Topical antiandrogens work to some extent: fluridil has been shown to be moderately benefitial for hairloss in one study(1) and topical spironolactone has been shown to be an effective therapy for hirsutism (2), which might be extrapolated to male pattern baldness.
I'm not too fond of topical flutamide because I've read Dr. Proctor say many times that its benefitial effects, when applied topically, are not a result from flutamide working locally, but from flutamide being systemically absorbed and then working in the scalp (as well as in other parts of our body where we don't want it to work).
Most importantly, the mother of all topical antiandrogens is RU58841, which has been shown to promote (in macaques) the same benefitial effects of finasteride in half the time. If you go to
http://www.hairsite4.com you'll be able to find lots of info about RU58841. If you could use it, it would DEFINETELY be the best topical antiandrogen therapy anyone could use.
If I were you and couldn't get RU, I would use topical spironolactone 5%, 1ml every 12 hours. You can use it either in cream or lotion, although it's often said that creams are more effective.
Many people just tries to find in topical antiandrogens an ALTERNATIVE to internal 5-alpha-reductase inhibitors. While this might be a nice aproach I think that our hair will think it's even nicer to use an internal 5AR blocker (finasteride or dutasteride) and, AT THE SAME TIME, using topical antiandrogen therapies in order to avoid AR binding from testosterone (against which finasteride/dutasteride cannot do anything) and any DHT which might be left. I think both therapies complement each other and I think that everyone who's really serious about fighting male pattern baldness should be using both approaches at the same time.
1:
Fluridil, a rationally designed topical agent for androgenetic alopecia: first clinical experience.
Sovak M, Seligson AL, Kucerova R, Bienova M, Hajduch M, Bucek M.
Radiology Research, University of California, San Diego, California, USA.
msovak@ucsd.edu
BACKGROUND: Fluridil, a novel topical antiandrogen, suppresses the human androgen receptor. While highly hydrophobic and hydrolytically degradable, it is systemically nonresorbable. In animals, fluridil demonstrated high local and general tolerance. OBJECTIVE: To evaluate the safety and efficacy of a topical anti- androgen, fluridil, in male androgenetic alopecia. METHODS: In 20 men, for 21 days, occlusive forearm patches with 2, 4, and 6% fluridil, isopropanol, and/or vaseline were applied. In 43 men with androgenetic alopecia (Androgenetic Alopecia), Norwood grade II-Va, 2% fluridil was evaluated in a double-blind, placebo-controlled study after 3 months clinically by phototrichograms, hematology, and blood chemistry including analysis for fluridil, and at 9 months by phototrichograms. RESULTS: Neither fluridil nor isopropanol showed sensitization/irritation potential, unlike vaseline. In all Androgenetic Alopecia subjects, baseline anagen/telogen counts were equal. After 3 months,
the average anagen percentage did not change in placebo subjects, but increased in fluridil subjects from 76% to 85%, and at 9 months to 87%. In former placebo subjects, fluridil increased the anagen percentage after 6 months from 76% to 85%. Sexual functions, libido, hematology, and blood chemistry values were normal throughout, except that at 3 months, in the spring, serum testosterone increased within the normal range equally in placebo and fluridil groups. No fluridil or its decomposition product, BP-34, was detectable in the serum at 0, 3, or 90 days. CONCLUSION: Topical fluridil is nonirritating, nonsensitizing, nonresorbable, devoid of systemic activity, and anagen promoting after daily use in most Androgenetic Alopecia males.
2: Panminerva Med. 1990 Apr-Jun;32(2):49-55.
Oral and topical spironolactone therapies in skin androgenization.
Messina M, Manieri C, Musso MC, Pastorino R.
Dipartimento di Fisiopatologia Clinica, Universita di Torino, Italy.
The most important clinical studies using spironolactone as an antiandrogen drug either per os or topically are referred. Menstrual disturbances very often occur during SP treatments thus limiting its systemic use.
As far as the topical use is concerned SP seems to be highly effective with absence of systemic effects. Local mild side effects were present in a small number of patients.
