Shedding:
This can be painful but it’s worth it. In the first 1-3 months many experience a shed on minoxidil, some also on finasteride and dutasteride. RU and CB don’t seem to induce a shed and they work quickly. I saw a reduction in hair coming out after about 3 weeks. On finasteride/dutasteride for most people by about the 2-4 month mark it will be noticeable that less hair is coming out. You should really know if it’s working by 6 months. My finasteride and dutasteride experiences were similar- I noticed less hair coming out by month 2 and some thickening at the back by month 3 which continued until month 6. I had a heavy shed from 2 weeks in to minoxidil then decent thickening at the front by month 3/4. Some say give it a year to see if shedding reduces. I personally think if you aren’t seeing less hair coming out by 6 months then you are probably losing hair rather than shedding and it’s probably time to add to your regimen. Sometimes it’s hard to distinguish between shedding and losing hair. One way to check is if the individual hairs get thinner and lighter in colour towards the root then this is miniaturisation during the cycle. That is hair loss. If the hairs are the same thickness through the shaft then it’s more likely to be shedding. This is just a guide- there will be variation within this so keep a close eye on it. I have read reports of people shedding for 9 months before regrowth so in some cases it could take up to a year to see shedding stop. Unfortunately individual responses vary wildly so this is something we each need to monitor carefully ourselves. Go with your gut feeling. When did it start/ accelerate? Does this feel like a normal, steady rate of hair loss or is it unusually rapid? If it’s faster than normal it’s probably a shed, if it’s steady then it’s likely loss Essentially if you have the same hair density a year from starting anti-androgens then you are winning the battle. Be aware that some people, particularly diffuse thinners, will see some small fluctuations in density over the course of treatment. This normally returns within about three months so take note of when you first notice it and check it doesn’t go over 3ish months. It’s a tricky thing to judge. If you haven’t returned to normal by 3/4 months it’s probably an indication that you’re losing the battle and need to add something new.
Watch for increased shedding particularly in the shower (maybe buy a hair catcher) or when rubbing in minoxidil over a white sink. Know what is a normal amount of hair to see in the sink/ your hands or in the hair catcher. Maybe write this down. This will enable you to act quickly if you notice an increase that lasts over a month or so. If you notice an increase in shedding watch closely for a change in the density of hair on your head or more visible scalp in sun light or when wet. An increase in shedding is a warning sign, the decrease in density is the moment you need to pull the trigger and add to your regimen.
Emotional Impact vs Risk of Meds
Don’t underestimate how devastating hair loss can be- it has the potential to effect every aspect of your life. The tragedy is that you won’t truly understand the impact of hair loss until it’s too late-so take it from me that you want to avoid it as long as possible. When your hair eventually does go it could feel like a bereavement. This goes well beyond vanity- part of your identity has been ripped away without your consent. You may look at yourself in the mirror and not recognise the person looking back. Many feel that their youth has been abruptly cut short. Honestly I haven’t felt the same since propecia stopped working- it is the hardest thing I have ever been through. The (minimal) risk of using medication to fight it is much less significant than the very real damage it can do to your quality of life. Finasteride is an FDA approved and tested medicine that has the power to dramatically enhance your life and is safe for long term use. The 9 years that I maintained on finasteride were the best years of my life. It’s never too late to start as your hair will only get worse without intervention. In time you won’t have the option of being able to stop hair loss as DHT is only part of the equation, it’s just the part we have *some* control over. My recommendation is to do the best you can now with the tools we have. Often people wait until it’s really causing them distress before treating it and then end up never satisfied and putting far more chemicals into their body to achieve a head of hair they can live with. In the early stages Finasteride alone may have been enough. This leaves other treatments for the future when finasteride’s effects wane.
Planning Your Next Step
Always plan your next step for when your current regimen starts to lose the battle (you notice increased shedding/ less density/trouble styling). Maybe have it ready in your house so you can take action immediately when it happens. Eg if you are using finasteride buy a box of dutasteride, if you’re maintaining on dutasteride have RU powder in your freezer and stemoxidine ready to mix it into.
When you know a treatment is available that might help your situation it is very difficult to resist using it as your condition worsens. However, you will save more hair by adding a new treatment from the moment you see a decrease in density. Perhaps acknowledge that in time you will use all the available treatments (if that is the kind of person you are) and it is better to use them earlier than later. When I look back on this I’ll need to know I did everything I could with what was available and if I’m bald that’s just how it has to be. I said I’d draw the line at Dutasteride because RU was untrialled... 6 months later I didn’t feel I had a choice so started using RU. Now I wish I’d started sooner. All that said, we all have regrets about not starting earlier- it’s the nature of the beast- so don’t beat yourself up about it if you feel you’ve waited too long.
