(M23) Losing ground - In need of your advice (+ photos)

[321nickname123]

Hello all,

I’ve been lurking on the forum for over a year without ever posting something. There have been lots of useful threads on here which I’m very thankful for. Now, I’d like to ask you guys for help and advice since I need it.

About me:

• M23, Continental Europe
• Hair loss since 2017 approximately
• Currently approaching NW3
• Very little facial and body hair

My regimen:

• Oral finasteride, 0.5mg daily (since July 2019)
• Dutasteride 0.5mg once weekly (since October 2020)
• Essengen 6 Plus (topical finasteride/minoxidil solution), +/- 1ml daily (since June 2020)
• Derma pen, 1.5mm, once weekly (since September 2020)
• Oral castor oil, 2-3ml daily (since August 2020)
• Shampoo: Regenepure DR (since beginning of 2019) as well as Nizoral (since October 2019) and OGX Biotin Shampoo and Conditioner (since end of 2019)
• Foligain hair growth tablets and multi vitamin tablets, alternating (since end of 2019)
• Scalp massage (2x 2-3 minutes daily since recently, using my fingers)

Stopped:

• Kirkland 5% minoxidil topical lotion (February 2019 – June 2020), quit to use Essengen 6 Plus instead
• Derma roller (April 2019 – September 2020), quit to use derma pen instead

Hair situation:

Comparing pictures from early/mid 2019 to now, I can definitely tell that I’ve lost ground. It’s been going slowly, but my temples have recessed further and my hairline got thinner. My crown is still good (although I’m scared that it’ll thin in the months/years to come). Would say I’m about a Norwood 3 right now. My hair is of medium length by the way. I'd say my hair has gotten darker in the last +/- 1.5 years, but not necessarily thicker. Also, some of my hairs (especially at the front) have split ends and they've gotten curlier whereas naturally I do not have curly hair. Is this simply a symptom of alopecia, or could it be an effect of any of the medication I'm using? I recently decided to use the conditioner more often but doubt it'd help...

As you can tell from my regimen, I’ve been adding new elements in the last few months. Between February 2019 and the summer of 2020, the only things I used were the big 3 (Minoxidil, Finasteride and the shampoos). I would occasionally take some vitamin or hair growth capsules. My hope was that this would be sufficient. Well unfortunately it isn’t for me.

As a result, I have added new things. Right now the most potent things I’m using are oral finasteride, topical finasteride/min, and since this month dutasteride once weekly. I have read multiple stories here that dutasteride could be harmful for the hairline (which is exactly the area I want to maintain). I have also read stories of people who regrew or maintained their front with dutasteride but not with finasteride (and vice versa). Some people here have said that RU works very well with dutasteride – which is the option I’m exploring next.


Now, I have a couple of questions:

• Should I add RU to my regimen (once daily) and get rid of the Essengen 6 Plus?
• To those using RU; how has it worked for you until now?
• Is it better to order a pre-made RU solution from e.g. Actifolic or is it better to make it yourself?
• If you make RU yourself, which vehicle is best to use and why? (any threads detailing this?)
• Is it okay to keep using finasteride in addition to dutasteride and RU?
• Are there any other things I could add to my regimen that may work?

In addition, my plan is to get an FUE procedure done next year. However, it is important that I further stabilize my hair beforehand. I’ve had multiple consults and they said I’d need between 1500 and 1800 grafts. Personally, I think I’ll need around 2200-2400 to make my hair future proof. Have about 6500 donor grafts available according to the clinic but bet it could be stretched to 7000 ish.

I attached a few pictures of the 2019 – 2020 period for you to see the progression. 2019 pictures are from June to August. 2020 pictures are all from the last couple of weeks. Sadly the quality isn't great and they're not 100% comparable (different lighting, angles, etc.). Feel free to comment on it and let me know what you think. Any tips, advice or critique is much welcome.

