So I stopped taking 1mg finasteride at the end of November and starting taking .5 mg dutasteride ED the very next day. Within a week to the day I was shedding hair in the back and sides which I initially attributed to dutasteride but was most likely caused by abruptly stopping finasteride. In hindsight I should have stayed on finasteride for 3 months while introducing dutasteride. I’m now 3 months in and my hairline is taking a beating. Anyone have advice? Aside from quitting everything which will likely spell the end is there any benefit to adding finasteride back in while dutasteride continues to build or will that only exacerbate the problem? I’m kicking myself for listening to a few forum members who said there was no need to overlap treatment. I now see lots of threads saying the opposite.
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Mistakes Made Going From finasteride To dutasteride
- Thread starter MKP05
- Start date
I’ll add it’s not just my hairline. I’ve lost density everywhere in 3 months. Again I should’ve known better to not drop finasteride cold turkey after 17 months but I mistakenly relied on others who indicated there was no need to do so. I’ve never had any sides on either drug.
I’ll add it’s not just my hairline. I’ve lost density everywhere in 3 months. Again I should’ve known better to not drop finasteride cold turkey after 17 months but I mistakenly relied on others who indicated there was no need to do so. I’ve never had any sides on either drug.
im shedding too after 2 months.
There is no need to drop finasteride cold turkey.
Dutasteride after 1-2 weeks inihbit 89-90 % of dht. And after 6 months 94%.
Its written in the leaflet of avodart.
Its not sense take both. A lot of guys report a big shedding when they started, i think its because duta is so much strong and shock hairs to grow more thicker
Ok. Others report it takes 3 months to build up. Even the HairLossTalk.com admin years ago advised to never drop finasteride cold turkey. Hope I recover.
It takes 6 months to build up and inihbit 94%. But in the meanwhile it inihbit something like 90%. Its written in the leaflet of the medication, its not my invention.
The shedding seems a bit agressive , my hairline took a beat too, we should be patient and wait until 6 months
arnoldd made a good point, which I fully support:
It's true this weird idea of combining finasteride and dutasteride during a transition to dutasteride mono therapy seems quite embedded on this forum. I've seen a good number of threads suggesting this approach. I don't see any science behind it. I suppose this nonsense comes from a misunderstanding of a well-cited graph that shows the extent of DHT inhibition from dutasteride at different doses (0.5 - 5 mg) in comparison to finasteride over time, in addition to excessive cautiousness (probably due to very stress from addressing hair loss and constant fear that any change is risky) of the proponents of this approach.
There's no need for a transition combo therapy. I would never advise this if I was not sure about such a potentially serious aspect:
1) 1-2 weeks on dutasteride is more than enough to achieve a superior (to finasteride) level of DHT inhibition, it's top level of the inhibition is usually achieved by 6 months. It is completely reserved during 6-12 months off dutasteride.
2) An abrupt secession of DHT inhibition (e.g. if one stops finasteride with no replacement) cannot cause hair loss within a few months - unlike minoxidil or corticosteroids. Usually it takes 6-12 months to see some sings of further pattern hair loss progression. Extra (non-inhibited) DHT needs to accumulate around hair follicles, immune response in the DHT case is very slow. A secession cannot cause a rapid noticeable shed that is more intensive than usual - human body immune system does not work this way. It usually takes years, not months for follicles to shrink and hairs to miniaturise first. Although the number of hairs lost gradually increases, most of them do regrow but weaker and at a slower pace until they reach a point of no-regrowth.
I studied these aspects very throughly, as I needed to understand what will happen to my hair when I need to temporary discontinue dutasteride for a year in case I make up my mind to become a farther.
