Mistakes Made Going From finasteride To dutasteride

[baba_yaga]

When you started finasteride for the first time, when did you notice the worsening? (after a week?)

 

[Anatoly]

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.

OMG! Thank you for making me so stressed)), as I'm very worried about your health now. At least it's good you've mentioned this.
1) MOST IMPORTANT: you should IMMEDIATELY resume Lipitor. It's a drug of vital importance to reduce your risk of MACE. It's not only about cholesterol. It lowers both 1) LDL cholesterol with the target of LDL below 1,5 mmol/L (in 2020 it's a well-established truth that the lower LDL - the better, to stop atherosclerosis from progression one usually requires LDL below 1,5 mmol/L; consult Steve Nissen from Cleveland, who conducted numerous trials on lipid lowering drugs for their FDA approval); and 2) high-sensitive-CRP (a marker showing general level of inflammation in your body, incl. your blood vessels), the target is below 1,5 mg/dL.

It's true statins have hair loss as a side effect (listed in prescription info). But it is rare and of very minor importance. Actually, statins indirectly protect your hair in the long term: Lipitor protects your blood vessels, allowing to slow down or even stop the progression of atherosclerosis and maintain proper blood supply e.g. in your carotid arteries.With respect to hair loss you've to proceed from the fact that you have be on statins for the rest your life, in the future the Q is only about increasing the dose and adding second- and third-line drugs if you fail to achieve the targets for LDL and hs-CRP. You may discuss with your cardiologist: a switch from Lipitor to Crestor (at a lower dosage, as Crestor is twice as powerful in lowering LDL + it lowers inflammation better even at low doses); a combination therapy -e.g.Lipitor/Crestor at a lower dose + evolocumab (Repatha, a newer and much more expensive lipid-lowering drug), Repatha is proven to reverse atherosclerosis by extremely lowering your LDL (but it does not lower inflammation).

You have also to RESUME METOPROLOL: it's a very serious drug and you cannot stop abruptly, it's dangerous for your heart. Medical care in the USA is very advanced and I doubt it has been prescribed to lower blood pressure. It does lower blood pressure, for which it was used in the past. Now it is a forth- or fifth-line therapy to lower blood pressure. It's main importance and indication is not blood-pressure lowering, but pace and rhythm control, which is revenant for risk of arrhythmias. I'm certain you started it with a titration to achieve a target dose and Holter monitor results. You cannot stop it abruptly (only by gradually reducing the dose), it's very dangerous, as it may result in increased heart rate and life-threatening arrhythmias.
Therefore, I cannot say whether you should resume it at your usual dose. If you missed metoprolol for a week, you probably have to restart it with a titration (as it was at the start of the therapy). Consult your cardiologist for advice on a resumption scheme. Do it today. Pay attention to the episodes of abnormal heart rhythm and increased heart rate, if you've recently experienced these.
For hair loss metoprolol is of minor importance.

What makes me even more stressed is that not only you discontinued metoprolol, but also resumed minoxidil which increases heart rate and may facilitate dangerous arrhythmias. Actually, given the risks (heart pace and rhythm) of high-strength minoxidil, a beta-blocker such as metoprolol of of great help to counter these risks and allow you to take minoxidil safely.

2) Nizoral: it does make hair look lifeless, but it's not a justifiable reason for discontinuation. It's just a cosmetic condition and the issue is very easily addressed by a good hair balm. I use 2% Nizoral every day, then some after-shampoo care (mint conditioner and balm that I spread only to my hair, avoiding 1-2cm at the roots so as not to make my scalp dirty because of oils they contain to make hair shiny and detangled). My hair is very shiny, silky, soft, easily combed and lie perfectly. The point is that although Nizoral causes what bothers you, the issue is very easily addressed by after-shampoo care.

3) good news that you start to see improvements of your hair, try not to ruin everything again by erratic minoxidil use (Now you've restarted, so don't stop for a single day, it works half a day - this is why you have to use it twice daily) and by corticosteriod interventions (whether topical or oral..)