Variation in Response.
Hair loss is multi faceted and what works for someone else may not work for you. Also treatments work in different areas and for different lengths of time for different people. Don’t give up if a treatment you had high hopes doesn’t render results- try something else with a different mechanism. Try them all- you never know what might save your hair. For RU/ CB increase the dosage, frequency, vehicle or method of application.
Upping Dosage or Address a Different Angle?.
Generally it will be more effective to add a different treatment than to raise the dosage of the one you are on. Finasteride has a flat dose response so taking a higher dose won’t work any better. Apparently a dose of 0.5 mg daily is almost as good as 1mg so if you get side effects this might be worth a try. Also, in my experience anything over 5% minoxidil is not any more potent, though it seems that taking minoxidil orally (2.5mg-5mg daily) is more effective than topically. If finasteride isn’t enough to stop you losing you need to inhibit more DHT systemically with Dutasteride. If this isn’t enough it could be that you need to address another angle by using an androgen receptor antagonist topically like RU or CB on the scalp.
Dropping Treatments and Upregulation
You need to think very carefully about the potential impact dropping a treatment could have. Sometimes you will get lucky and everything will stay the same but the danger is in 3 months you might have a huge shed and really regret the decision. It is best to only ever add more to your regimen (inhibiting more androgens) and never step it down. If it’s just dropping an add-on alternative treatment like topical spironolactone or a lasercomb by all means drop it but if you’re thinking of dropping dutasteride in favour of finasteride I would not consider it. Upregulation is real and you won’t know the effect of dropping something until 3 months later. I have seen the damage done from dropping Dutasteride and going back to finasteride. The shed was very shocking and I progressed from NW2 to 3 in a few months. If you are getting side effects try reducing the dose/ frequency before dropping it completely. Also many get sick of the hassle of rubbing in minoxidil. If you feel like this then try it in tablet form (loniten) from a dermatologist.
Professional Advice.
Others may disagree with this but I have found no benefit in seeking advice from Dermatologists and transplant surgeons. I have had bad experiences so I’m biased but I would argue that there is just no need when more accurate advice can be sought online for free. There are very few experts on this in the world and the likelihood that you’ll find one locally is minuscule. I haven’t found one expert in London. I have spent hundreds of pounds visiting doctors only to realise that I was better informed than they were. You’re on your own. But this isn’t a bad thing. What I mean is it is your responsibility to preserve your hair as long as you can through doing your own research. All the information you need is available on this forum and on the Hair Loss Show podcast (YouTube link below). Spend a weekend searching for your specific problem on here and message people that you think seem well informed. I have been told by two transplant surgeons that finasteride will stop hair loss for life- this is simply not true and is dangerous to believe. Though it suits transplant surgeons to say it. I have also been advised to use a lasercomb, double my finasteride dose, that my hair loss was due to a vitamin deficiency or that I could swap finasteride for saw palmetto. Idiots! Go to them for a prescription or to discuss side effects but take what they say with a pinch of salt. Ultimately they don’t care about your hair like you do. It can also be counter productive because often you will unknowingly visit a bad one and then trust their bad advice simply because they are a doctor. For balanced, well informed professional advice watch this series of podcasts by two leading transplant surgeons:
. Maybe watch this whole series and then go to a dermatologist to get the physical prescription for what you want. Make sure you know what you intend to leave with when you go in and don’t let them talk you out of it. My Derm loves to do this and that’s why I now feel sad every time I look in the mirror.
How do I know if I’m losing hair?
Don’t expect a dermatologist to easily diagnose whether you are losing hair. It seems simple but I’ve had dermatologists point blank tell me I wasn’t only to realise months later that I’ve lost a significant amount of hair. Truthfully, if you think you’re losing your hair then you probably are. No one knows your hair like you do. Generally speaking if I pull on a handful of hair when maintaining nothing comes out, maybe one hair. If I pull on it when I’m losing hair between 1 and 5 hairs come out. This differs for everyone because it’s really about whether the hair is being replaced by a weaker follicle or not. Some people don’t have much hair coming out but are still losing density. A dermatologist’s pull test suggests that up to 5 hairs per pull is normal- this is just not correct for many people and it is well known that pull tests often give false negatives. Really it’s not about what comes out but about judging whether the density on your head has changed over time (maybe judge every 3ish months) which is why photos wet and dry in the same lighting conditions can be useful- I find bright sunshine the most useful. Be aware that photos can look different in different conditions/ different angles. Another test that you can do is to closely examine a lost hair- does it get thinner towards the root? If so it’s miniaturising during the hair cycle. Also if you are losing a lot of thin weak hair then this is a sign- though sometimes it is difficult to distinguish this from ‘shedding’ . It goes without saying that a GP or pharmacist has no knowledge at all about these treatments so don’t listen to them warning you off them or telling you that ‘nothing works’.