There is a related and more funny myth floating on this forum: some guys like to regularly measure their T and DHT levels. They emphasise that T has also smth to do with hair loss. Well, ok. After they switch from finasteride to dutasteride they note increased shedding. They also note that despite lower DHT on dutasteride, their T levels increase in comparison to T levels on finasteride. They conclude that this makes their hair loss worse- given that T can be also harmful. This misunderstanding gives way to very weird regimens - e.g. when one takes finasteride 6 days a week and dutasteride only once a week - trying to adjust it with the goal of maintaining T levels more or less the same as it used to be on finasteride mono therapy. At the very least this approach ignores the basics of how these drugs work: on dutasteride less T is converted to DHT, therefore all things being equal a blood test will show higher T levels on dutasteride than finasteride. Some have gone even further - trying to tackle this 'issue' - e.g. how to address higher T levels 'produced' by dutasteride - some switch back to finasteride, some try weird combo therapy, some go crazy (in my opinion) and add cyproterone-like drugs.
An abrupt switch from fina to duta was certainly not a mistake to regret.
It's true this weird idea of combining finasteride and dutasteride during a transition to dutasteride mono therapy seems quite embedded on this forum. I've seen a good number of threads suggesting this approach. I don't see any science behind it. I suppose this nonsense comes from a misunderstanding of a well-cited graph that shows the extent of DHT inhibition from dutasteride at different doses (0.5 - 5 mg) in comparison to finasteride over time, in addition to excessive cautiousness (probably due to very stress from addressing hair loss and constant fear that any change is risky) of the proponents of this approach.
There's no need for a transition combo therapy. I would never advise this if I was not sure about such a potentially serious aspect:
1) 1-2 weeks on dutasteride is more than enough to achieve a superior (to finasteride) level of DHT inhibition, it's top level of the inhibition is usually achieved by 6 months. It is completely reserved during 6-12 months off dutasteride.
2) An abrupt secession of DHT inhibition (e.g. if one stops finasteride with no replacement) cannot cause hair loss within a few months - unlike minoxidil or corticosteroids. Usually it takes 6-12 months to see some sings of further pattern hair loss progression. Extra (non-inhibited) DHT needs to accumulate around hair follicles, immune response in the DHT case is very slow. A secession cannot cause a rapid noticeable shed that is more intensive than usual - human body immune system does not work this way. It usually takes years, not months for follicles to shrink and hairs to miniaturise first. Although the number of hairs lost gradually increases, most of them do regrow but weaker and at a slower pace until they reach a point of no-regrowth.
I studied these aspects very throughly, as I needed to understand what will happen to my hair when I need to temporary discontinue dutasteride for a year in case I make up my mind to become a farther.
There is a related and more funny myth floating on this forum: some guys like to regularly measure their T and DHT levels. They emphasise that T has also smth to do with hair loss. Well, ok. After they switch from finasteride to dutasteride they note increased shedding. They also note that despite lower DHT on dutasteride, their T levels increase in comparison to T levels on finasteride. They conclude that this makes their hair loss worse- given that T can be also harmful. This misunderstanding gives way to very weird regimens - e.g. when one takes finasteride 6 days a week and dutasteride only once a week - trying to adjust it with the goal of maintaining T levels more or less the same as it used to be on finasteride mono therapy. At the very least this approach ignores the basics of how these drugs work: on dutasteride less T is converted to DHT, therefore all things being equal a blood test will show higher T levels on dutasteride than finasteride. Some have gone even further - trying to tackle this 'issue' - e.g. how to address higher T levels 'produced' by dutasteride - some switch back to finasteride, some try weird combo therapy, some go crazy (in my opinion) and add cyproterone-like drugs.
An abrupt switch from fina to duta was certainly not a mistake to regret.
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arnoldd made a good point, which I fully support:
It's true this weird idea of combining finasteride and dutasteride during a transition to dutasteride mono therapy seems quite embedded on this forum. I've seen a good number of threads suggesting this approach. I don't see any science behind it. I suppose this nonsense comes from a misunderstanding of a well-cited graph that shows the extent of DHT inhibition from dutasteride at different doses (0.5 - 5 mg) in comparison to finasteride over time, in addition to excessive cautiousness (probably due to very stress from addressing hair loss and constant fear that any change is risky) of the proponents of this approach.
