Hair Loss Cure 2020

Over the years I have read 100s of posts by hair loss sufferers who are uncertain about the most efficient dosage of finasteride (brand name Propecia) or dutasteride (brand name Avodart) to take in order to get the best possible outcome in terms of probable hair maintenance (and possible regrowth) versus risk of side effects. A few people have also e-mailed me with questions about this, but I usually refrain from responding or ask them to consult a doctor.

Each person has a different risk tolerance. For many people, a 90 percent chance of hair maintenance (and maybe some regrowth) combined with a 10 percent chance of significant side effects is preferable to a 80 percent chance of hair maintenance combined with a 5 percent chance of significant side effects. For others, the reverse is true. Similarly, some people might be happy with a 60 percent reduction in dihydrotestosterone (DHT) levels, but others are willing to take a higher dose of a drug in order to get a 70 percent reduction.

The majority of people probably do not even look too deeply at finasteride or dutasteride related studies to try and find all the relevant statistics, and instead just prefer to experiment themselves or go with the doctor recommendation. Others are taking unusual doses (e.g., by cutting 5 mg pills into 4 pieces to get 1.25 mg) that are never covered in studies anyway. Furthermore, many people want to adjust the frequency of their drug intake to an unusual one (e.g., 3 times a week instead of 7 times a week) that is almost never covered in finasteride or dutasteride related studies.

In this post, I will discuss some established dosage details based on published studies and data. Thereafter, I encourage people to comment on what dosage and frequency they have tried in the past, and what seems to have worked best. Scientific dosage related feedback is especially welcomed. I am also curious to hear what people think of taking their finasteride or dutasteride before eating versus after eating; in the daytime versus at night; alongside food such as grapefruit that can impact drug effectiveness; and so on.

Prostate v/s Serum v/s Scalp DHT Levels

Before continuing, one thing to note is that most studies on dihydrotestosterone (DHT) reduction measure serum (aka circulating/blood) DHT levels and scalp (aka follicular) DHT levels when it comes to hair loss related discussions. Prostate DHT level measurements are more common in studies looking at BPH, although many hair related studies also mention them. Both finasteride and dutasteride reduce serum DHT levels by a higher percentage than they do scalp DHT levels for all dosages it seems.

Finasteride (Propecia) Dosage Discussion

Finasteride was originally approved in 1992 to treat benign prostatic hyperplasia (BPH — which means enlarged prostates, a problem typically seen in older men). The finasteride dosage used for treating BPH is 5 mg a day (and the original brand name for this dosage version is Proscar (manufactured by Merck), although generics are now commonly used).

In 1997, the US FDA approved finasteride (at a dosage of 1 mg per day) to treat hair loss. The original brand for this product is the infamous Propecia. However, since Propecia was very expensive for many years when generic versions were not available (due to Merck’s now expired patent), people would buy the 5mg Proscar and cut it into 4 pieces and then take 1.25 mg of the drug every day. This strategy worked out to be a lot cheaper. However, note that there is no guarantee that a pill cutter is accurate enough to ensure 1.25 mg finasteride evenly distributed per quarter pill. Moreover, I have even read that the main ingredient in any pill is not evenly distributed throughout.

So perhaps one quarter of Proscar could theoretically have 1.5 mg instead of 1.25 mg, while another could have 1 mg instead of 1.25 mg. I have no idea if such significant variation in ingredient distribution in a pill is common, but it does seem to have logical merit. When I used to cut generic 5 mg finasteride pills into four pieces a few years ago, I always lost some of the pill to crumbling/powder residue.

In any event, taking 1 mg versus 1.5 mg is not likely to be very different when it comes to finasteride. With dutasteride (see next section), small dosage variations have more of an impact. It should also be noted that some people take Propecia aka finasteride every other day rather than every day.

Finasteride is a type II and type III 5α-reductase enzyme inhibitor, meaning that it prevents the conversion of testosterone to DHT by the type II and III isoenzymes. However, it does not inhibit the type I 5α-reductase enzyme so DHT inhibition is not complete. At a dosage of 1 mg, finasteride results in a decrease in serum DHT levels by about 60-70 percent according to several studies I checked. The number for scalp DHT is a bit unclear, with several sources suggesting a reduction from anywhere between 40-65 percent. Prostate DHT levels decline by around 80-90 percent.

Whole doing research for this post, I uncovered something that I had not realized before. According to this study from 1999, It seems like Finasteride is almost as effective at 0.05 mg per day as it is at 1 mg per day or 5 mg per day when it comes to scalp skin DHT levels. And 0.2 mg per day is almost as effective as 1 mg per day or 5 mg per day when it comes to serum DHT levels.

Results quote from the full version of the above study:

Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56.5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.

Another unusual study I found was this old one from 1990. They were testing up to 100 mg (!) per day of Finasteride in patients (for 11 days), which seems crazy.

Dutasteride (Avodart) Dosage Discussion

As I mentioned earlier, the biggest drawback of finasteride is that it does not inhibit the 5α-reductase type I isoenzyme, and therefore does not inhibit more than 70 percent or so (depending on dosage) of circulating DHT levels. However, in 2001, the US FDA approved a new drug called dutasteride (initially only sold under the brand name Avodart, with GSK’s patent on the drug having expired in 2015) to treat BPH. This new drug inhibits all three isoforms of 5α-reductase (i.e., type I, II, and III). As a result, almost all circulating DHT is eliminated (serum DHT levels decline by over 90 percent). This results in superior hair growth results in comparison to finasteride, but greater chances of side effects.

For men with BPH, Dutasteride is typically taken at a dose of 0.5 mg per day. Most hair loss sufferers also take the same dosage. While Dutasteride has been approved to treat hair loss in South Korea and Japan, the same has not yet occurred in the US or the EU as of 2017.

A person by the name of Dr. Richard Clark conducted some very important studies during the years immediately preceding and following the approval of Dutasteride for BPH that compared DHT inhibition from various doses of Dutasteride versus Finasteride 5 mg. Below are several highly useful charts from his studies. Note that in the first chart, the lower the better (i.e., greater DHT inhibition).

Dutasteride and Finasteride Dosage

Linear versus Nonlinear Elimination

A few months ago, commentator “PinotQ” sent me an interesting e-mail that threw another twist into this confusing story. He also referenced this study from 1999. Key quote from his e-mail:

“FYI — About a month ago, I switched my avodart dosage from .5 mg per day to 1mg Monday, 1mg Wed and 1.5mg on Friday. Dutasteride has a non-linear elimination curve meaning the more you take at once, the longer the half life. At a dose of only 0.1 mg/day, the half-life is only around two or three days while at .5 mg it is 4-5 weeks. For this reason, my doctor suggested that 2 pills taken twice a week may be as effective (or more), than 1 pill per day. I am hoping for a little more powerful response going 3 times per week at 2-2-3 as I had read from Dr. Shapiro online that when switching from finasteride to dutasteride, to see renewed effectiveness, you would probably need to be at the 1mg per day dosage level………but this is just all educated speculation.”

Half-Life of Finasteride v/s Dutasteride and Side Effects

Dutasteride has an extremely long half-life of around 4 weeks. On the other hand, finasteride has a half-life of only 6-8 hours. Unfortunately, dutasteride also has higher side effect rates in comparison to finasteride. Most studies indicate that serious side effects are minimal when it comes to both dutasteride and finasteride (less than 5 percent of people get major problems, and even fewer get irreversible side effects). However, it should be noted that most people who are currently taking the more powerful dutasteride have only been doing so for less than 15 years since the drug was only approved for use in 2001. So we still do not know the really long-term ramifications of taking dutasteride.

I have covered anti-aging research on this blog a few times in the past: partly because aging reversal can also imply hair loss reversal; and partly because I also cover medical items of interest a few times a year. This week was one of the best ever in anti-aging research, especially for mice (and their fur). A number of people have posted links about some of the below developments in the last post, and several people have also e-mailed me relevant links.

Senescent Cell Destruction Results in More Youthful Mice

For many years, scientists have known that the quantity of senescent cells (i.e., aged cells that have stopped dividing) correlates with aging in humans. More recently, research has suggested that senescent cells also damage other nearby healthy cells. So, not surprisingly, some scientists have conducted experiments to see if removing these old senescent cells (ideally, without damaging other normally functioning cells) reversed signs of aging and increased life expectancy. A few experiments in mice have suggested the answer to be in the affirmative (e.g., this one from 2011 and this one from 2015). There is now even a name (senolytics) for the class of drugs that can kill senescent cells.

This week, a groundbreaking study (led by Dr. Peter de Keizer) from the Netherlands found that a drug that they developed to kill senescent cells causes dramatic improvements in mice health and essentially reverses their aging. For our purposes, the most important thing was that these mice saw regrowth of healthy fur/hair! Key photos below (green arrows on rightmost column show hair regrowth in almost all mice after FOXO4 peptide ingestion):

Anti-aging via destroying senescent cells. — Anti-aging of mice. Making them younger and furrier via destroying senescent cells.

The team behind this research plans clinical trials in humans in the near future. There are literally 100s of articles on this development, and various scientists from other countries have been quoted as saying that this development is potentially a huge breakthrough in anti-aging science. Two contrasting sources here and here.

Addendum 1: In case anyone got the wrong idea from my recent post on obesity perhaps benefiting scalp hair, this study is worth reading.

Addendum 2: Specially for Mr. “nasa_rs”: “JAK inhibition alleviates the cellular senescence-associated secretory phenotype and frailty in old age“.

David Sinclair Update

I have covered anti-aging Harvard-based Australian researcher Dr. David Sinclair (widely associated with resveratrol) several times on this blog. In a new paper, him and his colleagues have found a way to protect a mouse’s DNA from damage via boosting NAD+ levels, and they are supposedly ready to test it in people. Dr. Sinclair in some ways is the Dr. George Cotsarelis or Dr. Ken Washenik of the anti-aging world.

Note that there is also a Dr. Rodney Sinclair who is a famous hair loss researcher that I have covered a few times on this blog. He is also from Australia.

Young Blood Without the Need for a Donor

In recent years, a number of scientists have been researching the fascinating subject of whether older people can be rejuvenated by the infusion of blood from the young! Billionaire Peter Thiel is especially interested. However, one major problem with this strategy for older non-wealthy people is that there might not be enough young healthy donors with the correct blood type willing to donate at reasonable prices.

However, this week, scientists from Germany published research that could be a workaround for this problem. Just make old blood young again (in mice) via the addition of osteopontin protein and forget about the young. After all, “youth is wasted on the young”.

Dutasteride and Finasteride Dosage Discussion