Hey guys, as the end of 2023 nears, I thought I'd do a post for those coming to this sub in desperate need of help.
In this post I’m going to be talking about the science of hair loss and what to do if you are balding and want to stop it.
I’m a medical student and have donated a lot of my personal time to pharmacology, hormones and hair protocols through research and experimentation. There’s a lot going on here on Reddit, and as a beginner it can be very daunting to decide on what to do. Obviously everything should be discussed with your doctor, but below is my best attempt at a guide to explain a little bit about hair loss:
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I first noticed I was balding around 12 months ago, and rather than get caught up in the genetics of hair loss and trying to figure out whether it was Dad, my Mum’s Dad, my Mum’s Dad’s Dad or the goldfish he owned when he was 10, I thought to myself:
I can’t change my genetics. Whatever my DNA sequencing (genomic regions) has in store for me in regards to balding, that’s pretty much set. The best I can do is fight as long as I can using the highest quality science, products and methodologies to offset it.
And that’s what I’ve been doing, with good success, over the past 12 months.
Let’s get into it, and I’m going to do this in order of most important to least (in my opinion).
Getting to the root cause: DHT
Okay, so if we look at the entire testosterone/HPT axis pathway, cholesterol is converted to testosterone and some people think that’s the end of the line, but it’s actually not; 5-alpha reductase (5A1/2 in the image below) is the enzyme responsible for converting Testosterone (T) to its much more potent form DHT (dihydrotestosterone).
5-alpha reductase converts Testosterone to DHT, the hair killer.
Now, interestingly, 5-alpha reductase for whatever reason is very high prevalent in skin tissue - including the human scalp. And side note: this is why guys who take testosterone gel or cream often have very high levels of DHT compared to guys who take injections, because the cream is being converted through the skin into DHT at a much higher rate than injectable esters into muscle bellies. But, basically, it is this 5-alpha reductase activity in the scalp that is converting testosterone to DHT, and DHT through a variety of mechanisms leads to follicular miniaturisation (hair thinning, and eventual loss of your hair follicles).
But why? Well, there are hundreds of factors: hormonal (androgen receptor density & sensitivity to said androgens), physical, genetic, environmental. The list goes on.
Note; this study goes into a lot more depth for those of you interested.
But, how do we actually combat balding?
Most men tend to lose their hair in patterns as described by the famous Norwood Scale.
With how much I’ve spoken about 5-alpha reductase and DHT, it seems logical that stopping this conversion of Testosterone to DHT is the absolute first line of defence against hair loss.
To really, truly combat hair loss, the first mechanism is as follows: you absolutely need to reduce your hair follicles’ exposure to DHT.
And how do we do this? Well, finasteride is a drug that acts as a 5-alpha reductase inhibitor. Sold under the name Propecia, the molecule is a strong 5-alpha reductase inhibitor, and has been shown to inhibit around 70% of serum (blood) levels of DHT from peak. The usual starting dose is 1mg daily. Dutasteride (sold under the name Avodart) is an even more potent inhibitor (usual starting daily dose is 0.5mg), and can block up to 98% of conversion from T to DHT: it is a much more potent inhibitor of the enzyme that converts T to DHT. Dutasteride would be an option if you wanted a nuclear option to block almost all DHT. In fact, one of my favourite studies compared the difference between Finasteride vs. Dutasteride, and as you can see below, the suppression of DHT levels from Dutasteride was significantly more than Finasteride. Not only this, but the half life of Dutasteride is significantly longer than Finasteride (~8 hours vs. 5 weeks!), and you can see that in the Dutasteride group after stopping treatment (Follow-up Period), DHT levels remained suppressed for a much longer time.
DHT vs. Finasteride - what a study.
Side effects from 5-alpha reductase inhibitors are rare, although we should speak about them. Online, through various forums, Reddit posts, YouTube videos and TikTok’s time and time again I see posts about nasty Finasteride side effects, post-Finasteride syndrome and how Rob can’t get his Johnson hard anymore because of Finasteride, so his girlfriend left him.