There's no need for a transition combo therapy. I would never advise this if I was not sure about such a potentially serious aspect:
1) 1-2 weeks on dutasteride is more than enough to achieve a superior (to finasteride) level of DHT inhibition, it's top level of the inhibition is usually achieved by 6 months. It is completely reserved during 6-12 months off dutasteride.
2) An abrupt secession of DHT inhibition (e.g. if one stops finasteride with no replacement) cannot cause hair loss within a few months - unlike minoxidil or corticosteroids. .
Can you explain the role of corticosteroids in hair loss ? I used a course of medium dose of prednisone for 3 weeks. After 3 months i have some thinning and dont know if corticosteroids have hurt my hairs or its cause the shedding of dutasteride which i started 2 months ago
I saw your other thread where you mention prednisone. To put it short: I do understand why dermatologists like to prescribe glucocorticosteriods - they are very powerful and rapidly produce very visible effects, incl. the cases of hair loss (whether areata or pattern hair loss or... other inflammation-related causes) - but it is a road to hell. You highly likely to regret using these in mid-/long-term and/or in cases or erratic treatments (discontinuation), unlike dutasteride/finasteride - their very serious effects can become irreversible.
I've been very puzzled by MKP05's case, found an older thread - you may be interested in some points about corticosteriods I tried to make, I'm too lazy to repeat everything here, check https://www.hairlosstalk.com/intera...ck-thinning-on-dutasteride-pics.126660/page-3
My point is there are a lot of nuances of how they work and what you should expect if take this route
My point is there are a lot of nuances of how they work and what you should expect if take this route
I suspect this admin confused data on DHT inhibition timing with data on time required for effects on prostate hyperplasiaOk. Others report it takes 3 months to build up. Even the HairLossTalk.com admin years ago advised to never drop finasteride cold turkey. Hope I recover.
Another thing is that smb cannot read graphs properly- e.g. the first link (I googled) containing that well-known graph (scroll down a bit): https://donovan-hair.squarespace.com/hair-blog/?category=Male+pattern+balding
a superior level of inhibition (dutasteride) is achieved only by week 4, then stable; does it mean it takes as much as 4 weeks to achieve this level? - no, the marks on the graph indicate # of measurements: the first one at the start, the second = week 4, the line connecting these dots (measurements) does not adequately reflect the supposed 'gradual' nature of achieving a certain level of inhibition, around the same level is already achieved by week 1, as clinical pharmacology of this drug suggests (there are variations across studies, everyone is different in the end, which is reflected in different p-values for certain % of inhibition among certain % of participants at day 5...7...10...28
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I saw your other thread where you mention prednisone. To put it short: I do understand why dermatologists like to prescribe glucocorticosteriods - they are very powerful and rapidly produce very visible effects, incl. the cases of hair loss (whether areata or pattern hair loss or... other inflammation-related causes) - but it is a road to hell. You highly likely to regret using these in mid-/long-term and/or in cases or erratic treatments (discontinuation), unlike dutasteride/finasteride - their very serious effects can become irreversible.
Im interested in the hormonal effect.
i suspect corticosteroids can hurt hairs by increasing insulin which lowers SHBG, so there is more free testosterone.
However there are plenty of studies where the use of chronic glucocorticoid is associated with lower testosterone, because they inihbit both adrenal and gonadal secretion.
Maybe, and i hope that (lol) , they lower shbg but also testosterone, so the ratio testo:shbg remain unchanged and there isnt any deleterious effect such more androgens activity.
----- what is really serious with respect to hair loss is that once you start e.g. prednisone, you cannot stop otherwise you will observe much more devastating loss than e.g. with minoxidil discontinuation , this is about corticosteroid dependencyIm interested in the hormonal effect.
i suspect corticosteroids can hurt hairs by increasing insulin which lowers SHBG, so there is more free testosterone.
