finasteride

the big 3 of hair loss

The Big 3 of Hair Loss Prevention

The Big 3 of Hair Loss Prevention

written by Matt Dominance

If you are new to my website, make sure you read Medical Disclaimer before you continue reading this article.

3 Simple Steps to Prevent Early Balding

In this short post you will find out what are the 3 best anti hair loss treatments you can start using once you notice the first signs of male pattern baldness!

These treatments have been selected based on:

  • Their proven effectiveness in multiple clinical studies 
  • Friendly cost of a monthly supply 
  • Treatments are easy to stick to

1. Ketoconazole Shampoo

Ketoconazole shampoo is known for providing extra protection against dandruff, which could be responsible for scalp inflammation and additional hair loss. Ketoconazole could benefit not only to kill dandruff but potentially block DHT topically and thus slow down the hair miniaturization. 

The shampoo with Ketoconazole I use is the Revita Shampoo with 1% Ketoconazole in it. I’ve been using it successfully for more than 2 years by now. 

I have been noticing reduced hair loss several days after shampooing. My daily shedding tends to increase a little, if I don´t apply Ketoconazole shampoo for more than 5 days.

Ketoconazole seems to improve the proportion of anagen hair folliclesfights seborrheic dermatitis and promotes hair thickening.

2. Minoxidil 5% and Derma Roller

Minoxidil is a hair stimulant which supposedly works by opening potassium channels via topical application on the scalp. This treatment is FDA approved and for it to be successful, patients have to apply it consistently at least once a day on a dry scalp. 

This medication also prolongs the anagen (growing) phase of the hair follicle and delays the hair shedding. It also comes with initial shedding stage (first 1-3 month of using Minoxidil).

Minoxidil – induced shedding is completely normal and it is a sign that this medication is working.

In case you want to try another hair stimulant which comes without the initial hair shedding, you can check out my article about Stemoxydine and how it compares to Minoxidil.

Derma-rolling is another great tool to have in your hair loss prevention toolkit. Regular use of the derma roller or derma pen has been shown to boost the absorption of Minoxidil 5% and thus increase the hair regrowth potential of Minoxidil treatment.

If you decide to combine these two together, make sure you don’t apply Minoxidil product on the scalp earlier than 24 hours after your derma rolling session.

In this article I explain how I practice derma rolling as well as its additional benefits compared to using Minoxidil alone.

3. Finasteride

Please consult your doctor before taking Finasteride/Propecia as it requires prescription!

Finasteride is the 2nd FDA approved medication next to Minoxidil with only one difference – it requires a prescription from a doctor (dermatologist, or a hair transplant doctor). Side effects from Finasteride incl. decreased libido, erectile dysfunction or depression are linked to inhibition of 5 – alpha – reductase.

Inhibition of 5AR enzyme is the main mechanism of action by Finasteride. It’s the reason why this drug can successfully prevent hair loss. 5 AR converts Testosterone into more potent Dihydrotestosterone DHT and thus acts as a precursor of male pattern hair loss by genetically predisposed individuals.

This drug has to be taken orally once per day. Usually 1mg is the standardized dose prescribed by doctors. 

However you can also take anywhere from 0.25mg to 1mg to successfully block the DHT on the scalp.

Taking 1mg is recommended to achieve a faster Finasteride accumulation in the scalp tissue and thus faster hair loss prevention.

Here you can check out my experience with Finasteride and results after 1 year of use!

Are you interested in a hair transplant but don´t know where to start?

finasteride before and after

My Finasteride Results After 1 Year

My Finasteride Results After 1 Year

written by Matt Dominance

If you are new to my website, make sure you read Medical Disclaimer before you continue reading this article.

In this post you will find out:

  • How was my 12 month experience with Finasteride?
  • Before and after results and photos.
  • Side effects I experienced during my 1 year treatment with Finasteride?
  • Will I continue using Finasteride to prevent further hair loss?