Now, don’t get me wrong, side effects have been noted, although current research puts the risk of side effects at around 1-3% of people, so even though online there is a lot of noise about finasteride and its side effects, I personally don’t think the research supports this scaremongering. There is also going to be a natural selection bias with the stories online, because the guy for whom Finasteride is working well and who is not experiencing any side effects, he isn’t really going to post. Because why would he? He’s doing fine.
However, I absolutely sympathise with the people who just cannot tolerate 5-alpha reductase inhibitors. Side effects can be very real, and this is why it is vitally important to always consult with a qualified doctor before deciding on any medication: I’m just presenting the science. Everyone reacts slightly differently, and these can be strong medications - so it's important to be well-informed and sensible with whatever path you and your medical practitioner decide to go down.
Topical Minoxidil 5% (Rogaine):
Minoxidil is a compound that has been shown to increase the rate of DNA synthesis in anagen (growth phase) bulbs of hair follicles. Basically minoxidil stimulates hair cells to move from telogen (resting phase) to anagen (growing phase) - so instead of having hair follicles resting, it is telling the body to move them back into a growth phase by shortening the resting phase. The idea here is that you get more ‘regrowth’ of hair follicles.
Minoxidil stimulates hair cells to shorten the resting (telogen) phase and go back into an anagen (growing phase). Often, progress pictures will show significant new regrowth or ‘baby’ hairs growing with minoxidil treatment.
I apply Rogaine, a 5% strength Minoxidil foam twice daily in areas that I feel are receding. The nice thing about the foam is that it isn’t super sticky (unlike some people report with the gel), and it also acts as a nice way to hold my hair throughout the day, like hair product.
As you can see from the photo below, there is a vast difference between telogen (resting phase) and anagen (growing phase), and the idea is that the more hairs you can keep in anagen, the more healthy your hair will be, by limiting the amount of follicles that inevitably go through an anagen restart and die off.
There is also the option of oral minoxidil, which anecdotally at least seems to be very powerful at regenerating ‘baby’ hairs (or, new regrowth). Again, oral minoxidil can have some pretty significant side effects and drug interactions with blood pressure medications, so speaking through with your doctor is key!
Ketoconazole Shampoo:
This shampoo is primarily an anti-dandruff shampoo, but research has shown it may increase the proportion of hairs in anagen phase (growth phase) - resulting in reduced hair shedding. This study showed that 1% ketoconazole shampoo increased hair diameter over baseline after 6 months of use and reduced shedding. Interestingly, participants’ hair diameter also increased over baseline, showing that it may play a role in creating thicker hair.
Nizoral is a common brand here in Australia of 2% strength ketoconazole shampoo.
What is good about ketoconazole, is that it’s also a weak androgen receptor antagonist. What does this mean? It means it competes with DHT and Testosterone for binding to the active binding domain on the human AR (androgen receptor). If a compound can bind to a receptor without influencing its usual effects, it is said to be an antagonist. Basically, if ketoconazole can get into an androgen receptor before Testosterone or DHT, it will occupy that site and block T/DHT from binding and starting their usual process of killing off hair follicles (follicular miniaturisation).
Goodbye DHT, nobody wants you here.
Dermarolling
Derma-what?
Dermarolling is the process of creating micro punctures in the scalp skin to induce a wound healing response, with an array of tiny microneedles.
In this study, the dermarolling + minoxidil treated group was statistically superior to the minoxidil only treated group in promoting hair growth in men with balding patterns, for all primary efficacy measures of hair growth. In fact, the microneedling group outperformed even the minoxidil group in terms of how much hair was regrown after 12 weeks:
The mechanism seems to be that continued microtrauma to the scalp skin leads to a release of platelet derived growth factors and other growth factors that are sent to the area of scalp, to aid in the skin wound regeneration. The added benefit is that there seems to be some carry over effect to hair growth, as dermarolling seems to activate stem cells or ‘unspecialised’ cells that are yet to be differentiated, and differentiate them into hair follicle cells, meaning more hair growth. Basically, its a wound healing response that brings growth factors to the area of the scalp to increase hair growth.
