The big 3 minus 1?

[chrisis]

In light of concerns from people posting recently about side effects, I'm curious how effective the "big 3" are without finasteride/Propecia?

Anyone doing this with success? Or is Propecia the kingpin?

[clandestine]

Propecia is rather important, yes.

[2020]

In light of concerns from people posting recently about side effects,

.... this is an old drug. It has been tested on thousands on subjects over the past 2 decades.
We already know the risks and they are very low - something around 2%. Side effects are NEVER permanent.

Millions of people are already using it and vast majority of them are satisfied with the results. For the love god, don't listen to anything StressedToBald says...

[Tracy C]

Lets look at what the different parts of the "Big 3" do.

Propecia (or generic Finasteride) blocks the formation of the hormone that causes the damage to hair follicles and triggers hereditary hair loss - but it does little to nothing to stimulate hair follicles that can still grow hair to grow hair. It basically "allows" your hair to keep growing. How important is this? It is pretty important because this is the closest to treating the actual cause of hereditary hair loss that is currently possible. When trying to resolve any problem, resolving the cause is the most important thing.

Rogaine (or generic Minoxidil) stimulates hair follicles that can still grow hair to start growing hair again - but it does nothing to block the hormone that triggers hereditary hair loss. How important is this? This can be pretty important depending on how long a persons bald patches have been void of hair. Once hair follicles stop producing hair they go into a dormant state. They can only stay dormant for so long before they loose their ability to be restarted and grow hair again. How long dormant hair follicles can remain dormant and still be able to be restarted is unknown. However my best educated guess after reading information for many doctors is that it is probably about five years. So with that thought in mind, if your hair loss is less than five years along, using Rogaine can be pretty important.

Nizoral (Ketoconazole) is a mild anti-androgen that may be able to block reception of DHT at the scalp. If it actually does do that, it's usefulness in treating hereditary hair loss is obvious. There are other benefits to using Nizoral that make it worth adding to your regimen anyways such as reducing inflamation and helping to improve the general health of your scalp.

[chrisis]

Thanks clandestine, 2020 and especially Tracy C, for the explanation.

It does seem finasteride is a very significant component of the big 3, but my research and personal experience is leading me to the belief that serious side effects are quite common. I realise everyone has their own anecdotes which lend heavily to bias on these forums, but I'm not prepared to dismiss the risks as I think I'm experiencing some side effects myself. I'm considering at least cutting my dosage.

With any luck someone will chime in who's happy with their maintenance regime that does not involve finasteride, so that I can weigh up my options.

I'm sure there are people who don't have any side effects and that's great, but it would be good if the forum could accommodate people who do.

[25 going on 65]

Finasteride (or dutasteride, depending on the person) is the single most important treatment of the Big 3 in maintaining your hair in the long term (i.e. longer than 1-2 years).
If you only use ketoconazole and minoxidil, you will see gains over the next year or two followed by loss of those gains and continued loss beyond where you are now. Keto and minox are good supporting treatments but they don't address the cause of hereditary MPB by themselves (to be exact, keto may address it to a small degree, but not strongly enough to stop hair miniaturization).

Purely looking at hair loss, it would be more effective to quit the topicals and just take finasteride than vice versa. To be honest I wouldn't even bother with shampoos and lotions if I wasn't blocking DHT, though they would produce some results on their own (better than nothing).
Also, I strongly recommend against surgical transplants for anyone who will not or cannot take a DHT blocker. I only bring that up because I know you were considering a future procedure. Fin/dut allow your hair loss to stabilize, which makes it easier to determine how to approach a transplant, and it will also maintain your native hair after the transplant - otherwise, you will continue losing native hair and eventually only the transplanted follicles will remain (which tends to create an odd appearance).

[Tracy C]

It does seem finasteride is a very significant component of the big 3, but my research and personal experience is leading me to the belief that serious side effects are quite common.

Fear mongering can do that. Fear mongering works exactly the same way as the placebo effect. The reality is the possible side effects are not common, though fear mongers want you to believe they are. Another reality is that those possible side effects usually go away for those few who actually do experience them, even for those who continue taking the medicine - but fear mongers want to believe they are permanent. The point is, fear mongering can and often does increase the percentage of people experiencing negative side effects from any medication, just by inducing fear. Fear mongering is no different than shouting "FIRE" in a crowded theater. Even if there is no real fire, bad things happen to people.