Kind regards

 

[Androgenic Alpaca]

Sounds like you are on the right track. The continued hair loss even on finasteride is alarming to be sure. I think the addition of dutasteride + topical finasteride could slow or prevent further hair loss, the three months hasn't really been enough time to judge effectiveness. Keep on dutasteride + topical finasteride for another 3-6 months and then judge if its been effective.

Finasteride and dutasteride work largely on the same mechansim, you can think of dutasteride as a stronger form of finasteride. However, If you're only taking dutasteride once a week, it is probably worth it to stay on finasteride. If you start taking dutasteride more often, there's probably no point to taking both orally. Also, stick to the topical finasteride even on oral finasteride/dutasteride, since the topical will increase the concentration of the medication in the scalp tissue which is where you need it most. oral finasteride/dutasteride is very good at decreasing blood serum DHT levels, but may not decrease scalp DHT enough since scalp tissue produces DHT in the tissue.

Curious, do you have any problems with acne? Acne can also be caused by excess DHT.

I wouldn't give to much weight to stories about dutasteride harming the hairline.

RU is the next logical step since it functions differently from finasteride/dutasteride and will complement those therapies. I make my own RU solution. Usually you can mix RU right into the minoxidil solution that you use. I'd stick with your topical finasteride/min solution. Maybe even increase usage of that to twice daily.

your main goal with RU + dutasteride + finasteride will be to stop further hair loss. If you get regrowth, that'll be great, but the purpose of these medications are to stop further balding, not to regrow. Oral castor oil, dermarolling, and minoxidil are growth stimulators that could lead to regrowth.

Hate to say it, but your hair growth tablets, multivitamins, and fancy shampoos probably aren't doing too much, so if you want to save some money you can stop those, but if you want to continue them it won't hurt.

Besides RU, the next logical things to add are stemoxydine (which is very weak in any case), tretinoin/retinol (which might increase effectiveness of topical minoxidil), and oral minoxidil (be careful with this, though - it could have side effects)

Since you're in Europe, stemoxdine should be pretty easy to get. Also, I believe that alfatradiol is easier to get in Europe. Both of those are rather weak growth stimulants, but could be worth it if you can get them cheap (In the US, they're frequently too expensive to be worth it)

I'd say in 99% of people, RU + finasteride + dutasteride will be enough to halt baldness from progressing, but if not, there are still options for more extreme treatments. There's more extreme treatments for growth stimulation, too. Make sure you do your research, these could have undesireable side effects. Look around this forum for some of the experimental treatments some people are trying.

 

[321nickname123]

Sounds like you are on the right track. The continued hair loss even on finasteride is alarming to be sure. I think the addition of dutasteride + topical finasteride could slow or prevent further hair loss, the three months hasn't really been enough time to judge effectiveness. Keep on dutasteride + topical finasteride for another 3-6 months and then judge if its been effective.

Finasteride and dutasteride work largely on the same mechansim, you can think of dutasteride as a stronger form of finasteride. However, If you're only taking dutasteride once a week, it is probably worth it to stay on finasteride. If you start taking dutasteride more often, there's probably no point to taking both orally. Also, stick to the topical finasteride even on oral finasteride/dutasteride, since the topical will increase the concentration of the medication in the scalp tissue which is where you need it most. oral finasteride/dutasteride is very good at decreasing blood serum DHT levels, but may not decrease scalp DHT enough since scalp tissue produces DHT in the tissue.

Curious, do you have any problems with acne? Acne can also be caused by excess DHT.

I wouldn't give to much weight to stories about dutasteride harming the hairline.

RU is the next logical step since it functions differently from finasteride/dutasteride and will complement those therapies. I make my own RU solution. Usually you can mix RU right into the minoxidil solution that you use. I'd stick with your topical finasteride/min solution. Maybe even increase usage of that to twice daily.

your main goal with RU + dutasteride + finasteride will be to stop further hair loss. If you get regrowth, that'll be great, but the purpose of these medications are to stop further balding, not to regrow. Oral castor oil, dermarolling, and minoxidil are growth stimulators that could lead to regrowth.

