October 2020 Note: This post was authored back in 2013, and 7 years later, I’d expect the hair loss landscape to have changed a bit. So fair warning, this is an old article.
As someone for whom hair loss is in the family tree, I was keen to find out if with all our modern technology and drugs, it could be prevented. I delved deep into the subject, and below I share what I’ve learnt.
Index of Sections
- My journey into the world of hair loss prevention
- My personal experience with Treatments
- Discussions with Experts
My journey into the world of hair loss prevention
Hair loss in guys is a common thing – and you’d expect there to be a way to fix it.
Back in 2008 I began looking into ways I could do this…
When looking for a solution to a problem you need to first define the problem clearly.
We know that genetic predisposition can cause hair follicles on the top of a mans head to be sensitive to DHT exposure. And if that is the case then they will lose hair on their head some point in their life unless they are castrated (ouch!).
There are lots of forums out there that discuss hair loss to varying lengths. As far as I’m aware the two most popular are:
My preferred choice of the two is Hair Loss Help. I occasionally post under the name of “chin_up”.
The other source I find interesting is http://www.baldingblog.com/ – headed up by Dr Rassman.
Currently the most effective way of treating hair loss is to firstly slow it with an internal systematic drug. Internally there are two common treatments; finasteride and Dutasteride. Finasteride is a 5-alpha reductase type 2 inhibitor. Dutasteride is a 5-alpha reductase type 1 & 2 inhibitor. This does raise the question – what is 5-alpha reductase? Wikipedia does a good job at explaining it here.
The problem with the inhibition of DHT is that it doesn’t just prevent DHT reaching the hair follicles but it inhibits DHT system-wide.
DHT is key at puberty because it causes the growth of secondary male characteristics. The theory is that after they have developed it is not a fundamental requirement in the sites where 5-alpha reductase type 2 (5AR2) exists.
Certain members of the Hair Loss Help forums cite a rare subset of humans that are born pseudo-hermaphrodites (because they don’t have the 5AR Type 2 enzyme) as evidence that it is safe to inhibit 5AR Type 2. They don’t produce DHT… and other than their sexual issues are not thought to be have any other problems (“Individuals with 5-ARD can have normal male external genitalia, ambiguous genitalia, or normal female genitalia”). The key thing also being that they don’t get AA.
I found Alex Miller’s discussion incredibly interesting. One of the scary things for me was the inhibition of allopregnanolone when taking finasteride.
Commonly people don’t use Dutasteride unless Finasteride isn’t doing the job. This is because dutasteride also blocks 5AR Type 1 which can lead to greater risk of side effects.
The problem with both of these internal drugs is that they have side effects. These side effects are especially serious because the drugs have to be taken ones “whole life” if they want to keep their hair.
Propeciahelp.com is a site setup by people suffering what they call post-finasteride syndrome (PFS). They have a forum section set up specifically to discuss sides. I think it’s safe to say that not all these side effects come from the use of propecia – however it is interesting to read some of the lesser known *possible* side effects – here.
Read the Wikipedia entry here. The key comment I have is that minoxidil doesn’t stop the hair that’s falling out from doing so. It simply grows new “minoxidil” hair – and this will fall out if you stop applying minox. It’s not wise to use on its own – but appears to work synergistically with finasteride. I used it in a couple of ways. The first was a regular liquid, with which I got heart palpitations. After that, I tested out the Rogaine foam version (which sits easier on the scalp, instead of running off onto your clothes), and this worked better for me.
Read the Wikipedia entry here. It can’t prevent hair loss on it’s own as a topical.
Nizoral shampoo won’t prevent hair loss, but its incredibly useful for reducing the itchyness often experienced with male pattern baldness. Nizoral is a great tool, and I used it a lot before shaving my head.
Read the Wikipedia entry here. From what I’ve read Sprio does have anti-androgenic properties and could be helpful in fighting hair loss in conjunction with the successful use of an internal.
Combining Ketoconazole & Spironolactone
This was an idea I got from someone called Dr John Crisler. There was a big thread that he participated in over at hairlosshelp. Essentially he treats people for various endocrine issues and found there were a number of people coming to him with “post-finasteride syndrome”. He saw that this was clearly a dangerous drug and spoke out against it. He suggested using a topical mix of Ketoconazole and Spironolactone instead. Unfortunately it was not possible to get in the UK – and I did look into it. Even if I could now get hold of it I am very skeptical about the efficacy of it – after all these aren’t great androgen inhibitors.