How I started with Finasteride

I started using Finasteride in September 2019 (before my 2nd hair transplant). My goal was to stabilize my hair loss as well as strengthen my hair before my 2nd hair transplant to prevent shock loss.

Dosing and frequency

For the first 5.5 months I have been using topical Finasteride liposomal gel and after that I switched to oral Finasteride only. My dosing was 0.5-0.6mg of Finasteride per day. The standardized dose of Finasteride for male pattern hair loss condition is 1mg though. I took less, because I was more side-effect concerned back then. 

Effectiveness

I started experiencing less hair loss already after the first month of using topical Finasteride. 

I didn´t have any shock loss/increased hair shedding as a result of starting with Finasteride(this is only a temporary shedding though, which some people can experience).

In my experience, the hair thickening effects of Finasteride came between 4th and 12th month. Before that, I have been only able to notice way less shedding than before.

 

How does Finasteride work?

Hair thickening effect of Finasteride happens as a result of Finasteride partially inhibiting the activity of 5 – alpha – reductase enzyme (which converts Testosterone into Dihydrotestosterone).

Dihydrotestosterone (DHT) is known for being more androgenic (more potent). Such increased potency compared to Testosterone makes it a more potent agent for transcribing its androgenic effects on the androgen receptors in selective tissues like beard, body hair, prostate, hair follicles etc. 

DHT is known for disrupting the proper hair follicle growth cycle as well as the progressive miniaturization of the hair follicle.

By accumulation of Finasteride in the scalp tissue over time, there will be much lower 5 – alpha – reductase activity, and this less DHT formation. This will lead to slower hair miniaturization process.

Side effects

Some of the side effects are sexual dysfunction, decrease in libido, weaker erections, breast enlargement or depression. Personally I haven´t experienced any of these. It´s also known, that about 2% of all patients are likely to experience them to a degree. 

My hair in September 2019

before Finasteride treatment
My hair in September 2019 (before Finasteride treatment)

Hair Situation before starting with Finasteride

  • Diffuse hair thinning inside of the white circle
  • More severe baldness inside of the red circle
  • Frontal hairline has been already restored (during my 1st FUE hair transplant)
  • NW 4-5 transition pattern if I hadn´t done my 1st hair transplant

Combining Finasteride with my 2nd FUE Hair Transplant

2nd FUE hair transplant on the area where the red circle (mid-scalp region) | 1.5 months on topical Finasteride

940 grafts transplanted on the mid-scalp region

  • I started with topical Finasteride 1.5 months prior to my 2nd hair transplant to strengthen my native hair and help avoid shock loss (after the surgery)
  • During this time I was applying my topical Finasteride on the rest of the mid-scalp and crown
  • After 1 month post-op I started applying topical Finasteride on the transplanted area as well (because there was also some native hair in it)
  • Here you can check out my FUE progress after the 2nd Hair Transplant!

8 Months after using Finasteride

My Finasteride Results - 14 months after using finasteride + hair transplant
8 Months on Finasteride | 6 Months after my 2nd FUE hair transplant

Results of 8 Months on Finasteride and 6 Months after my 2nd FUE

  • The hair in the vertex region and mid-scalp thickened
  • Better hair coverage in the red circle due to hair regrowth after hair transplant
  • Reduced hair loss on the whole vertex and mid-scalp as a result of taking Finasteride

14 Months after using Finasteride

14 months after using finasteride + hair transplant
14 Months on Finasteride | 1 Year after my 2nd FUE hair transplant

Am I staying on Finasteride or not?

  • I am definitely staying on Finasteride since my response has been very good so far
  • Over the course of the next year I don´t expect any huge improvements in terms of hair thickening but rather maintenance of the current hair thickness
  • I need to further take Finasteride in order to maintain my current hair thickness (especially mid-scalp and vertex region) and thus avoid further hair transplants in these regions

Finasteride requires prescription. You should always consult your doctor or GP before considering this medication. If you are new to my website, make sure you read Medical Disclaimer!

