Non surgical treatments for hair loss.

[bananas007]

I noticed there are a lot of hair loss post on this forum as it is a common side effect of AAS. I work in the hair transplant industry but also have a lot of knowledge about non surgical options. I wanted to list some current options available and their efficacy.

1. Dutasteride - this is the most powerful option. It is NOT FDA approved for MPB, so has to be used off label. It decreases serum DHT by greater than 90%. If you are considering this , you should discuss the risks with your doctor

2. Finasteride – this Is FDA approved for hair loss at 1 mg dose. It decreases DHT by about 60-70%. Again discuss risk with your doctor

3. Topical Minoxidil – also known as rogaine. This is available otc and helps with promoting hair growth

4. Oral Minoxidil – this is also something that has been used more commonly in the recent years. It used to be a blood pressure medication in the old days but now we have better BP meds. This is once again NOT FDA approved for hair loss so a lot of the use is off label. Once again discuss risk with your doctor

5. Ketocanazole shampoo – this is an anti androgen shampoo to be used 3 times a week and is shown to be beneficial for hair loss from MPB

6. Laser Hats- When they were studying mice for faster healing of wounds under laser light they noticed that the hair was growing very fast in the area exposed to laser. This led to the development of laser caps you see on the market that help with boosting hair growth. I would say the efficacy is sub par and most users will probably be disappointed.

7. PRP – This is used for hair loss as well. Efficacy is modest. Benefits include low chances of any side effects. If you do PRP make sure you go to someone that uses a good concentration of platelets and preferably activates the platelets right before injecting them.

All therapies can have side effect. So before starting any you should discuss with your physician.
I do not have enough knowledge or experience with other drugs that never made it to the market such as RU58841 . I discourage people from using something that is not “well studied.”

Feel free to post any questions you may have and I will try my best to answer them if I am knowledgeable about it.

 

[bananas007]

A common misconception I often see with the general population is “oh I will just get a hair transplant” and reverse my hair loss. A hair transplant is USUALLY not a one and done thing. Since hair loss is usually a life long process, a hair transplant can only return the hair loss you have lost up to that point in your life. Most people will need more than one transplant in their lifetime as they continue to lose hair further in life. So you want to make sure you select a surgeon that respects the natural course of this disease and plans accordingly otherwise you will be left with a very unnatural look.

This is why patients that are on medical stabilization (finasteride etc.) usually fare better than the patients that don’t take meds. Their hair loss is significantly slower.

 

[Keefs]

I noticed there are a lot of hair loss post on this forum as it is a common side effect of AAS. I work in the hair transplant industry but also have a lot of knowledge about non surgical options. I wanted to list some current options available and their efficacy.

1. Dutasteride - this is the most powerful option. It is NOT FDA approved for MPB, so has to be used off label. It decreases serum DHT by greater than 90%. If you are considering this , you should discuss the risks with your doctor

2. Finasteride – this Is FDA approved for hair loss at 1 mg dose. It decreases DHT by about 60-70%. Again discuss risk with your doctor

3. Topical Minoxidil – also known as rogaine. This is available otc and helps with promoting hair growth

4. Oral Minoxidil – this is also something that has been used more commonly in the recent years. It used to be a blood pressure medication in the old days but now we have better BP meds. This is once again NOT FDA approved for hair loss so a lot of the use is off label. Once again discuss risk with your doctor

5. Ketocanazole shampoo – this is an anti androgen shampoo to be used 3 times a week and is shown to be beneficial for hair loss from MPB

6. Laser Hats- When they were studying mice for faster healing of wounds under laser light they noticed that the hair was growing very fast in the area exposed to laser. This led to the development of laser caps you see on the market that help with boosting hair growth. I would say the efficacy is sub par and most users will probably be disappointed.

7. PRP – This is used for hair loss as well. Efficacy is modest. Benefits include low chances of any side effects. If you do PRP make sure you go to someone that uses a good concentration of platelets and preferably activates the platelets right before injecting them.

All therapies can have side effect. So before starting any you should discuss with your physician.
I do not have enough knowledge or experience with other drugs that never made it to the market such as RU58841 . I discourage people from using something that is not “well studied.”

