Tratamentos para calvicie

What treatments for baldness work?

5-alpha reductase inhibitors

Finasteride

The government should be spraying finasteride into the cereal bowl of all men over 18 years old. Not seriously. Some of you may know finasteride by its business name, propecia. Finasteride is neither a hormone nor a derivative of it, it is simply a potent suicide inhibitor of the 5-AR II and III enzymes. It has been approved by the FDA since 1991 and has other uses besides hair loss. Finasteride can potentially work on all scalp hairs, although it tends to have better results in the vertex and mid-anterior parts, unlike the frontotemporal regions.

Now pharmacology tells us that only 0.05 mg of finasteride was almost 50% as effective as 100 times the 5 mg dose in reducing DHT serum after a single dose.

Not only that, but 0.05 mg was close to 90% as effective after the daily dose in reducing DHT serum. See the following study:

It takes about 4 days of daily use to achieve a stable concentration of finasteride at serum levels. Finasteride begins to reach about 90% of its maximum efficacy after a single oral dose above and including 0.5 mg. 0.2mg / day was the least ideal dose to achieve the same response as a full 1mg dose in reducing serum DHT. In other words, 1.4mg / week works almost as well as 7mg / week in reducing DHT serum.

The general consensus on the 1mg dose has to do with the start of the MERCK study in 1998, before prophecy hit the markets. Where it showed that this dose provided the best compensation for hair growth and dosage amount, according to the logarithmic dose response curve staying flat near 1mg. We will see later that serum DHT levels and subsequent inhibition are not a real measure for stopping hair loss, but at best a proxy for finasteride's effectiveness.

Your final dosing schedule should not be less than 1.4 mg / week. To approach the full benefits. It's okay to start with less, and probably advisable as well. But in the end, at least 1.4 mg / week should be kept. Studies show that 0.2 mg per day was 80% as effective as 1 mg per day in increasing capillary count, almost 5 times the dose. In addition, it was 64% effective (this number should be closer to 75% based on differences in medication period) for 25 times the 5mg dose per day. Based on the pharmacokinetics and pharmacokinetics of finasteride, 0.5 mg should be even more effective than 0.2 mg, leaving it almost as effective as the 1 mg dose according to the log dose response curve. Similarly, the EOD protocol appears to be as effective as serum DHT levels do not begin to increase after the last dose of finasteride for at least 56 to 72 hours, consistent with the slow turnover for Type II enzyme complexes. II human. with a half-life ranging from 7 to 14 days.

Everyone ended up hearing how dangerous propecia is, we all read horror stories on the internet about how finasteride gave me a soft cock, destroyed my sex life and killed my dog. But the fact of the matter remains, dissatisfied people are usually the noisiest. For every idiot on the internet creating sizzling topics about how finasteride wrecked their lives, there are hundreds of thousands of people taking the pill every morning and too busy to post their positive experiences on the internet due to living a good life without stress or hair loss. . People with “post-finasteride syndrome” are very scarce and involve about 100 people who originated propeciahelp.com. Of course, their credibility should not be taken seriously, as they are nothing more than online reporting. We do not know what doses they were taking, their source of medication, what kind of lifestyle they were taking, what other medications they were using, what drugs they were taking, or their general health. In other words, there is no way to find out if you would tolerate it yourself unless you tried, any side effects you might experience will likely dissipate over time. Otherwise, they will dissipate on discontinuation, usually within a month at most, as it is the time required before making blood donations, and just enough time to complete the 5-AR II enzyme turnover.

Several large, long-term placebo-controlled population studies using the International Erectile Function Index-5 questionnaire and the objective method (Night Penile Tumescence) to assess erectile function have not shown clear evidence of the negative effect of finasteride on erectile function. Ejaculatory volume reduction is the only causal relationship established between finasteride and sexual dysfunction. Although finasteride causes a significant reduction in all semen parameters except sperm morphology, they did not fall below borderline levels to interfere with fertility. Therefore, the sexual adverse effects associated with finasteride should be seen in relation to the normal prevalence and natural history of erectile dysfunction in the population, patient age, other confounding factors and also nocebo effect.

