spironolactone or fluridil?

[Steven85]

I am 26 years old, been using finasteride and nizoral for a month. I want to add an anti-androgen to my regimen.

The question is which one?

I hear spironolactone or fluridil are the best options. Which one would you recommend considering the price, effect, and manageability of the product?

Do you also know a good place to buy it online?

Also considering adding rogaine but seeing as maintaining is most important for me I think an antiandrogen is first priority.

 

[Steven85]

by the way was fluridil approved in europe? what is the ingridient in it that makes it an anti androgen? maybe fluridil was approved in europe but not here in north america

Copypasted from: http://www.eucapil.com/xhtml_en/eucapil.shtml

*
How and where is Eucapil® approved?
Eucapil® is approved as a cosmetic hair care agent for topical use in the Czech and Slovak Republics and can therefore be employed as such in all other EU countries.
*
Is Eucapil® approved in the U.S., Japan or Canada?
Eucapil® is not yet approved for sale in these countries. Depending on the particular regulations , cosmetics can be brought in by travelers or imported for personal use. Please consult your customs agency.


Btw, why is the nizoral 2% cream never mentioned in any antiandrogen discussions? Doesnt it have any effect as an aa?

 

[Steven85]

don't bother. neither spironolactone or fluridil are proven products. the closes thing you can add is nizoral shampoo once or twice a week. stick with proven produts such as propeci, rogaine, nizoral. I only use propecia and nizoral. things like spironolactone, fluridil, ru, blah blah blah.

the best duo would be propecia and nizoral shampoo in my opinion

You are probably right Tom. I'm just scared I am one of those unlucky ones that won't get the expected results from finasteride (and nizoral) as an antiandrogen alone. Therefore I think I should add a topical androgen, hoping that may be the extra little complement I need to be sure to stop my hair loss. Desperate times call for desperate measures, or something like that, right?

 

[Harry S Truman]

A. Every person is different, people respond and don't respond along with getting sides and not getting sides differently...

B. spironolactone def has systemic absorption, it will drop your testosterone levels... Dont believe people when they tell you it doesn't...

C. I am interested in trying fluridil... Maybe its claim to be water soluble will hold up where spironolactone doesn't... Anyone have a place where they purchase it ?... or has anyone used http://xtshop.eucapil-shop.eu/index.php?language=en& ? ( i don't work for them or a shill)

 

[Steven85]

spironolactone def has systemic absorption, it will drop your testosterone levels... Dont believe people when they tell you it doesn't...

So In other words spironolactone is something you can recommend and you disagree with Tom? Could you please elaborate on this?

 

[Harry S Truman]

So In other words spironolactone is something you can recommend and you disagree with Tom? Could you please elaborate on this?

Every person is different, i responded well to spironolactone S5, but it def knocked down my testosterone and had difficulty operating on it and had to stop..... It was working because it was absorbing systemically..... All i can say is to try things an see what you respond to and what your body can tolerate...

 

[Steven85]

Ok. I think I know what to do now. I've already been using finasteride and nizoral for 5 weeks and will continue that.

Two scenarios for further additions:

1. I start using rogaine for 4-6 months. If I see regrowth within that time I continue with it. In time, if I see new signs of hair loss, I consider adding topical spironolactone.

2. If I see no regrowth with rogaine after 4-6 months I quit rogaine. Seeing as rogaine is for regrowth and not maintaining there is no point continuing it if I dont see regrowth in 4-6 months, right? If I havent seen regrowth within that time, there will most likely be no regrowth to gain? Ok, so I quit rogaine and then start using topical spironolactone instead to complement finasteride on maintaining what I have.

Does that make a good plan (please say yes)?

I might add biotin pills btw. Cant hurt, right?

 

[Harry S Truman]

Ok. I think I know what to do now. I've already been using finasteride and nizoral for 5 weeks and will continue that.

Two scenarios for further additions:

1. I start using rogaine for 4-6 months. If I see regrowth within that time I continue with it. In time, if I see new signs of hair loss, I consider adding topical spironolactone.

2. If I see no regrowth with rogaine after 4-6 months I quit rogaine. Seeing as rogaine is for regrowth and not maintaining there is no point continuing it if I dont see regrowth in 4-6 months, right? If I havent seen regrowth within that time, there will most likely be no regrowth to gain? Ok, so I quit rogaine and then start using topical spironolactone instead to complement finasteride on maintaining what I have.

Does that make a good plan (please say yes)?

I might add biotin pills btw. Cant hurt, right?

I didn't see much results with rogain till about the 1 year mark, but if i stopped, i def noticed a difference in my hair, so i would give it at least a year....

