In this Magnum Workshop guide, we will discuss hair biology, causes of hair loss, delve into hair loss drugs, and all other hair loss treatments. A thick head of hair is attractive to women because it signals health, virility, and youth. Whereas baldness signals weakness and impotence (unless you happen to look exactly like Vin Diesel or Jason Statham). A thick head of hair will always be attractive and not something you want to lose if you can help it.
A study done by John Hopkins University in 2015 had over 100 men and women rate pictures of 13 different men, 7 of which had undergone hair transplants, and 6 of which served as a control group and did not receive a hair transplant. Each man was shown to each participant, who was asked to rate attractiveness, youthfulness, success, and approachability. The men who had hair transplants consistently scored higher in each category.
Hair Follicle Anatomy
Hair is important in humans. Females will evaluate you for your hair and will expect you to have a reasonably thick head of it. Hair helps provide protection, serves as a filter in the nose, a mechanism for regulating balance in the middle ear, and a moisture/heat retention system. The male hairline looks like an M.
Hair follicles come in groups of one to four hairs called a follicular unit. A surgeon will extract follicular units during hair transplantation surgery and move them to where they’re needed.
The hair follicle is made up of several parts:
- Hair Shaft – This is the visible part of the hair. It grows at a rate of 0.5 inches (13 mm) per month.
- Hair Root– This is the part of the hair that’s under the stratum corneum (dead layer of skin cells which you see with your eye). It resides in the deeper epidermis layer.
- Arrector Pili Muscle – The arrector pili muscles attach to several follicular units. They cause the hair to stand up when the body is cold by all contracting simultaneously and trapping heat.
- Sebaceous Glands – These glands secrete oils that help protect the hair follicle and keep it from becoming brittle.
- Sweat Glands – These glands secrete sweat, which helps to cool down the body by letting water evaporate off your skin. This cools the skin down.
- Papilla – The deepest part of the hair follicle, the papilla contains blood vessels that help nourish the hair.
The hair growth cycle consists of four phases:
Anagen (2-7 years): The growing phase. Your hair is alive and active. Hair shaved in this phase will just grow back.
Catagen (2-3 weeks): The follicle begins to die and detaches from your skin. It is still attached however and doesn’t fall out until later.
Telogen (3-5 months): The hair is resting in this phase while the old hair follicle remains detached and may or may not fall out. During times of stress, more hairs fall out.
Exogen: The hair follicle falls out and new hair is growing, going back into the anagen phase. Dozens of hairs are falling out every day, which is why you find loose hairs when you use a comb.
Normally, your hair stays in the anagen phase for several years before falling out. All your hairs are in different phases of the hair cycle. This means they won’t all fall out at the same time. Telogen effluvium occurs when some sort of stress (like a fever, or restrictive diet) causes your hairs to all enter the telogen phase simultaneously. This leads to a bunch of new hairfall that you happen to notice because it occurs at the same time.
Both of the primary hair loss drugs (minoxidil and finasteride) lead to shedding and a new, prolonged, anagen phase.
Causes of Hair Loss
There can be several causes for hair loss, but as of now, medical science has found one main single culprit which is basically the main root cause of hair loss: DHT, which is an androgen that’s basically just a way stronger type of testosterone. If you handle DHT, you basically handle most future hair loss.
Male pattern baldness (also known as androgenic alopecia) is genetic. For most men, DHT damages hair follicles. However, some men don’t have androgen receptors in their hair follicles, and so nothing happens. But for the rest of us, the hair that’s on top of our scalp has a limited shelf life due to DHT. Other hair, like on the side or back of our head, or on our body, also lacks androgen receptors and is immune to DHT. Some people are more predisposed to male pattern baldness because the androgen receptors in their scalps are more sensitive. It’s purely genetics.
The main cause of male pattern baldness according to modern medical science is the degeneration of the hair follicles by DHT. DHT is a more powerful form of testosterone. An enzyme called 5-alpha reductase (5-AR) converts testosterone to DHT, or dihydrotestosterone. DHT travels to the blood supply of your hair follicles and binds to DHT receptors. This cause the hair follicle to shrink (leading to thinning of the hair), shortens the anagen phase, and increases the telogen phase. The more that DHT attacks your hair follicle, the shorter the anagen phase of the hair gets. Eventually, the hairs on your scalp never get the chance to pierce the skin.