In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p <0.05). Adverse events were also not considered important, and these side effects disappeared as soon as treatment was discontinued.

Finasteride: Administering 1 mg per day in male androgenetic alopecia in different age groups: 10 years of follow-up, the Italian research team sought to fill a gap in our understanding of the long-term effects of Propecia hair loss treatment. The study followed hair growth in 118 men between the ages of 20 and 61 years with mild to moderate hair loss who were treated with 1mg finasteride. These patients were evaluated before treatment and then again at 1, 2, 5 and 10 years of treatment. The authors concluded that a patient's response to finasteride within the first year is a good indicator of how effective long-term treatment will be for the patient. The better growth he experiences in his first year, the more likely he will have continued growth beyond 5 years of treatment. Among other findings, a patient's age had a statistically significant effect on outcome, as patients older than 30 showed better long-term hair growth. On the subject of side effects, 7 subjects (5.9%) experienced them, and some of these patients remained in the study because of what they perceived as the benefits of treatment.

OBJECTIVES: To evaluate the incidence and resolution of adverse sexual experiences (AEs) in men with benign prostatic hyperplasia treated with finasteride 5 mg compared with placebo.
METHODS: The Proscar Long-Term Efficacy and Safety Study (PLESS) was a randomized, double-blind, placebo-controlled, 4-year study evaluating the efficacy and safety of finasteride 5 mg in 3040 men aged 45 and 78 years old, with benign symptomatic prostate hyperplasia, enlarged prostate and no evidence of prostate cancer. Patients completed a screening questionnaire about their history of sexual dysfunction. During treatment, spontaneously self-reported sexual AEs were recorded.
RESULTS: At screening, 46% of patients in each treatment group reported some history of sexual dysfunction. During year 1 of the study, 15% of finasteride-treated patients and 7% of placebo-treated patients had sexual AEs that were considered drug-related by the researcher (P <0.001). During years 2-4, no difference between groups was observed in the incidence of new sexual AEs (7% in each group). The drug-related sexual profile of finasteride was similar for men with or without a history of sexual dysfunction. Sexual AEs resolved while therapy continued in 12% of finasteride patients and 19% of placebo patients. Only 4% of finasteride patients and 2% of placebo patients discontinued the study due to sexual AEs. In men who discontinued sexual AS, 50% and 41% resolved their sexual AS after discontinuation of finasteride or placebo therapy, respectively.
CONCLUSIONS: Compared to placebo, finasteride-treated men experienced new drug-related AEs with an increased incidence only during the first year of therapy.

Originally posted by JOU, Volume 174, Issue 3, September 2005

OBJECTIVES: To evaluate the safety and efficacy of finasteride 5 mg over a 10-year period in men with enlarged prostate. It is important that the safety and long-term efficacy of drugs intended for chronic administration in men with BPH are well understood.
RESULTS: Twenty-four (56%) of the 43 original patients randomized to finasteride or placebo were judged to be successfully treated for the next 10 years finasteride (17 patients taking finasteride alone at 10 years and 7 patients taking finasteride). alone when discontinued during the 10-year follow-up for reasons unrelated to finasteride treatment). In total, 22 (51%) of the 43 original randomized patients continued finasteride treatment at 10 years (17 taking finasteride alone, 4 taking finasteride plus an alpha-blocker, and having a finasteride for hematuria treatment). Long-term treatment with finasteride was well tolerated, with a low incidence of drug-related sexual adverse events occurring during the first year and even fewer occurrences during the open 5-year extension. No new adverse experiences occur with increasing duration of drug exposure.

Dutasteride

Dutasteride was more effective and showed less variation in the inhibition of different type II 5-reductase genotypes than finasteride. In some genotypes, finasteride showed better inhibition than dutasteride, indicating that patient genotyping would be beneficial in choosing treatment. This also provides a possible answer as to why some people who treat their hair loss with finasteride see many improvements when switching to dutasteride, and why some notice a worsening of their condition. It may well be due to some genotypes that respond better to one drug than another.

Statistically, dutasteride is more likely to give better results, but finasteride may be a little more effective despite theoretically lower inhibition, which is why some people tend to stick to both. This is only statistically speaking, but I prefer to use science.

