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.
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.