I wonder how they confirm that the "nanozyme" compound is the thing that helped here and not the presence of the needles themselves, considering microneedling is already commonly used to stimulate hair growth, sometimes in combination with Minoxidil[0][1]
My impression was the the patch goes on the affected skin. I don't know where T->DHT, but I assume that it's not in the skin. I am not a doctor and I'm not even well informed on this matter.
Testosterone as a hair loss theory is based entirely on correlation.
What it fails to explain is why, if testosterone is the culprit, hair grows in other places later in life.
A much more compelling theory is that hair loss is due to the stretching of the scalp as the muscles and bones in the face grow in aging. It also explains why men have more hair loss then women. The force diagrams match male pattern baldness perfectly. (yes, also correlation)
As said up thread it doesn't explain the successful transplants of follicles to these areas.
If follicles transplanted to these areas also failed, then the mechanical explanation would hold more water, but they empirically don't...so something is obviously different at the follicle level.
Yes, exactly, we can (and do) mess with hormones and see what happens. This causal link is extremely well established and rubicon33 does not know what they are talking about.
How would you then explain all the double-blind clinical trials that demonstrated the majority of patients on Finasteride (a popular DHT inhibitor) slowed down, or slightly reversed, their hair loss, compared with the patients who were on placebo?
(please Google for the studies and data, I don't have links ready but have reviewed them in the past, there are tons by different groups of researchers across many countries)
If it is not DHTs fault (and by proxy Ts, as more T = more DHT) then why do finasteride and dutasteride work so very well?
At this point, rejecting as main culprit for AGA either too much DHT or a DHT sensitivity that is to high or, worst case, both at once in one man, is nothing but crazy fringe science.
To stress this out, the vast majority of men will keep their hair forever with oral minoxodil and oral finasteride and someone not keeping it on oral dutasteride instead of finasteride is a freak of nature.
I believe there have been studies where they've transplanted hair from and to different parts of the body and found that they largely continue to grow the way they did at their original site, implying that follicles from different parts of the body just respond to hormonal environment differently.
Also the current understanding is that it's specifically DHT (a second order type of testosterone) that causes head hair follicles, and hormone treatments that modulate conversion of T into DHT one way or the other have fairly predictable effects on hair loss patterns.
There probably isn't just one single cause here, but hormones are definitely a big part of it.
You're underselling modern medicine and giving rubicon33 way too much credit. This isn't merely academic, it isn't merely correlations, it isn't speculative, and it isn't a mess of competing explanations. Hair transplants are a common and reliable intervention for male pattern baldness.
If MPB were due to a tension mechanism, transplants wouldn't work. But they do. If MPB were due to a tension mechanism, surgical intervention would be simpler than transplanting thousands of follicles. But it isn't. If MPB is due to an endocrine mechanism, which it is, transplanted hair would behave differently than adjacent "native" hair against the progression of balding. It does.
Billions of transplanted follicles on millions of balding heads testify to the fact that rubicon33 is way off base.
To me it's probably a combination of stress from dht exposure and mechanical stress that causes thinning and baldness once the total stress level around the follicle surpasses some threshold. You can't just dismiss mechanical stress that easily, it would be an insane coincidence for scalp tightness to correlate so closely with dht sensitivity in the absence of any causality.
I really don't know what in my post made you feel like I was giving the GP any credit at all. This is a weirdly combative reply for a vehement agreement?
I've perused some literature and the noise from online forums resulting in a plausible theory of the mechanism of male pattern baldness that I've seen proposed:
1 - Higher testosterone, generally correlated with higher amounts of DHT as testosterone is metabolized into DHT. This obviously depends on some intermediary metabolic process and all of the dependencies involved there.
2 - Certain hair follicles are DHT resistant. Why does MPB follow a M-shaped pattern and devolve into common patterns across those afflicted?
Takeaway: mechanical stress induces chronic inflammation on the scalp, localized in areas that correspond to MPB hairloss areas. Chronic inflammation begets androgen binding and those with high amounts of systemic DHT/vulnerable follicles develop MPB.
> mechanical stress induces chronic inflammation on the scalp
This seems measurable (inflammation markers in titers), testable (A/B test with NSAIDs), and amenable to preexisting population studies without tracking patients over time (eg. find patients with long hair, that wear hats, etc.)
