Pixie, my guy. I suggest you take a lab coat approach to your issue instead of a kitchen sink approach.
Think. Your hair loss at this point is evidently male pattern baldness/Androgenetic Alopecia and not any other problem. male pattern baldness is catalyzed by DHT, but you’re blocking DHT. That leaves a few possibilities:
A.) Your DHT pre-finasteride was so astronomically high that even at 70% reduction there’s enough left to damage your hair
B.) Your follicles are just hopelessly sensitive to DHT
C.) Other androgens are binding to the receptors in your follicles and causing damage
There is also some very, very early research that may support the idea that the inflammatory process started by DHT can continue on its own in DHT’s absence. I’ll cover that at the end of my post. First I’ll go over each point listed above. A proper approach to self diagnosing this problem imo would be to begin ruling things out in order of most to least treatable.
In regards to point
A.)
Get a blood test. If your DHT levels are still in the low to medium range, your problem is solved. Someone who responds well to finasteride should have the DHT levels of a post-menopausal woman. Enough, but no more. Typically around <1ng/dl. If you’re higher than that, you just aren’t blocking enough. The solution is to switch to dutasteride. That should give you the DHT levels of a dead post-menopausal woman (zero). I personally would recommend against systemic 5AR inhibition in any capacity at all, but I’m not your mom. If you aren’t getting sides on finasteride, there’s a good chance you won’t on Dutasteride.
In regards to point
B.)
A will tell you if B is true.
In regards to point
C.)
There are a few ways you can check and see if other androgens are responsible for your hair loss. A good indicator would be if your estradiol or free testosterone levels are abnormally high. A little bit of DHT will damage your hair but a fuckload of regular T will do the same damage. A blood test would be necessary to test for that. Another way would be to try dutasteride. If once your DHT is sufficiently managed you continue to shed, your follicles will likely require total, non-selective androgen deprivation to continue living. That means heavy duty topicals such as flutamide or RU58841. Maybe even pure estradiol. If you decide to go this route, I would recommend tapering off whichever systemic you are taking.
In regards to what I mentioned earlier in my post, there is a hypothesis out there that once DHT has initiated the inflammatory calcification process of male pattern baldness, blocking DHT will do nothing. That’s where drugs like Setipiprant, Fevipiprant and prostaglandin supplements like PGE2 come into play. Instead of trying to halt the balding process at step 1 (DHT), they try to do it at step 4 (inflammation and calcification caused by PGD2). There is a fairly small body of research in existence on this topic in regards to androgenic alopecia but there is a relative dearth of info on these forums about it. Personally I think the theory has some merit to it and if I could afford it I would add it to my regimen. Taking Setipiprant at effective doses orally will cost you around $600/month, Fevipiprant almost double that.
Best of luck and keep us appraised of your situation brother
Edited to add: an alternative to total AA topicals would be systemic hormonal manipulation. Basically, chemically castrate yourself. There’s a 200+ page thread about it on these forums. Essentially, you’d need to be okay with:
- Clinically low testosterone
- female levels of estrogen
- a 40% chance of gynecomastia
- a significantly increased risk of any type of side effect
- a decent chance you’ll be infertile
- chronic testicular pain
But
@bridgeburn seems to be doing quite well and has defeated his hair loss. His thread is a long read, but worth it if only for the learnin’
