Medications have enabled me to hang on to a large portion of my hair. However, the follicles are incapable of growing long due to a short anagen phase cycle throughout the scalp. The area above my ears cannot even grow one inch in length before dying or shriveling up. And some areas of my scalp are sparser than others.
How Many Hair Transplants do you Need?
Eventually, I will have to choose between shaving it all off or getting a hair transplant. Unless a greatly improved hair loss treatment comes along. I do not like the messy dishevelled look, nor a combover. I also do not like the idea of shaving my head every week in case I go for the barren look. I know I will shave weekly due to having some obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) tendencies.
One of the reasons that I am wary about getting a hair transplant is because I am certain that I will need more than one procedure. I feel like the vast majority of patients need two procedures. Moreover, if you are unlucky, even your “permanent” donor hair at the back of the scalp can thin out before old age. Meaning that over the years you may lose some of it after it is transplanted to the front, and then require a second hair transplant. My mother’s father lost most of his “permanent” donor hair before he hit his 70s, although he never took any hair loss medications.
“Two-thirds (68.2%) of members reported performing an average of one procedure to achieve the desired hair restoration result. The average number of procedures needed to achieve the desired hair restoration result was 1.4.”
I would still go with my guess of 2.0 rather than 1.4. If the ISHRS were to follow these one-and-done patients for 20 years, I bet that the majority do end up getting a second hair transplant in the long run. Or at least wanting a second one, but not going through with it for various reasons.
Edit: Joe and Spencer on the July 28th Bald Truth show raised a great point that some of the patients who go for a second hair transplant with a different surgeon might not get counted as “two”. An accurate survey would poll the patients rather than the surgeons.
In the ISHRS census chart, only 28.6% of patients needed two procedures, and just 3.3% of patients needed three procedures.
Number of hair transplants needed. Source: 2022 ISHRS Practice Census.
Obviously these statistics are impacted by many factors including:
The size of each procedure. FUE procedures tend to be smaller than FUT/Strip procedures. See my post on FUE versus FUT.
The need for any separate repair or scar revision surgeries.
Patient preference for a small versus large session.
Surgeon comfort level in performing larger one time megasessions (or even gigasessions).
It is extremely rare to hear of anyone who has had more than four hair transplants in their lifetime. Most people seem to get two and are done. However, some do go crazy.
Hair Transplant Addiction
On this site, I have covered the two most prolific hair transplant recipients in the world (Spex and Joe) many times.
Joe Tillman (formerly Jotronic) has had 9 hair transplants. He now has an almost daily hair loss show called “The Mane Event“. I have a nagging suspicion that sooner or later Joe will have his 10th.
Obviously, some of these procedures were very small and entailed repair work or scar revision. Joe had some initial surgeries to repair prior bad work. He also had a small body hair transplant procedure. I do not know much about most of Spex’s various procedures.
Both these major hair loss world influencers have access to their choice of leading surgeon. Moreover, I am assuming that they can get free procedures from any quality surgeon nowadays if they document the work in return.
I thought that no-one would ever come close to ever matching Joe and Spex when it comes to this crazy statistic. Besides the significant cost of a single hair transplant procedure, no-one I know likes to go under the knife on a regular basis. Then I read something crazy last week, and further research led to finding yet more anomalies.
Christopher Maloney had 8 Hair Transplants
Singer Christopher Maloney became a viral hit on the UK X Factor show in 2012. His major nervousness as well as stellar voice garnered him a lot of fans. Including 87 million views of the below video:
“My body dysmorphia, my anxiety and depression has taken over my life. In the past 12 months it’s gone into overdrive.”
One fact in the article struck me more than anything else:
Mr. Maloney has had 8 hair transplants (and 7 nose jobs)!
He seems to go to Poland for most of his procedures. In general, people who suffer from BDD will never be willing to get covered in the media. I have to give kudos to Mr. Maloney for sharing his story so publicly. And for having the courage to sing in front of the world.
Interestingly, in the Daily Mail article, Mr. Maloney blames stress for causing his initial hair loss. i.e. telogen effluvium. But that usually reverses itself after a while. In my opinion, he always had thin hair and likely suffers from androgenetic alopecia (AGA). Chris’s new hair looked good the last time he updated his Instagram a few months ago.
Joe Buck had 9 Hair Restoration Procedures
Well known US sports announcer Joe Buck had his eighth hair transplant in 2011. His story makes for a very interesting read. For a long time he lied to people about a surgery related side effect on his vocal cords in order to avoid discussing his “hair plug addiction”.
He had his first ever procedure in 1993 in New York at the age of 24.
“As a young man, one of Buck’s overwhelming fears was losing his hair, and the possibility soon consumed him.”
Also of note, UK reality TV star Calum Best had his sixth hair transplant several months ago. It involved moving beard hair grafts (including from just beneath his neck) to his scalp. In his own words:
“I feel so much better about myself. If science can sort out a problem, why not use it if it is going to improve your mental health and put a smile on your face?”
Calum does not want to take medications such as Finasteride due to any potential side effects. So his hair loss has continued at a faster pace than that of hair restoration patients who are on hair loss drugs.
American actor Cheyenne Jackson has had five hair transplant procedures across 14 years. He calls his significant strip procedure scar “gnarly”. He had his first surgery at the age of 28. Both his hair loss and scar caused him anxiety and shame.
Kintor Pharmaceutical (China) is definitely the real deal. They are moving faster than any other company in the history of the hair loss industry. Moreover, they are conducting hair loss trials for:
Two separate androgen receptor (AR) targeting products: a degrader (GT20029) and an antagonist (KX-826 aka Pyrilutamide).
Each of them in two countries (China and US).
Each of them for both males and females with androgenetic alopecia (AGA).
So potentially 2*2*2*3 phases =24 clinical trials (plus any pre-clinical work)! Hence my excuse for this post becoming very disjointed. The newest updates are on top. The latest July 2023 pipeline from their site is shown in the below image:
Kintor Pharma updated pipeline for Pyrilutamide (KX-816) and AR-PROTAC (GT20029).
Update: July 19, 2023
Kintor Begins Enrollment for Second Phase III Trial for KX-826 in China
This is insane. If you recall, in March 2023 (see further below), Kintor announced that it had completed enrollment of 740 subjects in China and was beginning Phase III clinical trial of its KX-826 (pyrilutamide) androgenetic alopecia product.
Today, Kintor announced that it has also initiated a long-term safety Phase III trial of KX-826 with the first patient just enrolled. A total of 270 male and female AGA patients will be enrolled to evaluate the long-term safety of topical KX-826 for the treatment of AGA patients in China. The treatment period will last 52 weeks.
At the top of this post, I mentioned that Kintor could conduct 24 potential trials related to its hair loss products (plus preclinical work). It seems like they might be shooting for an all-time world record 32 trials! Most likely, they will not do two Phase III trials in every case. Nevertheless, this company is unlike any other that we have ever seen in our lives. All the stereotypes about Chinese product safety issues and trial shortcuts are clearly not apt in this case.
This is the first time in the history of the hair loss world that a company seems to have absolutely no financial restrictions in conducting clinical trials. That too in two countries (including the stricter US), with no significant delays at any phase of the process thus far.
Update: May 11, 2023
Phase 2 for KX-826 (AR antagonist — Pyrilutamide) Completed in the US
Kintor Pharmaceutical announced that the Phase II clinical trial of its KX-826 molecule for the treatment of male androgenetic alopecia in the US was completed successfully. The results are statistically and clinically meaningful with an increase of about 10 hairs per cm2 after 24 weeks of treatment with 0.5% BID KX-826. The safety profile was also favorable and the company plans to meet the FDA and pursue Phase 3 clinical trials. Note that this same 2 trial was already completed in China last year, with a superior result of a hair count increase of 22.73 hairs per cm2.
Update: April 14, 2023
Phase 2 for GT20029 (AR degrader) Begins in China
Kintor Pharma just completed the first patient enrollment in China for its proteolysis targeting chimera (PROTAC) compound GT20029. The Phase II clinical trial is a multi-center, randomized, double-blind, placebo-controlled study. It will evaluate the efficacy and safety of androgen receptor degrader GT20029 for treating male pattern baldness in Chinese adults. Kintor plans to enroll a total of 180 male AGA patients from 12 centers nationwide.
Update: March 28, 2023
Phase 3 for KX-826 (AR antagonist — Pyrilutamide) Begins in China
Kintor just completed enrollment of 740 subjects in China for its Phase III clinical trial of its KX-826 (pyrilutamide) androgenetic alopecia drug candidate. It expects to release the top-line data in Q4 2023. If the data is positive, the company plans to proceed with the NDA application with the China NMPA.
Update: March 21, 2023
Kintor Pharma Presentation at AAD2023
At the just concluded American Academy of Dermatology Association (AAD) 2023 meeting in the US, there is an interesting update from Kintor Pharma. The renowned Dr. Ken Washenik made a presentation on both of Kintor’s androgenetic alopecia products: pyrilutamide (KX-826) and GT20029. His talk was titled: “The Emerging Potential of Topical Androgen Modulators in Androgenetic Alopecia”.
Besides discussing clinical trial data, Dr. Washenik highlighted the emerging potential of topical androgen receptor (AR) modulators in the treatment of pattern hair loss. Key quote:
“The potential of an effective topical AR blocker without systemic side-effects has long been promising.”
Latest Clinical Trial Status
Per this latest news release (and their pipeline page), Kintor’s latest status of trials (as of March 2023) is as follows:
Conducting Phase III clinical trials in China of KX-826 for male AGA.
Conducting Phase II clinical trials in the US of KX-826 for male AGA.
Planning Phase III clinical trials in China of KX-826 for female AGA.
Conducting global multi-center Phase III clinical trials of KX-826 for male and female AGA.
Analyzing results of completed Phase I clinical trials of GT20029 for the treatment of AGA in China and the US.
At the same AAD conference, Dr. Adelaide Hebert also discussed Kintor’s KX-826 for the treatment of acne. It works by competing with dihydrotestosterone (DHT) for binding to ARs. It inhibits gene expression that in turn reduces sebum production and inflammation.
Update: December 1, 2022
Kintor Phase 2 Results for KX-826 in Females
Not surprisingly, yet another positive Kintor update. Their Pyrilutamide (KX-826) phase 2 clinical trial results for females with androgenetic alopecia just got released. And the findings are positive. Total area hair count (TAHC) increased 11.39 hairs per cm2 compared with the placebo group after24 weeks of treatment. It seems like they are going with a dosage of KX-826 5mg (0.5%) once a day, even though twice a day was also tested.
The overall safety profile of Pyrilutamide in females was good, and no participant needed to drop out due to any adverse event. Note that these results, whilst encouraging, are less than half what was seen in men (22.73 hairs per cm2 increase). See further below for the prior updates on the male trials. Both these Phase 2 trial were conducted in China, and Kintor is expected to conduct Phase 3 trials for men and women in China too.
Update: November 24, 2022
Phase 1 Trials for GT20029 a Success
Kintor just announced positive top-line results for its Phase I clinical trial of GT20029 for the treatment of androgenetic alopecia and acne. GT20029 is the world’s first topical Proteolysis Targeting Chimera (PROTAC) compound that has completed Phase I clinical trials. It works by degrading the androgen receptor. The topical administration of GT20029 was safe and well-tolerated, with limited systemic exposure. Note that this study was in China.
Kintor Releases KX-826 Phase 2 Trial Results in Males
Kintor just released the Phase 2 results from China on their website and they are positive. Note that this Pyrilutamide (KX-826) topical hair loss product is an androgen receptor antagonist. In contrast, existing hair loss products Finasteride and Dutasteride are both oral DHT inhibitors.
Key quote:
“The results showed that the KX-826 (0.5%) 5mg BID group demonstrated significant improvement in TAHC as compared with the baseline (increased by 22.73 hairs per cm2; and placebo group (increased by 15.34 hairs per cm2) after 24 weeks of treatment. The recommend phase III dose is determined as KX-826 (0.5%) 5mg BID.”
Note that BID means twice daily. A total of 120 Chinese adult male subjects with a mean age of 35.6 were enrolled in the study. All had a Hamilton-Norwood classification III or higher balding pattern. They were equally divided into four groups:
KX-826 2.5 mg (0.25% concentration) twice daily.
KX-826 5 mg (0.5% concentration) once daily.
KX-826 5 mg (0.5% concentration) twice daily.
Placebo.
The overall safety profile of KX-826 was good per these results. No serious adverse event (SAE), adverse drug reaction (ADR), or death occurred. After 14 days of topical application, the blood concentration of KX-826 was very low in all dose groups.
Kintor says that it will accelerate the clinical progress of KX-826 and GT20029 in order to:
“Bring more innovative and effective treatment options to the hundreds of millions of people suffering from AGA and acne vulgaris worldwide.”
Update: August 11, 2022
Pyrilutamide Phase 2 Clinical Trial Results
Great news per a Chinese contact. It looks like Kintor may finally present the results of its Phase 2 Chinese trials of Pyrilutamide (KX-826) for hair loss on September 3 at 8:20 pm . The presenter will be Dr. Zhou Cheng from Peking University People’s Hospital (where Kintor’s Phase 3 trials are also being conducted right now).
Note that Kintor is not named in the presentation. However, I noticed that the chairman of this group of presenters (from Peking University) is Dr. Zhang Jianzhong. This man is listed in Kintor’s press releases as the principal investigator. So I decided to update this post as it looks believable now after months of waiting and delays.
The possible presentation (after translation) is titled: “New progress in diagnosis and treatment of androgenetic alopecia.” Please note that this KX-826 androgen receptor antagonist product is unlikely to bring back long lost hair in totally bad areas of the scalp. All I am hoping for is something as good as Dutasteride, but with a different mechanism of action.
Kintor Pharma presentation of Phase 2 clinical trials results will occur on September 3 in China at a Dermatology conference.
Kintor Pharmaceutical Update: Three Clinical Trials
Update: August 9, 2022 — Kintor just completed enrollment of 92 subjects in China for Phase 1 trials of its GT20029 hair loss product. This proprietary Proteolysis Targeting Chimera (AR-PROTAC) product is the world’s first topical androgen receptor degrader compound to enter clinical trials. They will test a gel or tincture per the press release, and results will be finalized at the end of 2022.
Update: August 3, 2022 — Kintor just completed patient enrollment of 121 subjects in its Phase 2 clinical trials of KX-826 (pyrilutamide) in the US. This topical androgen receptor antagonist product will be used to treat androgenetic alopecia.
Update: July 2022 — The China Phase 2 trial results for pyrilutamide for hair loss will occur at the postponed 28th Annual Meeting of the Chinese Society of Dermatology. It runs from August 31-September 4, 2022 in Shenyang.
Updates in April 2022
Some very unique updates in our Kintor channel in the hair loss chat this past week.
Kintor will present the results of its Phase 2 clinical trials (of KX-826, aka Pyrilutamide) for androgenetic alopecia at a “high-profile symposium” in June 2022.
Some people managed to view a classified Phase 2 results slide that concluded Pyrilutamide’s hair growth effect to be similar to Dutasteride. This would be amazing if true, since Pyrilutamide (targets the AR receptor) is totally different from Dutasteride (targets DHT). Anecdotal reports for now, but seem to be causing a lot of excitement.
A number of people are starting to report their results from using KX-826 via a Group Buy. I cannot encourage such experimental behavior, but I am following the reports on Reddit and Discord keenly.
Kintor will Start Phase III Trials in China in January 2022
In the latest update from today (November 24th, 2021), Kintor Pharmaceutical announced that it will begin Phase 3 trials in China in January 2022. Update: Now begun.
The company’s IND application for the pivotal study (phase III) of pyrilutamide (KX-826) was cleared by China’s National Medical Products Administration. KX-826 is the first androgen receptor (AR) antagonist to enter phase III clinical trials anywhere in the world.
This is perhaps the best news in the hair loss world so far in 2021.
Update: November 12, 2021 — Kintor Pharma just started Phase II clinical trials in women in China with a first dose of pyrilutamide (KX-826). This trial pertains to androgenetic alopecia in women (i.e., female pattern hair loss).
Update: September 8, 2021 — Kintor Pharma just announced that its Phase II clinical study for KX-826 to treat androgenetic alopecia was a success. Primary endpoint was met. More detailed results will be released later per CEO Dr. Youzhi Tong. Phase III clinical trials in China will commence in the fourth quarter of 2021. Even better, Phase II trials are also currently taking place in the US. And Phase II trials for women will take place in China
Update: July 11, 2021 — The US FDA just approved Kintor’s Phase II clinical trial for pyrilutamide (KX-826) to treat androgenetic alopecia. Note that the company’s trials in China are already mid-way through Phase II per their pipeline page.
They area also working on another hair loss product named GT200029 that is an “AR-PROTAC” compound. Its Phase 1 trials will start in China this month.
April 15, 2021
Kintor Pharma: AR Antagonist and AR Degrader
Earlier today, it was announced that Kintor received approval in China to begin clinical trials for GT20029. This product will be in tincture or gel format, and will be tested for the treatment of androgenetic alopecia and acne.
The GT20029 product is an androgen receptor degrader (AR Degrader). It is developed using Kintor’s proprietary Proteolysis Targeting Chimera (PROTAC) platform. According to the press release, this is the world’s first topical androgen receptor (AR) compound (AR-PROTAC) to enter clinical trials. GT20029 degrades the AR protein via the E3 ubiquitin ligase pathway. During preclinical studies, GT20029 did not cause any notable side effects or systemic drug accumulation.
Note that Kintor’s main product for treating male pattern hair loss is KX-826 (Pyrilutamide) and is an androgen receptor antagonist (AR Antagonist). I covered the latter in prior updates to this post if you read till the end. KX-826 is currently in Phase 2 clinical trials in China and in Phase 1 trials in the US.
Note that Cassiopea’s Breezula (Clascoterone) is an AR antagonist that is well ahead of KX-826 when it comes to clinical trial stage. Kintor’s website has a very interesting article discussing both AR antagonist products and hair loss in China in general.
Kintor’s investigational new drug (IND) application of GT20029 for androgenetic alopecia and acne vulgaris was accepted by the National Medical Products Administration (NMPA) of China.
Kintor has moved forward with its trials faster than any other hair loss company. I am glad to see a Chinese company finally entering the hair loss cure market. Scientific and technological progress seem to happen faster in China than in the west. Hopefully, clinical trials for hair loss products will follow the same pattern.
Side note: In July 2020, Kintor and Applied Biology (US) collaborated on using Proxalutamide for the Treatment of COVID-19. There is a school of thought that suggests anti-androgens could help reduce Coronavirus fatalities. To date, more men have died from the disease then have women.
Kintor Pharmaceutical (China) also recently completed the enrollment of 120 patients in its Phase II clinical trials for pyrilutamide for hair loss. See the bottom half of this post for my original discussion on Kintor. Their stock is traded on the Hong Kong Hang Seng Index.
Key quote from CEO Dr. Youzhi Tong:
“We will accelerate the progress of its phase II/III clinical study so as to bring benefits to the people suffering from alopecia as soon as possible.”
May 26, 2020
A new Chinese company named Kintor Pharmaceutical is working on an interesting hair loss drug called pyrilutamide . It is extremely rare to hear about any Chinese company involved in hair loss cure research. Very strange, considering the country’s rapid pace of scientific advancement and massive population. Moreover, Chinese men and women are nowadays balding at much faster rates than in the past.
Four days ago, China-based Kintor Pharmaceutical (also known as Suzhou Kintor Pharmaceuticals) got significant Chinese media coverage. This interest was related to the company’s prostate cancer, breast cancer and hair loss drugs.
Earlier this month, Kintor Pharmaceutical also had a very successful IPO in Hong Kong.
While the company’s main focus seems to be its prostate cancer and breast cancer drugs, its androgenetic alopecia drug trials are also advancing rapidly. Their main androgen receptor blocking drug candidate is called Pyrilutamide (KX-826) and it is applied to the scalp topically. The company’s Proxalutamide drug slows or stops cancer cell growth by entirely inhibiting androgens.
Pyrilutamide
The one disappointing news is that Kintor aims to take on Johnson & Johnson’s Minoxidil. This could mean that topical Pyrilutamide is unlikely to be much better than Minoxidil. I hope I am wrong. Recently completed phase one trials in China proved that pyrilutamide is safe and causes no major side effects in humans.
Kintor is currently conducting phase 2 clinical trials for pyrilutamide on 160 men in China, and phase 1 trials on 30 men in the US. Phase 3 trials on 600 people in China, the US and Japan are planned for as soon as 2021. I would guess that the US FDA and Japanese PMDA will never accept Phase 2 results from China as any kind of proof to proceed to Phase 3 trials in the US and Japan.
So how can the company proceed so fast in the US and Japan?