I have played around with a few different protocols, but I use a 1.5mm roller and roll horizontally, vertically and diagonally for about 30 seconds in areas where my hairline is thinning or receding. I do this every 10 days. You don’t want to press so hard that you draw blood, but it should also hurt slightly. I mean, putting hundreds of tiny spikes into your scalp isn’t really my idea of Sunday night fun. But hey, if it regrows some hair why not?
There are also derma-stamps and motorised tools, all of which assist with the end goal: creating a wound healing response to bring growth factors to the scalp, and potentially assist the penetration of Minoxidil deeper into the scalp skin tissue.
Natural DHT blocking compounds:
Natural DHT blockers are also options, although obviously the results aren’t going to be nearly as strong as what is mentioned above.
Some people have good results (anecdotally) with rosemary oil applied topically, green tea and saw palmetto are options here. However, the science is very hit and miss, and in any event, I can’t see natural compounds competing against the 'Big 4'.
RU58841:
Now, that’s all good, but what if you need a nuclear chemical. Something that would attack the androgen receptor at a direct level in your scalp? Well, that compound is below. But a quick warning: I do not recommend this compound. A lot of people use it, but that doesn’t mean it’s safe. There is no (yes, zero) long-term safety data on the compound below, and whether you choose to take a completely untested chemical is up to you. But I don’t recommend it - have I said that enough?
Alright so, apart from sounding like a bunch of random letters because your cat ran over your keyboard, RU58841 is a strong DHT blocker (it has been shown to inhibit around 70% of DHT binding to the androgen receptor), but not in the way that Finasteride or Dutasteride work.
The chemical structure of RU58841.
Instead of finasteride and dutasteride which work on inhibiting the 5-alpha reductase enzyme, RU58841 works on the AR itself - occupying the active site, so that when DHT tries to get in and exert its hair destructive effects in the scalp, it can’t, it’s literally blocked from accessing the active site of the androgen receptor.
RU58841 operates like an androgen receptor antagonist (3rd receptor, on the right). It binds to the receptor and stops testosterone and DHT from binding, meaning that DHT cannot then exert its hair miniaturisation effects.
And in this study, RU58841 was found to inhibit 70% of DHT binding. Combining something like finasteride or dutasteride which attacks 5-alpha reductase converting T to DHT with RU58841 which stops ~70% of DHT binding to the androgen receptor, and you’d now be attacking hair loss from 2 vectors: T to DHT conversion, as well as at a receptor level. Now you can start to understand why this is a nuclear option for hair loss, and incredibly powerful.
However, despite how good all of that sounds in practice, just remember, RU58841 is completely untested in regards to side effects. There is no long-term safety data on how it may or can impact human health, so what I’m saying (for legal reasons) is don’t use it. Get what I’m saying?
Final Thoughts:
And, there it is guys. Now, just a quick note, this isn’t a super comprehensive list of all supplements for a hair regrowth/hair protection protocol, but is a solid start.
There are certainly more ‘niche’ options, or compounds in development now that may be promising (or not, looking at you Phase 3 of Pyrilutamide trials), but this guide was just the bare basics for a beginner to wrap his head around (no pun intended) the science and how to start combatting AGA.
In particular, if you want to save your hair, it’s going to be the ‘big 4’: finasteride (or Dutasteride), Minoxidil, Ketoconazole shampoo and derma-rolling roughly once a week to every 2 weeks.
This would follow the best possible science that we have at the moment, in terms of targeting as many vectors as possible:
T to DHT blockade (5-alpha reductase inhibitors, Fin/Dut)
Use this thread for general questions and advice,“Am I balding?”, “What are my options?”, “Does anyone else experience this?”, as well as discussing side effects, treatment experiences, or looking for opinions on your hairline photos and treatment options.
