hair loss management

Minoxidil Shampoo Pros and Cons

Minoxidil Shampoo

Minoxidil Shampoo - Good Idea or Not?

written by Matt Dominance

In this post you will find out:

  • What is M. Shampoo?
  • Effectiveness of Minoxidil-enriched Shampoos
  • Minoxidil Shampoo vs topical Minoxidil (Pros and Cons)
  • 3 Ways to boost Minoxidil effectiveness for non-responders
  • Conclusion

What is Minoxidil Shampoo?

It is a shampoo enriched with Minoxidil (usually 1% or 2%). Brands known for offering such shampoo are Foligain or less known – Bioken. 

 

Minoxidil Shampoo with 2% Minoxidil
Biotin Shampoo with Minoxidil
Biotin Shampoo with Minoxidil

Combining Shampoo with Minoxidil - Good Idea?

Minoxidil in a Shampoo

We know that shampoos with parabens and sulfates are bad for the overall health of our hair and skin.

We also know that DHT blocking shampoos containing useful Ketoconazole are scientifically proven to slow down hair loss and reduce/get rid of dandruff. 

But is Minoxidil really a must have ingredient in your shampoo?

Well, Minoxidil is known for prolonging the anagen (growing) phase of the hair follicles on the whole body not just on the scalp.

It can do so by opening potassium channels and also up-regulation of vascular endothelial growth factor (VEGF), which helps in maintaining dermal papilla vasculature and hair growth

How long should the Minoxidil Shampoo stay on the scalp?

In this study they also observed how soon Minoxidil 5% can stimulate cutaneous blood from in the scalp after one time application

minoxidil stimulates cutaneous blood flow in human balding scalps
Minoxidil 5% is able to stimulate cutaneous blood flow in the balding scalp within 15 min after application

We have to note, that only 0.25ml of 5% Minoxidil has been used in this study. 

Trying to achieve similar results with a Minoxidil Shampoo would require at least 1% Minoxidil concentration per each ml of the shampoo.

Furthermore, you would have to leave the shampoo on the scalp for up to 15 minutes.

How effective is the Minoxidil Shampoo 1%?

This study from 2015 investigated the therapeutic effect of Shampoo with Minoxidil 1% for 4 months.

It was a  double-blind placebo controlled trial with 60 subjects.

The treatment group used the Minoxidil Shampoo every other day for 4 months. The control group used a similar shampoo but with no Minoxidil in it.

Patients were also evaluated on a monthly basis.

Minoxidil Shampoo study

If we take a look at both parameters – vellus hair and terminal hair improvement, we can clearly see an increasing trend in the treatment group. In the placebo group on the other hand, it seems that the amount of vellus hair also improved in about 13% (21% in the treatment group). 

The amount of terminal hair increase however, seems to significantly improve between the treatment and placebo group.

The study unfortunately took only 4 months. Could we further assume increasing improvements in the terminal hair and vellus hair counts in the treatment group?

It seems that further studies are going to be necessary.

How does Minoxidil enriched Shampoo compare to Minoxidil 5% topical?

Before we try to compare the same active ingredient used in 2 different product variations, let’s take a look at what makes the active ingredient Minoxidil potent for hair loss:

  • Using Minoxidil with a proper application frequency
  • Allowing long enough absorption duration
  • Using Minoxidil in high enough concentration

The half-life of topical Minoxidil averages at 22 hours, which means that at least once a day application is required to maintain the ideal stimulatory benefits. That’s why it is recommended to use products with 5% Minoxidil at least once a day and sometimes even 2x a day.

Could you use MX Shampoo every day?

Although patients with very oily scalp and excessive sebum production could get away with shampooing their head every day, not everybody could do so without drying out the scalp and disrupting the ideal pH balance.

If we assume the usual shampooing frequency of 3-4x per week, and compare it to usual topical Minoxidil application of 1-2x every day, we get superior hair follicle stimulation by using Minoxidil with higher frequency than 3-4 times per week. 

How long will be the absorption with a Shampoo vs Topical solution containing Minoxidil?

Shampoo absorption will normally last no longer than 5 minutes while a topical solution can be left on the scalp for many hours.

minoxidil absorption chart

Minoxidil absorption over time has been researched in this study which discovered a more rapid absorption rate of 50% within the first hour of application followed by a less rapid absorption rate (another 25%) between 1 – 4 hours. 