Hate to say it, but your hair growth tablets, multivitamins, and fancy shampoos probably aren't doing too much, so if you want to save some money you can stop those, but if you want to continue them it won't hurt.

Besides RU, the next logical things to add are stemoxydine (which is very weak in any case), tretinoin/retinol (which might increase effectiveness of topical minoxidil), and oral minoxidil (be careful with this, though - it could have side effects)

Since you're in Europe, stemoxdine should be pretty easy to get. Also, I believe that alfatradiol is easier to get in Europe. Both of those are rather weak growth stimulants, but could be worth it if you can get them cheap (In the US, they're frequently too expensive to be worth it)

I'd say in 99% of people, RU + finasteride + dutasteride will be enough to halt baldness from progressing, but if not, there are still options for more extreme treatments. There's more extreme treatments for growth stimulation, too. Make sure you do your research, these could have undesireable side effects. Look around this forum for some of the experimental treatments some people are trying.

Thanks a lot for your detailed reply, much appreciated.

Indeed I'm taking dutasteride only once weekly to see if my body can tolerate it in terms of side effects. Ideally, I'd not take it more than twice a week. Just want to see if taking it once a week can make a difference. Will evaluate the effectiveness (if any) after 6 months or so.

In terms of topical finasteride; I'm planning to continue using it for now. But not sure if I can use both Essengen 6 Plus and RU. 2 topicals is quite a hassle and expensive as well.

Don't really have acne. I did however observe a minor increase in pimples on my head (face and on the sides of my head) in the last few weeks. Can be unrelated to dutasteride, but not completely sure.

About your RU: what do you mix it in? I guess I cannot mix it in my Essengen 6 plus (topical min+finasteride) right? Honestly I don't want to use Kirkland again since I get a lot of white flakes from it. More than with the Essengen 6 Plus. Is there another minoxidil which is good to use with RU, or maybe a different vehicle?

About the shampoos: I do agree, but my main goal is to refrain from using shampoos that contain sulfates and parabens. These shampoos are pretty innocent in terms of ingredients (although Nizoral dries the hair quite a bit, therefore I combine it with a conditioner). I've been using Regenepure NT as well for over a year but decided to stop using it since it's not much better than a normal conditioner. Do plan on taking the vitamin tablets just for my overall health . Might quit using the foligain tablets, but it only costs me like €4.50 a month if I take one every other day.

Could you maybe tell me more about tretinoin/retinol? Is it a topical or can it be used as a vehicle for e.g. RU? Tbh I'm not sure about adding new topicals beyond finasteride/min and RU, so maybe not handy to take this.

I think oral finasteride, oral dutasteride and topical RU/min (and/or topical finasteride) should be enough to halt (or at least drastically slow) the hair loss. If not, then I don't think there's much I can do. I believe dutasteride is the most potent drug that doesn't change you into a woman on the market...

 

[Androgenic Alpaca]

Thanks a lot for your detailed reply, much appreciated.

Indeed I'm taking dutasteride only once weekly to see if my body can tolerate it in terms of side effects. Ideally, I'd not take it more than twice a week. Just want to see if taking it once a week can make a difference. Will evaluate the effectiveness (if any) after 6 months or so.

In terms of topical finasteride; I'm planning to continue using it for now. But not sure if I can use both Essengen 6 Plus and RU. 2 topicals is quite a hassle and expensive as well.

Don't really have acne. I did however observe a minor increase in pimples on my head (face and on the sides of my head) in the last few weeks. Can be unrelated to dutasteride, but not completely sure.

About your RU: what do you mix it in? I guess I cannot mix it in my Essengen 6 plus (topical min+finasteride) right? Honestly I don't want to use Kirkland again since I get a lot of white flakes from it. More than with the Essengen 6 Plus. Is there another minoxidil which is good to use with RU, or maybe a different vehicle?