Please don't rely on other users to diagnose conditions or guide your treatment decisions. While you can share personal experiences, what worked for you may not be safe or appropriate for someone else. If you're experiencing symptoms, concerned about side effects, or considering treatment, please talk to a doctor rather than relying on internet advice.
If you want useful feedback on your hair, post good photos: high resolution, multiple angles, good lighting, and ideally both wet and dry.
Mention what changes you’ve noticed and over what period of time. Some people naturally have thinner hair, a higher hairline, or less density, so context helps members give you better feedback. It's vital to take identical photos every few months. Remember that consistent lighting is important.
Age and family history are worth mentioning.
You might not get an answer if your question is too basic or common. Nobody can predict if a treatment will work for you.
This is a community, and you can help out fellow members by commenting under their photos and upvoting people that leave you comments.
Wanted to break down the latest clinical data on Scientists Just Flipped the Master Switch for Hair Growth and what it actually means for people dealing with hair loss.
The Short Summary
Researchers have successfully activated the Wnt signaling pathway to regenerate full-thickness hair in mice and human tissue models. While this is not yet a clinic-ready treatment, it marks the first time we have directly manipulated the biological code for stem cell activation without causing tumors.
How It Works (The Deeper Mechanism)
The story of hair loss has long been a battle between biology and biochemistry. For decades, the standard of care has been minoxidil and finasteride, drugs that essentially slow down the process of miniaturization or extend the growth phase of existing follicles. They do not create new follicles. They do not restore density to a completely bald scalp. The real holy grail has always been regeneration: waking up the dormant stem cells that sit in the bulge region of the hair follicle. Those stem cells hold the blueprint for building a brand new hair shaft. The problem was that we did not know which specific molecular switch turned them on.
That switch is the Wnt signaling pathway.
What The Trial Numbers Show
Wnt is a family of proteins that act like internal postal workers. They carry messages from one cell to another, dictating what the receiving cell should do. In the context of the hair follicle, Wnt proteins tell the quiescent (sleeping) stem cells to wake up, divide, and start the anagen (growth) phase. If this pathway is blocked, the follicle stays dormant or enters telogen (resting and shedding). If it is overactive, you can get excessive growth or even tumors. The challenge for scientists has never been proving that Wnt matters. They know that. The challenge has been activating it precisely, only in the hair follicle, and only for the duration of hair growth, without causing cancer elsewhere in the body.
Target Pathway: Focuses on the biological root causes of miniaturisation rather than just masking symptoms.
Practical Verdict: Evaluates how this fits alongside existing regimens like finasteride and minoxidil, and whether the gains justify the timeline.
Side Effect Profile: Examines local scalp retention versus systemic distribution to assess hormonal and cardiovascular safety.
Full Clinical Dossier, Trial Proof & Microscopy Figures:
If you want to inspect the actual trial proof, the full breakdown on Haircure includes:
* 4 high-resolution histological cross-sections and trichoscopy scalp images
* Detailed dosage response curves and regrowth timelines
* Complete peer-reviewed bibliography and clinical takeaway rating
https://www.haircure.org/article/scientists-just-flipped-the-master-switch-for-hair-growth/
First pic was the first day and second pic is today (2 months)
Been using 5% minoxidil twice a day and derma stamp once a week for my hairline for 2 months, and just started fin a few weeks ago. Also been taking biotin.
My hair is 1/4 inch long in the second pic which may seem deceiving but I am definetly seeing new growth in the left corner. Pretty much no hair grew there at all and now it's looking pretty solid.
Hey yall so I been on this for 7months total as of today and I just wanted to get some feedback to see if I’m making decent progress or not, first of all I know is not the same length and lighting so please just know that I’m aware it’s hard to compare.
Is this good progress for 7months on this protocol? Sometimes I feel like I’m loosing my time because my hair is still very very thin.
I also want to add I do use topical minoxidil twice a day daily and derma rolling 3 times a week as well. First 3 pictures are from the first two months of treatment and then the rest is today.
