How Can A 18 Y/o Male Regrow Hairs After Initial Shedding From Anti-androgens?

Ein

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I'm 18 years old male. I've been experiencing hair loss ever since I was 16, particularly at the crown and the top of the scalp. It hasn't been very bad so far, but the loss in density is clearly visible. I was so frustrated due to it that I decided to treat it with anti-androgens.

Seven months ago, I started doing a lot of research about the different treatments and different types of anti-androgens. I read about Finasteride, Dutasteride, Spironolactone, Cyproterone Acetate, Flutamide and RU on the Internet and took the research to a level that I was even struggling to find every research data collected after clinical trials of the medications for different conditions.

Six months ago, I finally made my mind to get on Finasteride (1mg/day) and Spironolactone (100mg/day). I knew that an initial shedding phase is quite normal, and that's what happened. I started shedding almost 150-200 hairs a day from the second week. There were no side effects.
But three months ago, I found out that the shedding hasn't stopped. I decided to go for a stronger approach and therefore added Bicalutamide (25mg/day) to my regular regimen. I knew that 12.5-25mg Bicalutamide is alone sufficient for MTF HRT. Moreover, I selected it because it's supposedly the most powerful and the safest anti-androgen.
Two months ago, the hair shedding phase was still prevailing. I couldn't understand what could be the possible reason for this. Then, I came to a conclusion that maybe the electrolyte imbalance caused by Spironolactone is the culprit. It had given me a muscle spasm in the third month. Plus, there was some cognitive dysfunction that could've come due to Finasteride as well as Spironolactone. This made me reluctant to continue these drugs, and therefore, I went on 50 mg Bicalutamide per day. I was well aware of the fact that it's very strong and I'll soon have gynecomastia. I was right. Within two weeks, I acquired a very painful gynecomastia. This was not acceptable. I didn't want to get back on Spironolactone, and I didn't want to leave Bicalutamide. But I was helpless. I had to do something. Therefore, I added 20 mg Tamoxifen per day to my regimen. It turned out to be a wise decision. My gynecomastia and breast tenderness and pain vanished within ten days.

Currently, I take 50 mg Bicalutamide and 20 mg Tamoxifen daily. My hairs have be growing out pretty quickly, but the shedding hasn't stopped. I still shed around 150-200 hairs a day. Moreover, the hairs that I've shed in the past six months haven't really turned out to grow back. The current condition is not very bad everywhere, but my crown is definitely very thin. And there's a section above my left temple that has thinned out (which was already thin to begin with). My hairline is still kinda good (NW0 or sometimes it appears like an inverted U-shaped female hairline which is pretty low particularly in the temple areas). But my hair stands are of superfine texture. I don't really care about getting a coarse texture, but restoring the density is really important for me. The only improvement I've seen so far is the increase in density along the mid split and the side split (went from stage 3 to stage 1 or 1.5 on Ludwig scale, within the past four months).

In my opinion, the hair loss that I currently have (after starting Bicalutamide) is not androgenic alopecia. It, in fact, looks like DUPA and might be a temporary hair loss. My diet and lifestyle haven't been very healthy in the past few months, so there are chances of nutritional deficiencies, but I don't know anything for sure. I can't visit a doctor because my dad is allowing me to visit a dermatologist or a trichologist. My dad doesn't allow me to use minoxidil and laser comb, for some mysterious reason. Even I don't want to use minoxidil, because I'm can't stay committed to it.

So, I have a few questions:
1. Is the profuse shedding, that lasted for six months, normal?
2. What could be the possible reasons for no regrowth of lost hairs?
3. What can I do to stimulate hair regrowth, without any clinic-based treatments or minoxidil/laser combs? (I'm planning on starting dermarolling and castor oil + rosemary essential oil blend.)
4. What possible amendments would you recommend to my current regimen?

The possible reasons of my hair loss that I could think about:
1. Iron deficiency or anemia
2. Hypothyroidism
3. Protein deficiency
4. Vitamin deficiency
5. Stress
But it really doesn't matter if anyone isn't able to figure out the correct reason to explain it. All that matters is the treatment. Just that I can't stay regular at topicals.
 
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Ein

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It's not low inhibition, because it's not inhibition at all. Bicalutamide does not inhibit anything. It just makes me androgen insensitive. Instead of getting inhibited, my hormone (androgen and estrogen) levels would be flaring like crazy.
 

AnxiousAndy

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From what I've seen bicalutamide is poor for hair loss. You want to be using Androcur for real results. Also get on dutasteride and oral minoxidil. Maybe add in topical estrogen, you will almost certainly regrow a lot of hair.
 

Ein

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(1) Yes, you are experiencing a Telogen Effluvlium which was triggered by the hormonal changes from the use of DHT inhibitors, and AR blockers.
(2) You are most likely growing lost hair back however, because of your panic and adding an additional AR blocker 3 months after starting one you retriggered another Telogen Effluvium.
(3) The only proven treatment that stimulates hair regrowth is Minoxidil and it unfortunately doesn't work for everyone.
(4) Honestly, just get off the AR blockers and give Finasteride some time. I am transgender and I know for a fact that you can still have normal range serum levels of DHT even when Testosterone are low in female ranges. This was my case when I thought I was protected with Cyproterone Acetate and Estradiol, but blood tests showed otherwise.

Thanks for your reply.
1. I think you are right about the Telogen Effluvium. The hair shedding is non- patterned diffuse shedding (that I mentioned in my original post and called it DUPA - Diffuse Unpatterned Alopecia). I've also observed that I shed most of my hairs from the back of the head and least from my crown, and virtually there's no shedding around my frontal hairline. Your message backs my opinion.

2. You are right about the regrowth. It's only been two days since I've realized that the hairs that I lose in a week is enough to make me slick bald in about a month, yet I have a full head of hairs. My overall hair density on top of the scalp has either remained same after the six months or has increased by at most 35%. My crown is definitely thin, but it's not any worse from the condition it was in 6 months ago. (I don't have any photos of mine, so I can't upload the pictures of my initial condition for better analysis.)

3. Maybe I'll need to be patient and wait for a few more months to see any visible regrowth. By the way, does Minoxidil help in Telogen Effluvium? If yes, can I get off from Minoxidil after the Telogen Effluvium goes away without having a chance of losing the regrown hairs?

4. I think that presence of DHT doesn't matter much if our body can't respond to it. And I'm not expecting any DHT inhibition on my Bicalutamide treatment. In fact, I'm expecting a rise in DHT levels almost two to three fold times. But I can't ignore the fact that DHT has better receptor binding capacity than Bicalutamide. Maybe you're right about giving another chance to Finasteride. I'll be adding Finasteride to my regimen next month. But I don't want to withdraw from Bicalutamide, because it helps me with my acne as well, and my facial hairs grow less vigorously.

Do you think that I should give Minoxidil a chance? Do you think that I'd be able to get off from it after a few months? (I can't stay committed to Minoxidil Topical.)
 

Georgie

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From what I've seen bicalutamide is poor for hair loss. You want to be using Androcur for real results. Also get on dutasteride and oral minoxidil. Maybe add in topical estrogen, you will almost certainly regrow a lot of hair.
Incorrect. Androcur/cyproterone acetate has an equivalent effect to 200mg spironolactone at a dose of 50mg. They are both weaker than flutamide, which blocks significantly more androgens than both of those. Doses of 125-200mg, even 60mg of flutamide far outperform both spironolactone and androcur. Bicalutamide is a similar drug to flutamide, but stronger again. A dose of 50mg bical is equivalent to 200mg flutamide.
Studies have shown that these are far more potent antoamdrogens. People don’t use these as much because of the incidence of liver Issues, however visit any PCOS forum. More women will opt for flutamide or bical because it’s stronger than spironolactone and andro.
 

AnxiousAndy

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Incorrect. Androcur/cyproterone acetate has an equivalent effect to 200mg spironolactone at a dose of 50mg. They are both weaker than flutamide, which blocks significantly more androgens than both of those. Doses of 125-200mg, even 60mg of flutamide far outperform both spironolactone and androcur. Bicalutamide is a similar drug to flutamide, but stronger again. A dose of 50mg bical is equivalent to 200mg flutamide.
Studies have shown that these are far more potent antoamdrogens. People don’t use these as much because of the incidence of liver Issues, however visit any PCOS forum. More women will opt for flutamide or bical because it’s stronger than spironolactone and andro.
Interesting, I was under the impression androcur was supposedly a hardcore anti androgen and spironolactone was significantly weaker.. If that's the case then I will have to find a new anti androgen to use as I was leaning more towards androcur.
@Ein since you are on an extreme regimen you may as well add in estrogen, it's good for hair growth in most cases.
 
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Georgie

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Interesting, I was under the impression androcur was supposedly a hardcore anti androgen and spironolactone was significantly weaker.. If that's the case then I will have to find a new anti androgen to use as I was leaning more towards androcur.
@Ein since you are on an extreme regimen you may as well add in estrogen, it's good for hair growth in most cases.
Like I said, flutamide and bical are stronger than spironolactone and Androcur, and are the oral equivalent of RU in terms of effectiveness. People just don’t want to die of liver failure.
 

Ein

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@Ein since you are on an extreme regimen you may as well add in estrogen, it's good for hair growth in most cases.
Yes, estrogen is good for hair growth, but I don't need to add it to my regimen, because both Bicalutamide and Tamoxifen have to capability to naturally increase my serum estrogen levels. Bicalutamide does that by increasing Luteinizing Hormone that doubles the serum testosterone levels and the estrogen levels are tripled due to increased aromatization. Tamoxifen simply prevents it from acting on breast tissues, so the decreased consumption leads to increased bioavailability.
So, basically I'm not feminizing. I'm reversing my puberty. (Interestingly enough, bicalutamide is used in treatment of precocious puberty.)

Like I said, flutamide and bical are stronger than spironolactone and Androcur, and are the oral equivalent of RU in terms of effectiveness. People just don’t want to die of liver failure.
Bicalutamide does increase the liver enzymes, but the risk of hepatoxicity is invisible, unqualified and virtually non-existent. Enigmatically, flutamide (which has similar properties to bicalutamide) has an unbelievably high risk of hepatotoxicity, which is almost comparable to that of cyproterone acetate. Bicalutamide is supposedly the safest anti-androgen, unless you have Interstitial Lung Disease. The common side effect of all anti- androgens, i.e., sexual side effects and osteoporosis, are not the side effects of Bicalutamide.
 

AnxiousAndy

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Yes, estrogen is good for hair growth, but I don't need to add it to my regimen, because both Bicalutamide and Tamoxifen have to capability to naturally increase my serum estrogen levels. Bicalutamide does that by increasing Luteinizing Hormone that doubles the serum testosterone levels and the estrogen levels are tripled due to increased aromatization. Tamoxifen simply prevents it from acting on breast tissues, so the decreased consumption leads to increased bioavailability.
So, basically I'm not feminizing. I'm reversing my puberty. (Interestingly enough, bicalutamide is used in treatment of precocious puberty.)


Bicalutamide does increase the liver enzymes, but the risk of hepatoxicity is invisible, unqualified and virtually non-existent. Enigmatically, flutamide (which has similar properties to bicalutamide) has an unbelievably high risk of hepatotoxicity, which is almost comparable to that of cyproterone acetate. Bicalutamide is supposedly the safest anti-androgen, unless you have Interstitial Lung Disease. The common side effect of all anti- androgens, i.e., sexual side effects and osteoporosis, are not the side effects of Bicalutamide.
You know a lot about these drugs, kudos to you for that. Despite all your research and hardcore regimen you are still losing ground? How would you explain that?
 

Ein

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You know a lot about these drugs, kudos to you for that. Despite all your research and hardcore regimen you are still losing ground? How would you explain that?
Well, basically I was expecting tad too much from it. Currently, I'm not losing hairs, but just shedding a lot. But the shedding also reduced to almost half of the massive shedding in the past two weeks.
Thanks for the appreciation, but I only know a lot about androgenic alopecia and its treatments. Telogen Effluvium was not a part of my research, but now I'm trying to combat that as well. In spite of everything, my hair density is a little better that what it had been a few months ago. Maybe I'll need to be more patient.
 

AnxiousAndy

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Well, basically I was expecting tad too much from it. Currently, I'm not losing hairs, but just shedding a lot. But the shedding also reduced to almost half of the massive shedding in the past two weeks.
Thanks for the appreciation, but I only know a lot about androgenic alopecia and its treatments. Telogen Effluvium was not a part of my research, but now I'm trying to combat that as well. In spite of everything, my hair density is a little better that what it had been a few months ago. Maybe I'll need to be more patient.
Thyroid issues can also cause hairloss /telogen ellffluvium. I'm glad to hear things are getting better! How much are you paying for bicalutamide?
 

Ein

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Thyroid issues can also cause hairloss /telogen ellffluvium. I'm glad to hear things are getting better! How much are you paying for bicalutamide?
Bicalutamide is kinda expensive as compared to other anti-androgens. I need to pay almost 17 USD for 30 tablets of Bicalutamide. I know that it sounds pretty low, but it's entirely because of the fact that all the medicines are very budget friendly in India, as compared to the rest of the world.
 

AnxiousAndy

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Bicalutamide is kinda expensive as compared to other anti-androgens. I need to pay almost 17 USD for 30 tablets of Bicalutamide. I know that it sounds pretty low, but it's entirely because of the fact that all the medicines are very budget friendly in India, as compared to the rest of the world.
Do you get them from your dermatologist or a website? Any way I am able to purchase some from the same source as you?
 

Ein

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Do you get them from your dermatologist or a website? Any way I am able to purchase some from the same source as you?
I purchase it every month from a reputed drugstore. It's not available without a prescription, but I manage to get my hands on it. It's available everywhere in urban India.
If you live in India, you can purchase it from a local chemist. If you are from any other part of the world, try to get it from chemists. I won't recommend purchasing it online. It's difficult to get it without prescription, but not very difficult and nowhere near impossible.
 

Ein

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There really isn't anything that can be done to stop one once it's been triggered.
I know that. It's just that I'm trying to stay as healthy as possible from the inside now. If it doesn't go away in the next two months, I'll go for medical tests to explore the existing internal issues. But I'm quite confident that it was acute Telogen Effluvium that's gradually fading away.
Maybe I'll be posting some of my current pictures tomorrow, so that you guys get a better view of the condition, because I'm terribly bad in diagnosing the condition by analyzing the symptoms.
 

Ein

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Temple:
Temple.jpg


Mid-Split:

Mid-split.jpg


Hairline:
Hairline overview.jpg


Diffusion on Top:
Diffusion on the top.jpg
Diffusion on the top - Close up.jpg


Crown:
Crown.jpg
 
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