I have been reading about a "typical hormone regimen for transsexuals" on another website, which suggests that finasterfide or propecia should be administered in addition to sprirolactone. I know of several pre-ops who are on just spiro as the antiandrogen component of their regime, so wondered what is the significance or necessity of taking finasteride or propecia as well?

Any benefit from finasteride seems very limited if it exists at all.

I explained this in the past, but here goes.
Some people, women and men, are very sensible to DHT, which is the more potent type
of testosterone.
Even women, part of T will be converted into DHT at scalp level.
Hair that is sensible to it will be destroyed eventually.
If they are susceptible to its effects, they will slowly (or quickly) lose hair.
TS with substantial hair loss prior to HRT have a good chance of still continuing this loss
post HRT but at a much slower speed, post HRT unless they're able to keep as much DHT
away from the hair roots.

To stop all DHT to the root you can do a couple of things:
- Arrest all T production from testes and adrenals.
   - While its possible through the pituary feedback loop (with spiro)
     or directly (with Lupron) to stop the testes from producing T, its
     not possible to stop the adrenals from producing it that way
    (the adrenals produce T in women). If you can't stop all T, some
    of the adrenal T will be converted to DHT; for those will mild
    alopecia prior to HRT, that level of DHT will not be that damageable
    to the remaining hair and there will be some regrowth. Still, the remaining
    DHT can prevent the smallest miniaturized hair from regrowing even
    in those cases.
- So, the DHT converted from T can be blocked at the receptors.
    - Spiro has a 60% afinity to T receptors, which is one of the highest
      for non T compounds. So, if there is sufficient Spiro in the system,
      most T receptors will have a Spiro molecule stuck in it and DHT
      will not be able to bind and affect the hair.
   - The problem with this is that spiro has a short half life, so
     unless your taking big split doses, there will be times in the
    day when spiro levels will decrease and less T receptors are
     occupied and DHT will be able to bind.
   - Even if you take high enough doses of spiro, there's still
     the fact that spiro binds to T receptors all over the body while
     DHT has a narrower effect. So, there is a bigger chance that
     DHT is not bound yet and can still do some damage while
     spiro molecules are already bound to T.
   - Another issue is that DHT has a 100% affinity to T receptors.
     So, if spiro and DHT compete for a receptor, DHT will win.
- The answer to all those issues is simple, reduce the conversion of T to DHT, that's where
     finesteride and dutasteride come from.
    - By eliminating almost all DHT and T, and binding spiro to T receptors, the amount of DHT reaching hair folicles is almost zero. That allows those with strong alopecia tendencies to at least arrest it and hopefully have the chance to reverse it. Even for all the others will less alopecia, eliminating DHT will allow the smallest miniaturized hair to eventually become viable, the hair will thicken.
    - The only problem with eliminating DHT conversiion is free T produced from the adrenals, is slightly boosted +15%. But the adrenals produce a low quantity of T, so your T will still be well within female range.

So, there's not any downside to using finesteride (except money spent), especially since its dirt cheap, a proscar tablet can last 10 days if its split, and has little side effects. 

Keira, the DHT blerb was very interesting but I tried finesteride for quite sometime as I have some minor problems with a slight widows peak (about 1cm each side) , I thought it may be of some benefit. But it didn't do anything at all....

Usually it takes 6-12 months for any changes to be visible.

Unless there is a good reason not to take it, finasteride seems a very reasonable part of HRT for most inviduals.

The frontal area is very DHT sensitive, the temples are the most sensitive. Unless there is still some living folicles still there, cutting DHT won't help much.

Also, when hair is very very small (almost killed outright), it can take years of DHT suppression, 2+ before they can produce a viable shaft. For those hair, almost total DHT of dutasteride can accelerate this a bit.

