Understanding Finasteride Dosing | The Hair Loss Show

Summary

In this episode of The Hair Loss Show, Dr. Russell Nudson and Dr. Vicam J. Aach dive into the topic of finasteride dosing for hair loss treatment. They emphasize the importance of customized dosing, explaining that a one-size-fits-all approach doesn't work for everyone. The doctors discuss the benefits of lower doses, potential side effects, and the importance of patience, as results may take six months or more. They also talk about the differences in treatment for various patients based on their age and degree of hair loss, advocating for a balanced approach to maximize effectiveness while minimizing side effects.

Takeaways

• 😀 Customized dosing of finasteride is emphasized over a one-size-fits-all approach, with a focus on tailoring the dosage to individual needs.
• 😀 The standard dose of 1 mg is often effective, but lower doses such as 0.5 mg can be just as effective with fewer side effects.
• 😀 Higher doses of finasteride (above 1 mg daily) offer diminishing returns in terms of effectiveness, and the dose-response curve flattens at around 0.8 mg.
• 😀 Finasteride has a long half-life in the skin (30 days), allowing lower doses to accumulate and still provide effective results over time.
• 😀 Some patients may experience side effects early, which often resolve quickly with reduced doses, while others may develop side effects after months of use due to medication buildup in the system.
• 😀 A dose higher than 7 mg per week is considered unnecessary, as it does not significantly improve results but may increase the risk of side effects.
• 😀 Patients should not assume that increasing the dose beyond the recommended level will lead to better results, as once the effective dose is reached, more does not equal better.
• 😀 A balanced approach to medication, with a combination of enzyme blockers and stimulants, is preferred to avoid overcomplicating the treatment plan.
• 😀 For those with early signs of hair loss, a low dose of finasteride may be sufficient, and additional treatments like dermarolling or PRP can be considered but are harder to assess effectively in combination.
• 😀 Stability is key in assessing the effectiveness of hair loss treatments. It often takes at least 6 months to determine if a treatment is working and to distinguish between shedding and actual hair loss.
• 😀 The treatment approach should be tailored to the patient's age and degree of hair loss, with more aggressive treatments for younger patients and those with extensive hair loss, while older patients may benefit from a more conservative approach.

Q & A

What is the primary focus of this discussion on hair loss treatment?

The primary focus is on the dosing of finasteride, a medication used to treat hair loss. The discussion emphasizes the importance of customized dosing and how it can be tailored to individual patients to achieve optimal results while minimizing side effects.

Why do Dr. Nudson and Dr. Aash prefer lower doses of finasteride?

Dr. Nudson and Dr. Aash prefer lower doses, such as 0.5 mg or 1 mg every other day, because research shows that the effectiveness of finasteride levels off around 0.8 mg. Higher doses do not result in additional benefits but may increase the risk of side effects.

What is the concept of 'microdosing' as mentioned in the video?

'Microdosing' refers to using lower doses of finasteride, such as 0.5 mg daily or 1 mg every second day. This approach is based on the idea that lower doses can effectively block the enzyme responsible for hair loss while reducing the likelihood of side effects.

What does the 'dose response curve' indicate in this context?

The 'dose response curve' shows the relationship between the dose of finasteride and its effectiveness. It demonstrates that increasing the dose provides a significant benefit up to about 0.5 mg, but beyond 0.8 mg, the curve flattens, meaning higher doses don’t increase the drug's effectiveness.

What is the significance of the half-life of finasteride in the body?

Finasteride has a long half-life in the skin, lasting up to 30 days. This means that even with lower doses, the medication can have a prolonged effect, which is one reason why lower doses are still effective in the long term.

What are the two main types of patient responses to finasteride mentioned in the video?

The two main types of responses are: (1) patients who experience side effects early (within the first few weeks), which usually resolve with a reduced dose, and (2) patients who experience side effects after 6 to 18 months due to the cumulative effect of the medication, which can take months to recover from.

What is the maximum dose of finasteride recommended by Dr. Nudson?

Dr. Nudson recommends not exceeding 7 mg of finasteride per week, which is roughly equivalent to taking 1 mg per day. Higher doses, such as 9 mg per week, are considered wasteful as they do not provide additional benefits.

How do Dr. Nudson and Dr. Aash approach patients who are fearful of side effects?

They start with a low dose to reassure the patient that the medication is safe and effective. Once the patient is comfortable and does not experience side effects, the dose can be gradually increased based on their response.

Why is stability considered a key factor in the success of hair loss treatment?

Stability is important because even if a patient doesn't see immediate improvements, maintaining the same level of hair density or preventing further loss is considered a successful outcome. Improvements are typically observed after 6 to 12 months of treatment.

How do Dr. Nudson and Dr. Aash differentiate between shedding and hair loss in patients?

They differentiate by measuring the height of the hairline and examining the hair shafts using a video microscope. They also ask patients about their shedding—whether it involves long, dark hairs (which are healthy) or short, wispy hairs (which may indicate hair loss).