4 Primary Ways of Treating Hair Loss

4 Primary Ways of Treating Hair Loss - Androgenic Alopecia (AGA)

  1. Using 5-AR (alpha-reductase) inhibitors “DHT blockers”
  2. Anagen Phase Stimulating Agents (anagen stimulants)
  3. Anti-androgenic agents (topical solutions) 
  4. Hair stem cell-related agents (injectable treatments)

Part 1

1. Inhibiting 5AR conversion from T to DHT ("DHT blocking")

DHT has been shown to progressively miniaturize the hair follicles on the scalp which is only one if its androgenic effects on human body.  Unfortunately this unfortunate effect of DHT only occurs by individual with genetic hair loss susceptibility.

Blocking DHT (dihydrotestosterone) always starts by inhibiting 5AR isoenzymes. Inhibiting the activity of type 1 and type II. 5 alpha reductase isoenzymes can be enough for the start. Men who suffer from any type of patterned hair loss (besides alopecia areata) start taking Finasteride (branded as Propecia, Proscar).

 Finasteride can inhhibit the 5-alpha reduction of Testosterone into DHT by approximately 70%. It is the only FDA approved oral drug for treating male pattern hair loss (AGA). 

Some Finasteride users may experience more than hair loss stabilization. Many of them also report positive hair thickening benefits over time. These are so called – well respondents to 5 AR inhibiting drugs.

Hair Follicle Androgen Receptor Sensitivity to Androgens and how Finasteride (Propecia) can help with hair loss

 

Inhibition of the 5 alpha reduction of Testosterone into several times more potent androgen – DHT results in less hair loss. Plasma DHT levels – lowered by Finasteride result in less frequent interaction of hair follicle´s androgen receptors with the DHT. 

For that reason, patients who use 5 AR inhibiting drugs like Finasteride tend to notice less hair loss. Importantly Finasteride limits the interaction of the most potent naturally-occurring androgen in your body DHT – with the hair follicles´ androgen receptor.

Types of 5 AR inhibitors effective for Hair Loss

Finasteride (Propecia,Proscar)
  • Inhibits 5-alpha reduction of T into DHT by 70% systemically and 50% topically
  • Only FDA approved oral medication for treating male pattern hair loss
  • Inhibits only type II. 5 AR isoenzyme activity
  • Requires prescription in most countries (excl. Turkey, Saudi Arabia)
  • Can come with potential side effects (statistically low percentage though)
Dutasteride (Avodart) 
  • 5-alpha reduction inhibition of T into DHT by 90-95% systemically 
  • Not FDA approved oral medication for treating male pattern hair loss
  • FDA approved medication for treating enlarged prostate in men
  • Suppresses type II. and type I. 5 AR isoenzymes activity 
  • Can come with potential side effects (statistically higher than Finasteride)
Topical Finasteride 0.25% Solution 
  • Suppression of 5-alpha reduction of T into DHT by 70% topically (study)
  • Very low (if any) effect on systemic DHT suppression
  • Not FDA approved oral medication for treating male pattern hair loss
  • Inhibits only type II. 5 AR isoenzyme activity
  • Can be compounded by a licensed pharmacy or bought online for research purposes
  • Requires a prescription sometimes by purchases from a pharmacy
  • Side effects can´t be entirely avoided either (statistically lower as opposed to oral Finasteride)
Topical Dutasteride
  • Very few clinical studies done on topical Dutasteride
  • Better efficacy as opposed to topical Finasteride can be expected but only via transdermal injection delivery or mesotherapy 
  • Low potential for systemic DHT suppression
  • Higher mollecular weight compared to topical finasteride restricting proper transdermal absorption
  • Not FDA approved for treating male pattern hair loss
  • Topical dutasteride application via mesotherapy is still relatively unknown among dermatologists and hair transplant doctors
Saw Palmetto (Serenoa repens)
  • Inhibits 5-alpha reduction of T into DHT by 32% systemically
  • Not FDA approved oral medication for treating male pattern hair loss
  • Less potent 5 AR inhibitor in comparison to Finasteride or Dutasteride
  • Side effects haven´t been observed but can occur

The pros and cons of using 5 AR inhibiting agents for long-term hair loss management (AGA)

Advantages

Finasteride has been the most studied and most researched 5 AR inhibitor ever approved for hair loss by the FDA.

