This is a summary of what I’ve posted to date. Sorry about the lack of organization.
Short answer: Yes, you can use minoxidil and finasteride to essentially prevent the onset of MPB, or reduce its severity. Regrettably, questions re: hair loss provoke much incorrect information by SDMB posters. Do a search of my user name and you will find a fairly rigorous explanation of treatment options, caveats and assorted trivia.
Longer answer: The normal cycle of hair growth lasts 2 to 6 years (mean 4.5 years), during which time individual hairs grow about .5 inches per month. It’s estimated that approximately 90 percent of hair is growing at any one time, with the remaining 10 percent in a scheduled rest phase–typically coinciding with a hair’s fifth year–prior to falling out and being replaced with new hair within about six months. On average, we lose about 100 hairs from our scalp daily, but the average scalp has about 100,000 hairs, so the loss isn’t noticed.
There are different types of hair loss. Male (or female) pattern baldness (MPB) is caused by the failure to produce new replacement hairs, not by excessive hair loss. By age 30, 25 percent of men begin to bald. By age 60, 65 percent are either bald or have advanced balding. The pattern of hair loss associated with MPB typically sees a receding hairline and thinning at the crown/vertex. Women experience different hair loss patterns.
The chief culprit behind MPB is dihydrotestosterone, a metabolite of testosterone that is formed in the testes, hair follicles and adrenals by the enzyme 5 αlpha-reductase. Dihydrotestosterone is an androgenic hormone and believed about 30 times more potent than testosterone due to its increased affinity for androgen receptors within the follicle. This androgenic activity causes slower and less healthy regrowth. As hair cycles through its growth, rest and shedding phases, hairs grow back thinner, shorter and with less pigment until the hair resembles peach fuzz. Hair loss can be stopped by stimulating growth despite the effects of DHT.
Bottom line: This young thread is already riddled with inaccuracies and speculation, which is par for course. Anti-androgens far more powerful than finasteride exist. Left unsaid and unsearched, of course, are the long-term effects, especially when used by young healthy subjects. As you can imagine, the pharmaceutical industry isn’t pushing the frontier on this matter.
BTW, efficacy of minoxidil is dose dependent. Some online proprietors sell minoxidil at 12.5 percent strength–roughly 2.5 times the strength of the high-strength formulation and about 5 times stronger than the original. You can also obtain it formulated with 5 percent azelaic acid.
The current favorite hypothesis suggests that intracellular potassium channels in the follicles play an important role in regulating hair growth, and that antihypertensive agents (e.g., minoxidil) increase the exchange of potassium ions through vasodilation, resulting in hypertrichosis. (Minoxidil, of course, has no significant effect on counteracting the two key enzymes implicated in alopecia.)
[snatched this from a website. Didn’t snatch the url] …
Minoxidil for Frontal Hair Loss & Receding Hair Lines
According to a Dermatology Times article which portrayed a recent study of minoxidil in the treatment of frontal hair loss, there was clear evidence that showed minoxidil was effective in treating not only the vertex but the frontal scalp region as well.
“Results at 48 weeks (study conclusion) show that visible, photographically evident improvements were seen in the frontal scalp regions of 51 percent of men using 5 percent minoxidil, 42 percent using 2 percent minoxidil, and 13 percent of placebo users. Among these men, moderate to great increases in hair growth were seen in the frontal scalp regions of 19 percent of men using 5 percent minoxidil, 10 percent using 2 percent minoxidil, and 3 percent of placebo users.” - Dermatology Times, 2003
In answer to the OP, there are a couple of leading theories as to why regrowth in frontal hair loss is more difficult to reverse. First is the evident fact that this is where hair loss often begins, meaning that the miniaturization process is further along and more difficult to reverse. Given the start of the art, perhaps it’s tantamount to restarting the heart of a patient who has gone flatline for 10 minutes. The damage is done.
And why is the frontal hair region often affected first? The leading theory suggests this is where a disproportionate number of DHT receptors are located, and/or this area is more sensitive to DHT/5-alpha reductase.
All of this points to the need for prevention. Caught early, there’s no reason why a young man should continue losing his hair, unless he prefers baldness.
I’d ask your friend’s physician, but would expect few GPs to have indepth knowledge, though a bit-city dermatologist should. When paired with minoxidil, antiandrogens (e.g. propecia/finasteride, spironolactone, avodart, etc.) have been shown to be effective in halting and even reversing (recent) frontal hair loss. They are believed to work by blocking DHT receptors, but understanding into the underlying mechanisms is sketchy.
Avodart, in particular, blocks an amazing 93 percent of DHT. It’s prescribed off label, of course, and many dermatologists balk at prescribing any of these meds to women, regardless of whether they are in their childbearing years. Others, however, will.
Problem is, the very long-term research into side effects just isn’t there. Remember: We’re talking about healthy young men taking antiandrogens for hair loss, possibly for decades–not 60ish men concerned about prostate dysfunction. A recent small study raised linked antiandrogens and the growth of aggressive tumors. Skeptics scoffed. More research is needed
While finasteride and minoxidil do indeed yield clinically significant results in large trials for the treatment of MPB, the more operative question is whether combination therapy yields cosmetically acceptable results and whether said results justify the possible, albeit still unknown, risks of longterm use.
Clinical trials are just beginning to explore this frontier and the full picture may not be known for 10-15 years. Left untold–and currently medically unknown–are the possible longterm consequences associated with oral finasteride’s effect of “stopping [male pattern baldness] dead, case closed, end of discussion,” as you put it.
For now, consider these very preliminary findings, all layperson accessible and none conclusive:
“While finasteride (Propecia/Proscar) decreases serum DHT, it also is thought to increase estrogen which suggests that men over 35 may want to consider using it in conjunction with a systemic aromatase inhibitor such as Chrysin/Piperine (Super Miraforte), Arimidex, or stinging nettle extract, to maximize its hair growth effects and minimize potential side effects (that are listed in the PDR) such as Gynocaemastia (breast enlargement in males), sexual side effects, and an increase in fat deposition. These compounds have been reliably shown to increase testosterone and reduce excess estrogen, resulting in a youthful hormone profile that optimizes immune function and to some degree, body composition”
Proscar for Prostate Cancer Prevention: Q&A - WebMD, 6/24/03 - “a drug called Proscar can also prevent or delay prostate cancer. It also shows that the drug may increase the risk of aggressive, high-grade prostate tumors. And while men taking Proscar have fewer urinary problems, they also have more sexual problems”
Analysis Shows Drug Could Save Lives From Prostate Cancer - Science Daily, 3/16/05 - “the commonly used drug finasteride reduced the incidence of prostate cancer by 24.8 percent compared to a placebo. However, a possible increase in the number of high-grade tumors in the trial prompted many to question whether any benefits of the drug would be offset by an increase in mortality related to the higher-grade tumors. No difference in mortality was seen during the 7 years of PCPT”
http://64.233.161.104/search?q=cach...cia+risks&hl=en
Bottom Line: Combination therapy with finasteride and doxazosin for at least four years reduces the risk of clinical progression of BPH. However, long-term use of finasteride also is associated with an increased risk of high-grade prostate cancer (Thompson IM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med July 17, 2003;349:215-24). Until this risk is better elucidated, combination therapy should be limited to patients who have a prostate volume greater than 40 mL, a PSA level greater than 4 ng per mL, and a clear understanding of the risks and benefits of therapy. (Common POEM) (Level of Evidence: 1b)
http://www.aafp.org/afp/20040501/tips/2.html
The second study analyzed data from the landmark Prostate Cancer Prevention Trial, involving more than 18,000 healthy men. Some received finasteride, while others got a placebo. The trial, scheduled to last seven years, was cut short early because researchers found a nearly 25 percent reduction in the incidence of prostate cancer in the men taking finasteride.
However, that good news was tempered by the fact that the overall incidence of aggressive cancers was doubled in the men who took finasteride compared to those did not. So while most participants benefited from the drug, a minority may actually have fared worse.
Because of that paradox, “there was controversy about whether or not it was worth giving finasteride to the general population,” said Joseph M. Unger, the Prostate Cancer Prevention Trial statistician who performed the new analysis.
http://64.233.161.104/search?
q=cache:YskjVZjosT4J:health.yahoo.com/news/58984+finasteride+risks&hl=en
As for oral minoxidil, the form prescribed for high blood pressure, patients should use minoxidil only under medical supervision to ensure that excessive amounts of the drug are not absorbed into their bodies. Large amounts of minoxidil may increase the severity of the symptoms and side effects of hypertension.
http://www.healthatoz.com/healthato...y/minoxidil.jsp
Though some may find your certitude and zeal (e.g. “weapon of choice”) refreshing, “end of discussion” is rarely the phrase of choice in medicine. While finasteride and minoxidil do indeed yield clinically significant results in large trials for the treatment of MPB, the more operative question is whether combination therapy yields cosmetically acceptable results and whether said results justify the possible, albeit still unknown, risks of longterm use.
Clinical trials are just beginning to explore this frontier and the full picture may not be known for 10-15 years. Left untold–and currently medically unknown–are the possible longterm consequences associated with oral finasteride’s effect of “stopping [male pattern baldness] dead, case closed, end of discussion,” as you put it.
For now, consider these very preliminary findings, all layperson accessible and none conclusive:
“While finasteride (Propecia/Proscar) decreases serum DHT, it also is thought to increase estrogen which suggests that men over 35 may want to consider using it in conjunction with a systemic aromatase inhibitor such as Chrysin/Piperine (Super Miraforte), Arimidex, or stinging nettle extract, to maximize its hair growth effects and minimize potential side effects (that are listed in the PDR) such as Gynocaemastia (breast enlargement in males), sexual side effects, and an increase in fat deposition. These compounds have been reliably shown to increase testosterone and reduce excess estrogen, resulting in a youthful hormone profile that optimizes immune function and to some degree, body composition”
Proscar for Prostate Cancer Prevention: Q&A - WebMD, 6/24/03 - “a drug called Proscar can also prevent or delay prostate cancer. It also shows that the drug may increase the risk of aggressive, high-grade prostate tumors. And while men taking Proscar have fewer urinary problems, they also have more sexual problems”
Analysis Shows Drug Could Save Lives From Prostate Cancer - Science Daily, 3/16/05 - “the commonly used drug finasteride reduced the incidence of prostate cancer by 24.8 percent compared to a placebo. However, a possible increase in the number of high-grade tumors in the trial prompted many to question whether any benefits of the drug would be offset by an increase in mortality related to the higher-grade tumors. No difference in mortality was seen during the 7 years of PCPT”
http://64.233.161.104/search?q=cach...cia+risks&hl=en
Bottom Line: Combination therapy with finasteride and doxazosin for at least four years reduces the risk of clinical progression of BPH. However, long-term use of finasteride also is associated with an increased risk of high-grade prostate cancer (Thompson IM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med July 17, 2003;349:215-24). Until this risk is better elucidated, combination therapy should be limited to patients who have a prostate volume greater than 40 mL, a PSA level greater than 4 ng per mL, and a clear understanding of the risks and benefits of therapy. (Common POEM) (Level of Evidence: 1b)
http://www.aafp.org/afp/20040501/tips/2.html
The second study analyzed data from the landmark Prostate Cancer Prevention Trial, involving more than 18,000 healthy men. Some received finasteride, while others got a placebo. The trial, scheduled to last seven years, was cut short early because researchers found a nearly 25 percent reduction in the incidence of prostate cancer in the men taking finasteride.
However, that good news was tempered by the fact that the overall incidence of aggressive cancers was doubled in the men who took finasteride compared to those did not. So while most participants benefited from the drug, a minority may actually have fared worse.
Because of that paradox, “there was controversy about whether or not it was worth giving finasteride to the general population,” said Joseph M. Unger, the Prostate Cancer Prevention Trial statistician who performed the new analysis.
http://64.233.161.104/search?
q=cache:YskjVZjosT4J:health.yahoo.com/news/58984+finasteride+risks&hl=en
As for oral minoxidil, the form prescribed for high blood pressure, patients should use minoxidil only under medical supervision to ensure that excessive amounts of the drug are not absorbed into their bodies. Large amounts of minoxidil may increase the severity of the symptoms and side effects of hypertension.
http://www.healthatoz.com/healthato...y/minoxidil.jsp
