This Is My Current Hair Loss Prevention Protocol
I’ve suffered from male pattern baldness since I was 16 years old.
Today we are going to be talking about hair loss prevention and my protocol to maintain my hair.
Hair Loss Theories
At the moment of writing this, I am 27 years old.
And I didn’t just suffer from hair loss.
I got absolutely wrecked.
And many men will suffer too.
Two thirds of men experience some hair loss by age 35, and 85% by age 50.
Sadly, I did not make it to 30, or even 20. I started losing my hair at 16.
My dad is cue ball bald and he was there by my age, as with many of my cousins and uncles.
I’m Greek, and we suffer from some of the highest rates of male pattern baldness, along with 1.5 billion other men in the world.
But let’s have a quick chat on what causes hair loss, and that will better allow me to explain why the treatments work.
There are many theories.
The most common theory is that a potent male hormone called DHT attacks the hair follicles, causing them to get smaller and smaller, and eventually no longer grow.
In our bodies, we have testosterone.
Some gets converted to estrogen through the aromatase enzyme, and some converts to DHT via 5a-reductase.
There are some other theories that include reduced blood flow, increased local inflammation, and vitamin deficiencies.
But when people are castrated, meaning they have very little testosterone/DHT, they don’t experience hair loss.
Many bald trans women are actually able to regrow their hair back. So the DHT theory is most prevalent.
My History
So back to 16-year-old Christian, when I first noticed my hairline receding and thinning.
I was not on any special testosterone supplements or this jacked kid with high DHT.
I had swoopy long hair, and hair was tied to my identity at the time.
I started some treatments, but I was inconsistent with them so my hair loss continued to get worse over time.
As I got into my 20’s, my hairline receded further and I started to get a bald spot on my crown.
At this point I had been researching for hours each week on how to stop this.
I was STRESSED.
At 23 I started medical school.
The stress in my life only got higher.
The stress of school combined with strict unsustainable diets to get as lean as possible did a number to my hair.
I hated how my hair looked.
So I eventually got not just one hair transplant, but two.
My first hair transplant was in Dec 2021.
I was deep in my third year of medical school, and after a couple virtual consultations over Whatsapp, I flew alone to Istanbul over winter break and got 2500 grafts on my hairline and dispersed throughout my head.
Christian?
Why Turkey?
Turkey is one of the cosmetic procedure capitals of the world.
People from all over the world fly there for hair transplants, rhinoplasties, breast augmentations, veneers, you name it.
The quality is top notch, but a mere fraction of the cost of other countries.
When the first hair transplant came in, it looked awesome.
However, I was still very thin on my crown.
So this takes me to hair transplant round 2.
I always needed a second hair transplant.
In my first consultation, I was told that my donor area was on the weaker side, and I’d require two procedures to get full coverage to avoid over-harvesting, which could be damaging to my scalp.
But what is the donor area?
It’s basically the sides of your head.
Think George Costanza.
That hair is permanent, baby!
If you have thick hair on your sides and back, you probably are a good candidate.
So I flew out again, and got some more density on my crown and top of my head.
So now it looks pretty good.
That transplanted hair is permanent.
But that means I have to work hard to maintain the rest of the hair I have, because if that’s gone, my hair will look really bad.
How To Know If You Have Male-Pattern Baldness
The way hair loss happens in the body is pretty complex, but it appears in a pretty simple way.
For the most part, hair loss will start at the temples/corners of your hairline.
DHT will attack the hair follicle, leading to miniaturization over time.
Miniaturization is the hair follicle getting smaller and smaller, until it stops growing.
Eventually this progresses and leads to a thinning spot on the crown.
If you have hairs on your hairline and crown that are thinner and shorter than the rest of your hairs, you probably have male-pattern baldness.
The Treatments
Topical Minoxidil
So let’s get into the products that are the most effective for keeping your hair.
The usual first-line treatment is 5% topical minoxidil.
This one is a must, in my opinion.
The brand name for this is Rogaine, but I usually just get the generic minoxidil liquid from Costco or Amazon.
This was the first thing I tried when I started losing my hair at 16.
And even though I was relatively inconsistent with it, I think it prolonged my hairline’s life by a good 5-10 years.
So how does minoxidil work?
Minoxidil is actually a blood pressure medication that dilates your arteries, especially if you take the oral form.
And that is the gist on how it works topically too, by opening blood vessels to shuttle more growth factors and oxygen from your bloodstream to your hair follicles.
We also know that it prolongs the growth phase of your hair and increases your hair follicle diameter.
Beyond that, the mechanism of action is still unknown.
But the studies are pretty promising.
5% topical minoxidil absolutely increases hair follicle diameter and hair density.
Typically I apply it on the thinning areas of my scalp in the morning and night.
