Why finasteride stops hair loss forever

Summary

The video script discusses the efficacy of finasteride in treating androgenic alopecia, comparing it to other treatments like dutasteride and minoxidil. It emphasizes the importance of starting treatment early and being patient for optimal results. The script refutes fears of finasteride becoming ineffective over time, citing long-term studies that show its benefits are enduring. It also addresses concerns about side effects and the potential for treatment-induced shedding, advocating for trust in scientific evidence over anecdotal claims.

Takeaways

• 💊 Finasteride is an FDA-approved drug for treating androgenic alopecia and has been extensively studied for its efficacy.
• 📉 Finasteride reduces serum DHT levels by about 70%, whereas dutasteride can lower it by over 90%, suggesting different strengths in their 5α-reductase inhibition.
• 📈 A meta-analysis from 2010 showed that finasteride is significantly better than placebo in improving hair growth as self-assessed by patients and through objective measures like phototrichogram.
• 🔬 The effectiveness of finasteride increases over time, with more improvement seen in the long term, highlighting the importance of patience with the treatment.
• 🆚 When compared to topical minoxidil, finasteride has shown to be more effective in treating androgenic alopecia, solidifying its position as a first-line treatment.
• 🌐 Global photographic assessments by dermatologists confirm that finasteride improves the appearance of hair, providing an additional layer of evidence for its efficacy.
• 📊 Another meta-analysis from 2022 compared finasteride to dutasteride and found that while dutasteride is stronger, finasteride still offers significant benefits and is more studied.
• 🌏 Long-term studies, including those from non-Asian populations, confirm that finasteride's benefits are long-lasting, with continued improvement or maintenance of hair over a decade.
• 🚀 Starting finasteride early in the hair loss process is crucial for maximizing its benefits, as it is more effective at preserving existing hair than regrowing lost hair.
• 💡 For those seeking a comprehensive hair loss treatment, the combination of finasteride and minoxidil is recommended due to their synergistic effects.
• 🛡 Despite the availability of stronger alternatives like dutasteride, finasteride remains a preferred choice due to its well-documented safety profile, extensive clinical data, and long-term efficacy.

Q & A

What is the main topic discussed in the video script?

The main topic discussed in the video script is the efficacy of finasteride in treating androgenic alopecia and whether it is necessary to switch to other treatments like dutasteride or minoxidil.

What is the difference between finasteride and dutasteride in terms of their effect on DHT levels?

Finasteride lowers serum DHT by about 70%, whereas dutasteride lowers it by over 90%. Additionally, dutasteride at 0.5 milligrams can lower scalp DHT by about 50%, compared to finasteride which lowers it by 40%.

What is the significance of a meta-analysis in scientific research?

A meta-analysis is significant in scientific research as it combines the results of multiple studies into one large study, providing more valid and reliable results from the combined data.

What does the force plot in a meta-analysis represent?

A force plot in a meta-analysis represents the likelihood of improvement from a treatment compared to a control. It shows the amount of improvement and whether the treatment is better, worse, or equal to the control.

According to the 2010 meta-analysis, how effective is finasteride in improving hair growth as assessed by patients?

According to the 2010 meta-analysis, finasteride improves hair growth as assessed by patients, with the overall results showing a significant likelihood of improvement compared to placebo.

How does finasteride compare to minoxidil in treating androgenic alopecia based on the studies mentioned in the script?

Finasteride is more effective than minoxidil in treating androgenic alopecia. In the studies mentioned, 80% of men on finasteride showed improvement compared to 52% on minoxidil, and finasteride alone was better than minoxidil alone or a combination of finasteride with ketoconazole shampoo.

What is the general consensus on the combination of finasteride and minoxidil for treating hair loss?

The general consensus is that the combination of finasteride and minoxidil has an additive and potentially synergistic effect, providing additional benefits compared to using either treatment alone, making it the gold standard hair loss stack.

What does the 2022 meta-analysis reveal about the comparison between finasteride and dutasteride?