5 AR inhibitors tend to work well for majority of guys initially. However after some time their effectiveness may start to fade. How soon, will depend on the severity/aggressiveness of your AGA and changes in your androgen levels as you age.

Use of 5 AR inhibitors has been shown not only to slow down male pattern hair loss progression but also result in thicker scalp hair growth. Hair thickening effect after using 5 AR inhibitor depends on how good of a respondent you are. 

Disadvantages

5 AR inhibitors may not be enough for men with more “severe” genetic hair loss condition. 

5 AR inhibitors don´t protect the hair follicles´ androgen receptors from androgens in general.

DHT leftovers, testosterone and other “weaker” androgens can still cause hair loss by individuals with genetic hair loss condition using Finasteride already.

5 AR inhibitors are not able to “block” the androgenic effects of natural androgens or steroidal androgens.

Potential side effects related to low sexual desire, low libido, decreased sexual arousal , weak erections by small percentage of users were observed by 5 AR inhibitor users. Statistically only 1-2% of men experience side effects from drugs like Finasteride (slightly higher side effect profile by Dutasteride).

Make sure you do your due diligence on PFS (post finasteride syndrome)– mixture of psychologically- and sexually-related side effects, depression, suicidal thoughts, anxiety.

PFS suggests that these side effects may also persist after patients discontinue the use of any 5 AR inhibiting agent like Finasteride or Dutasteride.

Why are 5 AR inhibitors effective for the start?

 

DHT is the most potent androgen causing hair loss. DHT does it to the highest degree in comparison to other androgens like testosterone. Especially because it has a much higher binding affinity onto the androgen receptor of the hair follicle. By focusing on 5 AR inhibition and thus DHT suppression, most of men start seeing clear improvements. Less hair loss, hair becomes thicker and better to style again.

DHT is more likely to transcribe its potential damaging effects onto the hair follicle than any naturally-occurring androgen.  By inhibiting it 70% with Finasteride or  90%+ with Dutasteride, the pressure can be put off the androgen receptor. It only works while 5 AR is being inhibited. 

The efficacy of 5 AR inhibiting medication depends on the frequency and dosage of the used drug. 

Biological half-life of 5 AR inhibitors (Finasteride vs. Dutasteride)

Finasterides´ elimination half-life is only 6-8 hours whereas Dutasteride has a much longer half-life – up to 6 weeks. Consult a hair transplant doctor, dermatologist or any licensed medical professional to find out the optimal dosage for you.

How well the 5 AR inhibitors will work for you, depends on how good of a respondent you are. Many guys keep using Finasteride for a successful long term hair loss management for many years. Meanwhile 1 or more hair transplants may be required for improved hair density and thickness. 

post-finasteride syndeome - Matt Dominance

Post-Finasteride Syndrome: Real or Fiction? Summary of 12 PFS – Studies

An objective view on the post-finasteride syndrome based on 12 studies!

written by Matt Dominance

In this post I´m going to share my thoughts on the likelihood of any Finasteride user experiencing  post-finasteride syndrome or any sexual – /psychological – related side effects during or after discontinuing Finasteride treatment.

This post also gives you some useful suggestions on how to minimize the potential side effects of Finasteride while using it for successful hair loss management long – term.

Out of all 14 studies I was able to find on this topic, there are 4 studies which are suggesting the the occurrence of PFS is real and 8 studies suggesting safety of finasteride with no or minimal side effects of any kind. 

Here is a brief summary I especially liked on this topic coming from the International Journal of Trichology

Post-finasteride syndrome is obviously a problem that has to be dealt with. Low quality studies neither confirm nor refute the condition as a valid entity. 

