The Big 3

[Spex]

TheBig 3

The big 3 to beat DHT, THE CAUSE OF HAIRLOSS!

- Propecia ( Finasteride ), Minoxidil and Nizoral

Here is the thing you need to make sure you understand when it comes to MPB:

The main known factor that causes hairloss is DHT. To form DHT your body's 5a-reductase enzyme converts free roaming testosterone DHT inside the hair cell follicle. The DHT then binds to the hair cell receptor and causes it to atrophy or shrink. Eventually your hair follicle stops producing hair and you lose that follicle.

There are two types of the 5ar enzyme; Type I and Type II. Type II 5ar seems to be the main culprit in MPB as the type II enzyme is present in the hair follicles. Finasteride is a specific inhibitor of Type II 5ar inhibitor that reduces DHT produced by the type II 5ar by 85%-90% and reduces the overall DHT blood serum levels by 65%.

As you can see Finasteride (PROPECIA ) is extremely useful as a treatment for MPB as it directly attacks the problem. Nizoral shampoo is thought to help "dull" the androgen receptors in the scalp which the DHT binds to. Together they provide a synergetic effect.

Minoxidil is a hair stimulant. It is the only FDA proven hair stimulant on the market. However stimulating hair and protecting hair from further damage are two separate actions

Minoxidil will artificially augment your hair while you use the compound but it does NOT have any know effect on 5ar or the androgen receptors in the scalp.

The best way to attack MPB is to:

1. Stop further damage to your hair via DHT. You can accomplish this best by using Finasteride to inhibit the 5ar enzyme and Nizoral to "dull" the androgen receptors.

2. **If** further thickening/regrowth is needed after the hair damaging DHT androgen is reduced then minoxidil can be used to further augment your existing hairs and perhaps even stimulant some dormant hair follicles to resume growing.

Use all these 3 products together -

1. Minoxidil 2 x a day - once in the am and once in the pm
2. Finesteride (propecia/proscar) 1mg per day
3. Nizoral 2 x a weeks (no more) - will dry your scalp out!

Propecia is the best proven way to prevent further loss. If for some reason your not a responder theres Dutasteride/Avodart but i recommend you start off with Propecia/proscar and see how you repond.

FYI -

Dutasteride and finasteride (PROPECIA) are both 5-alpha-reductase (5AR) inhibitors. Both treatments work by inhibiting 5AR, the enzyme responsible for converting testosterone to dihydrotestosterone (DHT). DHT is the primary androgen in the prostate. It is a primary factor in the development and progression of benign prostatic hyperplasia (BPH) and other prostate diseases and is also a major cause of hair loss.

.5mg - 2.5mg of Dutasteride provides better results in hair maintenance/regrowth as opposed to Finasteride

However, the benefit likely comes from its higher inhibition of type II 5ar not its suppression of type I 5ar. Merck tested a specific type I 5ar inhibitor called "MK386" in a human trial and found it had no effect on balding.

Jumping on the Dutasteride bandwagon before the Finasteride bandwagon is not a good idea. For most men Finasteride is enough to halt and even reverse MPB... In the off-chance your body becomes tolerant of Finasteride (over the years) you always have Dutasteride to fall back on...

Side-effects on Dutasteride may be more common, any such sides would last longer as the half-life of Dutasteride is much longer then Finasteride, and unlike type II 5ar type I 5ar *is* present in brain tissue. Finally, keep in mind that DHT is not an evil androgen that just causes hairloss. Various bodily functions benefit from DHT. Finasteride inhibits 65% overall DHT levels leaving 35% for your body to use (most of that 35% is from the type I 5ar that isnt a big factor in hairloss). Dutasteride inhibits 90% or more overall DHT levels leaving 10% or less for your body...

Basically, use Finasteride **first** and only resort to Dutasteride if you must - This is just my opinion

[JimmyG]

Great summary, thanks Spex!

[Chris81]

Lossing hair with Rogaine

Hey, nice info. I have actually just started the big 3. I started with propecia, with worked ok. Then after a while, like 1 year i started rogaine. Now i have used Rogaine for like 1 month or so. and i noticed i started to lose a lot of hair after aprox 1 week after i started the treatment.

