Does Propecia work for life if it works

[abcdefg]

Not ignoring the fact in 6 years something better will probably be out. I personally think in 5 - 10 for real this time we will have a way to stop male pattern baldness from progressing at all in most men. Propecia is already close we just need a safer long term way to do that and things like CB in trials now sound a lot like that.

 

[LawOfThelema]

so tho the hair count declines, dont the hair weights remain roughly the same in the 10 yr trial?

 

[WarLord]

Evidence suggests that it can last for over a decade for some men, but I haven't seen anything that it can last for a lifetime. This is not my personal opinion, because placebo controlled studies show the same thing. See the following chart:

View attachment 18166


Results seem to peak around 1-2 years, then gradually decline after that.

Yes, this is the so-called "Bryan's fallacy". Results with any treatment must peak after 1-2 years, because the maximum of regrowth is attained after 1-2 years. The improvement in the following years is mainly due to the thickening of hair shafts. And since the regrowth in good responders stagnates, the curve must inevitably decline, because non-responders continue to lose hair.

I tell people over and over again that they misunderstand such graphs. But they continue to post them in order to prove that all the available treatments work for only 2 years. This is nonsense. Look at the Rossi et al.'s study: After 10 years, 86% men persisted in their improvements achieved during the 1st year of treatment. Only in 4 out of 102 men, the positive trend reversed. This is quite logical, because without DHT, the probability of a further hair loss is very low. How could it be possible that you can regrow a lot of hair during the first 2 years, but suddenly, during the 3rd year, you can't even keep them?! Use your brain. Moreover, the observed decline after 2 years may not be primarily due to the loss of efficiacy. It is known that hairs regrown within a short time during the early months of treatment will gradually start to "desynchronize" their growth cycles. As a result, the density will somewhat decrease, because less hairs will be in the growth phase at the same time.

And stop talking about "hair follicles becoming more sensitive to DHT". The current research indicates the opposite: Androgen receptors switch to a form that is less sensitive to DHT. Furthermore, with increasing age, there are less and less androgens produced in your body, and your chances to keep hair thus increase.

Basically, all your theories are based on the perversely biased and skewed picture that you get on internet forums.

 

[DoctorHouse]

Warlord, what age do you think hair loss tends to slow down for most people. Another words, I know you are never safe at any age for hair loss to occur but at what age do you think your Norwood level is pretty much established and your chances to fight hair loss becomes easier? My guess is over 50.

 

[Bowser]

Warlord, your comments are great and very knowledgeable! do you have some sort of medical background?
anyway, reading the posts here and others you have written i still believe that the response to hair treatments can be very individual. you seem to have had great results from the way you describe. i have been using minoxidil for 5 years and finasteride for 1.5 - with pretty dam good compliance with using these every day! i may have missed applying minoxidil about twenty days over the whole 5 years only. when i look at pics of myself year on in after starting these treatments you can definitely see that my hair has become gradually worse with time. i DO still think that both treatments are still working as i would probably be completely bald by now if i hadn't been using anything. in the frontal area particularly my scalp is showing more and more with time. i choose not to read too much around all the research and pathways but to report on things the way they occur on myself. i believe genetics maybe is the overriding factor in any individuals case. some peoples adaptation and homeostatic mechanisms may be stronger than some to these hair loss treatments and then the male pattern baldness eventually takes over again but at a much slower rate. this is only my personal opinion not based around any facts and does not intend to be controversial.

 

[Beingbaldsucksass]

I really think that preventing pdg2 will be the next best treatment and will also have more regrowth, don'tflow if f a miracle regrowth from 6 to 1 but defenietly more then finasteride cuz its proven to block hair growth, but we dont know what it means on areas with no hairs at all, but thining areas will defenietly get thicker. it will also have less side effect as it dosent interfere with sex hormones,

We just need finasteride to work for at least 10 years before switching to the pdg2 ones.

 

[WarLord]

^ just because some people get winning lottery tickets doesn't mean that all or most competition entrants will.