Why would the middle top back of the head be so subject to mechanical stress, if this theory is correct. I can see that for hat wearers, but that 'bald spot' is so common across the board even for non-wearers it seems not caused by mechanic stress as the first cause in the chain above.
> Nine mice were randomly assigned to one of three groups: negative control (testosterone), experimental (testosterone + MnMNP), and positive control (testosterone + minoxidil).
Have any other HN readers gone through all the standard hair loss prevention treatments and just given up?
I was obsessed with saving my hair in my late 20s. In my 30s I just accepted it and moved on. Treatments can be expensive with dubious results (Minoxidil, different shampoos) or have possible serious side effects (Finasteride). This can be really disheartening if you are single though.
I (mid 30s) have been on Finasteride for a couple years. No side effects whatsoever (healthy sex life, no depression, etc.) and it seems to have significantly slowed down my progression. I do not take Minoxidil because it would consume too much of my time, and am not comfortable with the oral version.
If Finasteride continues working for a few more years I might consider a FUE transplant to restore a bunch of density. I consulted with a top hair transplant surgeon (very famous and pricey, with a one year-long backlog) and he told me Finasteride is by far the most effective, and time-sensitive, treatment one can start to mitigate the problem. In his experience of 20+ years as surgeon administering Finasteride to 1000s of patient, he said the number of people exhibiting side effects is consistent with the published research during clinical trials, i.e. very very low. That being said, each person clearly has a different appetite for "risk".
He said I should not necessarily be in a rush with the transplant considering my situation, and that as long as I keep using Finasteride and it works it will keep my options open in the future for a transplant.
I'm also not single and my partner actually suggested multiple times she doesn't care about my hair, I just do like my hair and will explore all options this world has to offer before giving up :-)
> This can be really disheartening if you are single though.
I started to lose my hair earlier than I cared, so I started cutting my hair rather short to deal with it. I met my partner around this time, but we were both in other relationships. A few months later, I finally decided to shave my head, and only after that did my partner think I looked good. Maybe this will work for you if you haven't gone down this route already.
If hair treatments don't work, just completely shave your head or keep it trimmed really close - that's a look that can be pulled off by a lot of guys. What is generally considered unattractive (even if people are no longer allowed to say it out loud they still think it) is the male-patterned baldness look.
But just look at Jeff Bezos and Elon Musk in the late 90s vs. today - they took different but IMO equally successful approaches to their hair loss. Musk went the hair plugs route while Bezos went the "shave it all off" route (of course I don't think the hormone therapy for Bezos hurt either).
Getting ripped really helps Bezos pull off that look. No hair on your head, none on your face, and a dad bod can make one look like a giant baby or like someone under going chemo. Neal Stephenson seems to have done well with the facial hair route, not ending up looking like a pair of handlebars or someone with an upside down head.
That's something people really need to know: finasteride / dutasteride literally modify your endocrine (hormonal) system. They block (most) DHT production which is a key hormone for male sexual health / mental well-being etc. so it should be surprising if you have don't have side effects. Having said that though, the side-effects aren't necessarily bad. You might feel different but it depends on the person if that difference is considered good or bad (I think most men would feel bad though?) Note that since conversion from testosterone to DHT is blocked, your DHT decreases but your testosterone increases.
TL;DR: discuss the possible implications (especially fertility-related!) of higher T and lower DHT with your doctor before taking finasteride / dutasteride
Many drugs modify your hormonal system - that in and of itself isn't the issue. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/ is a really good overview in my opinion that does a thorough, fair analysis of many studies of finasteride.
The biggest problem I have when hearing about finasteride side effects is that anecdotal reports are completely useless when determining the true risks of finasteride, but they are played up a ton by the press. The reason being that finasteride is a long term medication. If you look at a large group of men from, say, age 30, tons of them will develop fertility issues, sexual issues, depression, etc. in the next 5 years regardless of any medications they are taking. But it's very easy to get someone on the news that says "I started taking finasteride last year and now I have no libido" and blame it on finasteride. The press rarely interviews people like me who have been taking finasteride for nearly 20 years with no ill effects.
And, to be clear, my anecdotal report is useless, too - only broad meta-analyses and your personal risk threshold should weigh into your decision of whether or not to take it.