DHT has several functions in your body:
- The primary function of DHT is to contribute to male sex characteristics as you’re going through puberty. DHT gives you a deep voice and increases the growth of muscles, the penis, the testes, and body hair.
- Maintaining muscle mass.
- Modulating libido. DHT receptors in your penis help with producing an erection.
- Promoting fertility.
When DHT is too high it can lead to:
- Hair loss.
- Enlarged prostate.
- Prostate cancer.
- Slow healing of wounds.
- Coronary artery disease.
When DHT is too low it can lead to:
- Delayed puberty in teenagers.
- Abnormal body fat distribution/storage.
- Gynecomastia (man boobs).
- Increased risk of prostate cancer.
Trying to limit DHT before the age of 18 can be dangerous because you’re still going through puberty. But it’s generally a good idea to limit it afterward as soon as you can if you’re predisposed to male pattern baldness. Limiting DHT production is the closest thing to a cure for hair loss that has the potential to save your hair.
Things rarely get better with age, and the same goes for hair follicles. Your hair follicle is susceptible to inflammation, toxins, poor nutrition, stress, etc. The older you get, the more your hair loses its color, gets thinner, loses volume, takes longer to grow and loses shine/texture. On top of this, DHT is attacking your hair follicles as you age. Unfortunately, there’s not much you can do about aging. It’s just a fact of life. The best thing you can do is try to limit DHT and live a healthy lifestyle.
Hair Loss Drugs
The best-known treatments currently in existence for hair loss are the big three: minoxidil, finasteride, and ketoconazole shampoo.
Finasteride inhibits DHT, which is the main cause of hair loss and prostate enlargement in men. You can take finasteride orally (1 mg), once a day. It prevents enlargement of the prostate and treats hair loss. This is the main preventative tool you have at your disposal for ensuring you don’t lose hair in the future. It’s not necessarily supposed to cause new hair growth, though in some individuals it does. The reason everyone isn’t on finasteride, however, is because of the sexual side effects.
Where to buy:
I recommend seeing your doctor and getting a prescription for the drug, as that’s the cheapest way to get it. You can get the drug from online pharmacies too. But that’s not recommended as you never know what you’re getting and could be dangerous.
The most common complaint is users report being unable to get or keep an erection on finasteride, loss of interest in sex, inability to achieve an orgasm, gynecomastia, and depression. Now, most studies show that finasteride is safe and that the incidence of sexual side effects is small (2-3%). Indeed, many people don’t experience sexual side effects. However, the real world paints a different picture. Even though there are in fact plenty of people that tolerate the drug well, it also seems like almost everyone and their dog report sexual side effects. I suspect the studies done on this drug are biased to some degree or paid for by the pharmaceutical companies that make these drugs.
There are horror stories all over the internet of users who gained persistent erectile dysfunction even years after quitting the drug, experiencing what’s called post finasteride syndrome. This is because DHT is responsible for modulating libido, and there are DHT receptors in the penis. Some people have claimed to have cured themselves of post finasteride syndrome by applying a DHT cream to the shaft of the penis. But either way, if you do get side effects, they will go away.
So does finasteride cause ED? Yes, it inhibits DHT which controls libido, so it can. However, the far larger component of this is psychological. A study by Mondaini et al showed that the nocebo effect is extremely prevalent in cases of erectile dysfunction. With the placebo effect, the treatment only works because you believe it works. The nocebo effect is the opposite: you experience a negative effect of the drug only because you think you should experience it.
The study looked at 100 male patients being treated with 5 mg of finasteride for prostate enlargement. The researchers gave the first group finasteride like normal. Then the researchers gave the second group finasteride, but also counseled the group about the potential side effect of erectile dysfunction. The results of the study were that “the incidence of ED, decreased libido, and ejaculation disorders were 9.6, 7.7, and 5.7% for group 1, and 30.9, 23.6, and 16.3% for group 2”. That’s 3 times the erectile dysfunction in the second group on the same exact drug. This was all because they became scared of the sexual side effects.
