Questions for Bryan (and others, of course :))

[triton2]

I have just signed up today but I have been reading this forum for a few weeks. I'm completely amazed at the level of knowledge that you guys have about hairloss treatments; I have read a lot of Bryan's posts and it's incredible; you have an incredible knowledge pal!!
I'd like to ask you a few questions:

1) If you had to order the effectiveness of the following treatments (topical spironolactone, azelaic azid+b6+zinc, folligen, emu oil) from more effective to less effective, how would you order them? What do you think of them? Which ones would be worth trying? and, most importantly, could you use all of them at the same time without negative interactions between them?

2) Do you think there's a risk, when using topical spironolactone, of topically absorbing a significant amount? (There have been claims that spironolactone could show significant systemic effects due to its low molecular weight and its structure).

3) If I were to use:

Oral dutasteride
topical spironolactone 5% (PPG+etanol vehicle) 2x day
folligen 1x day
minoxidil 2x day
nizoral shampoo 2% 2-3 times a week
azelaic acid + b6 + zinc 1x day

do you think that there should be any negative interaction between them? What about zinc and copper peptides? (Pickart himself is wary about mixing them).

 

[Dave001]

2) Do you think there's a risk, when using topical spironolactone, of topically absorbing a significant amount? (There have been claims that spironolactone could show significant systemic effects due to its low molecular weight and its structure).

Of what value is a speculatory claim that is contradicted by empirical evidence?

Opinions concerning the efficacy of topical spironolactone vary by a wide margin, but there doesn't seem to be much room for debate about its safety. There are no reports of systemic toxicity (toxicity is essentially synonymous with "significant absorption" when it comes to antiandrogens, especially in males ;-) resulting from topical spironolactone in the medical literature.

The only published study I'm aware of that analyzed blood and urine samples for the presence of canrenone (spironolactone's major metabolite) following its topical application is the following (endocrine markers were tested as well):

Rey, F. O., C. Valterio, et al. (1988). "Lack of endocrine systemic side effects after topical application of spironolactone in man." Journal of Endocrinological Investigation 11(4): 273-8.

Abstract: "In six healthy male volunteers, the percutaneous absorption of spironolactone was compared with placebo in a double-blind crossover study. The subjects were randomly given either a cream containing 5% spironolactone or placebo to be applied in a randomized sequential way to a well defined skin area equivalent to 55% of body area. [my emphasis] During the 72 h following the application of the ointment, blood levels of canrenone, the major metabolite of spironolactone, have been determined. In order to estimate the systemic antiandrogenic effect of spironolactone, plasma levels of 17-alpha-Hydroxy progesterone (17 alpha-OH-P), Testosterone (pT) and non-conjugated 3 alpha-Androstanediol (3 alpha-diol, metabolite of the active androgen 5 alpha-Dihydrotestosterone or DHT) as well as salivary Testosterone (sT) which relate to the free and active plasma testosterone fraction have also been measured. Urinary levels of canrenone have been determined 48 hours after cream application. No changes in any levels of these hormones have been detected and plasma canrenone levels were undetectable during the 72 hours of topical treatment. Topically administered, spironolactone appears to have only a local skin impregnation."

In summary, subjects essentially bathed in either a 5% spironolactone cream or placebo (vehicle only) in a controlled manner, and there was no evidence of percutaneous (systemic) absorption.

Countries in which topical spironolactone is commercially available as an "official" treatment for acne in both males and females have also consistently reported its absence of systemic effects. E.g.,

Messina, M., C. Manieri, et al. (1990). "Oral and topical spironolactone therapies in skin androgenization." Panminerva Medica 32(2): 49-55.

Abstract: "The most important clinical studies using spironolactone as an antiandrogen drug either per os or topically are referred. Menstrual disturbances very often occur during SP treatments thus limiting its systemic use. As far as the topical use is concerned SP seems to be highly effective with absence of systemic effects. Local mild side effects were present in a small number of patients."

Yamamoto, A. and M. Ito (1996). "Topical spironolactone reduces sebum secretion rates in young adults." Journal of Dermatology 23(4): 243-246.

Abstract: "The effects of topically applied spironolactone on the sebum secretion rates (SSR) of young adults were investigated. SSR was expressed as the ratio of wax esters/(cholesterol + cholesterol esters) (WE/(C + CE)) and the amount of sebaceous lipids (squalene, triacylglycerol and wax esters). Topical spironolactone 5% gel applied to the right cheeks of the subjects produced a significant reduction in the SSR at 12 weeks (4 weeks after termination of application), but not at 8 weeks (the end of treatment). Untreated "control" areas (the left cheeks of the subjects) showed no significant change during the study. None of the subjects experienced skin rash or signs of local irritation. This results suggests that topical spironolactone may be effective in the treatment of acne patients with high SSR."

 

[Britannia]

Hi, welcome to the forum. Looking through the treatments listed I would subsitute finasteride for dutasteride. Remember finasteride 1mg is approved for use with male pattern baldness, whereas dutasteride is not (this of course does not mean dutasteride does not work). There are loads of success stories about finasteride on this forum, why not start with that and if it doesnt work THEN consider duta. You can get finasteride 1mg in the form of Propecia (made by Merck) and Finpecia (made by Cipla), both are widely available on the net. You could also split 5mg finasteride pills (i.e. Proscar or Fincar) into 5ths and take them.

 

[HairlossTalk]

2) Do you think there's a risk, when using topical spironolactone, of topically absorbing a significant amount? (There have been claims that spironolactone could show significant systemic effects due to its low molecular weight and its structure).

Let me just tell you that if there was any risk, I would be the person who would know it. I can take a micromililiternanogram of finasteride and end up doubled over in a fetal position for 3 days from a migraine and finasteride's effect on my hormones. Had to discontinue because of it. spironolactone on the other hand I have been gooping on my head for 3 years now and have no problems. Only side effect I ever had which Dr. Lee says is hogwash ... was when I first applied it. Had a weird tingling pins and needles feeling going down the side of my face, down my neck. Definitely not hogwash but weird nonetheless. That lasted 3 seconds and I've been fine ever since

HairLossTalk.com

 

[HairlossTalk]

Hi, welcome to the forum. Looking through the treatments listed I would subsitute finasteride for dutasteride.

Just to clarify, this means to take finasteride.

 

[lukey]

Bump, does anyone know anything about questions 1 and 3?

 

[mvpsoft]

1) If you had to order the effectiveness of the following treatments (topical spironolactone, azelaic azid+b6+zinc, folligen, emu oil) from more effective to less effective, how would you order them? What do you think of them? Which ones would be worth trying? and, most importantly, could you use all of them at the same time without negative interactions between them?

. . . .

3) If I were to use:

Oral dutasteride
topical spironolactone 5% (PPG+etanol vehicle) 2x day
folligen 1x day
minoxidil 2x day
nizoral shampoo 2% 2-3 times a week
azelaic acid + b6 + zinc 1x day

do you think that there should be any negative interaction between them? What about zinc and copper peptides? (Pickart himself is wary about mixing them).

On #1, it's not quite that simple, as it is possible that some combinations of treatments are better than either alone. For example, one of the leading researchers on minoxidil (forget his name, too lazy to look it up) has stated that copper peptides and minoxidil work better when used together than either separately, since (according to him) minoxidil tends to grow vellus hairs, and cu's tend to "convert" existing vellus hairs to terminal hairs. I don't know whether this is true; I'm merely pointing out that it may be impossible to come up with a pure ranking of the sort you want.

As far as #3 is concerned, the last item on your list has the least amount of evidence for its efficacy, and it may actually harm the efficacy of Folligen, as you note. Why would you use those things if their is little reason to think they will help, and some reason to think they will hurt?

 

[lukey]

bump, anyone else on questions 1 and 3?

 

[lukey]

bump

 

[Freestyle]

I use spironolactone on my hairline at night, applied about 15 minutes after Minoxidil. I use Folligen on my hairline as well after showering. I use emu oil every few days, usually a few drops in my Nizoral. I use Xandrox15 on my hairline in the morning, and that contains Azelaic Acid.

As far as their effectiveness goes; I would lean more towards spironolactone, then Folligen, then the acid and stuff. Emu Oil isn't really a hair loss drug -- it's just a great scalp conditioner to alleviate itching etc. caused from topicals.

In theory, spironolactone tackles DHT at the problem sites (mine's my frontal hairline), so if you were looking into starting on it, I'd only recommend using it on the worst affected areas.

I use Tricomin all over my scalp and Folligen on the hairline for the extra kick.

I won't know whether this stuff is doing any good for me for another few months, but the Tricomin in particular definitely makes my scalp feel great and has definitely improved the appearance of my hair.

 

[lukey]

bump, anymore?