The Desire To Be 17 Again

[Wolf Pack]

Thought I would pop by (virtually lol) and see your pictures. Nice hair. It's very early and it's great you are thinking outside the box in terms of treatment. I don't see any harm as the male pattern baldness is VERY early and it may not be the case too. Some vellus and miniaturised hairs are present at the front of the hairline in a non balding person. Anyway, good luck

 

[Captain Hook]

Thought I would pop by (virtually lol) and see your pictures. Nice hair. It's very early and it's great you are thinking outside the box in terms of treatment. I don't see any harm as the male pattern baldness is VERY early and it may not be the case too. Some vellus and miniaturised hairs are present at the front of the hairline in a non balding person. Anyway, good luck

Thanks! I really appreciate the compliment and the approval of starting treatment. Yeah basically when I saw my dermatologist in July she said she didn't think it was Androgenetic Alopecia but also that it was too early to tell as I am young. Once I noticed my hair line recede even further in August and it prompted me to commence a basic regimen, one that I can build on and/or swap out treatments if Androgenetic Alopecia is 100% confirmed.

 

[jackakastones]

You have great hair man! As some have pointed out while your frontal recession may not be male pattern baldness after all, I know the worry it must be causing. Do you feel any change in density up top (ie diffuse thinning?) I hope your treatment works well for you! Keep us updated!

 

[Captain Hook]

You have great hair man! As some have pointed out while your frontal recession may not be male pattern baldness after all, I know the worry it must be causing. Do you feel any change in density up top (ie diffuse thinning?) I hope your treatment works well for you! Keep us updated!

Thanks for the kind words, much appreciated. These days I find myself too aware if that makes sense, like I've swallowed a metaphorical Androgenetic Alopecia red pill or something. I suddenly notice even the slightest recession in people's hairlines whereas 2 years ago I'd only notice NW4s or higher (I even thought Daniel Craig had a normal hairline when he is in fact NW3!)

To be honest I feel like it's kind of difficult to tell if I'm diffuse thinning or not, perhaps my hair is a bit thinner up top but it's definitely not as drastic as the change I've noticed in my hairline in the past 2 years. I do make sure to part a few sections and apply S5 cream to those areas just in front of the centre of the vertex just in case though, can't be too careful.

I'll certainly post pictures as well as a summary of how things are going at the 6 month mark, possibly earlier if I notice any regrowth although this is unlikely.

 

[Captain Hook]

Update 16/10/15:

Today (well technically tonight) 16 October 2015 I finished my first pot of S5 Day Cream. So it lasted about 7 weeks, not too bad considering gourmetstylewellness.com's shop claims "up to 2 month supply depending on use", I always think people tend to embellish a bit in advertising so I was surprised that it came close!

As mentioned in my treatment timeline, since I am tolerating the medication well, I have ordered S5 Bedtime Cream (which contains 1% adenosine as opposed to caffeine in the Day Cream) and will commence its use on the night of 17 October 2015.

To clarify, the update to my regimen now includes PM use of S5 Bedtime Cream whereas before I was using S5 Day Cream morning and night. What this means is 1% adenosine will now be effectively introduced to my regimen. My use of S5 Cream will now be AM Day Cream and PM Bedtime Cream daily.

Not much else to update you guys on, I've noticed a drastic decrease in shedding though, approximately from 50% less hairs seen on my hands in the shower and 75% less hairs seen on my pillow. It honestly looks similar to my level of hair loss back when I was 18 or 19 which is a good sign, it definitely seems like my hair loss has slowed down although it is too early to tell.

Further updates to my regimen as well as progress pictures at 6 months can be expected.

 

[Agustin Araujo]

Hi Captain Hook.

You have great hair, I saw the pics that you posted in your original post. It's nice to know that a mild maintenance regimen of using a Ketoconazole shampoo and topical Spironolactone has been working well for you, and has been reducing the amount of hair you shed. I'm looking forward to your progress pics, and again, you have great hair.

Thanks for your share. :heart:

 

[Captain Hook]

Hi Captain Hook.

You have great hair, I saw the pics that you posted in your original post. It's nice to know that a mild maintenance regimen of using a Ketoconazole shampoo and topical Spironolactone has been working well for you, and has been reducing the amount of hair you shed. I'm looking forward to your progress pics, and again, you have great hair.

Thanks for your share. :heart:

Thanks for the kind words, it hasn't been an easy journey and yours and everyone else's support speaks volumes to me, much appreciated!

Yeah I wanted to start with these two treatments and see how well they could perform, really only expecting a stopgap measure but if I end up noticing even complete maintenance by month 6 I'll be very pleased!

 

[deniak]

Hey Captain!


I really like to read your posts, you sounds like knowledgeable and down-to-earth guy. Now, when I saw your personal thread I must say two things: your hairs are still in great condition and you wisely choose components of - more or less - prevention regime.