With that being said, you should still talk to your doctor and get a prescription to at least try it. You can circumvent the sexual side effects by starting with a tiny dose and building up to the full dose. Or don’t build-up to the full dose at all if you get side effects. Even a little DHT inhibition over the span of years and decades will go a long way to saving your hair. Other people have reported that they got over the side effects just by getting used to the drug, or by getting their diet and exercise on point. Many people don’t get any side effects at all and the drug works as intended for hair loss for decades. Most likely, you’ll fall into that group.
Other side effects include watery semen, dizziness, headache, skin rash, weakness, cold sweats, dizziness, etc. Don’t let these long lists scare you, as most of these sides are very uncommon.
Minoxidil doesn’t prevent future hair loss. Instead, it helps you regrow hair and increase hair growth. It helps the papilla in the bulb survive longer, provides optimal conditions for the growth of the hair follicle and provides more blood flow to the scalp. But scientists still don’t fully understand Rogaine’s mechanism of action. You have to apply it (1 ml.) to your scalp twice a day (many people get away with just once though). First, you will undergo a shedding phase where you will actually lose hairs. Then, tiny vellus hairs will begin to sprout and eventually grow into full-blown normal hairs. This takes at least 4 months to get noticeable results, and at least a year to get the full effect. At some point, the hairs become terminal, which means they become fully matured adult hairs.
It takes one hour for 50% of minoxidil to get absorbed, and 4-5 hours for 75% to get absorbed. Make sure you get a 5% concentration. The 2% is too weak, and higher concentrations run the risk of giving you more side effects along with higher systemic absorption. The key to getting the drug to work is the duration of exposure, not the amount that you put on. So make sure to use as little of the stuff as you can, and just apply a super thin coat of paint on your skin. Buying concentrations higher than 5% is pointless.
Where to buy:
You can purchase minoxidil literally anywhere. All brands of minoxidil are the same. They all have the same active ingredient. It’s also available over the counter. I’d just go for the cheapest, which at the moment is the Kirkland brand (liquid). Or you can just buy Rogaine foam which is easier to apply. Again, there is zero difference in effectiveness. The liquid is just a bit harder to put on because it drips.
Even though it’s a topical drug, your body still has to absorb minoxidil for it to work. So minoxidil still gets into your system, causing potential side effects. The most common side effect seems to be chest pain. There is at least one documented case of erectile dysfunction. When I started taking minoxidil at first, I scared myself into erectile dysfunction because of a general paranoia I had about hair loss drugs. However, it quickly went away. You shouldn’t get erectile dysfunction on rogaine like you can with finasteride. And it really doesn’t make any sense, as minoxidil doesn’t affect testosterone. It only increases blood flow, so if anything it could potentially treat erectile dysfunction.
Other minor side effects include acne, skin irritation, inflammation around the hair follicle, facial swelling. But most side effects come from the overuse of the drug, such as dizziness, numbness, headaches, swelling, flushing and blurred vision.
Ketoconazole Shampoo (Nizoral):
Keto shampoo is an antifungal and also prevents hair loss by blocking DHT at the hair follicle level. It’s not as effective as finasteride but is more supplementary. In truth, it’s overhyped and not really a noticeable addition to your hair loss regimen. It’s thought that this shampoo kills the fungus that causes hair follicle inflammation, but we need more research. In truth, you’ll be just fine taking minoxidil and finasteride. But adding this to your regimen can’t hurt. At the least, it will prevent dandruff.
Where to buy:
Ketoconazole shampoo is over the counter and you can buy it anywhere.
The side effects of keto shampoo are similar to finasteride, as it’s inhibiting DHT. Many people report having a dry scalp.
Microneedling, sometimes called collagen induction therapy, creates tiny puncture wounds in the skin. These cause a micro-injury with inflammation that brings more blood flow to the skin. This brings more nutrients and stem cells that help your hair to grow, and it promotes the production of collagen. Collagen is important because it’s in the same layer of skin as your hair follicle. It literally frames the hair follicle, keeping it healthy. A study on mice showed that those with more collagen had more hair density. A study by Dhurat et al. showed that “(82%) patients reported more than 50% improvement” over a span of 12 weeks with microneedling.
