How bad is finasteride?

Jayvee

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Sep 10, 2020
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There are hundreds of other options for hairloss that dont involve finasteride (or any 'asteride' or saw palmetto). DHT isn't the cause of hairloss. I'd search this forum a bit deeper. Some topical solutions might be good or anything that stimulates blood flow in the scalp. I seen a thread recently about how even complete bald people can regrow hair.
 

Jayvee

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@ChemHead How did you recover from PFS the first time? And what are you doing now to recover again? Thanks
Yeah I really want to know. My cognitive issues are still trailing hard. I dont have a numb **** anymore (which took me 2 years to recover from)
 

tankasnowgod

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Jan 25, 2014
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250 - 500 ml every day and I imagine its around 20-40 % of total protein, but not sure since I drink a lot of milk.
I've never heard gelatin intake reported in ml. Is it in the form of Bone Broth?

It doesn't sound like you are sure, either. Maybe you should track your intake in cronometer for a few days and see how much it really is. Or, at least the read the labels of whatever gelatin you are eating.
I am not saying I am willing to throw it all in the garbage I am just wanting to know how bad is it considering I know several people taking it with no significant side effects and good results.
How much of a clinical evaluation did you do on these men?

Regardless of their subjective experience (if it's even as good as you think it is), the linked study and story suggest that the side effects can be long term, horrific, and manifest after a very short period of the medication. Did you read the medium story I linked? He said he only took it for 21 days, and the result was 6+ years of depression, sexual disfunction, headaches, bad vision, and insomnia. Why would you even consider risking this for a comparatively minor problem like going bald?
I dont think I will start it, but it seems like the drug route is the only way that really works and that makes me upset.
What do you even mean by that? "Really works?" Again, the only claim is that it SLOWS THE RATE OF HAIR LOSS. It does NOT even claim to regrow hair!

Again, do you even search this forum? There are several other methods.

Personally, I think the most promising are a very high gelatin/glycine intake, probably much higher than you are eating, and red light therapy. I've seen "Over Macho Grande's" laser helmets suggested before. Red Light Therapy seems like, far and away, most promising way to regrow hair, not "slow the rate of loss," which again, is Finasteride's only true claim.

 
OP
Lee Simeon

Lee Simeon

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Mar 3, 2017
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I've never heard gelatin intake reported in ml. Is it in the form of Bone Broth?

It doesn't sound like you are sure, either. Maybe you should track your intake in cronometer for a few days and see how much it really is. Or, at least the read the labels of whatever gelatin you are eating.

How much of a clinical evaluation did you do on these men?

Regardless of their subjective experience (if it's even as good as you think it is), the linked study and story suggest that the side effects can be long term, horrific, and manifest after a very short period of the medication. Did you read the medium story I linked? He said he only took it for 21 days, and the result was 6+ years of depression, sexual disfunction, headaches, bad vision, and insomnia. Why would you even consider risking this for a comparatively minor problem like going bald?

What do you even mean by that? "Really works?" Again, the only claim is that it SLOWS THE RATE OF HAIR LOSS. It does NOT even claim to regrow hair!

Again, do you even search this forum? There are several other methods.

Personally, I think the most promising are a very high gelatin/glycine intake, probably much higher than you are eating, and red light therapy. I've seen "Over Macho Grande's" laser helmets suggested before. Red Light Therapy seems like, far and away, most promising way to regrow hair, not "slow the rate of loss," which again, is Finasteride's only true claim.

Sorry, I thought I had wrote bone broth. 250- 500 ml of bone broth is what I meant. I know the amount and I have been tracking its just that it changes every day depending on my desires. But its always between 250 and 500 ml. I dont track anymore and I have not for a long time, but my protein intake is always consistent. I have been using red light daily since summer 2017 and I have been doing it for a while on my hair without noticing any effects. I use it mostly on thyroid and generally over the body but its probably been a year or so since I last did it dirrectly on my hair so will give that a shot, thanks!
 

ChemHead

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Dec 8, 2020
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Yeah I really want to know. My cognitive issues are still trailing hard. I dont have a numb **** anymore (which took me 2 years to recover from)
I'll respond to this. It will be a pretty long response so give me a little time.
 

MCurtone

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Jun 21, 2018
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I'll respond to this. It will be a pretty long response so give me a little time.
I'm also eagerly waiting to here this. 6 years deep here. No libido issues, purely cognitive. Had a stressful night after 6 months on finasteride, mind couldn't stop racing, crashed and woke up the next day in a completely different reality.
 

ChemHead

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Ok... here it is. There's somewhat of a TLDR at the bottom, but I would recommend reading everything... I'm not so sure it would make much sense.


After over a decade of finasteride use and many years spent in recovery, I believe I may know what actually causes the persistent side effects of finasteride use (or PFS). I'll try to explain as clearly as possible, but first I'll start with what I did when I recovered the last time and my process of discovery.

At the time of my last recovery, I was doing quite a few things that I felt could have been responsible for what seemed almost like a spontaneous recovery. It all seemed to happen very quickly... like within the span of a couple months, with some of the most significant changes occurring inside of just a couple weeks.

So, at the time, I had been taking various supplements (namely: riboflavin, niacin, iodine, D3, B12, biotin, l-dopa, and probably a few others). More significantly, I had made some pretty major changes to my diet within only a couple months of complete recovery. So, when I finally did recover, I attributed the recovery to the dietary change because of the many positive changes that had occurred in addition to the recovery. To keep this brief, I'll just say that, eventually, I came to believe that the diet, while still a positive force in my life, was not responsible for my recovery.

So up until about 6 months ago, my list of possible things responsible for my recovery looked about like this:

- dietary changes
- use of l-dopa or high doses of niacin/riboflavin, possibly something else like licorice root that I had been using at the time
- time

I tested the l-dopa and the other stuff and while I experienced similarities with my last recovery, none of this stuff ended up being significant. The only thing left was that I had recovered from PFS because it was simply time.. enough time had passed for whatever was screwed up to reverse itself. At times, I convinced myself of this, but the problem was that only maybe 4 months prior to my recovery, I had used finasteride for maybe around a week and then decided it wasn't worth it and quit. So, while time was still a possibility, I always remained skeptical.

So, being tired of seeing little to no improvement after another 2.5 years of life wasted, I decided to try and exactly retrace every single thing I had done around the time in the exact manner I did it when I recovered... even if it was something I had already done or decided to dismiss as insignificant.

