On Finesteride Since 2002 – Recent Changes

[Editor Ed]

My story is a long and mixed one, but to cut to the chase, a couple years ago, I was encouraged to increase my dosage of finesteride from 0.5 mg, which had been sufficient for years, to 5 mg. Since then, it appears that there was no prostate issue, which had been the impetus for the increase. I then tried to titrate the dosage back down to a lower amount as sexual function was impacted. Attempted twice to go down slowly beginning with 3.75 mg, and more recently closer to 3 mg over a period of 6 weeks, and each time, hair loss occurred.

I know how effective taking finesteride had been for over 17 years (I began at age 31) seemingly without issue, and even managing to retain its benefits on a half dosage for 4 years. Now it seems, after going up to 5 mg for a year, the body adjusted to this, and backing down from it without losses is challenging!

How have others handled such a situation -- what are the key recommendations for slow and safe dosage reduction? Thanks in advance.

 

[Roberto_72]

So you went from 0.5 to 5 in one fell swoop?
It is one big step.
If I were you I would step back by .5 a week until back to - say - 1 if you want to up the original dose.
Research says that the dosage that can help you keep your hair can be as low as .25 - .5 as you used to do.
5 is overkill.

 

[Who Farted]

You’re going to have hairloss no matter what. Your body has gotten used to the high dose and it now requires said dose to maintain what you have. That being said, taking that much is a really, really bad idea and backing off to a more reasonable dose isn’t just a smart move, it’s a necessary one.

Right now your body is basically in withdrawal. No matter the substance involved, dropping your dosage drastically or cold turkey is going to trigger a dramatic rebound and will remain so until your body adjusts to the difference. Unfortunately, some of your weaker, miniaturized follicles are not going to survive this process; if it took 5 to maintain them in that stage, anything less will be insufficient. By the time your body adapts these follicles will have sung their swan song.


That being said there are things you can do to mitigate your losses. While cold turkey will get you where you need to be faster, but it will come at the price of more severe withdrawal symptoms. If you want to minimize your discomfort and the severity of the shock dealt to your body, you should go with a taper until you get where you need to be.

 

[Editor Ed]

I was indeed familiar with those research findings and it's what lead me to take my does down to .5 daily for years, and then .25 for a couple years. The sudden jump up was on the advice of a physician who suspected prostate issues. Now having to bring the dose down, has been not quite an exact science in the dosing. Dividing the 5 mg pill with a cutter into quarters has some losses just from the nature of cutting, but let's say each quarter piece of the original 5 mg pill has 1.25 mg. I have been on 3.75 mg trying to go down to 2.5 mg for over a month, but can sense the delicate situation of incurring losses. A 0.5 step down, it stands to reason, would likely be better, but it is very hard to cut - it's quite inexact Perhaps a digital scale to weigh these would help at arriving at the proper/more precise dose. Still though, it appears we're lacking in any tested protocol for scaling down the dose in a secure as possible way that can be recommended. Perhaps decreasing by .25 mg every month is optimal - but who would know?

And since we don't wish to be taking more medication than necessary as a general rule, can either of you speak about your familiarity (not personal experience if you haven't any, but what you've read most often) with the adverse effects of 5 mg?

Compounding matters, I'm one of those people who seem to experience a side effect from Minoxidol (5%) if using it more than once a day -- lowering blood pressure and leading to a dizzy/faint feeling. So scaling up that drug while tapering the other, isn't an option.

This is all a difficult call.

 

[Screeech]

How long ago did you first start lowering down form 5mg?

 

[Editor Ed]

Several months ago. Close to a year. I'm at between 3.75 and 2.5 now, alternating, stepping down.

 

[Screeech]

Several months ago. Close to a year. I'm at between 3.75 and 2.5 now, alternating, stepping down.

Did you get any re-growth when you went up to 5mg?

Maybe the loss is hair that regrew when you started taking a stronger amount?

And has the hair loss consolidated at all after going down to lower doses or does it just continue to fall?

 

[Editor Ed]

No, I did not see regrowth. To explain further, I had underwent a surgery, about 2-3 weeks after running out of finesteride medication abroad (taking 0.5 mg up until then), and after surgery, retained water, which the surgeon speculated is sometimes due to prostate issues. I began noticing hairloss at this time, and stepped up to 5 mg, recommended as a possible help by a urologist while awaiting test results. When the urology test results came back, there were no issues visible at all, and it remains unclear as to why I retained water immediately after surgery (thus prompting the prostate/5mg track). Though finding nothing to be concerned about, the urologist said I could stay on 5 mg. Not a clear or strong recommendation. This physician or another said the finesteride could also be the cause of problems. But at no time was growth experienced after increasing to 5 mg, and this remains solely about avoiding losses.

 

[Kambrira159]

Lol 5mg of finasteride a day. f*****g retarded sh*t.

 

[Editor Ed]

Lol 5mg of finasteride a day. f*****g retarded sh*t.

Meaning?

 

[Michael1986]

I have read that finasteride is supposed to have an essentially flat dose response curve for all doses of around 0.5mg upwards. So 0.5mg should inhibit virtually the same amount of DHT as 5mg.

 

[Kambrira159]

Meaning?

Way too much per day. Completely overdosing.

I use 0.2mg per day of topical as per the clinical study from 2016.

 

[Who Farted]

I have read that finasteride is supposed to have an essentially flat dose response curve for all doses of around 0.5mg upwards. So 0.5mg should inhibit virtually the same amount of DHT as 5mg.

Yes that’s correct. The dose isn’t upped because the results will be more effective, it’s upped to overcome your body’s adapting to said dose. You take more for the same result. When you take an unnecessarily high dose you sacrifice years of viable treatment as your ability to taper up is restricted. This is why it’s important you take the lowest dose you respond to.

 

[Michael1986]

Yes that’s correct. The dose isn’t upped because the results will be more effective, it’s upped to overcome your body’s adapting to said dose. You take more for the same result. When you take an unnecessarily high dose you sacrifice years of viable treatment as your ability to taper up is restricted. This is why it’s important you take the lowest dose you respond to.

Is this phenomenon of your body adapting to the dose something that has been well studied? I haven't needed to increase my dose of dutasteride as of yet and I've been using it for over five years.

 

[Who Farted]

Is this phenomenon of your body adapting to the dose something that has been well studied? I haven't needed to increase my dose of dutasteride as of yet and I've been using it for over five years.

There was a study that showed that a low dose and a high dose have the same ceiling, taking more will never break through. The only difference between the two was that the higher dose reached the cap earlier than the low dose.

In other words, a higher dose allowed finasteride to reach its full potential faster, but did not lead to a better result than the lower dose, it simply got to that result faster. There was a forum post about that but if I find the link I’ll post it.

As to why you have to increase the dosage over time, it’s the same as any drug. You build a tolerance to it, which renders the initial dose ineffective over time and necessitates a higher dose to sustain the results.

 

[Michael1986]

There was a study that showed that a low dose and a high dose have the same ceiling, taking more will never break through. The only difference between the two was that the higher dose reached the cap earlier than the low dose.

In other words, a higher dose allowed finasteride to reach its full potential faster, but did not lead to a better result than the lower dose, it simply got to that result faster. There was a forum post about that but if I find the link I’ll post it.

As to why you have to increase the dosage over time, it’s the same as any drug. You build a tolerance to it, which renders the initial dose ineffective over time and necessitates a higher dose to sustain the results.

That's interesting. I wasn't sure if enzyme inhibitors worked in a way whereby a person will need more of the drug over time, but I guess it makes sense that your body would build up a tolerance. I think it might have been me who made the post you're referring to. It was a thread I made about a study in which 2.5mg of dutasteride was shown not to be more effective than 0.5mg. Results just peaked earlier at the higher dose.

 

[Editor Ed]

A new update: after a long and cautious steady decrease in dosage amounts, I'm now down, technically, to 1.8 mg a day from the original 5 mg of months ago. In actuality, I'm alternating between a half pill of Proscar (2.5 mg) and a quarter pill (1.25 mg) each day, so the daily average is ~1.8 mg.

I'm not noticing much improvement in function, semen amount, or libido, so I'm getting ready to retest with an endocrinologist for cholesterol levels, testosterone levels, and other health markers. I eat well, exercise like banshee 3-4 days a week, don't smoke, and drink only moderately.

A thought that arises, is that this situation of taking a varied amount every other day could be problematic on the endocrine system looking to settle into a steady state. It seemed I was doing better during an earlier stage in the titration process, when, for example, I took a half pill for 5 days in a row, before stepping it down 1 day with a quarter pill, and then returning to a half pill for the next 5 days. At any rate, I'm doing this slowly and cautiously over many months, as discussed, to avoid losing hair, and that's been a success: no real noticeable loss of follicles over several months despite now taking substantially less finesteride.

Onward to 1mg, and then 0.5 in the coming weeks/months.

Any thoughts about this flip-flopping 1.25 mg one day, and 2.5 mg the next day point and its effect on the endocrine system? I could jump ahead to the next level (usually done in 3 week stages to date) and take a more steady 1.25 mg for 2 or 3 days before alternating with 2.5 mg. Or just drop to 1.25 immediately now, but I hesitate, as the slow and gradual titration has been a success for retaining hair.

 

[Kambrira159]

You're still completely overdosing yourself. What the f*** do you expect?

You should just drop to 1mg immediately and if not 0.5mg immediately.

 

[Northface32]

Yeah if you were on .5 you should've went to 1 mg and probably would've been good. Glad to hear its worked and still is after all this time. Nice. I

 

[Editor Ed]

After a haircut today, the thinning that occurred over 1 1/2 years ago from which I'm trying to hold ground on seemed more pronounced on the sides than ever, right above the ears and behind them. This one area is a concern now and I'm wondering if loss on the sides alone suggests anything, as far as the cause, as well as whether it's possible to spot treat there more aggressively.

I've used Minoxidil 5% for over a decade, in conjunction with the varied amounts of finesteride. Try 15% Minoxidil--perhaps I should now, or should've begun trying far earlier? I've longish hair and have always used the liquid solution as the foam is impossible to apply through long hair. A further note: I've mostly always been a once nightly user of Minoxidil, albeit with about 25% more above the applicator line, due to how it affects the look of my hair for the day, matted down at top and streaked by the solution. So perhaps it may be worth applying in the morning to the sides now, either 5 or 15%. I know most all experience and testing recommends 2x a day; it hasn't been a match for my hair/hairstyle and life, but I can tolerate 2x a day on the sides.

Also, in this long titration process, I've opted not to linger in the current phase of 2.5 mg and 1.25 mg on alternate days for 3 weeks, suspecting this highly inconsistent high and low daily dose to be possibly worse for the endocrine system, and am skipping to 1.25 mg for 2 days then 2.5 mg on the third day.