25, new to hair loss - minoxidil as the only treatment and other questions

[JM9]

Hi all,

I'm 25 and have been balding for about a year now (crown/top diffuse thinning). I'm at a point where I'd still be happy just to keep what I have, but probably won't be much longer. I would really appreciate some pointers about possible treatments from more experienced and knowledgeable people here – while I have done my research, the amount of information on the topic is huge, and a large proportion of it seems to be anecdotal and contradictionary. What I'm looking for is advice in the light of what we know about hair loss treatments at this time, ideally supported by clinical or peer-reviewed studies.
(I apologize that this has turned out to be such a long post.)

I've only been using Nizoral so far, but that obviously won't do anything significant as far as I know. I went to see a doctor and he said there's 3 things that work against male pattern baldness – Propecia, Minoxidil (Rogaine) and PRP. As I found out browsing the web later, PRP is highly questionable, experimental treatment at best, so who can you trust... I'm scared of taking Propecia/finasteride, so what's left is Minoxidil. However, I've been unable to determine so far whether or not Minoxidil is worth it as a stand alone treatment for keeping what you have long-term (success rate statistically speaking), and there seems to be a lot of confusion about side effects. The only other viable option seems to be shaving my head and eventually getting scalp micropgimentation done, but that has some potential problems as well (mainly the quality/natural look of the treatment and the fact that I'd probably look like a cancer patient from outer space with a shaved head, being a white, short, small-framed guy).

Below I list treatments that I found mentioned and some of my questions regarding them. Now, I know that there's absolutely no question I can ask that hasn't already been discussed somewhere else – and I will continue researching these things on my own – so I will appreciate anything from links to direct answers - any valuable info. If possible, please be so kind and reference clinical/scientific studies to support your arguments, especially those that are not common knowledge, or specify what is your hypothesis, what is based on personal experience etc.

Propecia / finasteride
I know some doctors are huge proponents of Propecia, and that it's probably the only really effective treatment. However, with all the potential side effects I just wouldn't feel comfortable using this drug. Obviously it's hard to form an accurate picture by relying solely on web forum information, but I do get a feeling side effects (perhaps due to their often embarrassing nature) are under-reported. My main concerns are:

• long-term and/or persistent side effects and long term neurodegeneration (obviously when you're 65 your hormone levels are different compared to 30 years ago, so what happens after such a long time...)
• high grade cancer – what's the verdict on this one? You can find both claims that Propecia increases as well as decreases the chances of getting a nasty case of cancer.
• is it possible to determine optimal dosage and intake frequency by blood tests? I'm not a fan of approximate »just try this dosage and see what happens« methods and would like to predict as much as possible (the main problem here is that many doctors seem to be dismissive when you come to them with questions like this, since male pattern baldness is somehow considered not worth treating by many).
• Any experience/research on the relation between dosage/intake frequency and potential side effects, i.e. how much are side effects connected to dosage and frequency in terms of statistics? A lot of (seemingly credible) info can be found claiming lower dosages are equally effective. "I spoke with Dr. David Whiting, an expert on Propecia, some time ago and he informed me that finasteride 1mg and greater has equal value. A dose of 0.5mg is 80 percent as effective and a dose of 0.25 is less effective again." (I' cant provide sources to these quotes, as they get filtered out) I think a strong argument in favor of Propecia could be made by providing clinical data that would show, say, taking the pill just once every 5 days is still effective but exponentially decreases the probability of side effects.

What I've found so far is a quote by Jerry Cooley (MD):

»[...] several studies show that a single dose of finasteride suppresses serum DHT for 7 days or more (Eur J Drug Metab Pharmacokinet. 1991 Jan-Mar;16(1):15-21, J Clin Endocrinol Metab. 1990 Apr;70(4):1136-41, Prostate. 1989;14(1):45-53). So the finasteride is leaving the bloodstream, entering the tissue throughout the body, and binding to the typeII 5AR enzyme, resulting in long lasting DHT suppression.
[...]Most of my patients choose to take it on a Mon-Wed-Fri schedule, which is rational from my point of view. [...] There are no clinical studies showing that less than daily dosing is as effective at treating hair loss as daily dosing and for obvious financial reasons, the pharmaceutical company making finasteride has no incentive to fund such a study.«

Quotes such as these make me even less willing to try this drug:

"One outspoken critic was well-known hair-restoration expert L. Lee Bosley who publicly denounced Propecia as a 'serious health concern'"

(source: http://www.examiner.com/article/pro...w-of-drug-s-dangers-but-did-not-warn-patients

Finasteride seems to be the only truly effective treatment, but I'd honestly be afraid of taking it...