These were the items at the top of my list:

- test the use of one single dose of spironolactone @ 50 mg, which I had used only weeks before recovery
- test a particular type of iodine that I used during the last recovery but hadn't used since
- test the use of the androgen receptor antagonist RU58841 at 40mg/ml twice daily for ~3 weeks

I tested the spironolactone and pretty much nothing happened. I felt odd and a little dehydrated the night I took it and that was essentially it. I'm going to skip past the iodine to the RU58841 and say that I haven't tried this again yet, but it's still on the table because I have a good reason to believe that it could have possibly played a role in the recovery. I'll discuss this later. So, now, I'll get to the iodine. I believe this was actually responsible for the recovery and I'll discuss what has led me to believe this and why I overlooked it for so long to begin with.

During the last recovery, I had been taking iodine very religiously every day along with a bunch of other cofactors which included vitamin C, selenium, riboflavin, and niacin, while also ensuring adequate iron intake. I never felt immediate improvement of anything, nor did I experience a gradual, building improvement of anything. My recovery happened very quickly and suddenly and, because of this, iodine just wasn't on my radar.

So, fast forward to around 6-8 months ago, I began taking high amounts of "nascent" iodine, which, honestly, is probably just sodium or potassium iodide dissolved in glycerin... I really don't know wtf it is because I can't seem to find a straight answer other than the equivalent of "magic" or magnetic charge or some obfuscated pseudoscience. So, I took relatively high amounts for around 2 months... I think I took around 30 drops daily which is the equivalent of around 15 mg. I'm no stranger to this amount of iodine. I've taken higher amounts using 5% lugol's. In fact, probably only a few months prior, I had been taking lugol's. After a month to 2 months of taking the "nascent" iodine, I noticed that I began growing hair on previously barren spots on my hands. At this point, I realized that 5-6 months prior, when I was taking the lugol's iodine, I also grew this hair on my hands. The problem was that I never attributed the hair growth to the iodine and, even worse, 2 months after I quit using lugol's, the hair on my hands fell out again and I still hadn't realized the connection. It wasn't until I tried the experiment with the stupid nascent iodine and saw the hair growth inside of 1.5 months that I finally made the connection. Not coincidentally, I also experienced this increase in hair growth on my hands (and body hair, in general) during my last recovery.

Ok, so at this point, anyone reading this is probably thinking THYROID.. and yes, obviously, that's where this leads, but there's a little more to it and I believe this is important because it offers insight into what PFS might actually be and what causes it. I want to go back in time to when I first began taking finasteride. Over a decade ago, I took the typical 1 mg daily finasteride and it worked incredibly well, but also caused the horrible side effects. At that time, when I quit taking finasteride, it only took maybe 3-4 weeks for my body to make a full recovery and go back to normal. As I continued toying with finasteride over the years to discover what made it work and why it would stop working after only a few weeks to a month or two of use, the time it took to recover from finasteride after discontinuation gradually increased. Eventually it started taking 3-4 months and then seemingly 3-4 years based on the last recovery.

So, I thought that finasteride must be causing some type of long-term damage or epigenetic changes that cause the recovery time to perpetually increase with each subsequent use. What I hadn't considered, however, was that perhaps there was some underlying condition or genetic susceptibility that finasteride will exacerbate, but of which it isn't necessarily the cause. I've had hypothyroid-like symptoms since childhood, but I've never been diagnosed with hypothyroidism because my labwork has never indicated clinical hypothyroidism. I don't really have any thyroid labwork from a time prior to finasteride use, but anyone here that looked at my labwork done during PFS would assume hypothyroidism based off the TSH values. T4 and T3 levels seemed normal and within "range", but ranges don't really mean much to me anymore because the range that's right is what feels good.... not where the average of the population rests.

Anyway I started traversing the clinical and scientific literature for associations between thyroid and 5a reductase, as well as various other things like androgen receptor and 5AR antagonist, androgen receptor and thyroid, thyroid and prolactin, thyroid and gonadotropin releasing hormone.... and many other searches like this. I was trying to piece together a narrative that I was building in my head.. trying to tie all the things I already knew to what I had recently learned about the significance of iodine in my recovery.

At this point, I'm just going to start citing some of the studies and research I read and what I was thinking as I was reading them and what they subsequently led to. So, the first one I have is "Reversible 5α-reductase 2 deficiency in Hypothyroidism":


So, this essentially outlines a few case studies of "severe primary acquired auto-immune hypothyroidism, which show a similar picture of 5α-reductase deficiency". My first thoughts were that there seems to be a sort of "chicken and egg" situation... did the 5AR deficiency cause the hypothyroidism or the other way around? Or is there perhaps some sort of interdependence where either one could cause the other? Either way, they demonstrated that the type 2 5AR (SRD5A2) deficiency was completely reversible following administration of adequate thyroxine. So, great... I've found an association between 5AR deficiency and hypothyroidism. So, now, I know that anyone taking finasteride (or any other potent 5AR antagonist) could be inducing hypothyroidism. But then the question becomes "Well, if finasteride can induce hypothyroidism, then shouldn't that work itself out after discontinuation of fin?". And the answer, at least for most people that don't experience PFS, is probably yes. So, what about those who experience PFS? One thing I think is important to do when dealing with these chicken and egg situations is ask if the relationship between, for example, 5AR and hypothyroidism has any reflexivity in their associations. So, we know that hypothyroidism seems to be able to induce deficiency of SRD5A2 expression, but is it also possible that pharmaceutically induced 5AR deficiency can cause hypothyroidism which can then prevent return of normal 5AR expression?


Here's another study done on rats that seems to corroborate the previously mentioned 3 case studies:

(in case above link doesn't work: www(dot) jbc.org/article/S0021-9258(17)30647-6/pdf )

"Although GH has been shown to exert a positive, stimulatory effect on hepatic 5α-reductase activity when present continuously (Mode et al., 1982), the inability to support full enzyme expression in hypophysectomized rats (Waxman et al., 1989a and this study) led to the proposal that the effects of GH may require mediation by or interaction with other pituitary-dependent factors. The present study validates this hypothesis and establishes that T4, wihch is dependent on pituitary thyroid-stimuating hormone for secretion by the thyroid, can significantly restore hepatic 5α-reductase activity and its mRNA, both in hypophysectomized rats and hypothyroid rats."


