Update 13/11/2015
As mentioned in a previous post, today was the day I saw my dermatologist and sought her advice on my decision to pursue treatment with an oral 5-alpha reductase inhibitor. Here's how it went.
After broaching the subject she took out her ruler and compared today's measurements with the ones she took back in July. She said that there wasn't much of a difference but that if I was noticing more hair loss, especially since my hair appeared thinner, then something definitely is wrong. I brought up finasteride and she gave me a humourous look and said "you do know about the side effects right?" I nodded and told her I was well versed in the pharmacology of finasteride. She was glad and mentioned that any side effects I would get would subside after the discontinuation of treatment. She also asked about any blood work I've had done, I told her I had a comprehensive metabolic panel, liver values, thyroid function test and kidney function test all performed over summer. She was pleased and also agreed that since my serum estradiol was normal that I would likely not experience drastic side effects.
I brought up dutasteride as well and to my surprise she actually was aware of its off-label use for Androgenetic Alopecia. She told me that I should see how I fare on finasteride first, if I can tolerate it well after a few months to a year and I feel it would be a prudent option to switch then she said she will prescribe dutasteride for me if I so desire (she's honestly one of the sweetest and most understanding doctors I've been to, she really empathises with how much Androgenetic Alopecia has affected me, as well as the fact that she knows I'm a licensed and board certified pharmacy technician studying pharmaceutical sciences at university and hence knowledgeable about pharmacology). She just thought it was best to start with finasteride since she said '2/3 of men will see optimal results on it' and that she would prefer I see if I can achieve optimal results on an approved treatment before considering an off-label one. I was very impressed as she's a dermatologist at a laser centre, I wasn't expecting her to be this well versed in hair loss treatments. I was delighted to say the least. This also is fine with me just in case finasteride ends up being powerful enough to stop (and hopefully reverse) my Androgenetic Alopecia.
So there I was, with a smile of hope on my face and a prescription for 1 mg finasteride in my hand as I walked out, which I filled at the nearby pharmacy shortly after. $300 HKD per 28 tablet box of Maxteride brand generic 1 mg finasteride tablets, produced by Kern Pharma in Spain. This is rather expensive as dutasteride as brand name Avodart is $350 HKD per 30 tablet box (this is really cheap compared to most countries as far as I know), which I informed my dermatologist about, this is part of the reason why she's okay with letting me switch as it will be cheaper in the long run.
Speaking of price though, this may not matter as my insurance will possibly cover it entirely, since my hair loss originally arose from a bout of seborrhoeic dermatitis, my dermatologist may be able to clarify the diagnosis to my insurance as she wrote 'seborrhoeic dermatitis alopecia' on one of my receipts as the diagnosis. My insurance has covered various shampoos dispensed from her in the past for this exact diagnosis so they may very well cover finasteride or dutasteride as well. I'll keep you guys posted on this matter but I don't see why they wouldn't do the same as my health insurance is very extensive, if they do that'll be mint as (free finasteride and possibly free Avodart in the future, oh baby!).
I took my first 1 mg dose just a few hours ago. So Friday the 13th of November 2015 (lol how ironic) marks the beginning of my treatment timeline for finasteride. My current treatment regimen is simply just 1 mg finasteride daily. No more S5 Cream and no more 2% Nizoral. I'll still be using either 2% Nizoral or 1% selenium disulphide (Selsun Blue, I recently have been using it a bit due to the fact that I love the way it smells and makes my scalp feel, not to mention its ability to inhibit PGD synthase which means lower scalp PGD2 levels, check the Wikipedia page on PGDS and look at the references under prostanoid signalling, you'll see selenium disulphide listed as a known inhibitor of PGDS) once weekly as a prophylactic measure against seborrhoeic dermatitis as per the recommendation of my dermatologist but I will no longer be using Nizoral twice weekly for Androgenetic Alopecia purposes. I want to see how far I can get on finasteride alone. Hopefully it will be enough to halt my Androgenetic Alopecia and maybe even get regrowth if I'm lucky but if not I'm elated that my dermatologist will be able to write a prescription for dutasteride immediately if and when the moment arises that I notice that finasteride isn't powerful enough.
As for anxiety or whatever, I don't feel nervous at all, actually to be completely honest I haven't been this happy in a while. Knowing that I'm beginning treatment on one of the most powerful Androgenetic Alopecia medications currently approved really makes me feel positive. Not worrying about side effects should certainly help avoid any possible nocebo effect too!
For those curious here are the results from my comprehensive hormone panel, blood was taken back in June before I was on any treatments, analysis was performed by PathLab Medical Laboratories LTD. in HK at the 95% confidence level:
Estradiol (E2): 31 pg/mL (normal reference range for males is <56, keep in mind that
zero patients as per this study had serum E2 levels above 45 pg/mL, even while on dutasteride for over a year:
http://i.gyazo.com/dbbc762b031e11387805edd0605aedf1.png)
Follicle-stimulating Hormone: 2.1 mIU/mL (ref: 0.7-11.1)
Luteinising Hormone: 2.8 mIU/mL (ref: 0.8-7.6)
Prolactin: 7.6 ng/mL (ref: 2.5-17)
Total Testosterone: 591 ng/dL (ref: 160-726, median 323) (high test oh BABY)
*Finasteride Crew*