Tag Archive for: DHT

Dealing with Bald Spots and Male Pattern Baldness



Whether it’s a slow realization or a sudden awareness, discovering that you’re losing your hair is a difficult event. Every hair on the pillow or on the floor of the shower comes back to haunt you, and you’re at a loss for what to do. Fortunately, there’s steps you can take to slow – or sometimes even stop – your hair loss.

What Causes Bald Spots?

Men don’t have the monopoly on bald spots; women can have them, too! Everyone is at risk for developing a bald spot at some time in their lives, for a variety of reasons. However, some people are at a higher risk than others. 

The most common cause of bald spots in both men and women is the hormone dihydrotestosterone, or DHT.  Both men and women produce DHT, but some people have higher levels of DHT than others. Male pattern baldness (MPB), also called androgenic alopecia, results from a combination of DHT and variation in the androgen receptor (AR) genes. Androgen receptors allow hormones like DHT to bind to them, and men with AR genes tend towards male pattern baldness. (01)

High levels of DHT can damage or shrink hair follicles, preventing hair from growing normally. The hair follicles most sensitive to DHT are located at the hairline and at the crown, which is why these areas are often the first to experience hair loss. And although DHT can also cause hair loss in women, 

But it’s not just DHT that can cause bald spots. Other factors that trigger hair loss are: (02)

  • Severe emotional stress
  • Physical stress or illness
  • Hormonal Shifts
  • Medications
  • Nutritional deficiencies
  • Age
  • Hairstyling 
  • Hairstyling products
  • Repeated physical trauma (tight hats or headbands)

The First Signs of Balding

If bald spots or male pattern baldness runs in your family, you’ve probably been on the lookout for hair loss for awhile now. Sometimes it’s difficult to tell if it’s really a bald spot or just a bad hair day. Here are a few signs that you may be experiencing bald spots or male pattern baldness:

A Receding Hairline

Hair loss typically starts at the hairline. A receding hairline may occur so slowly that you might not notice it until you have something to compare it against. For example, you might spot your receding hairline when you start looking at old photos and see that your hairline looks  different today. Your hair loss may occur incrementally, making it tougher to see.

Reduction in hair thickness

Do you notice less hair on top? Does your hair feel different when you run your fingers through it? If your hair feels finer and more airy, then it might be due to male pattern baldness or hair loss.

Loss of hair at the crown

A growing crown area is one of the first signs of hair loss, especially male pattern baldness. Most people don’t look at the back of their head, so seeing differences in your crown can be challenging. Check your crown every so often using two mirrors to check for bald spots.

How Can I Manage Hair Loss?

Experiencing balding or male pattern baldness is tough, but you do have options. The following are steps you can take to slow down hair loss.

Surgical Treatments

Surgical treatments are typically reserved for advanced cases of balding or male pattern baldness. A hair transplant, for example, is an outpatient surgery that utilizes donor hair follicles. These donor follicles are implanted into sparse or bald areas, allowing new hair to grow. These implants, called follicular unit transplantation (FUT) or follicular unit extraction (FUE), leave little to no scarring. The donor follicles typically come from your own head, but the process still requires recovery time and post-surgical care. (03)

Because surgical options are invasive, there are contraindications that may keep some people from obtaining FUT or FUE treatments, like blood disorders or the tendency toward heavy scarring (keloids). Furthermore, surgery may result in adverse side-effects like swelling, folliculitis, numbness, and infection.  (04)

Scalp Reduction 

A scalp reduction is exactly as the name implies. To perform scalp reduction, areas of the scalp without hair are surgically removed, and the areas with hair are stretched to fill over the bald portions. If you’re wondering how much of the scalp can be removed, you might be surprised to find that scalp reduction can remove up to half of the scalp. 
The skin that’s meant to be stretched is prepared and loosened, prior to stretching gently. Scalp reduction may be combined with other treatments such as FUT or FUE treatments. Some people find the recovery period from scalp reduction surgery highly uncomfortable, due to a scalp tightness that lasts for a few months as skin adjusts. Hairline lowering surgery, for example, is a kind of scalp reduction surgery. To lower the hairline, the receding portion is removed and the portion with hair is pulled forward. (05)

Platelet-Rich Plasma

A procedure called platelet-rich plasma (PRP) uses an individual’s blood and separates out the plasma using a centrifuge. This platelet-rich plasma (hence the name) is then injected into bald patches and areas of thinning hair. The plasma stimulates growth and repairs damaged blood vessels, helping hair to regrow. Although effective, the PRP process is very involved, costly, and is the newest hair loss treatment option, therefore more research is still necessary to evaluate the ideal therapeutic levels. (06)

Non-surgical Procedures

Scalp micro-pigmentation creates the look of thicker hair through the application of pigmentation that appears like hair follicles. The process includes stippling a tattoo in small dots to mimic hair follicles. Men who have thinning hair or shave their head short are the ideal candidates for scalp micro-pigmentation. However, micro-pigmentation does not grow new hair, nor is it recommended for people with large bald spots or who have major hair loss and wish to regrow hair. (07)

Least Intrusive Procedures

Once you see the signs of male pattern baldness or bald spots, it might warrant considering the least intrusive method for managing hair loss. Medicinal treatments like minoxidil and finasteride are two FDA approved medications for hair loss. When used together, minoxidil and finasteride can slow – or even stop – hair loss and regrow hair. Better yet, when minoxidil and finasteride are customized for each individual, common side-effects can be avoided. 

Dealing with Bald Spots or Male Pattern Baldness: What to Choose?

How you manage your hair loss depends entirely on what’s best for your situation. Bald spots and male pattern baldness can be a distressing event, and making a choice isn’t easy. Talk to people you know who have opted for hair loss treatments and get some perspective. Determine what’s financially feasible and speak to professionals to evaluate with options that will work with your health and lifestyle. At Happy Head, we’re ready to answer any questions you may have about our hair loss products. Let’s talk!

Resources:

(01) https://www.webmd.com/connect-to-care/hair-loss/symptoms-of-high-dht

(02) https://www.aad.org/public/diseases/hair-loss/causes/18-causes

(03) https://www.ncbi.nlm.nih.gov/books/NBK547740/

(04) https://www.ncbi.nlm.nih.gov/books/NBK547740/

(05) https://pubmed.ncbi.nlm.nih.gov/24017989/

(06) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622412/

(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382144/

What Is Topical Finasteride?

If you’re searching for hair loss treatments, finasteride is a name you’ll need to familiarize yourself with. Why? Only two hair loss products have received the FDA’s seal of approval — minoxidil is one of them. The other product is finasteride

What is finasteride?

Although there are many different types of hair loss, the most common type is androgenetic or androgenic alopecia, also known as male pattern baldness or MPB. As part of a class of medications called 5-alpha reductase inhibitors, finasteride treats male pattern baldness by blocking testosterone’s ability to develop into dihydrotestosterone (DHT). DHT is a hormone that causes hair loss in adults, especially men. By blocking the production of DHT, finasteride reduces the amount of DHT within the scalp. (01)

Isn’t finasteride used for prostate issues?

Yes, finasteride is also prescribed for symptoms of benign prostatic hypertrophy (BPH) — an enlargement of the prostate gland. When used for BPH, finasteride reduces urinary frequency and urinary retention. However, the doses used in the treatment of BPH are much higher than the doses used to treat hair loss. As a treatment for BPH, finasteride is sold under the name Proscar.

What is finasteride’s history?

During finasteride’s use as an FDA-approved treatment for BPH under the name Proscar, researchers noticed its effectiveness against hair loss. Several years afterward, lower-dose finasteride was approved for hair loss under the name Propecia.

How does finasteride work against hair loss?

Finasteride works by inhibiting the action of the 5 alpha-reductase enzymes. Concentrated in the oil glands of hair follicles, 5 alpha-reductase, which helps convert testosterone into DHT, another hormone. For people who have the genes for hair loss, DHT binds to hair follicle receptors and diminishes the follicle’s size. If the follicle becomes too small, gradual hair loss occurs. 

Finasteride inhibits 5 alpha-reductase, thus reducing serum DHT (the DHT in the blood). Without DHT to constrict hair follicles, hair loss slows and — for many people — hair regrows. With less DHT in the blood, some people see their hair loss stop completely. In short, finasteride protects hair follicles from DHT damage and stops hair loss.

Which Types of Hair Loss Does Finasteride Treat?

The average person loses 100 hairs each day, even with no hair loss issues. Hair falls away as part of each strand’s natural growth cycle, and the loss is negligible. Each strand of hair grows until its fullest length, then rests and eventually falls away. Afterwards, another strand grows to take its place. (02)

Excessive hair loss is more than a normal part of a hair’s growth cycle. Hair loss can become a problem when more than the average amount of hair is lost over time or if hair fails to regrow. For many people — about an estimated 80 million US adults — a balding scalp or thinning hair is the result of hereditary factors. (02)

If a person’s hair loss stems from DHT’s damage to hair follicles, then finasteride can help.

Is oral finasteride better than topical finasteride?

Finasteride requires a physician’s prescription. A physician can determine the cause of hair loss and prescribe the most appropriate treatment. Getting to the root of the problem determines what works and what doesn’t — like oral finasteride versus topical finasteride. 

Oral finasteride, though effective, comes with a myriad of side effects. Many of the side effects of oral finasteride are life-altering, for example:

  • Decreased sex drive 
  • Pain or tenderness in the testicles 
  • Numbness in the testicles
  • A reduction in sperm count
  • Difficulty obtaining or maintaining an erection (erectile dysfunction)
  • Reduced ejaculatory volume
  • Severe mood changes
  • Breast enlargement 

In rare cases, oral finasteride may cause permanent side effects. 

Fortunately, taking finasteride topically reduces many of the more problematic side effects caused by taking finasteride orally. However, topical finasteride isn’t without precautions and still necessitates professional oversight to monitor and prevent side effects. Though not as severe as oral finasteride, some topical finasteride side-effects include:

  • Decreased sex drive 
  • Inability to urinate 
  • Swelling of hands and feet
  • Increased liver enzymes
  • Headaches
  • Testicular tenderness
  • Scalp irritation
  • Contact dermatitis 
  • Depression or anxiety
  • Dizziness or weakness

Can you buy finasteride over the counter?

Because finasteride works best for people with an inherited tendency for hair loss, it’s safest to have a physician determine its use. Therefore, finasteride is not a product that anyone can purchase at a pharmacy without a prescription. Finasteride is not an over-the-counter medication and requires a physician’s approval.

Is topical finasteride effective for hair loss?

Topical finasteride works excellently against hair loss. What’s more, topical finasteride avoids many of the adverse side effects that may deter others from completing treatment. The following are studies highlighting the effectiveness of oral finasteride.

  • A 2016 article published in the journal Dermatology Clinics and Research of 107 people found that:
    • Both topical and oral finasteride are equally effective.
    • However, participants on topical finasteride were more likely to complete treatment because there were less side effects. (03)
  • A 2019 literature review published in the Journal of Drugs and Dermatology found that topical finasteride delivered: (04)
    • A significant decrease in the rate of hair loss.
    • An increase in hair counts.
    • A reduction in DHT levels within the scalp and plasma.
  • A 2021 study published in the Journal of European Academy of Dermatology and Venereology utilized 458 study participants found: (05)
    • No serious adverse side effects in participants.
    • Fewer complaints of sexual side effects when using topical finasteride.
    • Topical finasteride improves overall hair count while producing fewer adverse side effects. 

To summarize, the topical application of finasteride is as effective as taking the drug orally. However, adverse side effects are less common with the topical application of finasteride when compared to oral treatment. 

When taken orally, finasteride goes through the digestive system and into the bloodstream. Applied as a topical, it bypasses the digestive tract and goes straight to its target with little to no side effects. This aspect makes topical use much more desirable, making users more likely to stick with the treatment! 

How do you balance the effectiveness of finasteride versus the side effects?

Getting the most benefits from finasteride with minimal side effects is achieved through:

  • Combining both finasteride and minoxidil, the two only FDA-approved medications for hair loss.
  • Customizing hair loss treatment to the needs of each individual, making every formula unique to each person’s needs.

Because each person is different, it’s essential to make every finasteride treatment as specific to the person as possible. By catering the therapy to each person, adverse side effects are less likely to occur. And because side effects like the loss of libido and a reduction in sperm count can lead to non-adherence with treatment, catering each treatment to the patient makes it more likely that customers finish their treatment and see successful results.

Making That First Step Towards Finasteride Hair Treatments

Happy Head requires a physician assessment to begin treatment. Happy Head, in collaboration with the physician and the customer, determines the most effective hair loss treatment with the least amount of side effects. The involvement of a licensed professional helps to improve safety, provides valuable feedback, and determines the most successful path toward stopping hair loss. 
With the help of board-certified dermatologists, you can find the right balance of finasteride treatments to suit your hair loss needs. Happy Head understands that hair loss can hurt. Losing your hair can be a traumatic event, even if it occurs slowly over time. Add the fact that hair loss treatments often come with side effects, and it can make anyone feel overwhelmed when searching for treatments. With Happy Head, help is just around the corner!

Resources:

(01) https://medlineplus.gov/druginfo/meds/a698016.html

(02) https://www.aad.org/media/stats-numbers

(03) https://www.scitcentral.com/article.php?journal=19&article=60&article_title=Randomized%20Comparative%20Research%20Study%20of%20Topical%20and%20Oral%20Finasteride%20with%20Minoxidil%20for%20Male%20Pattern%20Androgenetic%20Alopecia%20in%20Indian%20Patients

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/(05) https://pubmed.ncbi.nlm.nih.gov/34634163/

Side Effects of Topical Finasteride: Review of Current Medical Literature

Oral finasteride, also known as Propecia, is an oral medication that has been prescribed by physicians for decades for hair loss. It works in the majority of patients by reducing hair loss and stimulating hair growth however there are side effects. One of the most concerning side effects are the sexual side effects, which occur in 1.8% to 3.8% of patients who take it. As a result, many physicians have been switching to topical finasteride as an alternative. In recent years, there have been many studies on the efficacy and side effects of topical Finasteride. In this article, we will review the clinical trials and scientific data to evaluate the side effect profile of topical finasteride. 

In one of the first single-blind, placebo-controlled clinical trials of topical finasteride, Mazarella et al.1 (1997) published a study of 52 subjects ranging from 19 to 28 years of age. The patients were treated with topical finasteride 0.005% vs placebo for 16 months. Here were the results.

  • There was a significant reduction in the rate of hair loss after 6 months of treatment.
  • There were no reports of local or systemic side effects.

In another double blind, randomized clinical trial study of 45 male patients, Hajheydari et al.2 (2009) compared oral finasteride 1mg vs topical finasteride 1% for a total of 6 months.

  • Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.”
  • 1 person had erythema of the scalp after application of the topical finasteride. 

In a prospective pilot study conducted in 15 patients for 9 months by Rafi and Katz3 (2011), patients applied a topical solution called NuH Hair, which is a novel topical combination of finasteride, dutasteride, and minoxidil, with the option to add oral finasteride, minoxidil and/or ketoconazole shampoo for 9 months. 

  • Significant growth was demonstrated after 3 months of use of the topical solution.
  • There were no reports of sexual side effects or irritation or redness reported. 

In a randomized clinical study by Tanglertsampan C.4  (2012), 33 male patients ranging between 27 to 49 years old were enrolled to compare the efficacy and safety of a 24 weeks application of minoxidil 3% lotion versus minoxidil 3% combined with 0.1% finasteride lotion.

  • This study showed that finasteride combined with minoxidil is superior to minoxidil alone by itself.
  • Contact dermatitis and redness was observed in 4 patients (24%) using the finasteride + minoxidil combination. No sexual side effects were observed. 

Caserini et al. conducted two pharmacokinetic studies on topical finasteride. In a randomized clinical study of 23 males, Caserini et al.5 (2014) compared topical finasteride 0.25% twice daily vs oral finasteride 1mg once daily for 7 days. They measured DHT and testosterone levels in the serum (systemic DHT levels).

  • Similar reduction in serum DHT was observed by the use of topical 0.25% finasteride twice daily  (68-75% ) and oral finasteride 1mg (62-72%).
  • No sexual side effects were observed. 

In another randomized clinical trial, Caserini et al.6 (2015) did another study involving 50 male patients studying DHT in both the serum and the scalp. 

  • This pharmacokinetic study confirmed that topical finasteride 0.25% (1ml application twice daily) and oral finasteride 1mg (once daily) both have similar reduction in scalp (47-51%) and serum DHT levels (74-76%). No changes in testosterone were observed.
  • In the portion of the study where patients used 1ml of topical finasteride 0.25% twice daily, there were 2 patients (11%) that had the following side effects. Elevated ALT levels, pollakiuria and testicular pain. 
  • about 37-54% when 0.1ml, 0.2ml, 0.3ml and 0.4ml of topical 0.25% finasteride was used, showing relatively similar results to 1ml twice a day application of topical 0.25% finasteride. Serum DHT was reduced by 24% with the use of 0.1ml, 26% with 0.2ml, 44% with 0.3ml and 48% with use of 0.4ml of 0.25% topical finasteride. This testing suggests that lower dosage of topical finasteride may lead to lower reduction of serum DHT levels and thus lower sexual side effects (assuming that serum DHT is solely responsible for the sexual side effects).  
  Scalp DHT Serum DHT
Oral FInasteride 1mg 51% 76%
1ml (twice daily) of 0.25% Topical finasteride 47% 74%
1ml (once daily) of 0.25% Topical finasteride 71% 76%
0.1ml (once daily) of 0.25% Topical finasteride  52% 24%
0.2ml (once daily) of 0.25% Topical finasteride 47% 26%
0.3ml (once daily) of 0.25% Topical finasteride 37% 44%
0.4ml (once daily) of 0.25% Topical finasteride 54% 47%
Oral vs Topical Finasteride

In a retrospective assessment and prospective crossover cohort study of 50 male between 20 to 40 years old by Chandrashekar et al.7 (2017), all 50 patients used minoxidil 5% and oral 1mg finasteride for 2 years.They then stopped and their treatment differed.

  • Results showed that 80% to 84.4% of these patients maintained good hair density while on the topical combination of minoxidil 5% + finasteride 0.1% treatment for 1 year.
  • No sexual side effects were reported. 

The studies8 above demonstrate that topical finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair and that it has a lower side effect profile compared to oral finasteride. Out of the 7 clinical studies reported above, only one study showed one event with sexual side effects (testicular pain). This is 1 out of 268 subjects in all of the studies, which equates to a rate of 0.37%. In contrast, oral finasteride is associated with sexual side effects in 1.8% to 3.8% of patients, which means that in the above 268 subjects, there should have been about 5 to 10 subjects experiencing some form of sexual side effects. However, this was not the case. Only 1 person had sexual side effects as opposed to 5 to 10 individuals. 

Pharmacokinetic studies by Caserini et al. suggest that lower doses of topical finasteride result in lower reduction of serum DHT compared to oral finasteride and thus lower sexual side effects. No study has conclusively shown the reason of how finasteride can cause sexual side effects. Certainly serum DHT is a contributing factor but may not be the only factor. The reason for this conclusion is because there are studies that patients were on high dosage of topical finasteride and still had no sexual side effects. 

In conclusion, the majority of studies on topical finasteride show no to only a few sexual side effects. However, this does not mean that sexual side effects can not happen. It just suggests that risk of sexual side effects are lower due to the fact that the finasteride is not taken orally. Additional larger clinical studies are needed to address the sexual side effects of topical finasteride. 

References:

1. Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. GF Mazzarella, GF Loconsole, GA Cammisa, GM Mastrolonardo & Ga Vena; Pages 189-192 | Received 23 Aug 1996, Accepted 18 Mar 1997, Published online: 12 Jul 2009

2. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Hajheydari Z1, Akbari J, Saeedi M, Shokoohi L. .Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

3. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. Rafi and Katz. SRN Dermatol. 2011;2011:241953. doi: 10.5402/2011/241953. Epub 2011 Apr 11.

4. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. Tanglertsampan C1. J Med Assoc Thai. 2012 Oct;95(10):1312-6.

5. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Caserini M, Radicioni M, Leuratti C, Annoni O, Palmieri R.  Int J Clin Pharmacol Ther. 2014 Oct;52(10):842-9. doi: 10.5414/CP202119.

6. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R. Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27. doi: 10.5414/CP202467.

7. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. B. S. Chandrashekar, T. Nandhini, Vani Vasanth, Rashmi Sriram, and Shreya Navale. Indian Dermatol Online J. 2015 Jan-Feb; 6(1): 17–20. Doi: 10.4103/2229-5178.148925

8. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Sung Won Lee, MD,1 Margit Juhasz, MD,1 Pezhman Mobasher, MD,1 Chloe Ekelem, MD,1 and Natasha Atanaskova Mesinkovska, MD, PhD1. J Drugs Dermatol. 2018 Apr 1; 17(4): 457–463.

The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment.