Hi T-Nation. After being a long time lurker and learning a lot, I thought it was finally time for me to contribute and add some value in some way. This post is the post I wish I’d had when I noticed that TRT was causing my hair to thin and grow extremely slowly. It’s the regimen I’ve used to successfully bring back the same thick, full head of hair I had when I started TRT.
Here is what the post will cover:
- Basic background on why hairloss occurs in some cases with TRT
- Why just taking finasteride is the wrong approach
- A comprehensive explanation of 6 different compounds and strategies I use daily as a regimen, and scientific research to support their use
- A specific “recipe” you can follow to create your own regimen
- Detailed instructions on HOW to use said regimen
Please note that this is a WORK IN PROGRESS. If you see a mistake, or you believe I’ve missed something, please let me know. I’m human, so I’m certain I’ll have made some mistakes. Now, let’s dive in.
Why TRT causes hair loss (or accelerates it)
As you may already know, when exogenous testosterone is given in therapeutic dosages, some percentage of it is aromatized (converted) into estrogen, and some into DHT (dihydrotestosterone) by the 5AR enzyme the body naturally produces.
DHT initiates two key processes that induce hair loss, which is what the protocol described in this post addresses:
DHT binds to androgen receptors in your hair follicles, causing them to first “miniaturize” (become very fine and thin) and eventually, stop growing altogether and fall out.
As part of this process, localized inflammation in the scalp also restricts blood flow and nutrients to the hair follicles, accelerating the miniaturization and eventual senescence of the hair follicle.
NOTE: This inflammation is why your scalp may become extremely “itchy” when DHT levels rise in the scalp, and to me is a strong personal indicator that inflammation (and thus a process which eventually leads to hair loss) is occurring. I know I have my hair loss under control when my scalp doesn’t itch, and I know I need to take action when it does.
Thus, because an increase in testosterone = an increase in DHT, when TRT (or AAS) is administered, hair loss can occur where none was happening before, or drastically accelerate it for those prone.
Why just taking oral finasteride is the wrong approach
One of the two most common treatments for hair loss is the drug finasteride, also known as Propecia. This drug is as a 5AR inhibitor – it essentially “blocks” 5AR from converting testosterone into DHT, and thus can significantly reduce DHT levels.
However, MANY of the therapeutic benefits of TRT actually derive from DHT, which is considered the strongest androgen the body produces. In fact, many of the symptoms of “low T” are actually symptoms of low DHT. That’s because it’s associated, for many, with a feeling of confidence, well being, strong libido and erection quality, and so forth.
You can see evidence of this fact on various internet forums with scores of men complaining of erectile dysfunction, mood problems, and so forth, shortly after beginning finasteride for their hair loss, and in many cases, this doesn’t resolve with the cessation of finasteride usage.
If the goal is to maintain the benefits of TRT without losing our hair, then we need to address the two key issues outlined above:
We need to minimize or block DHT at the hair follicle WITHOUT significantly reducing our blood levels, thus maintaining its positive effect on well being without the deleterious effect on our hairline.
We need to minimize inflammation and MAXIMIZE blood flow and nutrients to our hair follicles so they can thrive.
We will use the following ingredients and steps to do so, in the following manner (each is outlined in greater detail below):
- Block the action of DHT at the scalp using Ketoconazole shampoo
- Block the action of 5AR at the scalp with minimal systemic effects by using topical finasteride
- Maximize blood flow and nutrients to hair follicles using minoxidil, rosemary oil, peppermint oil, and caffeine
- BONUS: Improve hair health and appearance of health using argan oil and deep conditioning treatments
STEP 1: Block the action of DHT at the scalp using Ketoconazole shampoo
Ketoconazole is an anti-fungal medicine that powerfully inhibits / blocks DHT. In fact, it’s so strong, it has been used medically to chemically “castrate” men. It’s also the key ingredient in the anti-dandruff shampoo Nizoral.
Put simply, just wash your hair DAILY with Nizoral 1% (available on Amazon) and you’ll have already made HUGE strides towards minimizing hair loss.
However, AND THIS IS ESSENTIAL, you can’t just wash your hair “normally” with Nizoral for it to work. It MUST have both the blood flow and time to penetrate your scalp to work. It took me 8 months to figure this out, but when I did, the “hair loss itch” I had constantly went away almost overnight.
Here’s how to wash your hair CORRECTLY with Nizoral:
First, after wetting your hair, use a scalp brush to gently brush through your hair 10-15 times until your scalp feels “stimulated.” This increases blood flow to the area and will maximize absorption of the ketoconazole in Nizoral into the scalp.
Then shampoo a liberal amount of Nizoral into your hair, gently scrubbing it in with your fingertips as though you are trying to rub it into your scalp (you are!). Do this for 30s - 1m. DO NOT RINSE YOUR HAIR.
Wash the rest of your body with soap and do anything else you do in the shower (shave, etc.)
Come back to your hair, and massage the shampoo into your hair and scalp again. If there isn’t enough that it’s still sudsy, use more. Basically you are doing a second shampooing of the hair here.
Rinse your hair, and condition it using a HIGH QUALITY conditioner, being sure to rub the conditioner in for 1-2 minutes. This will make a big difference in hair texture and health as the Nizoral is fairly harsh.
STEP 2: Maximize blood flow and nutrients to hair follicles using minoxidil, rosemary oil, peppermint oil – and their absorption using retinol
Minoxidil, the active ingredient in Rogaine, has been shown scientifically to increase blood flow to the scalp where applied, and support healthy and increased hair growth. It is only one of two FDA approved treatments for hair loss in the U.S. (the other being finasteride).