In short i would probably just add rogain to your regimen and stick with it, then down the line add spironolactone or Fluridil....

 

[Beingbaldsucksass]

Revivogen shampoo is good for cleaning the scalp from oil I use it every day for 6 months

 

[tedlin01]

I don't get it. You are on finasteride and Nizoral but still wants to add yet another antiandrogen? Both finasteride anz Nizoral is Anti-adrogens. What you need to add is a growth stimulator or a Anti-Inflammatory.

Minoxidil is the best growth stimulator on the market and Ahk Cu Copper Peptides or Hydrocortisole works as Anti-inflammatory.

 

[Steven85]

As far as I know Nizoral is both an antiandrogen and anti-inflammatory. So is Revita that I use from time to time (contains copper peptides and keto among another things).

So yes, I'm considering adding another antiandrogen. But a topical antiandrogen that is (and not a shampoo). I want to make sure my hair loss is stabilized before I add a growth stimulator. So thats why I'm unsure if I should prioritize spironolactone or rogaine as a first addition to my regimen.

 

[Beingbaldsucksass]

don't bother. neither spironolactone or fluridil are proven products. the closes thing you can add is nizoral shampoo once or twice a week. stick with proven produts such as propeci, rogaine, nizoral. I only use propecia and nizoral. things like spironolactone, fluridil, ru, blah blah blah.




by the way was fluridil approved in europe? what is the ingridient in it that makes it an anti androgen? maybe fluridil was approved in europe but not here in north america

I use revivogen shampoo as my daily shampoo, it's cleaning my scalp very good from sebum, that between my nizoral days

 

[TheLastHairbender]

If you want to give spironolactone a shot I can ship you two tubs of 5% S5 cream for $50, should be enough to last 4 months if you apply it once per day (at night if you're taking finasteride in the mornings). spironolactone is well-known to be a potent anti-androgen, but it's true that there is a lack of studies about its use topically for hair loss. I used it for the first year of my treatment and had great results (alongside finasteride, minoxidil, and ketoconazole shampoo, like Nizoral). I'm only stopping spironolactone use temporarily to try AHK-Cu for the next five months, as I've outlined in my story...because applying three topicals, two of which are twice a day, is just too messy. The tubs are still sealed, have been kept refrigerated, and bear a May 2013 expiration. Shoot me a PM if you're interested, it would be a lower cost way to give it a shot for 4 months rather than paying $35 x 2 + $6 = $76 retail price. I've been posting my pics and results on this site for over a year so you should feel comfortable it is legit.

Regarding spironolactone in general: So far I think it's the next best addition to a regimen based on finasteride, minoxidil, and ketoconazole. I believe those three things are responsible for the vast majority of success stories' results, but if you're looking to take it a step further, which I was, spironolactone is the next best addition:

- it seems to be better tolerated by most people than even finasteride and minoxidil (in terms of sides and irritation)
- it has been proven to have potent anti-androgenic activity in general
- it has been approved as safe for cosmetic use and is frequently applied topically for acne and hirsutism, providing more assurance of safety than for the research chemicals some people are using
- it is freely available for purchase online so you can ensure no interruption in your treatment. Many of the other possible additions are plagued by this: AHK-Cu, RU, CB, ASC, their ready supply is never ensured and you're always taking a gamble in their procurement, plus often require you to prepare your own formulation which introduces another layer of variability and complexity.

Once you've stabilized on the big 3 and are looking for additional improvement, there is something to be said for having a standardized and accessible treatment option, and that's where spironolactone shines relative to some of the alternative additions. My 14-month long story posted on this site is full of anecdotes about my spironolactone use along the way, most of it praiseworthy. In summary, I don't think it replaces finasteride as an anti-androgen (unless you can't take finasteride in which case it's your next best option), but I think it's a next logical supplement once you're comfortable with what finasteride/minoxidil/keto can do for you. Let me know if you have any questions, I've written a number of lengthy posts for individuals on this site about spironolactone use, and all of this holds true whether or not you choose to take mine off my hands...a meager $50 pales in comparison to my desire to help another bro suffering hair loss. Good luck!

 

[Steven85]

Thanks for the constructive post. I will keep your offer in mind. Only thing that makes me not order spironolactone right away is the fact that so few sites sell it. I mean, if the product is so great, why dont all hair loss shops sell it? Rogaine seem so much safer that way.

How much of a complementary effect to finasteride do you feel spironolactone has? Is it worth the hassle and expenses in terms of really having a discernible effect in maintaing your hair?

