Dutasteride ruining safe zones/speeding up diffuse thinning. (RH?)

zeldazoo22

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In need of advice, as my switch from finasteride to duta this past few weeks has lost me a lot of hair. Debating RU, spironolactone, etc., in addition to oral min which I started taking.

My story: 7-ish years on finasteride for solely a receding hairline (I'm now 27), with a break at some point in between. Starting roughly 2 years ago, my hair began to thin on the top as well, with about a 20-30% loss in density, a wispier, sad texture change, and redness on my forehead, sides of my nose, and above my butt (seb derm), and the hairline recession started to go more rapidly. I've always had seb derm on my scalp/dandruff, but it progressed/spread. I also started noticing WAY more hairs in the shower than usual - all over my hand, clogging the drain, different size hairs. My guess is that I started developing the dreaded reflex hyperandrogenicity. The dermatologist who founded the hairloss clinic at UCLA validated my suspicions and suggested that I could be right.

Fast forward to 3 weeks ago, I started oral min. and Duta, and fast forward to now, I feel I've lost another 10% in total density, with my safe zones getting hit. Scary. As. sh*t.

My question is, with the possibility of reflex hyperandrogenicity in mind, and then with that, the possibility of Duta exacerbating it more, what shall I do? I stopped Duta immediately, and will revert back to finasteride. Is there any point in me lowering my dosage of finasteride to lower my T levels a little - My T is usually quite robust? I think I need to add some topicals, but I'm not sure which. Also, are the hairs that Duta attacked these past couple of weeks gone forever?

Thank you.
 
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JaneyElizabeth

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In need of advice, as my switch from finasteride to duta this past few weeks has lost me a lot of hair. Debating RU, spironolactone, etc., in addition to oral min which I started taking.

My story: 7-ish years on finasteride for solely a receding hairline (I'm now 27), with a break at some point in between. Starting roughly 2 years ago, my hair began to thin on the top as well, with about a 20-30% loss in density, a wispier, sad texture change, and redness on my forehead, sides of my nose, and above my butt (seb derm), and the hairline recession started to go more rapidly. I've always had seb derm on my scalp/dandruff, but it progressed/spread. I also started noticing WAY more hairs in the shower than usual - all over my hand, clogging the drain, different size hairs. My guess is that I started developing the dreaded reflex hyperandrogenicity. The dermatologist who founded the hairloss clinic at UCLA validated my suspicions and suggested that I could be right.

Fast forward to 3 weeks ago, I started oral min. and Duta, and fast forward to now, I feel I've lost another 10% in total density, with my safe zones getting hit. Scary. As. sh*t.

My question is, with the possibility of reflex hyperandrogenicity in mind, and then with that, the possibility of Duta exacerbating it more, what shall I do? I stopped Duta immediately, and will revert back to finasteride. Is there any point in me lowering my dosage of finasteride to lower my T levels a little - My T is usually quite robust? I think I need to add some topicals, but I'm not sure which. Also, are the hairs that Duta attacked these past couple of weeks gone forever?

Thank you.
I find a lot of that puzzling as well. Oral min is pretty reliable, I think. No, I don't think any of that hair is permanently gone. Why don't you take a look at the following article and see if you can make it out as something that is pertinent to you. The thought is that if you are using proven hair meds like finasteride/duta/min that any subsequent hair loss must be due to shedding, with shedding being benevolent in these circumstances. I would recommend that you add nizoral/keto 2 percent and Selsun Blue for inflammation and see if that helps. You could also dial back duta if you think that is an issue but generally, if you stop treatment you are back at square one.

