Everything I know about preventing hair loss

This post documents my progress fighting hair loss (androgenetic alopecia) over the past ~6 months with (relatively) successful results, using a combination of topical minoxidil, dermarolling (Microneedling) and 5α-Reductase inhibitors.

I realize now that I should have started this process A LOT earlier. That’s why I’m writing this post. I’d like to simplify it and summarize it for others to try it as soon as possible. It’s a non-intrusive, non-expensive method.

This post explains in detail EVERYTHING I’ve learned and put to practice. As usual, there are contraindications and side effects to all of this, so it’s better for you to understand the root causes, sources and mechanisms of action.

What is Hair Loss?

Hair Loss can be caused by multiple reasons. In my case, it’s most likely just generic, congenital hair loss, also known as androgenetic alopecia.

I first noticed that my hair around the crown of my head was falling (or not growing) around ~5 years ago (around age 32).

What causes hair loss?

The most common reason for androgenetic alopecia is elevated levels of circulating DHT. Obviously stress is a big factor as well.

What is DHT?

DHT is a sex-hormone generated from Testosterone. “High” levels of testosterone is usually beneficial for males, as it helps increasing muscle mass (which in turns makes us “healthier”: reducing body fat, improving bone density, etc) improves cognition and more.

The problem is that higher level of testosterone will result in higher levels of DHT, which in turns can also be problematic, as it can cause prostate cancer.

So there’s no easy answer and as usual, the solution is to seek a balance. Good levels of testosterone levels with regular prostate checks.

How DHT affects hair growth?

DHT binds to androgen receptors in hair follicles, especially in genetically susceptible individuals, leading to:

• Miniaturization of hair follicles
• Shortening of the anagen phase
• Thinner, shorter hair shafts

Other causes of hair loss

Aside from Stress, vitamin deficiencies (especially Vitamin B) have been linked with hair loss. In my case, as I have a very well balanced diet, I have ruled out this possibility, but you might have to check for yourself. Honorable mention (again) to stress, as usual.

Have I stopped hair loss?

I’m not sure if I have stopped hair loss or I might have just slowed it down. Nevertheless, the results to the naked eye are palpable, so I assume I’m on the right track.

What have I done to stop hair loss?

Finally the important stuff. It’s very important to understand the root causes of things to make sure the solutions in place are effective. In my case my routine involves:

• Topical Minoxidil: every night after shower
• Microneedling. A very thin (0.3mm) dermaroller: every night after showering.
• STOP washing my hair so often
• Switch to a 5α-Reductase inhibitor shampoo (Nizoral in my case)

The cost of all this combined is probably ~$15/month.

Topical minoxidil (5%)

You can read A LOT about Minoxidil online, so I won’t extend a lot. Get Minoxidil 5% in any pharmacy, it costs just a couple of dollars, and apply it every day on your scalp after showering. The most popular (and expensive) brand is “Rogaine”. It doesn’t have to be that one. The most common presentation is a liquid, although I’m trying the foam version now and I like it better. It’s all pretty much the same.

Minoxidil works by keeping your hair in the growth phase (anagen) for a longer period of time. If you remember the reason of hair loss due to high level of DHT, it was because (among others), DHT shortens the anagen phase.

The MOST important thing to consider about Minoxidil is that it contains alcohol (propylene glycol) and it’ll DRY your scalp. BE CAREFUL. Read more below in the contraindication/side effects section.

There are (supposedly) a couple of brands producing Minoxidil without alcohol which could help with the dry scalp, but I haven’t tried them myself.

Microneedling/dermarolling

A dermaroller is a little handheld tool with lots of tiny needles on a roller. It’s not painful at all.

Supposedly, when you roll it over your scalp, it makes tiny pinpricks that help boost blood flow and can kickstart hair growth. People also claim that it helps with the absorption of Minoxidil (see below), although I couldn’t find any references for this.

I use the thinnest version I could find on Amazon (0.3mm). I use it daily, I don’t press it hard. I just go over my scalp in every direction. It’s important to replace it often and sterilize it properly. I use just ethanol (ethyl alcohol or pure alcohol) that is 96% pure alcohol. I soak the dermaroller in alcohol after use and that’s it. I change it every ~4 weeks.

Shampoo and hair washing

First off, I used to wash my hair A LOT. I do a lot of sports so I shower ~2 times per day and I’d wash my hair with shampoo every time. This is VERY BAD. The first few weeks I got conscious about hair loss I just stopped washing my hair all the time and I saw a considerable improvement. So, if there’s one thing you can do RIGHT NOW, is stop washing your hair with cheap shampoos.

Nowadays, I wash my hair every other day. At the beginning I felt dirty, but it’s clearly not the case if you do shower every day (or more than one time per day). The only issue you’ll have is that your hair will become more “greasy”. It might also be a problem if you live in a city with too much contamination and smog.

About the shampoo, I switched to a shampoo named Nizoral, which is originally indicated as an anti-fungal and anti-dandruff. The active component of Nizoral (and equivalent shampoos) is ketoconazole. So if you can’t find Nizoral (the brand), just look for a shampoo with ketoconazole.

Topical ketoconazole might help reduce the DHT levels in the scalp. It’ll also help with the dry scalp symptoms caused by Minoxidil.

Massaging

I don’t know how much influence this has so I’ll just quickly mention. But with the Nizoral I also try to massage the scalp for a couple of minutes. After all, alopecia is caused by bad circulation so if I can induce blood circulation in any way I’ll try it.

Avoid Finasteride, and everything is topical

You’ll read around a lot about Finasteride, how it helps reduce DHT (which in turn will help with alopecia). This might be 100% true. BUT, very few mention the side effects. Reducing DHT can potentially have an impact in your daily life. Some people claim reduction in libido and sexual drive, dizziness and other things.

In my case I tried Finasteride for 3 months and I felt TERRIBLE. I was always “tired” (low energy) and without changing my diet habits I gained weight. So I’m completely against the use of Finasteride.

The general rule for me now is that: everything has to be topical. Topical means applying it directly to the scalp, vs taking pills or drugs that will go into your digestive system (and your bloodstream).

There are versions of topical finasteride but I haven’t tried them.

Contraindications and side effects

In case you missed it, here’s what you should expect (or the things that could go “wrong”):

Minoxidil will dry your scalp, as it contains alcohol. There are some “oils” or products that help with the hydration of the scalp and supposedly help. I haven’t tried them. For me, I just avoid scratching my scalp and that’s it. I have to live with it.

Dermarolling too “harshly” (either thick needles, pressing too much, or a non-sanitized dermaroller) could cause an infection. It has not happened to me, but I’ve read about it.

Check by yourself

I think if there’s one piece of advice I could give you is: go to the source, and make sure you check what’s best for you. For example, some people say that Finasteride has no bad side effects on them.

It’s also important to understand the root causes of alopecia to find the optimal solution. So don’t just follow advice on Instagram (or even this blog post); try to find the source of the information and make sure you’re comfortable with the associated risks.

Next things to try

There are three things I’ll try in the following months:

Topical Finasteride: I want to give it a try again, it might help block even further DHT on my scalp.

Other shampoos: I’ve read about some other shampoos that help with hair loss because they either have 5α-Reductase inhibitors or other active components that might help, like caffeine. Saw Palmetto also looks promising.

Red Light: There’s some evidence that red light (660nm and 850nm wave length) might improve hair growth. There are even “caps” that contain the red lights. Just google “red light cap”.

Forums and sources

As usual, there’s nothing that beats collective intelligence. r/tressless/ is a great source of personal experiences. In my case, I follow the subreddit and once I see something that piques my interest I start checking for sources. Google Scholar first for research, and if I can’t find anything, I try to get to the root cause of the promoted “product”.