We can assume a 100% (close to 100%) absorption within 8 hours. 

Minoxidil application intervals in this study were every 12 hours.

This makes it impossible for the MX shampoo to beat topical MX 5% in terms of absorption duration.

In order for this to be a fair battle, we need to get a shampoo standardized with 5% Minoxidil in each 1ml of shampoo. Why is it important? 

Significance of 5% concentration over 2%

Long term effectiveness of 5% Minoxidil has outperformed the 2% Minoxidil.

By comparing the effectiveness of the Minoxidil Shampoo 1% (as it was described in the previous study) to 5% topical solution (FDA approved MX solution for androgenetic alopecia), the latter one will likely win the battle! 

Minoxidil Shampoo for non-responders to the traditional Minoxidil 5% solution

It has been shown, that patients with a very low activity of sulfotransferase enzyme on the scalp are less likely to have a less favorable clinical response to Minoxidil. That’s the reason why only every other person can actually regrow hair after using Minoxidil 5%.

Sulfotransferase enzyme is responsible for converting the inactive ingredient Minoxidil to Minoxidil Sulfate (MXS). By applying Minoxidil on the scalp, this conversion happens topically. 

This study on individuals with low/no sulfotransferase activity on the scalp has shown that applying Minoxidil Sulfate directly helped improve their clinical response. The concentration of MXS solution was 10%..

The problem with MXS though, is its instability. Therefore it should be supplied in a small package.

Individuals with little to no clinical response to traditional 5% topical Minoxidil in the past who are considering Minoxidil shampoo, should rather do the following:

 

3 Ways to boost Minoxidil effectiveness for non-responders

1. Minoxidil Solution enriched with Tretinoin

Topical tretinoin application influences the expression of follicular sulfotransferase. It has been shown in this cohort study. Another study compared Minoxidil 5% vs Minoxidil 5% + 0.01% Tretinoin and also confirmed potential benefits of including tretinoin in the topical Minoxidil formulations. 

Among very few available Minoxidil solutions with Tretinoin I’d suggest this one with 0.025% Tretinoin called Dualgen – 5R (Minoxidil 5%, Tretinoin 0.025%, Azelaic Acid 5%, Adenosine, Biotin and Caffeine).

Although topical application of Biotin hasn’t shown any significant stimulatory benefits on hair growth, Adenosine and Caffeine have been shown to positively affect the anagen (growing) phase of the hair follicle.

2. Minoxidil Solution enriched with Diclofenac sodium 0.5% and Tea Tree Oil 5%

In this study, they created a special micro-emulsion with Minoxidil 5%. Micro-emulsions are mixtures of liquid, oil and surfactant. 

Minoxidil study

Topical Diclofenac 3% is often times used as a treatment for Actinic Keratosis. This skin condition develops over time due to sun overexposure. This study accidentally included males with Actinic Keratosis who were also suffered from androgenetic alopecia. 

As a side effects of this treatment improvements in terminal hair growth was observed.

Unfortunately, I haven’t been able to find any topical micro-emulsion with Minoxidil incl Diclofenac sodium which is commercially available. 

The good new is, that Diclofenac sodium has been shown to be pretty stable. In this study they found out that a suspension with Diclofenac sodium stored in 60ml bottles for 93 days still retained 99.5% of its original concentration. 

3. Derma rolling or Micro-needling

Using derma roller regularly in conjunction with Minoxidil therapy helps open the pores in the skin and results in better transcutaneous absorption.

In the Derma Roller (DR) and Minoxidil (MX) study on 99 patients (50 in the DR+MX group and 44 in the MX only group), they observed:

8.5% increase in the mean hair count after 12 weeks in the MX only group

40% increase in the mean hair count after 12 weeks in the MX+DR group

In this article you can read more about how to use a derma roller, best derma roller frequency, and how to clean it after every use.

 

 

Conclusion

Although adding extra Minoxidil into your Shampoo could be superior compared to not including it there at all based on this randomized placebo-controlled trial, the additional benefits of such a shampoo should be still taken with a grain of salt before further research will be conducted.

There is also no reason to use such shampoo if one is already a user of topical Minoxidil 5%.

Short shampooing times compared with relatively long Minoxidil absorption time is really unfavorable for the efficacy of all Minoxidil-containing shampoos. 

For a more effective hair loss prevention regimen it would be much more advisable to use the standardized 5% Minoxidil solution topically together with the Ketoconazole Shampoo to maximize the results instead. This is the Shampoo I use myself and recommend.

Also you can read more about why Ketoconazole Shampoo is good for hair loss prevention here.

Individuals who were previously non-responders to conventional MX 5% are likely to get no additional benefits from using Minoxidil-enriched shampoos. In such case, additional use of tretinoin, diclofenac sodium or MXS can be considered for better clinical response to Minoxidil.

finasteride before and after

My Finasteride Results After 1 Year

My Finasteride Results After 1 Year

written by Matt Dominance

If you are new to my website, make sure you read Medical Disclaimer before you continue reading this article.

In this post you will find out:

  • How was my 12 month experience with Finasteride?
  • Before and after results and photos.
  • Side effects I experienced during my 1 year treatment with Finasteride?
  • Will I continue using Finasteride to prevent further hair loss?

How I started with Finasteride

I started using Finasteride in September 2019 (before my 2nd hair transplant). My goal was to stabilize my hair loss as well as strengthen my hair before my 2nd hair transplant to prevent shock loss.

Dosing and frequency

For the first 5.5 months I have been using topical Finasteride liposomal gel and after that I switched to oral Finasteride only. My dosing was 0.5-0.6mg of Finasteride per day. The standardized dose of Finasteride for male pattern hair loss condition is 1mg though. I took less, because I was more side-effect concerned back then. 

Effectiveness

I started experiencing less hair loss already after the first month of using topical Finasteride. 

I didn´t have any shock loss/increased hair shedding as a result of starting with Finasteride(this is only a temporary shedding though, which some people can experience).

In my experience, the hair thickening effects of Finasteride came between 4th and 12th month. Before that, I have been only able to notice way less shedding than before.

 

How does Finasteride work?

Hair thickening effect of Finasteride happens as a result of Finasteride partially inhibiting the activity of 5 – alpha – reductase enzyme (which converts Testosterone into Dihydrotestosterone).

Dihydrotestosterone (DHT) is known for being more androgenic (more potent). Such increased potency compared to Testosterone makes it a more potent agent for transcribing its androgenic effects on the androgen receptors in selective tissues like beard, body hair, prostate, hair follicles etc. 

DHT is known for disrupting the proper hair follicle growth cycle as well as the progressive miniaturization of the hair follicle.

By accumulation of Finasteride in the scalp tissue over time, there will be much lower 5 – alpha – reductase activity, and this less DHT formation. This will lead to slower hair miniaturization process.

Side effects

Some of the side effects are sexual dysfunction, decrease in libido, weaker erections, breast enlargement or depression. Personally I haven´t experienced any of these. It´s also known, that about 2% of all patients are likely to experience them to a degree. 

My hair in September 2019

before Finasteride treatment
My hair in September 2019 (before Finasteride treatment)

Hair Situation before starting with Finasteride

  • Diffuse hair thinning inside of the white circle
  • More severe baldness inside of the red circle
  • Frontal hairline has been already restored (during my 1st FUE hair transplant)
  • NW 4-5 transition pattern if I hadn´t done my 1st hair transplant

Combining Finasteride with my 2nd FUE Hair Transplant

2nd FUE hair transplant on the area where the red circle (mid-scalp region) | 1.5 months on topical Finasteride

940 grafts transplanted on the mid-scalp region

  • I started with topical Finasteride 1.5 months prior to my 2nd hair transplant to strengthen my native hair and help avoid shock loss (after the surgery)
  • During this time I was applying my topical Finasteride on the rest of the mid-scalp and crown
  • After 1 month post-op I started applying topical Finasteride on the transplanted area as well (because there was also some native hair in it)
  • Here you can check out my FUE progress after the 2nd Hair Transplant!

8 Months after using Finasteride

My Finasteride Results - 14 months after using finasteride + hair transplant
8 Months on Finasteride | 6 Months after my 2nd FUE hair transplant

Results of 8 Months on Finasteride and 6 Months after my 2nd FUE

  • The hair in the vertex region and mid-scalp thickened
  • Better hair coverage in the red circle due to hair regrowth after hair transplant
  • Reduced hair loss on the whole vertex and mid-scalp as a result of taking Finasteride

14 Months after using Finasteride

14 months after using finasteride + hair transplant
14 Months on Finasteride | 1 Year after my 2nd FUE hair transplant

Am I staying on Finasteride or not?

  • I am definitely staying on Finasteride since my response has been very good so far
  • Over the course of the next year I don´t expect any huge improvements in terms of hair thickening but rather maintenance of the current hair thickness
  • I need to further take Finasteride in order to maintain my current hair thickness (especially mid-scalp and vertex region) and thus avoid further hair transplants in these regions

Finasteride requires prescription. You should always consult your doctor or GP before considering this medication. If you are new to my website, make sure you read Medical Disclaimer!

elon musk hair surgery

Elon Musk Hair Transplant Analysis

How Elon Musk got his Hair back!

written by Matt Dominance

Questions answered in this blog post on topic of: Elon Musk Hair Transplant

  • Elon Musk hair before and after
  • How many hair transplant surgeries did Elon Musk undergo?
  • Did he do FUE or FUT hair transplant, or both?
  • Has he already started using Finasteride(Propecia) and Minoxidil prior to his hair transplant?

Elon Musk Hair before and after

Elon Musk started losing his hair already in his mid 20’s. By the time he turned 28-29, he was already seriously balding.

His loss progression back then could be described on a Norwood scale between NW4 and NW5.

Norwood Scale

It’s likely that Elon started taking anti hair loss medication Finasteride back in the days but it is even more probably that he didn’t start using it during the first signs of his male pattern baldness progression.

Otherwise he would have been able to avoid the NW4-NW5 scenario. 

Finasteride has been FDA approved for treating hair loss in 1997. During this time Elon was 26 years old. He was probably unaware of this medication until shortly before his 1st hair transplant.

It’s crucial to focus on slowing down/stopping your hair loss progression in order to end up in a similar situation as Elon did in his mid-late 20’s!

Also read “The Big 3 of Hair Loss Prevention” to help you keep your hair loss under control instantly! 

Elon Musk late 1990´s
Elon Musk | 28-29 years old | NW 4

Hair Situation in the late 1990´s

  • 28-29 years old
  • NW 4 – NW 5 transition pattern
  • Diffuse thinning on the mid-scalp
  • High likelihood that he has been already using at least Minoxidil(Rogaine) and Finasteride (Propecia) shortly before his 1st hair transplant

Elon Musk Hair Transplant nr. 1

Elon Musk after his 1st hair transplant | 32 years old
  • 32 years old (2003)
  • Denser-looking hair on the hairline as a result of taking medication (Finasteride and Minoxidil) and a minor hair transplant
  • Conservative hair density on the hairline achieved after the first hair transplant, which later has been improved with another hair transplant
  • Hair on the front looks darker and healthier compared to late 1990´s

Hair Situation after Elon Musk´s 1st minor hair transplant

Elon musk 1st hair transplant lower density on the hairline
Transplanted hair density of Elon Musk's first hair transplant surgery
  • Conservative hairline with lower hair density allowing higher see-through effect
  • Estimated hair density on the hairline: 30-35 grafts/cm2
  • Implanted hair doesn´t look pluggy but it does look more coarse because it comes form the donor zone (occipital region) on the back of the scalp which provides thick and healthy hair – unaffected by androgens (DHT).

Elon Musk Hair Transplant nr. 2

elon musk after 2nd hair transplant
Hairline density improves with the time | Elon Musk | Around 40 years old
  • 40-ish years old (2010 and on)
  • Even more denser-looking hair on the hairline compared to 2003
  • Slight lowering of the hairline is likely compared to 2003
  • Lower see-through effect on the hairline compared to his hair in his 30´s

Differentiating between transplanted and non-transplanted hair on Elon's hairline

transplanted vs non transplanted hair - Elon Musk
Difference between transplanted (hairline) and non-transplanted hair (temples)
  • Single follicular units on the temples (non-transplanted) look still thinner and more refined compared to the implanted single follicular units on Elon Musk´s hairline 
  • Estimated hair density on the hairline after his 2nd hair transplant: 45-50 grafts/cm2

Elon Musk started coloring his hair darker in his 40´s (possibly because of hair greying)

Did Elon Musk have FUE or FUT hair transplant?

It is not going to be easy to precisely guess the final number of Elon Musk´s hair transplants. He could have done 2,3 or more, but at east 2.

Below you can see a proof of his FUT because of the linear scar across his donor area. Watch the interview on CBS from 2018 and skip to 4:25 to see the scar better.

Below there is one more photo from the profile which makes us see the linear scar better.

The FUT scars which spread across the whole occipital region all the way to the left and right temporal regions suggest a major FUT session of 4000 grafts or even higher.

Elon Musk Hair Transplant Scar
FUT scar on the back of Elon Musk's occipital region
elon musk strip scar
FUT scar is visible across the left side of Elon´s scalp.

Why did Elon Musk only do small FUE hair transplants?

The photo below comes from 2020. You can see how dark and dense Elon´s hair looks in his donor area.

 

elon musk 2020 air force association interview


If he had done multiple larger FUE sessions, his donor area would look much more thinned out or “moth-eaten” as some hair transplant doctors say.

Of course, he might have gotten a scalp micropigmentation on the skin surface of his donor area but the nonetheless the hair coverage looks very good on the donor area.

Small FUE sessions are usually suitable for little corrections in the hairline and temporal region once the patient who has already done 1 or more hair transplants decides to improve the hair density in his hairline even further. 

Is Elon Musk on Finasteride(Propecia) and will he need another hair transplant?

Elon Musk Crown area

Screenshot from the CBS interview in 2018 shows slight crown area thinning but decent hair coverage and hair density across the top of Elon´s scalp.

Elon Musk - Hair Summary

Finasteride (Propecia)

Elon Musk has likely been using Finasteride (Propecia) to keep the rest of his native hair from falling out fast over the course of his 30´s and 40´s (for the last 15-20 years).

FUT Hair Transplant

Elon Musk got most of his hair transferred from the donor area onto the recipient area via FUT. 

Elon has likely undergone 1 larger (4000-4500 grafts) or 2 medium-sized FUT procedures (2000-2500 grafts and 2000-2500 grafts). 

FUE Hair Transplant

Elon has probably had also one FUE procedure with relatively small graft yield as his donor area doesn´t show any signs of FUE over-harvesting or donor area depletion with FUE. His donor area above and below the FUT scar shows very good hair coverage and density. 

Scalp Micropigmentation

On some photos, Elon´s FUT scar is less visible than on others. It suggests, that he might have made use of scalp micropigmentation to have the surface of his scarred skin covered with pigment (especially on the left and right side, where the hair is naturally thinner and has lower density compared to the hair on the occipital region).

Elon Musk Hair Loss, Shocking Change, How did he do it?

If you enjoyed this read, make sure you also check out MinoxidilMax’s blog article on Elon Musk’s hair loss reversal! Did his hair loss really recovered on its own and did he use PRP (platelet-rich plasma) injections to recover from his hair loss? Read more on Minoxidilmax!

Elon Musk Hair Loss - Minoxidilmax Post

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derma roller and minoxidil to regrow hair

How To Use Derma Roller and Minoxidil to Regrow Hair

How To Use a Derma Roller and Minoxidil to Regrow Hair!

written by Matt Dominance

In this post you will find out:

  • What is a derma roller?
  • Optimal derma rolling frequency for hair regrowth! 
  • How to use derma roller?
  • Best derma rollers types! 
  • Conclusion

What is a derma roller?

Derma roller is a small device with hundreds of tine micro-needles which are meant to promote controlled tissue injury through the formation of micro-channels in the skin.

Another benefit of derma rolling on the scalp is promotion of stem cell activity in the hair bulge area.

derma roller matt dominance

Science behind micro-needling for hair loss

derma roller study
A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study

Anti hair loss therapy with the derma roller is used to induce collagen formation, neovascularization and growth factor production of treated areas.

Micro-needling is a technique that promotes controlled tissue injury through the formation of micro-channels.

Scientific evidence suggests that micro-channels created by derma roller promote the absorption of anti-hair loss products applied topically e.g. Minoxidil (Rogaine), topical Finasteride, etc.

Micro-needling with a derma roller 1.5 mm can improve hair count on a treated area without adding any topical products! Study

Derma Rolling Frequency based on Derma Roller type

Frequency of using a derma roller for hair regrowth depends on the size of its micro needles!

The longer the micro needles are, the lower the frequency. The shorter the micro needles, the more often you can use it!

 

derma roller routine
Zoom in (Weekly Derma Roller Routine)

How to Derma Roll

  1. Choose a derma roller of your choice (preferably 1.5 mm)
  2. Start rolling it on your scalp in a longitudinal, vertical, and diagonal directions until you experience pinpoint bleeding (erythema)
  3. Your derma rolling session is finished. Wait 24 hours before you apply Minoxidil (Rogaine), topical Finasteride or any other alcohol- or propylene glycol-containing topical product which might irritate your scalp.

When you can start seesing results?

First hair regrowth can appear after 12 weeks of doing derma rolling. In this study (below) they compared Minoxidil 5% + Micro-needling with the derma roller 1.5 mm vs Minoxidil 5% only and after 12 weeks the hair regrowth in the derma roller + Minoxidil 5% group was already significant (better than in the Minoxidil 5% group).

 

derma rolling and Minoxidil
A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study

Is derma rolling painful?

When the roller’s needles are only up to 0.5 mm long, the procedure is essentially painless.

The pain increases as the depth of needle penetration increases. Either if you increase the rolling pressure or use a roller with longer needles than 0.5mm.

It also depends on the thickness of epidermis and dermis layer which influences the overall pain.

How many hairs can you regrow?

This will depend on 2 factors.

  1. How many hairs have you already lost? If you have already clear bald spots on your scalp (or spots with vellus hair – 2 mm long hair), derma roller won´t help you regrow any new hair in these areas. Derma roller only works on the areas with terminal hair incl. terminal hair which started to miniaturize recently.

  2. How well do you respond to conventional treatments like Minoxidil 5%? Since derma roller potentially acts as a transcutaneous penetration enhancer, it will greatly benefit all patients who are positive responders to Minoxidil. We know that combining Minoxidil + Derma roller can regrow more hair than using Minoxidil or Derma roller separately. 

Derma Rolling for non-responders to Minoxidil and Finasteride

This study observed (unfortunately only) 4 patients who failed to respond to conventional therapy for treating male pattern hair loss – Minoxidil 5% and Fiansteride 1 mg.

Case 1 - 6 months after Derma Rolling

Case 1 — A 30-year-old male was suffering from AGA since 8 years. He was on oral finasteride and topical 5% minoxidil regularly since 4 years and also had underwent hair transplantation surgery 2 years ago. He reported an arrest in hair loss but was unsatisfied in terms of cosmetic scalp coverage. 

case 1 before
Response to Microneedling Treatment in Men with Androgenetic Alopecia Who Failed to Respond to Conventional Therapy
Response to Microneedling Treatment in Men with Androgenetic Alopecia Who Failed to Respond to Conventional Therapy

Case 4 - 6 months after Derma Rolling

A 40-year-old male with female pattern type III of hair loss was taking conventional therapy for over 3 years but unsatisfied with respect to new hair growth

case 4 before
Response to Microneedling Treatment in Men with Androgenetic Alopecia Who Failed to Respond to Conventional Therapy
case 4 after
Response to Microneedling Treatment in Men with Androgenetic Alopecia Who Failed to Respond to Conventional Therapy

3 Dont's of Derma Rolling!

1. Respect the proper Derma Rolling frequency!

If you roll more than you need, then you may transect some of your scalp hair. The more frequently you roll, the more often such transection with derma roller can occur. 

When the hair is wet it is more flat and this id won´t stand up and potentially get in a way of the microneedles. 

2. Don´t apply Minoxidil right after!

You´ll still get boost in your hair regrowth if you apply Minoxidil 24 hours later so don´t rush with it. 

We known that Minoxidil contains alcohol, some versions even Propylene Glycol which have been shown to be skin allergens causing irritation by some people even without prior derma rolling. 

By using it right after derma rolling you´ll experience stinging, and skin drying , which makes the healing slower. 

Rather use vitamin A or vitamin E rich oil. Vitamin A influences 400–1000 genes that control proliferation and differentiation of all major cells in epidermis and dermis, and Vitamin E is an anti oxidant that supports skin health (almond oil). 

