- Reaction score
- 2,518
A lot of guys come on here wondering if they can safely use things like estradiol in low doses or other oral antiandrogens. Let me explain what your options are if you plan on keeping your virility.
- In theory, low dose E2 with short cycles and breaks would be good for hair. The problem is that it would likely just give you gyno, reduce your testosterone, and give you other sides, and give you no hair gains. It is very common to see breast growth precede hair growth, so in short, you cannot get hair gains on estrogen without getting sides. Furthermore, there are transgenders who take E2, but not enough of it, and don't really improve their hair. So the dose may have to be quite high. Again, it will reduce your testosterone as well and can permanently damage your HPA axis to where you can no longer produce normal amounts of endogenous testosterone, thus making you dependent on TRT or HRT the rest of your life. It is not an option for a standard male.
- Other forms of estrogen are simply not strong enough to get results from
- CPA is one of the worst ideas. It will destroy T, which means you will also have less E, and so you must supplement this drug with E. You can take this drug and still end up bald as well as infertile. Someone who is naturally very high in androgens might be able to tolerate low doses of this drug, but it is not worth the risk as you have to commit to it long term just like any hair loss drug. This drug will also screw up your natural production of hormones.
- Bicalutamide is the least harmful of the bunch, but still not an option orally. It is less harmful because it is non-steroidal (NSAA) and will not affect your HPA axis. It will also keep your serum androgen levels high, in fact your testosterone will be higher than normal. However, the drug will prevent you from being able to use a significant portion of testosterone (it just sits in the bloodstream, because bicalutamide will be occupying the androgen receptors). The drug will increase your estrogen by about 2-3 fold. Thus, this drug will cause gyno. It appears that, like estradiol, breast growth will precede hair growth too. But at least it appears that it will likely not cause significant side effects like infertility, as your natural hormone production remains in tact. Less side effects, but the cost is still gyno. Some people get surgery for it, so if you are willing to do that then this might be an option. The user dani500 has been using this drug as a cis male, but the rest of us should be aware that there is a cost to it, and you will not be able to avoid it by taking low doses or cycling.
- Spironolactone is a steroidal antiandrogen and thus may affect the HPA axis. It appears to be fairly weak but yet can still cause sides like gyno. Not worth it IMO.
With those things in mind, here are viable options:
- Finasteride
- Dutasteride - it is interesting to note that 0.5mg of dutasteride inhibits around 50% of scalp DHT, which is comparable to finasteride. However, 2.5mg of dutasteride daily inhibits 85% of scalp DHT, so that may be an option for some who are losing ground. Some people seem to have done well with it topically, which should minimize side effects since dutasteride is too large of a molecule to go very systemic. But some do not seem to do well topically. Also, there are anecdotes of hairline worsening, which I personally experienced. I would opt to make changes with your 5ARI with caution and instead try to add oral minoxidil or one of the topical antiandrogenic options.
- Minoxidil - can be made more effective with needling and tretinoin. Twice daily will give you better results than once daily.
- Oral Minoxidil is underrated as there is just as much fear mongering surrounding it as there is finasteride. I am not saying side effects do not exist - but what you see on the internet is often overblown. Also, the dose can be adjusted easily to mitigate sides. This is the most powerful weapon we have against hair loss IMO because it will compliment your other treatments and without a doubt create some improvement no matter how bad your situation is. I say that finasteride is not the most powerful, but it is the most consistent in terms of maintenance. Oral minoxidil gives us cis males the best chance at regrowth among any drug.
- Keto shampoo - be aware there is a 2% option available, and be sure to let it sit on your scalp for at least 6-10mins before rinsing. Also comes in a cream but is hard to find and more expensive so that it is not really worth it.
- RU58841 - a topical antiandrogen with a binding affinity equivalent to that of testosterone. Its weakness is its half-life of 1 hour, so in order to get noticeable results it should be applied twice a day, which is another inconvenience. Still, it addresses the issue in a different pathway than finasteride or minoxidil, as it blocks the receptor, and is likely more effective when stacked with those two treatments combined. Side effects seem to be fairly rare, more rare than finasteride it appears. The understanding is that it breaks down into harmless or at least less harmful metabolites when it reaches the blood stream. It is an NSAA, so it does not affect hormone levels.