We have similar attitude to hairloss drugs – trying most potent and less risky treatment to see if it pays off. Despite that Im probably NW2 Im also reluctant to take finasteride. Im pretty sure, that mild but noticeable side effects of inhibiting DHT are more common that everybody thinks and any impairment of cognitive or sexual functions are out of equation for me.


I also see that you deeply researched topic of ketoconzaole. Whats you thoughts on Nizoral 2% cream? 2 days ago I bought one tube and Im using it twice a day at hairline and temples as addition to my regimen: minoxidil 2% 0.4ml/day (corners of hairline and temples); Nizoral 2% Shampoo every third day; Castor Oil 1ml/day orally + topical from time to time at same places as minoxidil.


Few weeks ago I noticed quite upsetting second shed, oily skin on face and little itching on male pattern baldness areas, so I searched for some DHT blocking topical solution / something to strengthen current regime. I dont want to freak out and change treatments in regime, because most studies of proven drugs like minoxidil or keto show positive results after 1+ year of constant use. Before I start, I told myself to stick to plan and evaluate results no earlier than after 12 months. So, what do you think about using keto cream daily, is this have some potential as addition to shampoo?


Cheers

 

[Agustin Araujo]

Thanks for the kind words, it hasn't been an easy journey and yours and everyone else's support speaks volumes to me, much appreciated!

Yeah I wanted to start with these two treatments and see how well they could perform, really only expecting a stopgap measure but if I end up noticing even complete maintenance by month 6 I'll be very pleased!

Sure thing.

Captain Hook, since apparently it seems like you're maintaining very well on minimal maintenance so far, have you ever had any thoughts of perhaps adding a little bit of Finasteride? I personally believe it will give you a huge boost in maintaining your hair if your male pattern baldness is genuinely very mild. Would you be willing to give Finasteride a go?

 

[DoctorHouse]

Patient Information and History:

I am a 20-year-old male, 186 cm, 73 kg, Mediterranean descent, moderate drinker (7-21 units of ethanol per week), occasional non-habitual smoker (1-5 packs per year spread out throughout the year) and board certified pharmacy technician.

Supplements:

Daily: Centrum Men’s Multivitamin, Nature’s Own Triple Concentrated Fish Oil, Vitamin D3 1000 IU as cholecalciferol 25 mcg, Biotin 300-5000 mcg

3-5x per week: AllMax Nutrition Quickmass (contains 3.86 g creatine per serving)

PRN: choline bitartrate 100mg, Coenzyme Q10 100mg, No-Doz Plus, Vivarin, ephedrine, 2mg Nicorette gum, melatonin 1-10mg

5-6 months per year @ 3x per week: BSN N.O. Xplode pre-workout supplement (contains 2.5 g creatine per serving), Acetyl-L-Carnitine or L-Carnitine 500mg

Hair products:

-Silicone-free shampoo and conditioner (when not using Nizoral)
-Various styling products (mostly wax, paste or mousse)

There are known incidences of androgenic alopecia on my paternal side of the family, with my father having a Norwood grade I hairline at 62 years of age and my father’s brother being Norwood grade VII at age 55 with progression unknown. Only one incidence of advanced androgenic alopecia on my maternal side of the family, my maternal grandfather was at Norwood grade III until his early 40s and then progressed fully to Norwood grade VII shortly afterwards, my maternal grandfather did have type II diabetes but was otherwise in good health. My mother’s brothers progressed to Norwood grade II to III late in life, around age 40-50.

Treatment timeline:

(Studies can be found on Google by copying and pasting the study IDs I've mentioned)

I’ve been experiencing mild hair loss, first noticed at 19 years of age around April 2014, seeing slightly more hair on my hands in the shower after applying shampoo and conditioner (thankfully not in clumps but rather single strands).

Hair loss slowly worsened over the course of the year, especially so after my 20th birthday (September of 2014). I initially presented to my dermatologist with seborrhoeic dermatitis in early November 2014 (which is also when I began lurking on this forum) and was prescribed ciclopirox olamine 1.5% w/w shampoo in the form of Stieprox, after several months no regrowth was noticed, only worsening of hair loss.

I experienced a relapse of seborrhoeic dermatitis in mid-March 2015 and was treated with ketoconazole 2% w/w shampoo in the form of Nizoral with good success and there has been no further relapse of seborrhoeic dermatitis due to once a week prophylactic antifungal therapy with either Nizoral or Stieprox, with Stieprox being used more often due to its refreshing scent. Hair loss continued to worsen, albeit slowly, noticing hairs on my pillow at this point, similar to the hair I found on my hands in the shower, the hairs present on my pillow were also strands and not clumps.