The 2022 meta-analysis reveals that while both finasteride and dutasteride are effective, dutasteride is stronger than finasteride in increasing hair counts, with a notable difference of 6.1 hairs per square centimeter after 24 weeks of treatment.

What do the long-term studies on finasteride suggest about its efficacy over time?

The long-term studies suggest that finasteride's efficacy continues over time, with some studies showing continued improvement in hair growth up to 10 years, and a significant percentage of patients experiencing either maintained or further improvement in their hair.

Why does the video script recommend starting with finasteride instead of dutasteride?

The script recommends starting with finasteride due to its extensive clinical data, FDA approval for androgenic alopecia, and long-term safety data. It also mentions that finasteride might be a safer drug due to its shorter half-life compared to dutasteride.

What advice does the script give regarding the use of finasteride and concerns about its long-term effectiveness?

The script advises not to worry about finasteride's long-term effectiveness, as it has been proven to work indefinitely for the majority of users. It emphasizes that finasteride should be taken consistently and that any initial shedding is a normal part of the treatment process.

Outlines

00:00

💊 Finasteride's Role in Hair Loss Treatment

This paragraph discusses the efficacy of finasteride for treating androgenic alopecia, addressing concerns about its long-term effectiveness. It compares finasteride to other treatments like dutasteride and topical minoxidil, highlighting that finasteride is an FDA-approved medication with substantial clinical data supporting its use. The speaker aims to alleviate fears that finasteride may not be sufficient in the long run, emphasizing that many users experience improved results over time. The paragraph also introduces meta-analyses that consolidate various studies to provide a comprehensive view of finasteride's effectiveness.

05:00

📊 Analyzing Finasteride's Efficacy Through Studies

The speaker presents data from a 2010 meta-analysis comparing finasteride to a placebo, detailing the methodology and results of various studies included in the analysis. The paragraph focuses on different measures of finasteride's effectiveness, such as patient self-assessment, hair count improvements, and dermatologist evaluations. The summary underscores the objective improvements in hair growth and the significance of long-term use, as well as the comparison between finasteride and minoxidil, establishing finasteride as a more potent treatment for androgenic alopecia.

10:01

🔬 Finasteride vs. Dutasteride: A Scientific Showdown

This section delves into the comparison between finasteride and dutasteride, discussing the biological processes behind their actions on DHT levels. The paragraph reviews a 2022 meta-analysis that includes studies on finasteride's efficacy against hair loss, both in comparison to placebo and to dutasteride. It presents data on hair count increases and discusses the implications of these findings, suggesting that while dutasteride may be more potent, finasteride remains a strong contender in the treatment of hair loss.

15:01

🌐 Long-Term Studies on Finasteride's Sustainability

The speaker reviews long-term studies on finasteride's effectiveness, including data from Asian populations and a 10-year follow-up study from Italy. The paragraph emphasizes the importance of starting treatment early for better results and discusses the plateauing of finasteride's benefits after two years of use. It also addresses the misconception that finasteride's effectiveness diminishes over time, providing evidence to the contrary and highlighting the drug's long-lasting benefits for most patients.

20:01

🛡️ Choosing the Right Treatment Protocol for Hair Loss

In this concluding paragraph, the speaker offers recommendations on starting with finasteride due to its extensive clinical data and long-term efficacy. They discuss the possibility of using minoxidil in conjunction with finasteride for added benefits but caution about the commitment required for ongoing use. The paragraph also touches on the option of upgrading to dutasteride if necessary and reinforces the message that finasteride is a reliable, long-term solution for hair loss, urging individuals to trust scientific evidence over anecdotal claims.

Keywords

💡Finasteride

Finasteride is an FDA-approved oral medication used primarily to treat male pattern hair loss, or androgenetic alopecia. It works by inhibiting the enzyme 5-alpha reductase, which converts testosterone into dihydrotestosterone (DHT). The script discusses the effectiveness of finasteride in reducing hair loss and its comparison with other treatments. For instance, it mentions that finasteride lowers serum DHT by about 70 percent, which is less than the 90 percent reduction caused by dutasteride, another drug discussed in the script.

