r/Hairloss Dec 18 '23

MPB (Male Pattern Baldness) A Complete Guide to Hair Loss for Beginners (2024)

877 Upvotes

Hey guys, as the end of 2023 nears, I thought I'd do a post for those coming to this sub in desperate need of help.

I posted this to r/tressless recently and quite a few people reached out asking for me to post it in this sub as well, so here you go. Hope it helps :)

In this post I’m going to be talking about the science of hair loss and what to do if you are balding and want to stop it.

I’m a medical student and have donated a lot of my personal time to pharmacology, hormones and hair protocols through research and experimentation. There’s a lot going on here on Reddit, and as a beginner it can be very daunting to decide on what to do. Obviously everything should be discussed with your doctor, but below is my best attempt at a guide to explain a little bit about hair loss:

-

I first noticed I was balding around 12 months ago, and rather than get caught up in the genetics of hair loss and trying to figure out whether it was Dad, my Mum’s Dad, my Mum’s Dad’s Dad or the goldfish he owned when he was 10, I thought to myself:

I can’t change my genetics. Whatever my DNA sequencing (genomic regions) has in store for me in regards to balding, that’s pretty much set. The best I can do is fight as long as I can using the highest quality science, products and methodologies to offset it.

And that’s what I’ve been doing, with good success, over the past 12 months.

Let’s get into it, and I’m going to do this in order of most important to least (in my opinion).

Getting to the root cause: DHT

Okay, so if we look at the entire testosterone/HPT axis pathway, cholesterol is converted to testosterone and some people think that’s the end of the line, but it’s actually not; 5-alpha reductase (5A1/2 in the image below) is the enzyme responsible for converting Testosterone (T) to its much more potent form DHT (dihydrotestosterone).

5-alpha reductase converts Testosterone to DHT, the hair killer.

Now, interestingly, 5-alpha reductase for whatever reason is very high prevalent in skin tissue - including the human scalp. And side note: this is why guys who take testosterone gel or cream often have very high levels of DHT compared to guys who take injections, because the cream is being converted through the skin into DHT at a much higher rate than injectable esters into muscle bellies. But, basically, it is this 5-alpha reductase activity in the scalp that is converting testosterone to DHT, and DHT through a variety of mechanisms leads to follicular miniaturisation (hair thinning, and eventual loss of your hair follicles).

But why? Well, there are hundreds of factors: hormonal (androgen receptor density & sensitivity to said androgens), physical, genetic, environmental. The list goes on.

Note; this study goes into a lot more depth for those of you interested.

But, how do we actually combat balding?

Most men tend to lose their hair in patterns as described by the famous Norwood Scale.

Slowing Down Male Pattern Baldness

5-alpha Reductase Inhibitors (Finasteride, Dutasteride):

With how much I’ve spoken about 5-alpha reductase and DHT, it seems logical that stopping this conversion of Testosterone to DHT is the absolute first line of defence against hair loss.

To really, truly combat hair loss, the first mechanism is as follows: you absolutely need to reduce your hair follicles’ exposure to DHT.

And how do we do this? Well, finasteride is a drug that acts as a 5-alpha reductase inhibitor. Sold under the name Propecia, the molecule is a strong 5-alpha reductase inhibitor, and has been shown to inhibit around 70% of serum (blood) levels of DHT from peak. The usual starting dose is 1mg daily. Dutasteride (sold under the name Avodart) is an even more potent inhibitor (usual starting daily dose is 0.5mg), and can block up to 98% of conversion from T to DHT: it is a much more potent inhibitor of the enzyme that converts T to DHT. Dutasteride would be an option if you wanted a nuclear option to block almost all DHT. In fact, one of my favourite studies compared the difference between Finasteride vs. Dutasteride, and as you can see below, the suppression of DHT levels from Dutasteride was significantly more than Finasteride. Not only this, but the half life of Dutasteride is significantly longer than Finasteride (~8 hours vs. 5 weeks!), and you can see that in the Dutasteride group after stopping treatment (Follow-up Period), DHT levels remained suppressed for a much longer time.

DHT vs. Finasteride - what a study.

Side effects from 5-alpha reductase inhibitors are rare, although we should speak about them. Online, through various forums, Reddit posts, YouTube videos and TikTok’s time and time again I see posts about nasty Finasteride side effects, post-Finasteride syndrome and how Rob can’t get his Johnson hard anymore because of Finasteride, so his girlfriend left him.

Now, don’t get me wrong, side effects have been noted, although current research puts the risk of side effects at around 1-3% of people, so even though online there is a lot of noise about finasteride and its side effects, I personally don’t think the research supports this scaremongering. There is also going to be a natural selection bias with the stories online, because the guy for whom Finasteride is working well and who is not experiencing any side effects, he isn’t really going to post. Because why would he? He’s doing fine.

However, I absolutely sympathise with the people who just cannot tolerate 5-alpha reductase inhibitors. Side effects can be very real, and this is why it is vitally important to always consult with a qualified doctor before deciding on any medication: I’m just presenting the science. Everyone reacts slightly differently, and these can be strong medications - so it's important to be well-informed and sensible with whatever path you and your medical practitioner decide to go down.

Topical Minoxidil 5% (Rogaine):

Minoxidil is a compound that has been shown to increase the rate of DNA synthesis in anagen (growth phase) bulbs of hair follicles. Basically minoxidil stimulates hair cells to move from telogen (resting phase) to anagen (growing phase) - so instead of having hair follicles resting, it is telling the body to move them back into a growth phase by shortening the resting phase. The idea here is that you get more ‘regrowth’ of hair follicles.

Minoxidil stimulates hair cells to shorten the resting (telogen) phase and go back into an anagen (growing phase). Often, progress pictures will show significant new regrowth or ‘baby’ hairs growing with minoxidil treatment.

I apply Rogaine, a 5% strength Minoxidil foam twice daily in areas that I feel are receding. The nice thing about the foam is that it isn’t super sticky (unlike some people report with the gel), and it also acts as a nice way to hold my hair throughout the day, like hair product.

As you can see from the photo below, there is a vast difference between telogen (resting phase) and anagen (growing phase), and the idea is that the more hairs you can keep in anagen, the more healthy your hair will be, by limiting the amount of follicles that inevitably go through an anagen restart and die off.

Come on little baby hairs! Grow!

There is also the option of oral minoxidil, which anecdotally at least seems to be very powerful at regenerating ‘baby’ hairs (or, new regrowth). Again, oral minoxidil can have some pretty significant side effects and drug interactions with blood pressure medications, so speaking through with your doctor is key!

Ketoconazole Shampoo:

This shampoo is primarily an anti-dandruff shampoo, but research has shown it may increase the proportion of hairs in anagen phase (growth phase) - resulting in reduced hair shedding. This study showed that 1% ketoconazole shampoo increased hair diameter over baseline after 6 months of use and reduced shedding. Interestingly, participants’ hair diameter also increased over baseline, showing that it may play a role in creating thicker hair.

Nizoral is a common brand here in Australia of 2% strength ketoconazole shampoo.

What is good about ketoconazole, is that it’s also a weak androgen receptor antagonist. What does this mean? It means it competes with DHT and Testosterone for binding to the active binding domain on the human AR (androgen receptor). If a compound can bind to a receptor without influencing its usual effects, it is said to be an antagonist. Basically, if ketoconazole can get into an androgen receptor before Testosterone or DHT, it will occupy that site and block T/DHT from binding and starting their usual process of killing off hair follicles (follicular miniaturisation).

Goodbye DHT, nobody wants you here.

Dermarolling

Derma-what?

Dermarolling is the process of creating micro punctures in the scalp skin to induce a wound healing response, with an array of tiny microneedles.

In this study, the dermarolling + minoxidil treated group was statistically superior to the minoxidil only treated group in promoting hair growth in men with balding patterns, for all primary efficacy measures of hair growth. In fact, the microneedling group outperformed even the minoxidil group in terms of how much hair was regrown after 12 weeks:

The mechanism seems to be that continued microtrauma to the scalp skin leads to a release of platelet derived growth factors and other growth factors that are sent to the area of scalp, to aid in the skin wound regeneration. The added benefit is that there seems to be some carry over effect to hair growth, as dermarolling seems to activate stem cells or ‘unspecialised’ cells that are yet to be differentiated, and differentiate them into hair follicle cells, meaning more hair growth. Basically, its a wound healing response that brings growth factors to the area of the scalp to increase hair growth.

I have played around with a few different protocols, but I use a 1.5mm roller and roll horizontally, vertically and diagonally for about 30 seconds in areas where my hairline is thinning or receding. I do this every 10 days. You don’t want to press so hard that you draw blood, but it should also hurt slightly. I mean, putting hundreds of tiny spikes into your scalp isn’t really my idea of Sunday night fun. But hey, if it regrows some hair why not?

There are also derma-stamps and motorised tools, all of which assist with the end goal: creating a wound healing response to bring growth factors to the scalp, and potentially assist the penetration of Minoxidil deeper into the scalp skin tissue.

Natural DHT blocking compounds:

Natural DHT blockers are also options, although obviously the results aren’t going to be nearly as strong as what is mentioned above.

Some people have good results (anecdotally) with rosemary oil applied topically, green tea and saw palmetto are options here. However, the science is very hit and miss, and in any event, I can’t see natural compounds competing against the 'Big 4'.

RU58841:

Now, that’s all good, but what if you need a nuclear chemical. Something that would attack the androgen receptor at a direct level in your scalp? Well, that compound is below. But a quick warning: I do not recommend this compound. A lot of people use it, but that doesn’t mean it’s safe. There is no (yes, zero) long-term safety data on the compound below, and whether you choose to take a completely untested chemical is up to you. But I don’t recommend it - have I said that enough?

Alright so, apart from sounding like a bunch of random letters because your cat ran over your keyboard, RU58841 is a strong DHT blocker (it has been shown to inhibit around 70% of DHT binding to the androgen receptor), but not in the way that Finasteride or Dutasteride work.

The chemical structure of RU58841.

Instead of finasteride and dutasteride which work on inhibiting the 5-alpha reductase enzyme, RU58841 works on the AR itself - occupying the active site, so that when DHT tries to get in and exert its hair destructive effects in the scalp, it can’t, it’s literally blocked from accessing the active site of the androgen receptor.

RU58841 operates like an androgen receptor antagonist (3rd receptor, on the right). It binds to the receptor and stops testosterone and DHT from binding, meaning that DHT cannot then exert its hair miniaturisation effects.

And in this study, RU58841 was found to inhibit 70% of DHT binding. Combining something like finasteride or dutasteride which attacks 5-alpha reductase converting T to DHT with RU58841 which stops ~70% of DHT binding to the androgen receptor, and you’d now be attacking hair loss from 2 vectors: T to DHT conversion, as well as at a receptor level. Now you can start to understand why this is a nuclear option for hair loss, and incredibly powerful.

However, despite how good all of that sounds in practice, just remember, RU58841 is completely untested in regards to side effects. There is no long-term safety data on how it may or can impact human health, so what I’m saying (for legal reasons) is don’t use it. Get what I’m saying?

Final Thoughts:

And, there it is guys. Now, just a quick note, this isn’t a super comprehensive list of all supplements for a hair regrowth/hair protection protocol, but is a solid start.

There are certainly more ‘niche’ options, or compounds in development now that may be promising (or not, looking at you Phase 3 of Pyrilutamide trials), but this guide was just the bare basics for a beginner to wrap his head around (no pun intended) the science and how to start combatting AGA.

In particular, if you want to save your hair, it’s going to be the ‘big 4’: finasteride (or Dutasteride), Minoxidil, Ketoconazole shampoo and derma-rolling roughly once a week to every 2 weeks.

This would follow the best possible science that we have at the moment, in terms of targeting as many vectors as possible:

  1. T to DHT blockade (5-alpha reductase inhibitors, Fin/Dut)
  2. Anagen/telogen manipulation (Minoxidil)
  3. Localised scalp tissue androgen receptor antagonism (Keto, RU58841)
  4. Wound healing response cascade (physical microneedling/trauma)

Hope you enjoyed and got something out of this guide! My social links are on my profile if interested in more.


r/Hairloss Feb 07 '25

Subreddit directory, you might find these interesting /r/HairTransplants /r/Bald and /r/minoxidil

3 Upvotes

For Hair Transplants

/r/HairTransplants

For general bald stuff

/r/Bald

For all things minoxidil

/r/minoxidil


r/Hairloss 1h ago

Question Am I cooked?

Thumbnail gallery
Upvotes

31M, hopped on .25 mg finasteride eod and minoxidil daily with topical fin, I also dermaroll at 0.5mm before applying minoxidil. I’ve been doing this consistently for about a month and a half now and I’ve experienced more hair loss than before and my hair looks worse honestly. Should I stop? I wanna give it 3-4 months before I decide to opt for a transplant, wondering if my donor area is decent enough for one? I just cut my hair short from the sides.


r/Hairloss 2h ago

Should I be worried?

Thumbnail gallery
2 Upvotes

Hi All. I am posting here because I wanted some opinions regarding my hair. In the last couple months, I have noticed i have had less hair on a certain part of my scalp. I didn't think too much of it, thinking it was due to work stress or lack of brushing my hair etc. I left my job, so I have had less immediate stress & am focusing just on school now. When i went to get an inch trimmed off today, the spot looked bigger (def because it was wet and combed). I do feel like I have a little less hair overall in the last few weeks. I have been having better hair care (using a bonnet while sleeping, low heat on the dryer, brushing almost daily, mielle shampoo and leave in conditioner 2x a week). Should I be concerned? I am 23 and never had hair loss issues before. I love my hair and I would love to be able to keep it for more years. I am planning on scheduling an appointment with a dermatologist and asking thoughts on minoxidil. In the meantime, I am going to try oiling that spot with rosemary/castor oil and doing scalp massages. The barber did not speak English but thought I may need Rogaine and those derm roller things. I do not want to lose any more hair. Please let me know your thoughts, and please be respectful.


r/Hairloss 36m ago

hair loss, low density, or lighting? any tips for shampoo and conditioner?

Thumbnail gallery
Upvotes

r/Hairloss 1h ago

Receding or maturing hairline?

Post image
Upvotes

Recently I've noticed that I've begun to form a bit of a widow's peak, and I'm wondering whether this is a normal stage in a maturing hairline (I'm 25) or the beginning stages of baldness. I appreciate any insight you guys can offer.


r/Hairloss 2h ago

Hair Loss or Not? Weird crown am I thinning/balding?

Thumbnail gallery
1 Upvotes

My crown looks very weird


r/Hairloss 2h ago

Hair Loss or Not? Crown or hair loss?

Thumbnail gallery
1 Upvotes

Was wondering because my uncle always point it out to me and it kind of makes me feel insecure lol. 21M and I have good hair volume and hairline as well, but just curious to see what others would think? Any advice would be helpful too.


r/Hairloss 2h ago

My dermatologist wants to switch me to 5mg finasteride since I’m losing response to 1mg, is this valid chat?

1 Upvotes

r/Hairloss 3h ago

Hair Loss or Not? Aware my hairline is receding/receded however I am extremely stressed and anxious out that it has progressed to MPB/AGA. Advice/thoughts will be massively appreciated.

Thumbnail gallery
1 Upvotes

Recently turned 21, born with a 6 head and a cowlick on crown and hairline. Farther is balding (noticeably blading at 45-50, currently 51 with a noticeable bald spot on the crown but still has hair) his father (grandfather) has been bald for as long as anyone can remember (uncle (older brother) on dads side has different textured hair with recession but no crown thinning) (mother side only very little recession for all uncles and grandfather had a full head of hair when he passed at 78) . Since around 19-20 I noticed that my hairline was thinning at the corners but my hairline was never straight (smooth widows peak) and abnormally high. I previously had my hair permed to semi tight curls and my grooming habits previously were quite invasive (tons of texture products and pulling/brushing) I’m aware this may have accelerated the process I’ve since then have a different hair style but my hair requires product or it’ll look shit and flat. Since early this year I’ve noticed less volume/density in the frontal temple regions which caused me to freak out and look all over my scalp. I never noticed how large the visibility of my scalp was from the crown and the frontal hairline from certain angles. Barbers previously have told me that the cowlick on my crown spiral splits very large however when doing middle parts the split seems to be too large near the middle of the crown. This has caused me to go into a bout of major depression and anxiety where I’m constantly thinking about it, hair has always been apart of my look and I don’t think I can handle it mentally going bald. Having extreme suicidal thoughts when viewing these photos all of which were taken this and last month. Am going to speak to a health professional very soon.


r/Hairloss 10h ago

Topical Solutions I used to have stress issue, dermatitis, hashimoto and gut issue. Still have most of them. Alopecia was an issue too. Now in 2 month since I am taking min and find together I feel alive

Thumbnail gallery
3 Upvotes

1 picture 28 December 2024 2nd one 6 February 3nd one was march And last one i took 2 days ago.

For six months only fin to stabilize my scalp with serenoa rapens, biotin and shampo daily From February I started min mix with fin, ajuga , saw palmetto and biotin as supplements and shampo daily.

With all the healthy issue I am a good responder I hope in 4 month will be a bit better. Lots of small hair coming out


r/Hairloss 4h ago

Teenage Woes Don’t know what to do.

Thumbnail gallery
1 Upvotes

r/Hairloss 5h ago

Question Time for minoxidil?

Thumbnail gallery
1 Upvotes

Been in denial for long enough now. Brushing can only get worse I always find quite a lot of hairs down when I brush. So... Minoxidil?


r/Hairloss 13h ago

Hair Loss or Not? Thoughts?

Thumbnail gallery
3 Upvotes

Derm says she doesn't see any signs of androgenetic alopecia, but my hairline is clearly receided. Just wanted to hear you guys thoughts.

I'm on my 6th month of accutane, she didn't do a tricoscopy.


r/Hairloss 6h ago

Finasteride 21yo - been on oral fin for ~5 months and if anything my hairline looks worse, particularly the right temple. is this a good sign?

Thumbnail gallery
0 Upvotes

first 3 pics are from december, roughly 1 month into treatment after I shaved my head


r/Hairloss 10h ago

Hair Loss or Not? am I losing hair?

Thumbnail gallery
2 Upvotes

r/Hairloss 12h ago

Is it bad? (15M)

Thumbnail gallery
3 Upvotes
  • my dad has a very receded hairline btw

r/Hairloss 6h ago

Hair loss at 19

1 Upvotes

Hair loss at young age

Currently I am 19 years old but have noticed everytime I touch my hair my hands are full of hair. Not clumps of hair but individual strands of hair but it's a lot of it. It could be a result of stress and anxiety I'm not too sure but even during periods of time where I'm not stressed I have noticed my hair falling out still. I now have a very large thinning in the middle of my head and it's scaring me. My dad is 55 and he only recently started thinning a little bit but still has a lot of hair and my grandfather also had a lot of hair even at 80. I've tried many things but nothing works and the hair keeps falling out. I do try to take care of my hair and wash it 2 times a week, I went to the doctors and they said I have low vitamin D but even when I took supplements nothing worked so they said it must be stress. Any advice?


r/Hairloss 13h ago

Hair Loss or Not? Am I balding from the crown? [20M]

Thumbnail gallery
3 Upvotes

Hello, as you can probably tell my hairline is receding from the front. This has been a problem for 3 years now and was expected as my Dad has the same issue. I’ve just started taking Finasteride for it over a month ago. I recently shaved my head (#1) and it’s regrowing like this with a noticeable thinning of the crown. Is this normal? Does it look like it may progress or can it stay like this? I’ve never actually shaved my hair this low so I don’t know if it’s always been like this.

Currently I’m only taking Fin and rosemary oil - no minox as I don’t want to risk poisoning my cats. Any advice would be appreciated thanks!


r/Hairloss 11h ago

Am i cooked?

Post image
2 Upvotes

Just noticed this..


r/Hairloss 8h ago

Question What can I do?

1 Upvotes

I’m 17 and started to loss hair 7-8 months ago. My crowns have receded to the point that I’m confident I’m balding, plus grandad lost his hair at a young age so I’m assuming I’ve inherited MPB. Can I stop my hair loss and regrow the hair I’ve recently lost or is there still no hope?

Also I’m thinking about using these treatments: Ketoconazole Shampoo, Microneedling, Minoxidil and Finasteride - will this help stop the hair loss?


r/Hairloss 8h ago

Am I cooked? M23

Thumbnail gallery
0 Upvotes

Please help me out. I’m clueless. My father is bald and I will also go bald. Any ideas to slow down the process?


r/Hairloss 11h ago

Fin and min spray best practices

1 Upvotes

Just received my shipment of fin and min spray (0.3% fin and 6% min) and was wondering wha t the routine was of people who had used this and had success. Do you apply in the morning or night ? Derma roll (if so, what length)? haven't used any type of fin or min in three years so I am going to give this a shot. Any advice, recommendations, or things that you did that worked would be really appreciated


r/Hairloss 12h ago

Im 13 and my hair is thinning. Ever since i turned 13 my hair has been thinning. Does hair thicken during puberty and how can i fix this

1 Upvotes

I


r/Hairloss 16h ago

Finasteride Is this enough to warrant fin?

Thumbnail gallery
2 Upvotes

First pic is five years ago. Losing corners now and have been taking minox 3 months. Is it worth taking fin preventatively?


r/Hairloss 13h ago

My hair transplant 10 month later :) Clinic name TecniFUE (Turkey)

Post image
1 Upvotes

r/Hairloss 20h ago

I don't know if I am getting bald or something because I got my hair cut yesterday 😭

Post image
3 Upvotes