I had a reaction to spironolactone and lost essentially all of my hair over a few weeks, down to bald and I had only been receding. But because I knew my main meds definitely grew hair (estradiol and spironolactone), I rode it out by first shaving everything to one length and then found a wig that I like. For some folks, a temporary hair system might get them through and if anyone notices, one can just state a temporary medical issue:


What seems to happen in these situations of a "benevolent" shed is that the improvement itself causes inflammation initially most likely because the old follicles were too narrow compared to what is coming in so the body dumps them or many of them and links the regrowth to all happen in a regime of anagen synchronization.
 

zeldazoo22

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I find a lot of that puzzling as well. Oral min is pretty reliable, I think. No, I don't think any of that hair is permanently gone. Why don't you take a look at the following article and see if you can make it out as something that is pertinent to you. The thought is that if you are using proven hair meds like finasteride/duta/min that any subsequent hair loss must be due to shedding, with shedding being benevolent in these circumstances. I would recommend that you add nizoral/keto 2 percent and Selsun Blue for inflammation and see if that helps. You could also dial back duta if you think that is an issue but generally, if you stop treatment you are back at square one.

I had a reaction to spironolactone and lost essentially all of my hair over a few weeks, down to bald and I had only been receding. But because I knew my main meds definitely grew hair (estradiol and spironolactone), I rode it out by first shaving everything to one length and then found a wig that I like. For some folks, a temporary hair system might get them through and if anyone notices, one can just state a temporary medical issue:


What seems to happen in these situations of a "benevolent" shed is that the improvement itself causes inflammation initially most likely because the old follicles were too narrow compared to what is coming in so the body dumps them or many of them and links the regrowth to all happen in a regime of anagen synchronization.
How quick was your aggressive shedding on that previous treatment? This seems a little soon for me to start shedding this much. It just seems like a continuation of what has been happening, with lots of hair in the shower, etc. Maybe the combo of min and duta just accelerated the shed? Also, between topical RU, spironolactone, or E, which might you recommend to add? Thanks!
 

zeldazoo22

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How quick was your aggressive shedding on that previous treatment? This seems a little soon for me to start shedding this much. It just seems like a continuation of what has been happening, with lots of hair in the shower, etc. Maybe the combo of min and duta just accelerated the shed? Also, between topical RU, spironolactone, or E, which might you recommend to add? Thanks!
Also, I’m wondering if worsening scalp itch and oil means worsening reflex hyperandrogenicity
 

JaneyElizabeth

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How quick was your aggressive shedding on that previous treatment? This seems a little soon for me to start shedding this much. It just seems like a continuation of what has been happening, with lots of hair in the shower, etc. Maybe the combo of min and duta just accelerated the shed? Also, between topical RU, spironolactone, or E, which might you recommend to add? Thanks!
Well. I had never had any reaction to any hair med except maintenance but I started min young at 25 and then proscar ten years later and I saw no sheds or regrowth really but I had kept a lot of hair with only an incipient bald spot and a hairline that was still pretty low. But when I went on spironolactone, I really slammed the dosage starting out and I was doing two mechanical treatments, massage and micro-needling. All of these things can cause benevolent shedding as I refer to it because the scalp is trying to get hair growth in general in sync and dumping hair is apparently easier/faster than improving or fixing the DHT-affected hair.

I think that estradiol works far better than anything else but estrogen plus an AA also works great. The problem is that unless one has both knowledge and access to Selective Estrogen Receptor Modulators, you have to at least run the risk of significant breast growth. It's really rare though for cis-males to develop significant breast tissue but far from unheard of. I have had remarkable growth which I have just decided to "go with it" and @bridgeburn, one of the early HRT hair growth prophets also had fairly noticeable breast growth. Among the MtF boards though, disappointing breast growth is a topic that many seem obsessed with so, life can be like that where the people not seeking breasts get stellar ones.

It's hard to give further advice because virtually everything that works can lead to shedding and subsequent restoration. So, you could try to go slow by staying on finasteride and only using 2 percent minoxidil which might make your hair transition less bumpy but essentially the best bet against shedding is Keto two percent. After that, you get what you get and slowing or stalling hair loss is also likely to stall a recovery but I get that for most folks, a shed to baldness might not be worth risking if improvement brings that. So you are damned if you do and damned if you don't. Probably one reason for my remarkable recovery was that my body basically dumped all hair extant and started over again with the follicles in a much more synchronized and longer anagen cycle.

I don't believe in general that meds can cause baldness. If they cause shedding, it's because they are working properly.
 