Sometimes I forget, so I will probably do it 12 out of 14 times in a typical week.
Oral minoxidil Is also gaining in popularity these days, at a much lower dose than used for blood pressure (5 mg daily for hair loss).
This one is also as effective or potentially more effective than the topical version.
The caveat for this, is that you will grow hair everywhere.
Not just your head.
So if that’s your look, it’s worth a risk.
I’m already a wooly mammoth, so extra hair won’t really affect me, so I’m considering using this one in the future.
And of course, there is risk of lower blood pressure, but I think most people in society today could get away with lower blood pressure.
Talk to your doctor though.
Microneedling
Next, we have microneedling, which I started doing shortly after my first hair transplant.
I literally stab 1.5 mm holes in my head with a little roller.
You might think this sounds insane, but hear me out.
I think this one is another must if you are using minoxidil.
It’s a non-pharmacologic, nonhormonal treatment that takes you a couple minutes, but can double the effectiveness of your minoxidil.
Some people are non-responders to minoxidil, but microneedling can make them responders.
It really doesn’t hurt that much, but I do stab little holes in my head once a week.
It leaves my scalp red, and sometimes draws a little bit of blood.
But it works in a couple ways.
Creating microtraumas on your scalp will do something similar to minoxidil by shuttling more healing and growth factors to your head, which is something we need when we are losing hair.
But not only that, it also helps with better absorption of minoxidil, which is kind of intuitive because you have some holes in your head now to absorb it better.
There are some pretty good machines out there, I know there’s a hat you can wear that’s pretty expensive.
But I have a cheap Amazon one that I replace every so often.
I use it once a week and I don’t use minoxidil that day.
So I save on minoxidil and double my results.
Tretinoin
Next is a topical called tretinoin.
This is actually one of the only topical medications approved for treating fine lines and wrinkles.
I use it for that, but it also has some benefits with hair loss.
Like microneedling, tretinoin is a medication that can enhance minoxidil absorption up to three times.
When you apply minoxidil to your head, some enzymes called sulfonyltransferases break down minoxidil to minoxidil sulfate, which is how it becomes active.
Tretinoin upregulates sulfonyltransferases so minoxidil becomes more effective.
Minoxidil with microneedling and tretinoin is a life hack.
The way I use it is by applying a small pea size amount of .05% tretinoin to my scalp twice per week and applying minoxidil about 10 minutes later.
Scalp Massage
Enough about minoxidil. Let’s get into some other hacks for hair loss.
So we have the DHT theory of male pattern baldness, but there is also a scalp tightness theory.
The gist of this is that DHT isn’t the main culprit of hair loss, there is also a major factor of decreased blood flow, causing scalp muscles to tighten, and there to be a reduction of the subcutaneous fat layer on the scalp.
Beyond that, the tension theory suggests that more scalp tension will cause more androgen receptor density, creating more spots that DHT can bind to cause hair loss.
There is further evidence of this because botox injections to a balding scalp have shown to increase hair growth in those areas (by relaxing the scalp).
One thing that helps with this (beyond minoxidil) is a scalp massage.
There is evidence that scalp massages will increase blood flow to maintain the subcutaneous fat layer.
So I use a little scalp massage tool that I steal from my wife and just massage my scalp for a couple minutes every time I shower.
Finasteride/Dutasteride
Now it’s time to talk about the heaviest hitter.
It is a bit controversial…it is finasteride.
Going off the DHT theory, finasteride blocks 5a-reductase from working.
Remember, this is the enzyme that converts testosterone to DHT.
Less DHT floating around your bloodstream means less DHT available to attack the hair follicle.
This one is tried and true.
I used this one on and off for the last 6 years or so. Much more consistent with it in the last 3 years.
I take 1mg daily of finasteride, which is shown to lower serum DHT by about 20-50%.
I am considering using dutasteride at a dose of 0.5 mg daily.
Dutasteride is finasteride’s older brother on steroids. Finasteride blocks 5a reductase type 2, while dutasteride blocks type 1 AND type 2.
Yeah, there are multiple versions of the enzyme.
This will lead to an even lower serum concentration of DHT.
Ashton Kutcher is someone in the media who is known to take DHT.
His hair looks pretty decent.
I do need to touch on side effects here.
Many men hear that they will become infertile or their genitalia will not work.
I’ve never had these issues, and neither do millions of men on this medication worldwide.
Side effects do happen, but they are rare.
And the most dissatisfied people are always the loudest, as with anything.
Talk to your own doctor and assess your own risk tolerance here.
I’m not advocating anything, just telling you what I do.
I would recommend this typically over the topical antiandrogens.
There are topical finasteride and dutasteride formulations.
They definitely can work very well for some people and have a lower side effect profile since they are just working locally.
