by the way how important is DHT post puberty seemingly uh it depends cuz from a cognitive Health perspective from a balance of estrogen standpoint from a Vaso dilation in the penis standpoint like there are certain things where you could say it's pretty critical but then there's also you could just as easily say it's not necessary or mandatory like you will survive and likely Thrive just the same with a lack of DHT almost entirely like even when you a lot of people will demonize 5 Alpha reductase Inhibitors and justifiably so in some cases but even when
you look to literature that compares Placebo versus finasteride versus dutasteride side effect profiles are pretty similar even yeah dutasteride finasteride being Two drugs that block five Alpha reductases used initially for reducing prostate size because DHT disproportionately drives prostate growth uh but also used for I think I would say used more for hair loss now yeah um but yes and we have talked about this on two podcasts previously about post finasterid syndrome um which is a debatable idea in other words there's not a clear consensus in the Urologic literature about even the existence of this let
alone the prevalence let alone the reversability of it all of these things are really unknown and um actually it's created quite quite a bit of a a conundrum for us because we have a number of patients who take faside or dutasteride uh for hair loss and um what's your stance on five Alpha reduct this Inhibitors just at a yeah I mean look I think uh I I'll be honest with you I never really paid enormous attention to it until about a year ago um and I I think right now our stance is I probably wouldn't
start somebody on it m um and if a person so in other words if a person has BPH we're not going to manage that anyway but a urologist has far better tools to manage BPH than five Alpha reductase Inhibitors so I feel pretty strongly that if you're presenting with BPH you should not be on a five Alpha reductase inhibitor it's simply unnecessary it's like if someone came to me and said you know my apob is too high and I gave them a bile acid sequester and 1981 I mean it's just not necessary there's no upside
mhm if you're talking about it from a hair loss perspective again not something I obviously know much about I would say and they're going to go and see a Hair Doctor Who's going to try to give them 50 different proprietary compounds which by the way want to come back to that in a second I would encourage them if they've never taken it before not to because I think there are enough other compounds oral minoxidil topical minoxidil topical five Alpha reductase Inhibitors PRP transplants I think there are enough other tools that you can do to avoid
the small but not necessarily zero risk of something going wrong in terms of sexual side effects that in the worst case might not be reversible what about you what do you think I think that several of the drugs you just said have either comparable side effect profil like topical finasteride you end up with the same burden of 5 Alpha reductase inhibition systemically despite the effect that it's marketed otherwise topical dast is interesting because it may have some capacity to stay local especially if you do mesotherapy which we'll get to in a second why do you
think that's I wasn't aware of that difference yeah it's uh thought to be the molecular just hydrophobicity it's more the molecular mass of the drug so there's this like it's like an arbit arbitary rule but if the drug if the molecule is greater or less than 500 Daltons I believe it is off the top of my head it's been a while since I've Revisited it but there is a lesser or greater ability to actually absorb it and get systemic circulation and distribution over across the body with dutasteride it's like I think it's like 600 or
700 and with finasteride it's like 300 or 200 something and to be clear you're right I mean I don't think that you know systemic minoxidil is necessarily a benign drug and the other thing is nobody really can give an explanation for what the right dose is if you look at how people are dosing oral minoxidil it's insane so um yeah I don't again I I don't like to be in the business of prescribing things for which I don't have a great understanding which is why I'm not in the business of treating hair loss uh not
because I don't think it's you know something worth you know addressing if it bothers someone but I think the bigger issue is um it would be really awful if in trying to treat a a cosmetic condition like hair loss you induced um a devastating consequence on your endocrine system that that's really where I find myself concerned now it also appears that if you've been on finasteride for a long period of time and you're not experiencing any of these side effects you're probably fine so I also don't want this to turn into like someone listening to
this who's been taking propa for 10 years who's never had an issue going like oh my God I got to stop this stuff I the literature would suggest and there is a pretty good review we'll link to that if you're going to have these side effects you're going to have them in about six months yeah yeah my in general when it comes to hair loss the problem is often times the treatments if it doesn't actually interact with the AR or inhibit the potential for stimulation or agonizing the AR through DHT reduction or even systemic anti-androgens
