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
Personally, Avadort yielded much better results than Fina has ever done for me. I've heard the similar statements from other girls too.
And you continue to take Avodart specifically for hair loss while on another anti-androgen as well?
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.
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.
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.
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?
Quote from: Lillet on August 08, 2011, 04:27:59 PM
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.
Quote from: Lillet on August 08, 2011, 04:27:59 PM
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.
Quote from: regan on August 08, 2011, 04:48:17 PM
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.
Quote from: Lillet on August 08, 2011, 04:54:16 PM
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 (http://www.androgeneticalopecia.com/hair-loss-treatments/finasteride-propecia-female-pattern-baldness.shtml)
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.
Quote from: Lillet on August 08, 2011, 05:09:10 PM
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.
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.
Quote from: Lillet on August 08, 2011, 04:54:16 PM
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):
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fdesmond.imageshack.us%2FHimg96%2Fscaled.php%3Fserver%3D96%26amp%3Bfilename%3D12464120760790662711215.jpg%26amp%3Bres%3Dmedium&hash=81d85eda29a3b1d0405a1a5b16371db7e8eecdce)
This is my hair on Avadort after 13 months:
(https://www.susans.org/proxy.php?request=http%3A%2F%2Fdesmond.imageshack.us%2FHimg526%2Fscaled.php%3Fserver%3D526%26amp%3Bfilename%3D121010222656.jpg%26amp%3Bres%3Dmedium&hash=24e6b28c6bd8daeab12ac35a3f6418f075babf57)
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.
Quote from: Annah on August 08, 2011, 09:38:09 PM
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 :D
I really didn't have any hair to regrow... but my hair grows much faster now, and is much thicker. Big difference.
Quote from: JennX on August 08, 2011, 09:50:29 PM
This has been my experience as well. Estradiol + Spironolactone + Avodart = Epic Win :D
That's exactly what I'm taking. My doc calls it the miracle cocktail. :D
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.
Quote from: Asfsd4214 on August 09, 2011, 11:26:54 PM
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.
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.
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.
Quote from: Asfsd4214 on August 09, 2011, 11:26:54 PM
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.
This is exactly what I assumed when asking this question. However, the reason I asked it was because I'm much more interested in practice than theory, especially in the absence of controlled studies. As an aside, my understanding is that that big marketing push of Finasteride as Propecia is really only because they were provided with a readymade controlled study in the form of those boys born with a natural 5ar defficiency, I think it was in New Guinea.
when it comes to studies, the best advice is to try it yourself. Stop taking finasteride and take Spiro only and see what happens.
For me, I couldn't afford that luxury as I wanted my hair back as soon as possible and I knew Spiro only would not regrow lost hair back.
Now, I am not specifically familiar with finasteride but from what other transgender people have been saying is Avadort/dutas works much more effectively than finasteride will ever do. Some compare Finasteride is to Avadort as Premarin is to Estrodiol.
But the best thing is to monitor for yourself. I can only tell you how I reacted to the medications and how others reacted to it.
Quote from: Annah on August 10, 2011, 04:09:06 PM
Now, I am not specifically familiar with finasteride but from what other transgender people have been saying is Avadort/dutas works much more effectively than finasteride will ever do. Some compare Finasteride is to Avadort as Premarin is to Estrodiol.
They're the same class of medications, they just differ in the manufacturer. That being said, there shouldn't be a difference in the two.
Quote from: regan on August 10, 2011, 04:45:07 PM
They're the same class of medications, they just differ in the manufacturer. That being said, there shouldn't be a difference in the two.
No, Dutasteride blocks both types of 5ar enzymes, while Finasteride only blocks type 2. That's why Finasteride can lower DHT by around 70% at max dosage, while Dutasteride can get to 90%.
Quote from: regan on August 10, 2011, 04:45:07 PM
They're the same class of medications, they just differ in the manufacturer. That being said, there shouldn't be a difference in the two.
same "type" of medications but different chemicals and makeup.
Many websites that deals with hairloss states that Avadort grows hair 50% faster than finasteride
In clinical trials, chronic dutasteride thereapy reduces serum DHT by 93 to 94% while finasteride reduces serum DHT by approximately 70%A brief 3-month prospective and consecutive study was conducted to evaluate the onset of symptom relief with Avodart versus Proscar (finasteride, Merck & Co.) One hundred twenty men with symptomatic benign prostate hyperplasia (BPH) were treated with Avodart, followed by an additional 120 men treated consecutively with Proscar for 3 months in each trial. Among patients who recieved Avodart, there were significantly greater reductions in AUA-SO scores compared with Proscar in the first 3 months ( P <0.0016).In the study, 416 men with male pattern hair loss (MPHL) ages 21 to 45 years old, were randomized to receive dutasteride 0.05, 0.1, 0.5 or 2.5 mg, finasteride 5 mg, or placebo daily for 24 weeks. The results of the study showed that dutasteride increased hair counts in a dose-dependent fashion and dutasteride 2.5 mg was superior to finasteride 5mg at 12 and 24 weeks.Dutasteride (Avodart) inhibits both type 1 and type 2 5?-reductase and is approved at the 0.5-mg dose for treatment of symptomatic benign prostatic hyperplasia (BPH). It is about 3 times as potent as finasteride at inhibiting type 2 5?-reductase and more than 100 times as potent at inhibiting the type 1 5?-reductase enzyme.Dutasteride caused scalp and serum dihydrotestosterone levels to decrease and testosterone levels to increase in a dose-dependent fashion. Whereas 5-mg finasteride decreases serum DHT by about 70%, dutasteride can decrease serum DHT by more than 90%.Results: Finasteride 5mg 75.6 hairs
Dutasteride 0.1 mg 78.5 hairs
Dutasteride 0.5 mg 94.6 hairs
Dutasteride 2.5 mg 109.6 hairsThese quotes were taken from the ABHRS American Board of Hair Restoration Surgery and the ABD American Board of Dermatology.