About the shampoos: I do agree, but my main goal is to refrain from using shampoos that contain sulfates and parabens. These shampoos are pretty innocent in terms of ingredients (although Nizoral dries the hair quite a bit, therefore I combine it with a conditioner). I've been using Regenepure NT as well for over a year but decided to stop using it since it's not much better than a normal conditioner. Do plan on taking the vitamin tablets just for my overall health . Might quit using the foligain tablets, but it only costs me like €4.50 a month if I take one every other day.

Could you maybe tell me more about tretinoin/retinol? Is it a topical or can it be used as a vehicle for e.g. RU? Tbh I'm not sure about adding new topicals beyond finasteride/min and RU, so maybe not handy to take this.

I think oral finasteride, oral dutasteride and topical RU/min (and/or topical finasteride) should be enough to halt (or at least drastically slow) the hair loss. If not, then I don't think there's much I can do. I believe dutasteride is the most potent drug that doesn't change you into a woman on the market...

I mix my RU in with my other topicals in generic Rogaine (ethanol/PG solution). I don't know what vehicle Essegen uses, but I would guess that you could dissolve RU in it probably.

Tretinoin and retinol are both retinoids which are vitamin A derivatives that are used a lot in dermatology. The main effect of retinoids is to increase the amount of collagen, which by itself will be good for your scalp. But also, retinoids increase the amount of sulfotrase (sorry, not correct spelling) in your skin which is an enzyme that converts minoxidil to its active form (minoxidil sulfate). Skin naturally has this enzyme in it, but some people don't have as much so minoxidil will be less effective for them. This is also why oral minoxidil will tend to be more effective, because it'll be converted into minoxidil sulfate in the liver.

Retinol is the version that is available over the counter without a prescription, tretinoin (or Retin-A) is a prescription-only medication. They usually come in a cream or ointment

yeah, there's no reason to stop shampoo/vitamins, just know they won't be doing very much.

combining daily finasteride with weekly or twice weekly dutasteride is very common and an effective way to go if dutasteride every day gives you sides.

 

[321nickname123]

I mix my RU in with my other topicals in generic Rogaine (ethanol/PG solution). I don't know what vehicle Essegen uses, but I would guess that you could dissolve RU in it probably.

Tretinoin and retinol are both retinoids which are vitamin A derivatives that are used a lot in dermatology. The main effect of retinoids is to increase the amount of collagen, which by itself will be good for your scalp. But also, retinoids increase the amount of sulfotrase (sorry, not correct spelling) in your skin which is an enzyme that converts minoxidil to its active form (minoxidil sulfate). Skin naturally has this enzyme in it, but some people don't have as much so minoxidil will be less effective for them. This is also why oral minoxidil will tend to be more effective, because it'll be converted into minoxidil sulfate in the liver.

Retinol is the version that is available over the counter without a prescription, tretinoin (or Retin-A) is a prescription-only medication. They usually come in a cream or ointment

yeah, there's no reason to stop shampoo/vitamins, just know they won't be doing very much.

combining daily finasteride with weekly or twice weekly dutasteride is very common and an effective way to go if dutasteride every day gives you sides.

Do you think a topical consisting of RU + minoxidil + finasteride isn't dangerous? I'm not sure, but I've never heard of it before.
Either way, I can't use two different topicals (expensive + a hassle) so I'd have to choose. Would probably stick with oral finasteride+dutasteride and then topical RU in minoxidil. But for now I'll continue with the Essengen for a few months, just to see if it'll give any more results.

Will read up on tretinoin/retinol, thanks for the elaboration.

 

[Androgenic Alpaca]

Do you think a topical consisting of RU + minoxidil + finasteride isn't dangerous? I'm not sure, but I've never heard of it before.
Either way, I can't use two different topicals (expensive + a hassle) so I'd have to choose. Would probably stick with oral finasteride+dutasteride and then topical RU in minoxidil. But for now I'll continue with the Essengen for a few months, just to see if it'll give any more results.

