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So somebody who continues to take finasteride and does not stop like in the example you gave, it will often continue to provide it’s benefits in retaining hair and won’t necessarily lose its effectiveness?

Correct; however, hair has its own agenda with genetic codes for Apoptosis (cell hair suicide) which is delayed by finasteride but not always a guarantee that each hair may take its own course. Generally, finasteride slows this process down for the time you take the drug. I have had patients on finasteride for 25 years. When they stopped it along the 25-year history, they always lost hair. This tells me that finasteride works if you take it for anyone losing hair.

https://medicalxpress.com/news/2018-05-finasteride-prostate-cancer-death.html

With almost 300,000 person-years of follow-up and a median follow-up of 18.4 years, they found 42 deaths due to prostate cancer on the finasteride arm and 56 on placebo.

I recently hopped off Finasteride (2.5yrs) and Dutasteride (3 months) because I didn’t feel they were helping my hair at all. I figured that if I were to have any real results, I’d need surgery. I’ve been off them the last 3 months and I miss the “side effects”. My facial hair grows much quicker now and thicker. I miss when I rarely having to shave. My libido is also ANNOYINGLY high. I’m feeling way more sexual these days, especially compared to the past. Now when I see attractive strangers, I can’t help but think sexual thoughts. It’s the most annoying thing. I feel distracted! Anyways, just a rant about things some of you guys might consider “side effects.” I need to think further if I can get this mindset back with a Dr.’s help.

Interesting comments.

My hairline has receded at what I’d call an accelerated rate since I began finasteride. Would that be a bad sign or considered natural?

It should stop shortly, but that is assuming that the shed is the result of the medication and not your balding process itself.

I have been on finasteride for over 2 years with good results, but I’ve been dealing with pretty bad sleep/energy/anxiety issues the last ~18 months. (No sexual sides, though.)
I’ve made a lot of lifestyle changes to try to address those issues, but nothing’s really worked. I’m beginning to wonder if the issues are finasteride-related.
I’m thinking about cutting down from 1mg/day to 0.5mg per day for a month or two. Depending on how that goes, I might stay there or continue tapering off.
Is there any general advice regarding lowering/tapering off finasteride dosage?

Reducing your finasteride to half the dose may not have an impact on your hair; however, the more you cut, the greater your risk of losing the hairs you retained. If that happens, you might not get it back. I have seen many patients stop the drug for a couple of months and then lose ground so bad that they never get back to where they were before stopping it. Reducing the dose to every other day or every third day still keeps the drug effective above 50% of the full dose, so this is a reasonable approach if you think that your symptoms are drug-related.

The concept of a nocebo (a psychogenic effect of a drug) has been discussed in the various studies which focus on the sexual side effects of the drug Propecia (finasteride). The significant ‘hype’ on the internet, has driven many people to the conclusions that if they take this drug, they will become impotent. As doctors, we must discuss potential and known side effects of any drug we prescribe, but what happens following the disclosures, the patients read the internet and find many, many panicky young men who report sexual impotence from taking the drug. Is it real? We don’t know but what we do know is that many studies from other countries have not shown the high sexual side effects reported in the United States. So is this a Nocebo effect resulting from panicky people who read bulletin boards and web sites which focus on this issue.

Dr. Robert Haber, a very respected hair transplant surgeon from Ohio, started to test the concept of a nocebo effect and the general side effects on sex drive and sexual performance using patients who came into his office. This is an early report of his initial findings.

I am 23. For the past 5 months I have been suffering from hair shedding, itchy and flaky scalp, and growing spots of thinning in my crown area. I believe it is due to MPB. Prior to this, I never noticed any hair loss and no one in the family has experienced hair loss except an uncle on my dad’s side who started to thin in his 40s and still has a considerable amount of hair in his 50s now. I saw 2 dermatologists – one 2 months ago and another a week ago – and they both were not convinced that I am suffering from MPB rather stress related hair loss (telogen effluvium?). They said this because my hair loss is still not entirely noticeable. Instead, the nature of my new job (I work in investment management working 12+ hours) and had a breakup with my ex girlfriend 7 months ago would have triggered it. However, I am not convinced due to the fact that, and as pointed out to them, the hair loss is predominantly in my crown area and more importantly I have noticed hairs of different sizes and thickness falling out (or hair miniaturization). So I was wondering if I can get a third opinion on this matter and whether or not to seek consultation from another dermatologist as I would like to begin treatment of some kind early if it is MPB.

See here: https://baldingblog.com/value-haircheck-bulk-measurements-two-patients-seen-today/

Stress, in individuals with the genes for hair loss, will develop miniaturization on the path to losing hair. The single best way to make the diagnosis is with a HAIRCHECK instrument which will show, over time, how much hair bulk you lost. If you treat it successfully, this test will show improvements that your eye may not pick up.

Guillermo started his FUE in 1998 and followed his hair loss with us since then. As he got older, he lost the central forelock which shows prominently in the before photos that he is holding. As you can see, his FUE is nothing short of normal looking. We published the first article in the world on FUE in 2002 based upon 6 years of clinical research and the rest is history. Every hair surgeon in the world, having read the article, started performing FUE. It took years for most hair surgeons to perfect the technology.

See original article here: https://newhair.com/wp-content/uploads/2018/11/mp-2002-fue.pdf