need for finasteride for hair loss with other antiandrogens?

[Lillet]

Hi Everyone,

I've been taking a lose dose of finasteride for hair loss for a couple years and recently started on flutamide to begin my transition. I'm wondering if at a certain point of being on the flutamide it'll handle the hair issue on it's own and I'll be able to stop the finasteride.

My GP, although he treats a number of trangender patients, is generally of the opinion that this isn't an exact science (due to the absence of controlled studies) and requires experimentation with an individuals physiology. Hair loss is something I'm not willing to experiment on myself with, so I thought I'd ask others about their experiences.

Thanks!

Lil

[Annah]

Personally, Avadort yielded much better results than Fina has ever done for me. I've heard the similar statements from other girls too.

[Lillet]

And you continue to take Avodart specifically for hair loss while on another anti-androgen as well?

[Annah]

yes because fina and avadort is not a t blocker in the proper respect. It only limits the hormone functions that creates male pattern baldness. Fina or Avadort as a primary anti androgen would be extremely ineffective in other areas.

I was taking Spiro when I was taking Avadort.

[Lisbeth]

You need to understand the distinction. Anti-androgens block testosterone. Finasteride blocks dihydrotestosterone (DHT), which is the hormone that causes hair loss. DHT is made out of T, so anti-androgens will reduce DHT, but when you do both together the effect multiplies.

[regan]

I'm taking finasteride as well.  Finasteride blocks the conversion of T to DHT, which results in an initial increase of free T.  The rest is what's referred to as a negative feedback loop.  The increase in free T actually signals your body to produce less T over time.

Functionally its an AA, but a weak one.

[Lillet]

Regan, thanks for finally explaining the negative feedback loop thing in a way I can understand.  I was wondering why my Dr. scheduled labs for T, since Flutamide is just a blocker.  I guess the increase in free T will cause my body to stop producing it, so there may be a slight rise in serum levels after first, followed by a major drop over the long term? 

And I totally get how Finasteride and Dutasteride function.  I guess the point is that no matter how much Flutamide I was on, there would still be some receptors open, and it's much better to have T bind to them than DHT.  Still seems like it would be possible to drop the Finasteride once serum levels are low enough though, right?  For instance, one wouldn't continue on it after orchiectomy right?

[regan]

Regan, thanks for finally explaining the negative feedback loop thing in a way I can understand.  I was wondering why my Dr. scheduled labs for T, since Flutamide is just a blocker.  I guess the increase in free T will cause my body to stop producing it, so there may be a slight rise in serum levels after first, followed by a major drop over the long term? 

As your body detects the higher levels of T still remaining in your bloodstream it secrets less of it, since in its terms your body is using less of it.  So to answer your question, there should be a rise in free T before your body begins to compensate.  A lot of MtF hear "rise" and T in the same sentence and freak out, but the rise isn't as great as the compensatory drop (as I recall) and its FREE T, meaning your body's not using it.  I would suspect your doc would adjust his tests to compensate for the initial rise and actually test for the decreased levels.

And I totally get how Finasteride and Dutasteride function.  I guess the point is that no matter how much Flutamide I was on, there would still be some receptors open, and it's much better to have T bind to them than DHT.  Still seems like it would be possible to drop the Finasteride once serum levels are low enough though, right?  For instance, one wouldn't continue on it after orchiectomy right?

Males and females both produce T.  Testes are the major producers of T as Ovaries are the major producer of E.  Removal of either is going to cause a significant drop in the hormone they produce.  But both males and females need at least small amounts of the opposite sex hormone, so yeah continuing on AAs would be potentially disasterous.

[Lillet]

Males and females both produce T.  Testes are the major producers of T as Ovaries are the major producer of E.  Removal of either is going to cause a significant drop in the hormone they produce.  But both males and females need at least small amounts of the opposite sex hormone, so yeah continuing on AAs would be potentially disasterous.

Well this is exactly what I'm asking.  It seems that once your main antiandrogen (Spiro, Flutamide, etc.) reduces T levels to within the female range, Finasteride would be unnecessary to prevent hair loss.  However, everyone here is telling me they still take Finasteride along with their main antiandrogen and will continue to do so indefinitely (barring orchi or srs).  This is why I'm confused. 

[regan]

Well this is exactly what I'm asking.  It seems that once your main antiandrogen (Spiro, Flutamide, etc.) reduces T levels to within the female range, Finasteride would be unnecessary to prevent hair loss.  However, everyone here is telling me they still take Finasteride along with their main antiandrogen and will continue to do so indefinitely (barring orchi or srs).  This is why I'm confused.

Finasteride blocks the conversion of T to DHT (which is like super T) and DHT is what acts on the hair follicles to cause your hair to fall out.

http://www.androgeneticalopecia.com/hair-loss-treatments/finasteride-propecia-female-pattern-baldness.shtml

[Lillet]

As I wrote above, "I totally get how Finasteride and Dutasteride function."  Are you saying that Finasteride use must be continued to prevent hair loss even after T is at female levels, whether that be through a more powerful anti-androgen, orchiectomy, or SRS?  It's surprising to me that there'd be enough DHT produced to cause hair loss with such little T to produce it from.  My understanding is that androgenic alopecia in women is rare. 