Minoxidil / Rogaine
The main question is, is this a good stand-alone treatment for keeping existing hair on the top of your head long term? Some people claim to have maintained everything for over a decade using only Rogaine, while a lot claim it's rubbish.

Quote by Mark Baxa (MD):

"In reference to Rogaine, only about 40% or less men will see any results! Therefore, I really don't recommend it to most of my patients, accept for those with very minimal hair loss."

Another issue is the potential side effects, especially sexual side effects. Officially, they cannot happen, but lots of people on the web report sexual side effects. I don't know what to believe here. Moreover, there are concerns about increasing a chance of a heart attack and things like this:

"minoxidil is suspected of causing prolactinomas and elevated prolactin levels."

(source: http://www.peaktestosterone.com/Testosterone_Prolactin_Prolactinoma.aspx)
And also some people claiming it made their existing hair a lot worse.

Then there's this:

"We have been recommending against the use of Rogaine (Minoxidil) for many years as treatment for hair loss for several reasons. For starters it simply doesn’t work that well. For the vast majority, it has no effect whatsoever. For less than 50% it simply slows down hair loss for a limited period of time. For less than 20% it grows vellous (fine, peach fuzz) hair that typically last only a few months before shedding. [...] It you are using Rogaine for any length of time, (i.e. 4 months plus) and have to stop for whatever reason, there is a dramatic shedding, medically termed an “effluvium”«.

(source: http://www.hairloss-research.org/UpdateMinoxidilAlternatives6-11.html)
So basically if you stop using it you'll lose more hair than you would normally (even existing hair), or is this another myth (statistically speaking)? The above link recommends TRX 2, but that one seems to have its own problems.

Then there seems to be an unresolved question regarding the effectiveness of foam vs liquid, with propylene glycol being the main unknown.

Bottom line: at first, minoxidil seemed to me to be the best choice considering potential risk/reward ratio, promising to keep your hair with minimal chances of side effects. Now I'm uncertain if there's any point in using this stuff at all.

PRP
As mentioned, I've been told by a doctor that this is a treatment that »works«, but that doesn't seem to be the case. Is anybody familiar with any more recent research/reports (personal or otherwise) about PRP for preventing hair loss? I'd gladly pay for this if it would actually work, but I'm not convinced.

Laser combs
Is there anybody who used it properly and frequently (as you're supposed to) for treating early stage baldness and got any results? Judging by what I've read, it's got 'scam' written all over it. The company behind it makes claims they cannot support (last I checked there were no peer-reviewed studies confirming their claims), and even in their own study (which is kind of hard to obtain) they make conclusions that contradict the numbers presented – essentially, that there was no significant difference between a control group and a laser comb group. When I asked them about this on their forums, they deleted my question and emailed me an explanation, saying that in fact the measurements revealed that laser comb users had more hair (ie. that the comb works), it's just that they (self-reports by patients regarding the efficiency) were unable to detect them! Last thing I need is spending money on devices that grow/maintain invisible hair.

Shaved head + SMP (scalp micropigmentation)
When I first heard about SMP, I was highly sceptical, but some companies (namely HIS Hair Clinic, which seems to be the best) seem to produce quite impressive results. Although I find a lot of SMP hairlines to be either too sharp or too low, this seems to be a preference rather than a technological limitation. I fear I would look horrible with a shaved head (I'm a fairly pale short guy with a weak chin and a high forehead), but so far this almost looks like the best option – it certainly beats being bald in your 20s/30s. Any opinions on this? On HIS Hair Clinic forums people say it looks better in person than it does on photos, but I'm still sceptical about how realistic this would look (some results seem good, many don't). There's also a social downside – being percieved as a skinhead etc., and it would probably look weird once you got old, when being bald becomes more socially acceptable than having a shaved head. Still, looking at some of the results, this seems a highly attractive option.

Profollica, ZX42, ArganRain, stem cell therapies (not yet?), Fluridil (Eucapil), Proxiphen, Histogen, Revivogen, TRX2, HairIntegro, RU ...
Are any of these worth the money?

Supplements such as biotin, pumpkin seeds, selenium, garlic, carrot juice etc.
You can find claims that people stopped their male pattern baldness by e.g. eating garlic and massaging wine into their scalp, but what to make out of all this natural supllements stuff?

Scalp massage
Does it make a difference?

To conclude, experiencing hair loss in my 20s has been traumatic psychologically and came completely unexpected (neither my dad nor granddads experienced hair loss) – being a white, 5'7'' guy and single, I simply can't afford being bald at this age if I want to keep a prospect of ever having a normal social life. Despite being in a good physical condition, I've been born with mild yet noticeable deformities of spine and chest (as a result, my posture is abnormal and my ribs are a bit messed up), which stand out in negative way no matter how much muscle or definition I put on. This in itself puts me in the unattractive group - add hair loss and it's hard to be optimistic or have a positive body image. I realize there are people far worse off and with more serious health problems, but that doesn't make my reality any better... Not sure which way to go, though.