To rule out any other possible causes of hair loss I requested that my GP perform several blood tests as follows:

Comprehensive metabolic panel with lipid profile, complete blood cell count, thyroid function test panel, iron studies, serum zinc, serum magnesium and comprehensive male hormone panel (I'm at uni now and will update the exact values for this panel when I get home as I left the envelope with the test results back home). All came back within their normal reference ranges save for the serum zinc test which actually came back slightly higher than normal, but not high enough to interfere with copper levels (which would’ve showed up as an abnormality in the iron studies since copper is essential for iron metabolism)

I visited my dermatologist once again during mid July 2015 to assess the degree of hair loss, dermatologist’s opinion as follows: androgenic alopecia unlikely but is unable to make a definitive diagnosis at this point due to the patient’s young age. After performing a pull test, examining the scalp and taking photos and measurements of the hairline the dermatologist concluded that my hair loss is not advanced enough to be graded on the Hamilton-Norwood scale, with the dermatologist specifically stating that my hairline hasn’t receded enough to look like Norwood grade I. (I understand there is no such thing as NW0 but I’m just going by what the dermatologist said verbatim)

I then asked ophthalmologist about the removal of one of my topical ophthalmic medications that I take daily (I have ocular hypertension), timolol maleate 0.5% to which he approves, since beta-blockers are sometimes an etiology of alopecia, after one month of cessation I noticed no improvement and continual worsening of hair loss. Interestingly enough, I also take latanoprost ophthalmic, which belongs to a class of medications called prostaglandin analogues, currently being studied as a future treatment for androgenic alopecia, with another drug in a similar class (prostamides), bimatoprost (Lumigan), being marketed as a treatment that lengthens eyelashes under the brand name Latisse. It may be of note that while timolol wasn’t causing my alopecia, at least not to the same degree as in this case report (http://www.reviewofophthalmology.com/content/d/features/i/1317/c/25352/ as you can see, even when this patient discontinued timolol and recovered, he still remained NW2-3, meaning that the cause of timolol related hair loss is androgen independent and henceforth male pattern alopecia alone is not grounds for ceasing timolol treatment) it definitely could’ve triggered the onset of androgenic alopecia, which is mentioned on the American Hair Loss Association’s website as a mechanism of drug induced hair loss: (http://www.americanhairloss.org/drug_induced_hair_loss/).


Around early August 2015, I notice my hair loss worsening especially around the temples. It is likely that I am now at the point where my hair loss can be assessed on the Hamilton-Norwood scale, since the hair loss is not marked and is in the early stages I’m likely classed as Norwood grade I. (I’m going by what the scale’s pictures look like, I may very well be NW2 but to be honest the scale isn’t exactly easy to interpret, do tell me what you guys think based on the attached photos, with an extra one of my crown that I took today after I got my haircut for clarification as I'm unsure if I'm actually thinning back there or not. I've also attached a photo of my hairline the way it was back in mid November 2014 before any major loss occured) Having ruled out all other possible causes of alopecia (medication induced, malnutrition, thyroid pathologies) I decide to undertake treatment for androgenic alopecia after a diagnosis of exclusion and noticing the characteristic ‘male pattern’ presentation of my hair loss. Treatment regimen with my reasoning for use as follows:

Ketoconazole:

Ketoconazole 2% shampoo treatment in the form of Nizoral 2% began on 16 August 2015 with twice weekly 5 minute applications while showering indefinitely to inhibit dihydrotestosterone (DHT) activity in the scalp via dual pharmacological mechanisms, acting as an antagonist at the androgen receptor so as to not allow DHT to bind to the receptor and hence cause damage to hair follicles and inhibition of the 17α-hydroxylase/CYP17A1 enzyme which prevents the synthesis of DHT. As well as antiandrogen activity, ketoconazole 2% shampoo has also proven to be more effective than minoxidil 2% in stimulating hair growth, providing an 18% increase in hair density versus minoxidil 2%’s 11%. (PMID: 9669136)

Many people have marked concern about ketoconazole 2% shampoo’s ability to be systemically absorbed, this is unfounded due to the fact that the package insert for Nizoral brand ketoconazole 2% shampoo clearly states that plasma concentrations of ketoconazole were not detectable after topical administration on the scalp while plasma levels were detected after topical administration on the entire body. Therefore systemic side effects should be non-existent if one is using ketoconazole 2% shampoo as intended.

Another concern regarding ketoconazole 2% shampoo is its frequency of use. Countless forum users have said ‘why do we only need to use it twice a week when other hair loss treatments we use every dayâ€. The answer is simple; ketoconazole persists at therapeutic concentrations in the epidermal layers anywhere from 4-10 days, forgoing the need for daily use. (Kucers' The Use of Antibiotics Sixth Edition) This is due to its lipophilic nature and strong affinity for protein binding (read: keratin in the hair and scalp)

"Following a single application of ketoconazole shampoo, ketoconazole persists at therapeutic concentrations for 7 days in the epidermal layers. In addition, substantial pityrosporal inhibitory doses of ketoconazole were detected on the hair for several days after use of the shampoo, the mean level at 72 h was 11.6 µ mg."