You can buy a full microneedling system with needles that you need to replace. Or you can buy a cheap dermaroller that you roll on the top of your head. I think the microneedling system is more comfortable.
The dermaroller also helps increase product absorption. But this needs careful consideration if you’re going to apply this to hair loss. If you apply minoxidil or topical finasteride to your needle punctures before they heal, you unnecessarily risk higher systemic absorption of the drug and more side effects, for no extra benefit. Wait 24 hours before applying a dermaroller.
But if you’re interested in this route, you basically two options:
- Dermaroll every week or 10 days with a needle size of 1.5 mm. Wait at least 24 hrs before applying minoxidil.
- Dermaroll every day or every other day with a needle length of 0.25 or 0.5 mm, and apply minoxidil as usual. This won’t increase collagen production. But it will still bring some blood to the site and increase minoxidil absorption without it going into your bloodstream as much.
Microneedling with PRP
Microneedling with platelet-rich plasma (PRP) is essentially regular old microneedling but with one twist. Your blood is drawn and platelets are extracted from your blood serum. This blood serum is teaming with platelets, which stimulate cells that help in healing and growth. Find a specialist in microneedling with PRP for hair loss, make sure they have good reviews and certification.
In a randomized placebo-controlled trial by Gentile et al, 23 male patients 19-63 years old were injected with PRP in the scalp or put into a placebo control group. After 3 months, the control group lost 3 hairs in the target area, whereas the treatment group gained 33 hairs in the target area.
A hair system is basically an advanced wig. It’s not your own actual hair, it just feels and looks like it. You can swim in it, shower with it, work out with it, sweat with it, do almost whatever you want with it. You can even get it cut, but it won’t grow back obviously.
However, you do need to glue it down to your scalp and maintain your hair system. This consists of steps such as brushing the hair, untangling the hair, applying oils, applying pressure to prevent slippage. You should not expose your hair replacement unit to chlorine, hair dye, excessive tugging/combing, too hot or cold water or alcohol products like hairsprays. Some people pay professionals to take care of their hair system to make sure it’s done right.
Granted, for those staring down baldness and are too young to get hair transplant surgeries, this does seem like an enticing option. Some people are pretty happy with their hair systems and say that it’s comfortable. Personally, I’d hate having to wear something external on my scalp. I haven’t tried it, but if you feel like this is a good option for you, you totally should.
FUE (Follicular Unit Extraction)
Follicular unit extraction consists of taking a hair follicle unit (collection of hair follicles) from a part of your scalp with hair that isn’t sensitive to DHT and transplanting it to where you need it. Most hair transplants leave a scar. The scar from an FUE is probably the least noticeable because it’s literally just a tiny circle on where the follicle is extracted. This circle is too small to be noticeable unless you really get close and hone in on it. However, an unskilled surgeon can botch the surgery by extracting too many hairs from a single area, leaving what looks like a balding spot or cluster of them.
Some people are not good candidates for FUE. If you see a surgeon about this procedure, make sure he has good reviews, has accreditation, and more options available to him than just FUE. Be sure he has good before/after photos that he’ll show you.
FUT Surgery (Follicular Unit Transplantation)
This is like FUE, only a strip of skin is removed from your scalp beforehand. It provides more hair follicles for the surgeon to work with. The downside is it leaves a noticeable linear scar. For that reason, I wouldn’t even consider this, unless maybe you always rock long hair or are a woman.
There are some essential oils that are used for hair growth and blocking DHT such as rosemary, saw palmetto, peppermint oil, pumpkin oil, garlic, and onion juice. Unfortunately, the studies and evidence behind these oils are pretty weak. But garlic and onion juice appear to be effective treatments for patchy hair loss, and there are anecdotal reports of people getting results with peppermint oil (analogous to a weaker version of minoxidil) and saw palmetto (analogous to a weaker version of finasteride). If you’re interested in reading about these medicines or don’t feel like you’re ready to dive into drugs just yet, check out our article on natural treatments for hair loss.
Proponents of red light therapy claim that it speeds up wound healing, reverses sun damage, promotes stem cell propagation, and heals hair loss. Some studies claim that red light stimulates “a 35% percent increase in hair growth”. Wavelengths in the range of 630-670 nm. are absorbed by an enzyme called cytochrome C, which also promotes gene activity that can stimulate hair growth.
