Did a few years of oral finasteride, had extreme sides.
Gyno (had to be surgically removed). Lost of libido. Prostate pain. Extreme brain fog and fatigue. No erections
Switched to topical finasteride. Same sides even with the lower dose when used with DMI.
Switched to topical finasteride without DMI. 0.05%, absolute lowest dose. No side effects but did not stop hair loss either.
Switched to topical dutasteride 1%. (2mg per ml). Completely stopped hair loss. No side effects. I use it once a month to not allow build up
Only side effect I get is a little anxiety the first 2 days when waking up after applying it. Then it goes away.
Blood-work confirmed DHT levels are down 40% but my testosterone is also lower so it could be reducing less than that.
I believe you need a minimum of DHT to function without brain fog and libido. As long as you keep it on the low spectrum or a little below minimums you will function fine and halt the hair loss. My scalp DHT reduction is probably in the 90% area as the enzyme converts on hair follicles as well and the molecular weight (530 kda) allows dutasteride to remain there.
I want to go on TRT this year to get my levels back to 800-900 which was my natural test level at age 30. On the high of the spectrum.
I want my DHT to remain below 250 and estrogen below 60.
Right now my test is 470 (low). Free test is 10 (extremely low but withing range), DHT is 170 (below minimum) and Estrogen 40 (healthy)
I'm 34.