CharlesNohair

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I have the same situation, I was on Minoxidil for a year 0 result, I started finasteride 1mg ED in september 2020 and my alopecia progressed so much in the past 5 months that decided to switch to dutasteride 0.5 mg 3x week and Oral min 5 kg ED in february. Since then my hair los has progressed really fast and I've been shedding tons if hairs about 300-400 ED all of them thick hair. I don't know why my hair los has progressed that much when starting taking AAs. This sucks
 

zeldazoo22

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I have the same situation, I was on Minoxidil for a year 0 result, I started finasteride 1mg ED in september 2020 and my alopecia progressed so much in the past 5 months that decided to switch to dutasteride 0.5 mg 3x week and Oral min 5 kg ED in february. Since then my hair los has progressed really fast and I've been shedding tons if hairs about 300-400 ED all of them thick hair. I don't know why my hair los has progressed that much when starting taking AAs. This sucks
I feel you... are you gona stick with it?
 

zeldazoo22

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Well. I had never had any reaction to any hair med except maintenance but I started min young at 25 and then proscar ten years later and I saw no sheds or regrowth really but I had kept a lot of hair with only an incipient bald spot and a hairline that was still pretty low. But when I went on spironolactone, I really slammed the dosage starting out and I was doing two mechanical treatments, massage and micro-needling. All of these things can cause benevolent shedding as I refer to it because the scalp is trying to get hair growth in general in sync and dumping hair is apparently easier/faster than improving or fixing the DHT-affected hair.

I think that estradiol works far better than anything else but estrogen plus an AA also works great. The problem is that unless one has both knowledge and access to Selective Estrogen Receptor Modulators, you have to at least run the risk of significant breast growth. It's really rare though for cis-males to develop significant breast tissue but far from unheard of. I have had remarkable growth which I have just decided to "go with it" and @bridgeburn, one of the early HRT hair growth prophets also had fairly noticeable breast growth. Among the MtF boards though, disappointing breast growth is a topic that many seem obsessed with so, life can be like that where the people not seeking breasts get stellar ones.

It's hard to give further advice because virtually everything that works can lead to shedding and subsequent restoration. So, you could try to go slow by staying on finasteride and only using 2 percent minoxidil which might make your hair transition less bumpy but essentially the best bet against shedding is Keto two percent. After that, you get what you get and slowing or stalling hair loss is also likely to stall a recovery but I get that for most folks, a shed to baldness might not be worth risking if improvement brings that. So you are damned if you do and damned if you don't. Probably one reason for my remarkable recovery was that my body basically dumped all hair extant and started over again with the follicles in a much more synchronized and longer anagen cycle.

I don't believe in general that meds can cause baldness. If they cause shedding, it's because they are working properly.
Would topical spironolactone possibly be safer then? It’s a tough call to make.
 

JaneyElizabeth

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I have the same situation, I was on Minoxidil for a year 0 result, I started finasteride 1mg ED in september 2020 and my alopecia progressed so much in the past 5 months that decided to switch to dutasteride 0.5 mg 3x week and Oral min 5 kg ED in february. Since then my hair los has progressed really fast and I've been shedding tons if hairs about 300-400 ED all of them thick hair. I don't know why my hair los has progressed that much when starting taking AAs. This sucks
I find it distressing for all of you. I don't get really why so many people go into immediate sheds like that except that hormonal medications like finasteride and duta can be very powerful. Many allege similar shedding with minoxidil and so many people including myself who have had sheds as part of recovery, can only mention that temporary use of a wig or hair system might help you ride out a shed. This excellent article by the owner of the site seems pretty spot on:

 

JaneyElizabeth

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Would topical spironolactone possibly be safer then? It’s a tough call to make.
Topical spironolactone is exceedingly safe but only because it doesn't appear to work topically. I think topical spironolactone is a waste of time as are any of the RU or CB or alfatradiol meds for people who can tolerate finasteride and minoxidil. None of them work as well as either and there's not a lot of evidence that stacking meds in a pell-mell fashion is synergystic or even arithmetically effective.
 

CharlesNohair

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I feel you... are you gona stick with it?
I'll give a try at least I will wait a year on AA but I'm not sure if its going to work. Many studies suggest AA are very effective to treat Androgenetic Alopecia but also a lot of people in the forums says they don't really work and their Androgenetic Alopecia still progress with any sign of slowing the procesos or regrowing hair
 

CharlesNohair

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I find it distressing for all of you. I don't get really why so many people go into immediate sheds like that except that hormonal medications like finasteride and duta can be very powerful. Many allege similar shedding with minoxidil and so many people including myself who have had sheds as part of recovery, can only mention that temporary use of a wig or hair system might help you ride out a shed. This excellent article by the owner of the site seems pretty spot on:

Shedding should not be a visual hair loss in tour scalp and also shouldn't last for 6 months. In my case my hair has deteriorated so fast while on AA that Im starting to believe that really don't work. I went to a specialised dermatologist who diagnosed Androgenetic Alopecia and told me about the shedding and that I will see improvement or at least the Androgenetic Alopecia will be slowed down but really the progression has been somewhat accelerated. It doesnt make sense at least in month 7 of treatment
 

JaneyElizabeth

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Shedding should not be a visual hair loss in tour scalp and also shouldn't last for 6 months. In my case my hair has deteriorated so fast while on AA that Im starting to believe that really don't work. I went to a specialised dermatologist who diagnosed Androgenetic Alopecia and told me about the shedding and that I will see improvement or at least the Androgenetic Alopecia will be slowed down but really the progression has been somewhat accelerated. It doesnt make sense at least in month 7 of treatment
All that I can say is that in my case, it was indeed the AA almost certainly that led to my abrupt hair loss. I was probably three months in on spironolactone and was using 200 mg to 400 mg over just the course of a few months. But again, this was a benevolent shed and it might be that nothing but marginal improvement is possible without a substantial shed. By eliminating essentially all hair at once, the body now can easily synchronize all follicles in a new phase of lengthened anagen.

I never panicked surprisingly. I just cut it all down to crew cut length and proceeded with beard removal so I could then use a wig and it's worked great for me as something that took me off the clock, more or less since the wig seemed to be a hit for about a month until Covid. AA's meaning spironolactone, CPA and bicalutamide for the most part all are known either to grow hair or increase anagen or both. They work better when used with estrogen. A thread that now essentially deals with the value of bicalutamide on a daily basis is here: https://www.hairlosstalk.com/intera...-route-hair-life.109288/page-805#post-1957515

I have a similar thread focused on using HRT meds to grow/regrow hair and I post pics of my initial bald head and my progress the last 18 months and it started slow and steady and then it has gone better and faster as I added oral minoxidil and estrogel to the scalp:


Here's a useful article on shedding:

 

zeldazoo22

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Shedding should not be a visual hair loss in tour scalp and also shouldn't last for 6 months. In my case my hair has deteriorated so fast while on AA that Im starting to believe that really don't work. I went to a specialised dermatologist who diagnosed Androgenetic Alopecia and told me about the shedding and that I will see improvement or at least the Androgenetic Alopecia will be slowed down but really the progression has been somewhat accelerated. It doesnt make sense at least in month 7 of treatment
7 month in seems too long also. I’ve been getting constant hair falling out in shower for a year and finally my whole head you can see through to the scalp. So I switched to dutasteride and it’s accelerated it. I don’t have the balls to keep it moving. Going to hope my Oral minoxidil kicks in and helps out. Maybe I’ll add topical spironolactone for back up, as long as it rarely causes gyno.
 

trialAcc

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In need of advice, as my switch from finasteride to duta this past few weeks has lost me a lot of hair. Debating RU, spironolactone, etc., in addition to oral min which I started taking.

My story: 7-ish years on finasteride for solely a receding hairline (I'm now 27), with a break at some point in between. Starting roughly 2 years ago, my hair began to thin on the top as well, with about a 20-30% loss in density, a wispier, sad texture change, and redness on my forehead, sides of my nose, and above my butt (seb derm), and the hairline recession started to go more rapidly. I've always had seb derm on my scalp/dandruff, but it progressed/spread. I also started noticing WAY more hairs in the shower than usual - all over my hand, clogging the drain, different size hairs. My guess is that I started developing the dreaded reflex hyperandrogenicity. The dermatologist who founded the hairloss clinic at UCLA validated my suspicions and suggested that I could be right.