As another anecdote though, I started taking something like .1mg/day topically and I wasn’t anticipating side effects. My mood and libido absolutely tanked.
It’s the same as women on hormonal birth control. Some don’t notice any difference - and others get incredibly moody/sad/etc. Hormones are complex.
I refused to ever go down the chemical path and just lived with the ugliness of having splotchy hair on the crown of my head. It didn't seem to impact my dating life much but there are so many variables in such things that it's hard to know if things would have been somehow better if I hadn't started thinning. But then I went through a very stressful period of life and the hair loss accelerated and I started shaving it completely. Though I have since grown my hair out again, the pre-stress slotchiness is still there but I in general don't care.
Being Mr. Clean level bald for several years did come with some lessons. The biggest was that even with thinning hair, it provides far more thermal regulation than you'd expect. Without any hair, your head can quickly overheat in direct sunlight and you lose tons of heat during cold weather. Get accustomed to having hats. For me, the newsie type hat worked best but for some reason, there are plenty of people who think if you wear that particular type of hat, that you're trying to fool everyone into thinking you're not bald. Some people can be very assholish about it. But for the bald it is a good hat because there's not a lot of empty space for where hair usually would go. It does a nice job of replicating the thermal regulation hair normally would. Mesh trucker type hats are generally not a good choice. There's too much airflow and the bands tend to be abrasive.
Another thing you'll have to deal with if you still have significant amounts of hair outside of the balding spots is how much more time you're now going to spend keeping it shaved clean. Stubble might be seen as sexy on your face but it looks bad on your head. Any time savings from not needing to shampoo, condition, and style your hair can get consumed by needing to keep it shaved. There are specialized types of razors made for head shaving that use standard shaving cartridges. It's worth spending a few bucks on getting one instead of using a razor designed for your face.
Great summary. In my 60s I can tell you that the one thing you didn’t cover is the vast amount of hobbit hair one can have while still being bald. if only I could put my ear, nose, and toe hair to use for good instead of evil…
I am taking oral minoxidil at the dangerous upper limit I barely tolerate (12mg). At the start I once almost drowned in wild waters from the unexpected fast heartbeat and low energy.
Finasteride gave me severe depression. Also, I microneedle. My min + microneedle regime is extremely effective.
This happened to a friend of mine. Another is taking it for years and is fine. I honestly think people aren't warned enough about that side effect. I was more worried about possible sexual dysfunction.
I am using a pelcas one. On amazon there seems to be a pseudo brand cluster of pens that look very similar but use the same cartridges. You can check out /r/tressless for more reviews.
Trim it really close, im not going to pull off a jason statham or bruce willis, but its easy enough to cut with an electric razor myself. Used to have a cheap barber, but covid led me to try it myself, and doable
I take oral minoxidil and dutasteride without any negative side effects (okay - my eyelashes are now a bit too luscious for my liking, and my nails grow very fast). I've also had two (by design) hair transplants. Never cared about my hair loss re: women. I've found consistently that many (enough) women don't care. Body image issues are the problem.
I just wish there was an easy way to sort what works from what's snake oil.
You've got my barber recommending to check out some infrared hat thing you wear a few dozen minutes a day, you've got minoxidil and finasteride, special shampoos, microneedling, hair transplant, etc.
I'm about to join the 30-something club and my hairline has started to recede (temples first). To be honest, it's been around a lot longer than I thought it would be - my dad and grandfathers had little hair by age 30. Not that I've really taken advantage from a dating perspective (self-image issues are no fun).
I would like to keep it around if possible, but if the answer is more drugs with little research into long term usage, I'm not sure if I'd really be willing to make that trade-off.
The thing is, all of those things work - at least to some extent. I’d try Minoxidil, micro needling, and LLLT first (but not necessarily all three) as the side effect profile is low.
Even a super low dose finasteride gave me significant side effects, but I do have some hormonal issues on my own. Some people apparently get long term side effects, and my doctor was against me trying it for that reason.
Obviously hair transplants are the nuclear option.
Tried microneedling and all I got was oddly smooth skin that seemed to be accumulating scar tissue (hard to explain). This was with a Dr Pen and the 16 needle tip at 1.5mm. Hair seems thinner now.