💡Dutasteride

Dutasteride is another 5-alpha reductase inhibitor, similar to finasteride but with a stronger effect on DHT reduction. The script compares dutasteride to finasteride, noting that dutasteride can lower scalp DHT more significantly and suggests that it might be a more potent alternative for treating hair loss. However, it also raises the question of whether such a strong inhibitor is necessary from the outset or if finasteride is sufficient.

💡Androgenetic Alopecia

Androgenetic alopecia, also known as male pattern baldness, is a common type of hair loss in men. It is related to the hormone DHT and is the primary condition discussed in the video script. The script explores various treatments for androgenetic alopecia, including finasteride and dutasteride, and their effectiveness in preventing or reversing hair loss.

💡Minoxidil

Minoxidil is a topical treatment for hair loss that is often used in conjunction with oral medications like finasteride. The script mentions minoxidil as a comparative treatment to finasteride and dutasteride, indicating that while it is effective, it is generally less potent than finasteride in treating androgenetic alopecia.

💡Meta-Analysis

A meta-analysis is a statistical technique used to combine and analyze data from multiple scientific studies to identify overall trends and determine the effectiveness of treatments. The script refers to meta-analyses to support the claims about the efficacy of finasteride and dutasteride in treating hair loss.

💡5-alpha Reductase

5-alpha reductase is an enzyme that converts testosterone into dihydrotestosterone (DHT), a hormone linked to hair loss. The script explains that both finasteride and dutasteride work by inhibiting this enzyme, thus reducing DHT levels and potentially slowing hair loss.

💡DHT (Dihydrotestosterone)

Dihydrotestosterone, or DHT, is a hormone that plays a key role in male pattern hair loss. The script discusses how DHT binds to receptors in hair follicles, leading to miniaturization and eventual hair loss. Reducing DHT levels with medications like finasteride or dutasteride is a primary strategy for treating hair loss.

💡Phototrichogram

A phototrichogram is a tool used to measure hair counts and assess hair growth objectively. The script mentions phototrichograms as part of the studies that evaluated the effectiveness of finasteride, providing a more objective measure of hair growth compared to patient self-assessments.

💡Long-term Efficacy

The script discusses the long-term efficacy of finasteride, referencing studies that followed patients for up to 10 years. It emphasizes the importance of patience and the potential for finasteride to continue improving hair growth over an extended period.

💡Hair Loss Stack

A hair loss stack refers to a combination of treatments used together to treat hair loss. The script mentions the 'gold standard hair loss stack' as a combination of finasteride and topical minoxidil, suggesting that using both treatments can provide additive or synergistic benefits.

💡Norwood Scale

The Norwood scale is a classification system used to measure the extent of male pattern baldness. The script uses the Norwood scale to discuss the effectiveness of finasteride in patients with different stages of hair loss, indicating that the sooner treatment is started, the better the results.

Highlights

Finasteride is often considered overhyped, but it works for some and may not be enough alone for others.

Dutasteride is a stronger 5α-reductase inhibitor that may be considered for those who do not respond well to finasteride.

Finasteride reduces scalp DHT by about 40%, while dutasteride at 0.5 milligrams can lower it by approximately 50%.

A dose of 2.5 milligrams of dutasteride daily can lower scalp DHT by nearly 80%.

The question of whether to start with finasteride or go straight to dutasteride is raised.

Finasteride is an FDA-approved drug with extensive studies on its effectiveness.

Meta-analyses provide a combined view of multiple studies, enhancing the validity of the results.

Finasteride has been shown to improve hair growth as assessed by patients themselves.

Phototrichogram, a tool for measuring hair counts, provides objective evidence of finasteride's effectiveness.

Long-term studies show continued improvement with finasteride, suggesting it works better over time.

Finasteride is more potent than topical minoxidil in treating androgenic alopecia.

Combining finasteride with minoxidil has an additive and possibly synergistic effect.

A recent meta-analysis from 2022 compares the efficacy of finasteride and dutasteride.