(Pierard GE, Arrese JE, Pierard-Franchimont C, et al: Prolonged effects of antidandruff shampoos-time to recurrence of Malassezia ovalis colonization of skin. International Journal of Cosmetic Science. 1997;19:111-117.)

Again, if there’s any doubt in the treatment’s efficacy, look to the studies, where in one of them patients were only using the shampoo 2-4 times a week to achieve better results than daily 2% minoxidil use.

Lastly people seem to wonder if ketoconazole shampoo is ‘worth the hassle’. To be honest, I don’t see the inconvenience, we have to use shampoo in the shower anyway, and it only serves to conserve our normal shampoo if we use Nizoral twice a week. As well as controlling hair loss, I’ve personally had seborrhoeic dermatitis in the past and hence need to use an antifungal shampoo once a week indefinitely for prophylaxis to prevent a relapse of the condition, so for me using Nizoral is something I have to do regardless, so I figure it’s even easier to simply increase my usage to twice a week.

Spironolactone:

Spironolactone 5% topical cream treatment began on 30 August 2015 with twice daily applications indefinitely to inhibit DHT activity in the scalp via the same two mechanisms as ketoconazole albeit with much greater potency: androgen receptor antagonism and inhibition of the CYP17A1 enzyme as well as having three additional pharmacological mechanisms: progesterone receptor agonism which results in antigonadotropin effects, indirect estrogenic effects which increase the level of sex hormone binding globulin (SHBG binds to testosterone and hence lowers free T levels, therefore lowering the amount of free T converted to DHT) and the amount of testosterone converted to estradiol (meaning less T converted to DHT) and weak 5α-reductase inhibition (these last two lesser known mechanisms of spironolactone are supported via these studies: PMID: 7829618, PMID: 4033118, PMCID: PMC2923944)

I understand spironolactone can cause feminising effects when taken orally by men and hence most spironolactone studies are done only on women but while uncommon, the topical formulation has been proven in an older study on men and in a recent study on women to be effective for androgenic alopecia (alfatradiol is another antiandrogen that is effective for both men and women suffering from androgenic alopecia and it is clear that spironolactone is no different). It has also been proven that topical spironolactone is not absorbed systemically and hence has no endocrine systemic side effects. One of the studies showed even after applying 5% spironolactone cream to 55% of the patient’s body area, plasma canrenone levels (canrenone is the major metabolite of spironolactone) were undetectable during the 72 hours of treatment. Plasma levels of various hormones were measured both before and after application and also proved to be unaffected. (PMID: 3411088)

The specific topical spironolactone brand that I will be using is S5 Day Cream and will implement S5 Bedtime Cream after 2 months of use of the Day Cream. The reason being is to allow sufficient time to perform an allergy test and assess whether I tolerate the medication well (i.e. don't get a rash).

While some people are skeptical about the legitimacy of S5 cream and some even questioning its spironolactone content (a few people wondering if it even contains any spironolactone at all) all I have to say to that is that a decent trick to tell if spironolactone is present is its notorious odour. Being a drug that’s molecular structure contains a sulphur atom; it has a mercaptan-like odour, often described by many as a ‘rotten egg’ smell. I personally can confirm that S5 cream has this specific odour, although you can tell it’s been masked with limonene, resulting in a bit of a combination smell.

The vehicle used in S5 cream also comes under fire in various internet forums with many exclaiming ‘how do we know spironolactone is even absorbed at all’, this is also unfounded because the vehicle used for S5 (alcohol and triethanolamine) is the same as the vehicle used by compounding pharmacies who also make topical spironolactone formulations.

(Reference from this compounding pharmacy’s specific spironolactone formulation ID: US Pharm. 2012;37(12):43-44)

S5 Day Cream contains 1% caffeine in addition to 5% spironolactone; the addition of caffeine is thought to provide additional benefits for hair loss although further in vivo studies are needed to prove said benefits. (Evidence from in vitro studies showing stimulation of hair growth, suppression of androgen activity and 5α-reductase inhibition: PMID: 23075568, PMID: 24836650, PMID: 17214716)

S5 Bedtime cream contains no caffeine but instead includes 1% adenosine in addition to 5% spironolactone; the addition of adenosine is proven to provide benefits for hair loss with good evidence from studies done in humans, with results including thickening of hair density and one study even showing that topical adenosine in a 0.75% formulation was only slightly less effective than 5% minoxidil, with patients being more satisfied with the results from adenosine. (PMID: 24183218, PMID: 25925959)

It should be worth mentioning that while DHT is the pinnacle cause of androgenic alopecia, it is currently unknown whether other androgens have a pathological role. What we do know as of now is even those who are taking finasteride or even the potent dutasteride, some still inexplicably continue to lose hair and when a male with androgenic alopecia is castrated, said hair loss ceases to continue, this serves to suggest that other harmful androgens possibly have a lesser pathological role. With this in mind, androgen receptor antagonists such as ketoconazole and spironolactone offer peace of mind due to the fact that in addition to preventing DHT from binding to the androgen receptor, they also will prevent any other potentially harmful androgens from doing so as well.