Transplants
I am not very knowledgeable on transplants so feel free to correct me here. What I have heard is that transplants are really only for those who don’t have aggressive hair loss. Ideal candidates are often over 30, with minimal frontal loss (not a good solution for the crown) and haven’t yet had their run on the drugs. Do your research and be wary about what surgeons tell you, some are good, some are badly informed. The two I have spoken to were useless, I wouldn’t dream of letting them cut my scalp. If you aren’t maintaining through medical therapy then in a few years it will just be the grafts left. Look at Wayne Rooney’s transplant now if you need further clarification. Additionally the hair at the back/sides of your hair is not immune from androgenic damage despite what they’ll tell you. It’s just more resistant than the hair on top. In time even that will miniaturise. It is far more important to preserve the hair you have now than rely on a surgeon to move around what you have left later on. It’s just repositioning after all...
Hair Pieces/ Systems.
I am looking in to these at the moment so I can’t give any definite answers but many people are very happy with this solution. This is the option to use when the drugs stop working and you can’t get by on hair building fibres any more (Supermillions is a really good fibre, much better than Toppik). It seems that many start with Propecia/ Regaine then fibres, then systems. Spend some time on the hair replacement section of this forum- it is a very supportive community. Look at the photos on Northwest Lace’s forum, Hair by MHE and Hair Direct YouTube channels. This interview on the hair direct chanel really resonated with me
. It is an art form. The first thing you need to do is to try to keep the hair you have in whatever way you feel comfortable with- don’t skip straight to systems at the first sign of hair loss. Systems are really for when your own hair growing from your head is no longer a viable option. It is also worth noting that they work best when you still have some hair at the sides of your head so this is still worth preserving with finasteride/ minoxidil.
.
Last words!
Enjoy the years that you are maintaining your hair- it is a gift that through medical advancements we can now delay hair loss for many years. Make good use of this time knowing that it won’t last forever.
Good luck!
Continued on page 1: https://www.hairlosstalk.com/intera...g-their-hair-loss-journey-page-1-of-3.128423/
And page 2 https://www.hairlosstalk.com/intera...g-their-hair-loss-journey-page-2-of-3.128424/
This can be painful but it’s worth it. In the first 1-3 months many experience a shed on minoxidil, some also on finasteride and dutasteride. RU and CB don’t seem to induce a shed and they work quickly. I saw a reduction in hair coming out after about 3 weeks. On finasteride/dutasteride for most people by about the 2-4 month mark it will be noticeable that less hair is coming out. You should really know if it’s working by 6 months. My finasteride and dutasteride experiences were similar- I noticed less hair coming out by month 2 and some thickening at the back by month 3 which continued until month 6. I had a heavy shed from 2 weeks in to minoxidil then decent thickening at the front by month 3/4. Some say give it a year to see if shedding reduces. I personally think if you aren’t seeing less hair coming out by 6 months then you are probably losing hair rather than shedding and it’s probably time to add to your regimen. Sometimes it’s hard to distinguish between shedding and losing hair. One way to check is if the individual hairs get thinner and lighter in colour towards the root then this is miniaturisation during the cycle. That is hair loss. If the hairs are the same thickness through the shaft then it’s more likely to be shedding. This is just a guide- there will be variation within this so keep a close eye on it. I have read reports of people shedding for 9 months before regrowth so in some cases it could take up to a year to see shedding stop. Unfortunately individual responses vary wildly so this is something we each need to monitor carefully ourselves. Go with your gut feeling. When did it start/ accelerate? Does this feel like a normal, steady rate of hair loss or is it unusually rapid? If it’s faster than normal it’s probably a shed, if it’s steady then it’s likely loss Essentially if you have the same hair density a year from starting anti-androgens then you are winning the battle. Be aware that some people, particularly diffuse thinners, will see some small fluctuations in density over the course of treatment. This normally returns within about three months so take note of when you first notice it and check it doesn’t go over 3ish months. It’s a tricky thing to judge. If you haven’t returned to normal by 3/4 months it’s probably an indication that you’re losing the battle and need to add something new.