I have read on different sites that this is normal, to shed hair at the start of the treatment.
But i have been losing hair heavy for 1 month now and getting scared to be honest. Do you have any experiance of this? Shall i abort and just continue with propecia? I am afraid that the hair wont come back and i just gonna keep losing as long as i use rogaine.. Please i would be great full for your answer

Best Regards Chris

[Chris81]

Anyone that experienced the same issue?

/Chris

[Chris81]

Damn this was very usful reading THANKS, feel better already now that i understand.
Cant believe this is not explained on the prescription of the drug.

Just got one thought out of this..
you must look at what is left on the scalp. That is where it counts..
yes but since my shedding started my vetrex of thin hair has increased alot. But i guess this is only is the first fase, the new hairs will be larger so the nex shedding bot be noticied on the scalp as much. Right?


And the really qurius question.. if a person stop the treatment after shedding alot, will lost the hair grow back but equally thin or will the lost hair that "shedded" be gone for ever??


Regards /Chris

[Chris81]

Ok, thanks for the info.

Just out of curiusity, if i stop the treamtment, (i wont though) after shedding alot. Will the hiar grow back anyways but as the same thin shape that it was from the start or wont they grow back at all?

Realy curius about this. Thanks for your answers and for taking your time.

Kind Regards Chris

[Chris81]

Ok, thank you very much for straighten things out for me. This has been very usful, realy.

That was what i thought, for a moment i thought that if i stop the treatment the shedded hair will be lost forever. Thanks now i will sleep better

Regards Chris

[Chris81]

Another question, First off, i am stil shedding alot. Even at the places where i have not used. And that is my question acually.

Why am i also shedding thick hair at places minox never comes contact with?

Does the minox have som type of "overall" effect on your hair growht or what? Thanks

Regards Chris

[Steve]

Hair shedding

Hi , I have used rogaine for 2.5 weeks and notice sevre shedding around my hairlines . In truth I took a situation which was not that bad and made it worse . I could kick myself .

However I have stoped using rogaine for 2 weeks now and have started Finepecia [ finesteride ] and I notced some thinning of my hair in the hairline region .

My question is will hair shed ever regrow back once stopping using rogaine . I am highly stressed about this and would appreciate any information on the question .

Thanks a million guys

Steve

[Speegs]

This may seem like a silly question, but I went on a camping trip and was unable to wash my hair for almost three days, when I showered i shed like mad on to my hands, every swath through my hair seemed to produce ten hairs, most unminiaturized, I roughly shed like 180 hairs in the showr, is it safe to assume that was on account of having not washed my hair for several days and that i had accumulated several days of shedding in my shower?

I normally shed as low as 60 and as high as 100 hairs in the shower, yes i'm annal enough to stop and count them pretty regularly.

[Spex]

Ride it out!

Steve - shedding on meds initially is very common - ride it out bro!

See topic below:

Helpful info on shedding i found on an old topic.

Shedding:
Written by Dr. Kevin McElwee & ***

No doubt if you're a hair loss sufferer, you've had to deal with the most unpleasant part of it: Shedding. Find out why it happens, what it *really* is, how long it will last, and what you can do about it...

Whether it happened before, during, or after you started treatment can play a big role in how devastating a shed is for you, but no matter what, one thing is always for certain... its no fun. Shedding is one of the biggest complaints and the level of concern heightens when its seen *after* starting a treatment like Propecia or Rogaine.

Shedding is Normal

Believe it or not, shedding after starting a treatment is fairly common. In fact, more often than not, our users report increased loss a few weeks to a few months after starting Propecia or Rogaine (or both!). But what a shock it can be to those who don't expect it. They finally take that dive into the daily commitment of fighting their hair loss. They're finally ready to do something about it, and as hopeless as things may seem, they put all their trust in the clinical data. They have a few weeks of feeling a little better about things, hoping for the best, knowing they're doing all they can ... and then something goes wrong. They actually start to *lose* hair. At least that's how it looks. Instead of going forward, they're going backwards. The more level headed shedders decide to wait it out a few days, only to see it continue... and continue... and continue. The rest panic, or just throw in the towel entirely. They decide they are not "responders" to the treatment, that the treatment doesn't work, or quite simply that God has forsaken them. Fortunately, they're wrong on all three counts...

What exactly is Shedding?

