As many of you know, I began taking propecia approximately two months ago. Before I began Propecia I was a vocal advocate for the drug as a medical student after viewing its significant benefit for those experience androgenetic alopecia and weighing the relative risks for adverse reactions. Before I begin, I would like to encourage anyone reading to realize that I also use minoxidil once daily in a "nanosome" lotion preparation (MiN Agent 5%) and I shampoo with MiN Wash. These may help my experience, but it was clear that these alone had begun to fail. Photographs and comments by friends had made it abundantly clear that I was indeed losing my battle with hairloss on these two treatments alone.
I began taking Propecia after it was prescribed to me by a local hair transplant surgeon. While I have been taking photographs, none adequately demonstrate my baseline. At this hair transplant clinic, they did take pictures. After six months and a year on finasteride, I am going to request that they forward these photographs to me so that we can compare any regrowth, etc.
The following comprises my impressions at the 2 month mark.
1. Is it working?
It is hard to say. Two weeks ago I noticed a rapid shed. However, I was also stressed at the time and I tend to run my hands through my hair under times of stress -- this is probably a mild form of trichotillomania, but seeing as I have male pattern baldness on both sides of the family, I doubt it is having a major effect seeing as my areas of thinning are your typical male pattern baldness-implicated areas.
What I do know is that it appears that my hairline is filling in where it was previously thinning. This may be due, in small part, to the fact that my hair is darkening as a result of being indoors more. However, the hair that was previously short and thin appears to be growing longer. Another observation is that all of the hair on top of my head is growing FASTER and now seems to keep pace with the hair at the temporal regions of my head. Previously, I had noted that the hair on the top of my head had begun to grow more slowly as compared to the side of my head. As a result, even though the hair on the sides of my head are typically cut shorter, at each haircut it would be this region that was longer. This implies that the rate of growth and overall health of the hair follicles was markedly worse in my male pattern baldness areas as compared to my "donor" areas.
Thus, at the two month mark I have noticed my hair is healthier. My hairline has not moved forward, but areas of thinning HAVE thickened with new hairs sprouting. I cannot yet ascertain whether my vertex has thickened. It is still thin here, but I certainly have not progressed any further as far as I can tell.
2. Side Effects (ADRs)
BAD ONES at first. Decreased libido, loss of sexual sensation, decreased ejaculate, persistent testicular pain.
All have subsided after decreasing from 1 mg. When I restarted after quitting 1mg daily, I began with 0.25 EOD then 0.25 daily then 0.5 daily, which I am currently taking. It seems to be working, so I have no intention of increasing my dosage in the near future.
Continuing side effects include occasional testicular pain... perhaps once per week for an hour or so. Sometimes I think that it has decreased my ejaculate output, but other times I think it has had no effect.
As a continuation of this discussion, I am currently reading about the Genitourinary System for medical school, and I am finding some sense to finasteride-related non-motile sperm. It has been speculated on these boards by Mew that finasteride my cause your boys to stop swimming. I have my doubts seeing as spermatogenesis is mostly modulated by testosterone, estrogens, FSH, and LH. Interestingly enough, however, the effect of lowered DHT is well-documented on the prostate. It causes the prostate to involute and shrink -- this is the reason why it is used to treat Benign Prostatic Hyperplasia. Importantly, it is prostatic fluid during the ejaculatory phase of the male sex act that allows mature sperm to gain motility.
So essentially, what this tells us is three things.
1. The decreased and/or "watery" ejaculate reported by many is probably not a problem with spermatogenesis in the testes. Instead, it is a decrease in prostatic fluid output. This would result in the semen being more translucent and less "creamy".
2. It would also decrease the overall AMOUNT of semen.
3. Decreasing (not eliminating) prostatic fluid may have a negative impact on sperm motility. In healthy individuals, however, it is doubtful that this decrease would be enough to cause infertility, but it is a cause for concern and something that should be noted before starting finasteride.
Finally, I would still recommend Propecia but I may begin my future patients on smaller doses so that their body can acclimate to the change. The contention that 0.25mg inhibits as much DHT via 5AR is true OVER TIME. However, it is obvious that dosing on 0.25 mg brings the individual to the desired steady-state inhibition MUCH MORE SLOWLY than 1 mg.