Probably 6 sessions over two months. I stopped pretty early but given what it was doing to my skin and hair I didn't feel safe continuing. Also it hurts like hell.
If you decide to try again, my advice is to start at 0.5mm once a month for 6 months. Ease yourself into 1-1.25mm once every 2 weeks. Weekly 1.5mm is overkill.
72 comments
[ 3.6 ms ] story [ 145 ms ] thread[0] https://pubmed.ncbi.nlm.nih.gov/29028377/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746236/
They treated the control group with testosterone? I.e., the hormone most linked to baldness?
Different people have variable ratios, and genetics certainly play a role in the variability.
What it fails to explain is why, if testosterone is the culprit, hair grows in other places later in life.
A much more compelling theory is that hair loss is due to the stretching of the scalp as the muscles and bones in the face grow in aging. It also explains why men have more hair loss then women. The force diagrams match male pattern baldness perfectly. (yes, also correlation)
If follicles transplanted to these areas also failed, then the mechanical explanation would hold more water, but they empirically don't...so something is obviously different at the follicle level.
He simply says it the theory is based on correlation which you agree to in your first sentence.
(please Google for the studies and data, I don't have links ready but have reviewed them in the past, there are tons by different groups of researchers across many countries)
At this point, rejecting as main culprit for AGA either too much DHT or a DHT sensitivity that is to high or, worst case, both at once in one man, is nothing but crazy fringe science.
To stress this out, the vast majority of men will keep their hair forever with oral minoxodil and oral finasteride and someone not keeping it on oral dutasteride instead of finasteride is a freak of nature.
Also the current understanding is that it's specifically DHT (a second order type of testosterone) that causes head hair follicles, and hormone treatments that modulate conversion of T into DHT one way or the other have fairly predictable effects on hair loss patterns.
There probably isn't just one single cause here, but hormones are definitely a big part of it.
If MPB were due to a tension mechanism, transplants wouldn't work. But they do. If MPB were due to a tension mechanism, surgical intervention would be simpler than transplanting thousands of follicles. But it isn't. If MPB is due to an endocrine mechanism, which it is, transplanted hair would behave differently than adjacent "native" hair against the progression of balding. It does.
Billions of transplanted follicles on millions of balding heads testify to the fact that rubicon33 is way off base.
1 - Higher testosterone, generally correlated with higher amounts of DHT as testosterone is metabolized into DHT. This obviously depends on some intermediary metabolic process and all of the dependencies involved there.
2 - Certain hair follicles are DHT resistant. Why does MPB follow a M-shaped pattern and devolve into common patterns across those afflicted?
3 - https://pubmed.ncbi.nlm.nih.gov/26622151/ Mechanical stress points on the scalp seems to map injectively to the areas that see hair recede.
Takeaway: mechanical stress induces chronic inflammation on the scalp, localized in areas that correspond to MPB hairloss areas. Chronic inflammation begets androgen binding and those with high amounts of systemic DHT/vulnerable follicles develop MPB.
This seems measurable (inflammation markers in titers), testable (A/B test with NSAIDs), and amenable to preexisting population studies without tracking patients over time (eg. find patients with long hair, that wear hats, etc.)
What if the stress points simply cause lack of blood flow, leading to sebum buildup?
> Nine mice were randomly assigned to one of three groups: negative control (testosterone), experimental (testosterone + MnMNP), and positive control (testosterone + minoxidil).
I was obsessed with saving my hair in my late 20s. In my 30s I just accepted it and moved on. Treatments can be expensive with dubious results (Minoxidil, different shampoos) or have possible serious side effects (Finasteride). This can be really disheartening if you are single though.
If Finasteride continues working for a few more years I might consider a FUE transplant to restore a bunch of density. I consulted with a top hair transplant surgeon (very famous and pricey, with a one year-long backlog) and he told me Finasteride is by far the most effective, and time-sensitive, treatment one can start to mitigate the problem. In his experience of 20+ years as surgeon administering Finasteride to 1000s of patient, he said the number of people exhibiting side effects is consistent with the published research during clinical trials, i.e. very very low. That being said, each person clearly has a different appetite for "risk".
He said I should not necessarily be in a rush with the transplant considering my situation, and that as long as I keep using Finasteride and it works it will keep my options open in the future for a transplant.