Should hair loss not be controlled via the current treatment regimen, I will reassess after one year has elapsed and decide whether to add a topical 5α-reductase inhibitor such as alfatradiol. (References for effectiveness of topical alfatradiol: PMID: 7398983, PMID: 17451383, PMCID: PMC3412238)

I will not attempt treatment with finasteride, dutasteride or any novel oral 5α-reductase inhibitor due to the small but certain chance of irreversible side effects. My reasoning is similar for not attempting treatment with saw palmetto extract, which is not proven to be effective for androgenic alopecia yet also has a propensity to cause similar undesirable side effects.

I will not attempt treatment with minoxidil due to:

-Overall lack of long-term effectiveness as a hair growth stimulant, ending up being slightly better, equal or inferior compared to ketoconazole 2% and adenosine in concentrations of 0.75% and up depending on the concentration of minoxidil used.
-Lack of certain effectiveness since even Regaine/Rogaine’s website states that some minoxidil users only report maintenance or no effect at all (9/10 men kept or regrew hair was the exact statement, meaning it had no effect for 1/10 men and only some of the 9/10 experienced regrowth) and this recent study (PMID: 25112173) showing that the exact percentage of users that experience regrowth is only 40%. In addition, I’ve read Rogaine Foam has shown to provide regrowth in 85% of patients, so it seems results are equivocal.
-Absolute commitment to treatment as discontinuing minoxidil may cause rapid and irreversible loss of any newly grown hair whereas discontinuation of antiandrogens would simply allow DHT to slowly begin miniaturising hair follicles once again.
-Possible temporary worsening of alopecia (anecdotal shedding) with some anecdotal reports stating that no regrowth ensued after the shedding period, leaving them worse off than before.
-Side effects: While this study (PMID: 2826267) was performed in vitro and therefore we cannot draw definitive conclusions based on it until an in vivo study is performed, it mentions how minoxidil can inhibit collagen synthesis via lysyl hydroxylase inhibition and anecdotal reports have mentioned side effects of minoxidil that include increased wrinkles, dark circles under eyes and general acceleration of facial aging, while further trials need to take place to assume correlation, the evidence we have now is enough to provide me with yet another reason not to use minoxidil since I value my youthful facial appearance and skin quality greatly.
-As if the aforementioned reasons weren’t enough, lack of pharmacological ability to treat the underlying cause of androgenic alopecia, follicular miniaturisation via susceptibility to DHT is probably the biggest caveat of minoxidil therapy.

In short, minoxidil is far from a stellar product and in my opinion not absolutely necessary unless you are at the point where you absolutely need any benefit you can reap for your hair loss (e.g. grade III+ on the Hamilton-Norwood scale.))

This bit of advice is for the lurkers and the unaware. While it seems many sufferers of androgenic alopecia choose to use azelaic acid as a potential treatment, I caution them due to it’s lack of proven effectiveness for androgenic alopecia. While azelaic acid may hold promise for alopecia areata, the only studies relating azelaic acid to androgenic alopecia was one study that concluded that azelaic acid acts as a 5α-reductase inhibitor in vitro while cautioning the readers with a final statement of ‘if this inhibition is confirmed in vivo, zinc sulphate combined with azelaic acid could be an effective agent in the treatment of androgen related pathology of human skin’ and somehow many patients with androgenic alopecia seem to forgo this warning and assumed azelaic acid was “clinically proven†to work for androgenic alopecia. (PMID: 3207614)

My ultimate goal is to regrow my 17 year old hairline (which looks more or less the same as my 19 year old hairline in the November 2014 photo) but I understand that this is unrealistic statistically speaking. Even if I can only achieve maintenance with this regimen I will still be pleased. I'll post an update 6 months from now unless of course I see noticeable results earlier.

Also please let me know what Norwood you think I am, I'm not good at reading that scale at all.

Wow, Hook, for a 20 year old, you are very bright and articulate. Very impressive. You will go far in life. You are still a NW1 but its slowly diffusing. You might be forming a more mature looking hairline.

 

[Captain Hook]

Hey Captain!


I really like to read your posts, you sounds like knowledgeable and down-to-earth guy. Now, when I saw your personal thread I must say two things: your hairs are still in great condition and you wisely choose components of - more or less - prevention regime.


We have similar attitude to hairloss drugs – trying most potent and less risky treatment to see if it pays off. Despite that Im probably NW2 Im also reluctant to take finasteride. Im pretty sure, that mild but noticeable side effects of inhibiting DHT are more common that everybody thinks and any impairment of cognitive or sexual functions are out of equation for me.


I also see that you deeply researched topic of ketoconzaole. Whats you thoughts on Nizoral 2% cream? 2 days ago I bought one tube and Im using it twice a day at hairline and temples as addition to my regimen: minoxidil 2% 0.4ml/day (corners of hairline and temples); Nizoral 2% Shampoo every third day; Castor Oil 1ml/day orally + topical from time to time at same places as minoxidil.