- CB-03-01 (clascoterone/breezula) - a topical antiandrogen, however, it is important to note that this drug is steroidal and could potentially affect hormone levels to some degree. That said, it has a weaker binding affinity than RU. I don't recall the half life, but I do not believe it is very long either. It does seem to be very safe and cause very few sides anecdotally.
- Fluridil (topilutamide) - Another topical antiandrogen, but with a weak binding affinity. However it has a longer half life (about 6 hours IIRC) and can be applied either once or twice a day. It is hydrophobic, meaning that the compound breaks down once it is in contact with the water molecules in your blood. The side effects on this drug are extremely minimal. A very safe option but also a weak one. It is a topical version of flutamide and is an NSAA.
- Alfatradiol - A synthetic, weak version of estradiol. Low risk of side effects, but also very weak.
- Topical spironolactone - to my knowledge it is not very effective (basically inert topically) and not really worth it as it is steroidal too.
- Topical Bicalutamide - something I have been experimenting with. The idea is to get the benefits of the oral version (blocks the AR and also increases E2) but concentrate those in the scalp. Since it is an NSAA and keeps serum levels of T high it appears to have low risks as it does not impact the HPA axis. Since it has a half life of 7 days, it can be used once a week, making it very convenient as well. I would say it compares to RU in overall effectiveness but it is simply cheaper and more convenient.
- Topical Pyrilutamide - yet to hit the market but seems to have great potential to be one of the most powerful tools yet. Non-steroidal, a binding affinity stronger than DHT IIRC, and likely a long enough half life to be able to use less frequent applications.
- Microneedling
Other than that, there's stuff out there like PRP and LLLT, supplements, etc., which are too expensive, inconvenient, and not strong enough to worth mentioning. In general, you should stay away from oral antiandrogens and instead experiment with some of them topically. There isn't really any middle ground. Hopefully pyrilutamide will be efficacious and have low risk of side effects. There's also other experimentals being currently developed to degrade the AR. The cool thing is that all of these treatments could potentially be used together for a compounding effect since they work in slightly differing pathways. I cannot emphasize the efficacy of oral minoxidil, and I would recommend that be the first change someone makes to their regimen before experimenting with antiandrogens or dutasteride for that matter.
- In theory, low dose E2 with short cycles and breaks would be good for hair. The problem is that it would likely just give you gyno, reduce your testosterone, and give you other sides, and give you no hair gains. It is very common to see breast growth precede hair growth, so in short, you cannot get hair gains on estrogen without getting sides. Furthermore, there are transgenders who take E2, but not enough of it, and don't really improve their hair. So the dose may have to be quite high. Again, it will reduce your testosterone as well and can permanently damage your HPA axis to where you can no longer produce normal amounts of endogenous testosterone, thus making you dependent on TRT or HRT the rest of your life. It is not an option for a standard male.
- Other forms of estrogen are simply not strong enough to get results from
- CPA is one of the worst ideas. It will destroy T, which means you will also have less E, and so you must supplement this drug with E. You can take this drug and still end up bald as well as infertile. Someone who is naturally very high in androgens might be able to tolerate low doses of this drug, but it is not worth the risk as you have to commit to it long term just like any hair loss drug. This drug will also screw up your natural production of hormones.
- Bicalutamide is the least harmful of the bunch, but still not an option orally. It is less harmful because it is non-steroidal (NSAA) and will not affect your HPA axis. It will also keep your serum androgen levels high, in fact your testosterone will be higher than normal. However, the drug will prevent you from being able to use a significant portion of testosterone (it just sits in the bloodstream, because bicalutamide will be occupying the androgen receptors). The drug will increase your estrogen by about 2-3 fold. Thus, this drug will cause gyno. It appears that, like estradiol, breast growth will precede hair growth too. But at least it appears that it will likely not cause significant side effects like infertility, as your natural hormone production remains in tact. Less side effects, but the cost is still gyno. Some people get surgery for it, so if you are willing to do that then this might be an option. The user dani500 has been using this drug as a cis male, but the rest of us should be aware that there is a cost to it, and you will not be able to avoid it by taking low doses or cycling.
- Spironolactone is a steroidal antiandrogen and thus may affect the HPA axis. It appears to be fairly weak but yet can still cause sides like gyno. Not worth it IMO.