Watch for increased shedding particularly in the shower (maybe buy a hair catcher) or when rubbing in minoxidil over a white sink. Know what is a normal amount of hair to see in the sink/ your hands or in the hair catcher. Maybe write this down. This will enable you to act quickly if you notice an increase that lasts over a month or so. If you notice an increase in shedding watch closely for a change in the density of hair on your head or more visible scalp in sun light or when wet. An increase in shedding is a warning sign, the decrease in density is the moment you need to pull the trigger and add to your regimen.
Emotional Impact vs Risk of Meds
Don’t underestimate how devastating hair loss can be- it has the potential to effect every aspect of your life. The tragedy is that you won’t truly understand the impact of hair loss until it’s too late-so take it from me that you want to avoid it as long as possible. When your hair eventually does go it could feel like a bereavement. This goes well beyond vanity- part of your identity has been ripped away without your consent. You may look at yourself in the mirror and not recognise the person looking back. Many feel that their youth has been abruptly cut short. Honestly I haven’t felt the same since propecia stopped working- it is the hardest thing I have ever been through. The (minimal) risk of using medication to fight it is much less significant than the very real damage it can do to your quality of life. Finasteride is an FDA approved and tested medicine that has the power to dramatically enhance your life and is safe for long term use. The 9 years that I maintained on finasteride were the best years of my life. It’s never too late to start as your hair will only get worse without intervention. In time you won’t have the option of being able to stop hair loss as DHT is only part of the equation, it’s just the part we have *some* control over. My recommendation is to do the best you can now with the tools we have. Often people wait until it’s really causing them distress before treating it and then end up never satisfied and putting far more chemicals into their body to achieve a head of hair they can live with. In the early stages Finasteride alone may have been enough. This leaves other treatments for the future when finasteride’s effects wane.
Planning Your Next Step
Always plan your next step for when your current regimen starts to lose the battle (you notice increased shedding/ less density/trouble styling). Maybe have it ready in your house so you can take action immediately when it happens. Eg if you are using finasteride buy a box of dutasteride, if you’re maintaining on dutasteride have RU powder in your freezer and stemoxidine ready to mix it into.
When you know a treatment is available that might help your situation it is very difficult to resist using it as your condition worsens. However, you will save more hair by adding a new treatment from the moment you see a decrease in density. Perhaps acknowledge that in time you will use all the available treatments (if that is the kind of person you are) and it is better to use them earlier than later. When I look back on this I’ll need to know I did everything I could with what was available and if I’m bald that’s just how it has to be. I said I’d draw the line at Dutasteride because RU was untrialled... 6 months later I didn’t feel I had a choice so started using RU. Now I wish I’d started sooner. All that said, we all have regrets about not starting earlier- it’s the nature of the beast- so don’t beat yourself up about it if you feel you’ve waited too long.
Variation in Response.
Hair loss is multi faceted and what works for someone else may not work for you. Also treatments work in different areas and for different lengths of time for different people. Don’t give up if a treatment you had high hopes doesn’t render results- try something else with a different mechanism. Try them all- you never know what might save your hair. For RU/ CB increase the dosage, frequency, vehicle or method of application.
Upping Dosage or Address a Different Angle?.
Generally it will be more effective to add a different treatment than to raise the dosage of the one you are on. Finasteride has a flat dose response so taking a higher dose won’t work any better. Apparently a dose of 0.5 mg daily is almost as good as 1mg so if you get side effects this might be worth a try. Also, in my experience anything over 5% minoxidil is not any more potent, though it seems that taking minoxidil orally (2.5mg-5mg daily) is more effective than topically. If finasteride isn’t enough to stop you losing you need to inhibit more DHT systemically with Dutasteride. If this isn’t enough it could be that you need to address another angle by using an androgen receptor antagonist topically like RU or CB on the scalp.
Dropping Treatments and Upregulation
You need to think very carefully about the potential impact dropping a treatment could have. Sometimes you will get lucky and everything will stay the same but the danger is in 3 months you might have a huge shed and really regret the decision. It is best to only ever add more to your regimen (inhibiting more androgens) and never step it down. If it’s just dropping an add-on alternative treatment like topical spironolactone or a lasercomb by all means drop it but if you’re thinking of dropping dutasteride in favour of finasteride I would not consider it. Upregulation is real and you won’t know the effect of dropping something until 3 months later. I have seen the damage done from dropping Dutasteride and going back to finasteride. The shed was very shocking and I progressed from NW2 to 3 in a few months. If you are getting side effects try reducing the dose/ frequency before dropping it completely. Also many get sick of the hassle of rubbing in minoxidil. If you feel like this then try it in tablet form (loniten) from a dermatologist.
