Help me understand what Dr Powers' model for PFS says about risk profile of quitting finasteride.
TL;DR; Help me understand how to combine the various metaphors for how PFS works to better understand potential risks/rewards from quitting finasteride.
After about 18 months taking compounded finasteride/minoxadil for hair loss, I've just learned about PFS. I started estrogen monotherapy a few months after starting on the hair loss pills, and so even before learning about PFS my Dr and I were already discussing dropping the finasteride (since it's likely not doing all that much for me), but now having learned about PFS I get the impression that quitting finasteride can actually increase the risk/severity of negative side effects/symptoms.
Given that, I'm trying to understand the risk dynamics that might arise from quitting finasteride vs staying on it.
Since Dr Powers seems like one of the few experts who's actually making progress here, I've tried to read up on his theory of PFS to see if I could figure out what the right way to think about this is. Here's what I've gathered so far:
- I've seen the DVD-R / DVD-RW metaphor about how finasteride can cause some aspects of the body to adjust to the presence of finasteride creating a dependency, and then fail to re-adjust back when the finasteride is removed. This explains why some people only get symptoms after quitting and would suggest that quitting without symptoms would be risky.
- I've seen other explanations with metaphors about different kinds of damage in an RPG (e.g. fire spells, ice spells, blunt trauma, etc.), and characters with greater or lesser susceptibility to fire. That seems to frames PFS as a sort of accumulation of effect, which explains why some people get PFS after a single dose, others get it after a couple years and still others are fine. If I understand it correctly, that suggests that however many HPs one person takes from each "fire spell", they're less likely to run out of HP if they stop getting hit by fire spells (i.e. quitting should lower risk).
- I've seen still other comments from the PFS community at large, claiming that once you quit finasteride, restarting it drastically increases the risk of severe finasteride side effects (which I don't know how to fit into the model at all)
Unfortunately, I don't nearly understand the biology or epigenetics nearly enough to stitch these different ideas together into a single cohesive way to think about the risk for people who are already on finasteride.
Obviously, I need to talk to my doctor about this, but since most doctors know almost nothing about PFS, I'd love to go into that discussion with a bedrock understanding so I can have a more intelligent discussion with them, and advocate for myself effectively.
Can someone help me stitch these different metaphors together, to help understand the risk calculus that would go into a decision about quitting finasteride?