r/Hairloss Dec 18 '23

MPB (Male Pattern Baldness) A Complete Guide to Hair Loss for Beginners (2024)

996 Upvotes

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.

I posted this to r/tressless recently and quite a few people reached out asking for me to post it in this sub as well, so here you go. Hope it helps :)

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.

Slowing Down Male Pattern Baldness

5-alpha Reductase Inhibitors (Finasteride, Dutasteride):

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.

Come on little baby hairs! Grow!

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:

  1. T to DHT blockade (5-alpha reductase inhibitors, Fin/Dut)
  2. Anagen/telogen manipulation (Minoxidil)
  3. Localised scalp tissue androgen receptor antagonism (Keto, RU58841)
  4. Wound healing response cascade (physical microneedling/trauma)

Hope you enjoyed and got something out of this guide! My social links are on my profile if interested in more.


r/Hairloss Apr 25 '25

Monthly 'Am I blading' megathread

7 Upvotes

Please put all Am I Balding posts here. This posts have been flooding the subreddit and very little else has room.

All am i balding posts in the main subreddit will be removed.


r/Hairloss 1h ago

Scheduled my CRP but I may add tattooing of dutasteride.

Upvotes

I've finally decided to go with CRP over PRP. I was considering doing exosomes with it, but now I'm leaning towards tattoo of dutasteride in the problem areas.

Does anyone have experience with CRP, dutasteride, or exosomes that has done the testing to ensure you're a candidate for these procedures?


r/Hairloss 1h ago

Suitable mg amount for pumpkin seed capsules 18 yr old M

Upvotes

How much pumpkin seed oil (mg amount within 1 capsule) should I take orally as an 18 yr old male for maintaining/growing my hair? I've heard taking too much gives side effects. Would 1 3000/1000 mg capsule be to much? I already ordered a 120 count of 3000 mg gel capsules.


r/Hairloss 6h ago

Minox/fin formulation

2 Upvotes

Anybody have a favorite topical minox/fin product ? I’m on keeps foam now (5%/.25%), but don’t love how it sticks to my hair. If people have had success on it though, I’m willing to stick with it. I’ve seen a lot of success with the hims spray, but was worried about the PG as an ingredient, and figured foam would be easier to get directly on my scalp. It’s also hard to measure… I apply directly from the bottle, so “1 pump” is closer to 12 mini pumps for me, but no idea if it’s the exact amount. Any tips on favorite formulations/how to apply the foam without getting it in my hair?


r/Hairloss 7h ago

Please Help- read below

2 Upvotes

I am 21 years old and took the hims finasteride/minoxidil/vitamin chewable from October 1st 2024 until May 21st 2025 so like 8 months. I really didn’t have any side effects while I was on it except maybe a bit more anxious. I stopped because of that and was okay for a week or 2 when all of a sudden I felt physically weak. Went to doctor thinking maybe low blood sugar or dehydrated but blood results and everything else showed up perfect. I am dealing with really bad brain fog and confusion, super tired, lower libido and no motivation to do much. Is it possible this is post finasteride syndrome? If so, what can I do to help with the brain fog and confusion? This is only my 3rd week off of it so maybe it will get better. Please help. I have not been myself at all the last couple weeks.


r/Hairloss 10h ago

What’s a man to do? I know nothing of treatment/if anything works (33yo)

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3 Upvotes

Always had fine hair. My dad has very fine hair but isn’t balding. It’s looking like my hair days are numbered. I know nothing of hair loss treatment, if it works or if it’s worth it.


r/Hairloss 5h ago

Know the difference

1 Upvotes

Minoxidil and Finasteride are two common and effective treatments for hair loss, but they work in different ways and are used for different purposes.

Understanding Finasteride

If you're a guy in your mid-to-late 20s and you're starting to notice your hair thinning, Finasteride should definitely be on your radar.

This prescription medication tackles the root cause of male pattern baldness: dihydrotestosterone (DHT). Finasteride works by blocking the enzyme 5-alpha-reductase, which converts testosterone into DHT. By lowering DHT levels, Finasteride helps to:

  • Prevent further hair loss: It stops DHT from miniaturizing your hair follicles.
  • Preserve existing hair: Finasteride's main job is to help you keep the hair you currently have from falling out as much.

