Advice re. topical finasteride

[silo]

Hi all, apologies if I’m posting this in the wrong place (or if it’s something that’s been posted loads of times before), and sorry for the long post, but I would really appreciate any advice or tips. FYI I’m 32 and located in the UK.

Long story short, I’ve had recurrent episodes of diffuse hair shedding since 2020, with the remission periods between them becoming shorter and shorter. I’ve been applying minoxidil consistently for the past six months and have used ketoconazole shampoo for a good few years, way before the shedding started. Blood tests have come back clear and two specialists have said that it’s likely chronic telogen effluvium, with no known cause. I agree with this because the shedding has also at times been from the back and sides of my head, as well as my facial hair.

But the most worrying part for me is they said chronic Telogen Effluvium can accelerate androgenetic alopecia, if you were always genetically predisposed to it, which I think is what is now happening to me. My hair has gradually become thinner (which I think is to be expected with chronic Telogen Effluvium), but the main issue is that I’m noticing a lot of the hairs that are falling out now are short and thin, which I understand is miniaturisation and representative of permanent hair loss. Also the first cm of my hairline suddenly looks really thin and see-through (there are some tiny hairs coming through, but I predict they’re going to fall out like the other new growth has).

In terms of the chronic Telogen Effluvium, I’m not sure there’s a lot more I can do. But what I do want to try and do is not permanently lose any of the hair I’m shedding through Androgenetic Alopecia, which is why I’m considering topical finasteride. I appreciate even if it works, I could continue shedding that hair because of the Telogen Effluvium, but at least I’d be keeping the follicle ‘alive’ for the periods of remission, as well as for if/when the condition might stop.

I’m going down the topical route as I, like many others, am worried about the potential side effects. I realise there can be some systemic absorption over time, even with topical application.

I was going to order a 60ml bottle of topical 0.05% finasteride + 5% minoxidil (without alcohol) from Hims, which they recommend applying twice a day. From my understanding, this can be excessive, so my plan is to mix this with a 60ml bottle of 5% minoxidil (again without alcohol) to make a 120ml bottle of 0.025% finasteride + 5% minoxidil (please someone let me know if it doesn’t work like that!).

What I’m unsure of is how often to apply it – I’ve read that the half-life is three days, so would it be best to start with one application every three days and see how that goes? Or two applications (on the same day) every three days? It’s so hard to judge, because I want to minimise the risk of side effects, but I also don’t want to waste time continuing to lose hair because the dosage is too low. I was also thinking I could initially prioritise application at my hairline, rather than the entire top of my scalp, as this is where the main loss seems to be at the moment, and see how that goes first?

I’m also planning to get blood tests done before I start any treatment, and to monitor this semi-regularly (pricey, but I’d rather be safe than sorry). The clinic I’ve found offers blood tests for: DHT, androstenedione, LH, oestradiol, testosterone, FSH, prolactin, free androgen index, and free testosterone (calc.). Do you think that covers most bases?

Again, sorry for this being so long, but I’d be grateful for any help. I’m be happy to share progress and updates on here if that would be useful.

[rufus]

just apply every other day to start and monitor your progress along with potential sides. I.E. nipple sharp pain, testicular throbbing, swelling in feet or hands. If this occurs scale back even more. If it continues then its best to stop. However, it may be best to try one or the other 1st for a few months before adding another TX. that way if you experience sides you know exactly which drug it is. Also some recommended .25mg of oral fin every other day. Getting labs is an excellent idea. I would add a TSH, SHBG, ANA and a TGF beta. The ANA is b/c there is an unlikely chance of developing an-autoimmune condition with Minoxidil and TGF beta is another inflammatory marker that can rise with fin use. Nothing is a free lunch with this shit

[silo]

Thanks rufus.

I had my pre-treatment blood tests done and everything was in normal range, apart from FSH, which was slightly low, and DHT which was high (3.23 nmol/L – normal range is 0.33 to 3.01).

I guess that explains the recent more permanent thinning then! Though I was expecting my testosterone levels and Free T to also be high if my DHT is, but they’re both fine – is that normal?

Anyway, going to start this week with 0.025% topical finasteride + minoxidil once every other day (minoxidil on its own outside of this) and see how I go.

[rufus]

The test. is bound to SHBG and other proteins and in use by your body. That drives your Free or available Test.. Which many say DHT has a stronger affinity for SHBG. Anyways, a great source for understanding how your hormones work would be on this youtube channel "More plates more dates". You may have come across him and the dude is real knowledgeable. He's no doctor but uses science to really address this topic and you can gain much insight into understanding your hormone profile along with additional hair loss treatments. He even covers a rare but possible side effect of minoxidil. it can cause DISL. Drug induced Systemic Lupus. Not fear mongering but its always best to know what you're dealing with. Best of luck