Thanks for reading this.

Regards,
JM9

 

[Admin]

Post was placed in moderation. Approved. Bump.

 

[FridgeFridge]

Just on Minoxidil - I think a good analogy for it as far as hair loss is concerned is that it may rewind time a bit for you but wont slow it down. Basically that you may see regrowth but it will do nothing to stop the balding process so after the regrowth you will continue balding.

Whether people have maintained for years or not on just minoxidil I dont know, I've never been on it myself but ill tell you this, my hair loss barely changed between me first noticing it at 17/18 and 22 (when I got on dutasteride & Nizoral) so I imagine if I had have got on Minoxidil at 17 and even only seen minimal regrowth, at 22 I would proberbly have been in a position to say "been on Minoxidil 5 years and slght regrowth, no loss!" so you have to be careful when interpreting individuals findings IMO.

 

[WarLord]

Just on Minoxidil - I think a good analogy for it as far as hair loss is concerned is that it may rewind time a bit for you but wont slow it down. Basically that you may see regrowth but it will do nothing to stop the balding process so after the regrowth you will continue balding.

Whether people have maintained for years or not on just minoxidil I dont know, I've never been on it myself but ill tell you this, my hair loss barely changed between me first noticing it at 17/18 and 22 (when I got on dutasteride & Nizoral) so I imagine if I had have got on Minoxidil at 17 and even only seen minimal regrowth, at 22 I would proberbly have been in a position to say "been on Minoxidil 5 years and slght regrowth, no loss!" so you have to be careful when interpreting individuals findings IMO.

Blah blah blah... For Goodness sake, what is the source of this bullsh*t?! It is only spread by people, who have never used it on their own!
How is it possible that the people using 3% (!) minoxidil were still a way above baseline after 5 years?! And one-third of them was still improving?



There is no fundamental difference between minoxidil and 5-AR blockers. They both work, but they only work by different mechanisms. That's all. There is no doubt that 5% minoxidil is weaker than 5-AR blockers, but you must also consider that these drugs are dose-dependent and the 5% version is clearly suboptimal for many people. Is finasteride stronger than 15% minoxidil? That would be a theme for an interesting study!

 

[WorkHardPlayHard]

Not sure which is "better", if there's even a right answer to that.

finasteride is just optimal for me since I'm pretty busy and genuinely don't have the time (probably due to my own lack of organization) to mess with any topicals. I'm much better off popping a pill and moving on with my day.

For what it's worth, I'm 25 as well and having no side effects whatsoever. It's good to educate yourself and seek the truth, but know that there are also a lot of fear mongers and people unjustly opposed to the drug. You need to do what's right for you in the end though.

 

[FridgeFridge]

How is it possible that the people using 3% (!) minoxidil were still a way above baseline after 5 years?! And one-third of them was still improving?

View attachment 19932

My source is the Olsen 1990 study, which shows that after a few month hair loss continued at the same rate as the placebo group. - Basically regrowth took place and after this hair loss continued, the difference between the minoxidil group and the placebo group remained the same. (because they were both losing hair)

Your graph doesn't prove anything in response to my post. It only covers 5 years for a start - come on, did you even read my post?

My point was that imo these people saw regrowth then balding at the prior rate after their regrowth had finished (which yes, may vary in different people) I also conceded that it is perfectly possible for people to have the same amount of hair they have now as in 5 or 10 years taking only minoxidil. My point was that imo the hairs minoxidil has kept you (if you would have lost them otherwise) are now minoxidil dependant and in the coming years you will find yourself balding at the same rate as you were before starting minoxidil.

I have nothing against it and if I was a NW2 or 3 I would be on it as well as dutasteride, and I would take it happily.

Also if there are people out there who simply will not take finasteride and it is a choice between minoxidil or NOTHING AT ALL. I would say yes! get on minoxidil and it will more than likely improve the appearance of your hair over the coming years. But ideally for the longer term I would advise people get on both minoxidil and finasteride, (and nizoral)

 

[Finkle25]

Not sure which is "better", if there's even a right answer to that.

finasteride is just optimal for me since I'm pretty busy and genuinely don't have the time (probably due to my own lack of organization) to mess with any topicals. I'm much better off popping a pill and moving on with my day.

For what it's worth, I'm 25 as well and having no side effects whatsoever. It's good to educate yourself and seek the truth, but know that there are also a lot of fear mongers and people unjustly opposed to the drug. You need to do what's right for you in the end though.

Hey I was just wondering if you are still using finasteride a year and a half down the track and whether or not it is still working?

Cheers