Dutasteride inhibits the same enzymes as finasteride, and even does a better job on both the scalp and the prostate. With that said, any finasteride you ingest with dutasteride would be a waste. Seeing as Dutasteride effectively inhibits almost 95-99% of 5-AR2 enzymes at doses greater than and including 0.5 mg / day. Not to mention that the chemical's 5-week half-life theoretically allows it to remain long enough to interact with any new 24-hourly produced 5-AR enzyme. Simply put, a dose of 0.5mg dutasteride is comparable to 5mg finasteride, so it would be like taking 6mg finasteride, but a little better in the sense that dutasteride is a better target inhibitor of scalp tissue. Note that 5mg finasteride and 0.5mg dutasteride had similar hair counts, and the effects will not be additive, at least not significantly to be measured. While 1 mg of finasteride (assuming it is your dose) made about 18% worse than both 5mg F and 0.5mg D.

Typically, using both at the same time may be plausible if you intend to use a small dose of finasteride-coupled dutasteride. Some people take dutasteride 0.5mg once or twice a week with 1mg finasteride every day and experience some new growth even after 4 years of using finasteride alone. But in general you will not need finasteride at doses of 0.5 mg / day dutasteride or more, but you can always increase the dose for even more effective results, although they should be marginal in terms of hair count.

Dutasteride has slightly more effects on sexual parameters than finasteride, but they are still within normal limits. Testosterone alone is sufficient to maintain qualitatively normal spermatogenesis in most normal men; the statistically significant parameters between dutasteride and finasteride in terms of sexual function would be prostate size and ejaculatory fluid volume. An increased risk of gynecomastia or erectile dysfunction may also be prevalent as 5-AR blockade would make even more available free testosterone that could potentially be flavored. But studies show it's too insignificant to worry about.

Dutasteride has a tolerability profile comparable to placebo when used daily for up to 2 years, except for gynecomastia, impotence and decreased libido, which occurred at slightly higher incidences compared to the placebo group.

Interestingly, some studies show that Dutasteride actually has lower reports of side effects compared to finasteride, it is not known why this occurs. While other studies show dutasteride with 1.5x the statistical probability of finding side effects. The reason may be that there are many more studies done on finasteride while very few done for dutasteride, so the results may be statistically biased in this regard.

No long-term study showed adverse reaction to dual 5-AR inhibitors, but again, the longest study was almost 4 years, excluding one-year follow-up. Most medical literature at the moment tends to reflect its safety profile, at least for now.

Minoxidil

Minoxidil does not prevent baldness, it stimulates hair growth. It is a potassium channel opener and an antihypertensive vasodilator drug that promotes hair growth when used topically. Supposedly interferes with the beta-catenin pathway (check the graph of DHT pathways that cause hair loss) and improves blood circulation and thus the supply of oxygen and nutrients to the hair follicles, resulting in accelerated hair renewal. Hair cycles at one end the condition of the follicles at the other. On the other hand, 5-AR inhibitors stop hair loss, and your body may try to regenerate and reverse the miniaturization process that results in visible hair growth after a decent period of time. When used synergistically, minoxidil is like steroids for these weak and thin hairs and should provide faster and better results than when used alone.

The hair count for minoxidil was slightly lower than finasteride, its disadvantage was that eventually it loses its effectiveness under the effects of androgen damage, the hair count slowly begins to decrease after one year of use, probably reaching the baseline around from 8-12 years. But with 5-AR inhibitors, this should no longer be a problem.

You should theoretically keep all hair grown using Minox as long as you keep using it. However, these will not be your 'real' hair, in the sense that once you stop, all the hair you were keeping alive using minox would die, and your true genetically predisposed scalp will show. They say that minoxidil does not work effectively for 1/3 of people, keeps for 1/3 and regresses to the last 1/3. The 5% version is 45% more effective at regaining hair than the 2% version, it also shows much faster results.

The foam version is much less cluttered and practical as a leave-on than the liquid form. Especially if you decide to leave home. Also the liquid form is known to cause scalp irritations. One of the main reasons foam works best is because users are more compatible. The reason those who use foam are more compliant is because foam is easier to use. It's difficult to put the foam on the scalp if you have long hair, but it can be done.