Here's an excellent article that reviews the current state of research on the 5α-reductases and their physiological importance:


Of particular interest in this article is section 4.4 Thyroid hormones and androgens crosstalk. Read the whole section, but I'll point out what I find most significant.

They state: "hypothyroidism can decrease androgens, LH, and gonadotropin-releasing hormone levels, (rat: Chiao et al., 1999; Kala et al., 2002; bird: Weng et al., 2007; fish: Swapna et al., 2006), impair testicular development (rat: Wagner et al., 2008; Maran, 2009), induce atrophy of epididymis and seminiferous tubules, decrease sperm number and motility (rat: Anbalagan et al., 2010; bird: Weng et al., 2007; fish: Swapna et al., 2006), and can even lead to a female biased sex ratio (frog: Goleman et al., 2002; fish: Mukhi et al., 2007)".

Much of this is part of the manifestation of PFS, obviously. What I found more interesting, though is that 5AR expression appears to be regulated by a thyroid hormone response element (TRE) which is found within the promoter region of every 5AR isoform:

"This cross-regulation of SRD5αs by TH can be explained by predicted thyroid hormone response element (TRE) in the promoter of each SRD5α isoforms (Flood et al., 2013). However, the functionality of those TREs still remains to be tested to ascertain their direct role in the regulation of SRD5αs."

So, that question I asked earlier about reflexivity... hypothyroidism seems to be able to induce 5AR deficiency (as shown in the case studies as well as the apparent connection between 5AR expression and TREs in the genes encoding for each 5AR isoform), but is there a connection between pharmaceutically-induced 5AR deficiency and hypothyroidism? There appears to be:

"another important aspect in TH regulation is the existing crosstalk with androgens due to the presence of ARE in genes related to THs, such as deiodinases and TH receptors (reviewed by Flood et al., 2013). Indeed, 5α-DHT treatment increases transcription of thyroid receptor β and deiodinase 1 (Campbell and Langois et al., 2018), and FIN treatment impacts expression of TH-related genes such as deiodinase and TH receptors in S. tropicalis (Langois et al., 2010b; Langois et al., 2011)."

So, there are androgen response elements within the genes encoding for deiodinases and thyroid hormone receptors and DHT treatment increases transcription of thyroid receptor β and deiodinase 1. Moreover, treatment of finasteride impacts the expression of these genes. So, what I'm seeing here is not only a classical picture of hypothyroidism (where only thyroid hormones are insufficient), but potentially hypothyroidism on the receptor side. With pharmaceutically-induced 5AR deficiency, low synthesis of DHT can cause an under-expression of the genes for deiodinase 1 (which plays a direct role in deiodinating T4 to the active T3) and for thyroid receptor β. So, if hypothyroidism isn't being induced by lack of thyroid hormones (perhaps you may be supplementing THs?), it can also be induced by lack of thyroid hormone receptor β expression. That hypothyroidism can then cause a sort of catch-22 situation where you don't have 5AR expression (and, thus, no DHT), so you can't express TH receptors properly, and you don't have sufficient thyroid hormone stimulation of tissues, so you can't express 5AR. This is the essence of post-finasteride syndrome in my opinion.

Consequently, anyone who also happens to have a perpetually worsening thyroid condition seems to be far more likely to experience PFS. This, perhaps, explains why some people seem to be profoundly affected long-term by 5AR antagonists and others seem to bounce back just fine after discontinuation. It also explains why, with each subsequent use of finasteride, it took longer for me to recover... because I likely have a perpetually worsening thyroid condition.

BUT WAIT! THERE'S MORE! Don't worry. I'm going to tie all of this together in the end and it should give a nice picture of the etiology of PFS.

So, next, I want to talk about the association of elevated prolactin levels, hypothyroidism, and PFS. Let's start with this study:


I'm not going to say much about it, but you can read it if you'd like. The study shows "the prevalence of hypothyroidism symptoms in subclinical hypothyroidism on males and females." and "showed the higher prevalence of hyperprolactinemia in subclinical hypothyroidism in female than male, this prevalence was 21.7% and 11.3%, respectively."

I'll include this as well since it's relevant and interesting: "In hypothyroidism patients, TRH is the stimulant factor of rising prolactin level. A previous study suggested that perhaps estrogen caused to increase prolactin response to TRH that caused higher prolactin level in woman than men (22). Meier et al. reported that women before menopause or menopausal women that received estrogen had higher level of prolactin compared to menopausal women without estrogen replacement (21)."

So, the questions I have when I read this are:

- Why does prolactin seem to be elevated in hypothyroidism (and, consequently, why is it elevated in many who suffer from PFS)?
- Assuming the answer to the question above is that prolactin is released in a sort of package along with thyrotropin releasing hormone, is there any other possible reason for the increase in prolactin?

And a follow-up question to those two questions: Is elevated prolactin a side effect... collateral damage?... just a co-secretion along with TRH that needs to be controlled or lowered, or is its presence there to help address a deeper problem? I think, yes...


This is in mice, so take it for what you will. However, I believe that there is very likely the same or similar mechanism in humans.

"In earlier studies from our laboratory, we have shown that prolactin (PRL) enhances iodide accumulation by two- to threefold in cultured mammary tissues taken from pregnant mice... The lowest PRL concentration that elicited a significant response was 1 ng/ml, and a maximum effect was elicited with PRL concentrations >100 ng/ml. Actinomycin D, cycloheximide, and thiocyanate abolished the PRL effect on NIS accumulation, whereas perchlorate was without effect. These studies suggest that the PRL stimulation of iodide accumulation in milk is mediated, at least in part, by the PRL stimulation of NIS accumulation in mammary gland tissues. These studies further demonstrate that the PRL effect on NIS accumulation occurs via an RNA protein synthesis-dependent mechanism."

So, the sodium iodide symporter (NIS) is a transmembrane protein which is responsible for transporting iodide ion across the cell membrane and concentrating it within the cell. In the mice, prolactin appears to enhance NIS expression. I highlighted thiocyanate since it is a goitrogen when adequate dietary iodine seems to be lacking (just thought it was interesting). So, in a state of hypothyroidism and in PFS, whether clinically diagnosed or subclinical, hyperprolactinemia seems to be present. What are the chances that the elevated prolactin is an effort by the body to increase the expression of NIS to concentrate iodide in response to hypothyroidism? I've not found research on this yet, but I wouldn't be surprised if there's a connection. In case you're not aware of the role of iodine in extrathyroidal tissues, here's a reference:


There are many tissues, other than breast and thyroid tissue, that express NIS and accumulate iodide. The role iodide/iodine in these tissues is not yet very well understood.