However, when compared to the body evidence of evidence and scientific literature compared to finasteride and minoxidil, the efficacy of red light or those red light hats is looking pretty weak. If it worked well, many more people would be doing it, but it’s just not catching on. That’s not to say it doesn’t do anything. But at this point, it’s one of those things where even though it can’t hurt, you can throw it out of your daily routine and not really notice a difference. It certainly won’t hurt to try, however.
Living With Hair Loss
If your hair loss is too far gone, or you pull off a shaved look, considering buzzing/shaving the whole head and just keeping it. While you might not think the look suits you, you don’t know until you try. If you can’t save your hair, it’s better to go ahead and just take pride in it.
What’s more alpha? This guy:
Or someone failing yet still trying to keep the last vestiges of their hairline?
If you want to stop hair loss dead in its tracks, the one time-proven regimen that has a great track record is “the big three”. This consists of:
- 1 ml. of 5% minoxidil, two times a day.
- 1 mg. of finasteride once a day.
- 1% ketoconazole shampoo every 3 days.
You could potentially replace the minoxidil with microneedling and PRP, as they both essentially do the same thing: regrow hair. But overall this routine will stop the root cause of hair loss (DHT) and help regrow hair that was previously dead. Get a hormone profile before and 1 month after you start this treatment. If you get any side effects, sexual or otherwise, your course of action is simple:
- Take out the offending medicine.
- Wait until you get back to normal.
- Cut the dosage in half and try again.
- Increase the dosage at some point again after your body has had more time to get used to it.
Even if you don’t take a full dose of finasteride and only eat a speck of it, inhibiting your DHT over years and decades will certainly push back your hair loss. Combined with minoxidil, you’ll also regrow any hair that you’ve previously lost. Even though lots of people report a lack of libido and erectile dysfunction on this drug, your body should still be able to adjust to it at some point. This is why men get morning wood. Our brain needs our dick to work because that’s what ensures we pass on our genes. So if you give it time, any sexual side effects might go away, unless you’re just straight up taking too much of the drug.
Even though this regimen is for life, it’s a small sacrifice for a thick head of hair. If you want to be extra aggressive, you can try microneedling with PRP every 3 months, and then every 6 months to maintain your results.
Why can’t you just take topical finasteride to avoid side effects?
The fair follicle papilla is really deep in your skin and has a blood supply. Applying topical finasteride will work certainly, but the hair follicle will absorb the finasteride into your bloodstream. Studies have shown that at the end of the day, the concentration of finasteride in your bloodstream and in your actual hair follicle is the same between oral and topical finasteride. It’s all the same.
Can finasteride or minoxidil not work?
Anything is possible because everyone’s biochemistry is different. But finasteride should always work unless your hair loss is from something else than the standard male pattern baldness and DHT. There are some rare people that don’t respond to minoxidil.
Will finasteride mess up my gym gains?
No. DHT has been shown to have no effect on gains or muscle mass. However, be careful that your DHT doesn’t get too low.
Does finasteride prevent all hair loss?
No. Finasteride only inhibits about 70% of DHT. Your body still needs some DHT to perform its functions. Taking finasteride will drastically slow down the hair loss process, but you can’t really beat nature.
Does finasteride cause depression or anxiety?
Yes. That’s one of the symptoms that some people report. But if this happens to you, stop the drug until you get back to normal. Consult with your physician to see if you can take the drug at a smaller dosage.
What do I do if get gynecomastia (man boobs) from finasteride?
First, don’t freak out, and realize that it goes away. Cut your dose in half, and go from there. Then, the best thing you can do is take zinc and just keep your body fat low. Don’t attempt to take aromatase inhibitors and block estrogen, as you’re risking unnecessary side effects or possibly making them worse. If you feel like you still have a hormone problem though, go see your doctor and get some labs done.
Does finasteride cause cancer?
No. The label for finasteride originally indicated that you’d be at a higher risk for high-grade disease, but this was because taking the drug actually made diagnosing existing cancer much easier. In fact, finasteride can help reduce prostate cancer, which is one of the most common cancers for men.
Does finasteride regrow hair?
Finasteride is not meant for regrowing hair, but it does help promote the anagen phase of the hair follicle according to Sawaya et al. And indeed, some men find that they get some regrowth after being on the drug for an extended period. However, minoxidil is still the drug that’s indicated for hair growth.
Does finasteride decrease testosterone?
Finasteride actually increases testosterone if anything because it prevents you from converting your testosterone into DHT.
Does finasteride increase estrogen?
Yes, finasteride increases estrogen because you end up having more testosterone that turns into estrogen instead of DHT. However, estrogen will only increase by about 15%. If you take the average estrogen level in men, 40 pg/ml, then a 15% increase only raises it to 46 pg/ml. This isn’t very significant.
Can taking an estrogen blocker prevent sexual side effects with finasteride?
Maybe, but most likely not. Keep in mind that estrogen is also responsible for your libido, and if it gets too low you’re also going to have sexual side effects. It’s best to monitor your hormones with your doctor and just make sure they’re in a normal range.
Are finasteride side effects permanent?
No. Quitting for 5 days should bring you back to normal. Look into applying a DHT cream to the penis if you’ve had sexual side effects.
Does finasteride cause shedding?
Finasteride helps increase the anagen phase of hair follicles and regrow hair on some level, but the amount of shedding should be either minimal or non-existent. Since finasteride isn’t meant for hair regrowth like minoxidil it shouldn’t cause as much shedding as minoxidil.
Does finasteride ever stop working?
No. As long as you’re taking it and inhibiting DHT, it’s doing its job of slowing your hair loss. That’s not to say that you can’t lose hair on it though. You might have started too late or didn’t take enough of it to help save your hair. A full 1 mg. dose of finasteride for hair loss only blocks 70% of DHT.
Will applying just minoxidil save me from future hair loss?
Yes and no. While your minoxidil-powered hair will last longer than your normal hair, at some point DHT will catch up and you won’t even have that. You have to block DHT to actually have a protective effect against hair loss.
Does minoxidil cause ED?
There are some reported cases of minoxidil and erectile dysfunction, but considering that minoxidil is meant to bring blood flow to a site, getting ED just from minoxidil should basically be impossible. It doesn’t do anything that would cause ED and no studies have ever found any shred of evidence that it does. I myself experienced ED on minoxidil, but it went away, leading me to believe that it was all mental and I was basically just scaring myself with hair loss drugs. The same nocebo effect that comes from finasteride can easily apply to minoxidil.
Does minoxidil block DHT?
Minoxidil does not block DHT and does nothing to mess with your hormones.
Does minoxidil work for your beard?
Not only does minoxidil work for your beard, but it works very well. Unlike the hair area which has dead follicles that minoxidil brings back to life, the hair follicles on your beard aren’t dead. They just never sprouted into the terminal/adult phase. If you apply minoxidil to your beard for 1 to 2 years, the gains that you get are going to be permanent. Check out our article on minoxidil beards for more information.
Can I use minoxidil once a day?
I would venture to guess that most people get away with using it once a day, instead of twice as it says on the bottle. It’s certainly doable for most people, but you’ll get your results faster if you apply it twice a day. There’s no point in applying it three times a day.
Can I stop using minoxidil?
You can stop whenever you want, but you’ll experience rapid shedding of your minoxidil hairs. On top of that, you’ll think that you lost your original hair because it all shed at the same time, instead of your hair randomly shedding like in a normal head of hair. But technically, yes, you can get it over with and stop right away. If you want an easier transition to your normal hairline, it’s best to taper off the minoxidil.
Can you use minoxidil on eyebrows?
Yes, minoxidil works on eyebrows too. You’ll see results in about 4 months.
Can you leave minoxidil on overnight?
Even though people worry about the minoxidil smearing over your pillow and sheet, and getting on the rest of your skin, the fact is that leaving it on overnight should not adversely affect you at all as long as you give minoxidil enough time to dry beforehand. Keep in mind that you absorb 50% of minoxidil in the first hour, and 75% after 4 hours.
What do I do if I don’t see results on minoxidil?
Give it at least 6 months, you should notice some difference. Keep in mind that it takes a year to see full results. Otherwise, you might be one of those rare people that the drug just doesn’t work for.