Finasteride. Topical or Oral? Major Side Effects - Reddit AMA #2, Part 3

Author: AlphaMD

Excerpt from our second Reddit AMA podcast video: What is Finasteride? is Topical or Oral better? Are there risks in taking it?

This editable transcript was computer generated and might contain errors. People can also change the text after it was created.

Brian Mckinley: We're gonna go on to, I think our last topic for today, which is going to be talking a little bit about finasteride. Which is. so when someone who is prone to baldness, begins trt

Brian Mckinley:  We don't ever want to tell someone they shouldn't be on TRT, you know, I you know I have some hair thinning, but I'm also getting older.

Brian Mckinley:  And so for me TRT really hasn't affected that, but for some people, if it's in your family, if it's genetic, if you have a history of it, it is something you want to be concerned about on TRT. Well, finnestride is one of the ways to allow you to stay on a TRT regimen and to not have to worry as much about your hair loss. It's a substance that helps suppressed DHT. So that's di I hydrogen testosterone which is predominantly responsible for like essentially drying out the hair follicles and kind of call it causing it, die promoting hair loss. If you know you're prone to it. And finasteride essentially targets that and says, You know, please stop, please stop producing DHT and so the main reason we don't give it to everyone is because DHT is very strong 10 times stronger than regular testosterone, your body, produces it when it has testosterone. So when you add more testosterone today, adds more DHT as an effect but we like people to have that

Brian Mckinley:  because it's very beneficial if it doesn't hurt their hair and they're you know, from To baldness. And so this guy's asking essentially, Hey, I'm prone becoming bold finasteride, seems to work, good for that. From what I've read, you know. And what's your guys's opinion on taking it orally or using it topically? And then he also wanted another question of like, What's your opinion on subcutaneous and intramuscular injections of testosterone? Which Garrett has been experimenting with and we've been working with our patients on as well. So we'll touch on both of those. So yeah Garrett for finasteride. Oral versus topical. What's your take?

Garrett Soames: um, actually this one actually, I think is a pretty clear Which is the winner. And it topical is always the winner. And here's why. So, Finasteride is a IT blocks the enzyme in your body. It blocks the enzyme that converts testosterone into DHD, so all DHT was once testosterone.

Garrett Soames:  And again, DHT has great benefits in that. It's actually, yeah, significantly stronger. As far as, you know, if you're looking for physique benefits, muscle growth weight loss, all that But it has downsides. It attaches to your your hair follicles and makes them atrophy over time and then yeah you're hair falls out so it can definitely cause Male pattern baldness baldness.

Garrett Soames:  If but here's the thing, if you can block, you can block the DHT conversion, right? Systemically or locally. So, think about it like this. You know, you've got DHT floating all through your body, right? But if if you take, if you apply it just directly to the scalp where you're trying to prevent the damaging effects of DHT, Then your body absorbs, some of that, you know, that topical stuff, you know, just like some creams and stuff, you could absorbs into the bloodstream, but it doesn't nearly get as as much. So, There was a A study done actually, just last year just a few months ago, 20 December 2022.

Garrett Soames: It was the Journal of European Academy of Dermatology and Venereal Disease. Basically, it was an interesting study that it basically proved that, The DHT concentrations in the blood. So the actual DHT levels. Were 100 times greater than 100 times.


Brian Mckinley: Here.

Garrett Soames: Look, lower In men who took the pill versus topical. So we know Oral finasteride lowers. The, you know, if I were to test your blood, it lowers it over a hundred times more than than the DH. The DHT blockage would, if you just applied, it but interestingly enough,

Garrett Soames: it works as effective at hair prevention, meaning You will lose less either way you won't lose. Oh, I should I should let me rephrase that if you take pills. Or if you do the topical, you're gonna protect the same amount of hair follicles. Oh, you get no.

Brian Mckinley: Okay.

Garrett Soames: You get zero benefit by adding pills. all you do is you add the side effects of finasteride, which Are in my opinion, not worth it and the main reason to me, honestly is the sexual dysfunction that can come with it.

Garrett Soames: You know it's it's a very known phenomenon. You can In fact there are many many support groups online about they call it Post Finasteride Syndrome. And really,…

Brian Mckinley: Oh damn.

Garrett Soames: yeah, so and there's some men that believe that it's permanent that the sexual dysfunction is permanent. I don't believe I believe you. You know, you can have performance and anxiety, performance, anxiety issues that associated with your lack to get an erection during your oral finasteride treatment. And then you get off of it. You're like this sucks. I'm getting off of it. But then you're stuck in your head about it and But again, it's it's a big. There are thousands of men who've reported. This is an issue. So, They're actually been lawsuits against doctors who failed to disclose this as a side effect. So

Garrett Soames:  long story short, if you if you want to take TRT and you want to protect your hair, You definitely should take finasteride, but you should only do the cream or shampoo.

Brian Mckinley: That's a surprising to me because, you know, a couple years ago, I might think something completely different.

Garrett Soames: Yeah. I mean if it logically you would think Okay? Well let's test what my DHT level is to see if it's actually working to protect my hair. Right. And so…

Brian Mckinley: Yeah.

Garrett Soames: if you draw your blood and you, you know, Hey is DHT levels, are are significant, they're they're lower but they're not as low as they could be just because he's using the shampoo. Well that doesn't matter because you're blocking the DHT right where it matters. This is this is the only part I want the DHD to block. Everywhere else,…

Brian Mckinley:  Yeah.

Garrett Soames: I want to actually want more of it. I want as much THC as I can get except for here. Right, so why not literally block it from? It's like putting on a, you know, a shower cap to keep your hair dry just in reverse. Mmm.

Brian Mckinley: Yeah, that's fine. Okay. Yeah, so definitely topical it sounds like and I don't think I'd really want to mess with with oral to be honest about the choice.

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