Additionally, I thought I might add that TSH itself also induces expression of NIS:


"TSH stimulation of NIS mRNA and protein expression are mediated by the cAMP pathway in rodent cell lines, Fisher rat thyroid cell line (FRTL)-5 cells (Weiss et al. 1984a, Kogai et al. 1997), PC Cl3 immortalized rat thyroid cells (Trapasso et al. 1999), and human primary thyroid cells (Saito et al. 1997, Kogai et al. 2000a). The upregulation of NIS in response to TSH is at both the transcriptional and the post-translational levels. TSH stimulates the NIS promoter and NIS upstream enhancer (NUE; Endo et al. 1997, Ohmori et al. 1998, Ohno et al. 1999, Taki et al. 2002), increases the half-life of the NIS protein, and stimulates the trafficking of the NIS to the plasma membrane (Riedel et al. 2001)... Since TSH stimulates NIS expression in both human and rodent thyroid cells, the regulatory region(s) for NIS induction by TSH was expected to be in sequences common to human and rat NIS genes."


Ok, I have one more connection to make between prolactin, the androgen receptor, and signaling in the hypothalamus and the pituitary.


In this study they essentially show that ablation of the AR in rat pituitary gland "resulted in no change in circulating testosterone levels, questioning the currently accepted paradigm of testosterone-mediated feedback at the level of the pituitary."

"Further to this observation, in this study we demonstrate that circulating gonadotrophin levels are unaffected by loss of pituitary AR, suggesting androgens do not mediate negative feedback on the HPG axis at the level of the pituitary in males. Instead, we show that pituitary AR is required for repression of prolactin production and release by the male pituitary."

So, androgenic stimulation is required in the pituitary for suppression of prolactin production. Pharmaceutically-induced 5AR deficiency seems like a good way to cause hyperprolactinemia. It would be interesting to know whether people with congenital 5AR deficiency experience elevate levels of prolactin. I've not looked into this, but just a thought.

So, at the level of the pituitary, AR expression doesn't seem to matter with regard to negative regulation of gonadotropins. However, AR may play a role in negative feedback upstream of the pituitary:

"The male HPG axis paradigm is centred on testosterone providing a negative feedback repression at both the hypothalamus (GnRH production) and pituitary (LH production). Our data show no change in circulating LH or testosterone [16] levels when AR is selectively genetically ablated from the male mouse pituitary. One explanation is that AR signalling, though dispensable at the pituitary level is required at the hypothalamic level. Since GnRH-producing neurons do not express AR [35] the level of hypothalamic repression must be upstream of GnRH production, potentially at the level of kisspeptin-producing neurons, which do express AR [36]."

So, why might this matter? Because 5AR antagonists cause AR overexpression:


"Due to the lower potency of T compared with DHT, 5ARI significantly decreased the total androgen effect (18). In this study, 5ARI significantly increased AR expression, matching the mechanism of hormone-refractory disease as AR overexpression or amplification."

So, if finasteride induces androgen receptor overexpression, and if there exists a negative feedback loop somewhere upstream of hypothalamic regulation, I'm hypothesizing that it's possible that AR overexpression can cause amplified negative feedback, causing hypogonadism. This, however, is probably predicated upon the presence of 5AR expression (perhaps type 1 5AR?) in this region of the brain to help amplify AR signaling. In this regard, I'm not as confident about the connection between AR overexpression and the persistent side effects associated with PFS. If you haven't realized it yet, this is where I believe the androgen receptor antagonist RU58841 could have possibly played a role in my recovery. However, at the moment, I think this is just very unlikely and that my last recovery was due to the iodine and restoring thyroid function which then restored 5AR expression.

I'll try to briefly recap since this was a lot of information:

- 5AR deficiency is able to be reversed in cases of hypothyroidism when thyroxine is administered (in both humans and rats)
- Hypothyroidism can cause hypogonadism
- There are thyroid hormone response elements (TREs) present in the promoter regions of the genes encoding for all isoforms of 5AR, indicating that thyroid hormones play a role in the positive regulation of 5AR expression
- There are androgen response elements present in the genes that encode for thyroid receptor β and deiodinase 1, indicating that androgen signaling plays a role in positive regulation of thyroid receptors and an enzyme that catalyzes the activation of T4 to T3
- PFS appears to be a catch-22 situation where you don't have 5AR expression (and, thus, no DHT), so you can't express TH receptors properly, and you don't have sufficient thyroid hormone stimulation of tissues, so you can't express 5AR
- Hypothyroidism is associated with hyperprolactinemia
- Elevation of prolactin and TSH increases expression of sodium iodide symporter in an effort to increase concentration of iodide within the cell
- Androgen signaling in the pituitary suppresses prolactin secretion
- Finasteride causes AR overexpression

I could probably say a lot more, but I'm tired. At some point, I think it would be nice to make a flow-chart to illustrate the interdependence of these issues.
 
Last edited:

Sedonagal

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Jun 10, 2014
Messages
44
Ok... here it is. There's somewhat of a TLDR at the bottom, but I would recommend reading everything... I'm not so sure it would make much sense.


After over a decade of finasteride use and many years spent in recovery, I believe I may know what actually causes the persistent side effects of finasteride use (or PFS). I'll try to explain as clearly as possible, but first I'll start with what I did when I recovered the last time and my process of discovery.

At the time of my last recovery, I was doing quite a few things that I felt could have been responsible for what seemed almost like a spontaneous recovery. It all seemed to happen very quickly... like within the span of a couple months, with some of the most significant changes occurring inside of just a couple weeks.

So, at the time, I had been taking various supplements (namely: riboflavin, niacin, iodine, D3, B12, biotin, l-dopa, and probably a few others). More significantly, I had made some pretty major changes to my diet within only a couple months of complete recovery. So, when I finally did recover, I attributed the recovery to the dietary change because of the many positive changes that had occurred in addition to the recovery. To keep this brief, I'll just say that, eventually, I came to believe that the diet, while still a positive force in my life, was not responsible for my recovery.