 

[MKP05]

OMG! Thank you for making me so stressed)), as I'm very worried about your health now. At least it's good you've mentioned this.
1) MOST IMPORTANT: you should IMMEDIATELY resume Lipitor. It's a drug of vital importance to reduce your risk of MACE. It's not only about cholesterol. It lowers both 1) LDL cholesterol with the target of LDL below 1,5 mmol/L (in 2020 it's a well-established truth that the lower LDL - the better, to stop atherosclerosis from progression one usually requires LDL below 1,5 mmol/L; consult Steve Nissen from Cleveland, who conducted numerous trials on lipid lowering drugs for their FDA approval); and 2) high-sensitive-CRP (a marker showing general level of inflammation in your body, incl. your blood vessels), the target is below 1,5 mg/dL.

It's true statins have hair loss as a side effect (listed in prescription info). But it is rare and of very minor importance. Actually, statins indirectly protect your hair in the long term: Lipitor protects your blood vessels, allowing to slow down or even stop the progression of atherosclerosis and maintain proper blood supply e.g. in your carotid arteries.With respect to hair loss you've to proceed from the fact that you have be on statins for the rest your life, in the future the Q is only about increasing the dose and adding second- and third-line drugs if you fail to achieve the targets for LDL and hs-CRP. You may discuss with your cardiologist: a switch from Lipitor to Crestor (at a lower dosage, as Crestor is twice as powerful in lowering LDL + it lowers inflammation better even at low doses); a combination therapy -e.g.Lipitor/Crestor at a lower dose + evolocumab (Repatha, a newer and much more expensive lipid-lowering drug), Repatha is proven to reverse atherosclerosis by extremely lowering your LDL (but it does not lower inflammation).

You have also to RESUME METOPROLOL: it's a very serious drug and you cannot stop abruptly, it's dangerous for your heart. Medical care in the USA is very advanced and I doubt it has been prescribed to lower blood pressure. It does lower blood pressure, for which it was used in the past. Now it is a forth- or fifth-line therapy to lower blood pressure. It's main importance and indication is not blood-pressure lowering, but pace and rhythm control, which is revenant for risk of arrhythmias. I'm certain you started it with a titration to achieve a target dose and Holter monitor results. You cannot stop it abruptly (only by gradually reducing the dose), it's very dangerous, as it may result in increased heart rate and life-threatening arrhythmias.
Therefore, I cannot say whether you should resume it at your usual dose. If you missed metoprolol for a week, you probably have to restart it with a titration (as it was at the start of the therapy). Consult your cardiologist for advice on a resumption scheme. Do it today. Pay attention to the episodes of abnormal heart rhythm and increased heart rate, if you've recently experienced these.
For hair loss metoprolol is of minor importance.

What makes me even more stressed is that not only you discontinued metoprolol, but also resumed minoxidil which increases heart rate and may facilitate dangerous arrhythmias. Actually, given the risks (heart pace and rhythm) of high-strength minoxidil, a beta-blocker such as metoprolol of of great help to counter these risks and allow you to take minoxidil safely.

2) Nizoral: it does make hair look lifeless, but it's not a justifiable reason for discontinuation. It's just a cosmetic condition and the issue is very easily addressed by a good hair balm. I use 2% Nizoral every day, then some after-shampoo care (mint conditioner and balm that I spread only to my hair, avoiding 1-2cm at the roots so as not to make my scalp dirty because of oils they contain to make hair shiny and detangled). My hair is very shiny, silky, soft, easily combed and lie perfectly. The point is that although Nizoral causes what bothers you, the issue is very easily addressed by after-shampoo care.

3) good news that you start to see improvements of your hair, try not to ruin everything again by erratic minoxidil use (Now you've restarted, so don't stop for a single day, it works half a day - this is why you have to use it twice daily) and by corticosteriod interventions (whether topical or oral..)

Haha. Sorry to stress you out! I was planning to resume my medication this week anyway. I’ve been on Lipitor for years. It brings my cholesterol into perfect ranges. The metropolol was prescribed specifically for my blood pressure about 3-4 years ago. It has become consistently borderline so I take 25 mgs a day to get it within range. My heart is fine as far as I know. I have an EKG every year (next one is on Friday) and I’ve never had any issues.

