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Sunday October 26, 2014

What causes Hair Loss and what, if anything, can you do about it?

Written by Will Brink

Hair Today Gone Tomorrow: The Sequel!

Let's face it, bodybuilding is a visual endeavor and sport. No one wants to have a great body without a full head of hair to match. So, it should have come as no surprise to me that I received so much mail after I wrote my first article on the topic in 1997 in MMI (issue 179). "Hair today gone tomorrow" was published in MMI and later on the BrinkZone.com web site. It was clear to me that I hit a nerve with readers as I received more email and snail mail then I had expected, especially considering the fact it was an article that had nothing to do with building muscle! Why did I write it? From the last article,

"I thought a new article for those people who are really bumming that their hair is falling out, want to make sure their hair does not start falling out, or are just real paranoid about their hair falling out, was in order. If you fit any one of the above descriptions-which most people do- than this is the article for you! So why do I care so much about hair loss? My mother's father was bald, my father is mighty thin up top, my hair started to thin a while back -you do the math!"

I have received countless emails and letters over the years asking me to update the article. Here, finally, is the updated version which will integrate info from the last article and the newer recommendations. People who have not read the first article can view that at: http://www.brinkzone.com/hair.html

Readers of this article may be confused by some of my comments if they are not familiar with the last one, so I recommend you read the first article. Go ahead, I can wait!

What causes male pattern baldness (MPB)? From 1997:

"So what makes your hair fall out? Well for a long time scientists thought that DHT was the sole cause of hair loss, but this does not appear to be the case. As most of you already know, androgens such as testosterone (natural and otherwise) can convert to DHT by the previously mentioned enzyme 5AR. People who have high levels of the enzyme 5AR have higher levels of DHT and are prone to losing their hair.

Men with a congenital deficiency in 5AR show no receding of the hair line. This knowledge of the relationship of DHT to hair loss kicked off the big race to find things that shut down the 5AR enzyme and thus reduce the amount of DHT. Simple enough right? Well I have said it a thousand times before and I will now say it a thousand and one times: two plus two rarely makes four in the human body and this is the case again regarding the relationship of DHT to hair loss."

"People and researchers who used 5AR inhibitors such as Proscar and Saw Palmetto found it helped with the hair loss but in no way shut it down or regrew much of the hair that was lost. What appears to be the ultimate cause of hair loss for most people is an auto immune response where the body actually attacks the hair follicle like some kind of foreign invader thus causing an inflammatory response.

By yet unknown mechanisms, DHT causes a change in the follicle signaling the immune system to attack the follicle and your hair starts falling out (If you take a close look, you can actually see a red line of inflammation on the scalp of some people losing their hair). How do we know this? It was discovered that the hair follicles of people losing their hair look very similar under a microscope to people who experience organ rejection after surgery. And, it has been found that the immune system suppressing drug which is used to stop the organ rejection (Cyclosporine) grows hair like crazy because it shuts down the immune response in the body.

A cure you say?

NO! If you take some Cyclosporine and you grow hair it will be because you have no immune system and you will get very sick and possibly die. I shit you not-don't mess with this stuff. Anyway, though DHT is clearly important in the cause of hair loss, it is not the final cause and a new race has been started to address the inflammatory response which ultimately causes you hair to fall out.

Clearly, you have to attack hair loss from both the DHT and inflammatory response, and that's what most of this article is about....sort of. There are also other factors related to hair growth and hair loss such as nutrition, SODases, Nitric Oxide (NO) and others, but DHT and the immune response are the two biggies."

2005 comments:

Interestingly, almost a decade later, our understanding of the cause of MPB has changed little. Androgens (e.g., DHT) and a poorly understood immune response, that has interactions with SODases, NO, and other factors, creates the environment for MPB.

1997 treatment options versus 2005:

In the previous article, I covered copper binding peptides, Nizerol shampoo, Proscar, Minoxidil, and a very promising mystery drug called RU 58841. What follows in this section are comments on each of them from 1997 followed by my thoughts now after almost a decade of experience with them:

Copper binding peptides: back when I wrote the first article a drug called Iamin had just been approved by the FDA for wound healing. Another drug similar to Iamin is Tricomin. Both Iamin and Tricomin were invented and subsequently patented by Dr. Loren Pickart. As I stated in the 1997 article about these compounds,

"These drugs are copper based compounds that have certain peptides added to them. When put on the skin they have profound anti inflammatory properties and increase the rate at which skin heals dramatically (hence Iamin700s approval for wound healing). As I mentioned earlier, chronic inflammation at the site of the hair follicle appears to be a major link in the chain of what makes hair fall out."

2005 thoughts: Unfortunately these products did not turn out to be nearly as effective for MPB as I had hoped. Feedback was lackluster at best. I believe they still have some use in multi ingredient formulas that may add some small additional benefit, but the general advice is they are minimally effective for MPB alone.

Nizoral Shampoo 1997:

"Nizoral is an anti fungal shampoo and the active ingredient is a plant derivative called Ketoconazol and is produced by Janssen Pharmaceuticals. How and why Nizoral works on hair loss in not very well understood. It might work by blocking the DHT at the follicle and/or working by reducing the amount of inflammation at the hair follicle."

2005 comments:

Nizoral turned out to be a big disappointment. It was very popular when I wrote the article, but has dropped out of use by most people. It can now be had without a prescription in 1% strength, but it's a moot issue at this point as Nizoral is ineffective for treating MPB in my opinion. There was one small study (Pierard-Franchimont C, et al. Dermatology. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. 1998;196(4):474-7 )that appeared to find Nizoral about as effective as Minoxidil, so people can use Nizoral if they want I suppose, but feedback and experience says it's of no use.

Proscar 1997:

"...Proscar is a very specific inhibitor of the enzyme (5AR) that converts androgens into DHT. Its official use is for prostate enlargement which is also related to DHT levels (among other things). It was felt originally that Proscar would not be effective for hair loss because it only inhibits the enzyme found in the prostate and not in the hair follicle.

Well again, nothing is cut and dry in the human body, and Proscar has been found to reduce the amount of DHT in circulation which reduces the amount of DHT the follicle has to deal with and thus less hair is lost. Several recent studies have shown Proscar is effective for hair loss and can help regrow some hair on some people, but as I said before, the use of 5AR inhibitors only deals with a part of the problem and are generally not very effective when used as the only treatment."

2005 comments:

At the time I wrote the above, Proscar (finasteride) came in 5mg pills and was approved for benign prostatic hyperplasia (BPH) only. Because studies found 1mg almost as effective as 5mg for lowring DHT, I recommended people split the 5mg tabs into 4, which gave you 1.25mg. Of course the producer of finasteride (Merck) saw the marketing potential for treating MPB, and finasteride was packed in 1mg pills and sold as Propecia.

There is of course no difference between Proscar and Propecia except the dose, so people in the know still buy Proscar and divide it into 4 pieces to save money. I would still recommend Finasteride for MPB, but it is far from the miracle drug for MPB people hoped it would be when it came out. Side effects such as gyno, reductions in libido, and others also appears to be higher in the real world then the studies claimed. Finally, finasteride does appear to work topically (contrary to what Merck claims) which will greatly reduce systemic side effects. However, topical is generally less effective then oral treatment.

Minoxidil 1997:

"...Minoxidil did not turn out to be the hair growth stimulant we all hoped it would be and if it had not recently gone OTC I would not even have included it in this list. However, being minoxidil can now be purchased without a prescription and is about half the price of what it used to cost, I think it is a useful addition to a person's regimen. For hair growth, minoxidil has pretty much been a bust, but for reducing hair loss, I have found it is definitely better than nothing."

2005 comments:

The only thing that has changed since I wrote the above is that Minoxidil comes in a stronger version for men (5% vs. 2%) and can be found as a generic, saving money for the user. I think Minoxidil makes a good carrier for other compounds you may want to use topically, such a Finasteride, etc.

1997 comments on RU 58841:

"RU 58841: This is the mother of all topical anti androgens. RU58841 is made by the Roussel Corporation of France. This stuff shuts down DHT at the hair follicle like nothing else. One of the major problems has been that anti androgens such as Spironolactone and Flutamide taken orally might be good for hair loss, but they cause all sorts of problems related to having low androgens in your body, such as loss of muscle, increased fat, loss of sex drive, gyno, etc.

When these same anti androgens have been used topically (put directly on the scalp) they do not cause the negative systemic side effects, but they did not seem to do much of anything for hair loss or growth either. Therefore, a topically active anti androgen without systemic effects would be highly desirable. RU58841 is a topical anti androgen that shuts down DHT at the follicle without any systemic side effects in the body!"

2005 comments:

If there has ever been a drug that appeared to be close to a cure for MPB with no side effects, this was it. So what happened to it? That too is a bit of a mystery, but the general consensus is that the company never developed it for market for financial reasons after other drugs for MPB faired not nearly as well in the market place as was expected. It's a real shame. After the article came out, I knew several enterprising people with enough money to have batches made up for their personal use, and they all said it was the best thing they had used topically.

Additional possible treatments for MPB:

Avodart:

Recently, a dual inhibitor of both enzyme types (5ar-1 and 5ar-2) that convert testosterone to DHT has been approved for BPH. It's called Avodart (dutasteride)and is made by GlaxoSmithKline. Finasteride was shown to reduce DHT by up to approximately 70+% or so, where as Avodart reduced DHT by 90-96% depending on dose (0.5mg - 2.5mg). So, this drug would appear more effective for treating MPB, and Glaxo's data found 2.5mg of Avodart grew 1.5 times more hair compared to 5mg Finasteride over a 6 month period with approximately similar side effects as Finasteride.

Real world feedback is that it is indeed superior to Finasteride for MPB, but side effects are more common. Several doctors I know who prescribed it for MPB told me many men stopped using it due to side effects, so the claim that it has a similar incidence of side effects to Finasteride may not be true. However, it may be worth using topically mixed into some vehicle such as Minoxidil or some custom blend. There are many of them found on the internet in fact, and feedback is generally good. As stated, topical is never as effective as oral, but the side effects are minimized.

Flutamide and Spironolactone

Flutamide is not really a new drug, but an old drug being used for MPB. It's a powerful anti -androgen used with men with prostate cancer. I consider the side effects for healthy men FAR too great to be used orally, though some men have gone that route. I think they're crazy. However, topical versions are fairly common on the ‘net and this may be viable alternative - albeit a less effective alternative -to oral administration. Pretty much everything I have said about Flutamide goes for Spironolactone. Gyno, reductions in sex drive, etc, is common in men taking it orally, but topical formulations exist and appear to be moderately effective, especially when combined with other compounds.

Best overall multi ingredient topical formula:

There are hundreds, perhaps thousands, of topical formulas on the market. I have not viewed them all nor used them all. Keeping that in mind, my recommended all-in-one topical formula I recommend is Proxiphen produced by a Dr. Proctor out of Texas. Dr. Proctor is probably one of the foremost experts on MPB and one of the good guys in an otherwise shady industry. I have spoken to him many times and he knows his sh*%. Proxiphen contains minoxidil, as well as the prescription agents phenytoin and spironolactone, SODs, copper peptides, TEMPO, PBN...over a dozen active ingredients in all. Another plus is that Dr. proctor never sits on his success with Proxiphen in that he is constantly adding new compounds to the formula if he feels they show promise for MPB.

Because it contains prescription agents, Proxiphen can only be dispensed on a physician700s diagnosis of hair loss. This is not as big a deal as you may think, but you will have to see your doctor to get an official diagnoses of MPB. You do not have to travel to TX to get it, but your Doc will have to communicate with Dr Proctor for you to obtain Proxiphen. Dr, proctor does produce non prescription products that may also be worth a try, but none of them will be as effective as his prescription based product. Dr. proctor can be contacted at 800-926-1752 or 713-960-1616. Web site: www.drproctor.com

Low Level Laser Therapy (LLLT)

99% of the time, something that looks like a scam and smells like a scam, is a scam. There is that 1% of the time when what looks rather scam-ish at first actually may work as claimed. Such may be the case with LLLT. Makers of LLLT devices have claimed for years they grew hair but there was no hard data to support it, and what the mechanism was was never really explained. Thus, I was very skeptical say the least.

I have had to alter that opinion however as a study published in the International Journal of Cosmetic Surgery and Aesthetic Dermatology ( Vol. 5, Number 2, 2003.) found LLLT may actually work as claimed. The study found increased hair counts and improved tensile strength in 28 men and 7 women who used the LaserMax Hair Comb (www.Lasermax.net) for 6 months. The results were impressive and no side effects were reported as one would expect. I have also spoken to the director of one clinic that does many hair transplants and they find greatly increased healing rates post op using the laser comb. So, my opinion of this gizmo is guardedly positive and it may be worth incorporating into your hair loss prevention plan.

If All Else Fails!:

Ok, so you have tried most of the above, don't want to try the above, or don't have enough hair left on top of your head for the above to really make a difference, and you want information on transplants. As you know, when transplants first came out, they were pretty crude and looked pretty damn bad. Things have changed for the better in the last few years with some truly impressive results.

So, the good news is there are procedures that now look totally natural. Bad news, none are going to give you the hairline you had before you started losing your hair. You have to have realistic expectations here to begin with.

Ok, after a great deal of research I am of the opinion that the laser method is superior to other methods. There is a great deal of confusion out there regarding the laser method propagated by people using outdated information or fear of competition. People who put down the laser method claim all sorts of things that are simply not true today with the right laser being used by an experienced medical professional.