-------- This mechanism exists. What to do? Ignore that) It's all theory, in practice anti-inflammatory properties of cortocisteriods far outweighs things like this, a slight alteration in your daily meal can produce a more substantial increase in insulin
However there are plenty of studies where the use of chronic glucocorticoid is associated with lower testosterone, because they inihbit both adrenal and gonadal secretion.
--------- This is an example of an irreversible effect of corticosteriods on T secretion in the long term, but it is of mediocre importance for hair loss discussion, ignore that
Maybe, and i hope that (lol) , they lower shbg but also testosterone, so the ratio testo:shbg remain unchanged and there isnt any deleterious effect such more androgens activity.
----- irrelevant for hair loss discussion (but relevant for a male's long-term health indeed), ignore that & keep calm)
----- what is really serious with respect to hair loss is that once you start e.g. prednisone, you cannot stop otherwise you will observe much more devastating loss than e.g. with minoxidil discontinuation , this is about corticosteroid dependency
So you think they have a positive effect. For Alopecia areata its clear, not sure for androgenetic alopecia
they're usually prescribed for areata - a more tricky mechanism of inflammation, but they are also very effective to combat pattern hair loss (although not usually used as there are finasteride and other less serious drugs) or to combat acne - there're indications for a very long list of various inflammatory conditionsSo you think they have a positive effect. For Alopecia areata its clear, not sure for androgenetic alopecia
PS don't use these unless you badly need them for a life-threatening condition or smith that severely affects the quality of life (e.g. joints pain etc),
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they're usually prescribed for areata - a more tricky mechanism of inflammation, but they are also very effective to combat pattern hair loss (although not usually used as there are finasteride and other less serious drugs) or to combat acne - there're indications for a very long list of various inflammatory conditions
PS don't use these unless you badly need them for a life-threatening condition or smith that severely affects the quality of life (e.g. joints pain etc),
Yes i read that sometimes they are using in the treatment of serious acne, and even for the prostate cancer, so they cant have an androgenic effect if used for these diseases.
So my pattern hair loss started exactly one month after getting corticosteroids injections for areata plus 2 rounds of prednisone pulses (massive doses of prednisone taken orally at once). As I’ve detailed in my threads I previously had areata for 20 years but had come off a ten year stretch with no outbreaks. Since 2018 I have had two areata episodes - the initial one was very large the size of a softball and one small the size of a dime. Both times treated with corticosteroids and both times followed with increased pattern hair loss. If there truly is a connection between the corticosteroids and my hair loss due to dependency I’d love to know when that dependency will stop. The problem is these are just guesses. All a doctor will say is that I’ve got aggressive pattern hair loss which doesn’t respond to finasteride or dutasteride.
Is it the same doctor who prescribed you corticosteroids? I have no idea why they refuse to consider corticosteriod discontinuation syndrome. Timing fits perfectlyBoth times treated with corticosteroids and both times followed with increased pattern hair loss.
----- This was a discontinuation syndrome. There is a very high probability that if you had stuck to taking daily prednisone, you would have seen a good regrowth. They affect your entire scalp incl. areas prone to pattern hair loss.
I'm aware of a good number of stories and results that I've seen among those guys who want hair, but cannot afford Rogaine and/or do not want to use DHT blockers, therefore they use a possibly cheapest option- hydrocortisone-like topicals on their deceased areas of the scalp. They combat inflammation incl that caused by DHT and see good regrowth. It's sad that they've to take this route for financial reasons, as at some pinto they will lose much more due to skin atrophy.
If there truly is a connection between the corticosteroids and my hair loss due to dependency I’d love to know when that dependency will stop.
---- Hardly I know how serious your dependency is. I only know that over time corticosteriods produce certain irreversible effects. Given your timing, I hope if you avoid these in the future, you''ll recover. Alternatively, you've to use them regularly, regardless whether you have areata at the moment or not.
The problem is these are just guesses. All a doctor will say is that I’ve got aggressive pattern hair loss which doesn’t respond to finasteride or dutasteride.
