Going Deep On Hair Loss Prevention Drugs With Peter Attia - From Tame To Nuclear

Summary

The discussion explores the significance of DHT post-puberty, its impact on cognitive health, estrogen balance, and penile vasodilation. It debates the necessity of DHT, referencing 5-alpha reductase inhibitors like finasteride and dutasteride, used for hair loss and prostate size reduction. Concerns about post-finasteride syndrome and the side effects of these inhibitors are raised, with a preference for alternative treatments to avoid potential irreversible sexual side effects. The conversation also touches on the importance of early intervention in hair loss treatment to prevent irreversible follicle miniaturization.

Takeaways

• 💡 DHT (Dihydrotestosterone) plays a critical role in certain areas like cognitive health, balance of estrogen, and vasodilation, but its necessity after puberty is debatable.
• 🧠 5-alpha reductase inhibitors, like finasteride and dutasteride, are used for reducing prostate size and treating hair loss by inhibiting DHT, though side effects are a topic of debate.
• ⚖️ The side effects of finasteride and dutasteride, including potential sexual dysfunction, are often overstated, and post-finasteride syndrome remains a controversial and poorly understood condition.
• 💊 Topical and oral hair loss treatments like minoxidil, PRP, and even hair transplants are alternative approaches to DHT inhibitors, though all have varying degrees of effectiveness.
• ⚠️ The risk of irreversible side effects from DHT inhibitors, particularly sexual dysfunction, raises concerns, especially when treating a cosmetic issue like hair loss.
• 🔬 Topical anti-androgens, such as RU58841, are experimental treatments for hair loss that target androgen receptors in the scalp without systemic side effects, though they lack FDA approval.
• 🧴 The effectiveness of topical versus oral treatments depends on the drug's molecular mass and its ability to stay localized, with topical dutasteride potentially having fewer systemic effects than finasteride.
• 🕒 Preventing hair loss early is more effective than trying to regain lost hair, as visual signs often appear after significant hair loss has already occurred.
• ⚙️ In severe cases, hormonal treatments like anti-androgens combined with estrogen are used in gender transitioning, and they can result in significant hair regrowth, although these treatments are extreme and not commonly recommended for hair loss.
• 🧪 Future treatments, such as the experimental drug pyriamide, show promise for addressing hair loss without the severe side effects of current DHT inhibitors.

Q & A

What is the role of DHT after puberty?

DHT (dihydrotestosterone) plays a role in cognitive health, maintaining balance of estrogen, and contributing to vasodilation in the penis. However, it’s not essential for survival or overall health, and many individuals can thrive with low or almost non-existent levels of DHT.

Why are 5-alpha-reductase inhibitors like finasteride and dutasteride used?

5-alpha-reductase inhibitors like finasteride and dutasteride are primarily used to reduce prostate size by blocking the conversion of testosterone to DHT, which drives prostate growth. They are also commonly used for hair loss treatment.

What is post-finasteride syndrome, and why is it controversial?

Post-finasteride syndrome refers to the potential sexual and psychological side effects experienced after stopping finasteride. It is controversial because the urologic literature lacks consensus on its existence, prevalence, and reversibility.

What is the speaker’s stance on using 5-alpha-reductase inhibitors for BPH and hair loss?

The speaker suggests that 5-alpha-reductase inhibitors are not necessary for BPH as urologists have better management tools. For hair loss, the speaker advises against starting them unless other options like minoxidil or hair transplants have been considered first, due to the potential side effects.

What are some alternatives to finasteride for treating hair loss?

Alternatives include oral and topical minoxidil, PRP (Platelet-Rich Plasma) therapy, hair transplants, and topical 5-alpha-reductase inhibitors, which may have a lower risk of systemic side effects compared to oral drugs.

Why might dutasteride be preferable over finasteride for some patients?

Dutasteride may be preferable because it stays more localized due to its larger molecular mass, which limits its absorption into systemic circulation. This could potentially reduce the risk of systemic side effects.

What are the risks associated with systemic minoxidil use?

Systemic minoxidil, though effective, can carry significant risks and unpredictable dosing requirements. It is often reserved for those who do not respond well to topical applications.

Why is it challenging to treat hair loss effectively long-term?

Treating hair loss is challenging because most treatments do not prevent the ongoing loss of existing hair. They either stimulate new growth or address cosmetic concerns but may not stop the underlying process, leading to continued thinning over time.

What is RU58841, and why is it controversial?

RU58841 is an experimental topical anti-androgen that blocks androgen receptors in the scalp. It has not received FDA approval, and its safety profile is not well-established, making it controversial and not widely recommended.

What is the potential benefit of upcoming drugs like pyramide for hair loss treatment?

Drugs like pyramide are promising because they offer localized anti-androgen activity without systemic effects, reducing the risk of side effects while still effectively increasing hair count. They have shown comparable results to dutasteride in clinical trials.