhibitor (similar to Fin/Dut), but just a weaker version. Am I incorrect?  

I know the topical anti androgens are not regulated yet.  I've seen some really good results on RU but also some scary stuff with it also.  If I go that route, I'd likely choose between Pyrilutamide or CB0301 in that instance. 

[mustang]

14 hours ago, jim1973 said:

Thanks man, appreciate the additional feedback.  As for 17a-Estradiol/Alfatradiol, I thought that just was another 5α-reductase inhibitor (similar to Fin/Dut), but just a weaker version. Am I incorrect?  

I know the topical anti androgens are not regulated yet.  I've seen some really good results on RU but also some scary stuff with it also.  If I go that route, I'd likely choose between Pyrilutamide or CB0301 in that instance. 

17a-Estradiol aromatizes your scalp free testosterone into a weak form of Estradiol. (Not feminizing and no shutdown). It has virtually no side effects.

Whatever scalp testosterone that is not being reduced to DHT is likely causing androgenic miniaturization. This is why Dutasteride affects many peoples hairlines were Testosterone has a greater impact than DHT (compared to the crown).

Alfatradiol does inhibit DHT but not by blocking 5AR, it aromatizes test into estradiol, so whatever Finasteride or Dutasteride leave behind.

CB0301 blocks the recepetor with a binding afinitty strong enough to compete with Testosterone, not DHT.

The ideal combo for people losing ground with Fin or Dut is

Liposomal Finasteride 0.1% or Dutasteride 0.05% with Alfatradiol 0.025%

or

Liposomal Finasteride 0.1% or Dutasteride 0.05% with Alfatradiol 0.025% and CB0301 1%-2.5%

 

 

[Dragonsphere]

On 6/6/2024 at 3:29 PM, Al - Moderator said:

You've been on meds for 11 years. When you have aggressive hair loss it may not be possible to stop the progression forever. This happened to me. I was on finasteride for 11 years. The first few years it seemed to be helping and I maybe gaining a bit. The next few years I was probably stable, not gaining, but not losing. The last few years I was definitely losing hair again. While you may be able to tweak a few of the meds to stop losing hair for a little while longer, it may be inevitable that you will eventually lose more hair. For me personally I stopped finasteride because it was thinning my body hair which I needed for further transplants, but you may want to keep using whatever meds you are on if you want to keep your donor area thick. It will probably continue working for that area since hair loss is much less aggressive there.

 

Castration stops hair loss indefinitely. 

No androgens = no hairloss. 

If one could get their follicular androgen level on par with a castrate, hair loss would not progress. 

On 7/18/2024 at 5:17 AM, jim1973 said:

My serum DHT is low, below normal. 

How is your scalp health? Do you have a large degree of sebum or inflammation. 

Have you recently relocated,  internationally or nationally? 

[jim1973]

23 minutes ago, Dragonsphere said:

Castration stops hair loss indefinitely. 

No androgens = no hairloss. 

If one could get their follicular androgen level on par with a castrate, hair loss would not progress. 

How is your scalp health? Do you have a large degree of sebum or inflammation. 

Have you recently relocated,  internationally or nationally? 

Scalp health is good, no dandruff, no flaking.  Nothing visible in hair but forehead has been very oily for many years (since began balding). Derm has confirmed no issues in scalp though.  I have not relocated.

[Dragonsphere]

19 hours ago, jim1973 said:

Scalp health is good, no dandruff, no flaking.  Nothing visible in hair but forehead has been very oily for many years (since began balding). Derm has confirmed no issues in scalp though.  I have not relocated.

Strange. All the information we have on Propecia/ Dutasteride is that it works better with age. 

Perhaps is just natural senile alopecia. After the age of 35 or so, men naturally thin regardless of MPB. 

Look at the rare cases of men in their 70s with NW1s, most of the time you can see the scalp through their hair. 

The only other thing I would suggest is, perhaps, a scalp biopsy to see how your microbiome is. 

[mustang]

Low estrogen will also thin your hair

[jim1973]

On 7/23/2024 at 2:22 PM, mustang said:

Low estrogen will also thin your hair

Last 3 blood tests have normal ranges for estradiol, estrogen, oestrogen.