I am an overweight (6’2", 300lbs) 40 year old male who has struggled with low testosterone since I was 30. Tried TRT at 32 and quit. I started again 5 months ago and have committed to it as a lifestyle.
I am taking 100 mg/week (.25 ml 2x/week) test cyp which puts me around 900-1000 test, but free test has been as high as 30 on this dose, which I now understand may be driving elevated DHT. I’m feeling great at this dosage, but my doctor is obviously concerned about free test at 30.
On the negative side, I’ve noticed my already thinning hair accelerating (e.g. I see hair in my hand when washing) and I’m getting a LOT more hair on my body. I now understand this is a side effect of increased DHT.
Wife is strongly against shaving, so I agreed to give pharma a shot here. Went to my Dermatologist and she prescribed .5 mg Dutasteride every day. She indicated it could actually increase testosterone up to 15% (I’ll need to watch bloodwork and adjust dose as needed) and may reduce libido (she said about 1% of men experience this). Online reports seem to indicate a much higher incidence of ED, but I also understand people who don’t experience the side effects aren’t making posts about it.
She prescribed the capsules because I’m applying a cream to deal with folliculitis (predates TRT) and she didn’t want two creams.
I have questions and concerns I was hoping to get input on from those with experience and knowledge.
TLDR:
40 Y/O male
overweight with pre-TRT test levels @ <200
100 mg test cyp per week (.25ml 2x per week)
Increasing male pattern baldness after starting TRT 5 months ago
Dermatologist prescribed Dutasteride .5 mg pill every day.
I’ve read all the topics on this forum, reddit, and YouTube (e.g. more plates more dates, hair loss network) related to Dutasteride while on TRT and there seems to be wildly different experiences. My questions are:
Are there better alternatives to Dutasteride in the context of being on TRT?
Dutasteride seems to nuke all DHT. Is this a good thing? Are there negative side effects to no/low DHT?
Any thoughts on whether Dutasteride will affect free test? I.e. if I’m already experiencing high free test (25-30) will Dutasteride raise/lower or have no effect?
Any studies on the side effects associated with capsules vs topical? She prescribed capsules because I’ll be using an antibiotic cream for a few weeks, but I can wait to start Dutasteride if it matters.
Any other questions I should be asking or something I should be worried about?
Rogain combined with a DHT inhibitor are your only proven options
No its not. DHT is a powerful male sex hormone. I elected to stop taking Finasteride years ago as my hair was not worth crippling my hormones.
It may increase it. Your dose is likely a little too high if its indeed 200mg per week. The way you wrote it makes no sense as you are certainly not taking 25ml.
Topical may not affect blood stream levels as strong as orals.
I doubt you will get a 15% increase while being on TRT. Natural guys get a bigger increase because they’re system ups production of Testosterone, because it now sees less androgens in the system. You may see FT go up because less of the FT is mostly stopped from converting to DHT. You may see E2 increase as well, since there is more FT available to convert.
I am skeptical about only 1% having reduced libido or ED. It is likely higher than that, but studies indicate it is less than 10%.
If you are one of those guys that get sexual sides, you can wait it out (many only have them for a few weeks, then return to normal), or stop taking it, and get back to normal in a few weeks. For those that claim it messed them up indefinitely, the studies don’t indicate that happening (and there are quite a lot of studies on 5 AR inhibition). IMO, it was almost certainly another cause of their sexual issues (sometimes it just happens as we age), which is why stopping the drug didn’t cure them. There are a few examples in studies where individuals claimed on going sexual issues, but the numbers were also equally represented in the placebo group (my takeaway is that something else caused the issue, or it was placebo effect).
There isn’t much risk in trying it out, but potentially a good reward. I use finasteride. I did have increased libido for a bit on it, which was not something I wanted.
What does your hair actually look like? It may be worth it, but if it is mostly gone, I wouldn’t bother. No sense in maintaining a NW6 IMO.
Makes sense to me. I started Finasteride when I had the first signs of thinning at the crown while on testosterone. I still use it, and have added in 2.5 mg of oral minoxidil (active ingredient in Rogain). You could ask your dermatologist about using that if you’re interested (can’t get it over the counter). I didn’t want to use a topical everyday, and the oral version is more effective, so I went with it.
Minoxidil is better at regaining lost hair than finasteride or dutasteride. Both of those are quite effective at maintaining what you have, but if you want to thicken it up, and add a bit of prevention to your current hair, minoxidil is the ticket.
It is a bit odd that she put you straight on the stronger drug (dutasteride) to me. Most seem to do fine with the weaker finasteride which lowers serum DHT by roughly 70% compared to ~90% with dutasteride. A study showed that about 2/3rds of guys had maintained baseline hair after 10 years on finasteride.
I doubt you will have issues while being on TRT with good levels of TT and FT. Most seem to do fine without much DHT if TT and FT are at a good level.
Anyways kinda a hair rant from me. I’ve looked into this stuff as my hair is important to me. I am probably going overkill with what I am doing, but it is peace of mind for me.