Loss And Regrowth. Progress Pictures. Treatment Timeline And Details. Shedding. Health Effects.

[Ramsey]

SUMMARY PHOTOS

Back:

Vertex:

Top:

I've found that it's very helpful to see detailed descriptions other people have written about their hair treatments. People have very different characteristics of both hair loss as well as reaction to treatments, so the stories posted on forums have given me lots of useful information which supplement the findings of research reports and journal articles. So I'm adding my story to all the others here. Hopefully it will be helpful for someone.



BACKGROUND
I'm 38. I was stable NW2 from 22 to 35. 3 years ago at age 35, I noticed my hair becoming thinner and white, but I denied it to myself. I always had my hair short, but I started then to grow long. I told myself that the long hair was just because I wanted a man-bun, but it's obvious now that I was subconsciously attempting to cover the increasing baldness.

I made excuses to myself for over a year. I'm a rational man in most situations. But about hair, I was denying reality and blinding myself with self-delusion. The lies I told myself are obviously stupid when I think about them now, but I believed them then. For example:

• I ski a lot, so I convinced myself that the signs of baldness were because of wool hats. I created an elaborate theory that sweating in the wool exposes the skin by rubbing the hair into small patches. I was so irrational that I didn't recognize the obvious problem that I've been skiing and wearing wool hats all my life but never had any exposed scalp until age 35.
  
• I decided that as I get older, my hairs are turning white, and white hairs show the underlying scalp skin more (interesting that it's easier to accept aging than balding).
  
• I'm tall, so I told myself that I was being too self-critical about my hair because most people can't see the top of my head anyway.
  
• As my hair grew longer, I convinced myself that long hair is naturally stringier and less bulky, so it appears more thin and bald when compared to my previous short hair.
  

Finally in Dec. 2016, I was shedding so much that my shower flooded, so I couldn't pretend any longer. In one year, my front had receded from NW2 to NW3. But my big worry was the huge bald spot opening on the vertex, the back thinning rapidly, and the diffuse thinning and shedding on the top where big patches of skin had become visible. The hairs remaining on my head were thin and soft in many places. They were wispy hairs, so sparsely distributed that they no longer bunched together, and I began to notice individual hairs blowing in the wind and tickling my forehead and neck when I played sports. I started wearing hats all the time.

I began finasteride in December 2016. No improvement. Then added minoxidil and Nizoral. Still no improvement. Two months later, I added dutasteride. Maybe some improvement in the back, but not great, and the top got even worse. In the summer of 2017, I spent huge time researching hair loss and added many more treatments. In the autumn, I was preparing to add strong anti-androgens and estrogen, but just at that moment, I started seeing big improvement, so I continued with the regimen I had. Now at the beginning of 2018, my hair is in very good shape. I focused my treatments on the 3 areas: back, vertex, top. Those areas are now thicker and denser than years ago. The front was not my focus, but it also is much better, with hairs even growing in places that were bald for 15 years. My hair continued to shed massively every day throughout 2017, but somehow it improved a lot despite the constant shedding.


PROGRESS
All pictures here are of my hair when wet. My hair looks better dry than wet, because the dry hair covers more area and seems bulkier. Nizoral in particular makes the dry hair seem fuller. I also discovered that my hair has waves when long, which also makes it seem fuller. For the pictures, I wanted the most honest assesment, so I photographed my hairs just after shower, when they were still wet and clean with no products or treatments on head.

My hair length is roughly the same throughout the last year, about 16-21 cm / 6-8 inches depending on position. Such long length can hide balding, even when wet, so I tried to comb my hair so as to show the balding in the worst way.

Hair pictures are very affected by lighting, angles, room, camera, combing, and wetness of hair (e.g., 5 minutes after the shower is very different than 10 minutes). I learned that even tiny differences in those factors have big effects on the pictures. Hair growth is so slow and hard to observe that it's useful to have very precise pictures for comparison. So I wish I had better standardized my photo methods. But nonetheless, the pictures I took have been helpful in guiding me.

Because of the different lighting and cameras I used, the pictures don't capture accurately the changes in my hair color. My hair is light brown or dark blond, and becomes lighter with sun or swimming. In the last 2 years, many of my remaining hairs turned white while I was thinning. Of the non-white hairs, many became desaturated in color. As my hairs have improved, they've become more saturated in color again. I still have white hairs, but much fewer than 1 year ago, and they're hard to see now. I think it's very likely that in addition to growth, the hair treatments have also been the cause of this regained richness in color.

Back progress:

Vertex progress:

Top progress:

[continued in next post]

 

[Ramsey]

[part 2/3]

TREATMENTS


Timeline (Dec. 2016-Dec. 2017):

I’ve done many treatments simultaneously, so it's impossible to know what specifically has caused benefit. I know that Nizoral and (especially) cetirizine reduce the feeling of itchiness; their effect is very quick, so there is no doubt. I'm fairly certain that it's oral minoxidil which is affecting my hair on moustache, arms, nose. Otherwise, I have no idea which treatments really have contributed to my good results.

Many treatments simultaneously is obviously horrible as controlled science experiment. But I decided that I’d prefer to do many treatments and hopefully have more hair while not knowing which of my many treatments to thank, rather than to have less hair knowing for sure that it’s the failure of 1 treatment and having wasted 3-6 months.

I was focused on escalating to get results in 2017. So much about hair loss and growth is not understood, and the variability between individuals makes me skeptical of any absolute claims. But it does seem fairly certain that recently-bald areas have higher chances of regrowth than long-bald areas. How long is not clear, but based on research, I guessed that I had a window of maybe 3 years after balding started before it would become more difficult to spark regrowth. My hair loss probably started significantly in early 2015, I didn't notice for at least half a year, then I wasted the rest of 2015 and most of 2016 denying reality. So I figured that my window of opportunity was closing fast and I was willing to do everything possible to get results before the end of 2017.

I thought a lot about drug interactions, but I haven't found satisfactory answers. It's a big issue when building out a regimen with lots of parts. Drug interactions can be very complicated, and most pharmacy industry research is often limited to major (non-hair) drugs. In many cases, drug interactions are simply discovered serendipitously, for example, the famous problems caused by the effect of grapefruit on the metabolism of many drugs.

• In hair research, I haven't seen much published about the topic of drug interactions. What I've found is mostly about interactions with sleep cycles, e.g. with melatonin, PGD2.
• On forums, I've found a little discussion about interactions and timings, but not much. For example, I've seen that SwissTemples emphasizes to separate by several hours what he considers PGE1 treatments from PGE2 treatments, but I'm not certain about how to classify many treatments (minoxidil is an example of this uncertainty: PGE1 agonist? PGE2 stabilizer? other?).
• Antydhtor has a schedule where he keeps oral minoxidil at least 1 hour away from 5ar inhibitors, cyproterone acetate 3 hours away from 5ar inhibitors, and estrofem 1 hour away from cyproterone acetate. To his credit, he's very aware that drug interactions are not well understood, so his goals are to take the drugs at separate times so they can absorb separately, with a fixed and stable cycle of treatment based on their half-lives.