Therefore, it would be only as inappropriate to dismiss the PFS as nonsensical, as it is to demonize finasteride for the treatment of male pattern hair loss.

The authors found that persistent sexual side effects were only documented in low-quality studies with strong bias selection, while a significant nocebo effect has been documented among patients informed about the possible side effects of finasteride. 

Let´s talk about statistics!

The higher the sample size of observed subjects in any study, the higher the statistical significance the study will have.

Statistical significance is the likelihood that a relationship between two or more variables is caused by something other than chance

Two variables in our case are: 1. Taking oral Finasteride, 2. Experiencing sexual side effects/post-Finasteride syndrome

A statistically significant experiment means that you can be almost sure that the results you observed are reliable and not distorted by selection bias for example.

The smaller the sample size, the less reliable the results are being considered from statistical point of view.

post - Finasteride syndrome probability

Statistical significance can be only present by studies which were done on large enough samples sizes. Sample sizes of 10, 20, 50 or even 100 are still considered to be very insignificant when it comes to statistical evaluation.

 

What is PFS Foundation?

 PFS foundation website focuses on documentation of individual post-finasteride syndrome cases all over the globe. It has been active since 2012 and documents 16,125 cases of post-finasteride syndrome to this day (28.1.2020). 

Furthermore, they also register 63 known suicides – which supposedly happened as a result of using finasteride.

 Their ultimate goal is to have Finasteride removed from the market completely. 

Are men becoming suicidal as a result of PFS? The truth…

Based on PFS foundation website there have been over 16,000 detected cases of post – finasteride syndrome and 63 known suicides between 2012 and 2020 so far.

Which makes it around 2000 adverse reactions per year and 8 suicides per year.

Finasteride has been approved for hair loss in 1997, which makes it the most frequently prescribed drug for treating hair loss with over 70.000.000 prescriptions between 2007 – 2017 (just in the USA) based on clincalc.com

Don´t you think that if you randomly select 70.000.000 Americans and observe them for 10 years, you will realize that 63 of them may easily try to kill or actually kill themselves anyways because statistically, the occurrence of such event by a sample size of 70.000.000 million is very likely regardless of whether the whole sample have been on Finasteride or not.

Actually, according to CDC´s National Center for Health Statistics the male suicides in the USA have been averaging from approx. 25.000 – 35.000 during 1997 – 2016.

 

Temporary and persistent sexual side effects. How likely are they to occur?

1-6 Studies suggesting the existence of post-finasteride syndrome. How reliable are they?

Study 1 (2015) 
472 men between 47 and 68 years of age on 5 mg oral finasteride per day for 45 months

Conclusion:

Testosterone levels in men treating with Finasteride for BPH (benign prostatic hyperplasia) decreased after taking Finasteride. Erectile dysfunction symptoms were also observed as a result of taking Finasteride. 

Limitations: (selection bias)

Sample size consists of middle-aged and older man with naturally lover testosterone production and thus more prone to erectile dysfunction

Study 2 (2011) 
 71 otherwise healthy men aged 21-46 years experienced sexual-related side effects 3 months after discontinuing the finasteride treatment

Conclusion:

Persistent sexual dysfunction associated with the use of finasteride:

Low libido: 94%

Erectile dysfunction: 92% Decreased arousal: 92%

Problems with orgasm: 69%

Limitations:

Very low sample size: 72 men

Study 3 (2012) 
54 men experienced persistent sexual side effects as a result of using Finasteride

Conclusion:

Persistent sexual side effects continued longer than 6 years after discontinuing the treatment (by 20% of men in the sample) and by the rest 80% side effects resolved after 14 months after stopping Finasteride on average.

Limitations:

Very low sample size: 54 men, no age information, no previous data about the lifestyle and health condition of the selected sample which could have contributed to sexual side effects

Study 4 (2014) 

8 men (aged 29-43 years) reporting sexual side effects including loss of penis sensitivity over 6 months after discontinuation of finasteride who were interviewed and clinically visited.