During the micro-needling studies they also used saline or betadine for cleansing the scalp after the derma rolling session. This also applies to any alcohol and PG containing topicals and even topical Finasteride which often times contains alcohol or PG as a penetration enhancer. 

3. Clean your roller properly after every use!

Forgetting to take a proper care of your derma roller can promote spreading bacteria and potential infection next time you use it. 

The better you take care of it, the longer you can use it. 

Most of the studies done on derma rolling and micro needling have been done in clinics or medical institutions where the micro-needling device like derma roller is going to be properly sanitized after the session or the pin needles of an automated micro-needling device like derma pen are being used only 1 time for each patient. 

For home use, I know many of you are re-using the same derma roll.

 

 

Diffuse Hair Loss in men and women

Short-term vs Permanent Hair Loss

Short-term vs Permanent Hair Loss

written by Matt Dominance

This blog post is a summary from my YouTube presentation on Short Term and permanent types of diffuse hair loss! 

You can also watch my video here!

3 Types of Diffuse Hair Loss

Short term vs long term hair loss difference
Hair Loss vs Hair Shedding

Diffuse Hair Loss as Telogen Effluvium

Telogen Effluvium Causes
Short Term Hair Loss Example

Diffuse Hair Loss as Chronic Telogen Effluvium

Chronic telogen effluvium

Diffuse Hair Loss as Androgenetic Alopecia

Diffuse Hair Loss as Androgenetic Alopecia

Diffuse Hair Loss as Androgenetic Alopecia

Diffuse Hair Loss Patterns
Diffuse Hair loss and permanent Hair Miniaturization

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. 

Topical Finasteride Before and After Results

Topical Finasteride Liposomal Gel 2.5% before and after results!

written by Matt Dominance

If you are new to my website, make sure you read Medical Disclaimer before you continue reading this article.

I have been using topical finasteride gel 2.5% – (non FDA approved hair loss treatment), and applying daily (1ml) on my crown area and mid-scalp for almost 6 months from September 2019 – February 2020.

Before I share with you my results, let me list out some pros and cons of using the Liposomal Topical Finasteride:

Pros 

 
  • Liposomal delivery allows a high ability to penetrate the first skin layer and keep the active ingredients in the desired areas (depot effect with a slower and more sustained release of finasteride into the scalp)
  • I have experienced significant decrease in rate of hair loss after 6 months
  • No smearing or greasing the hair because it gets absorbed very quickly
  • It doesn´t contain any Propylene Glycol or Alcohol which might cause skin irritations by some individuals or dry scalp

Cons 

 
  • High dosage of Finasteride active ingredient per 1ml. 25mg of Fiansteride active ingredient per 1 ml of liposomal gel can be considered rather high. 2.5% solution = equivalent of 25 mg of Finasteride active ingredient per 1ml (prescribed dose)
  • Systemic absorption is not entirely excluded and there is no study which could confirm 0% plasma permeation of this liposomal finasteride gel either
  • Some individuals on forums using this gel have mentioned side effects + long term accumulation of Finasteride in the system is likely even by very low systemic permeation of this liposomal gel
  • High price. Monthly supply costs 45-50 Euro excl. shipping cost
  • Short shelf life – 6 months

My Topical Finasteride Results: Month 0 – Month 5.5

Before starting with Topical Finasteride

  • Thinning hair on my crown area and portion of my mid-scalp. 
  • I have never used Finasteride before (oral/topical), only Minoxidil
Hair Loss Before starting Topical Finasteride
topical finasteride 1 month update
topical finasteride before and after 2 months
topical finasteride before and after 3 months
topical finasteride before and after 4 months

5.5 Months after using topical Finasteride (liposomal gel)

  • Hair loss stabilization on my mid-scalp and crown
  • Less hair fall on a daily basis
  • Only slight hair thickening so far
  • Some of my hairs started to look slightly darker on the crown area as a result of hair thickening
Hair situation after using Topical Finasteride for 5.5 months

Does Topical Finasteride work?

Shortly, yes. It worked for me right from the start. During the first month of using it I already noticed reduced shedding compared to my usual shedding rate.

However, if you are a diffuse thinner like me and you need to apply topical finasteride on a large surface of your scalp, I recommend you to use a more liquid version of finasteride.