In every medical study conducted, Avadort outperformed Finasteride even when Avadort was taken in the most smallest of doeses (Finasteride at 5 mg vs Avadort at 0.1mg)
So while they are the same class of drugs, Avadort has been proven clinically to be much more superior than just Finasteride. And when taken with an Anti-Androgen such as Spiro, the results are even greater without any added unhealthy side effects other than what is typically taken.
My doc uses Finasteride + Spiro for his AAs.
I'm not worried about undoing hairloss, more about hair "preservation" as far as MPB. As far as I understand from our conversation today, his goal is to get T down to a female range, his first line is Finasteride, I would bet Avodart would be his second line - though he even mentioned using Androcur in a worst case scenario. I don't know how he goes about getting the Androcur, but if he's willing to go that far he sounds pretty aggressive.
I don't know if I'm asking a question, but I feel like I am. :)
My doctor said the same thing about 5 years ago. Back then Avadort was really pushed as a prostate remedy and not for hairloss so my doctor was hesitant in trying it on his patients. When I first started doing this last year, I really had to sell him the results of Avadort.
Today, he uses it as his standard treatment alongside Spiro for hair regrowth.
But I can see why your doc is hesitant. Finasteride has been out much longer than Avadort.
Quote from: Annah on August 10, 2011, 05:06:48 PM
My doctor said the same thing about 5 years ago. Back then Avadort was really pushed as a prostate remedy and not for hairloss so my doctor was hesitant in trying it on his patients. When I first started doing this last year, I really had to sell him the results of Avadort.
Today, he uses it as his standard treatment alongside Spiro for hair regrowth.
But I can see why your doc is hesitant. Finasteride has been out much longer than Avadort.
As long as my levels end up where they're supposed to be, I'm not going to worry about it. Though he also says you can't follow the normal male/female endocrinology if you plan on "overpowering what the male body is programmed to do".
Quote from: regan on August 10, 2011, 05:31:30 PM
As long as my levels end up where they're supposed to be, I'm not going to worry about it. Though he also says you can't follow the normal male/female endocrinology if you plan on "overpowering what the male body is programmed to do".
sounds like a wise dr
Quote from: Annah on August 10, 2011, 11:15:01 PM
sounds like a wise dr
For the record (for the benefit of those following this thread)...
Always be aware of your insurance coverages and what prescription programs are out there. For example, my insurance requires "pre-authorization" in order to cover either Finasteride or Avodart. I researched this a little further and what I learned is that an automatic approval is granted to patients over 45. Under 45 (I'm 37), they require the prescribing doctor to certify that those medications are for the treatment of BPH or an enlarged prostate. My doctor is willing to diagnose these conditions for the sake of insurance approval.
Walmart (and others) offer Finasteride for $9 for a 30 day supply. No so for Avodart. My insurance aside, Avodart may be better, but Finasteride is better then nothing and insurance or not, $9 is pretty cheap and the money you would spend on Avodart could be spent better elsewhere. Where it gets interesting, with respect to not discussing dosages, I can get the prescription for Spiro filled for $5, no questions asked (since its used for controlling blood pressure), while going the walmart route and having to buy a larger amount of a smaller dose would cost me much more.
The moral is, know how the system works and work it to your advantage. HRT isn't always cheap, but there's no need to spend more then you have to to get what you want, even if it means chosing one medication over another.
I get my 30 dollar supply of Avadort for 6 dollars for 30 days at Target under Dutas
Quote from: Annah on August 11, 2011, 10:11:44 AM
I get my 30 dollar supply of Avadort for 6 dollars for 30 days at Target under Dutas
Good to know... :)
Without disclosing dosages, I don't know how we could establish a thread to share that kind of information though...
Quote from: regan on August 11, 2011, 10:31:57 AM
Good to know... :)
Without disclosing dosages, I don't know how we could establish a thread to share that kind of information though...
yeah that would be nice to have a way to confirm dosage for prescribers as to avoid the forums having self medicators to look into it but that would be a very daunting task!