I started taking oral minoxidil (¼ of a 2.5 mg tablet every other day) and dutasteride (0.5 mg daily) on June 29.
I was inconsistent with my medication and missed 37 days between June 29 and September 9 (around 2 months and 11 days).
After that, I changed my dosage to ½ of a 2.5 mg minoxidil tablet daily and 0.5 mg dutasteride once every 3 days due to side effects.
Recently, I visited my doctor, and as per their instructions, I changed my minoxidil dosage from daily to alternate days. I continue to take dutasteride 0.5 mg once every 3 days.
These are my before and after pictures showing noticeable progress of 3&1/2 months..
Hey guys, I’ve been dealing with hair loss for 3–4 years and have been consulting a doctor in my hometown, but nothing has really worked out. I’m now planning to visit a new dermatologist in the city where I currently live.
I’m back in my hometown right now, and I have a relative in pathology who can get me a good discount on blood tests. So I’m thinking of getting them done here and taking the reports to my new dermatologist.
+serum ferritin and Vitamin D
Where I live, finasteride is prescription-only. I went to see a doctor today about my hair loss, but she told me that she refuses to prescribe oral finasteride to male patients for hair loss.
Instead, she prescribed a topical combination of 5% minoxidil, 0.1% finasteride, and 0.01% tretinoin.
I’m a bit concerned about this because taking oral finasteride would be much more convenient for me. I’m wondering whether I should consult another doctor to discuss the possibility of getting a prescription for oral finasteride.
Hi everyone,
I used to take dutasteride, just three times a week. However, after 2–3 weeks, I started feeling a burning sensation in certain areas of my forehead, along with some marks. (The first and second images show this.)
My dermatologist switched me from dutasteride to finasteride. That is what I am taking now: 1 mg, three times a week.
There were no issues during the first month, but now—after that month has passed—I am noticing that same mild burning sensation and areas of slight redness. I’ve also noticed an increase in acne since I started taking finasteride. (The last two photos relate to the finasteride.)
Context: As additional information, I should mention that I also suffer from seborrheic dermatitis. I wash my hair daily using a small amount of ketoconazole (very little; I mix it with my regular shampoo) and a shampoo containing zinc pyrithione. My dermatologist prescribed this entire regimen.
Oh, I also notice that I tend to experience that burning sensation, especially after bathing. The burning lasts quite a long time—easily 7 hours or more.
Has anyone else experienced this exact issue with skin sensitivity, burning, or acne breakouts after starting oral finasteride/dutasteride? Did it eventually stabilize for you or did you have to adjust your treatment?
Hello, I just wanted to tell a quick story about a conversation with my mum. I was so angry at her for this. Me and my mum were sitting in a car and i had my hoodie on with my cap. She Said Why do you put your cap on so much? you know you will go bald because of this right. I replied just because I wanted to. She Said you will go bald because of that. I was so angry because most women don’t know what we are going trough and think it is a health issue, while the main reason is genetics and dht. I really was so irritated by it because how are people so dum.
Hi, im selling my 90g Ru58841, purity 99.14% from lyphar biotech, can also give my lab equipment and solvents. I live in EU so preferably someone from EU, as there wont be problems with the costums.
It’s been 19 days since I upped my dose of oral Minoxidil to 10mg and switched from Fin to Dut and the shedding in the last few days has been crazy.
During and after my shower today it felt like I lost hundreds of hairs, seemingly all located from around my top and behind ears, long dark hairs dropping out into the sink.
I need to hope that things are going to get better
This is my current state. I have thinning hair but no recession. I previously was on fin but had to stop I’m debating getting back on between Fin & Dut. Diffuse thinners which did you all do?
Hi everyone , I noticed my diffuse thinning 4 years ago and put a long time to start taking treatment , I did not wanted to accept it so I was just hopping on topical min 2 months a year seeing no improvement and stopping .
