DHT

4 Primary Ways of Treating Hair Loss

4 Primary Ways of Treating Hair Loss - Androgenic Alopecia (AGA)

  1. Using 5-AR (alpha-reductase) inhibitors “DHT blockers”
  2. Anagen Phase Stimulating Agents (anagen stimulants)
  3. Anti-androgenic agents (topical solutions) 
  4. Hair stem cell-related agents (injectable treatments)

Part 1

1. Inhibiting 5AR conversion from T to DHT ("DHT blocking")

DHT has been shown to progressively miniaturize the hair follicles on the scalp which is only one if its androgenic effects on human body.  Unfortunately this unfortunate effect of DHT only occurs by individual with genetic hair loss susceptibility.

Blocking DHT (dihydrotestosterone) always starts by inhibiting 5AR isoenzymes. Inhibiting the activity of type 1 and type II. 5 alpha reductase isoenzymes can be enough for the start. Men who suffer from any type of patterned hair loss (besides alopecia areata) start taking Finasteride (branded as Propecia, Proscar).

 Finasteride can inhhibit the 5-alpha reduction of Testosterone into DHT by approximately 70%. It is the only FDA approved oral drug for treating male pattern hair loss (AGA). 

Some Finasteride users may experience more than hair loss stabilization. Many of them also report positive hair thickening benefits over time. These are so called – well respondents to 5 AR inhibiting drugs.

Hair Follicle Androgen Receptor Sensitivity to Androgens and how Finasteride (Propecia) can help with hair loss

 

Inhibition of the 5 alpha reduction of Testosterone into several times more potent androgen – DHT results in less hair loss. Plasma DHT levels – lowered by Finasteride result in less frequent interaction of hair follicle´s androgen receptors with the DHT. 

For that reason, patients who use 5 AR inhibiting drugs like Finasteride tend to notice less hair loss. Importantly Finasteride limits the interaction of the most potent naturally-occurring androgen in your body DHT – with the hair follicles´ androgen receptor.

Types of 5 AR inhibitors effective for Hair Loss

Finasteride (Propecia,Proscar)
  • Inhibits 5-alpha reduction of T into DHT by 70% systemically and 50% topically
  • Only FDA approved oral medication for treating male pattern hair loss
  • Inhibits only type II. 5 AR isoenzyme activity
  • Requires prescription in most countries (excl. Turkey, Saudi Arabia)
  • Can come with potential side effects (statistically low percentage though)
Dutasteride (Avodart) 
  • 5-alpha reduction inhibition of T into DHT by 90-95% systemically 
  • Not FDA approved oral medication for treating male pattern hair loss
  • FDA approved medication for treating enlarged prostate in men
  • Suppresses type II. and type I. 5 AR isoenzymes activity 
  • Can come with potential side effects (statistically higher than Finasteride)
Topical Finasteride 0.25% Solution 
  • Suppression of 5-alpha reduction of T into DHT by 70% topically (study)
  • Very low (if any) effect on systemic DHT suppression
  • Not FDA approved oral medication for treating male pattern hair loss
  • Inhibits only type II. 5 AR isoenzyme activity
  • Can be compounded by a licensed pharmacy or bought online for research purposes
  • Requires a prescription sometimes by purchases from a pharmacy
  • Side effects can´t be entirely avoided either (statistically lower as opposed to oral Finasteride)
Topical Dutasteride
  • Very few clinical studies done on topical Dutasteride
  • Better efficacy as opposed to topical Finasteride can be expected but only via transdermal injection delivery or mesotherapy 
  • Low potential for systemic DHT suppression
  • Higher mollecular weight compared to topical finasteride restricting proper transdermal absorption
  • Not FDA approved for treating male pattern hair loss
  • Topical dutasteride application via mesotherapy is still relatively unknown among dermatologists and hair transplant doctors
Saw Palmetto (Serenoa repens)
  • Inhibits 5-alpha reduction of T into DHT by 32% systemically
  • Not FDA approved oral medication for treating male pattern hair loss
  • Less potent 5 AR inhibitor in comparison to Finasteride or Dutasteride
  • Side effects haven´t been observed but can occur

The pros and cons of using 5 AR inhibiting agents for long-term hair loss management (AGA)

Advantages

Finasteride has been the most studied and most researched 5 AR inhibitor ever approved for hair loss by the FDA.

5 AR inhibitors tend to work well for majority of guys initially. However after some time their effectiveness may start to fade. How soon, will depend on the severity/aggressiveness of your AGA and changes in your androgen levels as you age.

Use of 5 AR inhibitors has been shown not only to slow down male pattern hair loss progression but also result in thicker scalp hair growth. Hair thickening effect after using 5 AR inhibitor depends on how good of a respondent you are. 

Disadvantages

5 AR inhibitors may not be enough for men with more “severe” genetic hair loss condition. 

5 AR inhibitors don´t protect the hair follicles´ androgen receptors from androgens in general.

DHT leftovers, testosterone and other “weaker” androgens can still cause hair loss by individuals with genetic hair loss condition using Finasteride already.

5 AR inhibitors are not able to “block” the androgenic effects of natural androgens or steroidal androgens.

Potential side effects related to low sexual desire, low libido, decreased sexual arousal , weak erections by small percentage of users were observed by 5 AR inhibitor users. Statistically only 1-2% of men experience side effects from drugs like Finasteride (slightly higher side effect profile by Dutasteride).

Make sure you do your due diligence on PFS (post finasteride syndrome)– mixture of psychologically- and sexually-related side effects, depression, suicidal thoughts, anxiety.

PFS suggests that these side effects may also persist after patients discontinue the use of any 5 AR inhibiting agent like Finasteride or Dutasteride.

Why are 5 AR inhibitors effective for the start?

 

DHT is the most potent androgen causing hair loss. DHT does it to the highest degree in comparison to other androgens like testosterone. Especially because it has a much higher binding affinity onto the androgen receptor of the hair follicle. By focusing on 5 AR inhibition and thus DHT suppression, most of men start seeing clear improvements. Less hair loss, hair becomes thicker and better to style again.

DHT is more likely to transcribe its potential damaging effects onto the hair follicle than any naturally-occurring androgen.  By inhibiting it 70% with Finasteride or  90%+ with Dutasteride, the pressure can be put off the androgen receptor. It only works while 5 AR is being inhibited. 

The efficacy of 5 AR inhibiting medication depends on the frequency and dosage of the used drug. 

Biological half-life of 5 AR inhibitors (Finasteride vs. Dutasteride)

Finasterides´ elimination half-life is only 6-8 hours whereas Dutasteride has a much longer half-life – up to 6 weeks. Consult a hair transplant doctor, dermatologist or any licensed medical professional to find out the optimal dosage for you.

How well the 5 AR inhibitors will work for you, depends on how good of a respondent you are. Many guys keep using Finasteride for a successful long term hair loss management for many years. Meanwhile 1 or more hair transplants may be required for improved hair density and thickness. 

Working Out – Good/Bad for Hair Loss?

Working Out & Bodybuilding - Good/Bad for Hair Loss?

This article will help you better understand the role of Testosterone and DHT while working out. 

Do bodybuilding, fitness and working out in general influence your hair loss in any way? 

The main factor influencing your hair loss whether you´re  doing fitness or bodybuilding or HIIT, sprints, athletics, is your susceptibility to MPHL (male pattern hair loss) is your hair follicles sensitivity to androgens (mainly DHT and Testosterone). 

There is nothing which can influence the progression of your hair loss faster than the degree of your hair follicle sensitivity to DHT.

Genetic predisposition to Male Pattern Hair Loss

Your genetics decide whether your hair follicles get inflamed by the DHT or not. 

This results in the shortening of the anagen phase and simultaneous prolongation of the telogen phase, combined with hair follicle miniaturization. 

Before DHT interacts with the androgen receptor of your hair follicles, there are the isoenzymes: type I. and type II. 5-alpha-reductase which convert your free Testosterone into DHT. 

These isoenzymes responsible for DHT exist in every human body. 

The bad thing is that the local activity of 5 – alpha – reductase isoenzymes in the hair follicle is way to high. 

Enhanced activity of predominantly type II. 5 AR in the hair follicles causes its progressive miniaturization and dysregulation of a proper hair growth cycle. 

This defect can be partly mitigated by drugs like Finasteride (FDA approved for hair loss) and Dutasteride (not FDA approved for hair loss). 

These drugs work as 5 AR inhibitors and this let less DHT to be converted from Testosterone.

Genetic maple pattern hair loss susceptibility = androgen receptors of the hair follicles are sensitive to DHT (over-expression of type II. 5 – alpha – reductase in the hair follicle) as well as higher daily production rate of DHT in patients susceptible to hair loss (study).

Heavy working out + steroids = Hair Loss?

Bodybuilders no Hair Loss?

Bodybuilders from the 70´s and 80´s are a great proof of having good “hair genetics”. These guys really pushed working out to another level. 

Many of them also used anabolic steroids like Dianabol, exogenous Testosterone, Growth Hormone and many other anabolic substances boosting their protein synthesis, speeding up their recovery, increasing appetite and thus being able to train harder, recover faster and build more muscle.

Anabolic Steroids = Faster Hair Loss Porgression by the susceptible ones

Using anabolic steroids increases the amount of androgens in your system. 

By men with male pattern hair loss susceptibility (having androgen-sensitive hair follicles) faster hair loss can be expected if using anabolic steroids. 

Which steroids are more/less hair loss friendly?

 It depends on how androgenic these anabolic steroids are. For example Testosterone (androgen produced naturally in your body) has an androgen index of 100. 

The less androgenic the steroid is, the less likely it is to cause any undesirable side effects like hair loss, acne, sleeping difficulty, increased body hair growth etc.

These Bodybuilders were avoided by the "Hair Loss Gene" despite of Working Out for decades

Below you can see a very simple and trivial proof of  why Bodybuilding, Fitness or any heavy Weightlifting can´t cause your hair loss. 

It can only speed it up by predisposed individuals who are also using highly androgenic types of anabolic steroids. 

Lee Priest no Hair Loss from Steroids and Working out
Arnold Schwarzenegger no Hair Loss from Steroids and Working out
Dorian Yates no Hair Loss from Steroids and Working out
Bob Paris no Hair Loss from Steroids and Working out

Most of these bodybuilders have been working out for decades and taking steroids on top of that. 

Almost none of them experienced hair loss in their 20´s or 30´s. First signs of hair loss can be observed in their late 30´s and 40´s. 

It´s known for example, that by the age of 35 two thirds of American men have some degree of male pattern hair loss. 

By the age of 50, around 85% of men have significantly thinner hair in general.

Were the Bodybuilders from the Golden Era on any anti-hair loss preventative treatment?

I doubt that. In  the 70´s and 80´s there was no Minoxidil, Finasteride, PRP, RU58841, different topical formulations of Dutasteride or Finasteride, no hair fibers. 

Once a bodybuilder has started noticing hair loss back in the days, it was almost impossible to stop or reverse it as nowadays. 

Hair transplants were already common but they were too obvious because of the old school plugs. 

If somebody would have gotten a hairline transplant back in the days, it would have been pretty obvious.

Hair Transplants in the 70´s and 80´s

Injecting 1000 mg of Testosterone per week since the late 20´s and still no visible hair loss until the early-mid 40´s?

In the video below Dorian Yates reveals his steroid cycle he was on during his peak career. If you start watching the video from the 7th minute on you can hear him mentioning 1000 mg Testosterone per week. 

If we assume that some of his Testosterone converts to DHT in the same ration as by a non-enhanced athlete (5% – 7% of T converts to DHT), we´ll find out that his plasma DHT levels had to be really high back than. 

So had to be plasma DHT levels of other bodybuilders (mentioned before) who were also injecting Testosterone. 

How come they haven´ experienced any noticeable hair loss until they were in their 40´s and 50´s?

These bodybuilders are living examples of the importance of genetic predisposition to MPHL. 

It becomes obvious, that despite lifting heavy and  taking anabolic steroids which increase your T and DHT levels, you still may not experience hair loss. 

Why? Because you are either not susceptible to male pattern hair loss at all, or you are susceptible but the level of your hair follicle tolerance to DHT is very high. 

Can supplements like Creatine and Whey Protein cause Hair Loss?

No. Not creatine, no protein shakes and no pre-workouts have a thing to do with the typical male pattern hair loss 95% of the time. 

Male pattern hair loss is genetically predisposed and can´t be blamed on using supplements. 

It´s important to differentiate between a permanent male pattern hair loss condition and temporary hair shedding though. 

Temporary hair shedding can be experienced be over-consumption of low-quality supplements in rare cases. 

For example gainers packed with sugar and low quality carbohydrates or low quality whey protein. 

Only 1 single study on Creatine and DHT in 20 college aged men

This study showed 56% increase in plasma DHT levels by 20 college-aged rugby players. They were put on 25g of Creatine per day for 7 days followed by 2 more weeks of 5 g Creatine per day. Their Testosterone levels remained unchanged. Unfortunately, no information about hair loss was given in this study since it wasn´t any hair loss – related study.  

Conclusion: Hair Loss and Working Out

If you are a natural bodybuilder, you produce around 5-6 mg Testosterone per day (on average) which corresponds with the 300-1000 ng/dl T range in healthy males. 

Even if you could somehow manage to double your T naturally and thus also DHT production (theoretically) . 

It still wouldn´t automatically mean hair loss – just because of elevated T and DHT levels as many people may thing. 

Yes, you can keep working out even if you are already experiencing hair loss. 

The problem is when a guy susceptible to hair loss – he has enhanced 5 – alpha reductase activity in his hair follicles responsible for increased formation of DHT in his hair follicles. 

 Once you know you are the type of guy who is susceptible to some type of pattern hair loss. 

You should avoid using steroids without a proper anti hair loss management protocol. 

Although increased T levels and this elevated DHT formation as a result of steroid use may not necessarily lead to hair loss, they may – specially by individuals susceptible to hair loss.  

The best way you can find out how sensitive your hair is to DHT is by observation. 

The androgen sensitivity threshold can be different by every guy who has the predisposition for it in the first place. 

Some guys will be able to completely tolerate 20-30% increase in their DHT production as a result of working out or even taking T, while other guys won´t even have to work out and lose their hair anyways. 

There are plenty of men wit average plasma T and DHT levels, yet their hair follicles are being progressively “eaten up” by the enhanced formation of DHT – predominantly in their hair follicles as opposed to men with no MPHL condition with normal DHT formation in their hair follicles.