[img] http://www.************.com/forums/attachments/sheddiag.gif[/img]


In all cases, treatments or no treatments, shedding is not actually "losing hair". This is one of the most common misconceptions in the world of hair loss. Shedding is in fact just the transition of follicles from growth phase to resting phase. They don't fall out and die, never to return. They in fact "go to sleep", to return several months later. Hair follicles work in cycles as part of their normal processes. Even the person not losing his or her hair goes through the same cycles. The hair will grow for awhile, and it will rest for awhile. In the case of someone *not* using any treatments, but experiencing Androgenetic Alopecia (Male or Female pattern baldness), shedding is typically the continued cyclical process, combined with miniaturization. What does this mean? It means each time those hairs go dormant and come back, they come back weaker, thinner, and less pigmented, ultimately resulting in the perception of less hair and more scalp skin showing. There are theories out there as to why hair seems to go "all at once" for those losing hair, but they are still just theories. The most common one is the theory that those with androgenetic alopecia see more of a synchronization of dormancy. Meaning - more hairs go dormant at the same time, ejecting the existing hair and shutting down temporarily. Either way, the moral of the story is the same: Shedding is not losing hair. Its dormancy. And it is up to you as to whether those hairs cycle back in thicker and stronger, or thinner and weaker. That's where using a DHT inhibiting, or growth stimulating treatment comes into play.

Shedding *because* of my Treatment?!?

Its possible, and as mentioned above, rather common. Surprised? Its actually the most common reason why people think hair loss treatments don't work! If you start a new treatment like Rogaine or Propecia, you probably will shed, but the amount of hair shed varies from person to person. It has long been suspected that there is an increase in shedding in the first 3 months or so. Recently, some studies using a digital phototrichogram (Trichoscan, Marburg, Germany) proved that there was indeed a quantifiable increase in shedding and a corresponding loss of hair density in the first 3 months of minoxidil use. However, by the 6 month stage the subjects were shown to have regrown the lost hair and had increased hair density compared to that recorded at the start of treatment. By 12 months after starting minoxidil use their hair density was much improved and the diameter of the hair fibers was thicker than at the start of treatment and as compared to controls who did not receive treatment. This small study proves what has long been suspected and frequently discussed on hair loss forums, that there is an initial shed phase when first starting minoxidil use.

How long will it last?

Shedding is temporary. If the individual continues their treatment consistently, despite the seeming despair and loss of hope, shedding will end and the lost hair should be replaced.

Why does it happen?


Although we do not know exactly why the shedding occurs, the most likely explanation is due to how the hair follicle "organ" operates. Hair follicles are relatively inflexible in their anagen, "hair producing" state. In response to additional stimuli the growing hairs may be able to increase their growth rate or increase the diameter of the hair fiber produced a little, but it is not possible for a hair follicle to undergo big changes in size while producing hair fiber. What ends up happening, is that when that follicle gets hit with a growth stimulant like Minoxidil, it is given a very strong signal to change size (expand) and increase activity. The rule of the follicle is that it must then stop, and start over. The existing hair is ejected, the follicle goes into dormancy, and begins to restructure its processes to produce a thicker, stronger hair that can produce a bigger (thicker) hair fiber.

Shedding is a sign that the Treatment is Working

Howso??? When Rogaine is applied to stimulate hair follicles, the follicles must regress, shed the old fiber, rearrange themselves into a bigger hair follicle, and start making a new, improved fiber. This would inevitably lead to a temporary shed phase. You're seeing your hairs respond. Its unfortunate that the first sign of new hair growth is seeming hair LOSS, but that's the way it works, quite often.

There is a belief among some dermatologists that an initial shed phase when first starting to use a treatment for hair loss is inevitable regardless of the treatment used. Because of the hair follicle's inflexibility in changing the nature of hair growth mid stream, for any drug to promote hair growth it must involve hair follicles entering telogen to rearrange themselves into a larger follicle under the influence of the drug. However, certainly, the shed phase with minoxidil use can be very apparent in some people.

But "BOB" on xxxx.com told me that the shedding will NEVER STOP!