Few weeks ago I noticed quite upsetting second shed, oily skin on face and little itching on male pattern baldness areas, so I searched for some DHT blocking topical solution / something to strengthen current regime. I dont want to freak out and change treatments in regime, because most studies of proven drugs like minoxidil or keto show positive results after 1+ year of constant use. Before I start, I told myself to stick to plan and evaluate results no earlier than after 12 months. So, what do you think about using keto cream daily, is this have some potential as addition to shampoo?


Cheers

I'm delighted to hear that, thanks for the kind words! As for 2% Nizoral cream, I believe the Japanese ketoconazole study I posted actually involved that very formulation and with good results. I'd say using the cream and shampoo in tandem would only serve to provide higher epidermal concentrations of ketoconazole and hence more activity against DHT, so I personally see no harm in doing so, it could only be beneficial.

If you're looking to add other topical antiandrogens in the future (perhaps a year or so from now after assessing results from your current regimen) I definitely suggest spironolactone cream or even RU58841 if you're comfortable with using research chemicals. Best of luck mate!

Sure thing.

Captain Hook, since apparently it seems like you're maintaining very well on minimal maintenance so far, have you ever had any thoughts of perhaps adding a little bit of Finasteride? I personally believe it will give you a huge boost in maintaining your hair if your male pattern baldness is genuinely very mild. Would you be willing to give Finasteride a go?

Oh without a doubt. Despite what I said in my original post, after pondering on the subject for a while I've concluded that finasteride is definitely an option. I'd implement it after 1 year of being on my current regimen if my Androgenetic Alopecia appears to have worsened. However, if I end up achieving complete maintenance after 1 year and see no worsening of my Androgenetic Alopecia, I see no reason to add finasteride to my regimen.

That being said, if setipiprant ends up being marketed by Kythera in the future, I absolutely will add it regardless for peace of mind, simply because of the excellent side effect profile based on its previous trials for use in the treatment of asthma. I wouldn't do the same for finasteride simply because it does have a chance of causing side effects, albeit a very minute chance, hence I will only implement it if necessary. It's a risk/benefit analysis, finasteride is certainly worth the risk if my Androgenetic Alopecia appears to have worsened, but it personally is not worth the risk if I am maintaining with my current regimen.

Wow, Hook, for a 20 year old, you are very bright and articulate. Very impressive. You will go far in life. You are still a NW1 but its slowly diffusing. You might be forming a more mature looking hairline.

Thanks House, that means a lot! I really appreciate the evaluation by the way as I find the pictures on the Norwood scale a bit confusing.

 

[deniak]

I'm delighted to hear that, thanks for the kind words! As for 2% Nizoral cream, I believe the Japanese ketoconazole study I posted actually involved that very formulation and with good results. I'd say using the cream and shampoo in tandem would only serve to provide higher epidermal concentrations of ketoconazole and hence more activity against DHT, so I personally see no harm in doing so, it could only be beneficial. If you're looking to add other topical antiandrogens in the future (perhaps a year or so from now after assessing results from your current regimen) I definitely suggest spironolactone cream or even RU58841 if you're comfortable with using research chemicals. Best of luck mate!

Thanks! Honestly Im crossing fingers for combo of Seti for maintenance and PG protocol for regrowth. Time will tell...

 

[Pequod]

Hi Captain Hook, You wrote a very long amount of information and I have say that you know a lot about this stuff. Having said that I have to wonder when you got a diagnosis that your hair loss is not due to androgenic alopecia and later on you say that "having ruled out all other possible causes of alopecia (medication induced, malnutrition, thyroid pathologies) I decide to undertake treatment for androgenic alopecia after a diagnosis of exclusion and noticing the characteristic ‘male pattern’ presentation of my hair loss." why you think you have ruled all other causes out?

I notice early on you talk about a relapse of seborrhoeic dermatitis, that can certainly create hair loss from everything I have read. If I had to guess I would say that is it. You hair is very thick and that could have created the loss and will possibly continue to do it if it relapses.

Here is why this is important. You are taking some medications to combat supposed hair loss due to male pattern baldness and also have suffered relapses of seborrhoeic dermatitis. So if you get the hair growth back will it be due to the medications or the regrowth of temporary hair loss caused by seborrhoeic dermatitis ? We won't know is my point, at least I couldn't say based on what your situation is. Unless the dermatologist ruled out any hair loss due to seborrhoeic dermatitis I would say this is a possibility after all.

Also all of the studies you link to are almost all unscientific for the most part, they are more pre-studies that don't use placebo controlled arms to see if what people see is real or imagined. One study allows the patients to decide about results, which is completely unscientific. What I mean by this is as far as I can tell none of these would pass an FDA trial to get these products approved as a hair loss product based on the results.

