sup choose how y'all living hope everything is nova and you're all having a prime week so even though finasteride has been the first line of defense against androgenic alopecia since 1992 when the drug was first introduced to the market hair loss sufferers for ages have been looking for effective adjunct treatments for finasteride of course we also have minoxidil which is an effective adjunct treatment but minoxidil what it is it's a growth stimulant which works independently from hormonal mechanisms so as effective as it is it doesn't really target hair loss at its source since after all it is the trash hormone dht that causes hair loss and whatever we do in our quest to stop hair loss we need to use something to suppress that hormone if we want to stop hair loss long term fortunately the use of a five air inhibitor like finasteride is enough for the overwhelming majority of people but why is it you may ask that we lower dht by suppressing the five air pathway which converts testosterone into dht wouldn't it be more effective to block dht with a direct ancient antagonist well obviously an androgen antagonist administered orally is not a viable option for cisgendered men since it targets all androgens testosterone included which of course is not a trash hormone like dht but how about administering android antagonists topically as opposed to orally well unfortunately most of these direct anti-androgens like topical flutamide becaludamide or topical ciproterron can not be used even topically without compromising our virility since they do absorb systemically but there do exist some topical anti-antigens that can be used safely these days a popular choice includes florida which is an anti-angin that is chemically similar to flutibide except it is hydrophobic meaning it is deactivated when it enters the bloodstream thus negating the risk of side effects there are also upcoming topical anti-entrance in the pipeline that are currently undergoing clinical trials such as pure ludibide and class scotterone and while these are exciting none of them have yet even proven to be useful as anything more than just adjuncts for finasteride make no mistake while topical android antagonists might be useful five ar inhibitors like finasteride or dutasteride are absolutely still the gold standard when it comes to fighting hair loss because of their ability to markedly lower scalp dht safely even while using low doses of the drug interestingly enough though there is one anti-androgen that i had thought was all but forgotten about but now thanks to some new research it has been generating a bit of hype in the hair loss community and that compound is topical spironolactone so the story behind spironolactone is interesting because it is similar to the story behind minoxidil minoxidil was developed as a treatment for high blood pressure and incidentally was found to cause hair growth similarly spironolactone was developed as a diuretic but also was found to cause hair growth further research showed that spirolactone is a moderately effective ancient receptor blocker and also blocks some steps in the synthesis of testosterone so it can directly lower testosterone at high doses the way it works as an android blocker is that it basically is a very very weak androgen that competes with the angine receptors in your cells and thus prevents stronger androids like testosterone and dht from binding with them as such the drug when used for androgen suppressing purposes can cause hypogonadism and even feminization in fact at high doses it is even used by male to female trans women to help them transition it is important to note though that spironolactone doesn't exhibit anti-androgenic properties unless it is prescribed at higher doses usually 100 milligrams or more so it isn't a treatment you can micro dose orally as a way to get around its feminizing side effects and i only bring that up because i know some people have actually tried to do that on the other hand oral spiritolactone can be a viable treatment for women's hair loss and i made a video about that which i'll link below but it is absolutely not a viable treatment for cisgendered men so don't try to use it unless you're transgender so just like minoxidil is now used in a topical form in order to avoid its dangerous systemic side effects spirit of lactone can be used topically as well now topical spirit naloxone has been around for a long time it used to get a lot of hype in the 2000s and early 2010s as potentially being a finasteride alternative or at worst at least being a fairly powerful adjunct to an existing hair loss stack these days though until recently topical spironolactone has been rarely talked about at all it was overshadowed by newer treatments like florida alpha tridial and even research chemicals like ru5 and 841 which has also been around for a while but still gets a fair amount of hype despite the lack of clinical data on its safety and efficacy nevertheless there has been a resurgence of interest in topical spironolactone due to a recent article that compared it to topical minoxidil so let's go ahead and take a balls deep look at this new research that is causing all this hype about a once thought extinct topical anti-androgen for hair loss topical sternolactone so like i said just last year this article was published in 2021 it was an article from egypt that was published comparing topical spiritolactone with topical minoxidil it is titled quote a novel topical combination of minoxidil and spironolactone for androgenetic alopecia clinical histopathological and physiochemical study unquote this was a randomized controlled study of 60 subjects there were 39 men and 21 women all with androgenic alopecia aged 18 to 45 years