And what would you do in my situation, if you should add one topical to your regimen (Im allready on finasteride and nizoral) - would you go for spironolactone or rogaine? For me maintaining is most important. Some regrowth at my temples would be very welcoming, which is why im concidering starting rogaine, but most important is stopping the balding prossess.

And btw: Do the topical S5 spironolactone need to be kept refrigerated?

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Regarding spironolactone in general: So far I think it's the next best addition to a regimen based on finasteride, minoxidil, and ketoconazole.

Just to be sure, do you mean spironolactone is the next best addition, like second best, or that it is the best addition after finasteride, minoxidil, keto?

If its the first, what do you mean is best?

 

[tedlin01]

If I had to chose between (spironolactone or Fluridil) I would chose neither. Noone of them are worth the effort and/or money. Put the money on some more potent experimental treatments as RU58841, ASCJ-9. As TheLastHairBender said you can't put too many topicals on your head each day or they will get uneffective. Save some "space" for Minoxidil and/or OSH101 and/or Bitamoprost.

 

[TheLastHairbender]

Hey Steven,

Minoxidil and spironolactone should not even be compared. Minoxidil regrows hair. spironolactone will, at best, slow the balding process (although I personally believe anti-androgens like finasteride and spironolactone can actually improve hair by reversing miniaturization). But minoxidil is in a completely different league and far more beneficial to a regimen that already includes finasteride.

My comment about spironolactone being the next best addition was meant to imply as a fourth element. To me, finasteride is #1, then minoxidil (which in my experience has only worked when finasteride was included...I used minoxidil on the crown when I was 24 and NW3 and got zero results after about 4 months so I gave up. Two years later, 26 and NW6, I started daily finasteride and tried minoxidil again, showed improvement after 6 weeks and had nearly a full head of hair again after 3 months. That said - minoxidil demonstrated clinical effectiveness to the FDA in the absence of finasteride, and many people with sides from finasteride get some mileage from minoxidil alone, so everyone's experience can be different). With those two treatments in place you might as well use a ketoconazole shampoo like Nizoral or, in my case, prescription 2% keto, because there has been a ton of clinical and anecdotal evidence that keto does a number of good things: acts as an anti-inflammatory, anti-fungal, and even has anti-androgenic effects as tedlin pointed out, via selective competition for androgen receptors in the scalp (exactly what spironolactone does) and via inhibition of certain CYP enzymes that lead to testosterone formation in the first place. Although I don't think many people view ketoconazole as sufficiently anti-androgenic to replace finasteride altogether, it's a worthwhile addition to the regimen because it's typically delivered via shampoo and really no other shampoo has as much support for its use. That rounds out the big 3 treatments: a pill that acts as an anti-androgen, a topical that works as a growth promoter, and a shampoo that acts as an anti-inflammatory and anti-androgen.

My strong belief, although others may differ, is that the big 3 is the regimen you want to implement immediately to give yourself the best shot at success. Barring unbearable side effects, give the big 3 your full attention for the first six months, no need to start messing around with other stuff like spironolactone, AHK, Retin-A, and certainly not the new rounds of research chemicals many people are experimenting with. You'll get there...just focus on implementing the big 3 flawlessly first. Down the road you may find you've plateaued in your progress or may even give up some ground - at that point you'll be thankful you have a next move and didn't waste all your bullets in the first few months. To address your initial concern specifically, for now, finasteride and ketoconazole should provide all the anti-androgenic activity you need to slow or halt the progression of male pattern baldness and allow a growth promoter (minoxidil) to do its job of improving your current condition. If you're already taking finasteride and using nizoral, prioritize minoxidil above all else. (To save you some serious coin though I would skip Rogaine/Regaine and go for generic minoxidil. I started with Rogaine, had good results, switched to generic, and still continued to improve. It's wide consensus that they are identical. Liquid vs foam is a personal preference though, and I'm not sure if there is a generic foam available if you find that's what you prefer. I purchase Kirkland liquid 5% minoxidil on Amazon, at $50-$60 for a one-year supply although I use 2mL per application instead of 1mL so it only lasts me 6 months.)

Only thing that makes me not order spironolactone right away is the fact that so few sites sell it. I mean, if the product is so great, why dont all hair loss shops sell it?

Do the topical S5 spironolactone need to be kept refrigerated?