Generally, the oral formulation is going to be the most effective though.
But for those that can’t tolerate it, the topical versions could be a worthwhile substitute.
Ketoconazole Shampoo
Time to move on to shampoo.
There are plenty of shampoos marketed to prevent and reverse hair loss.
For the most part, these are not really valid.
There is only one ingredient that is in some shampoos that directly leads to hair growth.
It also competes with the androgens in the scalp for binding.
It is called ketoconazole.
This is an antifungal medication typically used for dandruff.
But when researchers studied how well it got rid of dandruff, they found it increased hair growth.
This shampoo completes the “Big 3”, which are minoxidil, finasteride, and ketoconazole.
The shampoos that contain this are Nizoral, which is in most grocery stores, and Regenapure DR.
This is typically used twice a week as a normal shampoo, but leaving it to soak in your head for a few minutes before rinsing it off.
I have been using this one for the last 8 years, but if there’s one I slack on, it’s probably this one.
Diet
It would be foolish not to mention diet as well.
What kind of diet will grow hair?
Simply put, it is similar to what I’ve stated before: just eat real food. Lean meats, fruits, vegetables, and dairy should form the basis of most of your diet.
A healthy diet will lead to fewer health conditions and less inflammation on the body, creating a favorable internal environment for growing hair.
You might be wondering…what about biotin?
Or other hair growth vitamins like vitamin C or zinc?
I know your cousin said she grew a TON of hair by taking biotin.
This can be true – let me explain.
Biotin and hair growth vitamins will only grow hair if you were deficient in the first place.
If you get the right amount of these vitamins and minerals through your diet (which you will be if you eat the foods I mentioned), you will not see any benefit from supplementing extra.
I know my hair density and quality always suffers in more stressful periods where my diet isn’t on point, so make diet a major focus of your life.
It’ll benefit much more than your hair.
Niche Products
There are a few niche products that are worth mentioning.
They are typically topical antiandrogens like RU-58841 and pyralutamide.
In the case of finasteride, we are reducing the conversion of testosterone to DHT, so there is less DHT available to bind to receptors in the scalp leading to hair loss.
Topical antiandrogens work in a different way.
They are absorbed in the scalp and compete with DHT at the androgen receptor in the scalp.
Less DHT available to bind means less hair loss.
These are still being researched for their efficacy and safety profiles, but I think they will be much more common and standard practice in the next decade.
I’m hoping to see some more stem cell therapy type treatments in the future, however.
Even a treatment where they extract some follicles like in a hair transplant, but clone those hair follicles and implant them in the scalp.
An unlimited donor supply will make for many “perfect” heads of hair.
The Stuff I’m Skeptical About
There are a few products that are popular that I remain skeptical about.
The first is Nutrafol, which is marketed as one of the hair growth vitamins I mentioned earlier.
To me, this is just a fancy multivitamin. If you aren’t getting your key nutrients from your diet, this could help a bit.
But I think there are more inexpensive ways to get the vitamins in this product.
One of the other supplements that is commonly used for hair loss is Saw Palmetto.
This is an herb that is a 5a-reductase inhibitor like finasteride.
So it will absolutely reduce DHT, and hopefully halt hair loss. It is much less effective at inhibiting 5a-reductase than finasteride.
So I opt for finasteride here.
Similarly, there are many hair oils that are reported to help with hair growth.
Some of them like rosemary oil have shown some promise and similar effects to minoxidil.
I don’t want to put oil on my head twice a day every day, but these could be a viable option for those who like going the more “natural” route.
I understand this is a pretty exhaustive list, and many people would rather just shave their head than deal with doing these treatments for many years of their life.
These are lifetime commitments, or until you decide you do not want hair.
It is common for people to maintain a substantial amount of hair for many decades.
In my opinion, I think the first line treatment should be to shave your head.
For real.
Some people can really pull off the look.
I think buzzing your hair and seeing that it really doesn’t look bad can be enlightening and dampen the stress of losing hair.
If you like how you look, screw everything I said.
If you aren’t the biggest fan, start the minoxidil, microneedling, tretinoin, scalp massages, and ketoconazole shampoo.
And then talk to your doctor and make sure finasteride is right for you.
Does having to take this stuff daily or weekly kinda suck?
Yeah it does.
At some point when I’m a baller living on a secluded self sustaining farm with a big family, maybe I’ll stop and shave it bald.
But really, it’s not that bad.
These are all normal parts of my routine now.
Weigh things out for yourself, and let me know if you’d like more dedicated videos on any of these.
If you need more help with maximizing a busy schedule, or with proper training and nutrition to build muscle, lose fat, or improving your health markers, fill out the application below and I will reach out when I have spots available!
Best regards
Dr. CP