I've tried to plan a schedule with similar criteria, but I recognize how limited my knowledge is and the potential for many unknown interaction issues.

Now that I have good results, I'm indeed in the situation where I don't know which treatments are useful and which to drop. But that's a lot better problem to have than the horrible state of my hair 6 months ago.

Treatment details:

Finasteride:
1.25mg daily in the evening. It was my first hair drug. Likely my hair loss was less because of finasteride than it would have been otherwise. But I definitely lost hair while on finasteride alone, as well as when used together with topical minoxidil and Nizoral.

I recently stopped finasteride as my hair has improved and I'm worried about effects on my liver of all the drugs.

Dutasteride:
0.5mg daily in the morning.

I added it when I saw after a few months that finasteride, topical minoxidil, and nizoral weren't improving my hair.

Based on timing of results, I think dutasteride has been effective for me on my back head hair and somewhat effective on the vertex. I think it stopped further balding in those areas and possibly also contributed to growth, particularly on the back. On the top, it likely stopped further balding, but uncertain if it contributed to the growth; my top growth didn't really begin until I added PRP, dermapen, oral minoxidil, and other treatments.

I'm deliberately using finasteride and dutasteride together for most of 2017. I know many people think it's redundant, but I decided to use both together to inhibit 5α-reductase. I've seen a few doctor reports and some anecdotal forum posts which show better results from dutasteride and finasteride together than the person got from either drug alone or from increasing the dosage of one or the other.

Topical Minoxidil:
5%, 1.5-2ml twice daily.

No idea if it has prevented further loss, but it certainly didn't cause improvement in my hair. I still use topical minoxidil, but after good results recently from other treatments, I'm thinking of dropping it.

Oral minoxidil definitely has a body-hair effect on me which topical minoxidil did not. So I've thought I might have relatively low sulfotransferase activity in the hair follicle, making me a non-responder to the topical form, whereas I have sulfotransferase activity in my liver which catalyzes the sulfation of minoxidil and makes me a responder to the oral form?

I've thought to try minoxidil sulfate topically; anyone have experience with it?

In any event, I wanted to do a sulfotransferase enzyme test of my hair follicles, but I can't find it offered anywhere. I found a few doctors/companies who advertise the test, but when I speak with them, it turns out that they don't actually have it. Has anyone found the test offered anywhere?

Nizoral:
2% keto shampoo. 3 times per week, leave it on 20 minutes each time.

Annoying to wait 20 minutes in the shower, so I created an efficient routine where I now put on Nizoral immediately in the morning, then shave, sh*t, drink coffee, read news, brush teeth, then finally rinse it off.

No evidence if Nizoral helps my hair loss/growth, but it eliminates the itching feeling on my scalp for a period of 2-3 hours after use.

PRP:
I started with PRP injections in a clinic, and then began my own DIY system for PRP at home. I inject all over the scalp once every 10 days. I don't use activators, kit, light, etc. Simply draw the blood (preferably get someone with experience to draw your blood; self-drawing is possible but not fun), centrifuge it, then inject the PRP in little injections.

My reasons for the DIY system rather than clinic are cost and frequency; from everything I've seen, the frequency of PRP injections is important for results (anywhere that they're used in the body, in fact, not just for hair). PRP here in Europe is not as expensive as in USA; in Eastern Europe in particular, non-activated scalp PRP costs $50-100 per session. But for the frequent injections I want, the total cost quickly becomes large, so I invested in the centrifuge and other equipment so I could do it myself.

Depending on your requirements, the price to get started will be US $300 to $900. My experience is that the lower end of that range is sufficient, but doctors have argued to me that you need certain equipment that are more expensive, you need certain techniques or methods, etc. In my opinion, it’s all a guess now and there are lots of questions about which techniques are most effective. Plus I’m not running a big clinic or lab, it's just for me. So I don’t see the need for the high-quantity, high-end equipment, but do your own research and make your own decision.

I saw no effects of my first PRP injections. Maybe it's because the injections weren't frequent enough, but I don't know. But I found that when I began frequent injections, I noticed increased shedding and - possibly - growth. I can't separate the results of the PRP from other treatments, but I believe it is a contributer to the growth I've had.

Dermapen:
I experimented with different techniques and lengths. I've settled into the following routine: day 0, 1.5mm; day 7, 0.25mm; day 10, 1.5mm; day 17, 0.25mm; etc. I reached that schedule based on the speed of my scalp healing; it takes me 3-4 days for visible healing to complete after 1.5mm, and just a few hours after 0.25mm. I stagger PRP between the dermapen days. My skin is always pink-red now from the wounding.

Regarding length of needle and wounding/scarring, best methods aren't clear. I've seen lots of research and theories with very different ideas and results. So my idea with alternating 0.25mm and 1.5mm is to cover all possibilities and get whatever benefits exist from both deeper wounding and light poking.

I use topicals about 30 minutes after dermapen.

I got my dermapen from Asia; the device and 200 needles cost $130.

I can't say if the dermapen or my specific methods are beneficial. I believe it's helping growth, so I'm continuing, but I have no evidence.

Oral Minoxidil:
I started with 2.5mg a day, then worked up to 5mg and 10mg. Currently I take 7.5mg per day: 3.75mg in the morning, 3.75mg in the evening.

I bought lots from a pharmacy in Thailand, $3 per bottle of 100. I'm wary of Chinese generics from Alibaba or chem sites, because I worry about impurities, cheap/unsafe manufacturing processes, and random additives inserted. I thought to buy a lot from China and test a batch, so the test cost would be spread over a large per-use base. But I decided I'm comfortable enough with the oral minoxidil from Thailand because it's commonly sold to local customers, prescribed by Thai doctors for hypertension, and regulated. Local use and prescriptions don't guarantee safety even in relatively developed markets - e.g., look at the problem with adulterants in Hong Kong medicines - but I trust the Thai oral minoxidil enough to take it for myself.

The oral minoxidil definitely affects the hair of my body. Nose hairs became thicker and darker, moustache hair changed from slow-growing and brown-blond into fast-growing and black, arm hair grows much longer (although still blond), and I now have several dark, thick, fast-growing hairs on my ears which did not exist before [see picture below]. My eyelashes are significantly longer and darker; women constantly compliment me about them now. Unchanged are hairs on eyebrows, beard, pubic, legs, armpits, chest. The body hair effects are likely due to the oral minoxidil, because I noticed the growth shortly after starting use and I don't think anything else I'm taking could have caused it. 5mg per day causes a noticeably greater effect on body hairs than 2.5mg per day, but I don't see any differences between 5mg, 7.5mg and 10mg.

I'm less certain about the effect the oral minoxidil has had on my head hair. I think it has helped on the top of the head. I also think that it might be contributing to the temple regrowth. But with all the other treatments, I can't be certain.

