propecia - the bigger picture

[Bryan]

Bryan

Yes, but you haven't answered the fundamental question: why does the growth first go UP, and then DOWN?

That's what I tried to answer. Propecia saves(regrows) hairs that have not already been severly damaged. That's the regrowth UP, the down comes from the fact that certain hairs cannot be saved. IT can;t go on regrowing hair forever. It saves what it can, from lowering DHT, that's it.

Yes, but why doesn't it MAINTAIN afterwards? Why would haircounts go DOWN again?

WHAT will catch up? The DHT? No, I defy anybody to find a study showing that finasteride eventually loses its ability to reduce DHT!

You misunderstood what I was saying. I agree propecia does not lose it's ability to reduce DHT as far as we know. What I was saying is that we benefit initially from a big drop in DHT. Bam, all of a sudden follicles get way less exposure to DHT which allows them to rejuvenate. However the 33% left(which may be more in some guys than others) is still roaming around attacking follicles. So in the long run this 33% is still doing damage.

So why doesn't that remaining 33% prevent the sudden spurt of regrowth from Propecia at the very beginning?

Bob, it must sound like I'm hounding you on this point, but I'm just trying to persuade you that the evidence doesn't really seem to fit the commonly-held belief that the "leftover" DHT is what causes declining results. I don't think it fits well with a sudden upsurge of growth at the very beginning, followed by an inability to maintain a year later. I really prefer MY theory that at least part of it is due to residual degenerative effects (ageing?) that are still there during Propecia usage.

Bryan

 

[Bob_Marley]

Bryan,

Not hounding me at all. I enjoy your knowledge.

"Regrowth" is badly defined. Do they count unpigmented newly miniturized hair in their baseline numbers. If you get what I'm getting at. Propecia is definatley not regrowing hair on slick bald area's. I prefer rejuvenate over regrow in propecia's case, but you may argue this with pleasure.

Now think genetically "programmed". Our hair apparently at a certain point starts getting it's *** kicked by DHT(baseline). SO at that level of DHT your follicles are under attack and are literally flying off your head. Now get rid of 67% of DHT and these damaged follicles at that "programmed" point in time can grow back stronger and become pigmented, but never acutally fully regrow to their original state. So, this new "sudden" DHT level drop allows some kind of temporary "reversal" Then the body reaches and adapts at this new level of DHT, but the 33% still is causing problems just at a way slower pace. It's the initial SHOCK to the system that allows for the "regrowth" at that particular span of time.

Your argument would be more relevant to dutasteride. Where guys are ridding themselves almost 100% DHT, but are still seeing loss. Also what you're syaing is their is some magic DHT level that one can reach where there won;t be anymore loss. If 100% baseline DHT was detrimental, then why would 33% left over DHT not be bad for our hair.

 

[Guest]

Keep in mind that the hair that is regrown(rejuvenated) initially after taking propecia for a year or 2 keeps the hair count significantly higher than baseline. So even 7 years down the road, you will still have a higher haircount than you did at baseline. If you look at the chart in the propecia circular it shows the peak at around the 1 or 2 year mark and after that the haircount slowly declines but still stays above baseline. The decline is very much slower than the rapid decline shown in the placebo group. They keep losing way ground way under baseline.

 

[Bryan]

From what I understand, what happens is that when Propecia or Avodart reduce DHT the immune systems stops or decreases it's attack on the hair follicles therby allowing them to grow. And thus making minoxidil more effective since the immune system is not attacking the hair follicles.

I think people in general possibly put a bit too much emphasis on the immune system's alleged role in balding. Dr. Proctor has said that that's something that probably enters the picture relatively late in the game. In the meantime, androgens DIRECTLY stunt the growth of scalp hair follicles, as has been shown in some in vitro experiments. Remember, there IS no immune system in a petri dish! :wink:

Bryan

 

[Kramer3]

I completely agree with Marley's theory on the slow progression based on predisposed genetics.

The reason I believe their is a sudden surge of growth during the intial phase of any treatment is because treatments stabilize hair loss. When hair loss is stablized hair that is in the growth stage that cannot be seen yet is able to grow while the hair that is currently visible is maintained. The reduction in shedding enables these hairs that are still healthy and growting to come in as the hairs that you orignally had sustain themselves. Thus after six or so months it appears as if you have more hair. Without the treatments the hair that was in the growth stage would have eventually became noticeable but at the point you would have lost much of the hair that surrounds creating a balance. When your able to maintain that hair instead of losing it, it appears as if growth occured when really the hairs that were in the growth stage simply grew in without surrounding hair diminishing.

 

[Rage]

Hey, if it maintains your hair for 10 years... then surely there will be new treatments out then. After 10 years, basically you are still at the stage just before you started taking finasteride. Not bad now is it? Presuming you started early that is...

 

[Jack_the_Lad]

Hey, if it maintains your hair for 10 years... then surely there will be new treatments out then. After 10 years, basically you are still at the stage just before you started taking finasteride. Not bad now is it? Presuming you started early that is...

Thats what we're all hopping for, in 10 years there will be better treatments out I hope, and maybe the cure. lets all hope that the cure won't cost us all an arm and a leg

 

[Bryan]

I completely agree with Marley's theory on the slow progression based on predisposed genetics.

The reason I believe their is a sudden surge of growth during the intial phase of any treatment is because treatments stabilize hair loss. When hair loss is stablized hair that is in the growth stage that cannot be seen yet is able to grow while the hair that is currently visible is maintained.

So why isn't the hair stabilized or maintained after the first year?