I understand about minoxidil and i plan on using it as long as necessary or until my hair loss gets to the point where it’s not salvageable. Haven’t decided about Nizoral yet but I may ask my derm to prescribe 2% just so I have it handy if I decide to throw it into my routine.

what are your thoughts on lowering cortisol levels? My stress levels have skyrocketed over the past few months and I know this is also contributing to my issues. I’ve looked at ashwagandha supplement as it is supposed to help in that regard but I’m concerned about 1) raising T levels and 2) auto immune impact. I’m really trying to naturally reduce stress but between work, my wife and kids, life in general and hair loss on top it’s been really challenging.

 

[Anatoly]

The metropolol was prescribed specifically for my blood pressure about 3-4 years ago. It has become consistently borderline so I take 25 mgs a day to get it within range.
----- Metoprolol for blood pressure is a very outdated approach. The first-line therapy for BP is ACE inhibitors or ARBs. However, given your Minoxidil use, maintaining metoprolol maybe a better option for to to additionally counter the risks associated with minoxidil.
25mg is a very low dose, you can resume it safely without titration.

My heart is fine as far as I know. I have an EKG every year (next one is on Friday) and I’ve never had any issues.
----- Hope it's so. The only thing is that EKG is just a few minutes = very low probability of 'catching' dangerous rhythm abnormalities. Holter monitoring is a 24 continuous study (you wear lions device) that allows assessments. But even this may be insufficient: research shows that a continuous monitoring during a month (not just 25 hours) 2-3 times raises the probability of catching e.g. atrial fibrillation. Just in case you decide to go on high-strength minoxidil, you should have Holter 24-hours monitor at least.

I understand about minoxidil and i plan on using it as long as necessary or until my hair loss gets to the point where it’s not salvageable. Haven’t decided about Nizoral yet but I may ask my derm to prescribe 2% just so I have it handy if I decide to throw it into my routine.

what are your thoughts on lowering cortisol levels? My stress levels have skyrocketed over the past few months and I know this is also contributing to my issues.
The main problem with cortisol is that it ruins your hair by triggering inflammation. If you manage to get xelijanz, you may not need to be concerned about stress and cortisol - as your inflammation will be under very good control.

I’ve looked at ashwagandha supplement as it is supposed to help in that regard but I’m concerned about 1) raising T levels and 2) auto immune impact. I’m really trying to naturally reduce stress but between work, my wife and kids, life in general and hair loss on top it’s been really challenging.
I'm very sceptical about 'natural' treatments. Discussions about 'natural' vs big Pharma-manufactured 'chemistry' have little to do with real science. It common when 'natural' treatment are much more dangerous, as the agents they contain are not in a purified/processed form. Companies spend millions of dollars to make agents (e.g. originally derived from some plant or mushroom etc or a synthetic analogue) that are safer, with fewer side effects and more effective than their 'natural' predecessors.
You should not be much concerned about your T level rising: T declines as males age - there is hardly anything good about it. This is not a concern at all given that you're on Avodart.

If you don't like an idea of being on antidepressants, you may find a doctor who will prescribe you a natural alternative - medical marijuana (although research is not so straightforward, a lot depends on a particular form of cannabis).

 

[MKP05]

When you started finasteride for the first time, when did you notice the worsening? (after a week?)

When I started the first time I noticed worsening 1 month in. Thinning had spread to forelock and just beyond. At 4-6 months the thinning peaked - you could make out the entire horseshoe pattern with wet hair. I’d say after 6 months it stabilized on the vertex and mid scalp but it never thickened up. The hairline and temples continued to recede for the entire 17 months on finasteride

 

[Purvis]

Sir, don't panic. Your hairs still looks very young. But why did you switch to dutas from finasteride?

 

[dehoha]

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.

Any update? What happened after the initial shedding?

 

[jamesbooker1975]

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 spouse if you are not using something more potent. You are now blocking almost 100 % of your DHT vs 70 % . You will also have more side effects .

 

[jamesbooker1975]

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.

"lipitor for cholesterol and metropolol " Lol, both drugs are listed to cause hair loss side effects , and it is a very common side effects of them . If you do a research, the main drugs that cause hair loss as side effects are beta blockers ( like metropolol ) and anti cholesterol drugs like atorvastatin.