[regan]

As I wrote above, "I totally get how Finasteride and Dutasteride function."  Are you saying that Finasteride use must be continued to prevent hair loss even after T is at female levels, whether that be through a more powerful anti-androgen, orchiectomy, or SRS?  It's surprising to me that there'd be enough DHT produced to cause hair loss with such little T to produce it from.  My understanding is that androgenic alopecia in women is rare.

The genetic link is carried on the X chromosome, cis-females need the trait to be on both X chromosomes in order for it to express itself.  XY individuals (cis-males and trans-women) only need one genetic marker for it to express itself.  So yeah, if you really want to be sure, I'd suggest taking it post-orchie or SRS.

[Lillet]

Thanks for clarifying!  I think the "really want to be sure" is the key though.  If 1mg Finasteride (which only reduces DHT around 70% at the 5mg max dosage) has been deemed enough to prevent hair loss in those with T levels in the male range, it would seem mathematically that there would be less DHT at female T levels without the Finasteride.  Indeed, I believe both Spiro and Flutamide are used to treat androgenic alopecia in women where the feminizing "side effects" are of no concern.  I guess for those of us on HRT, Finasteride and Dutasteride are just a little extra boost to your main anti-androgen.  I just think it's best to be on as few of these drugs as possible for decades of my life to come, so wanted to see if anyone actually tried going off it once their T levels were down.  Like I said initially, not so into experimenting with that. 

[Annah]

Well this is exactly what I'm asking.  It seems that once your main antiandrogen (Spiro, Flutamide, etc.) reduces T levels to within the female range, Finasteride would be unnecessary to prevent hair loss.  However, everyone here is telling me they still take Finasteride along with their main antiandrogen and will continue to do so indefinitely (barring orchi or srs).  This is why I'm confused.

If you take a typical anti androgen such as spiro it will lower your t but it will not do any drastic changes to your DHT levels. This is why many girls do Duta/Avadort/fina with an AA

When I was on spiro, my male pattern baldness stopped but i was not regrowing lost hair. It was only with the addition of Avadort, did my hair start to grow back

This is me about 2 months on Spiro and no avadort (I was on hrt before fultime..obviously lol):



This is my hair on Avadort after 13 months:



I had to combine avadort with my spiro for my hair to grow back.

And you can do fina and avadort along with an AA with the same type of risks as just taking one type of AA. My doc said is was perfectly fine and from the other girls I knew who took both, it didn't have any ill side effects.

[JennX]

If you take a typical anti androgen such as spiro it will lower your t but it will not do any drastic changes to your DHT levels. This is why many girls do Duta/Avadort/fina with an AA

When I was on spiro, my male pattern baldness stopped but i was not regrowing lost hair. It was only with the addition of Avadort, did my hair start to grow back

This has been my experience as well. Estradiol + Spironolactone + Avodart = Epic Win 

I really didn't have any hair to regrow... but my hair grows much faster now, and is much thicker. Big difference.

[Annah]

This has been my experience as well. Estradiol + Spironolactone + Avodart = Epic Win 

That's exactly what I'm taking. My doc calls it the miracle cocktail.

[Asfsd4214]

You shouldn't need Finasteride or Dutasteride if you're on a correct spironolactone dose.

Fun fact, spiro is already given to natal females for hair loss, so to say is does nothing is misleading.

Another fun fact, DHT comes from T, a type of enzyme called 5-alpha reductase (spelling from memory, don't kill me if it's wrong) is responsible for the conversion of T to DHT (along with several other conversions that the aforementioned 5AR inhibitors will also inhibit. Some of which have some sketchy indications of causing side effects like brain fog.

Regardless of its safety, if you have a natal female level of T, I've yet to hear an explanation why your DHT level would be so much higher than a natal female either, resulting in a natal female or lower risk... more or less.

Oh and another thing, spironolactone already blocks the DHT receptors. The reason the 5ar inhibitors are prescribed to men and spironolactone isn't, is because spiro will target all androgends and the 5ar inhibitors only target their conversion to DHT, making them more suitable because unlike women, men are supposed to have high (higher than women anyway) levels of androgens in their system.

[Annah]

You shouldn't need Finasteride or Dutasteride if you're on a correct spironolactone dose.

That's not entirely accurate. Spiro will stop male pattern baldness but if you expect it to regrow your lost hair it will take decades to do or not at all on Spiro. Adding Dutas/Avadort raises the levels in which it regrows it.

Will Spiro stop male pattern baldness? Typically, yes.
Does Spiro regrow your lost hair to that bushy prepubescent state? Typically, no.

I've never met a girl who regrew all her hair on just spiro. It stops the hair loss, yes. But I never seen anyone take just spiro and all of the sudden their hairline gains 4 inches of hair.

[caitlin_adams]

Annah, you look amazing. I was shocked to see your before photo.

So are you saying avo + spiro + estro in some cases grows back four inches of hairline? Imagine if one used minoxidil as well.

[Annah]

Thanks Caitlin

When it comes to Avo/dutas, your results will vary when it comes to a possible complete hair growth. Many factors come into play such as the amount of time you had lost your hair, how much balding you have, etc. I gained most of mine back because i had only start losing my hair about 4 years ago.  Someone who has been bald for 15 years may need other assistance such as hair transplants.

However, you stand a much greater chance recovering lost hair when taking Avadort vs just spiro.