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I have seen 4 different dermatologists one of which is the one I have been to over two multi month periods to get corticosteroid injections for areata since 2018 and prescribed the prednisone which I took only over two months in 2018. 3 of the 4 have dismissed any other reason for my hair loss other than male pattern baldness. My current derm at Columbia university in NY is slightly more skeptical and seems open to other possibilities. I see her again in about 10 days and I’ll discuss the corticosteroids withdrawal possibility with her. I always thought the injections had a local affect only. I have never gotten injections anywhere except the back of my head where the areata always presents itself. But I did use prednisone in 2018 and clobetasol on and off in 2018 and 2019. I’m very curious to discuss zeljanz again with her as she thought it was worth a trial over 3 months to see if it triggers any regrowth. She said 3 months would be enough time to see if it was worthwhile to continue.Is it the same doctor who prescribed you corticosteroids? I have no idea why they refuse to consider corticosteriod discontinuation syndrome. Timing fits perfectly
Given that you have areata as well, zelijanz would be a particularly attractive option:I’m very curious to discuss zeljanz again with her as she thought it was worth a trial over 3 months to see if it triggers any regrowth. .
- corticosteriod injections are widely used to treat areata spot locally, but esp. if it is around the same spot for injections- at some point this exposure will result in extreme damage to your scalp in this area and it may not be able to produce hair
- injections locally are certainly more effective than e.g. oral prednisone alone + this allows to minimise systemic effects on your body
- another problem is that it's unjustifiably risky to be on oral corticosteroids on a regular basis for the sake of just a cosmetic condition,
- a withdrawal effect will affect your entire scalp (by temporarily reducing inflammation in e.g. pattern hair loss zones and then shock your follicles when inflammation increases again) again and again when your areata reappears
- using this immunosuppressant regularly is likely to lower the risk of areata spots in the future and you may not need occasional extra treatments for areata
So I have made a few slight changes over the past week. I stopped using Nizoral as I noticed that on days of use my hair was dead, lifeless and looked grayer and thinner. Secondly I stopped taking 2 medications - lipitor for cholesterol and metropolol for blood pressure. Both are widely known for causing hair loss. I’ve also added topical minoxidil back into my regime at the hairline only (it was a mistake to stop in the first place).
My hair looks and feels a lot better the last couple of days. I’ve even gotten some of the color and life back. I think the nizoral was doing me more harm than good. Dropping the medications are obviously not a long term solution because my health is more important than my hair but I thought I’d do a small experiment to see if these may have been contributing to the problem. I have an appointment with my GP this week and I’ll discuss potential alternatives. I’m pretty sure there are other statins available which don’t cause hair loss. The BP med might be more difficult. Adding the minoxidil will hopefully give my hairline a boost. I have to say that today is the best my hair has looked or felt in about a month where every day it felt and looked worse than the previous day. Also The last 6 weeks my hair had felt like it was growing at about half the normal pace...it was really strange. I feel like the growth rate is getting back to normal and even in the past couple of days it seems to growing like crazy again. Maybe my system is beginning to normalize a bit. Tomorrow could be a different story but at least for today the health of my hair seemed much better. Hopefully a sign of good things to come.
My hair looks and feels a lot better the last couple of days. I’ve even gotten some of the color and life back. I think the nizoral was doing me more harm than good. Dropping the medications are obviously not a long term solution because my health is more important than my hair but I thought I’d do a small experiment to see if these may have been contributing to the problem. I have an appointment with my GP this week and I’ll discuss potential alternatives. I’m pretty sure there are other statins available which don’t cause hair loss. The BP med might be more difficult. Adding the minoxidil will hopefully give my hairline a boost. I have to say that today is the best my hair has looked or felt in about a month where every day it felt and looked worse than the previous day. Also The last 6 weeks my hair had felt like it was growing at about half the normal pace...it was really strange. I feel like the growth rate is getting back to normal and even in the past couple of days it seems to growing like crazy again. Maybe my system is beginning to normalize a bit. Tomorrow could be a different story but at least for today the health of my hair seemed much better. Hopefully a sign of good things to come.