For some hair, if they are small enough and there is a high enough sensibility to DHT, unless DHT doesn't exist at all in the system (which is not possible), there is no possibility to ever recover and the folicle will eventually die.

my advice, having been through this process and succeed is this:

if you want to stop Male pattern baldness, you need oestrogen and androcur

finesteride is for men who don't want to lose capability to function as a man, but thats not a problem for us so we can take more risks.

androcur, in a small dosage for a year, then half it if T-level is ok. Eventually phase it out.. im taking a low dosage 4 times a week now,

accompanied with oestrogen which also regulates teststerone without the need for androcur...

then, if you hair is still ->-bleeped-<-.. get a hair transplant.

best doctors are in the states, should cost you around $10000, feller, shapiro, rahal, hasson and wong, they're the best..

kiss goodbye to hairloss problems forever and don't mess around, you only get one life.

Androcur blocks T production, its affinity to block T has the same problem as spiro. So, if you have major problem with hair loss prior to HRT, finesteride or dutasteride is a must.

Estrogen per say regulates T in the body this way.
E + T produced by testes --> Body says whooaa too much hormones, lets cut back T production from testest. but since E is endogenous, the feedback loop never is able to adjust things and eventually, the testes are instructed to shut down all production leaving just the E that is taken.

E also has a direct effect on the hair folicle, extending its active phase, the hair lasts longer before dying. That alone helps help folicle recovery since the hair shaft without the effect of DHT has more time to become bigger, which helps in the next phase. If the growing stage is short, it can take a long time for the hair shaft size to grow bigger.

During pregnancy, most hair that would have fallen off normally is kept growing, that's why pregnant women have thicker hair. At the end of pregnancy, E levels go down and all those hair that should have become dormant do so almost at the same time and a women can lose a lot of hair. This is quite frequent.

I take proscar daily plus I use the Rogaine Foam. It took almost 6 months to notice "peach fuzz in my clearing areas on my temples wich means it will be another 6 months before I even have hair there. DHT in the smallest amounts can stop feminization in many people even if they are on spiro to reduce T. DHT is a totally seperate thing.

I'm thinking you were at transgendercare.com....Read and listen to what they say there. They are experts. Hopefully you can get your endo to help you out with a finesteride. A dutasterdide (Dutas or Advodart) would be better because it blocks both forms of DHT.

In my estimation, those that take a DHT blocker with their HRT regimine feminize far better.

I am now 60 and although I have fine hair, hair loss has never been a problem except for some very slight recession at the temples which is a male family trait, so from the hair loss point of view I may not need finasteride.

My GP who has known me for years initially expressed disbelief about my GID and is not very co-operative, when I asked to be referred on suggested I should go home and think about it as he would be inclined to refer me to a psychiatrist in the first instance. The trouble for me is that time is running out for me and I don't want years of waiting for appointments with this one and that one, so although I know it's wrong I feel I can't wait to perhaps be prescribed hrt at some point in time, maybe never. That is why I want to know all the facts about hormones and antiandrogens so that I can make some informed decisions for myself.

Thanks Keira for repeating the information for my benefit - much appreciated. And Kimberley, I knew I could rely on you to give me your honest opinion -thanks. And to all others who have so far replied - I am very grateful.

I just wish I was 30 not 60! :-)

Louise

Quote from: Lori on October 13, 2007, 07:09:42 AM
In my estimation, those that take a DHT blocker with their HRT regimine feminize far better.

In theory, DHT blockers really shouldn't help with feminization much at all. Consider that many, many non-TS men use Propecia, Proscar and Avodart *without* experiencing any feminization (although some breast swelling and tenderness is listed as a rare possibility). The only thing I can think of is perhaps the lower DHT allows the E to work better? But I don't know.

My personal experience is that these drugs HAVE helped restore much of my hair. I was on Propecia for many years prior to HRT, and my hair loss not only stopped, but filled in a bit. Not super-dramatic, but considering I was LOSING hair rapidly... to have MORE hair years later was a miracle.

I started HRT and Avodart together a year+ ago, and the results are even better. It's not going to give me a teenager's full head of hair, but it IS noticably better than it was.

~Kate~

Frankly hair loss is the only thing I worry about now.  It puts me in some pretty depressive cycles though.  I am on HRT and Avodart at the moment and if this doesn't work I don't know what I am going to do.  I have only been taking it for 3 months and right now I seem to be in a shedding phase (Oh I hope its just shedding ) so I have no way of knowing how effective it will be. 

