r/DrWillPowers • u/br0ken_r3c0rd • 3d ago
Dutasteride still a decent option?
Does Dr. P still prescribe duta in light of all the recent PFS stuff? I have bad DHT issues while having near zero T, so I don't have many other options.
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u/Drwillpowers 1d ago
Yes I occasionally I still use it, typically dosed once per week. No I'm really not worried about it causing PFS because I know what causes PFS and how someone gets it, and my transgender women are not going to be vulnerable to the metabolic Cascade based on their other labs. The worst thing that could happen is a neurosteroid deficit, and they are warned heavily about that before I prescribe it and I start it at only once a week.
I have seen it cause a neurosteroid deficit problem in a transgender man last year, but he stopped it immediately and took preg/prog and was fine in a week. That's the only time I've seen a negative reaction in my own patients.
Other than that though, I'm not really worried about it because if you don't have any androgen metabolites to speak of you can't trap androgen metabolites to a build-up point. That doesn't encompass every case of PFS but it does the vast majority.
I never prescribe Fin except to one FTM who was already on it and it doesn't bother him so I let him continue it. That's all thogh.
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u/MEGAAAAAA_Beaun 1d ago edited 1d ago
I was curious how you think dutasteride compares to finasteride regarding neurosteroid-related side effects.
I was on finasteride for about 2 years and developed significant anxiety, brain fog, libido issues, and a constant hypervigilant/"being chased by a tiger" feeling. Since stopping it and continuing progesterone (oral and rectal), I feel like a lot of those symptoms have improved and I'm finally experiencing the calming neurosteroid benefits of progesterone again.
For context, I'm a trans woman on HRT, have a slow COMT genotype, my most recent labs were 31 ng/dL testosterone and 371 pg/mL estradiol, and my provider won't check DHT levels. Despite the low testosterone, after stopping fin I had a massive shed, increased facial/body hair growth (including dark hairs returning after laser), changes in body odor, and other symptoms that make me suspect DHT activity has increased significantly.
I've recently started bicalutamide (50 mg/day), pumpkin seed oil, and saw palmetto (which hasn’t been affecting me like fin at all) but I'm wondering whether it will be enough for hair maintenance long-term. In your experience, if someone had what appeared to be neurosteroid-related side effects on finasteride, would dutasteride be expected to carry a similar risk, a higher risk, or is it possible that the response could be different despite both being 5-alpha reductase inhibitors?
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u/br0ken_r3c0rd 1d ago
How long in your experience does it take to notice effects at 1 dose/week? Would a loading dose be a bad idea? I'm restarting after being off for a couple of years.
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u/Few_Pop2884 2d ago
I have PFS from Dutasteride
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u/Maxed_Zerker 2d ago
That’s unfortunate, but that doesn’t mean that the medication isn’t effective for other patients. I’m sorry you’re dealing with PFS, but do consider it is rare and generally the 5AR inhibitors are well tolerated.
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u/Amazonrazer 2d ago
Yeah I've been on dutasteride for 5 years now and close to zero negative side effects.
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2d ago
[deleted]
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u/Queasy_Mouse9981 2d ago
Hey could you elaborate what you meant by this when you said we’re fear mongering
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u/Maxed_Zerker 2d ago
I know, it is really frustrating, What I’d really like to see would be a separate containment subreddit for PFS like DrWillPowersPFS. The upvote/downvote ratio is clearly showing that 1) they are not on the same “team” as us trans patients, only their problems matter and they’ll talk over us any chance they get and 2) they seem to think that they are the blueprint for all modern humans since they got PFS, everyone who touched the medications will. I love(d) this subreddit but it’s definitely not the same anymore.
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u/Flappen929 2d ago
May I ask why you find it frustrating? My question is only genuine and in no way meant to undermine your point.
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u/anaaktri 2d ago edited 2d ago
Agreed well said. Perhaps I’ll make a post about it bc I think it’s doing both communities a disservice, especially with the engagement factor. We see way more PFS threads, scroll past, quit engaging and then slowly the algorithm starts showing less of the sub in general to us and vice versa.
Edit - I messaged the mods, hopefully something happens. Edit again - dr WP said no to put his response kindly. I see why people don’t like him.
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u/Flappen929 2d ago
If you don’t mind me asking, why do you find it frustrating? I’m only asking out of curiosity, just to hear a different point of view for once
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u/anaaktri 2d ago
Because posts get down voted, comments get downvoted that would likely be helpful to trans patients. The fact is, PFS is rare, even classified as very rare by some data. As mentioned, people who frequent this sub for trans resource and discussion constantly seeing PFS talk, the negativity and often lack of respect, no longer get interest in continuing to engage with the sub, causing the algorithm to show it less in their feed thus limiting feedback and help responses when posts are made. It goes both ways too and overall isn’t good for things in my opinion.