Before we get to that, a little background. Lasers are finding new applications in the medical and cosmetic field almost every day such, such as their use in surgery and the use of lasers in skin rejuvenation and resurfacing. It700s been slower in the field of hair transplantation using lasers. The reason for this is simple, the first generation of lasers used for hair transplants were non-pulsating CO2 lasers which caused damage to the local blood supply (dry hole) and poor hair growth resulted.

Keep in mind, blood supply to the transplanted follicle is essential for any growth to take place. Without adequate blood supply, the transplanted follicle simply dies. These older lasers caused thermal damage to the area (burned the area due to excessive heat from the laser), which of course is not what you want. This is the main criticism of the laser approach.

However, newer generation pulsating CO2 lasers showed a vast improvement in maintaining blood supply resulting in improved graft growth and survival of the transplanted hair. Later improvements added the Super Pulse laser which is a big improvement over older lasers that caused extensive thermal damage. Another type of laser that is used is the Erbium laser.

Both lasers appear to have their strengths and I have seen excellent results with either. The right laser in the hands of a doctor who has experience with this method does not hinder blood supply at all, and excellent graft growth follows after the hair follicle is transplanted. The laser greatly reduces actual surgery time and trauma to the area, so post op pain is reduced and recuperation time is also reduced.

Some other reasons the laser method is superior to having someone cut holes in your head with a scalpel or needle punch: every time a laser hole is made, bald tissue is actually being removed. This reduces the total amount of bald area present. This advantage is not seen when using a scalpel blade or needle to prepare recipient sites. Lasers also decrease the incidence of what is called "postoperative epidermal inclusion cysts." These are ugly little bumps that often show up in the area of the transplanted hair, and they look like sh*$ to be honest.

There are yet more advantages to the use of the laser versus the "cold steal" methods (e.g., scalpel, needle punch, etc.) that I don700t have the space or need to cover. It's the only method I have personally seen where I simply could not tell that work had been done on the person's head until I saw the before pictures!

The clinic with probably the most experience with laser transplants is the Hair and Scalp laser Clinic in Clearwater Florida. The clinical director is John Satino and the doc doing the work is Dr. Markou. They can be reached at 1-800-883-4247 or 1-727-572-9344. Web site is www.hairscalplaserclinic.com

Now, if you can find someone in your area using the laser method who has real experience with it and can give you referrals to speak to regarding their work, by all means use them, but not many people are currently using the laser method for transplants. On a final note, I don700t want people to think there can700t be satisfactory results with some of the more traditional scalpel and needle punch methods, but in my opinion none of them are superior, or more natural looking, than the results achieved with the laser in the hands of an experienced medical professional.

Conclusion.

Ok, please don't bombard me with questions about the latest greatest cure for hair loss you read about or are using. The above is about the only treatments I have any faith in. The longer I have been researching the topic the more I realize how few of the products out there actually work and what a vexing problem MPB is to solve. However, the information in this article is about as good as you are going to find in your attempt to not end up looking like the guy in the Gold's Gym logo!

 

About the Author - William D. Brink
 
Will Brink is a columnist, contributing consultant, and writer for various health/fitness, medical, and bodybuilding publications. His articles relating to nutrition, supplements, weight loss, exercise and medicine can be found in such publications as Lets Live, Muscle Media 2000, MuscleMag International, The Life Extension Magazine, Muscle n Fitness, Inside Karate, Exercise For Men Only, Body International, Power, Oxygen, Penthouse, Women's World and The Townsend Letter For Doctors.

He is the author of Priming The Anabolic Environment and Weight Loss Nutrients Revealed. He is the Consulting Sports Nutrition Editor and a monthly columnist for Physical magazine and an Editor at Large for Power magazine. Will graduated from Harvard University with a concentration in the natural sciences, and is a consultant to major supplement, dairy, and pharmaceutical companies.

He has been co author of several studies relating to sports nutrition and health found in peer reviewed academic journals, as well as having commentary published in JAMA. He runs the highly popular web site BrinkZone.com which is strategically positioned to fulfill the needs and interests of people with diverse backgrounds and knowledge.

The BrinkZone site has a following with many sports nutrition enthusiasts, athletes, fitness professionals, scientists, medical doctors, nutritionists, and interested lay people. William has been invited to lecture on the benefits of weight training and nutrition at conventions and symposiums around the U.S. and Canada, and has appeared on numerous radio and television programs.

William has also worked with athletes ranging from professional bodybuilders, golfers, fitness contestants, to police and military personnel.

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