Old Baldy said:
He's the doctor, I'm a layman. Just wish I could find some evidence on azelaic acid other than "statements".
Background: Azelaic acid (pronounced az-uh-LAY-ic) is a simple molecule ( HOOC(CH2)7COOH, CAS Number 123-99-9, also known as 1,9-Nonanedioic acid) that is found in some whole grains and in trace amounts in human bodies. Although it is an acid, it is an extremely weak acid - much weaker than vinegar. It's current use in medicine is in Azelex or Skinoren, which is a cream base containing azelaic acid as 20% of its weight. Azelex is available by prescription in the USA and is used in the treatment of acne. Skinoren is available outside USA.
Azelaic acid may be useful as a hair growth stimulant. A research report by Stamatiadis in 1988 suggested that azelaic acid (and combinations of it and zinc ion and vitamin B6) was a strong type I 5-alpha reductase (5-AR) inhibitor. The enzyme 5-AR (both types I and II) convert testosterone to dihydrotestosterone (DHT). DHT has been shown to contribute to male prostate enlargement (benign prostatic hyperplasia, BPH) and to damage hair follicles.
Abstract of Stamatiadis' 1988 study:
Br J Dermatol 1988 Nov;119(5):627-632 Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid.
Stamatiadis D, Bulteau-Portois MC, Mowszowicz I
Laboratoire de Biochimie B, Hopital Necker-Enfants-Malades, Paris, France.
The effects of zinc sulphate and azelaic acid on 5 alpha-reductase activity in human skin were studied using an in vitro assay with 1,2[3H]-testosterone as substrate. When added at concentrations of 3 or 9 mmol/l, zinc was a potent inhibitor of 5 alpha-reductase activity. At high concentrations, zinc could completely inhibit the enzyme activity. Azelaic acid was also a potent inhibitor of 5 alpha-reductase; inhibition was detectable at concentrations as low as 0.2 mmol/l and was complete at 3 mmol/l. An additive effect of the two inhibitors was observed. Vitamin B6 potentiated the inhibitory effect of zinc, but not of azelaic acid, suggesting that two different mechanisms are involved. When the three substances were added together at very low concentrations which had been shown to be ineffective alone, 90% inhibition of 5 alpha-reductase activity was obtained. If this inhibition is confirmed in vivo, zinc sulphate combined with azelaic acid could be an effective agent in the treatment of androgen related pathology of human skin.
PMID: 3207614, UI: 89087983
This is the ONLY published study... Dr Lee adds assurance that his Xanadrox is higher enough in concentration that azelaic acid should be carried into the scalp, and that in his patients it seems to work when minoxidil does not. (And if he splits the 15$/bottle extra with me Ill sign a letter supporting that view). I seriously doubt he actually did the needed 1year followup with hair counts study needed to prove this. Why would he? It would only cost him and potentially hurt his sales if negative.