Hair Loss

[Michael Scally MD]

Gubelin Harcha W, Barboza Martinez J, Tsai TF, et al. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. Elsevier

BACKGROUND: Dihydrotestosterone is the main androgen causative of androgenetic alopecia, a psychologically and physically harmful condition warranting medical treatment.

OBJECTIVE: We sought to compare the efficacy and safety of dutasteride (type 1 and 2 5-alpha reductase inhibitor) with finasteride (type 2 5-alpha reductase inhibitor) and placebo in men with androgenetic alopecia.

METHODS: Men aged 20 to 50 years with androgenetic alopecia were randomized to receive dutasteride (0.02, 0.1, or 0.5 mg/d), finasteride (1 mg/d), or placebo for 24 weeks. The primary end point was hair count (2.54-cm diameter) at week 24. Other assessments included hair count (1.13-cm diameter) and width, photographic assessments (investigators and panel), change in stage, and health outcomes.

RESULTS: In total, 917 men were randomized. Hair count and width increased dose dependently with dutasteride. Dutasteride 0.5 mg significantly increased hair count and width in a 2.54-cm diameter and improved hair growth (frontal view; panel photographic assessment) at week 24 compared with finasteride (P = .003, P = .004, and P = .002, respectively) and placebo (all P < .001). The number and severity of adverse events were similar among treatment groups.

LIMITATIONS: The study was limited to 24 weeks.

CONCLUSIONS: Dutasteride increased hair growth and restoration in men with androgenetic alopecia and was relatively well tolerated.

 

[GodChild1]

So finasteride vs dutasteride?

Seems like lots of dudes in the gym are still using finasteride.

 

[noah_k]

I think it's because finasteride has a long history and they wanted to stick with what was known. That was my reasoning, at least, for buying a shitload of fina as a preventative measure.

 

[kobefan]

fin / dut are better "tolerated" when on exogenous Androgens

 

[Joeblack]

Been on fina for a little bit now. No sides besides watery semen and I see less hair come out when I shower. I'm only taking 0.5mg EOD since it has a long half life. That and rogaine. I have high hopes.

I'm just thining a little btw. I'm catching it before it gets bad

 

[Michael Scally MD]

Panchaprateep R, Asawanonda P. Insulin-Like Growth Factor -1: Roles In Androgenetic Alopecia. Exp Dermatol. Insulin-Like Growth Factor -1: Roles In Androgenetic Alopecia - Panchaprateep - Experimental Dermatology - Wiley Online Library

Of all the cytokines or growth factors which have been postulated to play a role in hair follicle, insulin-like growth factor-1 (IGF-1) is known to be regulated by androgens. However, how IGF-1 is altered in the balding scalp has not yet been investigated.

In this study, expressions of IGF-1 and its binding proteins by dermal papilla (DP) cells obtained from balding vs. non-balding hair follicles were quantified using growth factor array. DP cells from balding scalp follicles were found to secrete significantly less IGF-1, IGFBP-2 and IGFBP-4 (P< 0.05) than their non-balding counterparts.

Our data confirmed that the downregulation of IGF-1 may be one of the important mechanisms contributing to male pattern baldness.

 

[Michael Scally MD]

Nieves A, Garza LA. Does Prostaglandin D hold the cure to male pattern baldness? Exp Dermatol. Does Prostaglandin D2 hold the cure to male pattern baldness? - Nieves - Experimental Dermatology - Wiley Online Library

Lipids in the skin are the most diverse in the entire human body. Their bioactivity in health and disease is underexplored.

Prostaglandin D2 has recently been identified as a factor which is elevated in the bald scalp of men with androgenetic alopecia and has the capacity to decrease hair lengthening. An enzyme which synthesizes it, prostaglandin D2 synthase (PTGDS or lipocalin-PGDS) is hormone responsive in multiple other organs.

PGD2 has two known receptors, GPR44 and PTGDR. GPR44 was found to be necessary for the decrease in hair growth by PGD2. This creates an exciting opportunity to perhaps create novel treatments for androgenetic alopecia which inhibit the activity of PTGDS, PGD2 or GPR44.

This review discusses the current knowledge surrounding PGD2 and future steps needed to translate these findings into novel therapies for patients with androgenetic alopecia.