If you have any questions for me based on my experience and my NON-LICENSED medical opinion, I would be more than happy to assist. Keep in mind there is an inherent risk to this drug, because of our limited knowledge pertaining to ALL of the functions DHT performs.
I began taking Propecia after it was prescribed to me by a local hair transplant surgeon. While I have been taking photographs, none adequately demonstrate my baseline. At this hair transplant clinic, they did take pictures. After six months and a year on finasteride, I am going to request that they forward these photographs to me so that we can compare any regrowth, etc.
The following comprises my impressions at the 2 month mark.
1. Is it working?
It is hard to say. Two weeks ago I noticed a rapid shed. However, I was also stressed at the time and I tend to run my hands through my hair under times of stress -- this is probably a mild form of trichotillomania, but seeing as I have male pattern baldness on both sides of the family, I doubt it is having a major effect seeing as my areas of thinning are your typical male pattern baldness-implicated areas.
What I do know is that it appears that my hairline is filling in where it was previously thinning. This may be due, in small part, to the fact that my hair is darkening as a result of being indoors more. However, the hair that was previously short and thin appears to be growing longer. Another observation is that all of the hair on top of my head is growing FASTER and now seems to keep pace with the hair at the temporal regions of my head. Previously, I had noted that the hair on the top of my head had begun to grow more slowly as compared to the side of my head. As a result, even though the hair on the sides of my head are typically cut shorter, at each haircut it would be this region that was longer. This implies that the rate of growth and overall health of the hair follicles was markedly worse in my male pattern baldness areas as compared to my "donor" areas.
Thus, at the two month mark I have noticed my hair is healthier. My hairline has not moved forward, but areas of thinning HAVE thickened with new hairs sprouting. I cannot yet ascertain whether my vertex has thickened. It is still thin here, but I certainly have not progressed any further as far as I can tell.
2. Side Effects (ADRs)
BAD ONES at first. Decreased libido, loss of sexual sensation, decreased ejaculate, persistent testicular pain.
All have subsided after decreasing from 1 mg. When I restarted after quitting 1mg daily, I began with 0.25 EOD then 0.25 daily then 0.5 daily, which I am currently taking. It seems to be working, so I have no intention of increasing my dosage in the near future.
Continuing side effects include occasional testicular pain... perhaps once per week for an hour or so. Sometimes I think that it has decreased my ejaculate output, but other times I think it has had no effect.
As a continuation of this discussion, I am currently reading about the Genitourinary System for medical school, and I am finding some sense to finasteride-related non-motile sperm. It has been speculated on these boards by Mew that finasteride my cause your boys to stop swimming. I have my doubts seeing as spermatogenesis is mostly modulated by testosterone, estrogens, FSH, and LH. Interestingly enough, however, the effect of lowered DHT is well-documented on the prostate. It causes the prostate to involute and shrink -- this is the reason why it is used to treat Benign Prostatic Hyperplasia. Importantly, it is prostatic fluid during the ejaculatory phase of the male sex act that allows mature sperm to gain motility.
Function of the Prostate Gland said:
So essentially, what this tells us is three things.
1. The decreased and/or "watery" ejaculate reported by many is probably not a problem with spermatogenesis in the testes. Instead, it is a decrease in prostatic fluid output. This would result in the semen being more translucent and less "creamy".
2. It would also decrease the overall AMOUNT of semen.
3. Decreasing (not eliminating) prostatic fluid may have a negative impact on sperm motility. In healthy individuals, however, it is doubtful that this decrease would be enough to cause infertility, but it is a cause for concern and something that should be noted before starting finasteride.
Finally, I would still recommend Propecia but I may begin my future patients on smaller doses so that their body can acclimate to the change. The contention that 0.25mg inhibits as much DHT via 5AR is true OVER TIME. However, it is obvious that dosing on 0.25 mg brings the individual to the desired steady-state inhibition MUCH MORE SLOWLY than 1 mg.
If you have any questions for me based on my experience and my NON-LICENSED medical opinion, I would be more than happy to assist. Keep in mind there is an inherent risk to this drug, because of our limited knowledge pertaining to ALL of the functions DHT performs.