Just FYI about spironolactone: I don't know why so few shops sell it but I have found that to be the case also. I've been getting mine from here on HairLossTalk.com for the past year reliably but I would also like to have alternative sources. Honestly you're going to find that this is the achilles heel of almost every ancillary treatment to the big 3. Even despite the apparently limited availability of spironolactone it's still the next easiest thing to procure regularly. The AHK-Cu I'm using had to be synthesized special order from a plant in China, with a $25,000 minimum order (hence like 60 of us had to go in on it). Other things like RU/RUM, 17ap, ASC, NEOSH may be available from these fly-by-night sites that are popping up lately but their long-term supply is even less assured and quality less reliable. I also urge you to stay away from those research chemicals for now - there's no need for you to go off the deep end yet and those things have not yet been fully vetted for safety. spironolactone, AHK, and Retin-A have at least demonstrated clinical safety, if not effectiveness as a treatment for hair loss in particular.

Also - the S5 spironolactone jars read on the label 'Store at room temperature or keep refrigerated'. As with many things, degradation of active ingredient happens more rapidly at higher temperatures, therefore the fridge can preserve it for longer than if kept at room temp. How much? I don't know for spironolactone in particular; my assumption is that the expiration date refers to room temperature storage, so with a little extra shelf space on the fridge door I usually opt to be on the safe side. This is not the case for everything though - cold storage can cause some mixtures to separate or solutions to precipitate. Liquid minoxidil preparations take well to the fridge though due to the high alcohol content of their vehicle...and raw AHK-Cu virtually requires cold storage, as it breaks down rapidly above 8*C (46*F).

And to answer your other questions directly just for your future information:

How much of a complementary effect to finasteride do you feel spironolactone has? Is it worth the hassle and expenses in terms of really having a discernible effect in maintaing your hair?

Great questions. spironolactone's complementarity to finasteride is like picking up change on your way to the bank. You're already going to get there - spironolactone is just nickel-and-dime-ing every last cent.

Is it worth the hassle and expenses? Depends on your personal wealth. As I wrote in my story when I was experimenting with spironolactone last year, I don't find its application to be much of a hassle. Apply it about 10 minutes after minoxidil (this was the infamous Dr. Lee's directions for use of his spironolactone cream in tandem with minoxidil), and since it's a more viscous cream than liquid or foam minoxidil I've found that S5 lends itself to my styling needs really well, so much so that I now completely skip using American Crew Forming Cream in the morning which has a very similar texture. The expense is severe though, so its eventual use alongside the big 3 will probably ultimately come down to cost. Using 1mL applications twice a day I was going through one tub per month at a cost of $32 when purchased in the 3 pack. By comparison my finasteride, minoxidil, and keto combined cost $18/month. It is safe to say the return on investment in spironolactone pales in comparison to that for the big 3. But it is still a non-negative return, and likely slightly positive. So it really depends on the alternative consumption possibilities you'd be forgoing to purchase spironolactone. If you're a successful late-career professional with disposable income to burn then go for it, $32 is nothing for even a slight shot at improvement. But if the 85 in your username indicates that you, like me, were born in 1985, then put that $32 a month in your brokerage account instead - your follicles will already be basking from the finasteride-induced reduction in DHT. If you really feel like you have money to burn, consider putting the $32 in my brokerage account instead haha!

Sorry to answer at such length but since you're asking relatively green questions I wanted to take the time to give you the full story in my experience so far before someone else starts telling you to slather home-compounded RU Myristate all over your head without even giving finasteride+minoxidil a shot first. To qualify my support for simply the big 3 here's a look at what it did for me (ok fine I was using spironolactone too but I don't give it much credit - I haven't lost a thing after discontinuing spironolactone use for several months now):

Initially:

Month 3:

Month 5:

and today, Month 14:

The big 3 can work.

Here's a link to my full story, I've been near-religious about keeping it updated and full of information, lots of spironolactone discussion too. I just helped kadir657 on the path to the big 3 with even more info that may be useful to you on page 13. Link: http://www.hairlosstalk.com/interact/showthread.php/55155-TheLastHairbender-s-story

Good luck Steven, we're here for you bro!

 

[TheLastHairbender]

I wanted to take the time to give you the full story in my experience so far before someone else starts telling you to slather home-compounded RU Myristate all over your head without even giving finasteride+minoxidil a shot first.

Put the money on some more potent experimental treatments as RU58841, ASCJ-9. ... Save some "space" for Minoxidil and/or OSH101 and/or Bitamoprost.

