Okay tagging /u/CarlSagans as well so he sees it.
Long story semi-short, Finasteride is the name of a drug. It was originally developed as a drug to help older men with prostate issues, but they found when they were on the drug, their hair was growing back. So the exact same drug was turned the name brand hair-loss drug that you probably have heard of: Propecia. It's the exact same drug as generic Finsateride (Finasteride is to Propecia as Ibuprofen is to Advil, if that make sense), just in a 1MG dose instead of a 5MG dose.
But here's the rub, Propecia costs a lot, I think it's something like $120+ for 30 pills, so that's like $1500 a year. But you can get a prescription for regular 5MG Finsateride. You just need to get a simple pill cutter (I got this $5 on on Amazon) and cut each pill into 1/4ths, and that's a roughly 1MG dose.
In California, with no insurance, this costs $9 for 30 pills, so 120 doses, which is $27 a year. That's roughly a 98% savings.
All you have to do is know to ask your doctor for this prescription for generic 5MG Finasteride. A lot of people have anxiety about this, they think it's like asking to steal or something. It's not. It's incredibly common. My doctor, the first time I ever saw him, instantly knew what I was talking about and wrote me the scrip in 10 seconds. Didn't bat an eye.
Finasteride has been amazing for me, millions of men have taken it and it's totally safe, and I highly recommend getting on it.
Staggering medication start times is generally done so that if you have an adverse reaction to one of them, it's apparent which one is causing it. Also, I'm suggesting going bicalutamide-only initially just so you can tell if it's effectively blocking testosterone before starting the rest of the therapy.
By splitting pills, I mean getting a tablet splitter and physically cutting your pills into halves or quarters. Bicalutamide is intended to treat prostate cancer, so its dosage in a single tablet is actually much higher than most transgender women need.
A drug's half-life time is the amount of time it takes for your body to eliminate half of the drug. Flutamide has a half-life of 6 hours, so 12 hours after taking it, you only have a quarter of the dose still in your body, and an eighth after 18 hours. In comparison, bicalutamide has a half-life of 6 days, so you can sustain an effective level in your body around the clock much more easily. The flip side though is that if you took enough bicalutamide for it to immediately be effective at the first dose, you'd quickly reach toxic concentrations by taking that same amount every day. It takes about three months for the amount of bicalutamide you take daily to equal the amount eliminated by your body, regardless of what that dose is.
I'm taking selegiline too, here is the pill cutter I use:
$6 and works very well. The key to cutting them evenly is in placement and then the quickness of your cut. You want to put it in the pill cutter, bring the blade down close to the pill but then make a "chopping" motion down to make the cut. Not too fast or you get an uneven cut, not too slow or you end up with too much powder. Once you do it a few times you get a very good feel for it and are able to make perfect cuts.
I think those hair clinic places view you as one of two kinds of patients. You're either a guy like us with semi-fixable hairloss, or you're an older rich guy who they can try to get to pay tons of money for drastic treatment. I think they don't pay a ton of mind to the stuff that doesn't pay them a fraction as much as those whales do.
The Proscar trick is super easy. Basically, Finasteride is a prostate drug. They were giving it to old guys to reduce their prostate size, and their hair started growing back. So it was rebranded as Propecia (and I guess the topical stuff your doc recommended), and sold at a lower dosage for a lot more money. But you can still purchase the prostate version Proscar, which is 100% Finsasteride, exact same drug as Propecia, just at a different dosage. It costs $9, with no insurance, here in California, for 30 pills. The pills are 5mg of Fin, and Propecia is 1mg per pill. So you just purchase a pill cutter (I got this one on Amazon for $5), and cut the pills into 4ths. So 30 5mg pills becomes 120 daily doses of 1.25mg. That's $27 for the whole year, vs. hundreds a month for Propecia. If you want to get on Fin, this is the way to do it. I just asked my regular general practice doctor about it at a checkup, he knew exactly what I was talking about, and wrote me a prescription within 30 seconds.
As for results, I've been on it maybe for just about 2 years now. My baldness was mostly in the crown. I saw some regrowth there, and my hairline moved up slightly in the front. Not dramatic results, but I'm happy for $27 a year. And I've only been using Fin. What it really did was freeze my hairloss in place. It was rapidly losing more and more hair, and it just stopped it in place. So the sooner you can get on, the better, even if it's not a massive regrowth. It works differently for everyone.
