Androgenetic alopecia: why DHT matters, 5 alpha reductase considerations
Since I read a lot of conflicting, sometimes tin foily information on 5 alpha reductase inhibitors and alopecia, I thought I would write something up.
Here’s a Too-Long-Won’t-Read:
TLWR - Hair loss is associated with a bunch of metabolic conditions. Hair follicles can be sensitive to DHT. Get your Testosterone and Estradiol at decent levels. Nuke 5ar. In this scenario, HRT protocols can be widely beneficial for hair and overall health. Be aware of side effects - be aware that they by and large seldom happen.
Just in case you won't read it in one go, I'm about to break it down into three articles and publish them on my blog
Intro - why not just buzz my hair?
- Don’t believe the (internet) hype
- I’ve heard DHT isn’t even bad for hair
- I’ve heard 5ar drugs are another Big Pharm scam
- if DHT can do it, Test can do it
- Three tangents to consider on top of Test + Duta
Intro: But IDGAF about luscious hair!
Hair loss (just like acne, BP and so on) is associated with a bunch of severe conditions, thus instead of shrugging it all off, you may want to care about good hair health, however vain it sounds. Hair loss is like a smoke signal that gets dismissed as another almighty case of “100% genetics”.
In any event, I’d take hair loss seriously. How about bad lipids, poor cardiovascular health, kidney and liver stress and so on? A bit of androgen management could be due.
More specifically, 5a-DHT management, because I see nothing wrong with Testosterone and its 5beta reduced metabolite:
5alpha-DHT exhibits potent genomic-androgenic effects but only moderate vasorelaxing activity, whereas its isomer 5beta-DHT is devoid of androgenic effects but is a highly efficacious vasodilator. These findings suggest that the dihydro-metabolites of T or other androgen analogs devoid of androgenic or estrogenic effects could have useful therapeutic roles in hypertension, erectile dysfunction, prostatic ischemia, or other vascular dysfunctions.
Since 5beta-DHT is generated from T via 5-beta reductase, it would be nice to take penis-related horror stories on 5ar inhibitors with a grain of salt. My hypothesis at this stage is that ED/impotence upon 5ar inhibitors use comes from reduced overall androgenic effects, which could be balanced by injecting some more Testosterone. More on that below.
Part 1: Alopecia is, in fact, androgenetic.
a. DHT considerations
I see online charlatans trying to make money off of the idea that androgenetic alopecia is a myth, and DHT should, in fact, be good for you, because it doesn’t aromatize and stuff. Since DHT is portrayed like masculinity’s savior, it’s become increasingly frequent in the male blogosphere/YouTube sphere to defend DHT and blame estrogens for just about everything including hair loss. Pushing some non-pharmaceutical grade hormones that they happen to sell. I wouldn’t have guessed that humans had gone full retard and pretended that more DHT is the answer to hair loss, while Big Pharma wants your castration, but apparently conspiracy theories sell books so whatever.
Testosterone goes lower and lower with age, while DHT becomes relatively more important. Most males’ genetics get them to go bald in the very process of saving masculinity. A mountain of evidence such as this type of study concludes that DHT is bad for hair while estradiol (in isolation, at the hair follicle level) is beneficial
Sure enough, DHT can become metabolized into various hormones among which 3b-Diol (binds to the “good” Estrogen Receptor Beta) and other hormones, and glucuronidated/sulfoconjugated molecules. I’ve tried going this route, using the tactics described towards the end of this article … didn’t get results. I guess coconut, olives, zinc, T3 and NADH can only go so far against hair loss. YMMV.
Can we hack away our body and reverse the aging equation? Some guys do it with radical methods. Such as using tons of female hormones yielding the most incredible hair regrowth there could be - usually leaving the DHT-loving-Estrogens-hating folks speechless.
I do not recommend using freakin Birth Control pills to grow hair as per the example above, I am going to recommend using good old 5 alpha reductase inhibitors in this post, mostly Dutasteride alongside TRT to preserve your hair. Interestingly enough, the guy above was using his BC pill + topical e2 + Dutasteride. Let’s stick to basics and move on from there.
- androgenetic alopecia is not a Big Pharma conspiracy,
- DHT is terrible for hair; just because some reports show a beneficial effect of DHT supplementation in the context of BPH management doesn’t mean that we should all rub DHT on our scalps,
- Topical estradiol can work, but isn’t free of side effects
b. 5 alpha reductase considerations
Why do I advocate for HRT when using Dutasteride/Finasteride? Well, DHT defenders usually reiterate some potential side effects from DHT suppression:
DHT blocking drugs may increase the risk of developing prostate cancer, kill your libido, increase depression, cause erectile dysfunction and make reaching orgasm more difficult.
^Quote from a random blog post by a bald author, not kidding.
A quite concerning study that I must share, if you DO feel mentally off - keep in mind that other hormones get 5 alpha reduced at the brain level. Side effects still appear to be quite low compared to placebo. The “nocebo” effect can be strong. I won't pretend that any drug is perfect 100% of the time. Barring neurosteroids discussion (for now), some of those adverse events seriously sound like low Testosterone to me. It could be that natties who have insufficient levels of Testosterone should NOT use 5ar inhibitors in isolation. My own theory - if Testosterone starts to dip and 5ar conversion to DHT becomes a natural beneficial mechanism, and you decide to block 5ar enzymes using Fina/Dutasteride, then you can indeed expect bad stuff to happen.
I’m just here wondering whether Doctors routinely prescribe thorough hormonal blood panels before writing Finasteride scripts. Anyone who was prescribed Fina/Duta feel free to jump in and let us know what kind of blood tests you’ve done pre (and during?) treatment.
Anyhow, the solution to reverse a vicious cycle of DHT-dependent penile health could be quite straightforward: get Testosterone back up to youthful levels using TRT/HRT. Then use anti-DHT medications. Since Fina doesn’t block all types of 5ar, just use Duta and regrow more hair even at pretty low doses.
Read a full hair count here
Comments from a blog: https://www.holdthehairline.com/dutasteride-hair-loss/
Doctors measured a target area of hair at the beginning of the experiment, than 24 weeks after daily usage of a placebo, Finasteride 5mg, Dutasteride 0.1mg, Dutasteride 0.5 mg, and Dutasteride 2.5mg. The test area after 24 weeks showed the men using the placebo had lost 32.3 hairs, Finasteride 5mg users gained 75.6 hairs, Dutasteride 0.1mg 78.5 hairs, Dutasteride 0.5mg 94.6 hairs, and Dutasteride 2.5mg 109.6 hairs.
More good stuff:
Mean change of hair counts from baseline to 6 months after treatment start was an increase of 12.2/cm2 in dutasteride group and 4.7/cm2 in placebo group and this difference was statistically significant (P = .0319). Dutasteride showed significantly higher efficacy than placebo group by subject self-assessment and by investigator and panel photographic assessment. There was no major difference in adverse events between two groups.
Since Duta could be pricey even at ,5mg per day I'd strongly recommend reading this study and saving your cash for significant enough hair gains and a few hundreds saved
The pharmacokinetics of GI198745 showed an unusual profile, where a high volume of distribution (511 l) and a low linear clearance (0.58 l h−1) combined to give a half-life of up to 5 weeks at high concentrations. As concentrations declined towards *Km* (0.96 ng ml−1) the proportion eliminated by the relatively rapid saturable elimination pathway, with a maximum clearance of 6.2 l h−1 (calculated as *V*max/*Km*), increased and the half-life reduced to about 3 days.
Bottom line - pharma drugs work. 1mg ish per week should grow hair back very nicely. 2 pills can do the job just equally as well as 7! I’ve also read that raws aren’t expensive.
- For natties: if sexual adverse events appear when using 5ar inhibitors, you don’t want to be left with an impossible choice (hair vs penis/prostate/brain health) - keep 5ar inhibitors in and try to supplement T, then reassess.
- In case of serious MENTAL side effects, automatically readjust
- Keep in mind that those side effects typically happened less than 10% of the time. That's 90% of bros with thick hair and good quality of life
Part 2: will T do the job?
5ar enzymes appear to be a useful back up plan in case of low Test.
From this study, we know that castrated rats have a prostate that is “flabby, small, tough, with little secretion”. Many papers discuss the following concept:
in utero, DHT is responsible for normal differentiation of the male external genitalia; after puberty, however, DHT may be considered a “bad” hormone
DHT, useless? Bad? A longer, more argumentative version
Why then did the steroid 5α-reductase system evolve for androgens? Forty-six XY males with steroid 5α-reductase deficiency exhibited ambiguous or female external genitalia at birth and poor prostate development, but underwent normal muscle and bone development during pubertal transition. The phenotype of these patients suggests that steroid 5α-reductase plays an essential role in the development of prostate and phallus by providing local amplification of an androgenic signal without systemic hyperandrogenemia during critical periods of sexual differentiation, illustrating nature’s extraordinary ingenuity in creating mechanisms for tissue-selective amplification during development. We speculate that in adult men, in whom this tissue-specific amplification is not essential because the circulating testosterone concentrations are substantially higher than those in the fetus, testosterone and DHT can interchangeably subserve many androgenic functions. When circulating testosterone concentrations are low, intraprostatic DHT formation may become important in maintaining prostate growth, thus buffering the effects of decreasing testosterone levels, which has been suggested by Marks et al.
Bottom line: as a grown up adult, you may not even need DHT for “male functions”, provided you've got enough Test.
Side note - I've seen a few anecdotes of hair shedding when free T was elevated and Dutasteride had nuked DHT to nonexistence / while using Finasteride. Which got people to say that Testosterone itself can cause hair loss. In the former case, the famous YouTuber was on very high levels of Test and tries to sell RU58841. Red flag IMHO. Regarding the latter, well Finasteride doesn't block all DHT, and those people who would keep losing hair on it may also have a pro inflammatory lifestyle. Since 5ar inhibitors tend to increase total and free Testosterone, I wouldn't blame T for hair loss. I've even seen some theorize that T codes for better thickness.
- If you’re healthy, Test is best.
- You can nuke DHT to save your hair, but make sure to keep T nice and high.
- Iron and sperm production, muscles, strength, penis gains - There’s nothing DHT does that T can’t do. While keeping your prostate and hair in check. Not too shabby?
- No peer-reviewed evidence shows that strictly Test-related hair loss is a thing
Part 3: other considerations for PEDs users / HRT
Say you want to preserve your hair. Say you’ve got Minoxidil and all sorts of cutting edge shampoos, you embrace that Duta+TRT route. No horror stories. Hair sprouting back.
Not done yet?
a. HCG tangent
I like using HCG regularly since cholesterol metabolism is dependent on LH.
Low LH = subpar cholesterol metabolism = less protective hormones (pregnenolone, progesterone, DHEA...) = less neurosteroids = not desirable. I frankly don’t care about the cholesterol hypothesis and how it may or may not cause heart attacks, but we've all seen trashed lipids on AAS. I want more protective hormones in general, thus I strongly dislike reading high cholesterol on a bloodwork. If HCG enhances my chances at getting less LDL and more protective hormones, I'll use it on and off.
b. Thyroid Tangent
What about thyroid? To get started, know that proper thyroid function helps to keep your LDL receptors active and again, less LDL cholesterol = more pregnenolone, progesterone, etc. Same story as LH.
Put it simply, a thriving thyroid improves hormones and health in many aspects.
Try to find the time to read this PDF as it has 10 pages of references backing up 13 pages of crystal clear reviews of thyroid function, not only at the pituitary but also at a peripheral level. Huge emphasis on how TSH and most conventional thyroid testing mean jack shit.
Whenever you hear “TSH is all you need”, change Doc. Up-to-date endos prescribe reverse T3 and I’ve seen some discuss saliva testing alongside salivary cortisol to assess thyroid+adrenal function. You can also try to get a DUTCH test for full hormonal + adrenal panel. Also not discussed so far, and I'm only going to drop it here, vitamin D levels. Check them out.
Therefore, on top of all standard pro-thyroid dietary recommendations, Armor (or its raw thyroid equivalents) can be useful. If you’re on Synthroid or know someone on it, definitely pass them that PDF above and discuss it with an open-minded Doc.
c. Brain Tangent
Why the hell would my thyroid not be thriving anyway? From that same PDF above: stress and depression come first on the list of thyroid foes. Your mental health causes powerful thyroid suppression.
Stressed, unhappy - hits home? If it does: fix your brain. Seek a therapist. Yes, a lot of stuff is “all in the head”. We can’t really measure stress, happiness, frustration - doesn’t matter, talk about it, fix it.
Holistic recap: Eat mostly fruits, vegetables, plants and quality whole animal foods that agree with your gut. Get some sunlight, manage stress and be happier.
Pharma recap: Test, Duta. Maybe HCG, Raw Thyroid. Topicals if you wish.
A nice study done on men using Dutasteride or Placebo with various doses of Testosterone, measuring lean mass gains, quality of life, sebum secretion, sex function. Too bad they didn’t count hairs!!!? https://jamanetwork.com/journals/jama/fullarticle/1105045
Also, from Glaxo: Avodart: tips and science