Start fin and min at the same time or separately?

[ElocT9]

I am actually more a newbie as well here and have to make a decision as well.

What I am wondering about is if it makes really sense taking both at once. I mean I heard that they do not work with everyone. I would like to see what works and what not so that I may give up on Minox if it does not help any. Would that be possible?

[Paul Shapiro, MD]

Here are my answers to the questions posted today.
When using both Finasteride and Minoxidil the shed should be about the same as using only one. It would not be double the shed. And don’t worry, if you do shed, it usually is not a large percentage of hair. We shed about 100 hairs a day naturally and don’t even notice it. The shedding may make you look a bit thinner, but not significantly thinner in most cases. And in 3 months you will look thicker. If the shed bothers you, using cover up like DermMatch can help. But if you are exteremely worried about shedding I would just start the Finasteride and wait 3 to 6 months to start the Minoxidil.
The reason for the shed is that some of your hairs that are in the growing stage when stimulated to grow more by these medications go into the resting phase and shed. This resting phase last about 3 months. But only some of the growing hairs do this. We are not exactly sure why.
Ketokonalzole is an antifungal agent which also has an anti-inflammatory effect. We don’t know why it helps prevent hair loss in some patients, but it is not as effective as Minoxidil.
As I said if a patient is very worried about the shedding I would start Finasteride first. Since it will block the formation of DHT which is the cause of male pattern hair loss it is much more affective then Minoxidil. And studies have shown that the sooner one starts Finastgeride the better it is for hair loss. Then if you want to try Minoxidil down the road you can start it.
I have a lot of patients that are only on Finasteride because they do not like the hassle of Minoxidil or it irritates their scalp.
One can start both together, of start the Finastride first. I consider Minoxidil an adjunct in helping thicken hair. The only patients I have only on Minoxidil are ones who cannot tolerate Finastride and female patients.
I hope this is helpful
Dr Paul

[JDW]

Balding Bad
I usually suggest patients start Finasteride and Minoxidil together.
They promote hair growth by different mechanisms and together can have a synergistic effect. They have different side effects so you should be able to tell if a side effect is from Finasteride or Minoxidil.
Finasteride has a much more profound effect on hair growth then Minoxidil but the effects can take up to 6 months to be apparent. Shedding can happen with finasteride but is not common.
Minoxidil does not has a much and effect, but the results usually are seen sooner than Finasteride. Shedding is more common on Minoxidil, but not always seen. If it does happen it is not a bad thing. It just means the hair that shed is going into a resting phase and should grow back thicker and longer.
I tell patients that if they are only going to take one medication to take Finasteride because it is so much more effective.
But if you are going to take both you may as well start both at the same time. If you get shedding just be patient. And the side effect profile of each is completely different so you should know if you’re having any side effects.
I hope this is helpful
Dr Paul

Dr Paul,
thanks for answering questions, much appreciated. Quick one if I may. I've been on combinations of Dut and Fin for years with seemingly no effect. I'm currently on 0.5mg Dut ED and 2.5 mg of Fin ED yet still lose hair rapidly. Have you seen cases of such strong medication not working? Also is there any point in me adding Minox if the other meds haven't stopped the loss?

Many thanks in advance!

[BaldingHelpMe]

Dr Paul,
I'm currently on 0.5mg Dut ED and 2.5 mg of Fin ED yet still lose hair rapidly. Have you seen cases of such strong medication not working?

Exactly my problem before. Have you tried using only either one, but not both at the same time? For some reason, I lost a lot of hair while taking both drugs each day, and I was previously only on fin. I'm now back to only on fin now.

[Paul Shapiro, MD]

There are some patients who do not respond to these medications. The studies showed that 90% of patients respond to Finasteride. You may be in that 10% who don't respond. What I would suggest is to stop the finasteride and start Dutasteride at a higher dose. In the studies on Dutasteride they used up to 2.5 mg a day and saw more growth on that dose. I know it is expensive. This may help.
There is no need to take Finasteride if you are taking a large dose of Dutasteride.
Also I would suggest seeing a dermatologist that specializes in hair and possible getting a biopsy. Sometimes other dermatological conditions such as diffuse Alopecia Areata and Difuse LPP can look like Male Pattern Balding.
Hope this is helpful.