 

[hardmark]

Hey I didn't see any mention of Spironolactone as a topical. I've had a lot of luck with this along with taking Finasteride. (If you can get your doc to write you a prescription for finesteride instead of propecia you'll save a lot of money) With the 5mg tablets use a pill cutter and cut into quarters and take ED.
Also, I have found the Bosley shampoo products better than Nioxin. (just don't buy their minoxidil or their hair growing tablets (biotin) , they fare a rip off).
With topical 5 % Spironolactone, I do not have a system down, but apply when I'm going to be home and not going to go anywhere for a couple of hours because it smells horrible, like a skunk smell. Apply to thinning areas. BTW my widow's peak on my forehead is returning with this stuff.

 

[Michael Scally MD]

Jo SJ, Shin H, Park YW, et al. Topical valproic acid increases the hair count in male patients with androgenetic alopecia: A randomized, comparative, clinical feasibility study using phototrichogram analysis. J Dermatol. Topical valproic acid increases the hair count in male patients with androgenetic alopecia: A randomized, comparative, clinical feasibility study using phototrichogram analysis - Jo - 2014 - The Journal of Dermatology - Wiley Online Library

Valproic acid (VPA), a widely used anticonvulsant, inhibits glycogen synthase kinase 3beta and activates the Wnt/beta-catenin pathway, which is associated with hair growth cycle and anagen induction. To assess the efficacy of topical VPA for treating androgenetic alopecia (AGA), we performed a randomized, double-blind, placebo-controlled clinical trial.

Male patients with moderate AGA underwent treatment with either VPA (sodium valproate, 8.3%) or placebo spray for 24 weeks. The primary end-point for efficacy was the change in hair count during treatment, which was assessed by phototrichogram analysis. Of the 40 patients enrolled in the study, 27 (n = 15, VPA group; n = 12, placebo group) completed the entire protocol with good compliance. No statistical differences in age, hair loss duration and total hair count at baseline were found between the groups.

The mean change in total hair count was significantly higher in the VPA group than in the placebo group (P = 0.047). Both groups experienced mostly mild and self-limited adverse events, but their differences in prevalence rates were similar between the two groups (P = 0.72). A subject treated with topical VPA developed ventricular tachycardia, but it did not seem to be related to the VPA spray. Topical VPA increased the total hair counts of our patients; therefore, it is a potential treatment option for AGA.

 

[legitbru]

I'm young (18) and have baldness in my family on both sides.

I currently have a thick head of hair, what can I do as very early precautions?

 

[Drea'An]

I lost all of my hair during the summer, fall, and winter seasons of 1999 working as a recreation director at a recreation center. The influx of people was overwhelming, but what bothered me the most was the punk-ass teenagers.
I wanted to beat down a selected few of them so bad, but I knew if I did, I'd be going to prison for manslaughter. My hair reached the top of my shoulders and it was all gone in a matter of months. Saddens the fuck out of me.

 

[kobefan]

from baldtruth . desmond84

"The scientists @ Nanfang Hospital of Southern Medical University in China just published this article. They confirmed that the expression of several genes and proteins associated with hair follicle inductivity of DP cells, such as NCAM, Versican and ?-SMA were maintained using this 3D Matrigel Culturing Method.

THREE DIFFERENT TEAMS FROM ALL OVER THE WORLD HAVE MANAGED TO CRACK THIS ISSUE IN THE LAST 3 MONTHS Jahoda/Christiano, Taiwan Uni & Now the Chinese. We are so close Here's the abstract:

Controllable production of transplantable adult human high-passage dermal papilla spheroids using 3D Matrigel culture

We have succeeded in culturing human dermal papilla (DP) cells spheroids and developed a three-dimensional Matrigel (basement membrane matrix) culture technique that can enhance and restores DP cells unique characteristics in vitro.

When 10000 DP cells were cultured on the 96 well plates pre-coated with Matrigel for 5 days, both passage 2 and passage 8 DP cells formed spheroidal microtissues with a diameter of 150-250 ?m in an aggregative and proliferative manner. We transferred and re-cultured these DP spheroids onto commercial plates. Cells within DP spheres could disaggregate and migrate out, which was similar to primary DP. Moreover, we examined the expression of several genes and proteins associated with hair follicle inductivity of DP cells, such as NCAM, Versican and ?-SMA, and con?rmed that their expression level was elevated in the spheres compared with the dissociated DP cells. To examine hair-inducing ability of DP spheres, hair germinal matrix cells and DP spheres were mixed and cultured on Matrigel. Unlike the dissociated DP cells and hair germinal matrix cells co-cultured in two dimensions, hair germinal matrix cells can differentiate into hair-like fibers under the induction of the DP spheres made from the high passage cells (passage 8) in vitro.