So up until about 6 months ago, my list of possible things responsible for my recovery looked about like this:

- dietary changes
- use of l-dopa or high doses of niacin/riboflavin, possibly something else like licorice root that I had been using at the time
- time

I tested the l-dopa and the other stuff and while I experienced similarities with my last recovery, none of this stuff ended up being significant. The only thing left was that I had recovered from PFS because it was simply time.. enough time had passed for whatever was screwed up to reverse itself. At times, I convinced myself of this, but the problem was that only maybe 4 months prior to my recovery, I had used finasteride for maybe around a week and then decided it wasn't worth it and quit. So, while time was still a possibility, I always remained skeptical.

So, being tired of seeing little to no improvement after another 2.5 years of life wasted, I decided to try and exactly retrace every single thing I had done around the time in the exact manner I did it when I recovered... even if it was something I had already done or decided to dismiss as insignificant.

These were the items at the top of my list:

- test the use of one single dose of spironolactone @ 50 mg, which I had used only weeks before recovery
- test a particular type of iodine that I used during the last recovery but hadn't used since
- test the use of the androgen receptor antagonist RU58841 at 40mg/ml twice daily for ~3 weeks

I tested the spironolactone and pretty much nothing happened. I felt odd and a little dehydrated the night I took it and that was essentially it. I'm going to skip past the iodine to the RU58841 and say that I haven't tried this again yet, but it's still on the table because I have a good reason to believe that it could have possibly played a role in the recovery. I'll discuss this later. So, now, I'll get to the iodine. I believe this was actually responsible for the recovery and I'll discuss what has led me to believe this and why I overlooked it for so long to begin with.

During the last recovery, I had been taking iodine very religiously every day along with a bunch of other cofactors which included vitamin C, selenium, riboflavin, and niacin, while also ensuring adequate iron intake. I never felt immediate improvement of anything, nor did I experience a gradual, building improvement of anything. My recovery happened very quickly and suddenly and, because of this, iodine just wasn't on my radar.

So, fast forward to around 6-8 months ago, I began taking high amounts of "nascent" iodine, which, honestly, is probably just sodium or potassium iodide dissolved in glycerin... I really don't know wtf it is because I can't seem to find a straight answer other than the equivalent of "magic" or magnetic charge or some obfuscated pseudoscience. So, I took relatively high amounts for around 2 months... I think I took around 30 drops daily which is the equivalent of around 15 mg. I'm no stranger to this amount of iodine. I've taken higher amounts using 5% lugol's. In fact, probably only a few months prior, I had been taking lugol's. After a month to 2 months of taking the "nascent" iodine, I noticed that I began growing hair on previously barren spots on my hands. At this point, I realized that 5-6 months prior, when I was taking the lugol's iodine, I also grew this hair on my hands. The problem was that I never attributed the hair growth to the iodine and, even worse, 2 months after I quit using lugol's, the hair on my hands fell out again and I still hadn't realized the connection. It wasn't until I tried the experiment with the stupid nascent iodine and saw the hair growth inside of 1.5 months that I finally made the connection. Not coincidentally, I also experienced this increase in hair growth on my hands (and body hair, in general) during my last recovery.

Ok, so at this point, anyone reading this is probably thinking THYROID.. and yes, obviously, that's where this leads, but there's a little more to it and I believe this is important because it offers insight into what PFS might actually be and what causes it. I want to go back in time to when I first began taking finasteride. Over a decade ago, I took the typical 1 mg daily finasteride and it worked incredibly well, but also caused the horrible side effects. At that time, when I quit taking finasteride, it only took maybe 3-4 weeks for my body to make a full recovery and go back to normal. As I continued toying with finasteride over the years to discover what made it work and why it would stop working after only a few weeks to a month or two of use, the time it took to recover from finasteride after discontinuation gradually increased. Eventually it started taking 3-4 months and then seemingly 3-4 years based on the last recovery.

So, I thought that finasteride must be causing some type of long-term damage or epigenetic changes that cause the recovery time to perpetually increase with each subsequent use. What I hadn't considered, however, was that perhaps there was some underlying condition or genetic susceptibility that finasteride will exacerbate, but of which it isn't necessarily the cause. I've had hypothyroid-like symptoms since childhood, but I've never been diagnosed with hypothyroidism because my labwork has never indicated clinical hypothyroidism. I don't really have any thyroid labwork from a time prior to finasteride use, but anyone here that looked at my labwork done during PFS would assume hypothyroidism based off the TSH values. T4 and T3 levels seemed normal and within "range", but ranges don't really mean much to me anymore because the range that's right is what feels good.... not where the average of the population rests.

Anyway I started traversing the clinical and scientific literature for associations between thyroid and 5a reductase, as well as various other things like androgen receptor and 5AR antagonist, androgen receptor and thyroid, thyroid and prolactin, thyroid and gonadotropin releasing hormone.... and many other searches like this. I was trying to piece together a narrative that I was building in my head.. trying to tie all the things I already knew to what I had recently learned about the significance of iodine in my recovery.

At this point, I'm just going to start citing some of the studies and research I read and what I was thinking as I was reading them and what they subsequently led to. So, the first one I have is "Reversible 5α-reductase 2 deficiency in Hypothyroidism":


So, this essentially outlines a few case studies of "severe primary acquired auto-immune hypothyroidism, which show a similar picture of 5α-reductase deficiency". My first thoughts were that there seems to be a sort of "chicken and egg" situation... did the 5AR deficiency cause the hypothyroidism or the other way around? Or is there perhaps some sort of interdependence where either one could cause the other? Either way, they demonstrated that the type 2 5AR (SRD5A2) deficiency was completely reversible following administration of adequate thyroxine. So, great... I've found an association between 5AR deficiency and hypothyroidism. So, now, I know that anyone taking finasteride (or any other potent 5AR antagonist) could be inducing hypothyroidism. But then the question becomes "Well, if finasteride can induce hypothyroidism, then shouldn't that work itself out after discontinuation of fin?". And the answer, at least for most people that don't experience PFS, is probably yes. So, what about those who experience PFS? One thing I think is important to do when dealing with these chicken and egg situations is ask if the relationship between, for example, 5AR and hypothyroidism has any reflexivity in their associations. So, we know that hypothyroidism seems to be able to induce deficiency of SRD5A2 expression, but is it also possible that pharmaceutically induced 5AR deficiency can cause hypothyroidism which can then prevent return of normal 5AR expression?