Conclusion:

Side effects persisted for more than 6 months after discontinuing the treatment

Limitations:

Very low sample size: 8 men

Report 1 (online survey from 2015)

131 generally healthy men participated in an email survey 

Conclusion:

Side effects like exual libido, ejaculatory disorders, disorders of the penis and testes, cognitive symptoms, and psychological symptoms were present even 6 months after discontinuing the treatment 

Limitations:

Online survey – not a real clinical study with a proper pre-examination of the observed sample

Study 2 (online reports from 1998-2013)

4910 reports on Finasteride-related adverse event reports for men aged 18-45 were submitted between 1998 – 2013. These men were taking the standardized dose of Finasteride – 1mg per day.

Conclusion:

11.8% of the reports (577) experiencing persistent sexual side effects even after discontinuing Fiansteride. 

Limitations:

 –

7-14 Studies suggesting safety of finasteride. How reliable are they?

Study 7 (2012)

3177 Japanese men with androgenetic alopecia participated in this study in order to observe the safety and efficacy of finasteride 1 mg tablet daily from 2006 – 2009

Conclusion:

23 out of 3177 men experienced adverse reaction (study doesn´t specify whether these side effects were of sexual nature or not)

Limitations:

No follow-up examination of many patients in this study. 

Study 8 (1998)

In two 1-year trials, 1553 men (18 to 41 years of age) with male pattern hair loss received oral finasteride 1 mg/d or placebo, and 1215 men continued in blinded extension studies for a second year. 

Conclusion:

No mentioning of any sexual-related side effects in this study.

Limitations:

No information about the safety of finasteride in this study neither about the potential side effects. Study focused on observing the efficacy of finasteride instead of its safety. 

Study 9 (2000)

212 men, age 18-40 years received finasteride 1 mg daily or placebo for 48 weeks. Study measured anagen hair count at baseline, 24 weeks and 28 weeks.

Conclusion:

Study focused on observing the improvements in hair count before and after 48 weeks of finasteride treatment. The treatment was efficacious. 

Limitations:

No information about the safety profile of finasteride use by subjects during these 48 weeks.

Study 10 (2002)

1553 men with MPHL randomly received either finasteride 1 mg/day or placebo for 5 years.

Conclusion:

Study wasn´t able to identify new safety concerns during the long.term use of finasteride. Tolerance of finasteride: well.

Limitations:

Study 11 (2004)

414 Japanese men with male pattern hair loss received finasteride 1 mg (n = 139), finasteride 0.2 mg (n = 137), or placebo (n = 38) once daily for 48 weeks.

Conclusion:

General tolerance of finasteride treatment was well and study doesn´t report about any adverse effects.

Limitations:

Study 12 (2006)

Men with AGA randomly received finasteride (1 mg/d) or placebo for 192 weeks. 

Conclusion:

Study wasn´t able to identify new safety concerns during the long.term use of finasteride. Tolerance of finasteride: well.

Limitations:

The sample size available for analysis decreased with time.

Study 13 (2007)

120 patients, sexually active, randomly received finasteride 5 mg concealed as an “X” compound of proven efficacy for the treatment of BPH” for 1 year

Group 1 (n=52) didn´t receive any information about potential sexual side effects related to this drug.

Group 2 (n=55) received information about potential sexual side effects related to this drug ( erectile dysfunction, decreased libido, problems of ejaculation).

Conclusion:

Petients, who received the information about the potential side effects prior to the start of the treatment were more likely to experience sexual side effects (43.6%) as opposed to the group 2 (15.3%) – not knowing about the potential side effects.

Limitations:

Small sample size of each group (52 and 55 subjects respectively).

Study 14 (2003)

During 24 month period  424 men aged 41-60 years received finasteride 1 mg on hair growth/loss 

Conclusion:

General tolerance of finasteride treatment was well and study doesn´t report about any adverse effects.

Limitations: