31M on TRT, 3 weeks into finasteride but getting dizziness — should I switch to topical, lower the dose, or consider a transplant?

[Austin_Evans]

I

m 31 years old and have been dealing with progressive male pattern hair loss, mainly through the crown and mid-scalp. My frontal hairline is still fairly intact.

I’ve been on TRT at 70mg/week, and it feels like my hair loss has accelerated over the last couple of years. I recently started oral finasteride 1mg daily. The first 2 weeks were completely fine, but around week 3 I started getting recurring dizziness (I’d rate it about 4/10). I’ve never really had dizziness issues before.

My goal is to look my best for my wedding next April, so I’m trying to decide what makes the most sense.

Options I’m considering:
Staying on 1mg finasteride and seeing if the dizziness resolves

Lowering the dose (0.25mg–0.5mg)

Switching to topical finasteride

Adding minoxidil

Getting a hair transplant

I’ve attached wet and dry hair photos. The wet photos obviously look much worse, but I’d appreciate honest feedback on:

How advanced does my hair loss look?

Does it seem like I’m still a good candidate for medical therapy/regrowth?

If you were in my shoes, would you push through with finasteride, switch to topical, or start planning for a transplant?

Do you think a transplant would make a meaningful cosmetic difference by next April?

Any advice from people on TRT who have dealt with similar hair loss would be greatly appreciated.

Thanks!

[Henryk]

dizziness is a common side effect of oral min. switching to topical might reduce it since it acts locally. staying on fin is good for DHT reduction. since you’re microneedling, using topical min can enhance results. if the dizziness persists or worsens, definitely consider giving topical a try. hair transplant is best considered when your hair loss stabilizes, so continuing the current treatments to reach that point makes sense.