Here's another study done on rats that seems to corroborate the previously mentioned 3 case studies:

(in case above link doesn't work: www(dot) jbc.org/article/S0021-9258(17)30647-6/pdf )

"Although GH has been shown to exert a positive, stimulatory effect on hepatic 5α-reductase activity when present continuously (Mode et al., 1982), the inability to support full enzyme expression in hypophysectomized rats (Waxman et al., 1989a and this study) led to the proposal that the effects of GH may require mediation by or interaction with other pituitary-dependent factors. The present study validates this hypothesis and establishes that T4, wihch is dependent on pituitary thyroid-stimuating hormone for secretion by the thyroid, can significantly restore hepatic 5α-reductase activity and its mRNA, both in hypophysectomized rats and hypothyroid rats."


Here's an excellent article that reviews the current state of research on the 5α-reductases and their physiological importance:


Of particular interest in this article is section 4.4 Thyroid hormones and androgens crosstalk. Read the whole section, but I'll point out what I find most significant.

They state: "hypothyroidism can decrease androgens, LH, and gonadotropin-releasing hormone levels, (rat: Chiao et al., 1999; Kala et al., 2002; bird: Weng et al., 2007; fish: Swapna et al., 2006), impair testicular development (rat: Wagner et al., 2008; Maran, 2009), induce atrophy of epididymis and seminiferous tubules, decrease sperm number and motility (rat: Anbalagan et al., 2010; bird: Weng et al., 2007; fish: Swapna et al., 2006), and can even lead to a female biased sex ratio (frog: Goleman et al., 2002; fish: Mukhi et al., 2007)".

Much of this is part of the manifestation of PFS, obviously. What I found more interesting, though is that 5AR expression appears to be regulated by a thyroid hormone response element (TRE) which is found within the promoter region of every 5AR isoform:

"This cross-regulation of SRD5αs by TH can be explained by predicted thyroid hormone response element (TRE) in the promoter of each SRD5α isoforms (Flood et al., 2013). However, the functionality of those TREs still remains to be tested to ascertain their direct role in the regulation of SRD5αs."

So, that question I asked earlier about reflexivity... hypothyroidism seems to be able to induce 5AR deficiency (as shown in the case studies as well as the apparent connection between 5AR expression and TREs in the genes encoding for each 5AR isoform), but is there a connection between pharmaceutically-induced 5AR deficiency and hypothyroidism? There appears to be:

"another important aspect in TH regulation is the existing crosstalk with androgens due to the presence of ARE in genes related to THs, such as deiodinases and TH receptors (reviewed by Flood et al., 2013). Indeed, 5α-DHT treatment increases transcription of thyroid receptor β and deiodinase 1 (Campbell and Langois et al., 2018), and FIN treatment impacts expression of TH-related genes such as deiodinase and TH receptors in S. tropicalis (Langois et al., 2010b; Langois et al., 2011)."

So, there are androgen response elements within the genes encoding for deiodinases and thyroid hormone receptors and DHT treatment increases transcription of thyroid receptor β and deiodinase 1. Moreover, treatment of finasteride impacts the expression of these genes. So, what I'm seeing here is not only a classical picture of hypothyroidism (where only thyroid hormones are insufficient), but potentially hypothyroidism on the receptor side. With pharmaceutically-induced 5AR deficiency, low synthesis of DHT can cause an under-expression of the genes for deiodinase 1 (which plays a direct role in deiodinating T4 to the active T3) and for thyroid receptor β. So, if hypothyroidism isn't being induced by lack of thyroid hormones (perhaps you may be supplementing THs?), it can also be induced by lack of thyroid hormone receptor β expression. That hypothyroidism can then cause a sort of catch-22 situation where you don't have 5AR expression (and, thus, no DHT), so you can't express TH receptors properly, and you don't have sufficient thyroid hormone stimulation of tissues, so you can't express 5AR. This is the essence of post-finasteride syndrome in my opinion.

Consequently, anyone who also happens to have a perpetually worsening thyroid condition seems to be far more likely to experience PFS. This, perhaps, explains why some people seem to be profoundly affected long-term by 5AR antagonists and others seem to bounce back just fine after discontinuation. It also explains why, with each subsequent use of finasteride, it took longer for me to recover... because I likely have a perpetually worsening thyroid condition.

BUT WAIT! THERE'S MORE! Don't worry. I'm going to tie all of this together in the end and it should give a nice picture of the etiology of PFS.

So, next, I want to talk about the association of elevated prolactin levels, hypothyroidism, and PFS. Let's start with this study:


I'm not going to say much about it, but you can read it if you'd like. The study shows "the prevalence of hypothyroidism symptoms in subclinical hypothyroidism on males and females." and "showed the higher prevalence of hyperprolactinemia in subclinical hypothyroidism in female than male, this prevalence was 21.7% and 11.3%, respectively."

I'll include this as well since it's relevant and interesting: "In hypothyroidism patients, TRH is the stimulant factor of rising prolactin level. A previous study suggested that perhaps estrogen caused to increase prolactin response to TRH that caused higher prolactin level in woman than men (22). Meier et al. reported that women before menopause or menopausal women that received estrogen had higher level of prolactin compared to menopausal women without estrogen replacement (21)."

So, the questions I have when I read this are:

- Why does prolactin seem to be elevated in hypothyroidism (and, consequently, why is it elevated in many who suffer from PFS)?
- Assuming the answer to the question above is that prolactin is released in a sort of package along with thyrotropin releasing hormone, is there any other possible reason for the increase in prolactin?

And a follow-up question to those two questions: Is elevated prolactin a side effect... collateral damage?... just a co-secretion along with TRH that needs to be controlled or lowered, or is its presence there to help address a deeper problem? I think, yes...


This is in mice, so take it for what you will. However, I believe that there is very likely the same or similar mechanism in humans.

"In earlier studies from our laboratory, we have shown that prolactin (PRL) enhances iodide accumulation by two- to threefold in cultured mammary tissues taken from pregnant mice... The lowest PRL concentration that elicited a significant response was 1 ng/ml, and a maximum effect was elicited with PRL concentrations >100 ng/ml. Actinomycin D, cycloheximide, and thiocyanate abolished the PRL effect on NIS accumulation, whereas perchlorate was without effect. These studies suggest that the PRL stimulation of iodide accumulation in milk is mediated, at least in part, by the PRL stimulation of NIS accumulation in mammary gland tissues. These studies further demonstrate that the PRL effect on NIS accumulation occurs via an RNA protein synthesis-dependent mechanism."