Dutasteride is stronger than finasteride in head-to-head comparisons, but the difference is not drastic.

Long-term efficacy data for finasteride is available, showing its effectiveness over a span of 10 years.

The importance of starting treatment early with finasteride is emphasized for better long-term results.

Finasteride is recommended as a first-line treatment due to its extensive clinical data and long-term safety profile.

Dutasteride has a longer half-life than finasteride, which may affect the duration of side effects.

The video discusses the fear-mongering around post-finasteride syndrome and emphasizes the drug's safety.

Finasteride is confirmed to be effective for the vast majority of users, with benefits that are long-lasting.

Transcripts

sup chooms how y'all living hope

everything is no then you're all having

a pream week so a lot of people have

been telling me that I over hyped

finasteride sure it works for some but

come on Kevin for most people it isn't

going to be enough by itself and

eventually all of us are going to have

to use other drugs like topical

minoxidil or a stronger 5ar inhibitor

like dutasteride after all do test ride

lowers serum DHT over 90 percent versus

finasteride which only lowers it by

about 70 percent and more importantly

dutasteride at 0.5 milligrams lower

scalp DHT about 50 versus finasteride

lowering it 40 even better dutasteride

have a dose of 2.5 milligrams per day

can lower scalp DHT by almost 80 percent

so that leads a lot of people to think

that finasteride will only work in the

short term and eventually all of us will

have to switch to detestaride which

really begs the question why even bother

starting with finasteride we might as

well just start with the good stuff and

join the dutasteride master race right

away right but is it really necessary do

we really need to go balls to the wall

with our 5 Air inhibition or is

finasteride by itself good enough in

stopping hair loss from androgenic

alopecia even more important than that

will finasteride be enough to stop hair

loss indefinitely even a lot of people

who are taking finasteride and are

pleased with the results they have

gotten so far still kind of have that

lingering fear that one day finasteride

will not be enough and they'll start to

lose ground again people want assurance

that the finasteride they are using will

still work even when they are much older

this is important to know because I am

seeing more and more people telling me

they are worried that finasteride isn't

going to be enough for them or won't be

enough long term after all a 40

reduction in scalp tht really doesn't

sound like all that much so let's take

another look at finasteride and take our

patented balls deep approach to see if

we're doing it enough to stop our hair

loss by using finasteride both in the

short and the long term so let's take a

look at the efficacy of finasteride we

all know know that it works of course

but does it work well enough that we can

take it not have to worry about hair

loss at all well fortunately this is an

FDA approved drug we're talking about

here so there is no shortage of studies

on the effectiveness of oral finasteride

this data includes the original clinical

studies that resulted in its approval by

the FDA as well as more recent studies

when a lot of studies on the same

subject are available it's often good to

see if someone has done a meta-analysis

of these studies a meta-analysis is a

way to combine the results of many

studies into one big study and it is a

good way to get the most valid results

possible from data as you can see right

here m a meaning meta-analysis is at the

very top of the pyramid when we look at

the hierarchy of scientific evidence so

whenever you are doing research it is

good to know what the quality of the

research is so you know what belongs in

a serious scientific discussion so

someone for instance wants to claim that

dutasteride made their hair loss worse

somehow and they can't provide any

stronger evidence than just their own

anecdote then you can safely dismiss

them as being full of and ignore

them so it's good we're working with

actual meta-analyzes here as opposed to

the testimonies of a bunch of

hypochondriac crayon eating morons on

trustless in fact we actually have two

bed analyzes that examine the efficacy

of finasteride for hair loss the first

one is from 2010 that looks at

finasteride versus placebo and the other

one is from this year of Our Lord in

2022 that compares the efficacy of

finasteride versus dutasteride we also

have some data on the efficacy of

finasteride versus topical minoxidil as

well as data on long-term finasteride

efficacy over at least five years of use

so it's time to massage our scalps and

get that boot flow going to our brains

and let's find out once and for all if

finasteride is still the first line

choice for treating androgenic alopecia

today the first meta-analysis is from

2010 and it is titled quote efficacy and

safety of finasteride therapy for

androgenetic Alopecia a systematic

review unquote in this meta-analysis 12

randomized controlled studies of

finasteride versus placebo were combined

there were

3927 male subjects with 2152 being on

finasteride and

1775 on Placebo so this was a huge study

it has more subjects than all the

subjects in every study ever funded by

the PFS Foundation combined this table

here shows the characteristics of the

studies included in the meta-analysis

most of the studies used a standard dose

of one milligram per day of finasteride

though three studies did use five

milligrams per day which is what is

typically prescribed for an enlarged

prostate most of the studies lasted 12

to 24 months a few were of a shorter

duration and two studies lasted up to 48

and 60 months so this is already much

longer term than most hair loss research

but we have data which is even more

long-term coming up soon so these

studies all looked at different

endpoints including patient

self-assessment of the results hair

counts and Global photographic

assessment by dermatologists who were

blinded to the treatment group let's

take a look at the results of

finasteride assessed by the patients

themselves first

so first let's get oriented to this type

of figure on the left there are a whole

bunch of numbers representing short-term

and long-term results from the

individual studies but instead of

getting bogged down with all that let's

concentrate on the graph on the right

this graph is what's called a force plot

and it's important to understand this

type of graph because they are used all

the time in meta-analyzes basically a

force plot shows the amount of

improvement from a treatment versus a

control so in this case this Force plot

is showing us the likelihood that a

subject on finasteride would see an

improvement in their hair growth versus

a subject on a placebo the vertical line

in the middle represents the number one

and if the result was one then

finasteride would be equally as good as

Placebo which would mean it wasn't doing

anything at all if a point was to the

left of that line meaning less than one

it would mean that finasteride was worse

than Placebo and anything to the right

of the line meaning greater than one

means that finasteride was better than

Placebo anyway the little squares with

the horizontal line show the individual

will study results along with What's

called the confidence limits which is

basically similar to the range of these

results and the Diamonds show the

average results the bottom Diamond shows

the overall result of all the studies

and clearly as you can see finasteride

improves hair growth as assessed by the

patients themselves however

patient self-assessments can be pretty

subjective and it is hard to determine

exactly how effective finasteride is at

determining objective improvements like

increased hair counts fortunately we see

in the next graph here that hair count

as assessed by phototrichogram also

improve a finasteride a photo trigger

Ram is a tool that can measure exact

hair counts so it is better at giving us

objective measurements compared to

researcher or patient self-assessments

in fact in the short term meaning less

than or equal to a year on finasteride

hair counts improved by 9.42 percent

overall in the long term meaning over 12

months the results are even better with

24.3 percent increase in hair counts

this goes along with most of the studies

on finasteride that showed more

Improvement the longer you are on it and

that is important to keep in mind if you

have been on finasteride for less than a

year oftentimes people give up and

assume the treatment isn't effective

when they haven't even given it a year

yet so again it can take over a year for

finance tried to really Flex its muscles

so please don't give up keep using

finasteride and always remember the best

best is yet

finally right here we see the results of

a global photographic assessment and it

is clear that finasteride results in

Improvement in the appearance of the

hair as judged by dermatologists So

based on all this evidence it's clear

that finasteride works but how does it

compare to other treatments well let's

dispense with Minoxidil first minoxidil

is of great hair growth stimulant of

course but it can't compare to

finasteride in treating androgenic

alopecia here's a couple of randomized

controlled studies the first study is

titled quote an open randomized

comparative study of oral finasteride

and 5 topical minoxidil and male

androgenetic alopecia unquote this study

was a direct comparison of one milligram

of finasteride daily to five percent

topical minoxidil applied twice daily 65

men were enrolled and the study lasted

for 12 months overall eighty percent of

the men on finasteride showed

Improvement by clinical assessment

whereas only 52 percent of those on

minoxidil improved this figure shows the

results in detail tale and clearly men

did better on finasteride when comparing

the two treatments here is another study

that compared finasteride at one

milligram daily finasteride plus

minoxidil two percent two percent

minoxidil alone and finasteride plus

Ketoconazole shampoo and 100 men with

androgenic alopecia in this figure group

one is finasteride alone and group three

is two percent minoxidil alone clearly

one milligram finasteride per day is

much better than two percent minoxidil

and it's by a long shot which is no

surprise since we already know that

finasteride even beats out five percent

minoxidil by nearly 30 percent group

four is finasteride plus Ketoconazole

and there was really not any difference

from just plain finasteride which really

begs the question as to whether or not

Ketoconazole shampoos really do anything

at all maybe they do but they're clearly

not even in the same Stratosphere as

finasteride and minoxidil group 2

however did the best and that group used

a combination of finasteride plus two

percent minoxidil so clearly finasteride

plus minoxidil has has an additive and

even a synergistic effect which gives

additional benefits compared to using

either one alone that is why the gold

standard hair loss stack is finasteride

plus five percent topical minoxidil so

none of this is controversial no one

seriously questions that finasteride is

more potent than topical minoxidil after

all unlike minoxidil finasteride works

by actually targeting the root cause of

androgenic alopecia which is the trash

hormone DHT but what happens when it's

brother against brother or finasteride

versus dutasteride which one Reigns

Supreme in the good fight against the

slap head curse well that brings us to

the next meta-analysis this one was just

published this year in 2022 it is titled

quote finasteride for hair loss A reveal

unquote this article is a good review of

finasteride in general and it includes

some helpful figures like this one here

this figure shows how testosterone is

converted by the five air enzyme in the

cells into the trash hormone DHT which

then binds with the angioreceptors in

the cell nuclei that then activates

signaling Pathways and other factors

that end up triggering off the long

chain of events that ends in the

destruction of our hair finasteride of

course stops this destruction dead in

its tracks by inhibiting the five-air

enzyme and thus preserves the alpha Chad

hormone testosterone by preventing the

five air enzyme from wasting it by

turning it into the beta version

hormone DHT so this study was another

meta-analysis and it looked not only at

finasteride versus placebo but also

finasteride versus dutasteride eight

studies were combined and some of them

overlapped with the previous

meta-analysis we already covered but

since the study was published 12 years

after the last one some of the studies

are new anyways the results are

presented much like in the other

meta-analysis using Force plots here the

endpoint is changed in hair counts per

square centimeter with finasteride one

milligram per day versus placebo the top

graph is after 24 weeks and the bottom

one is after 48 weeks the raw numbers

showed an increase in hair counts of

12.4 hairs per square centimeter at 24

weeks and 16.4 hairs per square

centimeter at 48 weeks with finasteride

this is once again an indication that

finasteride not only works but it works

better the longer you take it so if

you're getting good results with

finasteride now then Rejoice because

things are only going to get better and

your hair will age like a fine wine the

top Force plot in the next figure here

shows dutasteride at 0.5 milligrams per

day versus placebo after 24 weeks of

treatment dutasteride increased hair

counts by 18.4 hairs per square

centimeter compared to Placebo the

bottom graph shows two studies that did

a head-to-head comparison between

finasteride right at one milligram daily

versus dutasteride at 0.5 milligrams

daily for 24 weeks do testeride as you

might expect given its stronging 5ar

blocking capabilities outgrew hair

versus finasteride by 6.1 hairs per

square centimeter which isn't a huge

difference but still a notable one so

the data shows that dutasteride is

stronger than finasteride and

finasteride is stronger than minoxidil

but let's look at one more aspect of

finasteride before coming up with some

recommendations about which five air

inhibitor you should use the last

question is does finasteride work

forever I know a lot of people who have

started finasteride as teenagers and

they're now worried that by the time

they're in their 30s the drobe won't be

effective anymore but is it really

something we need to worry about will

finasteride work as long as you keep

using it well I touched on the long-term

efficacy of finasteride before in

another video which I'll link below but

one source of criticism I got from that

video is that the data I cited has the

limitation in that the long-term studies

were done exclusively in Asian

populations so how is this relevant you

may ask well people like to argue that

androgenic alopecia is different in

Asians because it occurs less frequently

in them well even though it is less

frequent there is nothing else to

suggest that the actual disease process

is different even if it is less common

in that population but even if you do

believe that Asians have some genetic

resistance to hair loss compared to

Caucasians it turns out we do have some

long-term data now in non-asian

populations which confirms that Asian

studies are completely valid so before

we get into that let's review the Asian

studies one of the first long-term

studies was this one from Japan titled

quote five-year efficacy of finasteride

an 801 Japanese men with androgenetic

alopecia unquote in the study men were

assessed using Global photographs after

five years of treatment with finasteride

at one milligram daily the results are

difficult to believe though after four

years of treatment there was Improvement

in 99.4 percent of men and prevention of

disease progression and 100 of men I

mean I'm a big believer in finasteride

of course but this seems like an outlier

study to me and I find these results

hard to swallow no drug has a 100

efficacy rate not even lethal injection

drugs fortunately there is more data on

this though in this study from good

Korea 126 patients who had been on

finasteride had one milligram per day

for at least five years were evaluated

using photographs the investigators used

their own made-up alopecia scoring

system so it is hard to translate the

results into something familiar like the

Norwood scale but anyways this graph

used in the good Korean Norwood scale

shows that the effectiveness of

finasteride keeps rising and then Peaks

at two years after that it plateaus with

only a very small falloff and efficacy

overall 85.7 percent of patients showed

Improvement on finasteride after five

years of treatment so this study brings

us back to what I was saying about the

importance of being patient finasteride

can take up to two years to fully Flex

its muscles so people who say they've

been on it for two months and it's not

working should just take a deep breath

and relax it's going to be okay chims

now we're back to the Japanese again

this time with a 10-year follow-up study

in the study there were 532 Japanese men

and the main assessment was based on

global photographs of the hair this

graph here shows the main findings this

graph is especially interesting though

because it breaks down the results by

Norwood class so I guess the Japanese

don't have their own interpretation of

the Norwood scale like the good Koreans

do overall though for most Norwood

classes there was continued Improvement

in hair growth until five years at which

point the Improvement tends to Plateau

however those with the lowest Norwood

scales like one and two at the top of

the graph seem to improve throughout the

whole 10-year period while the North

with sevens at the bottom of the graph

get less Improvement and their gains

tend to drop off a little over time so

to explain it as simply as possible the

sooner you start treatment the better

finasteride works not just in the short

term but also in the long term people

who report unsatisfactory results with

finasteride are usually those who

started when they've already lost

significant ground and now thanks to

this graph we know exactly why that's

the case the longer you wait the less

effective finasteride is going to be so

this really reinforces the idea that it

is important to start treatment as soon

as you possibly can before hair loss has

had any chance to progress at all

although even if you have lost some

ground you're much better off with

finasteride than without it so don't

give up just because you're a Norwood 3

Norwood 4 or Beyond in fact the golden

option is to start finasteride before

you even notice hair loss at all rather

than waiting until you've lost ground

because finasteride is much better at

preserving what you've lost compared to

getting back what you've lost family

history of hair loss is an indicator but

it's not a 100 accurate predictor

meaning you can have a family member

with no evidence of hair loss and still

have the androgenic alopecia genes and

vice versa so don't think family history

is everything it isn't finally

let's look at the non-asian long-term

study that I mentioned before this study

is from Italy and it is titled quote

finasteride one milligram daily

Administration on male androgenetic

alopecia in different age groups 10-year

follow-up unquote in the study 118 men

on finasteride had one milligram per day

were assessed by photographs over a

period of 10 years so like the Japanese

study this is a very long-term study the

results of the study are somewhat

complex though because they divided the

men by different age groups and by

different Norwood classes there were two

main results number one if you are going

to respond to finasteride you will

usually start to see some results within

the first year of treatment number two

if you respond within the first year

there is only a four percent chance your

hair will get worse after 10 years while

there is a 28 chance it will be

maintained and a whopping 68 percent

chance of further Improvement overall in

this study after 10 years only 14

percent of patients had worsening of

their hair loss and 86 percent had

improvement over the 10-year period in

fact 21 of the subjects had better hair

at 10 years than after five years of

treatment so this study absolutely

confirms that the majority of patients

get long-lasting benefits from oral

finasteride and in many cases the hair

continues to improve during all 10 years

of treatment so all this data confirms

that finasteride is an extremely

effective drug for treating androgenic

alopecia and its benefits are long

lasting but there is some data that do

pastoride may even be more effective so

why is it that I recommend starting with

finasteride well I am not

anti-dutasteride and I fully believe

that both finasteride and dutasteride

are outstanding treatments that will

stop hair loss in the vast majority of

people who use them one of the reasons I

prefer finasteride though is that there

is a lot more clinical data on

finasteride than dutasteride which is

one recent finasteride is FDA approved

for androgenic Alopecia and dutasteride

is not there is also as I already showed

a lot of long-term data on finasteride

lasting up to 10 years that dutasteride

doesn't have when it comes to side

effects both drugs are extremely well

tolerated and the side effect profiles

from both drugs are comparable and I've

talked about that in many many videos

you can find on my channel but overall I

think finasteride might be a safer drug

given that dutasteride has such a long

Half-Life lasting five weeks versus six

to eight hours with finasteride thus if

you get side effects from dutasteride it

may take a longer time for them to

subside than with finasteride although I

should note that the side effects do

subside 100 of the time and the idea of

persistent side effects from either drug

are 100

fear-mongering and I've done

many videos where I prove that post

finasteride syndrome is little more than

a pseudoscientific q Anon conspiracy

theory so if you want a treatment

protocol where you can feel confident in

maintaining your hair forever then the

best thing to do is to start with

finasteride if you start early it

probably will be the only thing you will

ever need but just in case you want a

little extra insurance for your hair you

can always keep minoxidil on reserve

although if you want to start with both

minoxidil and finasteride at the same

time that's fine too but just keep in

mind that since the drugs work

differently any additional benefits you

get with Minoxidil on top of finasteride

will need to be maintained with

Minoxidil indefinitely so just be ready

for the long-term Commitment if that's

what you choose if you've given

finasteride a fair shot and it's been

say a couple of years after that time

you can then consider upgrading your 5

AR inhibitor to do test ride at 0.5

milligrams daily so if for some reason

that's not strong enough which is

extremely unlikely keep in mind that

dutasteride can be safely titrated all

the way up to 2.5 milligrams daily which

will suppress 80 percent of scalp DHT

which is twice as much of what as what

one milligrams of finasteride suppresses

and I have a video about that which I'll

link below again though I must reiterate

with as strong of an emphasis as I

possibly can that finasteride will

completely stop and even reverse hair

loss in the vast majority of people who

use it and this has all been validated

through the strongest and highest

quality scientific evidence in existence

so you should trust the science far more

than you trust some random douchebag on

a subreddit who claims without any

photographic documentation whatsoever

that somehow his hair is getting worse

on treatment these people are either

trolling you or more likely they are

just hypochondriacs who are freaking out

about a shed because they are

self-medicating and thus they never

received any proper education about the

drug all the hair loss treatments will

cause an initial shed and likely

repeated sheds will happen as well as it

is impossible to keep a hair follicle in

the ancient growth phase forever

anything lost while on treatment will

grow back and likely grow back stronger

and I have a video which goes over all

this which I'll link below so please

chooms stop worrying about shedding you

should be far more worried about what

happens if you stop treatment and for

the love of God stop worrying that

somehow finasteride is going to just

magically stop working someday it isn't

some drug you build a tolerance for like

alcohol and cigarettes it works

indefinitely and chances are greater it

will work even better in the long term

compared to how it works in the short

term so just take your finasteride like

an aspirin forget about hair loss and go

enjoy your life because you've earned it

God bless