Fast forward to 3 weeks ago, I started oral min. and Duta, and fast forward to now, I feel I've lost another 10% in total density, with my safe zones getting hit. Scary. As. sh*t.

My question is, with the possibility of reflex hyperandrogenicity in mind, and then with that, the possibility of Duta exacerbating it more, what shall I do? I stopped Duta immediately, and will revert back to finasteride. Is there any point in me lowering my dosage of finasteride to lower my T levels a little - My T is usually quite robust? I think I need to add some topicals, but I'm not sure which. Also, are the hairs that Duta attacked these past couple of weeks gone forever?

Thank you.
The derm at UCLA told you that you might have a condition that is not medically referenced in any medical literature, anywhere? And all that based on shedding? You should probably find a new dermatologist. Did he at least give you any recommendations on how to deal with it if he's pretending he knows what it is?

Dude you started oral minoxidil and flooded your scalp/body with free testosterone from Dutasteride. Oral min affects the entire body (ie the safe zones) and dutasteride triggers a shed in most people who start it. I can't advise you on medical treatments but if you started dutasteride AND oral min at the same time, so you should have been prepared for a heavy shed as those are doom shedding culprits #1 & 2.
 
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zeldazoo22

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The derm at UCLA told you that you might have a condition that is not medically referenced in any medical literature, anywhere? And all that based on shedding? You should probably find a new dermatologist. Did he at least give you any recommendations on how to deal with it if he's pretending he knows what it is?

Dude you started oral minoxidil and flooded your scalp/body with free testosterone from Dutasteride. Oral min affects the entire body (ie the safe zones) and dutasteride triggers a shed in most people who start it. I can't advise you on medical treatments but if you started dutasteride you should have been prepared for a heavy shed.
She is the founder of the hairloss clinic at UCLA, treating all types of alopecia (Dr. Carolyn Goh if you want to look her up). She admits that no one has a crystal ball, and entertains the idea that AA's don't work on certain people because of the androgens becoming too sensitive.

Why don't you take a look at this 2020 study, which encourages doctors to "sound the alarm" with finasteride and duta, because of the myriad lesser known but serious problems they might pose with regards to upregulating androgens: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308241/

A scary sign being something so recent, and sizeable hint that we don't know everything about these drugs and how they effect our androgens. I think its likely you're right about your above scenario, but I think its equally likely that studies on androgen receptors becoming more sensitive have not yet been done, largely because they are overshadowed by the more important and noticeable side effect of peoples' libido failing them. I also think its equally likely that people who have lost their hair even on finasteride and dutasteride have just attributed their hairloss to being "too agressive," instead of thinking that their bodies could have responded strongly the opposite way they wanted.

If you don't mind, what would be your explanation why finasteride has failed me after 6-7 years? The company does say it gets weaker with time, but wouldn't that possibly have to do with androgen receptors becoming more sensitive? If so, it makes me think my body could respond even more strongly to Duta which aims to block 90% DHT, no? So in the long run, thats probably bad, I would guess...

Maybe blocking the androgen connection at the scalp is the best route. I;m think of sticking to oral min and stopping the dutasteride. Thoughts?
 

zeldazoo22

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The derm at UCLA told you that you might have a condition that is not medically referenced in any medical literature, anywhere? And all that based on shedding? You should probably find a new dermatologist. Did he at least give you any recommendations on how to deal with it if he's pretending he knows what it is?