Example of a study here.
It used to be produced by Faith Eagle and Kouting – but I’m not sure who is still producing it now.
- Apparently a strong anti-androgen
- Potential systematic absorbtion
- Difficult to apply
- Not easy to source
- Next to no users and barely any trials
My inclination is that if this treatment worked well we’d all know about it. I’d imagine it to be a waste of time and money.
Fluridil is a topical that sounds more promising than it is. It apparently works by blocking the receptors near the hair follicle that are sensitive to DHT.
- It’s not a 5AR inhibitor – so no post-finasteride syndrome worries
- The molecule apparently degrades when coming into contact with water and this makes systematic absorption difficult
- Difficult to apply
- Insufficient number of people who have had good results with it
There are treatments that I may have skipped over or missed like the laser comb (which by the way, doesn’t work). However these are the main treatments. Be wary of anything that promises miracle results… they’ll come one day – but they don’t exist at the time of writing.
My personal experience with Minoxidil & Finasteride
Initially I was put off by finasteride. I knew that taking a drug internally when the problem was on the top of my head was risky business… so as do most people I think, I turned to topicals. Minoxidil is FDA approved and has quite a big commercial push behind it. I understand that it works and I wanted to try it. I purchased it in foam form online from Minoxidil-Direct (now defunct?) on the 16th May 2010. The problem I was getting from it after applying it at night was heart palpitations. They didn’t go away – and quite frankly scared the shit out of me. In the end I stopped applying it and sold what I had left on eBay.
I wanted to try out finasteride despite knowing full well that there may be side effects. It got to the point where I thought if I’m going to stop hair loss it needs to be now before I lose anymore hair – and it ultimately becomes pointless. There are people on forums that say they haven’t experienced sides at all. Some also say that they experienced sides initially and then they subsided.
Hair loss in the UK is considered a cosmetic issue and as such treatments are not covered by the NHS. Talking to my GP didn’t get me very far. They couldn’t prescribe me any medicine to treat the hair loss – nor could they give me blood tests. The point of blood tests in my eyes would be to get a base line of my hormone levels before I began medicine. The idea would then be to keep monitoring the hormone levels to check for changes. In particular a rise in estrogen could predict gynomastasia… and it would be a clear sign that problems lay ahead. Unfortunately I couldn’t afford the time and money it would take to book appointments with a private doctor to get this done. I figured that the side effects will most likely manifest themselves physically anyway so checking my blood levels wouldn’t help anyway.
The next step was to get hold of some finasteride. I decided to follow the crowds and source it from a company called inhouse pharmacy (now defunct?). I settled for a product they sell called finpecia – it is manufactured from a reasonably well known Indian company called Cipla. After a lot of online reading it appeared to be legit and comparable to the more expensive Merck made Propecia. They sell it in 1mg pills – each strip containing 10 pills.
It was actually quite exciting when I received the delivery. I thought wow… I’m making my first steps to ‘recovery’. I decided that I would lower the dosage from the recommended 1mg per day to 0.25 (1/4 pill) every other day. The idea being that the side effects if they occurred should be minimal. Then I would step the dosage up as time went by.
The reality was quite different. The first experiment with finasteride only lasted two weeks. The pills were effecting me mentally… I felt very tired and lifeless on them. Arriving home from work exhausted when normally I’d be buzzing with energy (you know that works done good feeling?). Then additionally I was having trouble stimulating errections. I’m happy to put the sexual side effects down the placebo affect – I’d already read about the potential and therefore I may have manifested them. However the mental exhaustion was new to me. I’ve not had that before and it was frankly horrible. After just 16 quarters (4 pills) I decided this was enough for me. Even if the side effects declined with time the thought that side effects like these could crop up further down the line scared me too much.
My next step was to try Fluridil (branded as Eucapil). I ordered a couple months of supply from the Czech Republic (£65). They come in these fancy glass vials that you have to snap to open, making it good fun to apply. When the supply ran out – I had to make a decision on the efficacy. Quite frankly without something like a trichometer it wouldn’t have been possible for me to work out if I was better or worse off after the treatment. I had however read more anecdotal evidence online to suggest Fluridil didn’t work – so I decided to cease the experiment. At the same time as I started the Fluridil I was also applying a couple of products from someone called ‘Dr Proctor’. These were Prox-N and Nano Shampoo. Quite frankly the less said about these the better. I’m embarrassed I even tried them – but it’s amazing what desperation does to your common sense.