I'm also not single and my partner actually suggested multiple times she doesn't care about my hair, I just do like my hair and will explore all options this world has to offer before giving up :-)
I started to lose my hair earlier than I cared, so I started cutting my hair rather short to deal with it. I met my partner around this time, but we were both in other relationships. A few months later, I finally decided to shave my head, and only after that did my partner think I looked good. Maybe this will work for you if you haven't gone down this route already.
But just look at Jeff Bezos and Elon Musk in the late 90s vs. today - they took different but IMO equally successful approaches to their hair loss. Musk went the hair plugs route while Bezos went the "shave it all off" route (of course I don't think the hormone therapy for Bezos hurt either).
TL;DR: discuss the possible implications (especially fertility-related!) of higher T and lower DHT with your doctor before taking finasteride / dutasteride
The biggest problem I have when hearing about finasteride side effects is that anecdotal reports are completely useless when determining the true risks of finasteride, but they are played up a ton by the press. The reason being that finasteride is a long term medication. If you look at a large group of men from, say, age 30, tons of them will develop fertility issues, sexual issues, depression, etc. in the next 5 years regardless of any medications they are taking. But it's very easy to get someone on the news that says "I started taking finasteride last year and now I have no libido" and blame it on finasteride. The press rarely interviews people like me who have been taking finasteride for nearly 20 years with no ill effects.
And, to be clear, my anecdotal report is useless, too - only broad meta-analyses and your personal risk threshold should weigh into your decision of whether or not to take it.
It’s the same as women on hormonal birth control. Some don’t notice any difference - and others get incredibly moody/sad/etc. Hormones are complex.
Being Mr. Clean level bald for several years did come with some lessons. The biggest was that even with thinning hair, it provides far more thermal regulation than you'd expect. Without any hair, your head can quickly overheat in direct sunlight and you lose tons of heat during cold weather. Get accustomed to having hats. For me, the newsie type hat worked best but for some reason, there are plenty of people who think if you wear that particular type of hat, that you're trying to fool everyone into thinking you're not bald. Some people can be very assholish about it. But for the bald it is a good hat because there's not a lot of empty space for where hair usually would go. It does a nice job of replicating the thermal regulation hair normally would. Mesh trucker type hats are generally not a good choice. There's too much airflow and the bands tend to be abrasive.
Another thing you'll have to deal with if you still have significant amounts of hair outside of the balding spots is how much more time you're now going to spend keeping it shaved clean. Stubble might be seen as sexy on your face but it looks bad on your head. Any time savings from not needing to shampoo, condition, and style your hair can get consumed by needing to keep it shaved. There are specialized types of razors made for head shaving that use standard shaving cartridges. It's worth spending a few bucks on getting one instead of using a razor designed for your face.
Finasteride gave me severe depression. Also, I microneedle. My min + microneedle regime is extremely effective.
This happened to a friend of mine. Another is taking it for years and is fine. I honestly think people aren't warned enough about that side effect. I was more worried about possible sexual dysfunction.
Functional sexual recovery took up to three months. At this point I do believe in post finasteride syndrome, and I am glad I completely recovered.
I did... "smalldose" at 0.5mg a day for only about 3 months.
And yes, the vast majority seems to have no nameworthy side effects. The norwood reaper is cruel.
I am using a pelcas one. On amazon there seems to be a pseudo brand cluster of pens that look very similar but use the same cartridges. You can check out /r/tressless for more reviews.
You've got my barber recommending to check out some infrared hat thing you wear a few dozen minutes a day, you've got minoxidil and finasteride, special shampoos, microneedling, hair transplant, etc.
I'm about to join the 30-something club and my hairline has started to recede (temples first). To be honest, it's been around a lot longer than I thought it would be - my dad and grandfathers had little hair by age 30. Not that I've really taken advantage from a dating perspective (self-image issues are no fun).
I would like to keep it around if possible, but if the answer is more drugs with little research into long term usage, I'm not sure if I'd really be willing to make that trade-off.
Even a super low dose finasteride gave me significant side effects, but I do have some hormonal issues on my own. Some people apparently get long term side effects, and my doctor was against me trying it for that reason.
Obviously hair transplants are the nuclear option.