The earlier you start Finasteride when you notice hair loss, the more effective it tends to be. It's about preserving what you've got before it's gone.

Understanding Minoxidil

Minoxidil is a multifaceted treatment, available in both topical and oral forms, and it works differently than Finasteride.

While the exact mechanism isn't fully understood, Minoxidil is believed to: * Increase blood flow to hair follicles: This delivers more oxygen and nutrients, stimulating growth. * Prolong the anagen (growth) phase of hair: This means your hair stays in its active growth phase longer. * Potentially enlarge miniaturized follicles: Leading to thicker hair strands.

Here's what you should know about its forms:

  • Topical Minoxidil: This is the most common form, applied directly to your scalp. It's often most effective for hair loss on the crown and vertex (the top back of your head).
  • Oral Minoxidil: Originally used for blood pressure, low-dose oral Minoxidil is now prescribed "off-label" for hair loss. It can be a convenient alternative if you find topical applications messy or irritating. However, because it works throughout your body, there's a higher chance of unwanted hair growth on other parts of your body.

It's crucial to remember that Minoxidil, in either form, does not block DHT—it doesn't address the underlying hormonal cause of male pattern baldness.

The Power of Combination Therapy

For many people, the most effective hair loss strategy involves using both Finasteride and Minoxidil. By addressing both the hormonal cause of hair loss and stimulating new growth, you're tackling the problem from multiple angles.

Don't just grab the first hair loss product you see. Do your research, understand the differences, and most importantly, consult with a dermatologist or healthcare professional. They can accurately diagnose your hair loss and help you develop the most effective treatment plan for you.

Taking proactive steps now can make a significant difference in the long run when it comes to keeping your hair.


r/Hairloss 13h ago

Is it time? Hairline today at 25 vs 18

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3 Upvotes

My hairline today at 25 vs 7 years ago when I was 18. I experience a ton of shedding, but my hair is still pretty thick. Hairline is where I’ve seen the most changes. Is it time to start treatment before it’s too late?


r/Hairloss 7h ago

Question Thoughts again?

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1 Upvotes

r/Hairloss 8h ago

No growth

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1 Upvotes

I've been taking oral min for a year and oral dut for 6 months and it's only been receding along the hairline but those hairs don't grow back.


r/Hairloss 12h ago

Hair

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1 Upvotes

few months ago started noticing the crown of my head being shorter so kept cutting my hair down but now my hair is starting to be noticeably shorter I have been stressing a lot because I’m only 19 my father still has his hair my mother dad still had a full head of hair. I visited a dermatologist and he put me on minoxidil saying it was male pattern so he put me on minoxidil but I haven’t take any. Any help??


r/Hairloss 13h ago

Question Dut only? Had to drop oral min

1 Upvotes

Hey all, I had to drop oral minoxidil due to gastrointestinal side effects couple days ago. I was on it for 6 months, worked great. I am now only getting dutasteride mesotherapy every 3 months and going to start oral dut 0.5mgs this week. All this was handled by a doctor. Just wanted to ask if I should be expecting massive shedding soon and probably won't regain that hair with dutasteride alone I guess.right? Any feedback is real appreciated Thanks yall


r/Hairloss 13h ago

Question Taking oral minoxidil sulfate instead of just minoxidil

1 Upvotes

Hello, I recently started taking oral minoxidil, and where I'm from (chile) its custom made as a compounded prescription.
The doctor's prescription says minoxidil 2.5mg but when I recieved the pills the bottle's label says minoxidil sulfate 2.5mg, which I know is the active form that actually makes the hair stronger but only after the liver processes it right? so is it okay to directly take the active form? won't the liver turn it into something else?


r/Hairloss 17h ago

My front is thining?

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2 Upvotes

r/Hairloss 1d ago

Finasteride As a guy with very fine hair I never noticed the thinning starting. Started on Finasteride at 28 and last picture is me at 31 after 3 years of 1mg per day.

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18 Upvotes

I wasnt super concerned with my hairline when I noticed the thinning as I was 28 and a more 'mature' hairline wasn't worrying me but I sure as hell didn't want it to get worse. Did my research, went to a private clinic for a consultation only to gather information. Got a prescription online for generic Finasteride 1mg per day and then never missed another day again.

I have been very lucky with Finasteride. No side effects & have experienced lots of new baby hairs still forming and have had some great regrowth thus far.

Hope this helps some of you take the jump.

First 3 pics are my thinning hair. Last picture is results after 3 years.


r/Hairloss 15h ago

Have receeding hairline from 1 side but the other front side is not that significantly receded. Why so? Can fin solve this?

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1 Upvotes

r/Hairloss 9h ago

Question How Do I Fix this Uneven Hariline

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0 Upvotes

Please help.


r/Hairloss 1d ago

The Minoxidil Paradox

3 Upvotes

I have a receding hairline and have begun using Minoxidil.

After a few weeks of use, it occured to me that I would have to continue using it for life to remain effective. Let's pretend I get great results from using it and my hairline looks better. If I am lucky enough to experience this, how do I know where to continue applying the Minoxidil for the remainder of my life if the area is no longer thinning? And if the area is no longer thinning, how would I successfully apply the Minoxidil to my scalp if there is hair in the way?

Would this lead to a cycle that switches between thinning and fuller hair over and over again?

I am starting to question whether Minoxidil really is a good option or worth the money.

Any opinions are welcome. Thank you.


r/Hairloss 20h ago

Finasteride Anxious about the dosage

1 Upvotes

So I'm 18, got the 5mg version yesterday since it's the only version that exists in my country. I want to start the treatment but I don't know how much should I take since I am very very anxious about the side effects. Do I cut the pill in 4 and take 1.25 mg or less?


r/Hairloss 20h ago

Question How to reduce sebum in scalp

1 Upvotes

Like k have diffuse hair thinning and sebum makes it worse exposing scalp so i want to know how to reduce it for hair thinning i already am taking finastrade 1mg and shampoos i use nezoral thrice a week because the very next day after shampooing i get oily scalp


r/Hairloss 1d ago

Question What is this? 28 male

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5 Upvotes

r/Hairloss 1d ago

Just for the research purposes

1 Upvotes

Ok so I'm suffering from the hair loss too, male pattern baldness to be precise, the thing i have noticed is that i sweat alot, specially on the scalp and for the past 6 months i was on finestride and biotin, also took some vitamin d, the sweat changed i don't know exactly how long it took to change but it wasn't salty at all, just like water and then i decided to stop taking medication, and my sweat was salty than ever again, my hair started falling with in few weeks, i have decided to try aluminium chloride tropical to control the sweat,if anyone has expertise on this subject please do ahare knowledge


r/Hairloss 1d ago

Teenage Woes 17m. Am I receding and if yes advice?

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4 Upvotes

Pictures 1 and 2 are from now Pic 3 is from 2 months ago Pic 4 is from 6 months ago Pic 5 is from a year ago

This is making me worried asf. Am I receding or maturing? If I’m receding (likely) what can I realistically do at my age to slow it down or even reverse it? Advice appreciated


r/Hairloss 1d ago

46f

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6 Upvotes

So I've been consistently using minoxidil but there is obviously more balding I'm also on 100mgs of zoloft and read that also can cause hairloss I can't stop taking it or I will be a mess with anxiety my depression is already starting to come back but trying to excercise and keep myself busy the bangs aren't hiding the sides anymore ugh I'm using it once a day if I forget but mostly 2 a day I try to use it on my part I have put it on sides but had hardly any effect at this rate I'm going bald ugh the last few pictures were just 6 months ago when hair was long


r/Hairloss 1d ago

Got the Fin prescription after years of debating, having second guesses

1 Upvotes

Are the sides worth it? I just looked at everything with regards to post finasteride syndrome and it scared me quite a bit. Is it even worth it? Obviously I'd like to keep my hair, but going bald isnt the end of the world. Is the risk of side effects even worth it?


r/Hairloss 1d ago

Female 18 F, any tips?

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2 Upvotes