Then for something more exotic. I decided to try and make my own topical Spironolactone mix. The shopping list consisted of:
- 2x Bottle of Spironolactone 25mg 200 Tablets – again from Inhouse Pharmacy
- 500ml bottle of Spirytus (Polish) Vodka @ 95% alcohol content (couldn’t find a way to legally get hold of Ethanol)
- 1l Propylene Glycol
- 4x Different sized blue plastic funnels – small to large
- 5x Amber tinted dropper bottles
- 1x 20ml Bombex Glass Measuring Cylinder
- 1x 10ml Bombex Glass Measuring Cylinder
- 1x Ceramic Pestle & Mortar
- Coffee filters
The process I had was pretty simple. Crush the pills up, mix with ethanol, filter the mixture through the funnel (containing coffee filter) to get rid of the pill’s filler, then add the PPG and share out among the bottles. Can’t remember the ratios I used – but Google and you can probably find the forum posts I used which specified ratios. I wasn’t sure if the Spiro would end up getting caught in the coffee filter – presumably it’s down to how well it dissolves in alcohol – but I didn’t have a scientist to ask – and I couldn’t find the answer online. What actually happened was the coffee filters turned out not to be porous enough, there was a jam, and I ended up filling the bottles with the orange filler gunk left in. It was a complete failure – when I applied the stuff it would leave orange marks where the liquid ran – and it smelled terrible! Was good fun though to play about with, but I didn’t end up using the mix.
After these failures I piped up the courage to try finasteride again. I lasted a similar amount of time to last before the fatigue forced me to stop – deciding that the exact same symptoms again couldn’t be a coincidence.
I think it’s safe to say that I’m glad I tried finasteride. When I go fully bald I can say that I experienced finasteride and chose not to use it. Some might say that it’s an informed opinion. Others might say I gave in too easily.
Discussions with Experts
– Dr Michael Norris
When I was researching a Trichologist that I could speak to about hair loss I came across someone called Dr Rushton who works in Harley Street, London. He happened to be relatively local, so I emailed him, and he was kind enough to setup a meeting to discuss the research he had been carrying out. He discussed finasteride and a topical mix of cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA). He said:
“CPA and MPA get into the blood stream and that is why we monitor blood levels of testosterone and dihydrotestosterone to minimise systemic effects. Whereas finasteride primarily interferes with the conversion of testosterone to dihydrotestosterone, CPA and MPA interfer with both which if not monitorred correctly will cause libido and spermatogenesis problems.”
He had an interesting take on ketoconazole and spironolactone in the treatment of hair loss:
“We did a lot of work with spironolactone and ketoconazole in the 80s. Spironolactone is not very good. The Americans only use it because cyproterone acetate is not licensed in the States. Similarly ketoconazole is also not much use. Your best bet is cyproterone acetate and medroxyprogesterone acetate.”
So there we go. I really appreciated talking to Dr Norris – because with his scientific background he gave me quite an objective view on the medicines available. He was very frank with me – and didn’t try to “sell” anything to me. He also didn’t try to make the treatments sound “safe” and said that regular blood tests and monitoring whilst on them should be carried out.
– Dr Barry J Stevens
Barry is/was the general secretary and registrar of the Trichological Society. I rang him up for some advice and he was quite happy to discuss hair loss with me. He got straight to the point and told me that to his knowledge there is no solution to hair loss. He told me that the best options are a hair piece or hair transplant (which is probably true). He was completely against drugs that can affect ones hormones and I respected him for his honesty and truthfullness. I can imagine as a trichologist you could potentially make a fair bit of money by selling minoxidil or finasteride to trusting, unsuspecting patients.
From the hours spent researching hair loss and the discussions I’ve had with experts in the field I have come to the conclusion that currently there is no safe method of preventing hair loss if you are, like me, genetically predisposed to Androgenic Alopecia.
Your time is better spent building your career, working out, eating healthily, traveling the world and indulging in the things you enjoy. In the future there may be a solution – when that time comes you’ll know about it.
I actually wrote a second post where I talk about how to transition from hair to baldness if you’re worried about what people think:
- How I used world travel to deal with the anxiety of going bald, and move on from it successfully – link