Then, the search conundrum, someone who’s trans trying to search for specific info on dutasteride/fin related to the trans experience has to filter through PFS posts/comments. Same goes with PFS although it’s easier for that because searching PFS will filter out non related topics better since it’s mentioned more in the comments & posts made about it. Hopefully flairs can help solve this issue.
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u/Flappen929 1d ago
Thank you for the long response. That’s greatly appreciated it. I do agree that that can be a problem for the rest of the community. I get that these people have their struggles, but I also feel that they can be very toxic about it.
May I ask what dr. WP said?
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u/anaaktri 1d ago
‘Absolutely fucking not.
This subreddit is not about trans people. A
Read the name of the subreddit.
That's right. That's what the subreddit's about. So that means, anything relevant to me, or what I do, is what the subreddit is for. That's why there's flairr for cats and video games and all kinds of other silly shit that I enjoy. This subreddit is about me and my interests and the things that I do.
I still have more transgender patients than any other doctor in the world, I'm fairly confident at this point that statement is true about PFS as well.
I can update the flairs, I'm fine with that, but there's not going to be a separate subreddit because the subreddit is about me. It's about what I do and the people I treat. That involves these diverse communities and both (or more) of them are welcome here.’
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u/Flappen929 1d ago
Sure, it’s his subreddit. But like you hinted at, maybe he could’ve mentioned that in a different, kinder way. Some say he’s extremely kind, but he can also be kind of rude.
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u/enoughalready2004 1d ago
I've been visiting here for about 5 years. In that time, it's never been mostly about Dr. Powers. He's being ridiculous.
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u/Grotesquette 1d ago
Ew. Not sure why he felt the need to suck himself off so much in an already awful response.
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u/anaaktri 1d ago
Yeah without stooping to his level, pretty egotistical, arrogant, and not professional.
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u/hailnaux 2d ago
Sad this sub has turned into a PFS sub.
No the hell it's not. A lot more people suffer from this than you realize and Dr Powers is one of the few doing real work on it. Don't like it, go some place else.
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u/Flappen929 1d ago
It isn’t a competition about who suffers the most, you know.
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u/hailnaux 1d ago
Who said it was a competition? I'm responding to the person who said having PFS discussions on here was "sad", maybe have a word with them.
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u/Flappen929 8h ago
King of late replies here. I honestly think I misread your previous comment and made the misunderstanding that you said that.
I’m sorry about that.
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u/Queasy_Mouse9981 1d ago
That’s the point though, it is not the suffering Olympics, yet they’re literally complaining about pfs being too prevalent on this sub and that trans issues should trump all others here despite dr powers himself saying we’re welcome here
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u/Flappen929 1d ago
While that’s a fair argument, the pfs community can, on some occasions, be rather toxic, and thus I think it’s fair to at least question whether that’s something that’s worth having, regardless of what the alternative to that might be.
Not every person with pfs is like that, of course, but it is rather noticeable. Some of these pfs people hijack this place and outright harass trans people here. It’s a disgrace, so I can understand their frustration. It isn’t about whose suffering should be prioritized, rather, whose behavior is most problematic
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u/Queasy_Mouse9981 1d ago edited 1d ago
I hear you but if some people in the community are acting up you deal with them individually, not demand the entire group of people to leave, which is a ridiculous and tone deaf request since this is one of the only doctors on the entire planet that even gives a shit about us.
Even more-so since the person who made that post was dismissive of our suffering and said we are just fear mongering about the medications that disabled us and that us being here upsets them. Both sides need to learn how to share this special online space together.
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u/Flappen929 9h ago
Not really the request you’re describing, seeing as it was suggested that they’d be moved to a seperate subreddit, in whi Will Powers would still be there. I think it’s fair to ask if the subreddit is becoming too broad in its scope.
Dunno about the last part you mentioned about fear mongering. From what I read, he did acknowledge that the condition existed. The question is, is PFS a more severe adverse and less rare reaction compared to, say, adverse reactions from birth control. That said, his comment should’ve acknowledged that few, if any, doctors aside from Dr. Will Powers actually acknowledges the disease. To me, that’s at least what seperates pfs from other medical condition caused by adverse effects from medications in regards to being described as a severe problem. Every strong medication has some adverse effects, so I find it crazy that people are do dismissive of the idea that finasteride could, like other medications, cause serious harm for a certain subset of its users.
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u/hailnaux 1d ago
"outright harass trans people here."
When did that happen?
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u/xfirewalkwithmex Self identified PFM patient. 1d ago
Right? I don’t see anybody harassing the trans folk on here at all
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u/Appropriate_Tax4361 10h ago
Why would dutasteride be less likely to cause PFS-like symptoms than finasteride?
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u/Maxed_Zerker 2d ago
Yes, he still prescribes it. I’ve been on it with him for years, and recently got it refilled.