Well, but the problem with those, who don't get these "winning lottery tickets" is that they come to internet forums and present their failures with anti-hairloss treatments like if it was an universal experience of all men on Earth. This creates an atmosphere of negativism that can be quite depressive for many "newbies". In reality, they may represent a surprisingly small minority of users. People, who have success don't need to look for help in the internet.

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Warlord, what age do you think hair loss tends to slow down for most people. Another words, I know you are never safe at any age for hair loss to occur but at what age do you think your Norwood level is pretty much established and your chances to fight hair loss becomes easier? My guess is over 50.

Well, the current experience is quite unequivocal: Young people with an advanced stage of hairloss have the least chance to succeed. The opposite applies for older men with little hairloss. (SEE THE ATTACHED PICTURE FROM KAUFMAN ET AL. 2008). I think that the vast majority of cases, in which the treatment "stopped working", concerns young people with bewildered hormones. This is typical for the age range between 20-30 years. If you pass the age of 30 years and especially 40 years, it should be better manageable.

I noticed first signs of hairloss, when I was 22 years old (in summer 1996). It took about 6 months, until I realized that it was real and that I was not paranoid. Still, I started with the treatment very early and I only lost about 1 cm of my hairline. I have kept it unchanged since 1997, although I experienced some loses of density in my temples due to two unhappy experiments with switching treatments (the first one in 1998, the second one just in 2011-2012). It is grotesque that during the whole time, I had to quarrel with several dermatologists, who told me that I should stop the treatment because of the risk of various side effects, and that the hairloss will continue further. It did not, and frankly, it has never occured to me that it should stop working. It was only in 2007, when I visited a hairloss forum for the first time, that I started to read the claptrap about the "loss of efficiacy". This disturbed me to the extent that I switched from 2% to 5% minoxidil in 2008. Interestingly, the 5% minoxidil turned out to be more effective than 2% minoxidil in 1997, as evidenced by some intermediate hairs that I regrew. This really doesn't suggest that the stuff was losing efficiacy over the years, and this also explains, why I can't grasp the stories of people, who regrew hair on minoxidil and then started to lose it after several years. It sounds like experiences of extra-terrestials to me. Furthermore, I have a fresh experience with 10-15% minoxidil and I know that the effect increases with increasing dosage in me. Therefore, logic tells me that I shouldn't worry about the future.

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Warlord, your comments are great and very knowledgeable! do you have some sort of medical background?
anyway, reading the posts here and others you have written i still believe that the response to hair treatments can be very individual. you seem to have had great results from the way you describe. i have been using minoxidil for 5 years and finasteride for 1.5 - with pretty dam good compliance with using these every day! i may have missed applying minoxidil about twenty days over the whole 5 years only. when i look at pics of myself year on in after starting these treatments you can definitely see that my hair has become gradually worse with time. i DO still think that both treatments are still working as i would probably be completely bald by now if i hadn't been using anything. in the frontal area particularly my scalp is showing more and more with time. i choose not to read too much around all the research and pathways but to report on things the way they occur on myself. i believe genetics maybe is the overriding factor in any individuals case. some peoples adaptation and homeostatic mechanisms may be stronger than some to these hair loss treatments and then the male pattern baldness eventually takes over again but at a much slower rate. this is only my personal opinion not based around any facts and does not intend to be controversial.

Your case must be quite difficult, when even the combination of finasteride and minoxidil doesn't work. But I think that you haven't done everything that you could have. If finasteride doesn't work in you, you should know your DHT and testosterone levels. If DHT is still high, you can add dutasteride. Alternatively, you can increase minoxidil dosage. I really think that with the current arsenal of treatments, you can never lose hair. It is only a matter of dosage.

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I really think that preventing pdg2 will be the next best treatment and will also have more regrowth, don'tflow if f a miracle regrowth from 6 to 1 but defenietly more then finasteride cuz its proven to block hair growth, but we dont know what it means on areas with no hairs at all, but thining areas will defenietly get thicker. it will also have less side effect as it dosent interfere with sex hormones,

We just need finasteride to work for at least 10 years before switching to the pdg2 ones.

