Side effects of Finasteride (Propecia) though are not common, there is a significant psychological overlay given so much bad press and social media gone crazy. Dr Bhatti's 5 strategies that he has been using for the past over 15 years for better compliance of Finasteride have helped reduce the likelihood of side effects significantly in his practice. Many patients want a hair transplant without Finasteride but if they are young and with extensie baldness, Dr Bhatti's advice is meant for them more than any one else.The pillars of Dr Bhatti's hair loss regime using Finasteride are-
CASE SELECTION: Detailed counseling to bring out personality types like OCD, body dysmorphia syndrome and rational goals and objectives. Avoid Finasteride in patients with BMI more than 30, those who live sedentary lifestyles, incurable smokers, uncontrolled diabetics and patents with depression & anxiety disorders. In the last video I even discussed various personality types and how to match Finasteride for each for better compliance.
CUSTOMISED DOSING: Start low and then scale up. I start with 0.5 mg on alternate days and in others 1 mg on alternate days and then scale up titrating the does with the response after 3 months are over. Since the patient’s psyche is pretty much labile in the first few weeks after starting the drug, he needs constant reassurance. Many a times patient will report some breast tenderness but this all goes down at the 4-6 weeks mark. You may need to add Dutasteride if the effect of Finasteride over the years begins to wane.
SWITCH-OFF/ SWITCH-ON STRATEGY: Finasteride levels in the body keep building in the tissues and these may cause late onset side effects. To flush out excessive Finasteride, I advise my patients to take a break from Finasteride for 15 days if asymptomatic and 30 days if they have a concern. This helps in long term compliance in patients especially youngsters who are on long term Finasteride to maintain thinning hair and the hair transplant result.
LET 2 PEAKS COINCIDE: The spike in testosterone levels in the body follows a circadian rhythm and levels are highest early in the morning. So as to facilitate the peak blood circulation levels of Finasteride match the testosterone surge in the early morning for best suppression of DHT even with low doses, the drug Finasteride should be taken late in the night for those who go to bed past midnight and early morning for members of the 5 AM Club. If you follow this advice, even lower levels of DHT blockers will be beneficial to you. For example if you were taking the medication at say 10 AM, the peak of the Finasteride level has already happened and 1 mg may even loose effect. But if you coincide the intake of medication with the circadian testosterone surge, even 0.5 mg taken daily will have a better effect.
WEEKEND BOOST: Weekends see a surge of testosterone levels due to increased physical activity. This period of intense activity needs to be adequately covered. A patient of mine achieved very good balance by taking 0.5 mg on alternate days and 1 mg a day on Saturday and Sunday with good compliance.
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This is Dr Bhatti's Darling Buds Clinic. Our RU-vid channel is a destination for those researching Hair Transplant and other remedies for hair loss. We make videos to showcase our hair transplant results on the web through RU-vid; all techniques available for hair transplant; and advances in the field of hair transplant are often dealt with.
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26 июл 2024