[JDW]

Thanks for the response I will give a double dose of Dut a go and see what happens.
Thanks

[PatientlyWaiting]

Same time I would say. Because they work differently, and they work well together.

[Herbaliser]

There are some patients who do not respond to these medications. The studies showed that 90% of patients respond to Finasteride. You may be in that 10% who don't respond. What I would suggest is to stop the finasteride and start Dutasteride at a higher dose. In the studies on Dutasteride they used up to 2.5 mg a day and saw more growth on that dose. I know it is expensive. This may help.
There is no need to take Finasteride if you are taking a large dose of Dutasteride.
Also I would suggest seeing a dermatologist that specializes in hair and possible getting a biopsy. Sometimes other dermatological conditions such as diffuse Alopecia Areata and Difuse LPP can look like Male Pattern Balding.
Hope this is helpful.

Can you please provide us the studies?
Who made the studies, and how many where participating in this study?
And you are suggesting to take Dutastaride! at a higher dose, and i really hope as a surgeon as you are to think twice what you are recommending.

[BaldingEagle]

Can you please provide us the studies?
Who made the studies, and how many where participating in this study?
And you are suggesting to take Dutastaride! at a higher dose, and i really hope as a surgeon as you are to think twice what you are recommending.

He's a doctor and has a reputation to uphold. Not to mention a lucrative career at risk. I highly doubt he would risk his reputation if he wasn't confident in his advice.

You're starting to get ridiculous man. Criticizing a doctor with a very good reputation for no other reason but your own distrust.

You have zero expertise or credentials and you push your silly home remedy that has only anecdotal evidence based on you and you alone.

Starting to seem like you have an agenda...

[Balding Bad]

Here are my answers to the questions posted today.
When using both Finasteride and Minoxidil the shed should be about the same as using only one. It would not be double the shed. And don’t worry, if you do shed, it usually is not a large percentage of hair. We shed about 100 hairs a day naturally and don’t even notice it. The shedding may make you look a bit thinner, but not significantly thinner in most cases. And in 3 months you will look thicker. If the shed bothers you, using cover up like DermMatch can help. But if you are exteremely worried about shedding I would just start the Finasteride and wait 3 to 6 months to start the Minoxidil.
The reason for the shed is that some of your hairs that are in the growing stage when stimulated to grow more by these medications go into the resting phase and shed. This resting phase last about 3 months. But only some of the growing hairs do this. We are not exactly sure why.
Ketokonalzole is an antifungal agent which also has an anti-inflammatory effect. We don’t know why it helps prevent hair loss in some patients, but it is not as effective as Minoxidil.
As I said if a patient is very worried about the shedding I would start Finasteride first. Since it will block the formation of DHT which is the cause of male pattern hair loss it is much more affective then Minoxidil. And studies have shown that the sooner one starts Finastgeride the better it is for hair loss. Then if you want to try Minoxidil down the road you can start it.
I have a lot of patients that are only on Finasteride because they do not like the hassle of Minoxidil or it irritates their scalp.
One can start both together, of start the Finastride first. I consider Minoxidil an adjunct in helping thicken hair. The only patients I have only on Minoxidil are ones who cannot tolerate Finastride and female patients.
I hope this is helpful
Dr Paul

Hi Dr. Paul, many thanks for the thorough reply, it's greatly appreciated. Your response has lessened my paranoia with the potential double shed.

Although I'm curious, does the shed happen with everyone and if so typically at one point does it begin?

I am supposed to be receiving my Min before my Fin, so not sure if I should start right away or wait until I receive my Fin (which I'm not too sure when that's going to be).

Regardless thank you for your response!