Hair t̵h̵i̵n̵n̵i̵n̵g̵ winning

Oct 3, 2021 at 9:13 PM

It’s never too late but it’s never too early. Ladies, this goes for you, too.

By [oddly] popular request: hair thinning. I take requests pretty frequently (so don't hesitate to ask!), and if it's not my expertise, I'm usually happy to at least take a 30000-foot view of the topic.

There are many different types of hair thinning, and appropriately, they each have their own interventions (at least theoretically). And from what I gather, it's multifactorial for most people with thinning (or outright balding). This article is primarily focused on therapeutic interventions, but that doesn't mean all the usuals don't apply: sleep well, good nutrition*, some cardiovascular exercise...

*eg, oysters, Brazil nuts, probably salmon skin for EPA/DHA (it's good for everything so why not?)

Numero uno: Rogaine! Hahaha laugh all you want, but topical minoxidil is easy, cheap generics are available, and the only downside (with the cheap generics) is that it makes your hair look greasy so best applied after you’re done going out for the day.

Side note: I almost always prefer local treatments. Like, for a hair product, my instinct is to look first for topical over systemic. Same with antibiotics for skin infections. Pre- and pro-biotics follow the same principle. Fortunately in this case, one of the best and well-studied interventions is topical. And OTC, but that has more to do with convenience than efficacy.

Speaking of efficacy, topical minoxidil actually seems like the most efficacious at the moment.

Mechanism: seems to improve blood flow to follicles.

Minoxidil 5% every day, once or twice daily. I dislike the concept of using topicals before bed because

you know

Eventually that’s gonna get all over your pillow. This is also why I shower at night and don’t wear shoes in the house.

There are bona fide non-responders to minoxidil. A cheap derma-roller can drastically improve the response to minoxidil on a genetic level (there was a study on this!). There are enzymes that convert minoxidil to it’s scalp-active form which are activated by the mild trauma induced by derma-rolling. Derma-rollers cost about $12, last forever, and only need to use a few minutes per week. Hard-core hair preppers use the deeper needles, but I haven't seen a good study on needle depth, so I wouldn't recommend anything that causes discomfort.

Number 2: anti-dandruff shampoo (Nizoral/ketoconazole, not Head & Shoulders). DHT is a big hair follicle thinner in both men and women, and ketoconazole is a 5-alpha reductase inhibitor. 5-alpha reductase converts testosterone into DHT. Finasteride and dutasteride are oral versions of this. All of them are effective, but my bias toward local/topical treatment leans me toward topical ketoconazole. Although fina & duta appear safe and low side effects. Bonus for the gents, systemic DHT lowering via oral 5-alpha dehydrogenase inhibition may benefit the prostate.

Dutasteride appears to be [currently] the most effective oral medication for hair loss (may require prescription).

TRT guys: topical testosterone increases DHT more than injected testosterone. Apparently lower, more frequent administrations is the best way to go. Women, this may only apply in the context of HRT post-menopausal. And gents, don’t rub testosterone gel on your nuts. It sends DHT through the roof.

DHT and blood flow are the most common levers to pull for hair maintenance.

The third is DHT again. Lol

Inhibiting DHT formation is one thing, but other hormones activate the androgen receptor, so why not block the receptor directly?

Because it’s not very well-tested... but still appears effective in clinical trials. Topical RU-58841 doesn’t have a fancy name like Clascoterone(™), but is available in liquid that can easily be applied topically or in a spray bottle (preferred if you have diffuse hair thinning). Inhibiting DHT production via topical ketoconazole or oral finasteride/dutasteride is one part, but preventing all other androgen agonists from killing your hair is another big part. If you had to choose one, I’d choose this one. Unless I had high PSA or a family history of prostate cancer.

Pro-hair bro-science YouTubers who aren’t horrible: MATTDOMINANCE and MorePlatesMoreDates. Basically anyone who isn’t selling topical saw palmetto.

Number 4. Getting into tin foil hat territory. Prostaglandins. Topical or small dose/infrequent castor oil. Ricinoleic acid -> PGE2 -> inhibits PGD2. PGD2 suppresses hair growth via GPR44. Small dose/infrequent oral castor because, well, you know the effects of castor oil. OK, if you didn’t know: diarrhea. Topical cromolyn may also influence this pathway. Cromolyn is a PGE agonist available OTC in a nasal spray that can easily applied to the scalp. Never been tested in this context tho. 100% speculation, but some other drugs are being tested on this pathway in a clinical context.

Others: oddly, Accutane (an oral vitamin A analog for acne) is bad for hair, but Retin-A (a topical vitamin A analog) is good for hair. Probably because Accutane kills a lot of cell types in skin permanently, whereas retin-a just increases cell turnover (which appears beneficial in a variety of skin conditions). Idk.

I’m not an expert on this, just learning, but topical minoxidil, ketoconazole, & RU-58841 seem like low hanging fruit (easy & OTC). Oral dutasteride/finasteride next. Castor oil, Idk.

Did I miss any of the easier interventions? Am I way out of my league on this? Let me know in the comments :)

That's all for now!

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