So, the sodium iodide symporter (NIS) is a transmembrane protein which is responsible for transporting iodide ion across the cell membrane and concentrating it within the cell. In the mice, prolactin appears to enhance NIS expression. I highlighted thiocyanate since it is a goitrogen when adequate dietary iodine seems to be lacking (just thought it was interesting). So, in a state of hypothyroidism and in PFS, whether clinically diagnosed or subclinical, hyperprolactinemia seems to be present. What are the chances that the elevated prolactin is an effort by the body to increase the expression of NIS to concentrate iodide in response to hypothyroidism? I've not found research on this yet, but I wouldn't be surprised if there's a connection. In case you're not aware of the role of iodine in extrathyroidal tissues, here's a reference:


There are many tissues, other than breast and thyroid tissue, that express NIS and accumulate iodide. The role iodide/iodine in these tissues is not yet very well understood.


Additionally, I thought I might add that TSH itself also induces expression of NIS:


"TSH stimulation of NIS mRNA and protein expression are mediated by the cAMP pathway in rodent cell lines, Fisher rat thyroid cell line (FRTL)-5 cells (Weiss et al. 1984a, Kogai et al. 1997), PC Cl3 immortalized rat thyroid cells (Trapasso et al. 1999), and human primary thyroid cells (Saito et al. 1997, Kogai et al. 2000a). The upregulation of NIS in response to TSH is at both the transcriptional and the post-translational levels. TSH stimulates the NIS promoter and NIS upstream enhancer (NUE; Endo et al. 1997, Ohmori et al. 1998, Ohno et al. 1999, Taki et al. 2002), increases the half-life of the NIS protein, and stimulates the trafficking of the NIS to the plasma membrane (Riedel et al. 2001)... Since TSH stimulates NIS expression in both human and rodent thyroid cells, the regulatory region(s) for NIS induction by TSH was expected to be in sequences common to human and rat NIS genes."


Ok, I have one more connection to make between prolactin, the androgen receptor, and signaling in the hypothalamus and the pituitary.


In this study they essentially show that ablation of the AR in rat pituitary gland "resulted in no change in circulating testosterone levels, questioning the currently accepted paradigm of testosterone-mediated feedback at the level of the pituitary."

"Further to this observation, in this study we demonstrate that circulating gonadotrophin levels are unaffected by loss of pituitary AR, suggesting androgens do not mediate negative feedback on the HPG axis at the level of the pituitary in males. Instead, we show that pituitary AR is required for repression of prolactin production and release by the male pituitary."

So, androgenic stimulation is required in the pituitary for suppression of prolactin production. Pharmaceutically-induced 5AR deficiency seems like a good way to cause hyperprolactinemia. It would be interesting to know whether people with congenital 5AR deficiency experience elevate levels of prolactin. I've not looked into this, but just a thought.

So, at the level of the pituitary, AR expression doesn't seem to matter with regard to negative regulation of gonadotropins. However, AR may play a role in negative feedback upstream of the pituitary:

"The male HPG axis paradigm is centred on testosterone providing a negative feedback repression at both the hypothalamus (GnRH production) and pituitary (LH production). Our data show no change in circulating LH or testosterone [16] levels when AR is selectively genetically ablated from the male mouse pituitary. One explanation is that AR signalling, though dispensable at the pituitary level is required at the hypothalamic level. Since GnRH-producing neurons do not express AR [35] the level of hypothalamic repression must be upstream of GnRH production, potentially at the level of kisspeptin-producing neurons, which do express AR [36]."

So, why might this matter? Because 5AR antagonists cause AR overexpression:


"Due to the lower potency of T compared with DHT, 5ARI significantly decreased the total androgen effect (18). In this study, 5ARI significantly increased AR expression, matching the mechanism of hormone-refractory disease as AR overexpression or amplification."

So, if finasteride induces androgen receptor overexpression, and if there exists a negative feedback loop somewhere upstream of hypothalamic regulation, I'm hypothesizing that it's possible that AR overexpression can cause amplified negative feedback, causing hypogonadism. This, however, is probably predicated upon the presence of 5AR expression (perhaps type 1 5AR?) in this region of the brain to help amplify AR signaling. In this regard, I'm not as confident about the connection between AR overexpression and the persistent side effects associated with PFS. If you haven't realized it yet, this is where I believe the androgen receptor antagonist RU58841 could have possibly played a role in my recovery. However, at the moment, I think this is just very unlikely and that my last recovery was due to the iodine and restoring thyroid function which then restored 5AR expression.

I'll try to briefly recap since this was a lot of information:

- 5AR deficiency is able to be reversed in cases of hypothyroidism when thyroxine is administered (in both humans and rats)
- Hypothyroidism can cause hypogonadism
- There are thyroid hormone response elements (TREs) present in the promoter regions of the genes encoding for all isoforms of 5AR, indicating that thyroid hormones play a role in the positive regulation of 5AR expression
- There are androgen response elements present in the genes that encode for thyroid receptor β and deiodinase 1, indicating that androgen signaling plays a role in positive regulation of thyroid receptors and an enzyme that catalyzes the activation of T4 to T3
- PFS appears to be a catch-22 situation where you don't have 5AR expression (and, thus, no DHT), so you can't express TH receptors properly, and you don't have sufficient thyroid hormone stimulation of tissues, so you can't express 5AR
- Hypothyroidism is associated with hyperprolactinemia
- Elevation of prolactin and TSH increases expression of sodium iodide symporter in an effort to increase concentration of iodide within the cell
- Androgen signaling in the pituitary suppresses prolactin secretion
- Finasteride causes AR overexpression

I could probably say a lot more, but I'm tired. At some point, I think it would be nice to make a flow-chart to illustrate the interdependence of these issues.
I rarely post and mostly lurk and have for years. But I can’t let this post go without saying how brilliant it is. Masterfully researched with logical, far-reaching thought processes and inquiry.
I myself have done a lot of research and study in my life over health issues and have been able to solve a lot of problems. While I have some medical background and do dig deep in studies, I don’t think I could ever get to the level of this and be able to understand it as you seem to.
 

Jayvee

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Thank you chemhead. Your post and the time and effort gone into this is massively appreciated. I think this deserves it's own thread. It certainly is one of the best theories I have come across, nicely tied up a lot of loose ends left out of other theories. It all matches with my experiences and the success stories I have read.
 

