Let's face it, bodybuilding is a visual endeavor and sport.
No one wants to have a great body without a full head of
hair to match. So, it should have come as no surprise to
me that I received so much mail after I wrote my first article
on the topic in 1997 in MMI (issue 179). "Hair today
gone tomorrow" was published in MMI and later on the
BrinkZone.com web site. It was clear to me that I hit a
nerve with readers as I received more email and snail mail
then I had expected, especially considering the fact it
was an article that had nothing to do with building muscle!
Why did I write it? From the last article.
"I thought a new article for those people who are
really bumming that their hair is falling out, want to make
sure their hair does not start falling out, or are just
real paranoid about their hair falling out, was in order.
If you fit any one of the above descriptions-which most
people do- than this is the article for you! So why do I
care so much about hair loss? My mother's father was bald,
my father is mighty thin up top, my hair started to thin
a while back -you do the math!"
I have received countless emails and letters over the years
asking me to update the article. Here, finally, is the updated
version which will integrate info from the last article
and the newer recommendations.
Readers of this article may be confused by some of my comments
if they are not familiar with the last one, so I recommend
you read the first article.
Go ahead, I can wait!
What causes male pattern baldness (MPB)?
From 1997:
"So what makes your hair fall out? Well for a long
time scientists thought that DHT was the sole cause of hair
loss, but this does not appear to be the case. As most of
you already know, androgens such as testosterone (natural
and otherwise) can convert to DHT by the previously mentioned
enzyme 5AR. People who have high levels of the enzyme 5AR
have higher levels of DHT and are prone to losing their
hair.
Men with a congenital deficiency in 5AR show no receding
of the hair line. This knowledge of the relationship of
DHT to hair loss kicked off the big race to find things
that shut down the 5AR enzyme and thus reduce the amount
of DHT. Simple enough right? Well I have said it a thousand
times before and I will now say it a thousand and one times:
two plus two rarely makes four in the human body and this
is the case again regarding the relationship of DHT to hair
loss."
"People and researchers who used 5AR inhibitors such
as Proscar and Saw Palmetto found it helped with the hair
loss but in no way shut it down or regrew much of the hair
that was lost. What appears to be the ultimate cause of
hair loss for most people is an auto immune response where
the body actually attacks the hair follicle like some kind
of foreign invader thus causing an inflammatory response.
By yet unknown mechanisms, DHT causes a change in the follicle
signaling the immune system to attack the follicle and your
hair starts falling out (If you take a close look, you can
actually see a red line of inflammation on the scalp of
some people losing their hair). How do we know this? It
was discovered that the hair follicles of people losing
their hair look very similar under a microscope to people
who experience organ rejection after surgery. And, it has
been found that the immune system suppressing drug which
is used to stop the organ rejection (Cyclosporine) grows
hair like crazy because it shuts down the immune response
in the body.
A cure you say?
NO! If you take some Cyclosporine and you grow hair it
will be because you have no immune system and you will get
very sick and possibly die. I shit you not-don't mess with
this stuff. Anyway, though DHT is clearly important in the
cause of hair loss, it is not the final cause and a new
race has been started to address the inflammatory response
which ultimately causes you hair to fall out.
Clearly, you have to attack hair loss from both the DHT
and inflammatory response, and that's what most of this
article is about....sort of. There are also other factors
related to hair growth and hair loss such as nutrition,
SODases, Nitric Oxide (NO) and others, but DHT and the immune
response are the two biggies."
2005 comments:
Interestingly, almost a decade later, our understanding
of the cause of MPB has changed little. Androgens (e.g.,
DHT) and a poorly understood immune response, that has interactions
with SODases, NO, and other factors, creates the environment
for MPB.
1997 treatment options versus 2005:
In the previous article, I covered copper binding peptides,
Nizerol shampoo, Proscar, Minoxidil, and a very promising
mystery drug called RU 58841. What follows in this section
are comments on each of them from 1997 followed by my thoughts
now after almost a decade of experience with them:
Copper binding peptides: back when I wrote
the first article a drug called Iamin had just been approved
by the FDA for wound healing. Another drug similar to Iamin
is Tricomin. Both Iamin and Tricomin were invented and subsequently
patented by Dr. Loren Pickart. As I stated in the 1997 article
about these compounds,
"These drugs are copper based compounds that have
certain peptides added to them. When put on the skin they
have profound anti inflammatory properties and increase
the rate at which skin heals dramatically (hence Iamin700s
approval for wound healing). As I mentioned earlier, chronic
inflammation at the site of the hair follicle appears to
be a major link in the chain of what makes hair fall out."
2005 thoughts: Unfortunately these products
did not turn out to be nearly as effective for MPB as I
had hoped. Feedback was lackluster at best. I believe they
still have some use in multi ingredient formulas that may
add some small additional benefit, but the general advice
is they are minimally effective for MPB alone.
Nizoral Shampoo 1997:
"Nizoral is an anti fungal shampoo and the active
ingredient is a plant derivative called Ketoconazol and
is produced by Janssen Pharmaceuticals. How and why Nizoral
works on hair loss in not very well understood. It might
work by blocking the DHT at the follicle and/or working
by reducing the amount of inflammation at the hair follicle."
2005 comments:
Nizoral turned out to be a big disappointment. It was very
popular when I wrote the article, but has dropped out of
use by most people. It can now be had without a prescription
in 1% strength, but it's a moot issue at this point as Nizoral
is ineffective for treating MPB in my opinion. There was
one small study (Pierard-Franchimont C, et al. Dermatology.
Ketoconazole shampoo: effect of long-term use in androgenic
alopecia. 1998;196(4):474-7 )that appeared to find Nizoral
about as effective as Minoxidil, so people can use Nizoral
if they want I suppose, but feedback and experience says
it's of no use.
Proscar 1997:
"...Proscar is a very specific inhibitor of the enzyme
(5AR) that converts androgens into DHT. Its official use
is for prostate enlargement which is also related to DHT
levels (among other things). It was felt originally that
Proscar would not be effective for hair loss because it
only inhibits the enzyme found in the prostate and not in
the hair follicle.
Well again, nothing is cut and dry in the human body, and
Proscar has been found to reduce the amount of DHT in circulation
which reduces the amount of DHT the follicle has to deal
with and thus less hair is lost. Several recent studies
have shown Proscar is effective for hair loss and can help
regrow some hair on some people, but as I said before, the
use of 5AR inhibitors only deals with a part of the problem
and are generally not very effective when used as the only
treatment."
2005 comments:
At the time I wrote the above, Proscar (finasteride) came
in 5mg pills and was approved for benign prostatic hyperplasia
(BPH) only. Because studies found 1mg almost as effective
as 5mg for lowring DHT, I recommended people split the 5mg
tabs into 4, which gave you 1.25mg. Of course the producer
of finasteride (Merck) saw the marketing potential for treating
MPB, and finasteride was packed in 1mg pills and sold as
Propecia.
There is of course no difference between Proscar and Propecia
except the dose, so people in the know still buy Proscar
and divide it into 4 pieces to save money. I would still
recommend Finasteride for MPB, but it is far from the miracle
drug for MPB people hoped it would be when it came out.
Side effects such as gyno, reductions in libido, and others
also appears to be higher in the real world then the studies
claimed. Finally, finasteride does appear to work topically
(contrary to what Merck claims) which will greatly reduce
systemic side effects. However, topical is generally less
effective then oral treatment.
Minoxidil 1997:
"...Minoxidil did not turn out to be the hair growth
stimulant we all hoped it would be and if it had not recently
gone OTC I would not even have included it in this list.
However, being minoxidil can now be purchased without a
prescription and is about half the price of what it used
to cost, I think it is a useful addition to a person's regimen.
For hair growth, minoxidil has pretty much been a bust,
but for reducing hair loss, I have found it is definitely
better than nothing."
2005 comments:
The only thing that has changed since I wrote the above
is that Minoxidil comes in a stronger version for men (5%
vs. 2%) and can be found as a generic, saving money for
the user. I think Minoxidil makes a good carrier for other
compounds you may want to use topically, such a Finasteride,
etc.
1997 comments on RU 58841:
"RU 58841: This is the mother of all topical anti
androgens. RU58841 is made by the Roussel Corporation of
France. This stuff shuts down DHT at the hair follicle like
nothing else. One of the major problems has been that anti
androgens such as Spironolactone and Flutamide taken orally
might be good for hair loss, but they cause all sorts of
problems related to having low androgens in your body, such
as loss of muscle, increased fat, loss of sex drive, gyno,
etc.
When these same anti androgens have been used topically
(put directly on the scalp) they do not cause the negative
systemic side effects, but they did not seem to do much
of anything for hair loss or growth either. Therefore, a
topically active anti androgen without systemic effects
would be highly desirable. RU58841 is a topical anti androgen
that shuts down DHT at the follicle without any systemic
side effects in the body!"
2005 comments:
If there has ever been a drug that appeared to be close
to a cure for MPB with no side effects, this was it. So
what happened to it? That too is a bit of a mystery, but
the general consensus is that the company never developed
it for market for financial reasons after other drugs for
MPB faired not nearly as well in the market place as was
expected. It's a real shame. After the article came out,
I knew several enterprising people with enough money to
have batches made up for their personal use, and they all
said it was the best thing they had used topically.
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