I won't be surprised, if there is not a big difference. We already have a chemical that works against PDG2 indirectly via the increase of PDE2 - minoxidil. Why should minoxidil be inferior and why should a PDG2-blocker be a miraculous breakthrough? What about if it again starts to lose efficiacy in some guys?

 

[Beingbaldsucksass]

Minoxidil dosent remove the pdg2 from the scalp that's it, if if there is a chemical we don't know if it direcly attack the pdg2 on the scalp

 

[Bowser]

thanks Warlord! that's a great reply. i never really considered getting my dht levels checked until you mentioned. i am glad to report that like you i did increase my minoxidil dosage in stages- from 2 to 5 to 10 and now Im on 15% according to dosage my hair required. i wish i started finasteride years before i did!

 

[WarLord]

thanks Warlord! that's a great reply. i never really considered getting my dht levels checked until you mentioned. i am glad to report that like you i did increase my minoxidil dosage in stages- from 2 to 5 to 10 and now Im on 15% according to dosage my hair required. i wish i started finasteride years before i did!

O.K. But the other side of my story was that 10-15% minoxidil caused a rapid telogen effluvium in me and I lost more hairs than I regrew. I admit that 15% minoxidil can do great things for some people, but for me it was simply too strong. I can't even tolerate 10% minoxidil. This shows that I am a very good responder to this drug and my hair follicles react excessively, if I increase the dosage too much. Furthermore, after I switched from 10% back to 5% minoxidil, I experienced another telogen effluvium and my hairs in my left temple virtually disappeared without trace. It was a bitter end, because instead of the increase of density, there were almost no hairs left. I do hope that I will recuperate from the mess that this stuff did in me, but it seems that it will take many months. I added finasteride in late June and I have been experiencing a very good regrowth since mid-August. But the regrown hairs are still mostly weak and barely pigmented, so I am not fully satisfied yet.

The lesson: Stop taking minoxidil, if the shedding lasts for several (3+) months. And don't switch to lower minoxidil concentrations abruptly, otherwise you will experience a disaster.

 

[LawOfThelema]

And hence there is your 90% success rate. In my opinion it is probably nearer 40% if aggressive sufferers were included, as the best they can hope for is for the hairloss to be slowed down.

If you read the studies you can see the breakdown of sufferers by hair loss category. Those who interpreted the 10 year data in the 10 yr followup study conclusion was that those of more severe baldness saw MORE IMPROVEMENT on finasteride than those with only mild loss.

 

[Beingbaldsucksass]

I'm the type of those with very rapid balding, from June 10 to march 11 I went from Norwood 2 to Norwood 3.5 then in 6 months to nw4, after 6 months on rogaine I went to nw2 again and I'm also 3 months now on finasteride.

 

[BusterBluth]

The body will adapt to DHT blocking (well, mine did, anyway...)

After reviewing the "Propecia - serum DHT" figure, I decided not to take 1 mg Propecia, and instead try a lower dose. So, I was taking 0.25 mg Propecia for about 8 months, and it was working fine -- I was noticing more hairs at the crown, and hair at the hairline was more thick and healthy. During the first few weeks on Propecia, my sex drive dropped to zero and I had periodic nut-ache. However, my sex-drive returned to about 75% of normal, and the nut-ache went away.

After 8 months on 0.25 mg Propecia, suddenly my sex drive was back to normal. Then, over the course of about three weeks, I experienced a cataclysmic hair shed. All of the new growth was wiped out, and I'm probably worse now than I was in the beginning.

My theory is that my body has adapted to the 0.25 mg Propecia dose, and whatever hormone suppression was happening isn't happening anymore. The attached figure "mean_change_crossover_data_chart" shows the general effect of Propecia over time, and supports the idea that it begins to lose efficacy, with the average user being back to baseline in five years.

So, my recommendation is to take the 1 mg dose from the very beginning. I have increased to 0.5 mg, but if my body has become somehow 'resistant' to Propecia, then doubling the dose may not get me another 8 months of growth before I adapt again. The data in the attached 5-year study figure seems to support the idea that Propecia is not a "lifetime" solution, when it works.

 

[WarLord]

Just my 2 cents worth.
We know that Finasteride according to the clinical trials maintained hair counts in 90% of people after 5 years of treatment.
When Merck undertook trials they would have had to select a certain number of people to be treated with Finasteride for this amount of years.
Now if you want to sell your product that treats male pattern baldness, you would not select participants whom have an aggressive form of male pattern baldness.
You would ensure you have a good mix of ages, but you would not want to select an 18 year old who is NW4 +. Merck when advertising for trial participants would have requested an application form with information required to be filled in, asking their age, length of time they have been balding, type of baldness frontal/vertex/diffuse, history of male pattern baldness in family.
With careful analysis you could quite easily reduce the number of trial participants with aggressive forms of male pattern baldness.

And hence there is your 90% success rate. In my opinion it is probably nearer 40% if aggressive sufferers were included, as the best they can hope for is for the hairloss to be slowed down.

You were not much successful with finasteride, weren't you? And hence you don't believe that anybody on Earth could have success with it? In fact, the 80-90% success rate has been repeatedly confirmed in all countries on the planet. A recent Japanese 2-years' study incorporating more than 3000 men produced 87% success rate. The truth is that finasteride is least successful in young men with an advanced Norwood stage, and most successful in older men with a mild Norwood stage. The age of treated men is usually between 20-40 years, which ensures that all age groups are well represented. And it is quite understandable that they won't pick up men with Norwood 6-7, because all the available treatments are rather preventive.

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After reviewing the "Propecia - serum DHT" figure, I decided not to take 1 mg Propecia, and instead try a lower dose. So, I was taking 0.25 mg Propecia for about 8 months, and it was working fine -- I was noticing more hairs at the crown, and hair at the hairline was more thick and healthy. During the first few weeks on Propecia, my sex drive dropped to zero and I had periodic nut-ache. However, my sex-drive returned to about 75% of normal, and the nut-ache went away.

After 8 months on 0.25 mg Propecia, suddenly my sex drive was back to normal. Then, over the course of about three weeks, I experienced a cataclysmic hair shed. All of the new growth was wiped out, and I'm probably worse now than I was in the beginning.

My theory is that my body has adapted to the 0.25 mg Propecia dose, and whatever hormone suppression was happening isn't happening anymore. The attached figure "mean_change_crossover_data_chart" shows the general effect of Propecia over time, and supports the idea that it begins to lose efficacy, with the average user being back to baseline in five years.

So, my recommendation is to take the 1 mg dose from the very beginning. I have increased to 0.5 mg, but if my body has become somehow 'resistant' to Propecia, then doubling the dose may not get me another 8 months of growth before I adapt again. The data in the attached 5-year study figure seems to support the idea that Propecia is not a "lifetime" solution, when it works.

Oh, the famous graphs of "average hair counts" again! I tell people that they shouldn't repeatedly post this garbage, because it is very deceptive. Such graphs can't capture individual responses and create an infectious mythology that all treatments stop working after 2 years. In fact, the curve must inevitably decline after 2 years, because at the 2-years' mark, good responders achieve a (nearly) maximum regrowth, while bad responders continue to lose hair. So even if 99% users experienced no hair loss after 2 years and only 1% of users were still losing hair, the curve would be declining!

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If you read the studies you can see the breakdown of sufferers by hair loss category. Those who interpreted the 10 year data in the 10 yr followup study conclusion was that those of more severe baldness saw MORE IMPROVEMENT on finasteride than those with only mild loss.

Men older than 30 years responded quicker and better than young men aged 20-30 years, despite (or just because of?) the fact that their hair loss was more advanced. The authors speculate that this may have been due to the decrease of androgen levels, but they may have also had more lost hair that could be regrown. The majority of the young men was in the NW3 stage, and most of the treated men were NW3-NW4, which is understandable, because this is a point, where hairloss becomes uncomfortable and at the same time, it is not too late to start the treatment.

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Someone who has been balding for just 18months, but is already a NW3 (eg suffering only mild loss) could without treatment be a NW6-7 within 5years of first signs of hairloss. It is this group that you would want to eliminate or reduce from your trials if you are going to market a treatment for hairloss.

But the question is, why just NW3 is the most frequently represented group among young hairloss suffereres in these studies? You only pollute the air on this forum by your unsubstantied fabrications. If you want to ventilate your frustration, then you should find either a good psychiatrist or a good transplant surgeon.

 

[Bowser]

warlord by name warlord by nature. good stuff!

 

[Quadzilla99]

Crucify em warlord! Send their asses directly to the tree of woe!

 

[abcdefg]

I still think it varies person to person and not everyone stops male pattern baldness completely or for life. I think stopping androgens with something more powerful probably would but with propecia most doctors I heard from say hair loss will slowly progress still.
I think science is spot on about androgens but we might need to target receptors or some other method because over time the hair could adapt to use other androgens. I think androgens though can 100 percent stop male pattern baldness. My hair loss has progressed 100 percent with facial hair and body hair. I still have little body hair and most of my head hair. At 18 I had zero body hair/facial hair and Norwood 0 not a hair missing on my head. Its the answer its just how best to do it.

 

[WarLord]

Warlord

For your information i have had very good success with Finasteride, the effects of which have stabilised my loss and have generated moderate regrowth. Results to which i am very pleased with. I have absolutely no desire to question the effectiveness of Finasteride and am well aware of its benefits in treating male pattern baldness.

You are correct, it is more of a preventative treatment than a treatment of which you may generate significant regrowth. Although some people may get results which are out of this world.
The point i was trying to establish is that some people with aggressive male pattern baldness, can only hope for a slowing down in their hairloss journey. These are the guys that go from a NW1 to a NW5+ within 5years. Now a slowing down is a success when compared to taking a placebo. But after 5years of treatment their hair count will still be dramatically reduced from baseline, hence they have not maintained their original haircount.

Now by removing or having a lower number of people who fall into this category when undertaking a clinical trial, we can get that 80-90% haircount maintained benchmark.

So when these studies are published, it will generate bigger headlines and more dollars/pounds for the Pharmaceutical company in profits. If they declared 55-65% haircount maintained after 5 years the headlines will not be as big.

Now you do not have to agree with me, that is only my opinion. But the throwing of insults, spitting your dummy out of the pram is totally unnecessary. We are hear to debate, listen to everyones opinions (whether you agree with it or not). The world would be a boring place if we were all the same.

Good luck with your hairloss battle!

I really don't understand your point. How could you identify these "unwanted" guys at the beginning of the research? To me, the results look very similarly. You routinely get 80-90% success rate on finasteride virtually in every study. This is logical, because finasteride eliminates 70% DHT out of your body.

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I still think it varies person to person and not everyone stops male pattern baldness completely or for life. I think stopping androgens with something more powerful probably would but with propecia most doctors I heard from say hair loss will slowly progress still.
I think science is spot on about androgens but we might need to target receptors or some other method because over time the hair could adapt to use other androgens. I think androgens though can 100 percent stop male pattern baldness. My hair loss has progressed 100 percent with facial hair and body hair. I still have little body hair and most of my head hair. At 18 I had zero body hair/facial hair and Norwood 0 not a hair missing on my head. Its the answer its just how best to do it.

"Most doctors" don't watch new research regularly and many of them are pretty dumb. Once I believed that all doctors are experts, but after many experiences, I know that this is not true. In 1998, my dermatologist refused to give me a prescription to an anti-hairloss medication, saying that it has side effects and that I will lose my hair anyway. I had a serious conflict with her and she showed me the door. If I followed her "advice", I would be bald now.

Now, consider that there existed no long-term study that she could base her statement on. She simply fabricated it. And if her patients were losing hair, then it was certainly due to her ingenious "cure".

 

[Quantum Cat]

I've thought about swithicng to Dutasteride but I'm wary as it's much stronger than finasteride, ie greater risk of side effects.

has there been a proper Dutasteride study like the finasteride 10-year study?

 

[LawOfThelema]

There has not been.