What Is the Cause of DUPA

/by William Rassman, M.D./0 /

Started suffering sudden and rapid hair loss, most noticeably on the sides and back of head.. Thought it was telogen effluvium at first but it appears the hairs are miniaturizing rather than just shedding (hairs are coming in thinner and scragglier and not growing as long). Can DUPA be caused by anything other than androgens? If caused by stress or hormonal imbalance or thyroid, if the issue is addressed can the miniaturization be reversed? Or can only shed hairs from TE be grown back to normal?

Most men who say that they have DUPA, don’t have it. As the doctor who first identified DUPA, I don’t believe that anyone knows what causes it. It may be uniquely genetic because it is similar to some women with diffuse alopecia which presents similarly to men with DUPA.

Information on Liposomal Finasteride

/by William Rassman, M.D./0 /

Development of Liposomal Systems of Finasteride for Topical Applications: Design, Characterization, and in Vitro Evaluation

Rajiv Kumar 1, Bhupinder Singh, Gautam Bakshi, Om Prakash Katare
Affiliations 

Abstract

Finasteride (FNS) is a “drug of choice” for benign prostate hypertrophy and prostate cancer. The drug has also been reported to be useful orally in the treatment of some difficult-to-treat androgen-dependent skin disorders, such as seborrhea, acne, hirsutism, and androgenetic alopecia. However, the ideal route for its administration (i.e., topical) remains unexplored. This has logically suggested the search for strategic formulation approaches to make the drug effective on topical applications, hitherto unexplored. The present study targets the encasement of drug molecules in the interiors of vesicular compartments (liposomes) made up of hydrogenated phospholipids, as an attempt toward the development of a trans-epidermal therapeutic system of FNS. Multilamellar drug-loaded liposomes were prepared by thin-film hydration with sonication method and optimized with respect to drug payload, entrapment efficiency, and size by formulating different vesicular compositions under different process conditions. The vesicular systems consisting of saturated phospholipid (100 mg), cholesterol (50 mg), and FNS (5 mg) showed highest drug payload (2.9 mg/100 mg of total lipids), and drug entrapment efficiency (88.6%). Mean (+/-SD) vesicle size of the prepared liposomes was found to be 3.66+/-1.6 microm. Significantly higher skin permeation of FNS through excised abdominal mice skin of FNS was achieved from the liposomal formulations vis-à-vis corresponding solution and conventional gels. Liposomal FNS formulations also showed more than fivefold higher deposition of drug in skin than the corresponding plain drug solution and conventional gel. Stability studies indicated that the liposomal formulations were quite stable in the refrigerated conditions for 2 months with negligible drug leakage or vesicle size alteration during the storage period. Results of the current studies with FNS-loaded vesicular systems project the high plausibility of a topical liposomal formulation for effective localized delivery of Finasteride.

Risks of finasteride in pregnancy (from:reddit.com 6/11/2020)

/by William Rassman, M.D./0 /

This is a compilation of information gleamed from a Reddit poster who put together a series of articles which may point to risks brought on by finasteride in pregnancy. I will quote the entire post and all of the references for you to draw your own conclusions.  I have commented on two of the references.  Many of the articles are controversial. We have known for some time, that finasteride can impact the fetus on sexual identification. Many hermaphrodites come from women who have ingested finasteride or any similar compound during the first trimester of pregnancy, so items #1-6 have to my knowledge been previously identified. But to develop such abnormalities women were required to have significant exposure to finasteride with some of it being absorbed in their body during pregnancy. In my own practice, I have seen hundreds of men father normal children while they were on finasteride, so there is no 1:1 relationship when a man is taking finasteride and abnormal children and have not seen any patient come to me complaining of an abnormal child while they conceived a baby while on the drug. Of course, that is just my experience and does not guarantee the safety of this drug. I leave that up to the FDA. The rest I will leave for you to judge after reading the material below.

Risks of Finasteride Exposure in Pregnancy

Finasteride/Dutasteride

Finasteride, Propecia and Duasteride labels warn that pregnant women must not be exposed to the drug. This includes by taking it, touching a tablet, or by being exposed to semen from a man who is taking it.1

This is because if the active ingredient in Finasteride is absorbed by a woman who is pregnant with a male baby, it can cause the male baby to be born with abnormalities of the sex organs. Finasteride blocks DHT, which is necessary for male baby organs to form and grow. Prenatal Finasteride exposure has also been shown to affect cognitive function in both male and female babies.

What are the specific problems? According to the research they include:

  1. Higher rates of miscarriage

  2. A small penis

  3. Hypospadias

  4. A small underdeveloped scrotum

  5. A prominent midline raphe (scrotum doesn’t join normally)

  6. Ectopic testicles (which don’t reach the scrotum)

  7. Cognitive problems in both males AND females

  8. Memory problems in both males AND females

Three sources detailing these effects are provided below.