Dude you started oral minoxidil and flooded your scalp/body with free testosterone from Dutasteride. Oral min affects the entire body (ie the safe zones) and dutasteride triggers a shed in most people who start it. I can't advise you on medical treatments but if you started dutasteride AND oral min at the same time, so you should have been prepared for a heavy shed as those are doom shedding culprits #1 & 2.
Do you have an idea why my T has remained very high on finasteride, and why my seb derm has gotten REALLY bad starting two years ago, aftering being on finasteride for 6 years? Do you think that means I need to hit the hairloss harder with Duta? I almost feeling like an estrogen booster could benefit me with such high T. My libido has always been strong, which is not the common complaint.
 

trialAcc

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She is the founder of the hairloss clinic at UCLA, treating all types of alopecia (Dr. Carolyn Goh if you want to look her up). She admits that no one has a crystal ball, and entertains the idea that AA's don't work on certain people because of the androgens becoming too sensitive.

Why don't you take a look at this 2020 study, which encourages doctors to "sound the alarm" with finasteride and duta, because of the myriad lesser known but serious problems they might pose with regards to upregulating androgens: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308241/

A scary sign being something so recent, and sizeable hint that we don't know everything about these drugs and how they effect our androgens. I think its likely you're right about your above scenario, but I think its equally likely that studies on androgen receptors becoming more sensitive have not yet been done, largely because they are overshadowed by the more important and noticeable side effect of peoples' libido failing them. I also think its equally likely that people who have lost their hair even on finasteride and dutasteride have just attributed their hairloss to being "too agressive," instead of thinking that their bodies could have responded strongly the opposite way they wanted.

If you don't mind, what would be your explanation why finasteride has failed me after 6-7 years? The company does say it gets weaker with time, but wouldn't that possibly have to do with androgen receptors becoming more sensitive? If so, it makes me think my body could respond even more strongly to Duta which aims to block 90% DHT, no? So in the long run, thats probably bad, I would guess...

Maybe blocking the androgen connection at the scalp is the best route. I;m think of sticking to oral min and stopping the dutasteride. Thoughts?
Finasteride stopped working for me after exactly 6-7 years as well lol, it's why I'm back on this forum. If you actually read between the lines of people who claim finasteride "sped up" or didn't stop their hairloss, most of them tried finasteride for under 1 year and got spooked by the shedding. Then you have the few who actually don't get any benefit and MAYBE experience something like RHA.

Further to the point, finasteride only blocks 60% of serum DHT, which may substantially reduces scalp DHT as well but not even by the 60%, because DHT is also synthesized locally on the scalp. This is why finasteride and even dutasteride doesn't stop everyone's hairloss, because there is still DHT and to a lesser degree testosterone attacking the follicles the entire time. The more sensitive you were to them in the first place, the more likely you are to experience loss while using them.

If you're losing hair while still on finasteride then adding oral min might give you a cosmetic boost for a bit, but wont address the underlying cause. I'd add the dutasteride 1x weekly and see what happens. There are examples of this working very well.
 

zeldazoo22

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Finasteride stopped working for me after exactly 6-7 years as well lol, it's why I'm back on this forum. If you actually read between the lines of people who claim finasteride "sped up" or didn't stop their hairloss, most of them tried finasteride for under 1 year and got spooked by the shedding. Then you have the few who actually don't get any benefit and MAYBE experience something like RHA.

Further to the point, finasteride only blocks 60% of serum DHT, which may substantially reduces scalp DHT as well but not even by the 60%, because DHT is also synthesized locally on the scalp. This is why finasteride and even dutasteride doesn't stop everyone's hairloss, because there is still DHT and to a lesser degree testosterone attacking the follicles the entire time. The more sensitive you were to them in the first place, the more likely you are to experience loss while using them.

If you're losing hair while still on finasteride then adding oral min might give you a cosmetic boost for a bit, but wont address the underlying cause. I'd add the dutasteride 1x weekly and see what happens. There are examples of this working very well.
Hm. What about topical progresterone? I could maybe stomach doing duta 1x weekly. At .5 or 2.5mg? I feel like I need to lower my T which finasteride has caused to rise.
 

trialAcc

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Hm. What about topical progresterone? I could maybe stomach doing duta 1x weekly. At .5 or 2.5mg? I feel like I need to lower my T which finasteride has caused to rise.
.5 for the 1x weekly. No idea about topical progresterone.
 
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