With those things in mind, here are viable options:
- Finasteride
- Dutasteride - it is interesting to note that 0.5mg of dutasteride inhibits around 50% of scalp DHT, which is comparable to finasteride. However, 2.5mg of dutasteride daily inhibits 85% of scalp DHT, so that may be an option for some who are losing ground. Some people seem to have done well with it topically, which should minimize side effects since dutasteride is too large of a molecule to go very systemic. But some do not seem to do well topically. Also, there are anecdotes of hairline worsening, which I personally experienced. I would opt to make changes with your 5ARI with caution and instead try to add oral minoxidil or one of the topical antiandrogenic options.
- Minoxidil - can be made more effective with needling and tretinoin. Twice daily will give you better results than once daily.
- Oral Minoxidil is underrated as there is just as much fear mongering surrounding it as there is finasteride. I am not saying side effects do not exist - but what you see on the internet is often overblown. Also, the dose can be adjusted easily to mitigate sides. This is the most powerful weapon we have against hair loss IMO because it will compliment your other treatments and without a doubt create some improvement no matter how bad your situation is. I say that finasteride is not the most powerful, but it is the most consistent in terms of maintenance. Oral minoxidil gives us cis males the best chance at regrowth among any drug.
- Keto shampoo - be aware there is a 2% option available, and be sure to let it sit on your scalp for at least 6-10mins before rinsing. Also comes in a cream but is hard to find and more expensive so that it is not really worth it.
- RU58841 - a topical antiandrogen with a binding affinity equivalent to that of testosterone. Its weakness is its half-life of 1 hour, so in order to get noticeable results it should be applied twice a day, which is another inconvenience. Still, it addresses the issue in a different pathway than finasteride or minoxidil, as it blocks the receptor, and is likely more effective when stacked with those two treatments combined. Side effects seem to be fairly rare, more rare than finasteride it appears. The understanding is that it breaks down into harmless or at least less harmful metabolites when it reaches the blood stream. It is an NSAA, so it does not affect hormone levels.
- CB-03-01 (clascoterone/breezula) - a topical antiandrogen, however, it is important to note that this drug is steroidal and could potentially affect hormone levels to some degree. That said, it has a weaker binding affinity than RU. I don't recall the half life, but I do not believe it is very long either. It does seem to be very safe and cause very few sides anecdotally.
- Fluridil (topilutamide) - Another topical antiandrogen, but with a weak binding affinity. However it has a longer half life (about 6 hours IIRC) and can be applied either once or twice a day. It is hydrophobic, meaning that the compound breaks down once it is in contact with the water molecules in your blood. The side effects on this drug are extremely minimal. A very safe option but also a weak one. It is a topical version of flutamide and is an NSAA.
- Alfatradiol - A synthetic, weak version of estradiol. Low risk of side effects, but also very weak.
- Topical spironolactone - to my knowledge it is not very effective (basically inert topically) and not really worth it as it is steroidal too.
- Topical Bicalutamide - something I have been experimenting with. The idea is to get the benefits of the oral version (blocks the AR and also increases E2) but concentrate those in the scalp. Since it is an NSAA and keeps serum levels of T high it appears to have low risks as it does not impact the HPA axis. Since it has a half life of 7 days, it can be used once a week, making it very convenient as well. I would say it compares to RU in overall effectiveness but it is simply cheaper and more convenient.
- Topical Pyrilutamide - yet to hit the market but seems to have great potential to be one of the most powerful tools yet. Non-steroidal, a binding affinity stronger than DHT IIRC, and likely a long enough half life to be able to use less frequent applications.
- Microneedling
Other than that, there's stuff out there like PRP and LLLT, supplements, etc., which are too expensive, inconvenient, and not strong enough to worth mentioning. In general, you should stay away from oral antiandrogens and instead experiment with some of them topically. There isn't really any middle ground. Hopefully pyrilutamide will be efficacious and have low risk of side effects. There's also other experimentals being currently developed to degrade the AR. The cool thing is that all of these treatments could potentially be used together for a compounding effect since they work in slightly differing pathways. I cannot emphasize the efficacy of oral minoxidil, and I would recommend that be the first change someone makes to their regimen before experimenting with antiandrogens or dutasteride for that matter.