Will read up on tretinoin/retinol, thanks for the elaboration.

I honestly can't tell you that RU isn't dangerous since it is an experimental research chemical that was never approved for human use. So definitely use it at your own risk. The human trials that were done on it showed no severe side effects, though. In my own usage, I'm not worried about RU itself, I'm worried about potential contaminants that could be in the RU that I purchase from unregulated grey market manufacturers in China.

That being said, I would expect using both RU and finasteride topically together would be no more unsafe than using RU itself. The two drugs act in different ways, so I would not expect any interaction. Minoxidil works in a third, completely unrelated mechanism as well. The only real question mark on a Ru + Min + finasteride topical treatment is the RU - whether you are willing to use an unapproved chemical from an unregulated lab.

If you are cool with unregulated labs, then you can buy both RU powder and Finasteride powder straight from China and it actually comes out pretty cheap. Use at your own risk, however.

 

[321nickname123]

Thanks a lot. I'll dive into it in the coming weeks.
Could you maybe PM me a link to the place where you get your RU powder from? The only (legit) places I know are Anageninc and Actifolic.


Was also wondering where people buy oral minoxidil? Might give this a try in the future.

 

[321nickname123]

Does anyone else have any comments, tips, tricks, etc.?
I'm sure there are a lot of people here who know more than me.

I'm thinking of adding RU powder to a topical finasteride/minoxidil solution (Essengen 6 Plus).

 

[Bora]

I'm 23 and I'm approaching nw3 as well, I started using topical minoxidil and oral dutasteride because RU is not available in our country.

 

[321nickname123]

I'm 23 and I'm approaching nw3 as well, I started using topical minoxidil and oral dutasteride because RU is not available in our country.

Have the medications worked for you so far?

 

[Selb]

Honestly, you just started the dutasteride so it might still help. I understand the fear that it’ll cause more hair loss at front since it’s known to do that for some reason, but that could also be nonsense passed along by people. I would say honestly to switch to topical dutasteride because apparently that suppresses more scalp dht without affecting serum too much. This will keep you side effect free if you want to use RU too I hope.

 

[321nickname123]

Honestly, you just started the dutasteride so it might still help. I understand the fear that it’ll cause more hair loss at front since it’s known to do that for some reason, but that could also be nonsense passed along by people. I would say honestly to switch to topical dutasteride because apparently that suppresses more scalp dht without affecting serum too much. This will keep you side effect free if you want to use RU too I hope.

Thanks for the comment. Where does one buy topical dutasteride? Or do you make it yourself?
I'd like to maybe make a topical which includes RU and minoxidil, and also finasteride or dutasteride, but not sure if that's possible.

 

[Selb]

Thanks for the comment. Where does one buy topical dutasteride? Or do you make it yourself?
I'd like to maybe make a topical which includes RU and minoxidil, and also finasteride or dutasteride, but not sure if that's possible.

You can buy it from minoxidil express. I’m sure there are also tutorials to mix it yourself with dutasteride tabs. I wouldn’t combine the dutasteride with RU and minoxidil, since dutasteride being used once a week is enough. finasteride can be used daily, but topical finasteride affects serum levels anyways so I’d stick with oral.

 

[321nickname123]

Thanks for the comment. Where does one buy topical dutasteride? Or do you make it yourself?
I'd like to maybe make a topical which includes RU and minoxidil, and also finasteride or dutasteride, but not sure if that's possible.

You can buy it from minoxidil express. I’m sure there are also tutorials to mix it yourself with dutasteride tabs. I wouldn’t combine the dutasteride with RU and minoxidil, since dutasteride being used once a week is enough. finasteride can be used daily, but topical finasteride affects serum levels anyways so I’d stick with oral.