One of the studies 7398983 ends with this statement- These findings indicate that hair lotions containing 17 alpha-estradiol may have a therapeutic value in reducing androgenetic hair loss, if applied topically for a long period of time, similar to 17 beta-estradiol. However, no regrowth of new hair was found.

Now with finasteride we all have seen the links to the FDA trials of that medication. Nobody can question if they are legit because it was done scientifically.

Anyway from what you posted it is possible the Nizoral brand ketoconazole 2% shampoo helps to regrow hair as it could block the return of seborrhoeic dermatitis. If they were doing a scientific study on male pattern baldness and this shampoo I doubt they would allow you into the trial because of your condition. Does this sound reasonable? I am not pointing these things out to show i know more than you, I hope you don't take this the wrong way. I am only saying you may not get the right explanation of why you lost hair and are seeing it come back.

 

[Captain Hook]

Hi Captain Hook, You wrote a very long amount of information and I have say that you know a lot about this stuff. Having said that I have to wonder when you got a diagnosis that your hair loss is not due to androgenic alopecia and later on you say that "having ruled out all other possible causes of alopecia (medication induced, malnutrition, thyroid pathologies) I decide to undertake treatment for androgenic alopecia after a diagnosis of exclusion and noticing the characteristic ‘male pattern’ presentation of my hair loss." why you think you have ruled all other causes out?

I notice early on you talk about a relapse of seborrhoeic dermatitis, that can certainly create hair loss from everything I have read. If I had to guess I would say that is it. You hair is very thick and that could have created the loss and will possibly continue to do it if it relapses.

Here is why this is important. You are taking some medications to combat supposed hair loss due to male pattern baldness and also have suffered relapses of seborrhoeic dermatitis. So if you get the hair growth back will it be due to the medications or the regrowth of temporary hair loss caused by seborrhoeic dermatitis ? We won't know is my point, at least I couldn't say based on what your situation is. Unless the dermatologist ruled out any hair loss due to seborrhoeic dermatitis I would say this is a possibility after all.

Also all of the studies you link to are almost all unscientific for the most part, they are more pre-studies that don't use placebo controlled arms to see if what people see is real or imagined. One study allows the patients to decide about results, which is completely unscientific. What I mean by this is as far as I can tell none of these would pass an FDA trial to get these products approved as a hair loss product based on the results.

One of the studies 7398983 ends with this statement- These findings indicate that hair lotions containing 17 alpha-estradiol may have a therapeutic value in reducing androgenetic hair loss, if applied topically for a long period of time, similar to 17 beta-estradiol. However, no regrowth of new hair was found.

Now with finasteride we all have seen the links to the FDA trials of that medication. Nobody can question if they are legit because it was done scientifically.

Anyway from what you posted it is possible the Nizoral brand ketoconazole 2% shampoo helps to regrow hair as it could block the return of seborrhoeic dermatitis. If they were doing a scientific study on male pattern baldness and this shampoo I doubt they would allow you into the trial because of your condition. Does this sound reasonable? I am not pointing these things out to show i know more than you, I hope you don't take this the wrong way. I am only saying you may not get the right explanation of why you lost hair and are seeing it come back.

I understand I wrote a lengthy first post but at the same time I'd hope if people were to perform a critical analysis, that they had done well to read it thoroughly before drawing conclusions. My dermatologist stated verbatim "It's not likely that you have androgenic alopecia, however, it also is much too early to tell as you are young and hence I cannot make a definitive diagnosis". I think I had ruled all other possible causes out because both my dermatologist, GP and ophthalmologist had thought so too. Extensive blood work did in fact rule out causes such as mineral deficiencies and thyroid pathologies.

My relapse of seborrhoeic dermatitis occured mid-March and ever since then I have been on prophylactic antifungal therapy once weekly in the form of 2% Nizoral or 1.5% Stieprox (ciclopirox olamine) and switching exclusively to 2% Nizoral and upping the dosage frequency to 2x weekly on 16 August 2015. Surely in the span of March to August I would've noticed some improvement if my hair loss was due to seborrhoeic dermatitis, instead I noticed the same amount of shedding and gradual worsening of my temple recession. Also not to mention hair loss from seborrhoeic dermatitis doesn't present itself in the typical 'male pattern' like the way my temples are receding. My dermatologist even agreed in July that I no longer have seborrhoeic dermatitis and won't return as long as I remain on the minimum once weekly antifungal shampoo prophylactic therapy so she would've mentioned if there was a chance that seborrhoeic dermatitis would be responsible. I haven't had any flaking since the relapse in mid-March.

I never claimed that the studies I posted were scientifically sound, I just stated them as my reasoning to start treatment with the given options, with topical spironolactone and ketoconazole having at least one study that involved actual quantitative measurement of reduction of labelled DHT or measurement of hair shaft diameter respectively. In addition to anecdotal reports, this is good enough for me. The FDA is not the alpha and the omega, with many doctors recommending off-label treatments (even dutasteride is off-label for Androgenetic Alopecia and it is extremely effective), compounding pharmacies make topical spironolactone for a reason, because it works for androgen-related acne, so hence I felt no qualms attempting its use for Androgenetic Alopecia.