Ahh tedlin beat me to it while I was typing that whole dissertation! It's not that this is bad advice; RU, 17ap, ASC, OSH, OC, and especially bimatoprost all show tremendous promise. Just give yourself time on the big 3 first, then come back and re-evaluate the state of the art with these treatments after a year. Hopefully at that time we'll know more about the optimal dosages, best delivery vehicles, necessary application frequencies, and have established some safety guidelines for their use. You might not even have to buy them out of someone's basement and compound them on your kitchen counter at that point! It's also possible that after a year on the big 3 you, like me, will have regrown so much damn hair that there isn't even a need for more inconvenient, costly, and potentially hazardous treatments. Instead you can save the add-ons for five years down the road when finasteride and minoxidil start to lose their punch. ...It's like feeding a starving person at a five-start gourmet - the luxury would be wasted when plain rice would seem like a Michelin-star dinner. Enjoy your rice for a while, then when you're sick of that we'll take you out to a nice fancy dinner, and you'll enjoy it all over again.


As a final precautionary tale, look at that list of experimental stuff: RU58841, CB-03-01, ASCJ-9, OSH101, OC000459, bimatoprost (aka 7-[3,5-dihydroxy-2-(3-hydroxy-5-phenyl-pent-1-enyl)-cyclopentyl]-N-ethyl-hept-5-enamide). That's just six of the more prominent ones right now. It seems almost assured that ten years from now, out of all those experimental treatments, there's going to be one that we're like "dang, I can't believe people were putting that lymphoma bait directly on their skin for hair loss". ...So which one are you going to pick? Hope it doesn't turn out to be that one.

There are many more too: P45, KF19418, LGD1331, Thymosin B4, Naminidil, Diazoxide, Panacidil, Bicalutamide, steroid sulfatase inhibitors, Cromkalin, etc. Just because something inhibits 5a-reductase or activates potassium channel ions doesn't mean it's ok to start rubbing it on your head. Most of this isn't new either. Use Google Trends and see how long people have been talking about this stuff. OSH101? Yeah that was called PS1 back in 2003 and nothing has come of it since. RU? Not new. It has been the 'next big thing' since at least 2004. If safety and effectiveness were so assured with these novel treatments one surely would have been brought to this $10 billion market with how many commercial drugs under unique patent? zero?

There's a lot of lunacy in the hair loss community. UCLA released a study last year in which a new peptide regrew hair on five baldness-induced mice. There are already people lining up on the forums to have it synthesized and begin topical application. Nevermind that man's only experience with the stuff is on five mice, receiving it via injection, for a whopping five days and studied for all of four months. Topical Astressin-B is as likely to cause melanoma as it is to regrow hair. (The study itself shows a more immediate impact on melanocytes than on hair follicles, but you don't hear anybody talking about that). But inevitably someone is going to come along and tell you to try rubbing D-Phe-His-Leu-Leu-Arg-Glu-Val-Leu-Glu-Nle-Ala-Arg-Ala-Glu-Gln-Leu-Ala-Gln-cyclo(-Glu-Ala-His-Lys)-Asn-Arg-Lys-Leu-Nle-Glu-Ile-Ile-NH[SUB]2 [/SUB]into your scalp twice a day.

RU is praised for a reported lack of systemic absorption, yet some people are reporting E.D., clear semen, and shrunken testes. Some ASC experimenters are reporting joint pain throughout their bodies. OSH's class of peptides has been linked to Parkinson's disease. Bimatoprost can turn your iris permanently brown if it gets in your eyes (oh and you have to buy it in raw bulk powder and mix the preparation yourself - hope you have a steady hand). Not trying to scare you, I curse propeciahelp.com for that, but the fact is that we don't have safety profiles for much of this stuff, let alone an understanding of proper methods of administration, dosages, etc. To recommend you start using anything but finasteride, minoxidil, and keto is downright reckless. (Ok spironolactone, Retin-A, and the AHK volume in Tricomin get a pass because their safety has at least been established). You'll find a lot of desperate people willing to try anything in the hair loss community. You don't need to be one of them yet.

- - - Updated - - -

OK I wanted this to be a separate post but since there is no intermediate reply the new system is adjoining it to the former.

Please post references showing spironolactone topically having systemic effects and pm these to me to

I think you will have a hard time finding research support for that view. Early studies, as far back as 1988, suggested a lack of systemic absorption from topically applied spironolactone:

Rey FO, Valterio C, Locatelli L, Ramelet AA, Felber JP. "Lack of endocrine systemic side effects after topical application of spironolactone in man." J Endocrinol Invest. 1988 Apr;11(4):273-8.

Berardesca E, Gabba P, Ucci G, Borroni G, Rabbiosi G. "Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris." Int J Tissue React. 1988;10(2):115-9.

Messina M, Manieri C, Musso MC, Pastorino R. "Oral and topical spironolactone therapies in skin androgenization." Panminerva Med. 1990 Apr-Jun;32(2):49-55.


These early results remain unchallenged in the literature as far as I'm aware.