Mister

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@ChemHead Thank you friend, I'll link it in the other big thread.

Please keep us up to date when you recover again.

Btw your androgen receptor overexpression theory is also the basis of a famous recovery of PAL with high dose proviron:


"My take on PFS is that the receptors become hyper sensitive due to getting so little DHT for a long period of time. So when things compensate or go back to normal, they are too sensitive and you end up in a miserable state.

I decided to test that by supplementing DHT (proviron) and despite it being a general feel-good hormone for most, I felt absolutely dreadful when taking it. My symptoms increased by 10x and I couldn’t function but it made me realize I was on to something. I felt like my options were either to permanently decrease DHT in some way or decrease the sensitivity of the receptors.

The receptors likely became hyper sensitive by getting so little DHT for a prolonged period of time while taking finasteride. So I tried the opposite to reverse the situation. I took a large amount of DHT (proviron) for 7 weeks at 200 mg per day to reduce receptor sensitivity to DHT.

At first, I felt absolutely miserable when doing so, it is the worst I’ve felt in my life and I was unable to do almost anything but after some weeks it became more tolerable as the receptors lost some of their sensitivity.

After stopping 7 weeks later (when I ran out of my proviron), things felt off for a few weeks but then after around two months I got back to my pre-PFS state. Now and for the past six months, I feel great, my libido is great, mental issues are gone, ED is gone. This after having PFS constantly for 11 years. My life is finally back."
 
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ChemHead

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@ChemHead Thank you friend, I'll link it in the other big thread.

Please keep us up to date when you recover again.

Btw your androgen receptor overexpression theory is also the basis of a famous recovery of PAL with high dose proviron:


"My take on PFS is that the receptors become hyper sensitive due to getting so little DHT for a long period of time. So when things compensate or go back to normal, they are too sensitive and you end up in a miserable state.

I decided to test that by supplementing DHT (proviron) and despite it being a general feel-good hormone for most, I felt absolutely dreadful when taking it. My symptoms increased by 10x and I couldn’t function but it made me realize I was on to something. I felt like my options were either to permanently decrease DHT in some way or decrease the sensitivity of the receptors.

The receptors likely became hyper sensitive by getting so little DHT for a prolonged period of time while taking finasteride. So I tried the opposite to reverse the situation. I took a large amount of DHT (proviron) for 7 weeks at 200 mg per day to reduce receptor sensitivity to DHT.

At first, I felt absolutely miserable when doing so, it is the worst I’ve felt in my life and I was unable to do almost anything but after some weeks it became more tolerable as the receptors lost some of their sensitivity.

After stopping 7 weeks later (when I ran out of my proviron), things felt off for a few weeks but then after around two months I got back to my pre-PFS state. Now and for the past six months, I feel great, my libido is great, mental issues are gone, ED is gone. This after having PFS constantly for 11 years. My life is finally back."
Yeah. If what I'm currently doing doesn't work out in the next month or so, I'll be going down this path. My reasoning is that if fin causes androgen receptor overexpression, then could the inverse be true? Is it possible that an AR antagonist might increase 5AR expression? I suppose it would also be worth supplementing DHT. I've used DHT multiple times over the past few years, but not anywhere near 200 mg daily. Anyway, there might be something there. I kind of feel like there almost has to be a perfect storm of conditions to get return of 5AR expression and proper androgen signaling.
 

ChemHead

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@Mister

After reading the story you linked, it makes sense. A couple things that I think might deserve a little clarity:

The reason he felt like trash while taking the DHT is not because the DHT itself made him feel that way. It's because it probably suppressed gonadotropin secretion more than it already was and he was essentially deficient in nearly every steroid in the body and running on DHT. So, imagine being deficient in progesterone, pregnenolone, androgens and everything that comes forth from those like estrogens glucocorticoids, mineralocorticoids. Your adrenal glands will try to pick up the slack, but there's only so much they can do.

This also probably explains why some people end up fixing PFS with some variation of an hCG protocol. I would imagine that a good strategy might be to use the high amount of DHT, but also use gonadotropins like hCG and hMG (or even gonadotropin releasing hormone/gonadorelin) alongside to avoid the horrible experience of being steroid deficient.
 

Jayvee

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I think exactly this. As Joekool pointed out with his HCG protocol it hits a lot of the downstream hormones and helps then to recalibrate. I've seen multiple people recover from similar strategies including the high dose DHT. I have Stanolone DHT and respond really well to it. I cant afford to feel like crap for a few weeks but I might consider it and try some high doses. I wonder if Stanolone might be better than proviron. I went up to 10mg with it before and had a snapback reaction to it as described in the PAL post. Maybe lots of them might be safer/better than a super physiological dose.
 

milkboi

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I'll start taking Finestaride soon along with Pregnenolone, 150 mg of Testosterone a week and some Progesterone to hopefully avoid completely crashing my neurosteroids. A full head of hair is very important to me. The Peat strategies against hair loss don't have a good track record at all
 

Jayvee

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And Finasteride does have a good track record? Not to be a **** but that doesnt make sense. What do you think the cause of hairloss is? DHT? If so then, you want to block 5ar and take testosterone? I cant see that playing out well.
 

Jayvee

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I beg you not to take finasteride. Please dont even consider it. Hair was super important to me, I had a super high stamina, libido, energy and drive and arrogantly assumed it wouldn't happen to me, it's been 6 years of hell for me. I literally pray to be bald and have my life back. It should be banned. The symptoms don't gently come on and give you time to reassess it just hits you like a ton of bricks and your body switches state.
 

Mister

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I beg you not to take finasteride. Please dont even consider it. Hair was super important to me, I had a super high stamina, libido, energy and drive and arrogantly assumed it wouldn't happen to me, it's been 6 years of hell for me. I literally pray to be bald and have my life back. It should be banned. The symptoms don't gently come on and give you time to reassess it just hits you like a ton of bricks and your body switches state.
Amen + we have alternatives to fight hairloss, taking finasteride is playing russian roullete with almost all chambers filled with bullets.
 

milkboi

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Amen + we have alternatives to fight hairloss, taking finasteride is playing russian roullete with almost all chambers filled with bullets.
What good alternative do we have? Minoxidil (or any other growth stimulator) alone wont stop balding
 
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