Opinion about Finasteride and DHT

[Dr.Bart]

Graphs are nice, but do you have human studies that show clinical efficacy of scalp hair regrowth or maintenance at intermittent dosing? From what I remember most studies were done with daily dosing.

[SilentWatcher]

It depends on what you’re trying to achieve. If you’re aiming for perfect DHT suppression 24/7, sure, daily dosing might seem like the gold standard. But there’s a study PubMed link where they used 2.5 mg of finasteride every 3 days in women with hirsutism and saw great results. Sure, it’s not exactly our case, but it shows that intermittent dosing isn’t just wishful thinking. If it works for hirsutism, why not for other androgen-driven conditions?

Now, back to me. My risk of prostate cancer is high due to my DNA and family history, so I need DHT suppression. But I’m also concerned about the neurosteroid disruption that finasteride causes in the brain. That study Advances in Knowledge of Androgens: How Intentional and Accidental Neurosteroid Changes Inform Us of Their Action and Role paints a grim picture of how finasteride crosses the blood-brain barrier and messes with allopregnanolone and other neurosteroids. This could be related to the effects that @DeStrider and others have experienced (+estrogen).

So, here’s where I get a little creative. Beta-sitosterol and saw palmetto can reduce DHT by 30-40%, which helps relieve some BPH symptoms (with little / no side effects). By adding 1 mg of finasteride every 3 days, we can amplify that effect, reducing DHT by around 50-60%.

The real question is: Does intermittent dosing give neurosteroids enough time to recover? That’s where it gets interesting. On the off-days, you’re giving the brain a chance to reset its neurosteroid levels (at least partially). Will it fully bounce back? Maybe not. But the risk of long-term dysregulation could be lower than with daily dosing.

So yeah, no free lunch here, but with a 50-60% DHT reduction from intermittent finasteride, along with support from natural DHT blockers, I think I can still enjoy a decent lunch — without serving my brain up for dessert.

Comments and pointing to mistakes in my thinking are highly welcome

[RapAdmin]

Is anyone familiar with the variance of DHT suppression of topical vs. oral finasteride or Dutasteride? I tried Oral but they both killed my libido, so wasn’t worth it. But I’m thinking of trying topical versions of these drugs.

[nikney]

I take finasteride 1mg twice a week and I see great clinical benefits. It keeps my hair very strong. I have never had an erection problem. Intermittent dosing seems reasonable.

[DeStrider]

I think I’ll give twice a week a shot. Thanks, guys.

[SilentWatcher]

An additional concern with long-term finasteride use is androgen receptor (AR) upregulation. Studies, such as Immunohistochemical Evaluation of Androgen Receptor and Nerve Structure Density in Human Prepuce from Patients with Persistent Sexual Side Effects after Finasteride Use for Androgenetic Alopecia or Finasteride upregulates expression of androgen receptor in hyperplastic prostate and LNCaP cells: implications for chemoprevention of prostate cancer, show that finasteride can significantly upregulate AR expression in prostate tissue and cancer cell lines. This upregulation may reduce the long-term effectiveness of androgen suppression and could even contribute to higher-grade malignancies in prostate cancer.

One potential strategy to mitigate this is intermittent androgen suppression, a method used in prostate cancer management. By cycling on and off finasteride (or other 5α-reductase inhibitors), we may prevent the adaptive AR upregulation caused by constant low DHT levels. In prostate cancer treatment, cycles typically involve 6-9 months of suppression followed by several months to over a year off-treatment, based on PSA levels.

Adapting this approach from prostate cancer therapy could be an interesting option to explore for BPH management, balancing DHT suppression while potentially reducing the risk of long-term side effects. However, the exact timing and intervals for intermittent dosing remain open and require further research to determine the optimal approach.

[Dr.Bart]

@SilentWatcher

It depends on what you’re trying to achieve.

I edited my question to make it more specific.

[Virilius]

@SilentWatcher

and messes with allopregnanolone and other neurosteroids.

Finasteride is far too weak of an 5ar type 1 inhibitor to actually affect neurosteroid production, unlike dutasteride.