I also never claimed 17-alpha-estradiol regrew hair so I fail to see why you felt the need to bold that statement. I also never questioned the legitimacy of finasteride and stated in an earlier post that it is a future option to add to my regimen.

 

[Captain Hook]

Update 2/11/2015

So it's been a little over a year since my Androgenetic Alopecia has really progressed and as you can see from the comparison pictures, things aren't looking good.

I figure since I've lost this much ground when looking at the 1 year comparison photos (the before picture was taken in early November 2014), and even the slowing of shedding from my current regimen has evidently done nothing to help, I decided to book an appointment with my dermatologist when I return to HK next week. I have an appointment for 13 November and I'm going to inquire about finasteride and dutasteride, I'm hoping for a prescription for the latter if my dermatologist sees this as a prudent move.

I'm really astonished and hence I don't want to waste anymore time. I figure deciding to pursue treatment with the most powerful proven Androgenetic Alopecia medication available at the moment is the appropriate option. Dutasteride needs no introduction, we're all aware of the studies (as posted below) that show it provides increased hair counts versus finasteride, in addition, I've never heard of anyone losing ground on legitimate dutasteride. I see a lot of sad boys on this forum whinging about how they may be losing ground on finasteride and I honestly do not want to be one of them, nor do I want to spend any more time worrying.

As for side effects, they seem to occur at incidence rates similar to finasteride and they don't seem to show much statistically significant variation when controlled for placebo. The way I see it, if I'm going to take the oral 5ARI plunge, I might as well go full gas and select dutasteride, that way I can have peace of mind that I'm doing everything within my power to stop my Androgenetic Alopecia progression, no two ways about it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472914/

http://www.ncbi.nlm.nih.gov/pubmed/24411083

 

[macbeth81]

I feel your pain; my hairline took a hit around the same age. Hopefully you will be a good responder to treatment. Maybe the color contrast is making it appear worse than it is though.

 

[Agustin Araujo]

Captain Hook, in the pics you provided, you do have frontal hair loss. You have a strong forelock, so that's good. Getting on Finasteride is a smart move, your temples could make a full recovery if you respond excellently to the treatment especially since your hair loss hasn't been present for the longterm.

 

[DoctorHouse]

Hook, based on your age and aggressive loss at the front, I can understand why you want to hop on dutasteride right away.

 

[Captain Hook]

i think getting on finasteride or dutasteride is the right move - i'd do right away if i were you and monitor for sides; you gotta tackle it with everything you have to stop it/reverse it. Good luck

Oh believe me, I shall be, right after I walk out of the dermatologists office with a prescription (I know her pretty well, I can't see her not providing me with something) I'm heading straight to the pharmacy that's only a short walk away, filling the prescription, going home and then taking the first dose that night. There's no more time to waste. Thanks for the vote of confidence!

I feel your pain; my hairline took a hit around the same age. Hopefully you will be a good responder to treatment. Maybe the color contrast is making it appear worse than it is though.

Hopefully so, the lighting is much harsher in the second photo, but hey, so is the truth.

Captain Hook, in the pics you provided, you do have frontal hair loss. You have a strong forelock, so that's good. Getting on Finasteride is a smart move, your temples could make a full recovery if you respond excellently to the treatment especially since your hair loss hasn't been present for the longterm.

Thanks, that's the idea! From what I've read as long as the hair loss has occurred within the last 3-5 years then there's a decent chance of recovery and reversal when using oral 5ARIs. Hopefully this is the case for me. It's ironic, back in early September I was being mocked and was told I "have no hair loss" by a forum member named Xetudor. That kind of behaviour is unacceptable because it causes second thoughts and may delude people into thinking that they shouldn't seek aggressive treatment options early, just because people are salty about treating their own Androgenetic Alopecia too late doesn't mean they should encourage the same of others.

Hook, based on your age and aggressive loss at the front, I can understand why you want to hop on dutasteride right away.

Thanks for understanding House, I honestly didn't think it was this bad because my Androgenetic Alopecia didn't seem to progress quickly during the first half of 2015, my dermatologist didn't even think I had Androgenetic Alopecia back in July! During the second half though, progression just became exponential as opposed to linear for some reason.

 

[Swoop]

I wanted to say you probably have OCD and need to see a therapist but seeing your latest update there seems to be recession although the picture is hard to evaluate. Dunno why some people these days still take bad quality pictures like that.

Nonetheless going on finasteride/dutasteride is a good move. Did you really think you were going to maintain on S5 cream lol. Classical noob mistake I guess.

If you are lucky you might regrow some of what you lost, if not at least you will stop Androgenetic Alopecia from progressing if you act now. It's still minor recession at this point. Good luck.