Originally posted by decem
*** Answers to Hairloss Questions Here ***
I wrote to a doctor that works for a prominent company that deals with thinning hair, hair-loss, and hair regrowth and asked him questions about what I would need to use in order to block the effects of the androgen build-up in the scalp brought on by AAS use/abuse.
Here's his reply (I've edited/omitted areas that contain personal/company/doctor information):
In regards to your questions:
Which of these medications would be best suited for protecting against hair-loss due to the androgen build-up in the scalp caused by anabolic/androgenic steroid use?
Use a combination of 5% Xandrox liquid twice daily and 1/4 Proscar pill every other day. The alternative to Propecia (1 mg finasteride) is to order Proscar (5 mg finasteride). It must be purchased with either 1 bottle of Xandrox or minoxidil. Propecia is only marginally
effective in promoting hair growth without one of these other formulae.
The tablets are brittle and hard, so they will not break into four even pieces. Don't worry, if the pieces are of unequal size. Not only is the exact dosage irrelevant (the same effect is obtained with dosages between 0.2
> to 5 mg), but the binding of the enzyme lasts for many days. In fact, we have many patients taking ~1 mg of finasteride every other day.
If you decide to discontinue taking finasteride, it will take two weeks before your serum DHT level comes back up to your baseline level.
HOW TO USE HAIR GROWTH MEDICINES
Knowledge of the normal hair physiology and the understanding of the pathophysiology of alopecia androgenetica, more commonly known as male pattern
baldness or MPB, has dramatically expanded in the past decade. Currently, there are two effective
approaches to treating MPB: (1.) Stimulate the hair follicle to produce a hair shaft and remain in the anagen (growth) phase. (2.) Decrease the dihydrotestosterone [DHT] in the scalp to prevent the immune inflammatory
reaction that harms and miniaturizes the follicles.
There is only one FDA-approved, safe, and effective way to stimulate the hair follicles, which is to use topical minoxidil. Topical minoxidil is dose related, so the more minoxidil that can be delivered to the hair follicles,
the better its ability to stimulate hair growth.
On the other hand, there are several ways to decrease the amount of DHT that can affect the hair follicles. Oral finasteride (Propecia or Proscar) has been in use for many years to decrease the amount of DHT in the prostate. Several years ago, the FDA approved this same medication in a decreased dosage to treat MPB.
DHT in the scalp can also be reduced by topical medications. The most effective topical medication for this purpose is azelaic acid. Azelaic acid is also an FDA approved medication and has been used for the treatment of acne. Many well-designed studies have proven that azelaic acid very effectively inhibits the synthesis of DHT in the skin.
An alternative topical medication for decreasing DHT in the scalp is a spironolactone solution. Spironolactone is an anti-androgen. It prevents the formation of DHT in the scalp and locally increases the amount of the female hormone, estrogen. Spironolactone also is a competitive inhibitor of DHT at the androgen receptor sites, helping to prevent DHT from attaching to the receptor sites on the hair follicles.
There is one other medication that can be used in conjunction with minoxidil, spironolactone, azelaic acid and finasteride: retinoic acid (Retin-A). Retinoic acid acts as a chemical peel. It will cause the superficial layers of the skin to slough off, resulting in stimulation to new cell growth of the skin and an increased absorption of topical minoxidil
In summary, the best approach to treating MPB is to simultaneously stimulate hair growth and to decrease or eliminate the DHT in the scalp. The available
medications are 5% Minoxidil Daytime and Nighttime Solutions, Xandrox 5% Daytime and Nighttime Solutions, Xandrox 12.5% Lotion, Propecia (finasteride), and topical
spironolactone.
APPLICATION OF 5% MINOXIDIL AND/OR 5% XANDROX
Start your treatment by using 5% minoxidil or 5% Xandrox liquid twice daily. It is important to apply the topical minoxidil or Xandrox directly to your scalp, where the medicine will be most effective. Fill the medicine dropper with 1 mL of liquid. If you have pattern baldness, apply the 5% minoxidil or Xandrox liquid to the
areas of hair recession or balding areas. If your hair loss is generalized, part your hair in as many as six places and apply a portion of the 5% minoxidil or Xandrox liquid in the medicine dropper to each of these areas. You can use your fingertips to spread the fluid more evenly and to lightly rub the topical Xandrox into your scalp. In solution form, it is the alcohol that allows for penetration of minoxidil and azelaic acid into the scalp, so massaging the scalp has no appreciable benefit. Even though the minoxidil/Xandrox is not evenly distributed on the scalp, there is sufficient diffusion in the layers under the surface of the skin to allow for effective total coverage.
A consistent, twice/day application is the most efficient manner to use topical 5% minoxidil or Xandrox to treat male pattern baldness. Most patients will have a satisfactory response to 5% minoxidil (at the vertex) or to Xandrox 5% solution (at the vertex, crown and frontal areas) in 4 to 6 months. However, if after 6 months of treatment with the liquid, you find that there are remaining areas that are poorly responsive, you may want to consider using 12.5% Xandrox lotion in addition to the 5% solutions.
After two to three years of treatment, you may maintain your hair growth with a single daily application of 5% Xandrox or 5% minoxidil, but it is unlikely that you will recruit any more hair follicles to regrow a thicker hair shaft.
COMBINED USE OF 5% XANDROX LIQUID AND 12.5% XANDROX LOTION
Apply 1 mL Xandrox 5% liquid twice daily, once in the morning and once at night on all affected areas. After applying the morning or nighttime Xandrox 5% solution, allow a few minutes for the liquid to partially dry. Then apply no more than 1 mL of the Xandrox 12.5% lotion over the same area(s) of the scalp. Apply the Xandrox 5% solution and the Xandrox 12.5% lotion during that time of day when you can leave it undisturbed on the scalp for the longest period of time.
You may experience temporary flushing from the transfer agent, benzyl nicotinamide, in the lotion. The blushing is due to vascular dilatation, which is harmless and which enhances the absorption of minoxidil.
POTENTIAL SIDE EFFECTS OF TOPICAL MINOXIDIL
It is extremely rare to have systemic side effects from topical minoxidil, because the amount of absorption (approximately 1.7%) is very low. The systemic effects of minoxidil include a rapid heart rate, a drop in blood pressure, water retention with swelling in their hands and feet, and dizziness. If you experience these reactions, stop using both the 5% Minoxidil or Xandrox as well as the Xandrox 12.5% lotion.
TEMPORARY SHEDDING FROM MINOXIDIL
A small percentage of patients, male and female, experience slightly increased shedding of hair when they start the using any topical minoxidil product. This
shedding is a one-time occurrence and is usually so minor that it is unnoticed. The shedding affects only telogen hairs, which are those hairs that are no longer growing and usually represents about 10% of the hairs on the scalp. Although this shedding is understandably frustrating and exasperating, in actuality, it's a good prognostic indicator that those same patients will ultimately have good results with the therapy. All of the hair that is shed will be replaced with hair that is thicker
because the atrophic process is being reversed. However, the replacement of the hair usually requires that the hair follicle cycle complete its telogen (resting) phase, which lasts approximately 100 days.
MINOXIDIL 'TOLERANCE'
There are a lot of misconceptions about minoxidil and 'tolerance'. Minoxidil will help to recruit atrophic follicles to grow thicker hair again for about two years (sometimes as long as three years). Beyond that time, it continues to help keep the hair in the anagen phase, so the new hair has a longer anagen phase.
But, because most patients do not see any significant 'improvement' after a few years, they are assuming that the minoxidil has caused a tolerance and is no longer 'working'. If they are unfortunately convinced to stop minoxidil treatment, the hair that
they have regrown will shed again in 3-4 months.
5% XANDROX AND 5% MINOXIDIL WITH RETINOIC ACID
If you are going to use Xandrox or minoxidil solutions containing retinoic acid (Retin-A), please be aware that it may cause mild irritation, flaking and drying of the scalp where it is applied because of its direct effects as a
chemical peel. It will also cause the skin where it is applied to be more sensitive to sunburn, so take preventive measures such as using a sunscreen or wearing a hat, if you expect to get significant amounts of direct sun exposure. Since retinoic acid is used as a chemical peel, almost all patients will (at least initially) have some 'reaction' with its use. You may wish to acclimate yourself to its use by applying it once-only at night during the first week of therapy, twice-only during the second week, etc., until you are able to use it for every nighttime application. Since retinoic acid is degraded by strong light, it should be applied only at nighttime. The benefits of retinoic acid and minoxidil are additive and synergistic in the treatment of MPB.
If you have continuing scalp irritation from the Retin-A, then it is best to discontinue using it and use only the 5% Minoxidil or Xandrox formulas that do not contain retinoic acid. Minoxidil formulas containing retinoic acid are not recommended for patients who are taking Accutane. The cumulative amounts of retinoids may be harmful to hair follicles.
ALLERGY TO PROPYLENE GLYCOL
Propylene glycol is added to the alcohol/water base of the 5% minoxidil and Xandrox solutions as a stabilizing agent. However, if you experience scalp irritation from propylene glycol, then you should order propylene glycol-free minoxidil and Xandrox formulas. Because their liquid base substitutes non- allergenic glycerin, they tend to have a more 'oily' feel than the standard formulations of topical minoxidil.
FINASTERIDE FOR THE TREATMENT OF ANDROGENETIC ALOPECIA (MALE PATTERN BALDNESS)
Finasteride (Propecia/Proscar) helps to protect the follicles from DHT. When DHT attaches to the androgen receptor sites on the hair follicles of the scalp, it initiates an immune inflammatory response, which damages and
miniaturizes the hair follicles.
One mg of finasteride will lower the serum level of DHT by 60-80%. However, the amount of reduction of DHT around the hair follicles is far less than 60%-80% because the predominant enzyme that converts testosterone to DHT in the scalp is type 1 5-alpha reductase. Type 1 5-alpha reductase is not affected by finasteride.
The recommended dosage of finasteride is 1 mg/daily, but because the biological action of finasteride is so prolonged, variations on the daily dose are equally effective. Finasteride can be taken with or without food.
When male patients take finasteride, less than 10% of them report a decrease in libido, and a smaller number report an "ache in the groin area". These negative side effects are reversible usually within two weeks of
discontinuance of taking the finasteride. Even when patients continue to take the finasteride, the majority of the men will gradually regain their former libido and the side effects abate.
Unfortunately, we are also getting rare reports of "massive shedding", usually after several months of successful finasteride therapy. Apparently, the systemic reduction of DHT incites a telogen effluvium in a very small percentage of patients. If the massive shedding occurs, the consensus among dermatologist is to stop using the finasteride. However, it is recommended that you continue to use the minoxidil and use another anti-androgen that does not cause a hormonal shift
of DHT. The best alternative is the exclusive use of Xandrox formulations.
Fortunately, the massive shedding (telogen effluvium) caused by finasteride does not cause a scarring alopecia, so the hair will grow back in again.
Although finasteride can be used alone for the treatment of MPB, it is much more effective in regrowing hair, if it is used together with topical 5% Minoxidil or Xandrox.
AZELAIC ACID FOR THE TREATMENT OF ANDROGENETIC ALOPECIA (MALE PATTERN BALDNESS)
Many other medications have been developed, which will decrease the amount of DHT in the scalp. Topically applied azelaic acid has been proven to be the most effective inhibitor of DHT synthesis in the scalp. A topical 5% azelaic acid solution will reduce the amount of DHT in the scalp by greater than 98%. Xandrox
incorporates 5% azelaic acid and 5% minoxidil, so that there is promotion of hair growth as well as prevention of atrophy of the hair follicles. The 5% azelaic acid in all of the Xandrox formulations is approximately 3 times the concentration necessary to obtain essentially complete inhibition of DHT synthesis.
When azelaic acid is initially used, it may cause a temporary stinging or burning sensation. There are no harmful direct or side effects to the use of azelaic acid.
TOPICAL SPIRONOLACTONE FOR THE TREATMENT OF ANDROGENETIC ALOPECIA (MALE PATTERN BALDNESS)
Spironolactone is a potent anti-androgen, and it is effective applied topically. It successfully competes with dihydrotestosterone (DHT) for the receptor site on the hair follicles. Within the skin on which it is applied it
also inhibits the formation of testosterone and converts the existing testosterone in the skin to an estrogen. However, there are inherent problems with topical spironolactone formulations. It has a disagreeable odor and it is not stable in solution form.
Spironolactone is metabolized in the skin and does not affect any other organ system. In about 1% of patients, a rash can develop. If this happens, the patient should not use the spironolactone solution.
Topical spironolactone can be used by men and women with MPB. Oral spironolactone is occasionally prescribed for women to treat hair loss, but it is contraindicated in pregnant women because it upsets the estrogen/progesterone ratio. If taken orally by men, there can be serious side effects such as an increased potassium level in the blood, feminizing effects (gynecomastia) and loss of libido.
It cannot be overemphasized that in treating patients with MPB, it is important to simultaneously stimulate hair growth and decrease the DHT level in the scalp. Simply decreasing the DHT level may be totally ineffective in regrowing terminal hair. For instance, men who have been castrated for the treatment of prostate cancer, and therefore have no source of DHT, will stop the balding process, but they do not grow back significant amounts of hair. However, if they also use
minoxidil as a hair growth stimulant, most of the men will grow back some terminal hair. A combination of minoxidil and an anti-androgen is particularly important for growth outside the vertex/crown area of the scalp.
WHAT YOU CAN EXPECT FROM TREATMENT
The average patient will see a positive response to treatment in 4 to 6 months. Using a combination of 5% minoxidil and a drug to effectively reduce scalp DHT (e.g. 5% Minoxidil and finasteride or Xandrox alone) stops any further loss or regrows hair in 83% of patients with MPB. Approximately 70% of patients will see the growth of cosmetically acceptable hair. (Of those patients, 50% can expect a restoration of the frontal hair.) An additional 13% will report that their
MPB has stabilized, although they do not see any new hair growth. The remaining 17% may continue to lose
their hair, but the rate of progression of MPB is slowed.
Some patients will see a response sooner than 4 to 6 months. Other patients will take longer. Most dermatologist recommend refraining from judging a
treatment for MPB until there has been at least a year of treatment.
Please Scroll Down to See Forums Below 