Feel free to post any questions you may have and I will try my best to answer them if I am knowledgeable about it.

I’ve been on and off finasteride for a while. When I keep me trt dose very low I feel like I don’t really need it. I will generally take 1mg of finasteride daily for every 100mg weekly test that I take. This seems to help a lot but my question is, does 2mg reduce dht any more than 1? My thinking is that it has to or why would they make a 5mg dose for people with prostate issues. I would love to try some dutasteride since my hair is starting to thin pretty noticeably in the crown now, but my doctor was hesitant to even put me on finasteride.

 

[bananas007]

I’ve been on and off finasteride for a while. When I keep me trt dose very low I feel like I don’t really need it. I will generally take 1mg of finasteride daily for every 100mg weekly test that I take. This seems to help a lot but my question is, does 2mg reduce dht any more than 1? My thinking is that it has to or why would they make a 5mg dose for people with prostate issues. I would love to try some dutasteride since my hair is starting to thin pretty noticeably in the crown now, but my doctor was hesitant to even put me on finasteride.

Yes 2mg will reduce dht more than 1mg but you start seeing a diminshing return. So if 1mg suppresses 70% DHT, going on 2mg will suppress 80%.

So for a 100% increase in dose you only increased dht supression by 14%.

 

[Keefs]

Yes 2mg will reduce dht more than 1mg but you start seeing a diminshing return. So if 1mg suppresses 70% DHT, going on 2mg will suppress 80%.

So for a 100% increase in dose you only increased dht supression by 14%.

Thanks for your advice. I’m really appreciating the knowledge you are bringing to this community right now. One more question though! I ordered some topical minoxidil a while back and have yet to use any of it. I’m a little scared for two reasons. Number one, once you start on that journey it’s pretty much never ending. Second, even though it’s topical I’m pretty sure it will end up in my whole system whether I like it or not. I’m also concerned with it causing more hair growth in areas that I don’t have much at the moment. Like my back mainly! I have a few wild hairs there now but it’s very minimal. Could minoxidil cause hair growth all over the body when applied topically or ingested orally? What are your thoughts on this.

 

[bananas007]

Thanks for your advice. I’m really appreciating the knowledge you are bringing to this community right now. One more question though! I ordered some topical minoxidil a while back and have yet to use any of it. I’m a little scared for two reasons. Number one, once you start on that journey it’s pretty much never ending. Second, even though it’s topical I’m pretty sure it will end up in my whole system whether I like it or not. I’m also concerned with it causing more hair growth in areas that I don’t have much at the moment. Like my back mainly! I have a few wild hairs there now but it’s very minimal. Could minoxidil cause hair growth all over the body when applied topically or ingested orally? What are your thoughts on this.

Hypertrichosis or hair growth in other parts of the body is a common side effect of minoxidil but is much more common with oral minoxidil. With topical minoxidil, as long as you wash your hands after application, you should not have much more hair growth anywhere else. Some females notice some facial hair growth, but I am assuming you are not a female if you are on finasteride so you probably will not notice this much.

Interesting story, how minoxidil became a hair loss medication is back in the 80’s it was a pill for blood pressure. But they noticed that people who were taking it for blood pressure would have such severe hair growth in other parts of the body, that is when they found the connection.

What you say about being on something “life long” also holds true for finasteride too. If you stop taking it, you will lose the hair it is protecting.

It is possible to have systemic side effects from topical minoxidil but it is very rare. More common is application site irritation.

Finasteride is much more efficacious than minoxidil. If you are already on finasteride, its just a personal preference if you want to boost it a bit more with minoxidil. But twice daily applications can get annoying. So if you are not going to commit to it long term then no point in doing it.

 

[Keefs]

Hypertrichosis or hair growth in other parts of the body is a common side effect of minoxidil but is much more common with oral minoxidil. With topical minoxidil, as long as you wash your hands after application, you should not have much more hair growth anywhere else. Some females notice some facial hair growth, but I am assuming you are not a female if you are on finasteride so you probably will not notice this much.

Interesting story, how minoxidil became a hair loss medication is back in the 80’s it was a pill for blood pressure. But they noticed that people who were taking it for blood pressure would have such severe hair growth in other parts of the body, that is when they found the connection.

What you say about being on something “life long” also holds true for finasteride too. If you stop taking it, you will lose the hair it is protecting.

It is possible to have systemic side effects from topical minoxidil but it is very rare. More common is application site irritation.

Finasteride is much more efficacious than minoxidil. If you are already on finasteride, its just a personal preference if you want to boost it a bit more with minoxidil. But twice daily applications can get annoying. So if you are not going to commit to it long term then no point in doing it.

Thanks for your advice again. All of that makes a lot of sense. If I end up using minoxidil I think I will stick with the topical version. I don’t quite agree with what you say about dropping finasteride though. There are other ways of lowering DHT than taking finasteride. For instance, if i lowered my testosterone dose to 50mg a week that would also lower my DHT levels. Finasteride would not be necessary at that point and my hair would be fine.

 

[bananas007]

Thanks for your advice again. All of that makes a lot of sense. If I end up using minoxidil I think I will stick with the topical version. I don’t quite agree with what you say about dropping finasteride though. There are other ways of lowering DHT than taking finasteride. For instance, if i lowered my testosterone dose to 50mg a week that would also lower my DHT levels. Finasteride would not be necessary at that point and my hair would be fine.

What you are saying holds true on paper using math, but our bodies are more complex. There are negative feedback loops, enzyme inhibition, overcompensation, receptor up and down regulations going on etc. So a doubling of testosterone and halving of testosterone , adding finasteride stopping finasteride, your hormones will fluctuate on blood work. But you cant confidently conclude that : - the amount of hair loss on 50 mg testosterone/ week and 0 mg of finasteride will be equal or less than the amount of hair loss on 100 mg testosterone and 1 mg finasteride per week.

Also hormone fluctuations (getting on and off the finasteride) will cycle the hair from anagen to telogen everytime and you will see a shed. This is independent to the miniaturization of the hair shaft that is occurring from DHT. Each follicle is born with a limited amount of cycles before it will permanently shut down.

I am not saying what you are trying to do is an unreasonable strategy, but it is not bulletproof. Over ten years the areas you see are thinning will continue to thin and bald if you continue to go on and off finasteride.


EDIT: I am not stating the above as a scientific fact, but basing it on my knowledge and clinical experience.

 

[bananas007]

Here is an interesting fact, that some may or may not know. Hair loss is not a all or nothing event. What happens in androgenetic alopecia/ male pattern baldness is because of the effect of DHT your hair shaft miniaturizes "shrinks" over time. In the image below you can clearly see the miniaturized/ miniaturizing thin hair vs the healthy thick hair. As more and more hair miniaturize your scalp starts showing through and people notice they are balding. Since the crosssectional area of a hair shaft is pi(r)2 even a small decrease in the thickness has a 4 times decrease in coverage value and Vice versa (when you get on medications and reverse this miniaturization).

 

[Keefs]

What you are saying holds true on paper using math, but our bodies are more complex. There are negative feedback loops, enzyme inhibition, overcompensation, receptor up and down regulations going on etc. So a doubling of testosterone and halving of testosterone , adding finasteride stopping finasteride, your hormones will fluctuate on blood work. But you cant confidently conclude that : - the amount of hair loss on 50 mg testosterone/ week and 0 mg of finasteride will be equal or less than the amount of hair loss on 100 mg testosterone and 1 mg finasteride per week.

Also hormone fluctuations (getting on and off the finasteride) will cycle the hair from anagen to telogen everytime and you will see a shed. This is independent to the miniaturization of the hair shaft that is occurring from DHT. Each follicle is born with a limited amount of cycles before it will permanently shut down.

I am not saying what you are trying to do is an unreasonable strategy, but it is not bulletproof. Over ten years the areas you see are thinning will continue to thin and bald if you continue to go on and off finasteride.


EDIT: I am not stating the above as a scientific fact, but basing it on my knowledge and clinical experience.

I like your advice here and I think I’m going to stick with it. It won’t hurt for me to keep taking fin no matter what my dose of test is. Until I completely give up on my hair I’ll just keep taking it. You know I’ve also noticed that my skin seems nicer on fin too. Some people say it doesn’t affect your skin but for me it does seem to help. I’m prone to acne on higher doses of test but the fin knocks it right out.