The liquid formulation contains propylene glycol, water and alcohol. Propylene glycol is required as a carrier for the minoxidil solution. However, most adverse reactions are related to propylene glycol hypersensitivity. Itching, contact dermatitis and scalp scaling are attributed to the propylene glycol content in the minoxidil topical solution. With these aesthetic concerns, topical minoxidil foam, which is free of propylene glycol, has been developed. In the literature, there is no comparative study between the two formulations in humans. In an animal study, foam formulation was considered as effective as liquid formulation. Minoxidil 5% Once Daily Topical Foam is non-inferior and as effective for stimulating hair growth as 2% twice daily topical solution in women with androgenic alopecia and is associated with several aesthetic and practical advantages.

Minoxidil's main official side effects may include itching, allergic dermatitis, palpitation, scalp irritation and worsening of seborrheic dermatitis. If you are hypotensive by nature, be careful. Dark circles and wrinkles have also been reported, some studies show that minoxidil breaks down collagen in vitro, but this should not be a problem as long as it is not being absorbed systemically. I'm not sure how true this is, but it has been reported many times on the internet to be ignored. I would just use foam and keep it away from any direct skin contact on the face. In contrast to the fear of finasteride, this may well be exaggerated, either by misuse or inexperienced observations.

Ketoconazole

Ketoconazole is a scalp exfoliator and is commonly used to treat dandruff and oily hair. It is an anti-fungal steroid and has an anti-inflammatory effect. It is more common to reduce Malassezia colonization of the scalp, which helps to lose hair faster than normal through inflammation. If you are reading this, you are likely to have malassezia, it is more common than you might think. It also shrinks the sebaceous glands by about 20%, which can make your hair a little dry. Ketoconazole is used topically in the form of 1% shampoo, 2% shampoo or 2% cream. Shampoo and 2% cream have a prescription grade, but you can easily get them from various online suppliers. The most popular brand is called Nizoral. 1% shampoo can be found at your local pharmacy or purchased online. By itself, ketoconazole is not very effective as it is not powerful enough to stop the balding process, but I think it is a little underrated; And when used in combination with the other two treatments listed above, it can certainly have a positive synergistic effect. There has even been a study showing that 1% ketoconazole shampoo, used three to four times a week, can be as effective as 2% minoxidil. A 2% ketoconazole shampoo 2-3x / week should thicken the hair follicles well, as it tends to work better on hair follicle diameters than increase their numbers. You do not need to use an additional shampoo either. Just remember to use a good conditioner or hair oil because it tends to dry out the scalp. If your scalp becomes too dry or sensitive, reduce usage or buy the weaker version.

Spironolactone

Spironolactone is an anti-androgen that binds and nullifies androgen receptors and therefore competes with testosterone and DHT instead. Spironolactone, in its oral form at least, is arguably the most powerful chemical in terms of treating hair loss, and all other androgenic functions in the body. It is mainly used for male to female transgender, although some individuals use it to treat hair loss. Spironolactone should not be used in males because of the risk of feminization, so threads are used instead. Like ketoconazole, topical spironolactone (also called “spiro / S5”) works by blocking androgens from binding to androgen receptors on the scalp. Also like ketoconazole, it is only marginally effective in itself, which means it needs to be combined with other treatments to see any positive results.

The great thing about topical spiro is that it is metabolized in the skin and has very little systemic absorption, so it will hardly result in side effects if used properly. Some users complain that it smells really bad, I don't think there is a way around it. Anecdotal evidence of the topical form is generally positive, although systemic absorption cannot be undone. Side effects have been reported, although no study has been done to statistically measure the prevalence of their side effects. A tip would be not to use it on a wet scalp, as moisture tends to increase absorption at a much higher rate through the skin. How fast and how systematically it goes, no one knows, this is just a precaution.

This effect is related to the binding of spironolactone to dihydrotestosterone receptors in the sebaceous glands. Our study demonstrates that topical 5% spironolactone cream acts as an antiandrogen in human sebaceous glands, competing with DHT receptors and producing a decrease in labeled DHT. At the concentrations used, the effect was local only. No side effects were recorded.