Knowing that I still may experience hair loss even while on the regimen makes me very unhappy.

Charlotte   

I have to admit myself dutasteride (avodart) works very well as part of HRT.  While my Hair is not even close to where I want it, it is acutally growing back.  It just takes a very long time for this thing to happen, longer than anything else.  Everything else is moving along very quickly for me, but hair regrowth is a painful exercise in patience. 

Also it may help HRT because it does block the production of a androgen and thus decreases the likelihood of a type of testosterone having an influence.

The thing with me is I am still young (29) and most loss was after 24/25.  The truth is I just want it to the thickness to do an effective scalp advance instead of a scalp advance and grafting.

Quote from: Kiera on October 13, 2007, 07:57:33 AM
At 51 fortunately I do not have any hair loss problems at all

You just made the list of people I hate.   

Quote from: Kate on October 13, 2007, 09:54:32 AM

Quote from: Lori on October 13, 2007, 07:09:42 AM
In my estimation, those that take a DHT blocker with their HRT regimine feminize far better.

In theory, DHT blockers really shouldn't help with feminization much at all. Consider that many, many non-TS men use Propecia, Proscar and Avodart *without* experiencing any feminization (although some breast swelling and tenderness is listed as a rare possibility). The only thing I can think of is perhaps the lower DHT allows the E to work better? But I don't know.

The purpose of finasteride is to help change your body over to female-pattern hair growth.  Of course the baldness part has been well discussed.  But it also reduces male-type body hair.  And in my experience it works.  It takes a minimum of three weeks to notice any change, at least nine weeks for full effect, possibly longer.  It won't do much good if you not also taking estrogen.

Although the effect on hair growth speed of DHT reduction is pretty swift, the diminution of hair size and density can take a lot more time. It depends how big the hair shaft was pre-DHT conversion inhibitor.

In the case of the beard. unless it was fine and in its first years, it won't help, though it may make it more sparse.

There is also another little secret. Its called Retin-A. Google it..you may be shocked.

What I am concerned about is I have heard that it doesnt work when the hairloss is for genetic reasons which mine is.  Hopefully it works out in the end!

Quote from: Keira on October 13, 2007, 05:26:32 AM

The frontal area is very DHT sensitive, the temples are the most sensitive. Unless there is still some living folicles still there, cutting DHT won't help much.

Also, when hair is very very small (almost killed outright), it can take years of DHT suppression, 2+ before they can produce a viable shaft. For those hair, almost total DHT of dutasteride can accelerate this a bit.

For some hair, if they are small enough and there is a high enough sensibility to DHT, unless DHT doesn't exist at all in the system (which is not possible), there is no possibility to ever recover and the folicle will eventually die.

Don't get me wrong.......I do have a lot of hair and so far no signs of any hair loss (see avator pic) . The point I was making is I don't like my hair line which isn't completely straight and I thought finesteride might work on something that doesn't need much work doing to it. I must have taken it for a year or so but I didn't notice any difference.

Quote from: Kate on October 13, 2007, 09:54:32 AM
In theory, DHT blockers really shouldn't help with feminization much at all. Consider that many, many non-TS men use Propecia, Proscar and Avodart *without* experiencing any feminization (although some breast swelling and tenderness is listed as a rare possibility). The only thing I can think of is perhaps the lower DHT allows the E to work better? But I don't know.

At least some sources on the net claim that DHT blocks estrogen to some extent; also, if the T doesn't transform to DHT, some of it will turn into E instead. But no, I don't know either. Still, there are many non-TS men who have stopped taking finasteride for their hair loss after they started growing breasts, according to some web sites that warn about the side effects. There are estimates that a bit under half a percent of Propecia users get some breast development.

My own initial experiences are unusual enough that I'm quite baffled. I got a Propecia prescription three weeks ago, and my nipples started itching on the second day. By now I've already got a lump almost two inches across underneath both of them, and while people haven't started commenting on this in the locker room, I'm not sure I'd feel comfortable in a public swimming hall any more. According to everything I've read, this shouldn't be happening, not this quickly anyway.

I'm just waiting for the hair to show up too. 

  Nfr