10almonds Gets Hairy

Hair loss is a thing that at some point affects most men and a large minority of women. It can be a source of considerable dysphoria for both, as it’s often seen as a loss of virility/femininity respectively, and is societally stigmatized in various ways.

Today we’re going to focus on the most common kind: androgenic alopecia, which is called “male pattern baldness” in men and “female pattern baldness” in women, despite being the same thing.

We won’t spend a lot of time on the science of why this happens (we’re going to focus on the remedies instead), but suffice it to say that genes and hormones both play a role, with dihydrogen testosterone (DHT) being the primary villain in this case.

We’ve talked before about the science of 5α-reductase inhibitors to block the conversion of regular testosterone* to DHT, its more potent form:

One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…

*We all make this to a greater or lesser degree, unless we have had our ovaries/testes removed.

Finasteride

Finasteride is a 5α-reductase inhibitor that performs similarly to saw palmetto, but comes in tiny pills instead of needing to take a much higher dose of supplement (5mg of finasteride is comparable in efficacy to a little over 300mg of saw palmetto).

Does it work? Yes!

Any drawbacks? A few:

• It’ll take 3–6 months to start seeing effects. This is because of the hormonal life-cycle of human hairs.
• Common side-effects include ED.
• It is popularly labelled/prescribed as “only for men”

On that latter point: the warnings about this are severe, detailing how women must not take it, must not even touch it if it has been cut up or crushed.

However… That’s because it can carry a big risk to our unborn fetuses. So, if we are confident we definitely don’t have one of those, it’s not actually applicable to us.

That said, finasteride’s results in women aren’t nearly so clear-cut as in men (though also, there has been less research, largely because of the above). Here’s an interesting breakdown in more words than we have room for here:

Finasteride for Women: Everything You Need to Know

Spironolactone

This one’s generally prescribed to women, not men, largely because it’s the drug sometimes popularly known as a “chemical castration” drug, which isn’t typically great marketing for men (although it can be applied topically, which will have less of an effect on the rest of the body). For women, this risk is simply not an issue.

We’ll be brief on this one, but we’ll just drop this, so that you know it’s an option that works:

❝Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil.

Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil❞

Read more: The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review

Minoxidil

This one is available (to men and women) without prescription. It’s applied topically, and works by shortcutting the hair’s hormonal growth cycle, to reduce the resting phase and kick it into a growth phase.

Does it work? Yes!

Any drawbacks? A few:

• Whereas you’ll remember finasteride takes 3–6 months to see any effect, this one will have an effect very quickly
  • Specifically, the immediate effect is: your rate of hair loss will appear to dramatically speed up
  • This happens because when hairs are kicked into their growth phase if they were in a resting phase, the first part of that growth phase is to shed each old hair to make room for the new one
• You’ll then need the same 3–6 months as with finasteride, to see the regrowth effects
• If you stop using it, you will immediately shed whatever hair you gained by this method

Why do people choose this over finasteride? For one of three reasons, mainly:

• They are women, and not offered finasteride
• They are men, and do not want the side effects of finasteride
• They just saw an ad and tried it

As to how it works:

Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells

Some final notes:

There are some other contraindications and warnings with each of these drugs by the way, so do speak with your doctor/pharmacist. For example:

• Finasteride can tax the liver a little
• Spironolactone can reduce bone turnover
• Minoxidil is a hypotensive; this shouldn’t be an issue for most people, but for some people it could be a problem

There are other hair loss remedies and practices, but the above three are the heavy-hitters, so that’s what we spent our time/space on today. We’ll perhaps cover the less powerful (but less risky) options one of these days.

Meanwhile, take care!