We are the first to show that passage 3 human hair germinal matrix cells differentiate into hair-like fiber in the presence of human DP spheroids.

These results suggest that three-dimensional Matrigel culture technique is an ideal culture model for forming DP spheroids and that sphere formation partially models the intact DP, resulting in hair induction, even by high passage DP cells.

http://online.liebertpub.com/doi/abs....TEA.2013.0547"

 

[solo47]

Gubelin Harcha W, Barboza Martinez J, Tsai TF, et al. A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol. Elsevier

BACKGROUND: Dihydrotestosterone is the main androgen causative of androgenetic alopecia, a psychologically and physically harmful condition warranting medical treatment.

OBJECTIVE: We sought to compare the efficacy and safety of dutasteride (type 1 and 2 5-alpha reductase inhibitor) with finasteride (type 2 5-alpha reductase inhibitor) and placebo in men with androgenetic alopecia.

METHODS: Men aged 20 to 50 years with androgenetic alopecia were randomized to receive dutasteride (0.02, 0.1, or 0.5 mg/d), finasteride (1 mg/d), or placebo for 24 weeks. The primary end point was hair count (2.54-cm diameter) at week 24. Other assessments included hair count (1.13-cm diameter) and width, photographic assessments (investigators and panel), change in stage, and health outcomes.

RESULTS: In total, 917 men were randomized. Hair count and width increased dose dependently with dutasteride. Dutasteride 0.5 mg significantly increased hair count and width in a 2.54-cm diameter and improved hair growth (frontal view; panel photographic assessment) at week 24 compared with finasteride (P = .003, P = .004, and P = .002, respectively) and placebo (all P < .001). The number and severity of adverse events were similar among treatment groups.

LIMITATIONS: The study was limited to 24 weeks.

CONCLUSIONS: Dutasteride increased hair growth and restoration in men with androgenetic alopecia and was relatively well tolerated.

I never really planned it, but I began taking Avodart® regularly for BPH many years ago. Expensive as it is, I don't regret it for a second. I also added Nioxin shampoo and, occasionally, Nioxin scalp conditioner & Nizoral shampoo treatment. I was thinning pretty quickly when I started on the Avodart® back in my late 40s, especially on the back of my head. Unexpectedly, now that I just turn 64, still weightlifting (though not at the same pace), on TRT and doing cycles once or twice a year, I have a fuller head of (white) hair than when I began Avodart (just thin on the back, but there's hair b'god). I dye it, somewhat unwillingly, because of my younger wife, but I think Avodart has made all the difference. And, of course, I did not have the genes for early hair loss.

Respects,
Solo

 

[Ihatecivic]

Great info, thx for sharing

 

[Lorello]

Some of you bros dont care about hair loss, but it can be a big concern for most of us other bros. I'm 35 and I still have a thick and full head of hair. I am not one of those guys who would look good bald or balding. In some of my cycles years ago, I noticed large volumes of hair falling out in the shower during a cycle. This brought me to the point where I would look in the mirror and say, "What good is there in having huge muscles if my hair looks like crap?" So my search began to find the best possible hair solution, which involves stopping hair loss and even reversing it!



Let me just show you the final results (IN ORDER OF IMPORTANCE), and I will comment on each:

1. AVODART® (Dutasteride) - Dutasteride was developed to help shrink the prostate and was found to have an even more profound effect on regrowing hair than Finasteride! Not only that, it can take care of more of your DHT, it starts working faster, and stays in your system for much longer. 1 to 5 mg ED is all you need, and it also keeps that prostate down during your cycles. In my book, this is a win/win situation.
   
   
   
2. PROPECIA® (Finasteride) - Next to Viagra, this drug may have had one of the all time record advertising budgets. Finasteride is a hair loss prevention / regrowth drug. Recommended dose is 1 mg ED and after 6 to 12 months the user may achieve positive results. The reason I write "big 4" in the title of this thread is that it may not be necessary to use both Dutasteride and Finasteride, although there are no known drug interactions. I say roll with Dutasteride if you can and if not then use Finasteride.
   
   
   
3. ROGAINE® (Minoxidil) - Cheap to buy generic at target in three month supply, Minoxidil blocks DHT on the scalp. After handling DHT within the body via Dutasteride or Finasteride, you can also stop the damage of DHT on the scalp. Use twice a day. I use it after my morning shower and after my workout shower.
   
   
   
4. NIOXIN® (Cleanser, Conditioner, and Treatment) - Use these Nioxin products as your daily shampoo and conditioner. They work on the scalp to ensure that your skin is healthy. Shampoo removes impurities that clog follicles, including DHT. The conditioner keeps the scalp moisturized. The treatment adds botanicals and nutrients to the scalp skin.
   
