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self_made_human  C'est la vie  21d ago (open.substack.com)   1410 thread views

Escaping the Jungles of Norwood: A Rationalist’s Guide to Male Pattern Baldness

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Out of enlightened self-interest, I did a deep dive into the topic of male pattern baldness, and after freshening up on my rather rusty Bayes', I decided that I'd gone to enough effort to justify a proper blog post. Here you go.

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Whats the "ussri" name about btw?

He stuck to a regime and has a beard, which, if not quite Dwarkesh Patel standards, is eminently respectable.

As far as I know, beard minoxidil doesnt need to be kept up. Androgenic hair is easy to get and usually sticks around.

But this only holds if all the numbers are accurate and independent

I dont think Bayes theorem requires its numbers to be independent (whatever it would mean for a conditional to be independent of its condition).

It's no surprise I didn't think of this, since my anecdotal evidence is that there's no shortage of ungracefully balding Indian uncles both at home and abroad. But the numbers don't lie here.

It might be quite heterogenous within India, too.

Whats the "ussri" name about btw?

It's a frankly terrible pun that came to me in a dream. Possibly something to do with fully automated luxury space communism, with the homosexuality optional.

I dont think Bayes theorem requires its numbers to be independent (whatever it would mean for a conditional to be independent of its condition).

Oops. Not sure how that snuck it, the whole point is to find out conditionals and manipulate conditionals.

As far as I know, beard minoxidil doesnt need to be kept up. Androgenic hair is easy to get and usually sticks around.

I believe you're right, but minoxidil takes ages to show good effect. What I mean isn't that he's forced to keep it up while at risk of losing it all when he stops, but rather that he wanted it to get denser and denser, which takes a while.

My guess was USSR + SSRI, but that didnt and doesnt make sense.

No, no, you're right. I did say it was a bad pun. As a doctor in a very socialist medical system, SSRIs for everyone!

Nice write up, in the last couple of months there was some researcher, this one i think? https://pubmed.ncbi.nlm.nih.gov/29569259/ , that claimed that some structural issue with a vein in the groin is the main cause for prostate cancer, and that the way it works is that it causes very testosterone rich blood go directly from the testicles to the prostate. have you seen anything related to that in your research? i did some googling after that because it sounded like something that could have at least an indirect link and havent found anything too clear, but wondering if you noticed something

It didn't come up, but I'm passingly familiar with what you're talking about. I believe that Scott has written about this a few months back, and the mechanism attributed was venous stasis/insufficiency causing the local hormonal levels to go too high.

Not related to balding as far as I'm aware, and largely out of my wheelhouse. I'll defer to Scott, and limit my commentary to saying that I don't see anything obviously implausible with the mechanism purported.

As much as I dislike Substack, I'll give fair where fair is due - that was a fairly entertaining and educational read. Thank you for that.

Thank you. I try my best to make my existential angst both funny and educational. Sometimes this results in less angst!

...you didn't hear there's some new molecule that apparently revives dormant hair roots and in tests, bald men grew their hair back?

It's nothing hormonal and doesn't have the dire risk profile of finasteride etc.

I would find that quite interesting if true - both because I'm in the affected demographic, and because I consider MPB as one of the main pending milestone cases for radical medical life extension. In many ways it's an ideal baby version of the problem: age-related, highly prevalent, great market potential, no stigma around research, external, easily measurable objective success metric with quick feedback, doesn't directly involve any critical organs. It's quite likely that age-related organ failure involves a lot of metaphorical "hair", so as long as we couldn't figure out how to stop and reverse age degrading actual hair, I figure there is no chance that we could do this to the "hair" that might be some ion channels on the pancreas that we only have a tentative understanding of.

Nope, must have missed me. Got a link handy?

Okay, it might be noting, but here's some keywords you can look up.

https://x.com/hairypapasmurf/status/1935048213842772035

I mean, is this a peptide? Do you have a name?

Serious and genuine question:

Why not just shave your head? I ask because I've been balding since 26-27. I took the "plunge" and shaved it at 28 and ... everyone says I look better, I don't stress about going bald whatsoever, and I can get a dirtcheap haircut from anywhere because nobody can fuck up a zero buzz cut.