The authors report their clinical experience with topical treatment of seborrheic acne with 5% spironolactone cream in 20 patients, 11 male and 9 female, aged 12 to 28 years (mean 20.5). Duration of treatment, about one month. The treatment was remarkably effective in that it caused complete regression of acne in 30%, improvement in 65% of patients. The drug has always been well tolerated, side effects have never been observed.

Topical 5% spironolactone gel applied to the right cheeks of individuals produced a significant reduction in sebum secretion rates at 12 weeks.

RU-58841

RU58841 is a non-steroidal anti-androgen that is used topically. In all honesty, not much is known about RU58841, other than being a potent androgen receptor blocker whose clinical trials have been discontinued (many believe strictly for financial reasons). There is not much information about your security profile. Normally, I would not include this drug on the list of effective treatments because it is an experimental one, however there are enough users reporting positive results, there are very few reports of negative side effects, as RU58841 appears to be metabolized to an inactive compound once it becomes systemic ( inactive in terms of antiandrogenic effects). Users claiming positive results say that RU58841 works as well as finasteride, but without the side effects, although there is no hard data to prove it. Apparently this is supposed to be the holy grail for topical anti-androgens as it is claimed to block almost all DHT on the scalp. Although it may be a hassle to get your hands on it, and prepare it for treatment. Be aware, this is an experimental drug, so use at your own risk.

Here is a good guide on how to use it.

http://www.baldtruthtalk.com/showthread.php?t=12391

Tretinoin (Retin-A)

Tretinoin appears to aid in the absorption of minoxidil, thereby increasing its effectiveness. This should be the case with all topics as well. It may also have some mild regrowth properties on its own.

Topical all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil was tested for hair growth promotion in 56 individuals with androgenetic alopecia. After 1 year, the combination of topical tretinoin with 0.5% minoxidil resulted in terminal capillary regeneration in 66% of the subjects studied. Tretinoin has been shown to stimulate hair growth in approximately 58% of the subjects studied. A female with pronounced alopecia for over 20 years had hair growth using only tretinoin for a period of 18 months. Tretinoin has been shown to promote and regulate cell proliferation and differentiation in the epithelium and may promote vascular proliferation. These factors are important for promoting hair growth.

The efficacy and safety of 5% minoxidil and 0.01% tretinoin once daily combination therapy appear to be equivalent to those of conventional 5% minoxidil twice daily therapy for the treatment of AGA.

Derma roller

Derma rolling is believed to initiate wound healing and thus trigger an embryonic state in the skin that makes it receptive to receiving wnt protein instructions. Wnt's are a network of proteins implicated in the development of hair follicles. It should also help to increase local absorption of threads. The next study used 1.5mm needles once a week and minoxidil was not applied until at least 24 hours after needling, twice a day every day.

Results: (1) hair count - The mean change in hair count at week 12 was significantly greater for the Microneedling group compared with the Minoxidil group (91.4 vs 22.2, respectively). (2) Investigator evaluation - Forty patients in the Microneedling group had a +2 to +3 response on the 7-point visual analog scale, while none had the same response in the Minoxidil group. (3) Patient assessment - In the Microneedling group, 41 (82%) patients reported improvement of more than 50% versus only 2 (4.5%) patients in the Minoxidil group. Dissatisfied patients with conventional AGA therapy had a good response with Microneedling treatment.
The authors concluded that Dermaroller together with the Minoxidil-treated group was statistically superior to the Minoxidil-treated group in promoting hair growth in men with AGA for all 3 primary measures of hair growth efficacy. Microneedling is a safe and promising tool in hair stimulation and is also useful in treating hair loss refractory to Minoxidil therapy.

Non-chemical treatments

The topic of hair transplantation can be tricky, so here is what you need to know right away.

  1. A hair transplant involves taking the hair follicles down the back and sides of the head and "transplanting" them to areas of the scalp where you have lost your hair. The reason this works is because the hair on the back and sides is usually DHT resistant and not susceptible to androgenic hair loss.
  2. Hair transplants have come a long way. They have gone from doll hair, looking at results, to procedures where the end result is almost undetectable, if done by a talented hair transplant surgeon. HTs will probably not look as good as natural juvenile scalp.
  3. There are two methods of hair transplantation. The “strip method” is FUE, or follicular unit extraction. The strip method involves removing a thin piece of scalp from the donor area at the back of the head. This is often called a "safe zone". The hair follicles are then removed from this band, divided and transplanted to areas of the scalp that are thin or bald. The positive of this method is that it often produces great results, the negative is that many patients with the strip method have a scar on the back of their head, so they cannot use short hair or the scar will be revealed. FUE, on the other hand, is a newer technique and involves the use of a specialized tool to punch small donors. These follicular units have 1 to 4 hairs and are then transplanted to the required areas. Many patients opt for this method because it does not leave a linear scar, and they can still use short hair (some scars can still occur in the form of small FUE points. In my opinion, if this happens, they are still much less noticeable than a strip of scar). In addition, the FUE sometimes produces less than one result than the range method. Therefore, it is up to the patient and their doctor to determine which method is best.
  4. Insertion angle really matters, otherwise the texture of the transplanted hair is affected (ie some strands may point in a different direction significantly and look like a hood or something). Nape hair (base of back neck) is sometimes used to give hair a “softer” look, as the transplanted hair on the back looks very thick and coarse. I'm still not sure how they transplant the temple hair to look natural. There are procedures like “dense packaging” where more hair is transplanted on the front to give an illusion of density.
  5. There is not enough hair on the back and sides of the head to cover the entire scalp. So if you're completely bald (Norwood 6-7), you're unlikely to be able to get full coverage unless you have exceptional donor density, which means you have a lot more hair on your back and sides of your head. than the average person. This brings me to point # 6.
  6. You still have to take a medication like finasteride. If you do not do this, you will still lose untransplanted hair at the top of your head, and this can frustrate the goal of having a hair transplant. So if you want full coverage, you should keep as much untransplanted hair as possible on your scalp, because again, in most people, there is not enough hair for full coverage.
  7. If you have a lot of body hair, you can transplant it to the scalp as well. The results (if done by a respected surgeon) are often better than you might expect.
  8. Some people are not good candidates for hair transplant because their hair loss is very severe or they have something called DUPA, which is a diffuse and non-standard alopecia. This means that your "safe zone" is incredibly small, or that miniaturization is taking place on top of your scalp, back and sides. This condition is much rarer than standard male pattern baldness.
  9. Hair transplants are not cheap, especially if done by a respected doctor. Even small procedures will cost a grand pair. As with most things, you get what you pay for. So if you go to a cheap doctor, you can probably expect cheap results. Therefore, it is imperative that you do proper research on the hair loss clinic you select. Bottom Line: Hair transplantation should only be attempted when medication does not work, or hair loss has been stabilized. It's also a bad idea for someone who is young (under 25) to have a transplant because you don't know how far your AGA will progress. On the other hand, talented hair transplant surgeons can achieve miraculous results, given the right circumstances. The key is search, search and search. At my option, the best transplant candidates are those that are Norwood 4s and below. If you are a Norwood 5 and beyond, getting full coverage will be harder, however, I've seen it happen, so all hope is not lost.

Wigs

Ok, let's say you're not a good transplant candidate and the drugs were ineffective, what options are left? I will not suggest a wig or hair system, as I know this sounds like a nightmare to many people (including me). However, I will say that there are some that provide amazing results like toppik by just throwing it out there.

Micro-scalp pigmentation

A few years ago I would have said, "No, not at all." But in recent years this technique has become better and better. It has become a decent option for those who can rock the shaved look. Scalp pigmentation is basically a scalp tattoo made to look like you just shaved your head and have “stubble” growing. Again, this is not a perfect science, but when you run out of all other options, it is at least something to investigate. It's not permanent either, so you won't get stuck if it looks bad. On the other hand, you'll need retouching every two years if it's something you like. In addition, recent techniques involve micro-scalp pigmentation, followed by a small FUE procedure throughout the scalp to give a real textured look. Do a quick research on this; You may be surprised at the results. This is an option for those with severe hair loss and those who are not candidates for normal transplantation. Again, this is not the best option, but an option nonetheless.


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