   
   
5. NIZORAL® (A-D Shampoo) - Ketoconazole, the main ingredient in Nizoral, acts as a relatively mild anti-androgen. (Androgen binds to hair follicles and over time shrinks them down, causing thinner and thinner hair.) Use this shampoo once a week for help with DHT.
   

This hair regiment is not difficult to maintain, and can provide great results. I went from losing my hair to growing it back! It takes a few months to start working, so for the first 6 months have patience. Passing the 1 to 2 year markers using the "Big 4" regiment should yield significant hair gains, or at the very least put an end to your loss.



This article assumes appropriate nutrition, hydration, and sleep.



Peace,



-bj

Nice post!

 

[Michael Scally MD]

Dhurat R, Sukesh M, Avhad G, Dandale A, Pal A, Pund P. A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia: a pilot study. Int J Trichology 2013;5(1):6-11. A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study

INTRODUCTION: Dermal papilla (DP) is the site of expression of various hair growth related genes. Various researches have demonstrated the underlying importance of Wnt proteins and wound growth factors in stimulating DP associated stem cells. Microneedling works by stimulation of stem cells and inducing activation of growth factors.

MATERIALS AND METHODS: Hundred cases of mild to moderate (III vertex or IV) androgenetic alopecia (AGA) were recruited into 2 groups. After randomization one group was offered weekly microneedling treatment with twice daily 5% minoxidil lotion (Microneedling group); other group was given only 5% minoxidil lotion.

After baseline global photographs, the scalp were shaved off to ensure equal length of hair shaft in all. Hair count was done in 1 cm(2) targeted fixed area (marked with tattoo) at baseline and at end of therapy (week 12). The 3 primary efficacy parameters assessed were: Change from baseline hair count at 12 weeks, patient assessment of hair growth at 12 weeks, and investigator assessment of hair growth at 12 weeks. A blinded investigators evaluated global photographic response. The response was assessed by 7- point scale.

RESULTS:
(1) Hair counts - The mean change in hair count at week 12 was significantly greater for the Microneedling group compared to the Minoxidil group (91.4 vs 22.2 respectively).
(2) Investigator evaluation - Forty patients in Microneedling group had +2 to +3 response on 7-point visual analogue scale, while none showed the same response in the Minoxidil group.
(3) Patient evaluation - In the Microneedling group, 41 (82%) patients reported more than 50% improvement versus only 2 (4.5%) patients in the Minoxidil group.

Unsatisfied patients to conventional therapy for AGA got good response with Microneedling treatment.

CONCLUSION: Dermaroller along with Minoxidil treated group was statistically superior to Minoxidil treated group in promoting hair growth in men with AGA for all 3 primary efficacy measures of hair growth. Microneedling is a safe and a promising tool in hair stimulation and also is useful to treat hair loss refractory to Minoxidil therapy.

 

[Michael Scally MD]

Chaudhari ND, Sharma YK, Dash K, Deshmukh P. Role of Platelet-rich Plasma in the Management of Androgenetic Alopecia. Int J Trichology 2012;4(4):291-2. Role of Platelet-rich Plasma in the Management of Androgenetic Alopecia

 

[solo47]

You don't need Finasteride (Propecia®) if you're using Dutasteride (Avodart®). Is there any value to Minoxidil (Rogaine®)? I don't use it, and I've heard mainly negative things from those who used it alone. "Microneedling" it into your scalp tissue seems to make a big difference, according to Doc Scally (above).

"Hair today; gone tomorrow."

Solo

 

[billydidit]

You don't need Finasteride (Propecia®) if you're using Dutasteride (Avodart®). Is there any value to Minoxidil (Rogaine®)? I don't use it, and I've heard mainly negative things from those who used it alone. "Microneedling" it into your scalp tissue seems to make a big difference, according to Doc Scally (above).

"Hair today; gone tomorrow."

Solo

Yes there seems to be a synergy with Propecia and Rogaine used at same time. Since I use large amounts of test p and tren ace I don't mind using both Avodart and Propecia. Helps me piss and really controls the hair loss. However, if I had to choose I would pick Avodart because of it's dual function and it keeps working for months after it is built up in your system. I would like to know more about this "needling"

 

[billydidit]

I say add this into the mix. A Derma Roller. (micro needling)

Derma Roller 0.2mm DermaRoller
Derma Roller 0.2mm DermaRoller