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self_made_human  Grippy socks, grippy box  1mo ago (open.substack.com)   1589 thread views

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

open.substack.com

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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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.

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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