Thanks for the website! Looks interesting. I'm guessing you refer to this product: https://minoxidilexpress.com/product/regrowth-labs-d5a/
So you'd say: use the topical dutasteride from that website once a week, and use a RU topical on the other days? Perhaps I could put the RU powder in my Essengen 6 Plus (min/finasteride) topical then?

 

[Selb]

Thanks for the website! Looks interesting. I'm guessing you refer to this product: https://minoxidilexpress.com/product/regrowth-labs-d5a/
So you'd say: use the topical dutasteride from that website once a week, and use a RU topical on the other days? Perhaps I could put the RU powder in my Essengen 6 Plus (min/finasteride) topical then?

Yup that’s it. I’m not sure about mixing the RU topical together with those, I can’t speak to the stability of it when it’s mixed in with minoxidil and finasteride. I can’t imagine it’ll break down, but it would make life easier to have only a few topicals to worry about. Maybe you can do a topical dutasteride once a week, topical RU every night, and topical finasteride/minoxidil every morning.

Here’s a more plates more dates article about RU and minoxidil:

How To Make A RU58841 And Minoxidil Combination Solution

If you cannot source Ethanol, or you simple don’t want to spend the money on it as you already currently use liquid Minoxidil, aside from K&B solution, a viable alternative would be to mix your RU58841 raw powder in your Minoxidil liquid.

moreplatesmoredates.com

 

[321nickname123]

Yup that’s it. I’m not sure about mixing the RU topical together with those, I can’t speak to the stability of it when it’s mixed in with minoxidil and finasteride. I can’t imagine it’ll break down, but it would make life easier to have only a few topicals to worry about. Maybe you can do a topical dutasteride once a week, topical RU every night, and topical finasteride/minoxidil every morning.

Here’s a more plates more dates article about RU and minoxidil:

How To Make A RU58841 And Minoxidil Combination Solution

If you cannot source Ethanol, or you simple don’t want to spend the money on it as you already currently use liquid Minoxidil, aside from K&B solution, a viable alternative would be to mix your RU58841 raw powder in your Minoxidil liquid.

moreplatesmoredates.com

Thanks a lot.
Yeah, 3 topicals is kind of a no-go for me. I'd like to limit it to 1 (or 2 when I can use one of them, like dutasteride, only once weekly).

I think the best, for now, would be to use oral finasteride, topical RU+minoxidil, and then dutasteride either orally or topically once or twice a week.

By the way, do you buy your RU from e.g. Anageninc or Actifolic?
I've heard that some people source it from Alibaba etc. Cheaper, but riskier. But maybe those known companies also source their RU from "sketchy" Chinese suppliers.

 

[Topher]

I'm on dutasteride oral, and min & RU topical with micro-needling. I'm responding awesome.

 

[321nickname123]

I'm on dutasteride oral, and min & RU topical with micro-needling. I'm responding awesome.

That's great to hear!
May I ask, how old are you and what's your Norwood level when you began treatment?
And do you take Dutasteride every day, or e.g. once a week?

 

[Topher]

That's great to hear!
May I ask, how old are you and what's your Norwood level when you began treatment?
And do you take Dutasteride every day, or e.g. once a week?

I'm 39, I've been at this little over 2 years. I went to the doctor when I was 24 he said there's nothing you can do except for hair transplant. I've seen some crazy recoveries since. I was Norwood 6 maybe. I had to go to court to get my kid back, cost me 6000+. It was extremely hard and stopped everything for a time. I had effectively went from n6 to severe diffuse thinning. After few months after everything settled down I started again but tweaked my routine by dropping Ru and doing, minoxidil, spironolactone, dutasteride. It wasn't nearly as effective. I'm now back on my OG Nuclear protocol. Yes .5 dutasteride a day. I don't like pictures for the obvious reasons sorry. First pic is shortly into treatment second is less than 6 months of treatment.

 

[Bora]

Have the medications worked for you so far?

Not yet because I've been using minoxidil for almost one month and dutasteride for almost one week