Stemoxydine:
I use it for its claimed hypoxic effect, stimulating stem cells and waking up the dormant bulbs (kenogen). I use 2-4ml every day.

There's much cause for skepticism: it's a proprietary product, L'Oreal has a deservedly awful reputation, the only studies about stemoxydine were funded by L'Oreal and even those studies are over a decade old, and even L'Oreal itself doesn't currently seem excited about the product as there has been no additional research or promotion.

But I got a huge amount of it very cheaply, so if it's useless, then it's not much of a loss, because it's a convenient carrier for many of the other topicals I use, and I like the smell and feel of it. And if the research turns out to be real, then it's a nice additional benefit to my regimen.

Cetirizine:
I have much itching on the scalp which seems closely connected to the balding, so one focus has been reducing inflammation and itching. Idea with cetirizine is that it's an anti-histamine, hopefully inhibiting not just PGD2 but also other pro-inflammatory cytokines.

No idea if cetirizine has directly helped with my hair loss and regrowth; I'd guess it's likely a contributor, but I can't be certain. But it definitely is the best product I have found against itching. My itching stops very quickly after use; the reduction in itching can last 12 hours, sometimes up to 24 hours. To make sure I wasn't deluding myself, I blind-tested a topical with cetirizine and one without; the experiment confirmed my feeling that the reduction in itching occurs due to the cetirizine.

For use, I store cetirizine separately and only mix it immediately before applying. Very inexpensive. I use a little cetirizine every day, and on very itchy days, I use a lot. The relief is wonderful, because the itching was very annoying.

Vitamin B6, Zinc Sulfate:
The Zix treatment. A 1988 study (on foreskins of 2-month old baby boys!) found that B6 potentiated the 5-alpha reductase inhibitory effect of zinc. More recent reports that B6+zinc sulfate could lower prolactin, raise dopamine. The sulfate form might have some anti-fungal benefit.

I have no idea what benefit, if any, I get from B6+zinc sulfate, but I put it in my regimen because it's cheap, easy to add to existing treatments, and probably doesn't have any negative health effects or interactions with other drugs. I'll remove it soon as I now try to reduce the number of my treatments.

Salicylic acid:
A beta hydroxy acid used in some dandruff shampoos as well as Alipcort F.

I had lots of scalp flakes in 2017 [see picture below]. Nizoral didn't help. So I use salicylic acid on non-Nizoral days for its ability to remove outer layer of skin, flakes, and half-dead skin, hopefully cleaning pores, removing sebum, keeping scalp environment clean.

The timing might be a coincidence, but my flaking and general scalp condition improved shortly after starting the salicylic acid.

Selsun blue:
A shampoo containing selenium disulfide.

Selenium probably inhibits PGD synthase, maybe also increases PGE2. Big concerns about shock loss from use. A very old study ("Effect of selenium sulfide suspension on hair roots", Archer, 1960) shows "unequivocally" (their words) that selenium sulfide harms hair roots. It's an interesting study and a bit crazy in fact, plus it's also interesting to see how things were done back then, but it seems odd. Because of these studies, people definitely are worried still today about shock loss, so I've seen lots of advice to just use Selsun Blue quickly and only once a week. I haven't seen much good research on it from recent times.

I used it once a week for 2 months. It didn't cause any shock loss, fortunately. It seemed to reduce itching a bit, but it didn't help with my shedding. I stopped one month ago, haven't noticed any difference.

VPA:
Epilepsy drug, easy to get, fairly cheap. Idea is that it up-regulates the Wnt/β-catenin pathway.

Lot of research from South Korea on VPA with good results of hair growth for both mice and humans. There's concern about the potential for VPA to cause hair loss, but Korean studies find hair loss is caused by oral VPA due to the decreased biotinidase activity and biotin deficiency induced by VPA, maybe coming from damage it causes to the liver. Topical application avoids those problems.

Regarding use, I applied it daily. It's stable, low molecular weight, very easy to use as a topical. Based on the finding in one of the Korean studies that VPA stimulated hair growth in the wounds of mice, I was also applying it shortly after my dermapen wounding sessions.

No idea how much benefit it gave me, but I'd guess that the new growth on my top and temples is from the combination of VPA, dermapen, oral minoxidil, and PRP.

However, when my blood tests began showing liver problems, I suspected VPA and dropped it. Interestingly, my temple regrowth has stopped in the weeks since I dropped it. I will wait to see my liver results in the next blood test to decide whether to continue VPA.

If I have to permanently drop VPA, I thought to substitute methyl vanillate, a flavoring used for food and beverages; a good 2014 study from Korea about Wnt/B-catenin signalling for osteporosis found that methyl vanillate increased osteoblast differentiation with activation of the Wnt/β-catenin pathway.

 

[Ramsey]

[part 3/3]


HEALTH EFFECTS:
I've had very few negative side effects that I've noticed, which is good. But I think a lot about the potential long-term effects which we don't notice. I've accepted that many of the consequences of the drugs are unknownable, but to the extent possible, I've tried to monitor by testing and measuring myself frequently while I've been taking the hair treatments. Standard blood tests and liver tests, hormone tests, prolactin, body performance measurements, blood pressure, heart rate, EKG.


Liver:
All blood tests were fine until I found signs of liver problems starting in November. Not horrible levels, but my liver was clearly beginning to be negatively affected for the first time in my life.

The liver problem is most likely caused by the hair loss treatments, as I don't take any other drugs and I'm otherwise in great health. I don't know if it's one single drug or a combination of several which has affected my liver, so my plan is to stop one drug after another and test the effect on my liver of each change. My first guess for the cause is VPA, particularly as I was also applying it immediately after wounding, so I stopped the VPA even though I think it has helped with regrowth. I'm waiting a bit and will test soon to see if my liver has improved. I also dropped finasteride; I think it's maybe beneficial when combined with dutasteride, but I want to spare my liver a bit for now.

Blood pressure and heartrate:
Minoxidil is a vasodilator, lowering blood pressure. The body's heart rate rises, and side effects can include arrthymia. I measured my blood pressure and heart rate many times each day both before and after starting minoxidil. Topical minoxidil applied normally had no clear effect on my blood pressure or heart rate. In contrast, my blood and heart were affected both by oral minoxidil, as well as by topical minoxidil applied immediately after dermapen wounding.

It’s hard to measure the precise change in my blood pressure (BP) and heart rate (BPM=beats per minute) as they are so variable throughout the day based on food, time of day, sleep, exercise, stress. Even two measurements a minute apart can be quite different. I tested myself at a local hospital and at the same time with my own devices, just to confirm my home measurements and make sure I’m not missing anything; everything checked correctly. So, bottom line is that it’s tough to say exactly the effect which oral minoxidil has had on my BP and BPM, but looking at averages throughout the day, 5mg of daily oral minoxidil lowered my BP by about 10/5 and raised my BPM by about 8.

There was no additional change on either my BP or BPM from increasing dosage of oral minoxidil from 5mg/day to 7.5mg or 10mg/day, which is interesting because minoxidil is supposed to be dose-dependent for both blood pressure and for hair.

It’s pretty obvious, but from what I’ve found, the effect on your blood and heart depends a lot on your BP and BPM when you start. In my case, I’m in very good shape, low body fat, lots of sports including endurance competitions, and a diet which is good for BP. So my BP was already low, and my resting heartrate was very low compared to the general population. I'd suggest measuring your own variables thoroughly before starting, as the effects the drug will have on you will depend on your own starting point.



Sexual effects / testicles:
I had testicle pain 7 times in the last 10 months. First time was a few weeks after starting finasteride (before I had begun dutasteride). It feels like an ache in the testicles, steady in intensity, lasts for hours at a time over several days. Not connected to sex. Painful enough that I'm constantly aware of it, particularly when urinating, but it doesn't stop me from any activities. I found that stopping finasteride on one day eliminates the pain the next day, even if I continue with dutasteride and all other treatments. So now when the testicle pain occurs, I stop finasteride for 2 days, the pain disappears, then I re-start the finasteride again with no problems. It's odd that the pain seems linked with finasteride and not dutasteride, but I have no explanation why.

Regarding sex, I'm heterosexual and had a huge sex drive before starting hair treatments. It's still the same now. No changes, no problems. The only difference I've noticed is that the third orgasm in one session can be slightly painful on some nights, whereas before it was fine. The pain could be caused by hair treatments, or it might just be aging.


Body:
No body changes occurred in any noticeable way. I'm still roughly the same now as one year ago for body fat, strength, endurance, athletic performance. Because of sports, I have decades of detailed records about my body to use for comparison. I'm late 30s, so my performance isn't as good as my 20s, but it's most likely that the hair treatments in the last year haven't affected me. My measurements are slightly worse overall than one year ago, but it seems to be the long-term decline due to age rather than any sharp drop from drug treatments.

No sign of gyno, no changes in fat distribution on the body or the face. No tiredness, bloating, or rapid aging in the face. No tinnitus (= ringing in the ears, occasionally reported as side effect of minoxidil, particularly higher doses).

I had high testosterone levels before starting. That's stayed consistent. DHT dropped.

Beard and chest hair the same. Moustache grows faster and darker, which I'd guess is because of the oral minoxidil; it also has made my eyelashes significantly longer and darker. My eyes seem a lighter shade of blue than before; I thought at first it was perception caused by the contrast with the darker eyelashes, but even my mother swears my eyes themselves are lighter now, and although eye color is very difficult to precisely measure in pictures, the photos I have do seem to confirm the change. I've grown a few thick, dark hairs on my ears. Below is a picture of one of the first ear hairs I noticed a few months ago. I now have 3-5 on each ear. So I shave my ear lobes, which I hadn't expected but is no big deal and is definitely worth it for good head hair.

Shedding:
I shed 200-500 hairs every day. My shedding started in late 2016 and lasted all 2017. At the rate I shed, I estimate that I lost at least 100,000 hairs more than I should have - that's like one complete head of hair - in the last 14 months.

One week ago, the shedding suddenly stopped almost completely. Maybe it's finally over.

Given the timing of my treatments, I don't think any one drug was responsible. The shedding started before I began treatments, and continued throughout all the changes to my regimen. PRP treatments seemed to increase the shedding, but no other treatment seems to have had any effect, positive or negative.

To have precise count of my shedding in the last year, I put gauze over my shower drain, then collected and counted my shed hairs. I collected twice, first in the morning and then in evening. The average I collected is about 325 hairs per day. Here's what the collected sheddings look like from 7 days, 2 times each day:

Here are two days of shed hairs seen from close:

Regarding counting hairs: I made a visual scale of my own hair by counting every day for several weeks and taking detailed photos and notes. Then going forward, I was able to avoid counting by instead using that scale to estimate my daily losses based on the size of each day's hair ball.

Counting is very depressing work. If you don't want to count long enough to create your own scale, this journal article has a scale which gives you an idea how many hairs are in a ball. It has pictures for short, medium, and long hair, but since the guide is for women, those lengths are defined as shoulder-length, mid-back, and lower back. I'd guess most guys here are shorter than that. But at least it's a start if you don't want to count.

Every shed hair I check has a white bulb located on the end which was connected to the scalp. It's supposedly a distinguishing sign of a hair shed in telogen phase compared to an anagen hair and is often described as keratin. This bulb is mentioned frequently in forums and seems common, but I wasn't able to find good research on it.

I wanted to understand if my shedding is from androgenic alopecia (A.G.A) or telogen effluvium (T.E.). Studies which look at shedding use two measures to distinguish between A.G.A and T.E: the number of hairs shed and the length of those shed hairs.

• For the number of shed hairs, there is a lot of variance between the different studies, but they all show that A.G.A patients shed significantly fewer hairs than T.E patients. Combining different studies, T.E patients shed around 250-400 hairs per day, while A.G.A patients shed around 40-70 hairs.
  
  
• The length of shed hairs is used to estimate the ratio of miniaturized vellus hairs. (Diameter could also be measured, but most studies find that it correlates so closely with length that it's easier to just use length and not bother with measuring the diamter). As with the hair count, the results about length of shed hair vary between studies, but the main point is clear: in the A.G.A groups, roughly 20-25% of hairs are <3 cm in length, while in T.E patients, only 5-7% are <3 cm.

My shedding doesn't fit the pattern of either A.G.A nor of T.E. In my case, only 3% of my shed hairs are less than 3 cm, well below the ratio of all A.G.A patients and even below the typical 5% of most T.E patients. Moreover, hairs shed by T.E patients in studies tend to be 3-5 cm in length, but almost all my shed hairs are longer than 5 cm. Additionally, T.E patients shed hairs that are often thinner at the root than at the tip, but my hairs have uniform diameter.

So I don't understand my shedding. I shed more hairs and of greater length than is supposedly typical for A.G.A. But it also doesn't seem possible that I have extremely long-lasting telogen effluvium: my shed hairs are longer than is typical of T.E, they are not thinner at the root than at the tip, and my balding vertex spot is a classic male-pattern baldness not seen in T.E.

Many men on hair loss forums also have A.G.A with massive shedding. But despite its apparent prevalence, I haven't found good studies about the phenomenon. But I can at least contribute one new data point. These guys often ask whether it's possible that hair can improve while shedding. I'm happy to report that at least in my case so far, the answer is yes. My hair has gotten better while at the same time it's been massively shedding.

Last week, my hair suddenly stopped shedding for the first time in over a year. From 300-400 per day the week before to 5-20 per day in the last week. No idea why. But it's great to finally not clean hairs from my shower, pillow, keyboard, gym equipment, and food.


Flaking:
You can see in some of the progress pictures that my scalp skin had many flakes at different times. A close-up of some of the flakes:

I've had lots of scalp flakes. Some big, many small. No skin problems anywhere else on the body. I don't know the cause of the flakes, could be the hair loss treatments and all the topicals put on my scalp, could be dandruff or seborrheic dermatitis, maybe scalp psoriasis. It gradually stopped 2 months ago; it might be the salicylic acid which helped, but I'm not certain.


FUTURE GOALS
I'm very happy about my hair now. It's not back to teenage levels, but nonetheless it's quite thick and dense. The expert bald spotters here could notice the remaining thin areas when it's wet, but normal people probably would not. And when dry, I think it's impossible to see signs of balding or thinness unless you do a detailed examination from very close. If it stays this good, I will cut it short soon. I don't like long hair, it's annoying for sports and for life, and it's real freedom if I won't need long hair any more as a shield to hide thinning.

My hair improved most in autumn 2017 just before I was going to add heavy anti-androgens and estrogen, so I never did them. Even after the improvement, I still thought to strengthen my regimen starting now in January 2018 in a new focus on the front and temples. Those areas are already quite good now, but I was greedy for more. However, bad signs from tests on my liver made me change plans. Now I will reduce my regimen piece by piece to see if and how I can maintain what I currently have while not damaging my liver. Of course I'd like even better hair results, but I decided that any additional improvement beyond my current level isn't aesthetically important enough to risk further liver trauma.

Let me know if you have any insight about my situation or ideas for the future. It's a never-ending battle, so I'd appreciate any tips. And any questions or anything not clear, feel free to ask.

 

[DHTpolice]

Wow, that's a serious approach to the treatment. i appreciate it.
I am sure you did a lot of research and now your results speak for themselves. Congrats!

 

[Georgie]

Awesome post. I find I have shedding like that With oral minoxidil, but since being on dutas seems to have marginally decreased (80-100 per shower to 40-60). I did also start 1% topical CET around the same time so that might be helping. I’ve also been using topical RU for a week.

 

[shadowcast]

I find it interesting that you're quick to rule out so many of your treatments as being effective. Some people swear finasteride\min take a good year. Looking at your timeline, it also seems plausible that dutasteride\dermapen\oral min are the main actors.

 

[Oro]

Wow bro tnx for sharing your story!

 

[nikiblush]

wow, what was it like mentally losing more before gaining again? how did you stay patient?

 

[Johnmpb]

Awesome. Please describe how you make your ceterizine topical and what strength/amount u use thanks

 

[buckthorn]

Ladies and Gentlemen - we've found our God.

 

[Ramsey]

Thanks for the positive comments. I'm very happy about my hair now.

I find it interesting that you're quick to rule out so many of your treatments as being effective.

Actually, it's the opposite: I don't know the effectiveness of over a dozen treatments I used. As I wrote: "I have no idea which treatments really have contributed to my good results", I'm "uncertain", have "no idea" or "no evidence" about the effectiveness of most of the treatments with "no idea which treatments really have contributed to my good results," and I'm now "in the situation where I don't know which treatments are useful and which to drop."

I agree with you about the deeper issue that it's very difficult to determine the effectiveness of hair treatments. I think the problem applies not only in a multi-treatment regimen, but even when it's not part of a multi-treatment regimen. It's what makes hair loss so frustrating: so much is not understood, so much research is inconclusive, basic research is lacking, there's massive variance between individuals, small sample sizes in even the best studies, huge problems of predictability, lack of falsifiability, perverse effect of economic incentives and legal/regulatory structures, misuse of statistics. The list goes on. Most of these problems are currently a big issue in medical research in general and are widely discussed. In my opinion, research on hair loss/regrowth is particularly bad.

With this uncertainty about any treatment, the massive individual variance, and the lack of understanding in general, I decided that my best strategy would be to layer on an ever-increasing number of treatments. I knew that it would eventually be impossible to accurately establish which were beneficial. But I'm an individual rather than a research lab, and in my case, hair regrowth was the only goal; I value positive results over the knowledge of treatment effectiveness. Additionally, I believe that I had a tight time constraint. I felt my window of opportunity before regrowth becomes significantly harder to spark would end in 2017, so I was determined to escalate as much as necessary - in terms of both number of treatments and their strength/aggressiveness - in order to get results before the end of 2017. All of that is why, as I wrote in my post, "I’d prefer to do many treatments and hopefully have more hair while not knowing which of my many treatments to thank, rather than to have less hair knowing for sure that it’s the failure of 1 treatment and having wasted 3-6 months."

Some people swear finasteride\min take a good year. Looking at your timeline, it also seems plausible that dutasteride\dermapen\oral min are the main actors.

Possible. But anything is possible. Unfortunately, there's so much uncertainty about hair results that I think it's very hard to establish cause-effect relationship of any treatment with much certainty. In a multi-treatment regimen, it becomes near impossible. And with a n=1 study of just me, it is impossible. So you could definitely argue for anything to be the main actor, with benefits not achieved until a year after starting, and it's impossible to prove or disprove.

My guess is that there was not a long-delayed regrowth benefit which came from finasteride, dutasteride, or topical minoxidil. I base that guess on close-up pictures. I'd be more likely to believe the possibility of a long-delayed effect if I only had full-head pictures (such as those posted here) to compare where you could argue that effects might not be visible until months after regrowth starts. But in my case I also took many extremely close pictures of small areas of my head to track loss/regrowth closely. I found it was possible to use birthmarks, freckles, and moles as landmarks on the scalp so that I compare photos of exact areas over time. I believe those photos help me identify any loss and regrowth both sooner and more precisely than I would be able to achieve only looking at pictures of the overall view. The close-ups also particularly help in my situation because long-hair can hide both loss and regrowth.

As I wrote in my OP, my guess is that dutasteride was effective for me on my back head hair and somewhat effective on the vertex. On the top, it likely stopped further balding, but I'm uncertain if it contributed to the growth. Based on those close-up photos, I didn't see any top regrowth that I would attribute to dutasteride alone. My top growth didn't really begin until a while after I added PRP, dermapen, oral minoxidil, and other treatments.

But as I wrote above, it's impossible to have any level of certainty about the effectiveness of any treatment. But I'm happy to have that problem now with my good hair than to know for sure that one treatment didn't work and have bad hair and wasted several months.

Awesome. Please describe how you make your ceterizine topical and what strength/amount u use thanks

Cetirizine has a long history of use for hair loss. Recent Italian studies (https://www.ncbi.nlm.nih.gov/pubmed/28604133) showed positive regrowth from cetirizine use; they used a 1% solution daily, although both the description of the vehicle and the entire study are very unclear. On the German hair forum, many members tested it a few years ago; most got no results, while one guy only using cetirizine got temple regrowth and vellus hairs. There were lots of arguments about the vehicle.

I experimented with different ways to apply cetirizine. There's an issue of degradation in alcohol over days/weeks (Fischer effect), but I think it shouldn't be an issue on a very short-time basis, so I simply mix the cetirizine and then immediately apply. I've thought my quick mix-then-use technique might not be so clever and I'm still suffering degradation, perhaps even while it's on the scalp. But I've tested a few times, and I definitely notice the anti-itching effect of cetirizine which I discussed in my OP when it's in an alcohol vehicle, so it would seem that the immediate use after mixing ensures I get that benefit before any degradation occurs.

For usage, at first I bought pills and filtered. That worked fine. But when I realized how much I like it for its anti-itching, I bought the pure chemical to save the hassle of dealing with crushing pills and filtering. I use about 50mg on my whole head daily. On very itchy days, I sometimes used 100mg or more; that amount certainly calms down the itching, but I can't say if it really was necessary to use so much or if I could have just used 20mg, for example.

I've seen posts on hair forum about users getting side effects from topical cetirizine, including sleepiness. I haven't noticed any effects. It's strange to me how they occur, because it's a second-generation antihistamine (and it's being used topically). From wikipedia's explaination, it's "selective for peripheral H1 receptors as opposed to the central nervous system H1 receptors", which "significantly reduces the occurrence of adverse drug reactions, such as sedation, while still providing effective relief of allergic conditions."

In any event, I like cetirizine very much. No idea how much benefit it's contributed to my hair regrowth; I'd guess it contributes, but who knows. But it's certain that it causes a quick reduction in the itching. My itching and inflammation was a big focus for me in the last year. I'd thought to try JAK inhibitors, but I discovered that cetirizine worked well enough for me.

wow, what was it like mentally losing more before gaining again? how did you stay patient?

Sucks for sure. Still sucks: all of us have this problem for life, and we're always going to be fighting a battle which we can never win. For me to stay good mentally, I've focused on knowledge, control, and long-term challenge:

• Knowledge: It's really frustrating to lose my hair. Feeling of helplessness. So I researched as much as possible. I downloaded and marked up about a hundred journal articles, looked through a few hundred more, read many hair forums, read MTF forums. I took detailed notes on all of it, ended up with a document of 5000 lines of my notes, questions, references, ideas, links. All this helped me understand the details and make plans, obviously, but the indirect benefit was psychological.
  
  
• Control: I can't control the hair loss, but I can control my reaction to it. I focused on observing and understanding what is happening to me. Take very detailed pictures. Count hairs shed two times every day. Experiment vehicles for topicals. Measure my blood pressure, heart rate many times every day. Frequent tests of blood, liver, hormones. Record all of that information, analyze it. Again, the direct benefit is obvious, and all these things helped me, but the indirect benefit was to reduce the feeling of helplessness, create areas of my hair loss misery over which I had control, and allow me to plan the steps of the battle.
  
  
• Long-term challenge: I enjoy long-term challenges which require lots of work over very long periods in order to achieve a goal. The grind of the process is fun for me. I've done it enough times in life that I know to focus on the process rather than results: intense focus on small improvements in the process will eventually lead to long-term results. So I'm treating hair-loss as a similar long-term challenge where focus on the process will eventually yield good results. So far, it's worked.

Everyone has different strategies. The most common probably is to accept and be bald. But I don't want that option, so this is what has worked for me to fight this battle. Everyone's different, but I hope that something here that I write can help you in some way.

 

[Jk1]

Hi nice results im thinking of doing topical dute and dermastamping also. Which dermapen did u get for $200 from asia and is it good ? Im useing a manual stamp is the electric one better ?

 

[michel sapin]

wow crazy log bro ! and crazy result !
so fina was not enough ?

 

[Georgie]

I think the addition of oral minoxidil pretty well coincides with the jump in your hairgrowth, but having said that, already being on dutas probably made it more effective. It’s hard to say whether or not the other stuff helped. Maybe the PRP did, although I don’t hear great things about it.

 

[DAVAT]

Great results and detailed post here, thanks.
Two quick questions.
1) Do you think the oral minoxidil at that dosage is a major factor? it seems to fit in with the timeframe of the shedding stopping. are you planning to use it as a long term solution?
2) with the salicylic acid, I have a dropper bottle of 2% liquid. Is this what you are using? How often do you use it and can you explain your application process.

Cheers mate

 

[Ramsey]

Micro-wounding: manual vs. electric

Which dermapen did u get for $200 from asia and is it good ? Im useing a manual stamp is the electric one better ?

As I wrote, I got my dermapen from Asia; the device and 200 needles cost $130.

Because of the fast oscillation, the number of wounds caused by the dermapen is orders of magnitudes greater than what you can cause with the dermastamp. Additionally, the dermapen gives you higher density of wound punctures in any area. Whether all that is important for follicle stimulation is debatable. I'd guess that theoretically, it should help, but the devil is in the details. In contrast to the dermastamp, the dermapen also has the advantage of being able to easily adjust the needle depth, and the dermapen needles can be replaced without having to get a new device, which is also practical.

At that point, for me, the question of manual stamp vs. electric pen centers on skin tearing. I've found two contradicting arguments:

• The argument against the manual stamp:
  
  The dermastamp needles cause micro-tearing of the skin in the horizontal direction because they enter and exit at angles. There's no way to ensure clean vertical-only wounds; the design of the device requires that it roll, hence the horizontal-direction micro-tearing. Under this view, dermapen avoids the tearing because the needles enter and exit at nearly perfect 90 degree angles, move in and out so quicky that there is no tearing horizontally, and has much finer needle tips.​
• The argument against the electric pen (dermapen):
  
  It is the dermapen, not the stamp, which causes horizontal tearing because the dermapen needles can only move up and down, rather than roll, and they are oscillating rapidly not in time with your movements. So at any given moment, some number of the needles are completely extended into your skin, some are halfway into your skin, some are at the surface of your skin... and when you move the dermapen across your skin, even only slightly, all of them are pushed horizontally by your movement of the pen while they're moving up and down. So a large percent of them tear your skin in a horizontal direction. Under this view, manual dermastamps avoid the micro-tearing because the needles move together at the same speed with the rolling of the dermastamp, so it's synchronized that the front rows of needles hold the dermastamp steady while the back row of needles exits the skin and doesn't cause tearing.​

​

I think dermapen is more popular than dermastamp now because of the speed, greater wounding-per-area, ability to vary the depth, and (most likely) better marketing due to its higher profitability. I've seen two styles of using the dermapen:

• Example 1: The doctor moves the pen around the scalp without lifting.
  
  
  
  
• Example 2: The doctor lifts the pen, puts it on a spot briefly, lifts and moves to another spot.
  

Given all that, I decided on the dermapen for its speed and ease of use, but I use it in the style of example 2 above in the hopes of minimizing the horizontal microtearing which comes from moving the pen without lifting. I can't say if this strategy works or not - I have no way to measure microtearing, so who knows. Maybe I'm microtearing my scalp every time, and the only benefit from this method is that it just psychologically makes me feel as if I've done the best I can lol.

Regarding the effectiveness on hair growth of micro-wounding:
I think micro-wounding has helped. I have many more pictures than I've posted here, including lots of close-ups. Based on those photos, it seems that some little hairs started to grow a while after starting the dermapen. But as I've written, I have many simultaneous treatments, so it's impossible to know for sure that the hair regrowth was caused by the dermapen and not any other part of the regimen.

For what it's worth, I'd really recommend micro-wounding / dermapen to you and anyone else considering it. The science behind it is pretty solid, there are good results from several very differently-constructed studies, and it seems to have very high safety. Especially compared to hair-loss drugs with their many negative side effects, micro-wounding offers a great trade-off of potential benefit vs. health risk. I'm currently reducing the number of treatments I'll use in order to cut down the size of my regimen, but all that's why I like dermapen and will definitely keep using it.

_______________

wow crazy log bro ! and crazy result !

Crazy is a good thing, you mean? In that case, thanks!


_______________

Hair worsened during finasteride treatment

so fina was not enough ?

Correct. Finasteride alone wasn't enough. Finasteride, minoxidil, and Nizoral together also wasn't enough.

It's tough to really know the effectiveness of any one treatment. But in my case, my hair loss increased for the 7 months after starting finasteride: worse on the top, worse on the crown, worse recenssion at the temples. It's possible - likely, in fact - that my hair loss during that time wasn't as bad as it would have been if I hadn't been taking finasteride. But I definitely lost hair while on finasteride alone, as well as when used together with topical minoxidil and Nizoral. So that's why I decided to start adding many other treatments.

_______________

Gyno

so you didn't get gyno with duta ?

No. Nothing. Zero gyno. Not from dutasteride, not from anything I've taken. I've been very aware of the possibility, so I check very closely, and no signs of even the smallest changes.

_______________

Oral Minoxidil

I think the addition of oral minoxidil pretty well coincides with the jump in your hairgrowth, but having said that, already being on dutas probably made it more effective.

Maybe. But it's really hard to say.

The oral minoxidil likely stimulated growth of body hair that I already had: nose hairs, moustache hair, arm/hand hair. And it seems to have caused several dark, thick, fast-growing hairs on my ears which did not exist before. I can't be certain that the body hair is due to the oral minoxidil alone, but my guess is that it's likely the cause because the growth began shortly after starting use and I don't think anything else I'm taking could have caused it.

I'm not as sure about the effect that oral minoxidil has had on my head hair. As I wrote, I think it helped on the top, and maybe contributed to the temple regrowth. But since I have so many other treatments, I can't be certain. Also, based on all the pictures I've taken, including many close-ups, I'd guess that the top growth really got started thanks to the PRP and dermapen, with the oral minoxidil, cetirizine, and valproic acid contributing a secondary effect to a regrowth which had already budded when they were added. But it's really tough to say.

You're right that it's hard to know what really helped. The uncertainty about different treatments is one reason I decided to continue stacking many on top of each other. There's so much variation between individuals in the results of one treatment. In studies, the average growth caused by one treatment gets the headlines and is what gets repeated by doctors and on forums, but I think it's very notable that the range of results among patients is enormous in almost every study. That convinced me that it's best to hedge my bets by treating many angles of the problem at the same time, so even in the case that my individual reaction to one treatment is far below average, I might still end up with growth thanks to an above-average reaction to a different treatment. I thought that there's also the chance that I've gotten positive synergies from the interaction between different treatments.

A big potential downside to a multi-treatment regimen like this is negative interactions between the drugs. As I wrote in the OP, I spent a lot of time researching the issue of interactions, but I didn't find any good answers. I tried to plan a schedule and regimen to minimize any possible issues, but knowledge is very limited in this area and there definitely is risk of problems.

The other disadvantage of a multi-treatment regimen like this is that if you get good results, you have no idea which treatment(s) to thank. But I think that's a good problem to have

_______________

 

[Ramsey]

PRP

It’s hard to say whether or not the other stuff helped. Maybe the PRP did, although I don’t hear great things about it.

I think it's hard to evaluate PRP because it's a new treatment and the methods of use are so variable. Unfortunately, there isn't yet enough research, particuarly for hair loss, to have settled on exact recommendations for use and dosages. That opens the door to scams and charlatans - there are a lot in the hair-loss world - so the solid science behind PRP gets incorrectly tainted with a snake-oil reputation.

There are big differences in how PRP is used today: frequency of use, devices, preparation methods, activation methods, additional injectates, and lots more. Nothing is standardized because it's not yet known what is best. It's not even known if there is one best way which would apply for everyone, or if every patient and situation would benefit from a different particular solution. The research is still in its infancy, even on issues of the basic science. As an example, it's a guess whether or not to include leukocytes in the injectate: maybe it's better to remove them due to the harm of proteases and reactive oxygen released from white cells, but on the other hand, it might be helpful to select for them because of cytokines and enzymes that might control infection and inflammation. There are lots of basic issues like this that are still unanswered.

I spent a lot of time in the orthopedics world, reading through orthopedics research about PRP and speaking to doctors about it, because the hair/scalp research on PRP is pretty small in comparison. There’s a lot of published research on PRP for joints (knees and hips are most common, but also wrists, ankles, elbows, every joint really), some good youtube talks discussing growth factors, many orthopedic surgeons who have experience with it, and lots of doctor and patient comments on forums. You have to sort out the marketing spin [it’s from US providers mainly; in particular, Regenexx is a leader in private practice, with interesting evidence and reports worth reading, but they dress it all with a big layer of hype]. And on orthopedic forums, patients (and even some doctors) are too quick to see cause-effect and declare a treatment as unequivocally good or bad (just as in the hair world, including this forum).

My conclusion from all this is that although the PRP field is still in its infancy, and I understand how it can seem to be very bro-sciency, there’s now a decent body of research showing real results and there are many investigations of different techniques you can follow.

One important point I took from both the research and the clinical results is that the frequency of injections matters a lot. In several cases I've seen, one injection might help a bit, but a regular schedule of frequent injections can really get results. There are lots of potential reasons, but most basically, more frequent injections of growth factors seems better than infrequent injections, seemingly regardless of technique. But in most cases, there are practical limitations to how often patients can receive PRP treatments: cost and time are often too great for frequent injections, and patients receive infrequent treatments. So that’s what motivated me to set up my own DIY system: I can avoid the logistical and financial problems of dealing with clinics, and instead just do PRP myself on a regular basis.

I think PRP treatments are massively overpriced in the hair world. Prices charged in the US in particular are crazy compared to the costs. I've seen offers on the internet of US $700-2000 just for one session. Europe is significantly cheaper: it costs maybe US $1000-$2500 for a package of 3-6 treatment sessions in Western Europe, although I think that is still too expensive. In Eastern Europe you can find simple, non-activated treatment for $50-100 per session.

