@Outdoctrination: STOP focusing on DHT & finaste...

STOP focusing on DHT & finasteride for male pattern baldness ("androgenetic alopecia").

Here's what doctors won't tell you... the REAL PROBLEM BEHIND PATTERN BALDNESS:

First off, I would like to say that:

I am NOT

1. bald or have ever been
2. claiming DHT is irrelevant

I AM

1. Claiming we should not FOCUS on lowering testosterone or DHT, and that androgens nor genetics are the TRUE ROOT CAUSE of MPB.
2. Claiming DHT is necessary for male pattern baldness, BUT NOT SUFFICIENT.

To give the androgen - genetic model its credit:

1. There is strong heritability of baldness
2. DHT is higher in balding scalp
3. Stopping DHT can help regrow hair
4. DHT can shrink hair follicles through the androgen receptor
5. Genetic variations in the androgen receptor can drive it
6. People with no androgens are immune from baldness

Seems like an open and shut case, but let's get into why blaming androgens is actually silly.

Male pattern baldness increases with age.

This is important because:

1. It means it is potentially another age related disease, like Alzheimer's or cancer
2. Androgen production DECLINES as we get older

The enzyme that produces DHT, that finasteride inhibits, IS NOT genetically associated with baldness.

So, DHT might be higher in the balding scalp, but this is due to an environmental cause, not genes.

Finasteride, the drug that lowers DHT for hair loss, is not very effective.

For every person to see results, around 3-6 people need to be given the drug, meaning the majority of those given finasteride DO NOT BENEFIT.

If DHT is the main problem, why does crushing DHT barely work?

"after 5 years of faithful [finasteride] use, those threatened with baldness can expect somewhat more than a 10% improvement over what they would have experienced without any treatment."

Hair loss is also mainly an issue of civilization.

In 1899, Dr J. Blaine stated…

“The bald head can only be found among enlightened nations, and it must therefore be caused by following the arts and customs of civilisation … Trace the genealogy of a bald head back through a few centuries and it will be found that the progenitors of our race had hair in abundance”

Hard to argue genetics, then.

Hair loss is also becoming MORE PREVALENT, especially among younger people.

Recent studies have stated that the prevalence of male pattern baldness may have DOUBLED in the last decade.

If its prevalence is changing rapidly with time, it cannot be mainly genetic.

People with male pattern baldness are less healthy across the board.

There is a 5X increased likelihood of insulin resistance in those with baldness,

and an elevated risk of heart disease.

It is clear that people who have MPB are simply unhealthy systemically.

DHT can shrink the hair follicles, but mainly by stimulating inflammation.

This is the key point.

DHT works by increasing the levels of other proteins, and these mediators drive hair loss, not DHT directly.

Inflammation can stimulate the formation of DHT in the scalp.

Through increasing 5 alpha reductase.

This is probably why DHT is high in the balding scalp, not because of genetics.

(NF-KB is the master inflammation regulator in cells)

But the increase in DHT might be a protective, adaptive response.

DHT in the scalp can lower key inflammatory mediators, like COX-2 and NF-KB.

Balding scalp cells produce more inflammatory / balding mediators in response to DHT.

It is these mediators that actually drive the hair loss.

Anti-inflammatory remedies can treat male pattern baldness.

For example, antihistamines have shown great promise for hair growth.

I've written more about histamine and what drives its release here, as a systemic inflammatory mediator:

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Lowering inflammation regenerates hair.

DHT can increase the inflammatory mediator inducible nitric oxide synthase (iNOS),

but lowering nitric oxide without touching DHT regrows hair.

I've also written about how nitric oxide is an anti-metabolic, inflammatory mediator here (and what drives its elevation):

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Another example is how stopping prostaglandins can increase hair growth.

DHT can increase prostaglandins, but they are primarily increased under circumstances of inflammation.

Prostaglandins are also direct products of excess polyunsaturated fat (seed oils).

People with male pattern baldness have higher pathogenic microbes in the scalp, which drive inflammation.

especially Malassezia, a yeast that can directly cause hair loss by inducing inflammation and oxidative stress near hair follicles.

OXIDATIVE STRESS is what makes DHT harmful.

DHT can increase the levels of hair loss mediators (like TGF-B), but only under conditions of high oxidative stress.

This is vital to understand.

Oxidative stress is also higher in people with male pattern baldness.

Oxidative stress comes from, and drives, inflammation.

Oxidative stress is also driven by:

➡ Excess seed oil consumption
➡ Heavy metals, excess iron or copper
➡ Any issue with energy metabolism
➡ Deficiencies of B1, B2, B3, B6, iron, copper, zinc, selenium and glycine.

Meanwhile, antioxidants can regrow hair.

Much like other modern, age related conditions - male pattern baldness is a disease of:

1. Poor energy metabolism
2. Oxidative stress
3. Inflammation

with genetics being a factor, but not the ultimate driver.

Improving mitochondrial metabolism can regrow hair.