Still, there has been a non-negligible number of reports of gynecomastia from topical spironolactone use, which seem to follow the discontinuation of oral anti-androgens for the same reason. It's possible that individuals exist in the hair loss community with sensitivities to estrogen that were not well-represented in the small N studies referenced. Let me attempt to reconcile these observations:

Noting that the first study used N=6 "healthy" males, a single application of spironolactone, and 72 hours of post-treatment observation, the hypothesis that certain estrogen-sensitive individuals may demonstrate non-severe systemic side effects after medium- or long-term use can not be immediately refuted. Put more convincingly: I conjecture that topically applied spironolactone may be systemically absorbed after long-term use in sufficient quantity so as to generate systemic side effects in particularly sensitive individuals while remaining at undetectable levels after 72 hours of a single application among healthy individuals. The experiment from the first referenced study is of insufficient duration and contains insufficient variation in its sample group to refute this conjecture. In fact both can be true: a single application of topical spironolactone may be systemically undetectable for 72 hours among healthy individuals and also exhibit long-term systemic absorption among sensitive individuals, even if only in small amounts (the question about amount is more a question of how much it takes to generate gynecomastia among individuals already demonstrated to be gynecomastia-prone when on 5a-reductase suppression, which could be argued to be very little).

The second study, which I believe provides the strongest basis for our beliefs in spironolactone's safety and effectiveness, is more convincing. Study participants apply 100mg of spironolactone to 25 square centimeters of their back, approximately the same area I typically cover when applying to my vertex and temples. A 5% strength cream yields 47.5mg/mL, so the experimental application volume was 2.1mL, roughly double what I attempt to apply at one time (although my metering out of spironolactone is anything but scientific, one of my main complaints about its application), and was maintained under occlusion, further amplifying typical absorption rates. This heavy application, combined with their long-term results from one month of twice daily application without occlusion, presents a stronger confirmation of spironolactone's strictly local influence (and its effectiveness for selective AR competition). Still, the tiny sample size of six can surely not be expected to span the population space.

The third paper is a survey and I have other things to do with my life right now.

If you're of the belief that spironolactone is not systemically absorbed. . . then I'm in agreement with you, at least up to the 98 or 99th percentile in terms of sensitivity. In that sense, the small-sample findings can still be logically reconciled with the observation that several among many, many individuals, particularly those that have previously demonstrated sensitivity to DHT inhibition, may exhibit side effects consistent with systemic absorption. I am personally comfortable with the general belief in topical spironolactone's safety (and efficacy for that matter).

 

[Steven85]

Thanks for those extremely elaborative posts lasthairbender (and yes, the 85 in my user name means I'm born 1985). I think you have convinced me to drop spironolactone for now. These forums are great, but also create a lot of confusion as so many users have completely opposite perceptions of how these treatments work, and what is best. Just a few days ago another user on HLH explained in great detail, and also very convincingly, why you should prioritize spironolactone or another topical antiandrogen over rogaine. His explanation was that spironolactone helps finasteride maintain your hair, and that maintaining should be first priority. If you are starting rogaine before a topical-antiandrogen you risk masking the fact that you are losing hair, and by the time you realize it, its to late. His key point was to stabilize your hair loss before adding a growth stimulator.

Anyway I think you convinced me even more, so Ill probably hold off with the spironolactone. Your winning point was this:

Down the road you may find you've plateaued in your progress or may even give up some ground - at that point you'll be thankful you have a next move and didn't waste all your bullets in the first few months.

With that though should I consider holding off with rogaine too, for now. My hair loss is not that advanced yet, as I only have recession at my temples. That way I will have yet another bullet to spare, right? Its not that I wouldn't like some temple regrowth right now (I really would!), but maybe I'm better of saving it for later. What do you think?

Also: after reading a lot of positive comments on revita I ordered a bottle a few days ago. But now I have read that the formula has changed and a lot of people don't like it anymore. Anyways I was thinking about alternating it with Nizoral 2%, using nizoral once a week and revita 2-3 times a week. What do you think about that, and what is your take on revita in general (copper peptides, biotin, keto and all that other stuff it contains has to stand for something, right)?

 

[akp22191]

Hey could you check mines out. I'm new to this & it would be very kind of anybody who's reading this to check my story out. I just created a profile, so I'm going to need replies from people. Please don't hate me for posting this on your thread lol. Yours was the most recent one and I thought maybe some of the viewers might look at mines and give me a reply.

- - - Updated - - -

Here's the link to my story http://www.hairlosstalk.com/interac...ttern-Baldness-or-just-Maturation-of-Hairline

 

[TheLastHairbender]

Haha thanks for reading that extended discourse Steven! It's funny you ask about Revita, I just elaborated on my thoughts about it in response to kadir657's post in my story moments ago, before seeing your question. Let me reproduce that here and link you to the full discussion: tiny.cc/nu1yiw

Looking at Revita shampoo it seems like a reasonable product - claims to contain caffeine, copper peptides, SOD, ketoconazole, MSM, and biotin, among other things. A few thoughts: The idea of copper peptides and SOD is nice, but it's not clear what peptides are used; there are many available, AHK-Cu and, to a lesser extent, GHK-Cu, have the most clinical support, but are also the most expensive. It's more likely this product contains a random (and less expensive) mix of soy peptides, like Folligen does. They may still be a good thing, but I wouldn't select this shampoo strictly on that basis. Related, exogenous SOD may not be that helpful either, which is why copper peptides are more widely used to induce the production of endogenous SOD. This is currently a frontier of modern clinical research so none of us can say with certainty, but the suggestion has been that topical AHK-Cu in particular is the preferred method for harnessing the antioxidant effects of superoxide dismutase, which is what the 'copper peptide' and SOD ingredients aim to do. Also it's not clear that MSM and biotin are active topically, but it doesn't hurt. Most importantly, the shampoo claims to contain ketoconazole, which should definitely part of your regimen and is ideally delivered through shampoo. Most people use a dedicated ketoconazole shampoo like Nizoral, in 1% or 2% strength. I can't find the concentration in Revita, some claim 2% but I don't believe that's true because anything over 1% requires a prescription in the U.S. It's possible there is an insufficiently small quantity of ketoconazole included just for purposes of including it on the label. That said, it does seem to have generally positive reviews. Would I trade Nizoral 1% or my Rx 2% every few days for Revita? Probably not, plus for daily use I've found Aveda Pure Abundance to do the most for my hair cosmetically compared to the other brands I've used (Nioxin, Infusium volumizing, others I can't remember right now), but it's probably not of first-order importance in the presence of finasteride and minoxidil. In any case, you want to make sure the ketoconazole stays on your head for about 5 minutes, re-lathering a few times in the process, then rinse it out completely.

I think the idea of using it alongside Nizoral once or twice a week is a good one, and what I recommended to kadir. The only risk being overexposure to ketoconazole. I'm not sure how much keto that means, and I'm not sure how much keto is in Revita, so it's a rather speculative issue. I think the Nizoral 1 or 2% is the most direct and recommended source of keto, and your secondary daily shampoo is of little import. I tend to choose on the basis of cosmetic effect and cost until something comes along that shows more promise, and I don't think anything shows more promise than a dedicated keto shampoo right now despite the claims of many shampoo manufacturers. It may be worth bearing in mind that, despite wide agreement on oral finasteride being the most effective treatment for hair loss, there are so many more designer shampoos developed rather than designer oral or topical hair loss treatments. I believe this is the result of companies pandering to consumer perception that for something to be effective for treating hair loss it must actually come in contact with and be proximally near to the hair itself. And since shampoo is a product everyone already buys and uses anyway, it's less of a hurdle to get consumers to switch to a particular brand of shampoo than to integrate a separate topical or oral treatment into their daily life, despite the fact that those methods of administration have proven more effective than shampoo has been. So I think that a majority of what you see marketed for hair loss is based more on what consumers can be induced to buy than on what actually works best (which is actually very few things to date). Whether Revita, Regenepure, Revivogen, etc. falls into this category I can't say, but you see a ton more success stories using the big 3 without a designer shampoo than you see from using a designer shampoo without the big 3. The bottom line: focus on the Nizoral, finasteride, and minoxidil components and don't stress over the other shampoo.

Also, for what it's worth, I started with Nizoral 1% for 3 months before switching to prescription 2%, which may be responsible for never having any perceptible dryness issues.


Your point about not starting minoxidil is well taken, and I think you might be exactly right about that. It depends on your degree of hair loss so far and where you'd need it to be to feel comfortable. It sounds like you're being very proactive about male pattern baldness, in which case you could probably benefit from finasteride alone without the hassle of minoxidil use until you really felt like you need it. I was unfortunately more reactionary in my approach, I had already reached a nearly terminal balding pattern at 25 before I was compelled to do something about it, so starting with finasteride, minoxidil, and spironolactone made sense for me. Based only on what you've told me, which represents your own opinion of your current state and is far more relevant than any objective measure of the progression of your hair loss, I would suggest avoiding the minoxidil for now. Using minoxidil is a lifelong commitment. Once you start you can never go back; most people are left worse than when they started after discontinuation (arguably where they would have been anyway in the absence of minoxidil use over that period), and it doesn't sound like you have much room for minoxidil to show improvement. At 26/27 some recession at the temples is not a noteworthy bad look. With proper styling of the hair and your overall picture, it can play really well into differentiating you from the naive early-twenties. I mean, this is a more personal issue to you in particular, but guys like Jude Law, Bradley Cooper, and many others have made the 'mature hairline' a point of admiration. I think this is the best time in recent history for guys rocking the mildly receded mature hairline. In fact you might not even need to go so far as to use daily oral finasteride. spironolactone alone may be able to give you the support at the temples you're looking for. It really depends on what you expect your balding pattern to be, so take a look at dad, the uncles, and grandpas; if you expect a spot to develop on the vertex or diffuse thinning to set in, I'd jump right into finasteride. If it starts at the front and works strictly backwards, then I'd just start topical spironolactone for now, monitor things closely, and just be ready to start finasteride if topical spironolactone doesn't keep things under control after 3 to 6 months.

I know this only introduces more questions and complexity at this point, but it's basically a chance to save yet another bullet. If spironolactone helps you hold the line for another couple years you can then add oral finasteride for a couple more years of safety. If things start progressing after that you can add topical minoxidil and bring it back for another five years. If you plan, execute, and remain patient you could have this under control for the next 10 years or more, holding out til 40. On the other hand I'm already worrying about developing tolerance or resistance to my treatments, and will be lucky to keep my hair in place til 30. ...The risk for you with spironolactone alone is not hitting it hard enough and letting it progress a bit further. That's why I recommend starting immediately, 1mL at the temples twice a day, take weekly pictures and monitor things very closely. Don't drive yourself nuts, but have a plan that after three months if recession continues despite twice daily spironolactone use you'll start daily finasteride (which you could probably start at a dose of just .5mg/day). I would suspect spironolactone would do you very well. Take a look at that second study I posted. It shows really conclusively that topical 5% spironolactone (at the same frequency and quantity that I recommended to you) resulted in a marked decrease in DHT bound to dermal androgen receptors like those in your follicles, and all without any measured systemic absorption. This is direct clinical evidence of effectiveness and safety for precisely your desired outcome and using a methodology you can replicate exactly - it really doesn't get any better than that.

To be precise: since you'd be covering a smaller area than that used in the referenced study, one of, say, 3cm x 2cm at each temple, so 12 square centimeters total, in order to deliver the same treatment quantity of 4mg/cm2 you'd need to apply only 48mg of active ingredient in total. A 5% w/w concentration implies 50mg spironolactone per gram of cream. So you'd want to apply .96 grams of cream total to that 12 square centimeters to deliver 48mg of spironolactone. Lucky you, a volume of 1 milliter has mass of .95 grams (30mL = 1 oz = 28.5g, so 28.5g/30mL = .95g/mL), so you'd just apply exactly 1mL of cream every morning and night - much easier to meter out a precise volume of a cream than to meter out a decimal quantity mass on a scale. I'll even send you a 1mL pipette dropper for free if you need one, I have bunch of brand new extras. Further, the commercially available S5 cream contains 60mL per tub, so each one would last you exactly a month at 1mL/application, 2mL/day ($32/month if you buy them in the 3 pack for $96). Anyway hope that info helps if you decide to give spironolactone a shot before jumping into finasteride.

There I go again...3 hours typing a response to a simple question.

It should serve to illustrate a simple point for you to remember though Steven: it's good to be overly skeptical when taking advice from people on these forums. In this thread somebody jumped in and recommended you start using an experimental unapproved treatment with arguably the worst side effects of any known treatment to date without even knowing the condition of your hair loss, what your goals for maintenance/regrowth were, or even how you felt about your progression in male pattern baldness. It sounds like you have a good attitude about things and aren't like afraid to go outside or anything due to hair loss...why the heck would someone suggest you bet your freaking balls (literally) when it turns out only a slowing of male pattern baldness progression is warranted. I'm somewhat guilty of this myself in advocating for the full big 3 without adequate background information, but I think the consequences to using FDA-approved treatments is comparatively minimal and given that you were already investigating second-line treatments like spironolactone and fluridil I incorrectly assumed you were a bit more desperate and advanced in your progression than you actually may be. So you're doing the right thing by doing lots of research on your own before taking anyone's hasty conclusion as the gospel truth. Hopefully my recommendations have been sufficiently justified from my own experience and the cited clinical evidence so as to save you some headache in gathering information. Let me know what you think and good luck!