Professional Advice.
Others may disagree with this but I have found no benefit in seeking advice from Dermatologists and transplant surgeons. I have had bad experiences so I’m biased but I would argue that there is just no need when more accurate advice can be sought online for free. There are very few experts on this in the world and the likelihood that you’ll find one locally is minuscule. I haven’t found one expert in London. I have spent hundreds of pounds visiting doctors only to realise that I was better informed than they were. You’re on your own. But this isn’t a bad thing. What I mean is it is your responsibility to preserve your hair as long as you can through doing your own research. All the information you need is available on this forum and on the Hair Loss Show podcast (YouTube link below). Spend a weekend searching for your specific problem on here and message people that you think seem well informed. I have been told by two transplant surgeons that finasteride will stop hair loss for life- this is simply not true and is dangerous to believe. Though it suits transplant surgeons to say it. I have also been advised to use a lasercomb, double my finasteride dose, that my hair loss was due to a vitamin deficiency or that I could swap finasteride for saw palmetto. Idiots! Go to them for a prescription or to discuss side effects but take what they say with a pinch of salt. Ultimately they don’t care about your hair like you do. It can also be counter productive because often you will unknowingly visit a bad one and then trust their bad advice simply because they are a doctor. For balanced, well informed professional advice watch this series of podcasts by two leading transplant surgeons:
How do I know if I’m losing hair?
Don’t expect a dermatologist to easily diagnose whether you are losing hair. It seems simple but I’ve had dermatologists point blank tell me I wasn’t only to realise months later that I’ve lost a significant amount of hair. Truthfully, if you think you’re losing your hair then you probably are. No one knows your hair like you do. Generally speaking if I pull on a handful of hair when maintaining nothing comes out, maybe one hair. If I pull on it when I’m losing hair between 1 and 5 hairs come out. This differs for everyone because it’s really about whether the hair is being replaced by a weaker follicle or not. Some people don’t have much hair coming out but are still losing density. A dermatologist’s pull test suggests that up to 5 hairs per pull is normal- this is just not correct for many people and it is well known that pull tests often give false negatives. Really it’s not about what comes out but about judging whether the density on your head has changed over time (maybe judge every 3ish months) which is why photos wet and dry in the same lighting conditions can be useful- I find bright sunshine the most useful. Be aware that photos can look different in different conditions/ different angles. Another test that you can do is to closely examine a lost hair- does it get thinner towards the root? If so it’s miniaturising during the hair cycle. Also if you are losing a lot of thin weak hair then this is a sign- though sometimes it is difficult to distinguish this from ‘shedding’ . It goes without saying that a GP or pharmacist has no knowledge at all about these treatments so don’t listen to them warning you off them or telling you that ‘nothing works’.
Transplants
I am not very knowledgeable on transplants so feel free to correct me here. What I have heard is that transplants are really only for those who don’t have aggressive hair loss. Ideal candidates are often over 30, with minimal frontal loss (not a good solution for the crown) and haven’t yet had their run on the drugs. Do your research and be wary about what surgeons tell you, some are good, some are badly informed. The two I have spoken to were useless, I wouldn’t dream of letting them cut my scalp. If you aren’t maintaining through medical therapy then in a few years it will just be the grafts left. Look at Wayne Rooney’s transplant now if you need further clarification. Additionally the hair at the back/sides of your hair is not immune from androgenic damage despite what they’ll tell you. It’s just more resistant than the hair on top. In time even that will miniaturise. It is far more important to preserve the hair you have now than rely on a surgeon to move around what you have left later on. It’s just repositioning after all...
Hair Pieces/ Systems.
I am looking in to these at the moment so I can’t give any definite answers but many people are very happy with this solution. This is the option to use when the drugs stop working and you can’t get by on hair building fibres any more (Supermillions is a really good fibre, much better than Toppik). It seems that many start with Propecia/ Regaine then fibres, then systems. Spend some time on the hair replacement section of this forum- it is a very supportive community. Look at the photos on Northwest Lace’s forum, Hair by MHE and Hair Direct YouTube channels. This interview on the hair direct chanel really resonated with me
.
Last words!
Enjoy the years that you are maintaining your hair- it is a gift that through medical advancements we can now delay hair loss for many years. Make good use of this time knowing that it won’t last forever.
Good luck!
Continued on page 1: https://www.hairlosstalk.com/intera...g-their-hair-loss-journey-page-1-of-3.128423/
And page 2 https://www.hairlosstalk.com/intera...g-their-hair-loss-journey-page-2-of-3.128424/
Last edited: