Core Hair Loss Guide: "The Big 3"

Core Hair Loss Guide

Table of Contents

While I have talked about other aspects of hair loss previously I haven’t done a full guide on hair loss itself – a core hair loss guide for beginners.

This post will discuss the basics of male pattern hair loss also known as androgenic alopecia or male pattern baldness. I’ll also touch on some of the most common treatment options for hair loss and explain some of the underlying mechanisms and some of the benefits and risks involved.

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Explaining Hair Loss

For the vast majority of men, androgenic alopecia is the reason for their hair loss. We have discussed this in other posts but if you are wondering why your hair is falling out the answer is likely this. In men prone to balding, their hair follicles are genetically sensitive to DHT which miniaturizes follicles causing them to eventually thin and completely break down.

A core hair loss guide must include DHT inhibitors as a key.

This is why catching hair loss early is so important – it is very hard to reverse this type of damage once it has been done.

The two main types of male pattern baldness are the receding hairline types and the diffuse thinning types of hair loss. This loss will eventually lead to only hair on the sides and the back of the scalp.

Treating Hair Loss

In this post, I’ll go over the “Big 3” which for the majority will at least halt and at best reverse hair loss. There are many other compounds available but those are more niche products. I cover more specific or newer treatments in other posts. These 3 products are each used for a specific reason, and their synergy is why they are recommended together.

Finasteride

This is one of the few products that target the core reason for hair loss in men, DHT. Finasteride is a five alpha-reductase inhibitor (5ARI) which means it blocks the conversion of testosterone to DHT.

The drug is now generic and available at low costs – many telehealth companies employing qualified medical professionals offer it. They also likely carry topical versions. This is what will stop most people’s loss in its tracks and for some Finasteride even allows for the regrowth of hair in previously lost areas. Finasteride itself is not a growth stimulant but when the pressure of DHT is taken out of the equation, if the follicle isn’t completely lost, there may be a chance for recovery.

Many users notice results after around ~3-4 months of consistent use. Some note experiencing a shed phase which can seem scary but is likely due to old hair falling out and new healthier hair growing in. The standard dose for hair loss is 1 mg daily in oral pill form. Many people buy a 5 mg “Proscar” and just cut the pill into quarters to achieve 1.25 mg daily to save money. This will reduce serum and scalp DHT by around 70%.

Just to note – doses as small as .25 mg are nearly as effective as 1 mg in terms of serum and scalp DHT reduction. Some have found success microdosing the product to potentially avoid side effects if their hair loss isn’t as aggressive. Your mileage may vary. Finasteride is also available topically meaning you apply the product to your scalp directly instead of taking it orally. This has some evidence for it in terms of preventing systemic exposure and therefore potentially reducing side effects although it is still highly debated. My post on microdosing topical finasteride.

All of these options depend on your preferences, goals, and how you react to finasteride. Some people experience side effects on even small doses while some, the majority, can tolerate 1 mg orally with no major side effects.

One of the major controversies that is heavily debated in terms of finasteride is the risk of side effects. A small percentage of users claim to experience brain fog, depression, sexual dysfunction, and gynecomastia due to the use of finasteride. An even smaller percentage claim to experience this even after stopping use.

I’m personally somewhere in between, the medication is limiting a key enzymatic process in the body (DHT) and this also impacts neurosteroids. This is something to consider before using and is why I aim to microdose the product topically. Some of these symptoms are related to the increase in estrogen finasteride may cause in some. The increase in estrogen may be because when less testosterone is being used in the body to convert to DHT, more converts into estrogen. The drug has also been shown to atrophy penile tissue in rats.

Finasteride is huge for many hair loss protocols, but is also a big decision for some. Something to research a bit about and make an educated decision on. DHT and the downstream impacts caused by blocking are not things to take lightly in my opinion.

You need to stay on the drug indefinitely to retain benefits. If you come off your progress will fade away. The drug is heavily researched and is proven to be effective for male pattern hair loss. This is a treatment I use to maintain quality hair and reverse the loss I’ve experienced.

For those that don’t see results from finasteride the next strength is found in its “sister drug” known as dutasteride. Dutasteride blocks even more of 5AR (and therefore DHT) compared to finasteride making it the logical next step up for those wanting more strength.

Study

Minoxidil

Minoxidil is a growth stimulant. Scientists aren’t entirely sure how the product itself works but it was originally used to treat high blood pressure.

Important note: this product is toxic to some household pets like dogs and cats, and potentially to others as well. Be extremely careful when applying this and then petting them, licking your hair, getting into the product itself, or contacting residue from your hair onto a pillow, etc.

This product is most commonly applied topically although some users seeking higher strength take it orally. Common topical doses are 2% and 5% and you can get the product over the counter in a solution or foam delivery method. Common oral doses are 2.5 mg to 5 mg for men. Most people start to see results after ~2 months. There is also a shed phase associated with this product for similar reasons – new healthier hair is growing in so older hair will be falling out.

This product is honestly great for improving the look of your hair. It doesn’t solve the core issue that is degrading your hair (DHT) but it can thicken up and give you a lot of life back in terms of appearance.