Because you look worse because of it in most cases. Hair changes your face a lot. Beyond just the look, the hair is a sign of youth as young people have more of it. Some rare cases may look better, most can't.

This is a link to a marketing fluff piece by the company "Hims", which makes its money selling finiesteride, promoting the "sexiness" of shaved / bald heads

The fact that a bullshit e-commerce company that profits off of male insecurity took the time to say "bald is sexy" makes me seriously question your unsubstantiated assertion.

This is obviously not true though? Men can look fine/good without hair but hair is obviously better. Shaved is usually better than balding but nothing beats a full head of healthy hair.

I hate to use the cop-out, but it's so obvious here;

Physical beauty is inherent and always subjective, no? A higher level of body fat, for instance, has objective downsides compared to being within a more normal range, but there are people, both male and female, who viscerally and immutably prefer it. So, even if a full head of hair is objectively a better marker of virility, vitality etc. it can also be subjectively worse. And the whole genesis of this thread was obviously around female sexual interest (or lack thereof) in balding or bald men.

I don’t think I understand your cop-out unless you are saying “some women like bald men”

I'm not even going bald yet! Even from a purely internal notion of aesthetics, I think I'd look better with a full head of hair rather than being bald or shaved.

Appreciate the effort OP. As someone on Fin, it has to be the first line of defence and using it wihtout minoxidil or any other inhibitors like Dutasteride is a waste of time. Finasteride is extremely safe and there is nothing you can do beyond it and its bigger brother in Dutasteride.

Hair transplants are expensive, painful, give bad results and force you to hop on the same two drugs for life that I just pointed out. Most anti fin advice is garbage and is some form of real alpha male cope instead of some well thought out conclusion.

My hair is very straight, very thin, not very dense and I have a wider than average forehead. My dad and grandad have a full head of hair, my younger brother has denser hair than most girls I have met. By age 16 I could see that the norwood reaper was knocking at the door as my temple did have some recession, men on my mtohers side are bald. I saw my dermat and he offered minoxidial as fin should not be taken before puberty ends. Like all men in my situation I decided to simply pretend that I was not losing hair. I hit 21 and my hairline was still the same, yet I was worried about losing hair. I found the channel More Plates More Dates, ran by a Canadian roidhead named derek who was also sponosring a retired MMA fighter I knew. He laid out his own case with hairloss and often hammered hom the importance of finasteride.

The summer of 22, my grandad started complaining about my loose hair he found. One day my mother told me that there was a small bald spot, the size of a tiny apple on the top of my head. I went to the dermat the next day, hopped in fin and do not have that baldspot anymore. My three years have yielded zero side effects and I cannot think that youtuber enough since most if not all advice I see online is pretty garbage on this topic. My high school best friend would often joke about me being someone who would need a hair transplant. We stopped talking 6 years ago, I saw a photo of him recently and he is nearly bald from aggressive hair loss.

Going bald is absolutely traumatizes you and if you dont lie to yourself, it is very easily avoidable. I posted about this a few weeks ago and the response I got were not very good. If you are suffering from Male Pattern Baldness, see your dermat, pop finasteride (take it topically if you are afraid) and dont read about potential side effects, plenty get them via the placebo effect or something. I look normal now, I still did when I was receeding but getting it fixed at the right time did a lot of good to me.

Going bald is traumatic because it absolutely traumatic and if you dont lie to yourself, it is very easily avoidable. I posted about this a few weeks ago and the response I got were not very good. If you are suffering from Male Pattern Baldness, see your dermat, pop finasteride (take it topically if you are afraid) and dont read about potential side effects, plenty get them via the placebo effect or something. I look normal now, I still did when I was receeding but getting it fixed at the right time did a lot of good to me.

It is somewhat preventable, but the results of finasteride and dutasteride vary. I started balding at 18, went on finasteride and the balding stopped it for a couple years, then hair loss accelerated, I got on dutasteride and now I'm in my early 30s and the hair loss is starting to get pretty bad.