Spencer gave some great advice for those who choose to take the medicine. He advised not to read any of the negative information about the medicine.

[2020]

but my research and personal experience is leading me to the belief that serious side effects are quite common. I realise everyone has their own anecdotes which lend heavily to bias on these forums, but I'm not prepared to dismiss the risks as I think I'm experiencing some side effects myself.

this is the only research you should be doing:

http://www.ncbi.nlm.nih.gov/pubmed?term=finasteride%201%20mg

Discussion forums are not an accurate representation of how effective a particular drug is; people are more likely to complain than to compliment.

With any luck someone will chime in who's happy with their maintenance regime that does not involve finasteride, so that I can weigh up my options.

that's the thing... people who are happy with the drug have no reason to post their stories on the Internet.
Only the people who DO get side effects post about it because they don't know what to do next..

[chrisis]

I'm not sure if it's just fear. I realise the brain is a powerful thing, but my side effects are becoming quite substantial. They manifest not just psychologically in that I lack sexual desire, but also physically; I have far fewer erections and my semen is thinner and considerably lesser. Also I believe my symptoms were kicking in before I started reading these horror stories: I'm only reading them because they're especially relevant to me. I was aware of potential side effects before I started taking finasteride, but I dismissed it as being low risk. Lo and behold a few months later and I'm looking into this more and beginning to identify with the men who are reporting problems, but being roundly dismissed it seems.

Furthermore, I asked someone from this forum who I've been corresponding with about hair transplants if he had side effects from finasteride, and he said yes. He quit taking it.

Seems to me finasteride does affect some men and doesn't affect others. The numbers are up for debate, but it's something we should all be both aware of and less dismissive of.

It would be positive if the forum discussed the risks without rejecting them out of hand. It would also be positive if we started talking about alternatives. Maybe pulling the plug on finasteride will be good for the hair loss industry. Merck will have a $500m black hole in their annual revenue streams which they need to fill. Back to the drawing board and back to the labs; balding men will be looking to spend their money elsewhere, after all.

[chrisis]

I want to add that I've been on finasteride since November, minoxidil for about 3 weeks and Nizoral for a week.

Is it possible that my side effects are due to minoxidil or Nizoral, since I've only started taking them recently?? I read a topic about a guy who apparently lost libido after trying Nizoral.

I thought finasteride was associated with side effects, but I guess I can't discount Nizoral or minoxidil.

[khan]

chrisis,
Has there been any change in your life style recently. In my case, stress really has a negative effect on libido and other related functioning.

You could try lowering the dose for a few weeks and then seeing how thing go, instead of completely quitting. At the end of the days it your hair and your life, but if I were you, I wouldn't listen to anyone that hasn't tried the drug himself.

[2020]

Is it possible that my side effects are due to minoxidil or Nizoral, since I've only started taking them recently??

nope. The side effects you're describing could not have come from those two products.

I read a topic about a guy who apparently lost libido after trying Nizoral.

that could not happen... it's all in his head.

[Tracy C]

The numbers are up for debate, but it's something we should all be both aware of and less dismissive of.

Please don't take it as being dismissive, it is not itended to be that way. The current rash of fear mongering can certainly make it seem that way - and certainly make people act dismissive. This is yet another danger of fear mongering - it masks the true nature of the risk - from both sides. It is important for people to know the possibility is there - but it is just as important for people to know that it is not common and it usually goes away for those few who do experience it.

I have said before that I know many men who take the 5mg dose of Finasteride for their prostate. I have directly asked each of them about this since joining this forum. None of them are experiencing these side effects. Most of their wives are fiends of mine - and they are not complaining. Yes, women talk about how their men perform when their men are not around.

[chrisis]

Tracy C: Maybe there is some connection between the biochemistry that triggers hair loss and sexual side effects, that does not trigger in people who are only taking the medication for their prostate. It's all speculation, but possible...

Yeah 2020, I honestly can't see minoxidil or Nizoral being responsible for this. If anything, I'd suspect finasteride. I'm gonna cut down my dosage and see if anything improves.

[clandestine]

Minoxidil has been associated with various sides, but to my knowledge none of them are pertain to sexual function.

An anti-androgen shampoo such as Nizoral would not give you any sides. This I'm rather sure of; I can think of no reported cases. I've seen that thread though, and I remain suspicious regarding the validity of OP's claims.

If you are indeed experiencing sexual related sides, finasteride is likely the culprit.