Two Year Mark. Decision Point. Looking For Opinions/advice On Regimine

[bluecyclone]

Diffuse NW1.5 just hit two years after a huge Telogen Effluvium revealed male pattern baldness. I am shedding a ton of hair everyday and I’m on the brink of it becoming noticeable. I had crazy base density that’s bought be some time. I’m Sam a healthy 41, fit no grey, very lucky but still want to maintain. There is a pattern my biggest concern is density and forelock loss. Again I realize I am very luck and have decent hair for my age. Density is low getij new horizontal clumps.

Shedding is insane. Lose full follicular units at once. See photos. Each shower is over 150-200 with shedding all day. Hair is different length and quality.

Current regimine:

Oral minoxidil 1 year 1.25 ED
RU 4 months (60 in 6ml per day) ED
Dropped Keto a month ago (hair is much healthier)

Options (please advice what order I should try):

1. Start branded Propecia at .25 or .5 ED (been trying to make this a last resort)
2. Try to find the 1% 3rd Hasson and Wong Topical Finasteride
3. Start Oral Seti continue RU topical
4. Cut the long hair to save some that is being pulled out, tangled.

Thyroid is under control and finally have iron levels in the range to grow hair. Endocrinologist advised that already low DHT could be a problem on Finasteride. All other labs are ok. No sides from RU, no noticeable benefit.

Please advise. Thank you in advance.

 

[Newhere01]

Great hair for 41.

 

[Murkey Thumb]

Why oral minoxidil & RU? Normally the route is to start on the big 3 first then if they stop being effective try the experimental stuff but you seem to have gone straight to experimental.

 

[Retinoid]

I would either increase the oral Minoxidil to 5-10mg/day OR start topical Minoxidil 5%. 1.25mg is extremely low.

I would take .25mg of finasteride/day. Serum DHT is not really correlated with hair loss while increase follicle and scalp 5AR activity/DHT/AR receptor density is.


You should also be aware that since it is getting warmer you will be shedding more.

 

[bluecyclone]

Thanks. Derm insists there is a high percentage of chronic Telogen Effluvium. I think she’s wrong. I might consider increasing the oral dose but I know that holds some risk as well.

Urologist and Endocrinologist both advised against Propecia after the full lab panel.

I was desperate and thought the risk profile of RU was lower impact than anything serum based. Personally I’m also terrified by Finasteride stories.

Any thoughts on topical Finasteride?

 

[Retinoid]

Thanks. Derm insists there is a high percentage of chronic Telogen Effluvium. I think she’s wrong. I might consider increasing the oral dose but I know that holds some risk as well.

Urologist and Endocrinologist both advised against Propecia after the full lab panel.

I was desperate and thought the risk profile of RU was lower impact than anything serum based. Personally I’m also terrified by Finasteride stories.

Any thoughts on topical Finasteride?

It is always possible about the chronic Telogen Effluvium, thyroid hormones take a while to help hair loss if that is what caused them.

Why are you taking oral minoxidil as opposed to topical?

Why did the doctors advise against it?

Finasteride is probably the least impactful of anything dealing with androgens. It does not block all of the DHT (at .25mg you will be blocking like 60% DHT). Plus it can always be stopped.

I unfortunately do not know anything about topical Finasteride. Even with this you need to stay under a certain% or it can still inhibit serum DHT.

 

[DeterioratingWolf]

I would either increase the oral Minoxidil to 5-10mg/day OR start topical Minoxidil 5%. 1.25mg is extremely low.

I would take .25mg of finasteride/day. Serum DHT is not really correlated with hair loss while increase follicle and scalp 5AR activity/DHT/AR receptor density is.


You should also be aware that since it is getting warmer you will be shedding more.

what's the difference between serum dht and normal dht?

also @ OP. your hairline is phenomenal for 41 years old! I don't know what the other hair condition you have is but you look much closer to a Norwood 1 than a 1.5 to me, my temples are about 1.5 to 2 inches above my low center hairline and I'm told I'm a Norwood 2 but others are suspicious it could be 2.5 and I'm only 27! so be happy you're in such a solid state at your age, although 200 hair fall a day is kind of insane, but it doesn't show for you, at least not yet.

 

[Retinoid]

what's the difference between serum dht and normal dht?

also @ OP. your hairline is phenomenal for 41 years old! I don't know what the other hair condition you have is but you look much closer to a Norwood 1 than a 1.5 to me, my temples are about 1.5 to 2 inches above my low center hairline and I'm told I'm a Norwood 2 but others are suspicious it could be 2.5 and I'm only 27! so be happy you're in such a solid state at your age, although 200 hair fall a day is kind of insane, but it doesn't show for you, at least not yet.

Serum DHT is basically what is measure in the blood. The reason why you take Finasteride is to target the DHT production in the hair follicles and scalp tissue---it affecting the blood level is a consequence. This is why people with normal or even low DHT can still have male pattern baldness as the dysfunction is in the tissue itself and not the body.

 

[DeterioratingWolf]

Serum DHT is basically what is measure in the blood. The reason why you take Finasteride is to target the DHT production in the hair follicles and scalp tissue---it affecting the blood level is a consequence. This is why people with normal or even low DHT can still have male pattern baldness as the dysfunction is in the tissue itself and not the body.

ah thanks for clarifying. so then how does finasteride specifically single out dht in the scalp and not the serum in the body?

 

[Retinoid]

ah thanks for clarifying. so then how does finasteride specifically single out dht in the scalp and not the serum in the body?

Finasteride blocks 5AR2 which produces DHT and is located in certain tissues (such as the scalp) but leaves 5AR1 alone (which is present in other tissues). So it is blocking the enzyme that is in the area we want to target but overall is also reducing serum levels.