Bryan

 

[Kramer3]

Bryan: Generally your hair is stablized or maintained after the first year isn't it?? I thought in general when people were responders they could expect an initial slight increase followed by maintainence. Then after a certain amount of time whatever it may be (5-10 years) the drugs affect would slowly begin to diminish for whatever reason.

 

[Bob_Marley]

Bryan

Sorry, I dont understand your question. Stabilized, regrowth, maintenance are all very subjective words when used with hairloss.

Here's an awful awful analogy. Grass is growing in a good enviroment and then all of a sudden a lot of poisin is being constantly being dropped on the grass each day and eats away at the grass very fast. Now all of a sudden 67% of the poison is not being dropped each day, so less poisin reachs each individual blade, maybe some blades don't even get exposed.
Now the dead ones are gone, but the ones that don't get effected or those being less effected start to strengthen/rejuvenate/regrow. However each day in the long run 33% of the orginal amount of poisin is still being dropped into this enviroment and it will eventully catch up, ruining the entire enviroment, and the grass.

Like I Propose, it's the extreme short term difference.

Your age theory in all of this is still completely revelant and almost definatley plays a role.

 

[Bryan]

"Regrowth" is badly defined. Do they count unpigmented newly miniturized hair in their baseline numbers.

I believe they do. They counted "all visible hairs", which would apparently include vellus AND terminal hairs (and indeterminant ones, of course).

If you get what I'm getting at.

Not really, no...

Now think genetically "programmed". Our hair apparently at a certain point starts getting it's *** kicked by DHT(baseline). SO at that level of DHT your follicles are under attack and are literally flying off your head. Now get rid of 67% of DHT and these damaged follicles at that "programmed" point in time can grow back stronger and become pigmented, but never acutally fully regrow to their original state. So, this new "sudden" DHT level drop allows some kind of temporary "reversal" Then the body reaches and adapts at this new level of DHT, but the 33% still is causing problems just at a way slower pace. It's the initial SHOCK to the system that allows for the "regrowth" at that particular span of time.

I just can't buy any theory about a sudden "shock" to the system that allows for a TEMPORARY spurt of regrowth. I think that the remaining 33% would be causing problems from Day 1, not just a year down the road.

If 100% baseline DHT was detrimental, then why would 33% left over DHT not be bad for our hair.

That's MY line, actually! Why isn't the left over 33% bad for your hair during the FIRST year, not just the second (and subsequent) years?

Bryan

 

[Bryan]

Bryan: Generally your hair is stablized or maintained after the first year isn't it?? I thought in general when people were responders they could expect an initial slight increase followed by maintainence. Then after a certain amount of time whatever it may be (5-10 years) the drugs affect would slowly begin to diminish for whatever reason.

What we've been discussing is the average slow drop in haircounts that starts to occur AFTER the first year of Propecia use. It was observed in the long-term (5 year) results. During that final 4 years, the drop averaged something like only around 10 hairs/year, if I remember correctly.

Summing up the results in a nutshell: During the first year, there was a sharp INCREASE in average haircounts (relatively speaking), followed by slow declines during the next 4 years.

I suppose that "maintenance" is a relative term: if you experience only a very small drop in haircounts compared to normally balding guys, that's close enough to what could reasonably be called "maintenance"! But the precise CAUSE of that slow drop is what interests me. I think that it may be at least partly due to general degenerative effects (ageing?), and not a "failure" of the Propecia per se.

Bryan

 

[Hinde]

bryan, you say that the decline in hair count "may be at least partly due to general degenerative effects (ageing?)"

i might agree with you if we were talking about an older group of men, but there are guys in their teens and early twenties whose hair counts are declining as well. in those cases, i think the degenerative effects of balding are at work...

 

[Bryan]

bryan, you say that the decline in hair count "may be at least partly due to general degenerative effects (ageing?)"

i might agree with you if we were talking about an older group of men, but there are guys in their teens and early twenties whose hair counts are declining as well. in those cases, i think the degenerative effects of balding are at work...

I assume you actually mean the effects of pure androgenetic alopecia? Yes, you _may_ be right in that case, but we don't really KNOW if any younger guys were included in those long-term results that showed slowly declining haircounts! :wink:

Bryan

 

[Hinde]

Well, the mean age of participating subjects in the two-year U.S. phase III trials was 33. In the international trials it was 31. So I don't think it's unreasonable to assume that many of the men in the five-year study were in their 30s, some probably still in their 20s. Not an age in which non-pure androgenetic alopecia afflicted men lose hair to the degenerative effects of aging.

 

[Bryan]

Ok, but what exactly is your point? To disprove my theory, you'd have to establish that there were NO older guys in the 5-year Propecia trial!

Bryan

 

[Hinde]

my only point is that your theory holds no more weight than the theory that propecia loses its efficacy over time. both are unsubstantiated.

 

[Bryan]

Indeed. That's why I call it a "theory"! :wink:

Bryan

 

[Hinde]

touche

 

[GourmetStyleWellness]

Just wanted to say thanks for your participation here Bryan. Your knowledge of the hundreds of studies and understanding of the clinical data out there has enabled you to be a constant breath of at least "factual" fresh air here, in a forum that is frequently filled with uneducated guesses and theories that many times completely contradict the available data!

A theory is a good one if it manages to match and add to existing knowledge. A theory is a bad one if it contradicts existing knowledge in a ton of ways. Especially in the absence of new data to justify its contradiction!

Clear as mud?

gourmetstylewellness.com