This oxidative stress is also known to directly cause premature death of the hair producing cells.

STRESS drives hair loss, by increasing oxidative stress.

CRF (a player in the cortisol system) also directly upregulates DHT responsive hair loss triggers.

Again and again, we see that these environmental factors are the real culprit.

There are also numerous therapies for male pattern baldness that work without targeting DHT.

All of these work by increasing metabolism, lowering inflammation or DHT's propensity to increasing inflammation, or reducing oxidative stress.

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The take home here is that, while DHT does play a role, focusing on improving metabolism, inflammation and oxidative stress systemically is a much better option, and will improve the rest of your health as well.

If you would like some help from us with improving your health, systemically, you can schedule a free call here: prism.miami

Thank you for reading this. Definitely give this tweet here a repost if you found this interesting, this is a very pervasive narrative that could use some extra clarity:

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SOURCES:

5AR not genetically associated pubmed.ncbi.nlm.nih.gov/9620288/ - so even though there is high DHT it’s not genetic
Finasteride is mid, doesn’t work in advanced stages at all, doesn’t work for many in general
pubmed.ncbi.nlm.nih.gov/20956649/ (NNT = 3-6)
blog.petrieflom.law.harvard.edu/2013/01/31/fin… - 10%, small amount of hairs
link.springer.com/article/10.100…
sciencedirect.com/science/articl…
More prevalent now, frontiersin.org/journals/medic… doubled
Age of diagnosis younger belgraviacentre.com/blog/hair-loss….

jcpsp.pk/article-detail… , pubmed.ncbi.nlm.nih.gov/23991602/
sciencedirect.com/science/articl… master review

Inflammation drives androgen secretion
mdpi.com/1422-0067/24/2…, nature.com/articles/s4146…
Does DHT lower inflammation?sciencedirect.com/science/articl…
Androgens work through lowering IGF-1 (which drops in IR) iNOS, NO TGF-b1 TGF-b2 dickkopf1 IL-6 Inhibiting Wnt/BCatenin - onlinelibrary.wiley.com/doi/10.1111/ex…, jdsjournal.com/article/S0923-…, sciencedirect.com/science/articl… , pubmed.ncbi.nlm.nih.gov/21839661/
pubmed.ncbi.nlm.nih.gov/21881585/ - IL-6 upregulated IN BALDING CELLS (this means these r under more oxstr, makes sense bc NF KB is active w oxstr)
pmc.ncbi.nlm.nih.gov/articles/PMC76… - inflammation, mast cells
ANTIHISTAMINES pubmed.ncbi.nlm.nih.gov/2469708/, pmc.ncbi.nlm.nih.gov/articles/PMC10…, pubmed.ncbi.nlm.nih.gov/33909554/, pubmed.ncbi.nlm.nih.gov/28604133/
jidonline.org/article/S0022-… - blood vessels die, higher nuclear localization
iNOS inhibition researchgate.net/figure/Topical…
Dandruff is common, fungus can drive it

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ROS mediates DHT response - can it cause MPB without changing DHT?
pmc.ncbi.nlm.nih.gov/articles/PMC72…
sciencedirect.com/science/articl… “this suggests that DPCs maintained in an environment of low oxidative stress (e.g., 2% O2) are protected from DHT-induced TGF-β secretion.”
pmc.ncbi.nlm.nih.gov/articles/PMC41…
pmc.ncbi.nlm.nih.gov/articles/PMC38…
Antioxidants help
pmc.ncbi.nlm.nih.gov/articles/PMC11…
pubmed.ncbi.nlm.nih.gov/38685364/
CRF shortens hair, activates relevant factors, drives oxstr, cortisol is high in AGA
Stress + Thyroid, ROS pmc.ncbi.nlm.nih.gov/articles/PMC10…
PRP works by giving growth factors pmc.ncbi.nlm.nih.gov/articles/PMC89…

High PGD2 - is it more relevant than PGE2? - yes - sci-hub.se/10.1111/ijd.15…
mdpi.com/2073-4409/12/4…, (mediates DHT response) mdpi.com/2079-9284/11/5… blocking PGD2 grows hair

sciencedirect.com/science/articl…, nature.com/articles/s4141… - hair follicle metabolism, microbiome, ROS

SIRT negatively associated w hair loss bmcresnotes.biomedcentral.com/articles/10.11…

Pressure theory pmc.ncbi.nlm.nih.gov/articles/PMC41…

Transcriptomics of DHT pmc.ncbi.nlm.nih.gov/articles/PMC84…, nature.com/articles/s4159…

Methylation controls AR expression pubmed.ncbi.nlm.nih.gov/21428981/

pmc.ncbi.nlm.nih.gov/articles/PMC59… more on epigenetics, beard vs scalp but for T not DHT

Beard vs scalp jidonline.org/article/S0022-…

Genetics review: pmc.ncbi.nlm.nih.gov/articles/PMC11…