Why Aren’t DHT Treatments Working for Some Men?

Drs. Rassman and Pak,

I’m a 23 year old man with fairly extensive loss. I was on 1mg Finasteride for over two years with no success (I know, of course, it’s impossible to tell how quickly my loss may have progressed had I not been on the drug, but the rate of loss while on the drug was certainly no slower than it had been prior to beginning the medication.) Finally giving up, I relucantly sought, and obtained, a Dutasteride prescription, and have been on 0.5mg for some considerable time now, again with little to no discernible success. Not least thanks to warnings issued on this blog, I’ve finally woken up to the fact that my health is more important than my hair, and that, especially given its apparent ineffectiveness in my case, Dutasteride is not worth the risks. I’m about to stop the drug and let nature take its course.

As someone who has had little to no benefit from two treatments widely known to be effective in most patients, my question is this: do you or any of your colleagues in the field have any thoughts on why the two major oral DHT blockers aren’t effective in some men? Is it simply that in some men they somehow fail to block the DHT, or is it rather that some men have so much DHT that the drugs, though they may reduce it by a massive amount, still leave sufficient DHT to impact upon the hair. (I wonder if this scenario might be true of young men with aggressive balding patterns, like myself?) Or, alternately, is the fact that DHT inhibitors aren’t always effective in treating androgenic alopecia evidence to suggest that there are factors other than DHT at play in the hair loss game?

Just a theoretical brainteaser really, but I’d be interested to hear your thoughts. Lastly, you have my thanks: whilst it’s unfortunate that, at my age, my ‘baldness journey’ ends with sanguine acceptance that for me there is no realistic ‘fix’ for my hair, and that therefore I’m to be a bald man pretty soon, the calm, well-informed and often witty advice you continue to offer here has over the years helped me greatly in coming to terms with my situation.

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Read through the HairDX Test for Finasteride Response site and you will see some reflections on why some men do not respond to finasteride. Minoxidil is still another story.

You need to establish a good doctor-patient relationship and get the opinions of a good doctor who might help you. Sometimes, it just is what it is. I know it sounds cliche, but I don’t have all the answers and drugs do not solve all problems. Life isn’t that simple.

Tags: hairloss, hair loss, finasteride, dht

9 thoughts on “Why Aren’t DHT Treatments Working for Some Men?

  1. This is one of the most intelligent, articulate and well-stated posts on this board.

    It’s not DHT that’s the problem but the genetically-determined sensitivity of certain hair follicle to DHT that causes their loss- with huge variation in how that manifests itself throughout a person’s life.

    This is one of the most tragic of cases- a 23 year old moving toward a NH 6 or 7 pattern by age 30. I certainly wish the writer all the best.

  2. Sorry bro I can imagine how frustrating it can be but when you said you are a 23yo with extensive hair loss well that can just answer your question to why dht treatments may not work for you! You seem to be one of those unfortunate guys who lose their hair extremely fast and go bald in a few years! DHT treatments can’t just keep up with those type of men! Your genes are just too damn strong! I gotta a friend who’s 32 now he’s nearly a NW6 and he too started losing hair in his early 20s and it all disappeared in a few years but then again all the men in his family from his dad’s side suffered the same thing! It was bound to happen.

  3. I meant to say medical down-regulators and accidentally said genetic. Also, I meant to say “propionate-like” or “fluridil-like” molecules which are AR antagonists…figure out which one you might want to try. Get to know a chemistry departments and run tests if you want to verify identity of medicine. Sometimes you have to pull a “Lorenzo’s Oil” if you want to stop a disease. If you don’t want to go experimental, removing genes so they cannot be expressed or Surgery:hair cloning/FUE is the only other way to “cure” the hair loss really. In the meantime for your self-esteem it is important to understand that the constant use of hair loss medicines (even if you think they are not working) is vital. Hair loss will certainly get worse. Nothing about treating hair loss is easy – it is a truly horrific thing. Many people kill themselves over it every single day (and I’m sure if they did not have the hair loss they’d still be alive). But, there are absolutely things that can be done to fight androgenetic alopecia hard (many experimental topicals are out there which are pleasing to use) and possibly give ~90% improvement/remission (but that would require constant use of medical AR-downregulators with oral finasteride and growth factors). If you want NW1, current FUE surgery could only be used in a small area to provide you with the density you’d need to satisfy current aesthetic requirements. This should illustrate the importance of getting the hair loss under medical control now. Otherwise you truly will have to wait for hair cloning, which is a very political process and may not be affordable for many years.

  4. These are some of the most well thought out answers I’ve seen posted on here.

    Some people can have DHT ravaging in their system, but no hair loss because their follicles aren’t sensitive to it. Some people can have just a touch of DHT and go bald within a few years.

    I’ve also noticed the acne relationship. Acne is a result of DHT in men. I had acne as a teenager, and lost hair. Almost everyone I went to school with who had acne now has noticeable or worse hair loss.

  5. acne has nothing to do with male pattern baldness. I know many people who had acne and even severe forms and have full heads of thick hair, and I have also seen young people balding with perfect clear skin

  6. When I finally beat acne too at the age of 20 with accutane after suffering from it since i was like 11, then at almost 22 I saw early MPB! It’s really unfair. But I don’t think that having acne as a teen has any relation to MPB! Although DHT is the culprit in both but I know plenty of men who had severe acne as a teen you can see a lot of poke marks on their faces but they have full heads of hair and then there are men who never had acne at all and have bad hair loss, it’s really all up to your genes!

  7. If hair loss starts soon after Accutane, it might be Accutane-related. Vitamin A level builds during usage and can remain elevated for a long time.

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