Hair Loss Prevention
About 50% of the human male population are genetically susceptible to Alopecia Androgenetica, also known as Male Pattern Baldness. Although the exact causes of male baldness are still unknown, most knowledgeable in this area would agree that strong androgenic substances like DHT and testosterone play a large part. If you are prone to MPB and are concerned about keeping your hair, then read on. There are some products that when used alone or especially in combination, can be very effective in halting or even reversing male hair loss.
First, let's take a look at what is known about the causes of MPB. Testosterone is converted to DHT by the 5AR enzyme, which in turn finds its way to your hair follicles and causes them to fall out. The are a few theories on how this occurs. One suggests that DHT causes a progressive miniturization of the affected hair follicles. Another says that DHT causes an autoimmune response, causing the body to actually attack the hair follicles as if they were a foreign body. This in turn causes an inflammatory response that causes the hair follicles to shed.
Either way, its a frustrating problem. A problem that can become greatly accelerated by the use of androgenic drugs, especially those with a high conversion rate to DHT. Testosterone, Anadrol, D-Bol...all of these end up increasing the amounts of DHT in your system. Some, like test, convert through the 5AR enzyme. Anadrol, on the other hand, is not converted to DHT through the 5AR method at all. 1-testosterone can also convert 'back' to DHT though the infamous 'unknown pathway'...in any event higher levels of DHT end up at the scalp when you're using these substances. And, if you're prone, this could spell rapid accelleration of genetic hair loss.
Any androgenic hormone molecule binding to the receptors in your scalp could advance hair-loss in someone prone to MPB. When using steroids, especially those with strong receptor binding characteristics like 1-test or Trenbalone, the actual steroid itself could be a contributing factor to your hair loss, in addition to any elevated levels of DHT in your system.
So now we know that we need to prevent high amounts of androgen molecules from affecting hair follicles at the scalp. This could be done by using oral medication, like:
Dose: 1-2mg /day
Mean terminal half-life is approximately 5-6 hours in men 18-60 years of age and 8 hours in men more than 70 years of age.
There are two types of 5 alpha-reductase (AR), type I and type II, that act as a catalyst in converting testosterone into DHT. Propecia is a 5AR inhibitor, but only effectively inhibits Type II. It has no known effect on type I. Finasteride works by inhibiting the Type II 5alpha-reductase enzyme that is responsible for converting testosterone to DHT. It is not clear as to whether only Type II 5AR is responsible for damage to hair follicles or if Type I is also to blame. It is estimated that Propecia inhibits 70% serum DHT and 38% scalp DHT at the standard, recommended dosage of 1 mg per day. For people suffering from natural hair loss or hair loss brought on by testosterone supplementation, oral 5AR inhibitors could work very well. 1
Initially I was apprehensive about using finasteride to combat hairloss. However, not being satisfied with the rate of regrowth from topical-only solutions, I decided to start implementing oral Finasteride at ~1 mg/day. Since Ive started using it (along with LLLT therapy, see below), my hair really started to thicken - even on the areas of my scalp that seemed to respond more slowly to the topicals. I have no negative side effects at all.
Read more about Finasteride pharmacology here:
Dose: .5mg /day
invivo half life is approximately 5 WEEKS.
Dutasteride ('Duta', 'Duagen'), also known as Avodart, is another oral 5-alpha-reductase inhibitor. It is known to be more potent than Finasteride in that it inhibits both type-I and type-II 5AR enzymes in the body. Dutasteride also has a much longer half-life than Finasteride so any side effects that occur from use will be sustained for a much longer period of time.
Some interesting facts about Dutasteride:
2The medication causes a significant drop in both scalp and blood levels of DHT. Its effectiveness is felt to be related to both of these factors. In patients taking finasteride 1-mg/day, serum DHT levels decreased by 68.4% and serum testosterone levels actually increased by 9.1% but remained within the normal range. In patients taking dutasteride 0.5 mg/day serum DHT levels decreased by 85% in one week and 90% by two weeks. After one year of taking dutasteride 0.5mg/day serum DHT levels decreased by 94% and and testosterone levels increased by 19%, but the testosterone levels remained within physiologic limits. Thyroid Stimulating Hormone (TSH) levels increased 12.4% at 52 weeks and luteinizing hormone (LH) increased by 12% at 6 months and 19% at 12 months. We do not know what the long term consequences will be of the increase in testosterone, TSH, or LH.
However, a strong word of caution for those considering Dutasteride:
2The half life of dutasteride is 5 weeks at steady state. The average steady state concentration is 40ng/ml following 0.5 mg/day for one year. Following daily dosing, dutasteride serum concentrations achieve 65% of steady-state concentration after 1 month and approximately 90% after 3 months. Due to the long half-life dutasteride serum concentrations remain detectable (greater than 0.1ng/ml) for up to 4 to 6 months after discontinuation of treatment.
Due to the long half-life side affects may last much longer. Therefore, we recommend you take Propecia for 6 months to one year prior to starting dutasteride. If you tolerate Propecia well, you may consider switching to dutasteride at the end of your Propecia trial period. While higher dosages up to 2.5 mg of dutasteride have been shown to increase hair counts even greater than 0.5mg, this higher dosage has not been submitted to the FDA for their approval and no phase III human clinical trial at this dosage exist.
Another important thing to keep in mind is that Dutasteride is metabolized by the CYP3A4 enzyme in the liver. So are SERMs. I have no idea whether or not using them both in conjunction could cause undue stress on the liver,as there is plenty of CYP3A4 (its the CYP enzyme that's presnt in the largest amount in the body) but its something to keep in mind until a clear answer can be found.
In my own opinion, people should be weary of using Dutasteride to treat hair loss. Especially if you've never used an oral 5AR inhibitor before. Glaxo, the company that developed it, halted research on Dutasteride for a hair loss treatment for 'unknown reasons'. It probably isnt health related, because its still used as a BPH treatment. However, know that when you use Dutasteride to treat MPB, you are doing so at your own risk. It uncommonly long half life and lack of human trials would make me think twice about it, for sure.
More info on Dutasteride pharmacology:
A good page that compares Dutasteride vs. Finasteride with the pros and cons of each:
Note: oral 5AR blockers should never be used with Deca-Durabolin. It can actually promote hair loss in this situation. Deca reduces via 5AR to a less androgenic molecule called DHN (dihydronandrolone). If you inhibit 5AR while on a cycle of DecaDuraBolin, the compound could actually negatively impact your existing hair loss issues
This brings us to the next weapon in the hair loss prevention arsenal:
There are a few chemicals out there which have been shown to inhibit androgen and DHT molecules at the scalp itself, without showing any systemic side effects. These are:
Spironolactone was originally used as a "Potassium Sparing Diuretic", that has been used for many years to treat high blood pressure and fluid retention. Recently, it has also been used orally as an anti-androgen (it blocks the androgen receptor itself).
For hair loss prevention purposes, it has been found that a solution of Spiro in a 2-5% concentration can effectively block androgens (both DHT and others) from effecting the hair follicles at the scalp when applied topically. You can read more detailed info about some other uses of Spironolactone here:
Keep in mind that although Spironolactone is generally thought to be non-systemic when applied to the scalp, a few users have reported low-androgen related symptoms when using topical Spiro. IMO, it should only be used on cycle ,when a general androgen blocker is needed.
Used as an acne medication, azelaic acid also has one important property when applied to the scalp:
It inhibits DHT up to 100% at the area of application Taking all of the above information into consideration, its obvious why we would want this as part of a hair-loss prevention system.
Read more about Azelaic Acid here:
Nizoral Shampoo (2% Ketoconazole)
When used EOD, Nizoral shampoo can help block the formation of DHT in the scalp. A special version of Nizoral shampoo , 'Regrowth Treatment Shampoo', is available that contains 3% salicylic acid . The salicylic acid helps strip dead layers off the epidermis from the scalp, resulting in greater absorption of the 2% Ketoconazole.
I haven't learned much about this one yet. Thanks to LCSCULLA for bringing it to my attention. Supposedly has a longer half-life than Spiro. Cost might be prohibitive to some, but if it works as claimed it would be very valuable to those trying to save their hair. Also a general anti-androgen.
Read up on Fluridil here:
Ok, now we've covered treatments that can successfully block androgens and DHT at the scalp. For some, using these products alone might be enought to reverse MPB, prevent it during a cycle, etc.
For those of you who are definitely prone to genetic MPB, you will need something to assist the stimulation of new hair growth:
Hair Growth Stimulants
After blocking androgens from affecting hair follicles, the next step is to attempt to promote hair regrowth.
That's right, good ol' Rogaine. Well, the active ingredient in Rogaine, anyway. It was originally used as a high-blood pressure medication and vaso-dialator. Someone discovered that it increased hair growth on various parts of the body when taken in high enough concentrations orally. I guess from there they tried applying it to the scalp. Id love to be able to tell you exactly how Minoxidil works to regrow hair, but no one knows. Knowing that it works and has no systemic side effects is enough for now.
A Note On Minoxidil Use
Of course, there is a drawback with using Minoxidil to regrow your hair. You'll have to use it daily, forever. Its been shown that a few months after Minoxidil use has ceased, any hair regrown with it will start to shed. If your going to lose your hair anyway to genetic MPB, its a small trade off. 5 minutes 2x a day and there's a good chance youll keep your hair, or at the very minimum slow down the inevitable.
In addition, in a small number of users, Minoxidil can cause some slight hair shedding when it is first applied. This is usually very minor and is actually a good indicator that Minoxidil is working for you. The hair that is shed eventually will grow back thicker, having been stimulated by the Minoxidil.
Retin-A, or Retonic Acid, can be used in combination with Minoxidil for a synergistic effect. Studies have shown that combined with minoxidil treatments it will regrow more hair faster than with minoxidil alone. It may increase the absorption of Minoxidil through the skin, it also may have some hair regenerative properties. Again, not much is known about its method of action, only that it has positive results.
Low Level Laser Therapy (LLLT)
Initially, the notion of firing lasers at your scalp might seem like something out of StarTrek, not a real-world hair loss treatment. However, studies are showing the biocell stimulation via laser light in a particular range can actually encourage the follicular cells to grow new hair. I wouldnt have believed it, unless I'd experienced it for myself!
'Hair Loss Clinics' have been using 'Laser Hoods':
to treat hair loss for years, swearing up and down that it had a positive effect on regrowth. Im sure most people wrote them off as quack-jobs, until a company called HairMax developed a personal version and started marketing it for $700. I didnt hear about it until this DateLineNBC episode ran a segment called 'The Follicle Five', that documented 5 guys trying to save their hair via various methods:
Oddly enough, the guy using the Laser Comb had some of the best results! After seeing that, I set off on some research and found that several people were actually building their own 'Laser Brushes' and reported similar results. After reading through a bunch of threads, I came to the conclusion I could build a LLLT unit myself and I did, for $50. With 6 650nm 5mw Laser Diodes mounted in a nice boar's bristle brush, Ive been using it for the recommend 10minutes 2x per week and honestly, my hair has never looked better.
Keep in mind that I also started using Finasteride around the same time, but Finasteride isnt supposed to kick in for a couple months, and I noticed an improvement within 4 weeks using the laser brush.
The 'Hair Loss Prevention Stack'
So if you're truly worried about losing your hair, you have to take action as soon as possible. In this case especially, an ounce of prevention is worth a pound of cure. If you're got some very mild thinning or if you're not that suseptable to androgenic hair loss, then Nizoral Shampoo EOD might be enough to stave off hair loss.
For others that are sure they're going to lose their hair, its best to attack the problem from all feasible angles as soon as possible. For this, there is what I like to call the 'Hair Loss Prevention Stack'
My opinion is that your implementation of the various methods for combating hair loss should follow a level-based approach. Start small and work up. Keep in mind that once you start using a treatment, you have to keep using it. Forever. Studies show that with nearly any hair loss prevention treatment, discontinuing use will result in the person returning to his previous state of MPB within a few months.
With this in mind, start with a solution that isnt too intrusive, and easy to maintain.
Ive come up with a couple 'stacks' that could be implemented in a progessive manner. IE, if level 1 doesnt work, add level 2, etc.