I'm about to get on Rogaine again (I had years ago, but it wasn't totally working after a while, and I also had kind of long hair then and it was tough to manage. I have a buzz cut now.), so I'm hoping the combination is more effective at regrowth. But for literally everyone I know who has gotten on Fin, it did one thing. Froze their hairloss. Some had great regrowth, some didn't. But the results are pretty clear from everyone I personally know.
And if you're still worried about the side effects, /u/Clannadqs posted a great thing here a couple weeks ago. I'll quote it below if you want to read it, but it's a great into to why you shouldn't believe all the weirdos in the "hair loss community." It's honestly not a place I expected to find fringe lunatics, but there are a lot of them. They remind of people you see in /r/conspiracy. Pay them no mind. Here's his post:
>Hey guys, I'm pretty new into hairloss as I just found out I was receding not even three weeks ago. I spent the last two weeks researching everything I could and frantically posting every where about it in hopes of getting help and dealing with it. Here are a few tips from me if you are new to losing hair like me. Entirely ignore websites such as hairlosstalk, baldtruth, and slybald guys. They will never help you and will leave you in a worse state than when you went into it. hairloss and baldtruth are full of some of the most depressing humans you will ever find on this planet. If you even show any signs of balding they will tell you to enjoy not having a social life, have fun being a recluse, etc. On top of that, they are never in agreement about anything so when you ask questions you will be in a worse spot than before as well as "experienced" hairloss accounts are disagreeing right in front of your eyes. Also, don't go to slybaldguys because they will try to convince anyone to just shave their head and are completely delusional about the social impact of hairloss. Do not give into fear-mongering about finasteride or dut. That's another reason to keep away from these idiotic forums. Most will recommend fin or dut to help you out, but there are many that add fuel to the fire of fear-mongering. I'm well aware there are probably a few unlucky souls out there that experienced legit side effects from finasteride that continued after quitting, but 99% of the time I immediately view a poster who is going around spreading fear of these drugs as a complete idiot and ignore anything they have to say after that. There are dozens of studies that conclude that finasteride is entirely safe and in almost all of them outside of the PFS backed study (who would have guessed?) show the placebo group reported basically the same amount of sides during the test periods as the group actually taking the medication. Also, fear while taking the drug can actually mentally-induce sexual side effects on yourself and if you are mentally weak it can continue after discontinuation. I have NEVER heard of blood levels not returning to normal after discontinuing the drug. This shows there is literally zero connection between fin and these sides and the people experiencing them have absolutely no evidence it was finasteride in the first place. Just ignore these people. This leads me to the next tip. Get all of your advice from medical professionals and medical professionals only. 99.9% of the time your doctor will tell you finasteride is safe to take no matter how many different doctors you go to. Don't waste your time listening to some 500 post "expert" claiming he has erectile dysfunction while providing no blood tests, no mentions of family history, no mentions of what else they were taking or doing, etc. There has NEVER been a connection scientifically or medically to finasteride being the reason for these sides. As I said above, the placebo groups over 1-10 years reported the exact same sides close to the same percentage. Some people are natural all of their life and still have these issues at even 25. Don't live your life in fear. Post here (tressless, not this thread) for quicker responses if you do genuinely have a question that you want answered. This has, by far, been the best community to approach about this. There are no depressing individuals from what I have seen, people reply extremely quick, and there are some smart people here. No matter what you read around about natural remedies, vitamins, etc if you don't hop on fin or dut, you will lose your hair if you are prone. Not advocating taking these medications, it's up to you. But make sure you won't regret your decision down the road. Also, just to embarrass the user that tried to throw out the FDA review as an argument against finasteride, here are some of the results. Take time to read this page as it will ease your worrying. http://i.imgur.com/dqfIOYg.png Thanks guys.
A nice tablet cutter is really useful. We got one for our dog's medicine, and it works well.
https://www.amazon.com/Apex-Deluxe-Pill-Splitter-splitter/dp/B000EGP5DC
I've thought about doing some ND tablet cutters eventually.
I use this one. Cheap and effective. $5
This is an excellent product. The deluxe is better than the ultra version.
https://www.amazon.co.uk/Apex-deluxe-pill-splitter-Model/dp/B000EGP5DC
I would start at .25. Buy a pill cutter like this one it's easy to cut little pills into quarters with it.
These are available on amazon and almost all big stores that sell any kind of pill.