Where lots of people go wrong is only using minoxidil and hoping for the results to stay long-term. Minoxidil itself works long term to stimulate growth but if you aren’t blocking DHT the core hair loss will catch up at some point.

The most common side effects associated with minoxidil would be heart palpitations, dizziness, and skin issues such as wrinkles, skin aging, or bloating. Some claim that minoxidil alters collagen.

This is what hair transplant surgeon Dr. Hasson has to say on the matter: “I have had multiple patients complain of increased wrinkles in the face after using the drug (this suggests possible premature facial aging). It has now been shown that minoxidil inhibits the production of an enzyme, lysine-hydroxylase, which is responsible for the production of hydroxy-lysine which is of great importance in the cross-linking of collagen in the skin. In my opinion, this mechanism can account for my clinical observations.“

These are likely associated with too much absorption in the body and similar to finasteride these side effects are pretty rare. Just remember this was first used to treat blood pressure so it should not be taken lightly, especially oral use.

Similar to finasteride, you need to stay on it indefinitely and if you come off, all progress will be lost. This will be especially jarring if you weren’t blocking DHT while being on minoxidil and decide to come off.

I have not personally tried this product yet because I view it as more of a bandage compared to the real issue at hand causing hair loss. I may try it in the future to get crazy density and thickness back – I just don’t feel any need or want currently.

For people looking for a boost in appearance with relatively great safety, this is a heavily studied product for hair loss and is a proven growth stimulant that will provide great results for the majority of users.

Oral Study, Study 2, Study 3

Ketoconazole Shampoo

Ketoconazole Shampoo is a mild DHT inhibitor. It also fights fungus and inflammation in the scalp. All extremely useful things in regards to fighting hair loss. This is also a much milder option in terms of side effects when compared to the two previous options although the tradeoff is you likely won’t halt the majority of your loss from something like this. If I get a mild boost in hair health and a slight decrease in inflammation, fungus, and DHT from just a twice-weekly shampoo I am extremely happy.

Ketoconazole Shampoo is over the counter at 1% strength in the USA but for 2% you will likely find the easiest way to obtain this product is through a telemedicine clinic as it requires a prescription. Personally, there is not much of a difference but 2% is what was studied for hair loss.

I use the 1% shampoo because it’s easier for me to get although I have experimented with many varieties including 2% strength products. If I was on an extreme protocol I would use 2% to gain every advantage possible. All I do is let the shampoo soak in my hair for around 5-10 minutes and then wash it out twice weekly. I love the way Nizoral (generic ketoconazole brand, 1%) makes my hair feel. It does dry it out a bit but it makes it feel extremely thick and the appearance is crazy as well – overall looks dense and thick. I also really love the smell.

There are some brands like Keeps that sell the 2% at a pretty fair price. Nizoral is a great brand most stores will have which offers 1% ketoconazole as an active ingredient.

Those are just my experiences though – some users report that this dries out their hair too much, especially the 2% (although I think it’s more of the shampoos overall not the Ketoconazole) so just test out various protocols for yourself. Ketoconazole shampoo is something I would recommend to anyone – it seems extremely safe with a great risk-to-reward ratio and is something great you can use while figuring out what else you may or may not want to use.

Japanese Ketoconazole Study (33% of men showed pretty substantial regrowth with 2% Ketoconazole which is pretty wild), Systemic Review 1, Systemic Review 2, ketoconazole 1%.

Microneedling

Note: To be fully transparent – I have changed my views on microneedling itself and is now something I avoid doing. The risks don’t seem to be worth the rewards (if any) in my opinion. This is coming from someone who purchased a higher-end microneedling device. However – I will leave the information available to those interested.

As a quick bonus, I felt the need to include this in this core hair loss guide. I feel as though it’s talked about so often that it should be included as part of a new group called the “Big 4”. I’m talking about microneedling, the process of puncturing your scalp with dozens of microneedles to enhance hair growth and medication absorption (in theory).

However, some people get this wrong and use a cheap microneedle roller or do it too often which could cause damage or scarring. I use a medical product called “The Derminator” which is sold by a health company overseas. Something similar to this which is sold more worldwide is called the “Dr. Pen”. These devices puncture directly down and out of the scalp causing uniform holes while a dermaroller device will tear the skin and not hit as deep.

I use my Derminator once a month at .75 mm depth, 12 needles, and maximum speed. Going any deeper for any longer any more frequently is too risky to me and I don’t need it any more than this. I don’t want any damage. Lots of people say it doesn’t hurt while I think it’s a pretty uncomfortable process. The depth doesn’t impact pain but it does sting and bump against your head.

I use this for more absorption because I use topical products and as a potential growth stimulant instead of minoxidil.

The only thing to be careful about here besides using a proper product and schedule is to be very careful about infection. Keep everything clean and sterile. I only microneedling after a shower so I know I’m clean – this also helps get my hair slightly wet so the needle can glide around a bit and doesn’t get caught in hair or whatever.

Conclusion

Hopefully, this core hair loss guide gave you a great starting point in terms of hair loss knowledge.

It can be scary to find out exactly what you should do, but with this information, you have a nice base to do some further research and make an informed decision for yourself.

Don’t forget to consult with a qualified medical professional.

As always, good luck.