If you have the money, time, and/or ability to go frequently to a clinic which matches your budget, then it might be worth it for you to go to a clinic and avoid the hassle of ordering the supplies and then getting someone to draw your blood and inject into your scalp. But for me, I think the initial investment into my own equipment was worth it, because I now inject when I want, as much as I want, on my own schedule, with low marginal costs (the main material is your own blood, after all, so that's free)... all without having to bother with the time and expense of clinics and doctors.

For me, I believe that the frequent PRP injections have been very helpful to my hair regrowth. I didn't see any effect from initial infrequent injections at clinics, but when I began frequent injections with my own DIY system, I noticed increased shedding and possibly growth. I can't separate the results of the PRP from the many other treatments I use, but based on the timing of hair regrowth in my close-up pictures, I do believe the PRP is a big contributer to the growth I've had. I also guess that it's one of the drivers - if not the sole driver - of the change in my hair color from dull, white-grey, and lifeless to saturated and vibrant.

I'd really recommend frequent PRP. In my view, PRP has a similar profile as the micro-wounding that I discussed above: the science behind it is pretty solid, its likely method of action is different than what you can get with most other treatments, there are good results from several very differently-constructed studies, and it seems to have very high safety. That's a great trade-off of potential benefit vs. health risk, so even though I'm cutting the number of treatments in my regimen, I'll definitely keep the PRP.

Oral minoxidil and shedding?

Do you think the oral minoxidil at that dosage is a major factor? it seems to fit in with the timeframe of the shedding stopping.

As I wrote above in answer to Georgie's question, I can't say if oral minoxidil is a major factor. I think it helped on the top, and maybe contributed to the temple regrowth, although I'd guess it was more of a secondary contributor, with PRP and dermapen being the starters of growth. But I really have no idea; since I have so many other treatments, it's not certain and you could make a case for any of them.

Oral minoxidil stopping shedding? Hmmmm. I'd have to say no. I don't think it helped to stop shedding. My shedding started in late 2016 and continued every day without stop until the last week of December 2017. I started oral minoxidil in August 2017. So my guess is that oral minoxidil had nothing to do with my shedding, either in a positive or a negative way.

As far as I could tell, the only treatment that had any effect on my shedding was PRP. I was already shedding a lot before PRP, but the rate of shedding increased by around 50-100 hairs more per day after starting.

Long-term risks

are you planning to use [oral minoxidil] as a long term solution?

I really appreciate reading posters on various forums who discuss their personal thoughts on the risks they're taking (for example, on this forum, recently I've seen @bridgeburn, @IdealForehead, @jgray201, @recedingyt, even antydhtor, plus many other valuable contributions throughout the years). It's a very personal decision and no one can decide it for you. So here's my take.

I hate all these drugs. They're horrible for the long-term. You know the idea of known knowns, known unknowns, etc? For me, all these drugs have that issue. There are the bad effects which are known, both short-term and long-term. Then there are the known unknowns, the potential effects that are not yet observed but have been speculated might occur. But then on top of all that, you have to recognize that there are effects - the unknown unknowns - that aren't even currently considered which could hurt us in the future.

In life-threatening situations, you take these risks for the short-term benefit. But in my case, it's not life-threatening; it's "only" hair loss. I constantly ask myself how much risk to my health is worth it to me in exchange for an unknown benefit on my hair.

I've looked at a huge list of drugs such as dutasteride, finasteride, oral minoxidil, estrogen, bicalutamide, spironolactone, cyproterone acetate, flutamide, JAK inhibitors, prostaglandins, valproic acid, darolutamide. I've ended up using a bunch of them based on my evaluation of their risk-reward profile. My idea is the same as everyone's: get the best hair benefit at the lowest health risk. But they all suck, and I think very much about the huge risk of long-term damage. I've seen hair-loss people who think they're fine if they get no short-term side effects from the drugs. In my case, it's true that I essentially have no short-term side effects. But I still don't feel good about it, because the long-term risk is very big. I hope to live a very long life, and I worry about how much I might be hurting my 100+ year-old self, damage that even future science won't be able to fix. It's a horrible thing we're doing to our bodies: no one would take any of these drugs in normal circumstances. But hair loss is so terrible for some people - me, for sure, and probably you and most people on this forum as well, I'd guess - that we're willing to run the massive long-term health risk just to get the possibility of less hair loss.

In my case, I got great results. Only 6 months ago, I had massive, obvious, diffuse balding on the top and back, a huge bald spot on my vertex, and a hairline which had suddenly receded to a NW3+ position and looked to continue its backward recession up my head. But now, I have thick, full, richly-saturated hair everywhere on my head, a completely full vertex area with a perfectly filled-in whorl, and a hairline that is between NW1 and NW2 depending on the spot. It's great. I'm very, very happy about that. But I knew I was taking risks. And now blood tests show that I have the onset of liver damage already, and who knows what other prices I'll pay in the future.

So my goal now is to reduce the treatments as much as I can while still maintaining the hair that I currently have. I'm thinking about limiting to a regimen of only dutasteride, PRP, dermapen, and methyl vanillate. I'd love to remove dutasteride as well, but I think that it's essential. The other treatments in this list have - hopefully - very little health risk for the hair benefit they offer. We'll see how this attempt goes, I'll update here when I know.

So that's the long and roundabout answer. As for your qustion about oral minoxidil specifically... no, I don't feel comfortable using it for the long term. You can make a case that it's not so bad, that its effects on the heart (bpm up by an average of 8 in my situation) are tolerable, that it's relatively less worse than lots of other hair drugs, etc. But I don't like a drug that increases my heart rate in any way and can introduce irregular heartbeats. I don't like the effect on my blood pressure; I'm happy with where my blood pressure is from diet and sports, and I think it's bad - for both known reasons and for unknown unknowns - to lower it further through drugs. And I don't like ithe likely long-term effect which oral minoxidil has on collagen and skin.

I think it can be a very useful drug in the short-term for stimulating hair growth, particularly if you - like me and 2/3 of all people - get no benefit from topical minoxidil. That's why I added the oral minoxidil to my regimen. It might do nothing for you, but in some people I've seen some very impressive results from oral minoxidil alone. So for short-term use, I'd tell you to give it a try. But for me, I only think of it as a short-term fix, and I wouldn't use it long-term.

 

[abovedagame]

Have you had your hormone levels tested after being on this regimen?

 

[DAVAT]

Thanks for the detailed response, I've decided to give oral minoxidil a try at 2.5mg a day, will keep an update going on my topic.
Please keep us updated with any updates at your end and any alterations to your regimen. cheers

 

[dmuelliano]

As you did a lot of research I would especially be interested in what treatments you consciously decided not to take into your regimen. (especially regarding RU or Seti which seem quite popular here). Thanks for the detailed post, helped a lot!