The doses of finasteride used clinically are in the range of 1 to 5 mg per day, which is far less than the doses of 30 to 100 mg/kg used in rats in the study by Lawrence et al. Furthermore, in humans, finasteride is selective for the type 2 5α-reductase isoform and less active on the type 1 enzyme that is the isoform predominantly present in the brain. This selectivity is not observed with the rat enzymes. In sum, finasteride, as administered clinically in humans, probably does not block neurosteroidogenesis sufficiently to influence seizure susceptibility under most circumstances.

Neurosteroids on the Epilepsy Chessboard—Keeping Seizures in Check - PMC (nih.gov)

Beta-sitosterol and saw palmetto can reduce DHT by 30-40%, which helps relieve some BPH symptoms (with little / no side effects). By adding 1 mg of finasteride every 3 days, we can amplify that effect, reducing DHT by around 50-60%.

Which type of 5ar do those supplements mainly affect? It would be ironic if they turn out to be stronger 5ar type 1 inhibitors than finasteride. After all, their effect on hair growth is very, very weak.

[Phillipe]

Do you still take oral finasteride?

[Dr.Bart]

Every day for the past couple of years. I tried using topical for a while but it irritated my scalp. I took it on and off since my mid 30’s, small doses initially. I was scared off by the mythical PFS but I reviewed the studies and came to my senses. In my late 40s I noticed some difficulty in urination also, not a problem now since taking 1 mg a day.

[AgentSmith]

@RapAdmin

Is anyone familiar with the variance of DHT suppression of topical vs. oral finasteride

This is a nice summary article that reviews the research and led me to use only 6mg of fin dissolved into 60mL of Kirkland Minoxidil per month to avoid systemic suppression.

But I’m also going back to adding Anagen Inc’s RU58841 powder into the mix.

Topical Finasteride: The Best Dosage for Maximizing Regrowth and Minimizing...

One other thought on the libido part of the comment: the standard “fix” for libido for TRT users and AAS abusers is transdermal T to the scrotum, which puts DHT through the roof, or use a DHT derivative like proviron or masteron. That’s just information, not a suggestion.

[Phillipe]

I haven’t taken oral but am currently using topical for about 3 months now. I’m seeing slight hair growth (more than just fine hair) where there was none and thicker hair where there was existing before. HOWEVER, some diminished erection quality and to a less extent libido reduction is manifesting but not compromising-so far. Combo of minoxidil, finasteride (.3%), hydrocortisone and retinoic acid.

[Agetron]

Consider tadalafil daily 5 mg. Good for urinary health according to my urologist.
Balance the side effects.Get a big benefit.

[Phillipe]

Yes, I’m taking that dose of it. It revitalized the male, morning manifestation.

[Phillipe]

Very informative article AgentSmith linked above. I wonder what the efficacy of low dose, say .25mg, oral finasteride would be compared to topical. Since, the topical would go systemic anyway to a degree, it would certainly be a lot cheaper to go that route since topicals are expensive compared to pills.

[AnUser]

Another one falls victim to “Post Finasteride Syndrome Fear”.

Before:

After:

All because of a 2 → 4% risk of side effects (Propecia Randomized Controlled Trial).

[Virilius]

With statins, if you fall for fearmongering you likely won’t face any repercussions for decades. With finasteride, if you fall for fearmongering you will lose most of your hair within just years and end up looking bald and 10-20 years older.

[AnUser]

I have ordered a nocturnal erection tracking device because the PSYOP about finasteride got to me .

So I’ll be measuring nocturnal erection before and after finasteride. I’m unsure how long the baseline should be. It makes sense to care about erectile function, I guess from an evolutionary perspective as well. It’s pretty childish to not do so on the preventative side of things I guess.

@ AmyK any suggestions on how long is needed to establish a baseline before initiating a treatment with for example ED as a possible side effect? Anything else I should know?

[AmyK]

I’d measure a baseline for two weeks and that should be enough to get a good idea about frequency and firmness of erections.

And, remember that topical finasteride or dutasteride are also options for hair growth. There’s still some systemic absorption but we see higher DHT concentrations at the scalp with topical - and fewer systemic side effects. Good luck.

[Virilius]

I just take tadalafil 5mg 2-3 times a week for good measure, though even off them for a few weeks I don’t feel any difference.