This is true. But it's better to lose hair late than early. I'm safe so far and hope I can keep all my hair for a long time without any side effects.

Just noticed my typos, apologies, they are so embarrassing.

I agree that finasteride is treated unfairly. Even if you're in the unlucky 1-2% that gets significant side effects, they usually wear off in weeks or months from cessation.

Thanks for reading, and good luck keeping your hair while you still need it!

A British friend of mine takes Finasteride and swears by it. I asked my (urologist) doctor about it once in the dark days when I was fannying about worried about my hairline, and he looked at me and said "You will develop man-boobs." (Urologist due to BPH, but they can also prescribe it--though he said he was unwilling to).

Anyway since then I've both calmed down and lost much interest in Finasteride. I believe you mentioned minoxidil, which is basically Rogaine right? But has no hormonal component that I know of. (I write all this before reading your deepdive but I will from now.)

Minoxidil alone will not do much. You'll keep losing hair, fin is the most important intervention, pretty safe. Some people do experience heart issues when they ingest minoxidil orally. Topical use is safe.

At times, I am dismayed by other doctors' ignorance regarding base rates, relative risks, and their attitude towards pontification without additional qualifiers towards their patients. Of course, we're only human, fallible, and working with a patient population that isn't necessarily sophisticated enough to follow such caveats. I'm guilty of this myself, even though I strive to be better.

As far as I'm aware, there's no reason to think that finasteride must cause BPH and man boobs in your case. It increases the risk, but that's a quantifiable increase in probability and far from a certainty.

AFAIK, Rogaine is just a formulation of basic bitch minoxidil. It's inoffensive, doesn't have very strong effects, but when applied topically, doesn't have significant drawbacks either. We don't know for a fact how minoxidil even works, but the prevailing hypothesis is that it improves blood flow to the local tissues near where it's administered. This ?somehow increases hair growth.

Even if you're in the unlucky 1-2% that gets significant side effects, they usually wear off in weeks or months from cessation.

Papers on that say something completely different.

1.4% (167 men) developed persistent erectile dysfunction lasting a median of 1348 days.

My understanding is that this is a contested finding, but even assuming the usual relative risk of ED while actively taking finasteride (~1.5x baseline), the absolute risk is not so high that you need to run away screaming. That being said, unless my hair falls out by the fistful overnight, I would personally take my chances with minoxidil first.

I am weakly agnostic on this claim, but my primary motive was to explain that the claim by this pharma professor half a decade back was hyperbole.

the absolute risk is not so high that you need to run away screaming

You suggest this ED is some sort of lizardman finding and if you examined the health database you'd find 1.5% 15-42 male are getting ED that lasts 5 years even even if they don't use finasteride?

https://cks.nice.org.uk/topics/erectile-dysfunction/background-information/prevalence/

Erectile dysfunction is a very common disorder, and the incidence and prevalence increases with age [Hackett, 2018; Muneer, 2014; EAU, 2022]. The Massachusetts Male Aging Study (MMAS) in the USA, a community-based, random sample, prospective observational study of non-institutionalized men in the Boston area, used a self-administered sexual activity questionnaire, and found [Feldman, 1994]: A self-reported overall prevalence of erectile dysfunction in 52% of men aged 40–70 years. The specific prevalence for mild, moderate, and severe cases was 17.2%, 25.2%, and 9.6% respectively. The prevalence increased with increasing age (increasing three-fold between men aged 40 and 70 years).

A large German postal survey (the 'Cologne Male Survey') of men aged 30–80 years (n = 8000) reported [Braun, 2000]: A prevalence of erectile dysfunction of 19.2%. The prevalence of erectile dysfunction increased from 2.3% at 30 years to 53.4% at 80 years of age. Expert opinion in a review article

These are not really comparable, method or cohort wise. Postal survey is probably biased towards bored old people..

Also it's strongly suggestive that on the link paper claims length of exposure to finasteride was correlated with the ED..

You too doc. Fin is the single most important intervention. I was lucky that I did not heed advice from e Alpha Males for my issue. Did not know you had a substack.

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