not that I ever recommend that you are essentially just putting a Band-Aid on the issue so if you stimulate growth with Minoxidil you are still not preventing further loss if you get a transplant you are putting hair on your head but you're not preventing further loss of you know your actual existing hair so often times it's like you're almost trying to row against a current or something and it's like you are continuously getting pushed back and eventually you're going to get to a point where you have so few visible hair follicles even left that are
healthy that it's doesn't matter how much you've been on minoxidil or what have you and oral minoxidil it's like you know it's definitely effective um but I think it should be reserved for people who have weak response topically um because topical seems to be far more tolerated side effect wise and a lot more predictable with like hordes of literature and great outcomes and there are ways to enhance that and also turn yourself from a non-responder to a responder which we can get into but finasteride in itself it seems to be like I don't want to
try and come out and say I'm a proponent necessarily I try to play a balanced uh take a balanced approach to it but the prevalence of side effects is not nothing but it's quite overblown by the opposite camp that wants to assert that you know why would you ever inhibit you know a hormone that is the primary Endy you rely on but similarly why would you inhibit I don't know apob or something like is a clear outcome whereby there's benefit and when there is you know DHT and somebody who's prone to hair loss it's hard
to overlook that this is the primary thing dictating if you go bald or not and some people that that hair loss some people care a lot more than others obviously yeah I guess so so I do think there's a difference because I think apob serves no benefit we would actually if if someone created an anti- sensolo nucleotide that knocked out apob all it would do is guarantee we don't have heart disease in our species we wouldn't suffer we would still be able to use all the hdls in the world for cholesterol transport which we currently
use LDL for um but I think to take your your analogy a step further what you're basically saying is if a person cares as much about hair loss as they do about heart disease and by that logic DHT is causal which sounds absurd but let's just you know run I would posit that there are lots of people who care more about hair loss and heart disease the the psychological stress for some people is significant and should not be overlooked by the um seemingly like uh you know the silliness of oh just lose it and just
shave it bro it's not a big deal there's tons of successful people who are bald it's like yeah sure but maybe I just deal with although I think I think there's a statistic that no bald person has ever been president of the United States oh so there you go so there's there's a couple of a couple of occupations you got to take off the list um now you mentioned when you were going through your insane anabolic steroid use you at a very young age if you're in your early 20s were already starting to lose your
hair so how did you reverse that so part of it was just dropping the dose significantly and eventually just going down to replacement therapy but it was the introduction of five Alpha reductase inhibitor initially finasteride and then thereafter I introduced a and I wouldn't necessarily recommend this blindly but a topical anti-androgen that's experimental never actually received FDA approval there are some that are in the FDA pipelines right now that actually look promising and have safety data behind them and whatnot that I'm watching closely and hope one comes to fruition because these are essentially compounds that
compete for the Androgen receptor locally but do not have systemic anti-androgenic activity so you can maintain all systemic Androgen levels with just localized activity in the scalp essentially so I use a topical antiandrogen coupled with a five Alpha reduct and hibitor those were the main two needle movers for me I also use a keto cono shampoo but it's like a very mild anti- anderen it's mostly just a good shampoo but those two things and decreasing the burden of vanderen significantly were fairly effective at getting me not to Baseline but you know meaning you never regain
no no no yeah and that's the thing with hair that's the sketchy thing is even if you're trying to decide oh you know maybe I should treat it maybe I shouldn't I'll think about it for a bit I'll see if it gets worse the visual representation of loss is typically not apparent until you've lost a lot of ground cuz you could pull a handful of hair out of your head and see no difference whatsoever once you finally notice defuse thinning or recession it's not something you've been looking for carefully because you've never dealt with it
so often times once you actually notice it in a picture or in heavy downlighting or something you've already lost 20 30% plus of your hair and there's no guarantee that's coming back so preventing so you're saying so did you regain hair that you had lost with this protocol or just completely stop the some some regrowth but expecting yourself to get back to Baseline where you had you know like 17-year-old Immaculate perfect hair if you've been exposed to androgens at a level where you're like visibly noticing it it's relatively unlikely yeah yeah so that's not to
say it's impossible like if I took minoxidil as well as micro needle and did a bunch of other stuff I could probably get a decent amount of the way there but it's uh the longer you wait and let hair follicles miniaturize the more permanency you are risking so getting making back ground is way harder than preventing yourself from losing in the first place it's almost like maybe analogous to building muscle when you're younger so then you don't have to try and build it in old age when you have like anabolic resistance or what have you
so what are again the names of because people are gonna I don't let's make sure we give people the names of these compounds you're using so so faside is like the main primary five Al take one milligram of that daily I take dast now so you take 0.5 milligrams isn't that is that5 take5 a day so that is uh Soft gel that essentially wipes out systemic DHD um and your DHT level is close to zero it's like worse than a teenage girl yeah it's terrible so but I seem okay at least now I think one
of the guys with the highest IQs on the planet has been on dast ride for decades if that's notable for anyone okay so then what else you taking besides dutasteride dast ride right now is the only thing I take more of convenience because a topical application schedule can be quite burdensome when you were doing that when you were doing that big Salvage effort in your early 20s what was the rest of the stack oh it was topical application of something called ru58841 it's was like a experimental anti-androgen so so I don't necessarily recommend people use
ru58841 when there are actually Alternatives with human safety data on the horizon with that said it's also hard to tell me you know however many years ago that wait you don't you only have so much time right so I'm not going to sit around and what are these things that are on the that have more safety data coming down the pipeline uh this company called kintor has a compound called pyramide and it seems to pretty well tolerated and comparable outcomes of hair count increase to dast ride if I recall off the top of my head
which is pretty substantial given that there are very few things that produce outcomes that are even make it worth taking another drug like right now the most effective things are going to be five Alpha reductase Inhibitors and minoxidil on top of that everything else is like little sprinkles on the cake essentially like some people might get better benefit from you know PRP than another person or what have you but in general the main meat and potatoes are going to be minoxidil potentially micr needling with monoxil if you're not a good responder or have low sulfo
sulfotransferase enzyme activity in the scalp and the inhibition of free androgenic signaling in the scalp whether you do that through five Alpha reductase inhibition or anti-androgen activity locally that's kind of up to you or some people are going to couple both of them like I did but those are the main needle Movers ultim and some people go super hardcore and like the most crazy hair loss reversals you will see are always in men transitioning to women who use female hormone therapy I would never recommend anyone do that but it's a pretty interesting data set to
like pull from from so estrogen and progesterone would promote hair growth I mean we do see it in women actually during HRT especially progesterone can really thicken hair progesterone this is in women I mean I have no idea yeah yeah I would more more uh I'm more talking about anti-androgen plus estrogen so somebody transitioning would typically use a cyproterone acetate bicalutamide something of that nature plus exogenous E2 or a synthetic estrogen and the first two which I'm not even familiar with are drugs that just block the Androgen binding to the Androgen receptor or cyone is
a very potently anti- gonadotropic I believe so it's like it will actually prevent it will actually inhibit you from producing I see you know uh G&R so it's it's it's a it's effectively a chemical ceration that's like a steroidal anti-androgen and then there's a nonsteroidal one and yeah it is effectively chemical castration um the non-steroidal variant by camine seems to be a bit better tolerated it's not as liver toxic and it will actually raise your hormone levels on paper your test levels go up it's just you can't actually interact with the receptor because it's occupied
by bicalutamide so it's like a silent Androgen receptor antagonist and yeah those are like extreme options they like essentially Irrelevant for anyone watching so maybe I shouldn't have brought it up