It just so happens that topically applied rosemary essential oil (from the herb), when compared to 2% minoxidil in a hair loss study, was just as effective. And peppermint essential oil has been show to be MORE effective than 3% minoxidil in inducing hair growth – again by inducing additional blood flow. Retinol, the last ingredient, is known to increase absorption and penetration of all three above.
My recipe is simple:
- Purchase Kirkland brand 5% Minoxidil solution, as well as peppermint and rosemary essential oil (just search for them on Amazon and buy a well reviewed one). You’ll also want to purchase “retinol serum” on Amazon as well.
- Then, put 10-20 drops of each oil into EACH bottle of minoxidil before use. Start with 10 in case your scalp is sensitive, and increase to the desired “level.”
- Add 1-3 droppers full of the retinol serum to your minoxidil solution. If you don’t have enough room in the minoxidil bottle, just do a few applications before adding the retinol. (Don’t use too much retinol or peppermint oil or your scalp can become irritated).
STEP 3: Block the action of 5AR at the scalp with minimal systemic effects by using topical finasteride
Finasteride is well proven to significantly reduce the progression of (or reverse) hair loss. However, it’s also a drug that I can say, from direct experience, can drastically reduce libido, well being, and “drive” – even 0.1mg / day taken orally caused nipple sensitivity, weaker erections, and reduced libido for me within a week.
It also has a CRAZY dose response curve, meaning that just a tiny amount has almost as much of an impact on reducing DHT levels. Thus, it must be used with CAUTION and with the understanding that less is more.
The good news is that there is some scientific research showing that a very, very small amount, applied topically, can be just as effective at reducing scalp DHT levels as oral finasteride in much higher doses, but with very minimal reductions in DHT blood levels.
I unfortunately can’t find the original study, but according to that study which measured DHT scalp and blood levels, the ideal dose of topical finasteride per topical application is 0.116mg if memory serves me correctly as it inhibited scalp DHT as much as larger doses and had the least reduction in serum DHT levels. (If anyone has this link I’d love to see it)
Here’s how to make your own Finasteride topical solution:
- I purchase finasteride in 1mg tablets from an overseas pharmacy. I’m sure you can too if you do some research, or you can see a dermatologist and get them to prescribe them for your hair loss as well.
- I use 2mL of minoxidil twice daily, which means that to get to the .116mg dosage per application, I want a total of 3.5mg of finasteride per 60mL bottle of Minoxidil.
- Thus I put three and a half tablets into the solution, let them dissolve, and SHAKE my minoxidil before every application
APPLYING THE MINOXIDIL / FINASTERIDE / REO / PEO / RETINOL SOLUTION:
- Before every application, I run the above scalp brush through my hair 10-15 times.
- I apply twice daily, once in the morning after showering and shampooing, and once before bed.
- My strategy is simple – wherever I notice thinning, or wherever I feel or have in the past felt the “DHT itch”, I apply my “fortified” minoxidil solution.
- I find I can’t get everywhere with 1mL (which is what they recommend) so I use 2 mL, not to increase the total amount of drug, but to ensure all areas are covered.
- I also transfer my solution to a glass dropper bottle as the dropper has a finer point and I feel I can get it on the scalp better that way. That’s it!
IMPORTANT: Watch for low DHT symptoms
When I first started using the topical finasteride, I figured not much would get absorbed systemically, and I became a little overzealous with the total amount I used in each bottle. Over several weeks I found that my erections became weaker and my penile sensitivity (how good sex felt) was much worse.
I didn’t put 2 and 2 together for some time, because the increased finasteride doesn’t impact you for a while; it has a long half life and takes time to build up in your blood.
I would STRONGLY encourage you NOT to exceed the doses outlined above, but if you do, keep an eye out for symptoms related to low DHT, and/or get bloodwork before starting finasteride and then again 2-3 weeks after any adjustments to your finasteride dosage.
STEP 4 - BONUS: Improve hair health and appearance of health using argan oil and deep conditioning treatments
I find that the harsh Nizoral shampoo, combined with somewhat slower growth on TRT, has given my hair a drier, frizzier texture than before the TRT, despite its now normal and healthy thickness.
However, I find that using an argan oil beard oil (one dropper full) – available on Amazon – after I apply the the minoxidil in the morning really seems to nourish and “smooth” my hair, making it feel much healthier and softer, but without weighing it down and making appear oily.
When you condition your hair, use good stuff and take 1-2 minutes to really get it to soak in. I use Pura D’Or conditioner for damaged hair from Amazon and it works well
I also recommend using an argan oil hair mask for 20 minutes a couple times per week. This is basically just a super deep conditioner.
All of the above is needed because the Nizoral is hell on hair health even though it helps it to grow, and really strips your hair. The above is just replacing what the Nizoral takes out.
The MOST Important Ingredient: Patience
What many people don’t know about hair loss is that hair goes through “cycles” of growth and rest. These cycles are MONTHS or YEARS in length. As you begin the process of using the above strategies, you must keep several things in mind:
It can take up to six months to begin to see a difference in your hair, both in terms of thickness and length. That’s because it can take that long for your hair follicles to go from the resting, telogen phase, to the anagen, growing phase, and then you need time to actually SEE the growth
It’s NORMAL and a GREAT SIGN for your rate of hair loss to INCREASE during this process. That’s because if the hair you have is in its resting phase (and if it’s thinning that’s highly likely), it may actually fall out before the growing anagen phase begins. THIS IS NORMAL! DO NOT PANIC! This is great news and it means what you’re doing is working and all your little hairs are waking up and getting ready to go to work.
Any questions? Let me know!