There are a few who claim that using treatments like Propecia and Minoxidil can cause a persistent shedding that lasts longer than the first three months. While there is no hard research evidence to support these claims, it is always possible that an individual may have an adverse reaction to a drug. We are each unique because of our different genetic make up and the different environments in which we live. This means that there are somewhat different responses to the same drug when used by different people. It is almost inevitable that a very few people will have a bad reaction to a drug. It may be that for a few minoxidil does more harm than good and follicle growth cycles are adversely affected. If this is the case, stopping use of the drug should allow the body to recover. However, it is most likely that many of the claims for persistent shedding actually come from those who are experiencing the expected shedding in the first 3 months, have not been consistent with their dosages, or have been continually adding or taking away from their treatment regimen.

But *I* think I have Telogen Effluvium!


Many hair loss sufferers with traditional male or female pattern baldness want to believe they have Telogen Effluvium (TE), because it provides a glimmer of hope that the whole ordeal is just temporary. Unfortunately, TE by definition is a condition that occurs in response to serious traumatic shock to the system as a whole. It is not a something that will happen without any abnormalities going on in your life. Things like sudden shock, chronic debilitating stress, extreme malnutrition, certain medications, and chronic serious illness are the most common causes. There is no way to know for sure how long shedding will last with telogen effluvium. Increased shedding occurs in response to a trigger factor. If exposure to the trigger is brief and there are no other contributing factors then the shedding may last for around 3 months and then recover so that 6 months later the hair is pretty much back to normal. However, if the trigger factor hangs around, like chronic stress or illness, then the shedding may persist. The hair follicles can get into a habit of short, truncated growth cycles, producing short hair that falls out after a few months. This results in a high shed rate – although the hair loss on the scalp need not progress much.

In Conclusion - Don't Count Hairs

In terms of understanding hair loss, the nature of shed hair and the rate of shedding is not very important, although it may be disturbing to see. Shedding is natural, everyone sheds hair daily whether affected by hair loss or not. You can shed up to 100 scalp hairs a day without having any scalp hair loss. A few people may shed more than this but still not develop baldness. To understand the development of hair loss the main factor to consider is the rate of hair growth and replacement, not so much the rate of shedding. Some people have a high rate of shedding but also a high rate of hair growth. The result is no net loss of hair on the scalp. Some people have a low rate of hair shedding and a low hair regrowth rate. The result is similarly no alopecia development. The problem comes when someone sheds hair at a faster rate than it is replaced. This is the scenario where baldness develops. You can have a normal or even a low shed rate and still develop baldness. If the hair is being shed faster than it regrows then alopecia will develop. So the amount hair shed each day/week/month is a poor diagnostic indicator of hair loss. To define alopecia you must look at what is left on the scalp. That is where it counts.

[brando1]

Hi and thanks for sharing..

I have been using 5% Rogaine for about 7 months 2X Day and started using Proscar (Prescription) about 4-5 months ago (5MG Cut Into 4) 1.25MG X2 in the morning and night because thats when my estro levels are high. I dont have any side effects now like I did when I first started.

My hair is thining in the vortex area to the crown but I still have hair so I am not completely bald yet.
I havent seen any results yet but then again I shave my head weekly with clippers using no guard so I wouldnt tell if I have been shedding. After one week from shaving I can see how my hair fills in which is the same, thin.

My question..
Is it better to use rogaine with a shave head (Not Shave With A Razor) so it would assorb better or should I just let my hair grow? I have been shaving my head for about 2-3 years. I also sometimes use 2% Nizoral but I find using head and shoulders with scalp moisturizer daily helps my scalp from itching.

Any feedback would be highly appreciated and thanks in advance.

[brando1]

So what are my options to grow some of that hair back? Do you think Duta is more effective?
Correct me if I am wrong but isn't Rogaine used to re-grow hair?

[PMCR1966]

Hi Doctor,

I very much appreciate the suggestions that you give on these forums! I have a question that maybe you might have one for.
I have been taking Propecia for hair loss for about one year, and for one month have been using Rogaine. Recently it has come to my attention that this might complicate my Hachimotos thyroid disease. I am considering quitting Propecia and just using Rogaine.
My questions are: does finesteride effect thyroid levels and what would be the effect of quitting Propecia and using just Rogaine.

Thank you again,

Paul

[jnd3344]

isnt Propecia 3 times a week (mon, wed, fri) enough?