Now that i can’t cover my temples anymore I’m trying everything to recover it but nothing works , I don’t even know if they are still dormant or dead follicules . It made me kind of depressed seeing that I am alone in this mess, none of my friends have this issue , I don’t want to be bald at 22 years old .
So now I am on oral min 5mg (1month) , oral fin 1mg(7 month) and topical min (9 month but not very diligent like not everyday) . I’m still shedding like crazy, it stopped when I was 4 month on fin but it restarted 2 month ago.I have the Dr.Pen still have a hard timing trying it because I don’t know if it will works or if it worsen . i’m kind of lost so if anyone could give me an advice if I should quit or if my temples can recover at least a bit . Thank you for listening to me.
Been seeing more advertisements for these and just curious if they actually provide steady improvements or if they’re just snake oil.
I’ve heard rosemary oil is beneficial to hair growth which is why I’m more than interested in including it to my daily routine.
Currently I’m on topical finasteride / minoxidil treatments at night so to me it wouldn’t be a burden to apply this after showering in the morning.
Would love some input on if it’s efficient / practical to add to my routine and if so any recommendations on reliable brands.
I've been using Regaxidil 5% (1 ml daily) for 10 years, but over the last 2–3 years I've noticed increased hair loss around my crown. I want to improve my treatment by adding topical finasteride while keeping the same once-daily application. I'm considering switching to a compounded solution containing minoxidil 5% + finasteride 0.1%, while maintaining the same daily dose of minoxidil.
I haven't decided on the vehicle yet. I'm considering either TrichoSol or an alcohol/propylene glycol/hydroxypropyl chitosan-based solution.
My main concern is that switching vehicles could trigger shedding or a loss of density after so many years of using Regaxidil, which has a hydroalcoholic base.
Has anyone made a similar switch? Did you notice increased shedding, differences in effectiveness, or any issues with either vehicle?
I'd especially appreciate hearing from people who switched from Regaxidil or another commercial minoxidil product to a compounded formulation, and how their hair responded during the first few months.
Started 4 months ago (I am 35) from NW2 temples, topical dutasteride 0.03% in trichosol (with 10 ml of alcohol 96) twice daily on hairline for 3 months.
6 months before starting meds I experienced some libido loss or ED while in a new relationship. Clearly due to anxiety and mild depression. I wasn't worried about it because I know it can happen. Sometimes during sex and sometimes alone. Normally I always had a high libido and had to do it once or twice daily. After a few months I was mostly ok.
For the first 2 weeks since starting meds (so 6 months into the relationship), I immediately felt pleasure less orgasms, which went away afterwards. Took one bottle for 1.5 months.
The second month I ordered another bottle which had no alcohol in it (different pharmacy). My libido went way up. And scalp itchiness too, hair fall increased (this is the usual sensation of feeling your scalp tingling, you touch it and then a hair or two fall, which is a constant reminder you are losing hair).
After about 2.5 months I get another bottle with alcohol. And again I feel 2 weeks of no pleasure as I start it. Then it goes away. Unsure about itchiness, but hair fall was the same as without meds.
After 3 months I added minoxidil 5%, but after a week since I was worried the topical dutasteride was useless (no results and I still had scalp itchiness) I asked for finasterids 1mg too.
So total time on meds is 4 months, 3 months topical dutasteride 0.03% twice daily. No results.
Then since 3 weeks morning minoxidil 5%, evening topical dutasteride and minoxidil.
Since 2 weeks of finasteride 1mg before bed. Much less itchiness.
I am now starting to see tiny hairs after 2 or 3 weeks of minoxidil on my temples. This could just be useless hair.
Problem is I don't know how to attribute this result and finasteride 1mg daily tanked my libido, I feel groggy in the morning, I have little desire, no morning wood etc. I feel much less anxiety and depression though.
I know 2 weeks of finasteride is too early for results. I know some people can power through sides and they improve. Or I can try to reduce the dose and see. So I'm not too sure what are my options right now. These small hairs are probably powered by minoxidil. Of course I will talk to my doctor.