Check it out:
Regrowth Treatment Shampoo & LLLT
Shampoo 3x per week
LLLT 10 minutes per session 2x per week
Squeeze a quarter sized amount into your hand, and shampoo your hair. Message it thourougly into your scalp, and leave in for about 5 minutes before rinsing. This shampoo dries your hair out, so its best to follow application with a good conditioner.
With the Laser Brush, hold it in place on your scalp for about 4 seconds at a time. Move it all around your head, trying to cover all the scalp evenly.
(Level 1 + ...)
Minoxidil 5%/Azelaic Acid 5%/Retin-A 2% Solution
Applied ED, at night before bed. Sunlight breaks down Retin-A and can cause it to irritate the scalp, so its really only to be used at night time. Apply 1ml to the affected areas of the scalp and message into the skin. If your hair loss in generalized, part your hair in several areas and apply the solution directly to the skin. Message into the skin.
Minoxidil 5%/Azelaic Acid 5% Solution
Minoxidil/Azelaic Acid is meant to be applied 2x daily. You should use the Minoxidil w/Retin-A at night, and a solution containing Minoxidil and Azelaic Acid during the day. Try to keep the applications close to 12hrs apart if you can. Apply to the scalp following the same method as outlined above.
The nighttime application of the Minoxidil solution that includes Retin-A is optional, and Ive found that it can irritate the scalp if used too often. If you choose not to go with the Retin-A, just use standard Minox/AA solution 2x per day.
(Level 1 + Level 2 + ...)
Oral Finasteride @ 1 - 2mg/day
You can get a script from your doc for the Finasteride, but it is also available from online vendors as a 'research chemical'. I prefer to keep the orals for last, as I'd rather not put another chemical in my body if I didnt have to.
I suppose you could keep going further here, and implement Dutasteride if the Finasteride wasnt working for you, but you get the idea.
The above products, when used in combination in a consistent daily regimen, have restored my thinning head of hair to a decently thick mane in the past 24 months. In fact, even on 200mg/1-test a day Ive had no shedding whatsoever.
There are stronger concentrations of Minoxidil and Spiro solutions for those that arent responding to the 2% and 5% stuff. Always start with the lower dose, however. I have used Dr.Lee's 15% Minoxidil solution and I found it to be quite effective. As always, YMMV.
A Final Note on Application
Some complain that these products can make the hair look greasy. I find that if I lightly towel-dry my hair, (not the scalp), my hair looks completely dry as if nothing were applied.
Where Do I Get This Stuff?
There are few places to get there products on the web, at decent prices. Ive had very good experience with www.minoxidil.com. In order to order from the site, you have to have an email consultation with Dr.Lee (the Dr. who runs the site and has developed the treatment methods). Its really a no-hassle deal and you'll be able to order within a week or so. They have the biggest selection and its the only place to get the Regrowth Treatment Shampoo. However, their Xandrox products, while excellent quality, are a bit on the expensive side.
Ive ordered from this site many times, but Ive noticed at times their customer service can be shaky at times. I got a bottle of Finasteride from them that I found to have a concentration of 20mg/mL!! (supposed to have been 2mg/mL).
Here's that thread:
A big bonus for me - but pretty alarming for obvious reasons, and after contacting them they had no idea that their product (which they get from another distributor) had such a high concentration.
These things aside, they ship very quickly and the minoxidil products cost about 50% less than those at Dr.Lee's site, and they do work well. Fast shipping and quick response to emails too.
Currently, Im using the 'Level 3' solution and experiencing excellent results. It took ~2 years to work my way into using oral finasteride, however. After you start a treatment, you really need to give it 2-3 months before you know if its working or not, sometimes longer. Some people have inhibitions about using topical treatments, but honestly, its not a big deal at all.
Also, one thing I didnt mention here is actual hair replacement surgery. This is a permanent solution and might be the only option for a non-responder to any of the above treatments. There's tons of info about this out there on the web, I suggest you read up on it if you're interested.
Hope that helped!
1 - http://www.hairlosslearningcenter.org/hair-loss-article.asp?CopyID=22