old the subjects were divided into three groups of 20 people the first group received topical minoxidil the second received topical spironolactone and the third group received a combination of both minoxidil and spironolactone in this study each subject served as their own control hair growth was compared before and after treatment using global photographs that were assessed by one of the researchers who was blinded as to what treatment they were receiving but there was no separate control group who just got a placebo treatment which is a limitation for the study since believe it or not sometimes just taking a placebo treatment can result in some hair growth and if you don't include a placebo group you can overestimate the effects of an active treatment fortunately the investigators also did scalp biopsies at the beginning of the study and at the end of the study which was after 12 months in these biopsies they looked at the number of anagen growth phase hairs the number of telogen resting phase hairs and the number of vellus hairs which are miniaturized hairs and this kind of microscopic evaluation is a much more objective assessment than just looking at photographs interestingly the researchers didn't use the standard minoxidil liquid or foam we're all familiar with instead they created a new homemade formulation which was a five percent gel the spironolactone was used as a one percent gel and the combination groups received the gel containing both drugs together part of the study involved doing chemical tests on the combination gel to make sure the two drugs didn't interact with each other in the gel but i can summarize that part of the research briefly by saying they found no problems for mixing both drugs together in a gel form what we're most interested in of course is the hair growth results well to summarize the photographic results in group one the minoxidil only group ninety percent of subjects were responders to treatment and four had excellent six had good two had fair and six had poor results in group two the spironolactone group there was a slightly lower response rate of eighty percent with five subjects with excellent four with good and seven with poor response the final group which is the group which used a combination of minoxidil and spironolactone had the best results there was a 100 percent response rate with eight having an excellent result 10 with a good result two with a fair result and none with a poor result or no result this figure here shows examples of results in the three groups of course it's hard to judge the overall results based on individual results but at least in all three of these individuals there appears to be good results also statistically the combination of minoxidil and spironolactone was significantly better than either drug used alone now if we look at the scalp biopsies all three groups showed improvements in the minoxidil only group the average number of engine growth phase hairs went from 9. 1 to 12. 1 in the spirit of lactone only group the average number of antigen growth hairs went from 7.
8 to 10. 1 hairs the group that combined spiritolactone and minoxidil had anogen hairs go from 4. 7 to 9.
7 all these changes were statistically significant so judging by the magnitude of the effect it looks like the combination was best but the researchers don't quote any statistics comparing the three groups with one another so unlike with the photographic results i don't think we can conclude from the biopsy results that the combination group was better than either therapy alone all three treatment groups also saw significant decreases intelligent and vellus hairs this figure shows some of the changes seen in the scalp on spironolactone there are more antigen growth hair shown by the black arrows and fewer telogen resting hair shown by the yellow arrows similar changes were seen with the other treatment groups regarding side effects there was contact dermatitis in 20 of patients but the investigators don't mention if this was worse with minoxidil or spironolactone or if both caused the same amount of dermatitis the dermatitis was quote mild and durable unquote there were fortunately no sexual side effects and no gynecomastia occurred as well which is good because gyno is definitely a side effect of oral spironolactone so it seems like at least topical sphere naloxone doesn't have much systemic absorption so this is a small study but it suggests that topical spear naloxone might be just slightly less effective than topical minoxidil which already works very well and the researchers suggest that the combination of the two drugs was better than either drug alone however i think the numbers are too small to conclude that spironolactone is worse than minoxidil and i also think the numbers are too small to conclude that the combination of minoxidil plus spironolactone is better than either drug alone there were only 20 subjects in each group and there was no true control group in this study also the investigators are basing their conclusions on global photographs which can be very subjective the scalp biopsy showed significant changes in all three groups but the researchers don't give any stats suggesting the combination therapy was better than either therapy alone when judged by scalp biopsies but i think we can at least conclude that topical spironolactone has some effects after all it is an angine receptor blocker and so will therefore probably lower dht in the scalp but i have to agree with the investigators when they say quote these results have yet to be confirmed by long-term studies to deeply evaluate their efficacy and safety with larger number of subjects unquote so yeah we can probably conclude that there is at least a decent chance that topical spherenolactone helps a little bit but what about compared to other topicals besides minoxidil well there isn't much data but we do have one study that compares topical spheronolactone to topical finasteride sadly though this is not exactly what most would consider to be a great study it's also from egypt and was published in 2020 the title is quote topical finasteride versus topical spironolactone in the treatment of androgenetic alopecia unquote in this study the researchers looked at 32 subjects with antrinic alopecia half the subjects were men and half were women the subjects were divided into two groups one group received topical finasteride 0. 1 percent solution the other got topical spiritolactone 5 solution there is no mention as to whether these solutions were applied once or twice per day also like in the previous study we discussed there was no true control group that just received a placebo treatment in the study the results were based on trigonograms done before and after six months of treatment in each group so it doesn't sound like too bad of a study design since the investigators used trichograms which are pretty objective as opposed to photographs that could be misleading due to different angles different lighting and hair styling etc the problem with this study though is that the conclusions from the study don't seem to follow from the results also the study is written in a strange way the method section is very short and the actual methods are included in the results section most of the results actually appear in the discussion section this discussion section just repeats the results shown in the tables and is virtually complete gibberish whoever was the medical editor who accepted this paper they were asleep at the switch clearly let's try to decipher the results here in this table the researchers showed that there was no difference in the trichogram results between topical spironolactone and topical finasteride in men and in this table they show there was no difference for females either for some reason the investigators looked at some more obscure trichogram features rather than hair counts they looked at hair diameter diversity which is hiring androgenetic alopecia because there is a mix of normal sized hair and miniaturized hair they also looked at what's called a trichia which is areas with no hair growth obviously the more atricia you have the more bald you will be and they also looked at what's called the propeller sign which is some darkening of the skin around the hair which supposedly correlates with inflammation around the hair follicles that can be seen in androgenic alopecia so as hoped for the trichoscopic features of androgenic alopecia generally improve with both treatments but there were no statistically significant differences between the two treatments however despite this the researchers for some reason concluded that topical spironolactone was better than topical finasteride they say quote our study shows that topical spironolactone is better than topical finasteride in male and female groups topical spironolactone and topical finasteride in female group were better than topical spironolactone in topical finasteride and male group unquote huh something must be lost in the translation here maybe this last page in the study explains it but i don't read elvish so i'm kind of left in the dark here but this study is clearly pretty bad now i've reviewed topical finasteride many times before and i'll go ahead and link some of the more recent videos i've made on the subject in case you haven't seen them yet but the bottom line is that topical finasteride it is effective but there are systemic effects so it's not the perfect alternative to oral finasteride some hope for in order to avoid oral finasterides very low risk of side effects however i have to say that this study is such a mess that it is impossible to conclude anything from it other than like in the earlier study we talked about topical sparinoloctone has some effectiveness but i don't think we have enough data to compare it to an established treatment like topical minoxidil or even know how it measures up to topical finasteride so the bottom line is that while i would never trust something with limited data like topical spirit electone to be used in place of a 5ar inhibitor like finasteride i still think some of the existing data indicates it may at least have some utility as an adjunct treatment to an existing hair loss stack overall though it is nothing to get too excited about especially since we have far more promising topical anti-androgens in development like pure ludamide which will likely render spironolactone obsolete and i did a video about perilous which i'll link below if you want more of an in-depth explanation about that compound which is coming out fairly soon maybe a year or two also i should mention that topical spirit of lactone is something i've actually tried before and even though i didn't use it for very long term just a few months i didn't notice any benefit from it in fact the only thing i remember about it was how disgusting it smelled almost like a combination of cheap rubber and a lemon-scented perfume or something it was very gross and it was punched enough that i could smell it even hours after applying it to my scalp truth be told though there probably isn't much point in incorporating spironolactone into your routine finasteride is going to be good enough to control androgens for the overwhelming majority of people and if finasteride isn't enough it would be much more convenient and cheaper to just use a stronger 5ar inhibitor like dutasteride especially since dutasteride can be easily titrated safely up to 2.
