To Avodart or not--need help (long, lots of questions)

[reverie]

Hi everyone, I am a woman and I'm here because I've exhausted the female hair loss boards and want input on Avodart which is my final resort. (If any of you read the hair transplant forum, I'm the same reverie there too, but since I had a consult with Dr. Epstein that determined I'm not a very good candidate due to the speed of my diffuse loss, I will try that only if I think I have nothing to lose.) I'm trying to retain what hair I have left and I don't know if I should take Avo. I read a lot of posts here before joining.

It's really humiliating to reveal so much about myself even though the internet is supposedly "anonymous" but I really need some input. I am 27 years old and I've been losing for a year and a half (since I turned 26) and since then have lost 50% of my hair density. I don't have PCOS or any other overtly abnormal hormone conditions. What I DO have is an alarming maternal family history of hair loss, coupled with extreme androgen sensitivity inherited from my dad, together which accounts for how fast I'm losing and why I'm losing at such a young age. All the women on my mom's side are bald on the crown (my mom, her mom, her mom's mom, I'm sure the first woman on that side is bald too), although none of them started until menopause. And I don't mean they are thinning a little, I mean they thinned diffusely in a major way concentrated on the top/crown (my grandma only has a few wispy strands left). I, my brother, and a few of our cousins on the paternal side suffer cystic acne, horribly oily "Crisco skin" and are generally walking androgen sensitivity pictures straight out of a dermatology textbook, although, just in case g-d wasn't humoring me enough, my 53-year-old dad and my 25-year-old brother both have all their hair (my brother may be starting to thin a little at the temples, but I can't tell because despite everyone's objections he took to shaving his head a few years ago so he wouldn't have to spend time washing and styling anymore). Boy, I only wish it were that easy for me.

I tried spironolactone 150mg a day for almost a year, and in the end had to quit because of the MANY problems it caused. I also experienced a reflex hyperandrogenic (extreme upregulation?) effect. For 10 months it helped my acne and cleared my skin and slowed my shed but suddenly, my skin erupted in oil twice as bad as it was before and labs taken a month later still showed really elevated T, androstenedione, and prolactin (none of which I had before and I have plenty of "before" labs to prove it). I don't know if my body returned to homeostasis since then because I haven't had repeat labs. I contacted Bryan about this on another board and I think he was quite bewildered, but kind enough to send me some reading info.

Currently using Rogaine foam twice a day spaced at 12-hour intervals, and religious about it since June 2006, plus Nizoral 1% every day. Neither help my wretched scalp problems (pain, burning, tenderness, itching, creepy-crawlies...you know what I mean). Hair continues to shed/thin at alarming rate. I really feel Avo is my last resort. (I can't use cpa/androcur or flut for other reasons, and I don't think finasteride is enough because it doesn't address the oil problem which I believe is where most of my DHT is concentrated. Please tell me if this is wrong.) My hesitations include:

* possibility of RH
* possibility of liver problems (I think 5ar-1 is present in the liver?)
* possibility of neuro/cognitive problems (I know 5ar-1 is present in the brain)
* insanely long half-life (I shouldn't pass on my genes (Androgenetic Alopecia is far from my only problem), but a part of me wants the option to have kids in the future)
* perhaps most importantly, does Avo increase estrogen (estradiol specifically) in a woman? If it does, I don't think I can take it.
* etc...basically all the other issues you guys have touched on

Also, most of my hair is now miniaturized. I'd say 50% or more--so is there a better course of action than Avo and Rogaine, given my history and symptoms above?

If I start Avo every day, how long will it take to get to steady-state, so I can drop to EOD?

Is there any news of a lower-dose Avo? I'd be much more comfortable with that...

Does saw palmetto block BOTH types of 5ar or just 5ar-2? Again, I don't think 5ar-2 is really my problem, because the only androgen problem I DIDN'T suffer is excess hair (although I have it now from the Rogaine), so I'll only make a bad situation worse by taking a 5ar-2 blocker only.

Is there a sole 5ar-1 blocker I don't know about? Something to address the oil problem.

What's the difference between oil and sebum or are they the same?

I live alone in hair depression 24/7, have hair nightmares sometimes, and hide it from everyone by day with combovers, lots of styling equipment (which I never used before), etc. I just finished law school and am taking the Bar exam in a month, so this is supposed to be a good if busy time in my life...but I worry about job interviews because I haven't been able to find a good piece yet. I worry about finding a partner. My relationship of 2 years recently dissolved, mostly on account of my hair and health problems (no, not how I was reacting to them, but the fact I have them).

Sorry for such a long novel. I hope I don't get laughed at. We're all suffering the same thing after all.

I welcome any input and thanks for reading.

 

[CCS]

I got to go to class, but I skimmed a few questions:

Yes, sebum is oil.

Reducing 5ar1 is supposed to inhibit sebum production somewhat, and does in hampsters, but in some studies does not in humans. Or at least it does not reduce acne much in some studies. But individuals vary.

I'm not surprised you got hyperandrogen reflexivity. Oral spironolactone or anything else that affects you bulk hormone produces (like a man's testicles) will results in an opposite response. Fortunately 5ar1 and 2 and the androgen receptor don't do this. I'm sure their production might be upregulated some, but not enough to raise DHT levels above baseline, according to the serum Dht graphs I've seen for when subjects were taken off finasteride or dutasteride.

There are a variety of things that can cause hair loss, including iron deficiency, or too much vitamin A. Make sure you read up on those and have the basis covered before you assume dutasteride is not working.



And yes, on my university campus I see a lot of balding women. Just the thin ones though. The fat ones don't see to go bald. I just saw one who was NW2.

 

[reverie]

To Moderators: What happened to the rest of my thread? When I checked 2 days ago, there was on response from Andrea, and I replied to that, now everything is gone except for my original post and CCS's reply. I don't think I violated any rules, but if I did please inform.

To CCS: Thank you for responding. I appreciate it, since the womens' forums don't have nearly as much activity and no one my age is on Avo/dutasteride.

The reason I asked about sebum/oil is because on the acne boards, someone posted that sebum is not the same as oil. :jackit: And, on the same forum, another (seemingly reputable) poster went into a diatribe about how DHT is NOT responsible for acne and hair loss? :lost: Instead, it has to do with dimers (???) formed in response to DHT, or something (I'm paraphrasing rather poorly)? That contravenes everything I've ever read about acne, hair loss, etc...which, while not as much as Bryan or some of you have read, is still A LOT. Is that poster totally off his rocker, or is everything I've been reading the dumbed-down version of acne and hair loss that doesn't explain the details?

I am the only woman who developed RH from spironolactone, and there are TONS of women taking spironolactone on the boards as it's the #1 drug of choice for acne and hair loss. I have to wonder if it's because I wasn't taking it every day (I had trouble with my periods on it). When I get on Avo, I plan to take it ED until I reach steady-state, then drop to EOD or every 2 days. Or will this increase the likelihood of RH?

I don't know if I buy the iron deficiency thing, because I've been anemic my entire life. I can pop iron pills like there's no tomorrow and my ferritin rises minimally, then drops back down to almost zero. So many women pin their hopes on ferritin even when they are losing in an obvious Androgenetic Alopecia pattern, but I'm not in denial. It's too obvious to deny. Still, maybe I'll ask a Doctor about getting iron injections...

Are you sure some of these young women don't naturally have manly hairlines? I already had a manlier hairline than ethnic men (extremely pointy receded-looking temples, favoring dad's side of the family), even as a little girl with no loss.

I wonder about the weight observation though. I'm 5'3", 100 pounds, but a premenopausal thinner almost always has PCOS (I don't so mine is much less treatable) which means she's usually overweight.

Again, thanks for your comments. If anyone has any clue on the 5ar-1 in the liver and brain questions I'd appreciate input.

I also read some posts on RU-something-or-other...is that for real?

 

[Aplunk1]

As far as Avodart goes, I'll let you know that it has essentially stopped my hairloss where Propecia did not. I've taken it for about 2 years now, and it has really done the trick for me-- the only downside being cost and a serious loss of libido.

The 5-AR1 thing scares me a bit, too. I wish I had the answers for you, but the medical community still doesn't know what purpose it serves in the brian.

 

[Dogs3]

aplunk, did dutasteride have any noticeable positive or negative effect on your skin? less oil or something?

 

[reverie]

Thanks Aplunk1.

Did you ever get the abdominal pain sorted out? Was it related to liver issues? (I'm assuming no because you are still taking it?) And did you have acne and oily skin before Avo compared to now?

For me, a 2-month trial of Avo costs just a little bit more than spironolactone and met, but if it works it's priceless. By comparison, getting a bonded piece (if it were even possible for me, which it's not due to my scalp problems) would cost me much more money plus I'd have to move to a city with a salon that offers it.

Does anyone know if saw palmetto blocks 5ar-1 as well? If it does, I'd like to try that before hitting Avo.

 

[Dogs3]

i was on saw palmetto for 3 years. Id say if anything it might have help thicken a bit but i continued to lose hair. Dont waste your money. Its supposedly does block type 1 5ar but it is not proven and there arent any legit studies on it. If you want your type1 blocked as well as type 2, avodart is the way to go, although there isnt much evidence that blocking type 1 does much for hairloss.

 

[CCS]

Because of the lack of studies behind SP, it is even more experimental than the other experimental stuff like spironolactone, peppermint, etc. It certainly is weaker than finasteride, since many people here have tried SP orally and topically and failed. But to be fair, people claim to fail on finasteride too.

Do not worry about dutasteride raising scalp testosterone. Every extra molecule of testosterone is one that would have been a DHT molecule. And the extra T means your scalp can make more estrogen.

I don't know why bulk hormone produces respond slower, but they do. When men take steroids, it takes weeks before their testicles start making less testosterone, and just as many weeks for them to start making it again after they stop taking steroids. 5ar1 and 2 and androgen receptor activity responds much faster, as was shown with many conclusive experiments.

Other stuff you can add, besides finasteride, are topical green tea extract, topical white curcumin, topical lavender essential oil... just read my other posts, or micheal barry's posts.

Anyway, unless you are sure you don't want to have kids in the next few years, you should be on finasteride.

Also realize that most people are lucky to just have maintainance, though usually you can get some peach fuzz from a few months of minoxidil.

 

[CCS]

there are two types of sebum. Sebum made from linoleic acid is oily. Sebum made from oleic acid is waxy and clogs pores. Linoleic acid is a much more potent 5ar1 inhbitor than oleic acid is, but not nearly as good as GLA. You can buy linoleic acid and linolenic acid at http://www.cityofindustry.com. These are free fatty acids, not oils. Oils are fatty acids bonded to glycerol.

 

[reverie]

Thanks guys.

Dogs3, did SP help your oily skin (I'm assuming you had that too, since you asked Aplunk1 about it)?

I'm still confused as to why messing with bulk hormones causes RH more than 5ar. When I was taking spironolactone, month after month my estrogen would increase till at the end everything just imploded. It was the cumulative effect and I think my body realized it wasn't working right. Towards the end I developed A LOT of estrogen-related/mediated problems, and suddenly my body started compensatorily pumping out way more androgens than it ever did. My serum labs went crazy. For me the suppressed T translated into a lot more E, but my endo thought I was high. I know E helps hair, but for health reasons I can't have tons of E. I just want no more DHT (if DHT really causes hair loss).

I didn't know 5ar takes effect much faster. That's good news as it relates to dutasteride. How long does it take for dutasteride to build steady state taking 0.5mg every day? Is there any way to take less?

I'd consider myself lucky (right now) to have maintenance too. I'm pretty sure either my Androgenetic Alopecia genes are too strong or my androgen problems are too severe or both because Rogaine alone doesn't do a thing.

I'm done with the denial game. I won't be able to find a man with hair like my mom (I look 27, except for my hair which looks 67 and soon to border on 87...actually I see plenty of 67 year old women with more/better hair than I) so I gotta get on something to control my loss and maybe grow back a little hair, meet someone, and IF he decides to stick around (which is a big IF from general knowledge of how the world works and especially based on my last experience), we can talk about kids later. I think it takes 6 months for dutasteride to leave your system (?), but I'd probably wait at least a year, maybe 1.5-2 years to have kids.

I know this is a big gamble for a girl, but honestly right now I'm more concerned about the brain, liver, and excess E stuff.

 

[Dogs3]

actually, i dont think SP had any effect on my skin. I have basically dry skin though maybe a bit combination on my face and i didnt notice anything in terms of helping or hurting my dry/ combo skin. I think though thats due to the fact that SP is simply too weak to have much of an impact on skin, or a noticeable one at that... dutasteride on the other hand might, im slightly worried because i do have dry skin and dutasteride may reduce sebum which might make it drier...but that can be remedied so im still going to try it.

Also, CCS, not to hijack the thread but one question: what do you think about topical copper peptides and SOD's like prox-n, do you feel that they can be effective?

 

[Aplunk1]

aplunk, did dutasteride have any noticeable positive or negative effect on your skin? less oil or something?

Yes, Dutasteride cleared up my skin very nicely. The skin benefits are very obvious after 4 months of treatment-- you will notice that most acne (if any) will disappear, and your skin will become more smooth.

I am still on Dutasteride, but I DID used to get abdominal pain on it. It's not happening now, but I'm keeping a watchful eye on it.

 

[Lordutasteride]

Dutasteride cleared up my skin very nicely too! unk:

 

[Dogs3]

did you have oily skin to begin with though? My skin is pretty dry im worried that dutasteride is going to dry it up wayy too much

 

[gazza2208]

As a female taking dutasteride is alright AS LONG AS YOU DO NOT GET PREGNANT! Dutasteride will cause major problems to a fetus that is the reason why women don´t take finasteride or dutasteride.
If you have bad genes (girl mustache) your body is making too many male hormones. All in all, if you go on the pill that might help your hair loss problem.