Source 1: S. Prahalada (1997) Effects of Finasteride, a Type 2 5-Alpha Reductase Inhibitor, on Fetal Development in the Rhesus Monkey2

In this study pregnant female monkeys were orally given 2mg/kg/day. Every single one of their male babies had genital birth defects.

“The male external genital anomalies were characterised by hypospadias which were confined to the glans penis (5/6; 83.3%), preputial adhesion to the glans (6/6; 100%), a small underdeveloped scrotum (6/6; 100%), a small penis (5/6; 100%) and a prominent midline raphe (6/6; 100%).”

“An apparent incidence in the fetal loss rate was observed in the 2mg/kg/day (23.1%) and the 800ng/kg/day (20%) finasteride treated groups when compared to concurrent controls…”

Source 2: Christopher Bowman, et al (2003). Effects of in Utero Exposure to Finasteride on Androgen-Dependent Reproductive Development in the Male Rat3

In this study Finasteride is shown to impact testicular descent: “Prenatal finasteride exposure significantly impaired testicular descent. Approximately 3, 23, and 73% of the adult males displayed ectopic testes in the 1.0, 10, and 100 mg/kg/day dose groups, respectively… The data from the current study suggest that the conversion of T to DHT in the developing gubernaculum is necessary for normal testicular descent.”

Even in the smallest dose of 0.01 mg/kg/day in the last stages of gestation there were genital issues affecting anogenital distance (AGD) of the males after the rats were born. “Late gestational exposure to finasteride significantly decreased AGD of male offspring in a dose-responsive manner… the AGD of male offspring displayed significant decreases of 8, 16, 23, 25, and 33% in the 0.01, 0.1, 1.0, 10, and 100 mg/kg/day dose groups, respectively.”

“The dose-response curves for finasteride-induced malformations fell into two groups. External structural changes such as decreased AGD and increased nipple retention had similar dose-response curves. These external changes were almost linear over the entire dose range (0.01 to 100 mg/kg/day) and approached 100% incidence by the highest dose.”

The authors note that “The lack of a no observed effect level (NOEL) in the current study was consistent” with the study by Clark (1990) which showed effects at doses down to 0.003 mg/kg/day.  (DR RASSMAN’S COMMENT: THIS STUDY WAS DONE IN MONKEYS ADMINISTERED FINASTERIDE IN VARIOUS DOSES DURING PREGNANCY.  THIS IS NOT THE SAME AS THE MALE MONKEY BEING ON FINASTERIDE WHEN THE FEMALE MONKEY BECAME PREGNANT)

Source 3: Jason Paris et al (2012) Inhibition of 5?-reductase activity in late pregnancy decreases gestational length and fecundity and impairs object memory and central progestogen milieu of juvenile rat offspring4

“Finasteride significantly reduced the length of gestation and the number of pups per litter…”

“Prenatal finasteride treatment significantly reduced object recognition, decreased hippocampal 3?,5?-THP content… inhibiting the formation of 5?-reduced steroids during late gestation in rats reduces gestational length, the number of viable pups per litter, and impairs cognitive and neuroendocrine function in the juvenile offspring.” (THIS STUDY WAS DONE IN RATS, AGAIN IN PREGNANCY AND DOES NOT CORRESPOND TO A MALE RAT TAKING FINASTERIDE WHEN THE FEMALE RAT BECAME PREGNANT)

While some of these research exposures were a lot higher than would be expected from semen exposure, don’t risk exposing a baby to any amount of this extremely dangerous US FDA pregnancy category X drug.5 Studies have demonstrated fetal abnormalities and there is positive evidence of human fetal risk.

Links:

1.https://www.drugs.com/pregnancy/finasteride.html#:~:text=-Finasteride%20is%20present%20in%20semen,wishing%20to%20conceive%20a%20child

2.https://www.docme.su/doc/1721148/effects-of-finasteride–a-type-2-5-alpha-reductase-inhibi…

3.https://academic.oup.com/toxsci/article/74/2/393/1716348

4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196810/#__ffn_sectitle

5.https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf&ved=2ahUKEwi5iY7a3_bpAhUvyDgGHVP2AIEQFjABegQICxAG&usg=AOvVaw1iQoISJACkyba4PNH1LzZM

Is Extreme Balding More Acceptable Today?

/by William Rassman, M.D./0 /

Back in the 80’s & early 90’s this was an acceptable hairstyle to rock for men with hair loss. The shaved head has only been a more recent trend among balding dudes. At some point will the horseshoe be considered a more stylish option than shaving your head? I’m curious because I’m sick of balding dudes all having to rock the same haircut.

Balding with a shaved head works for many men. Some men get Scalp Micropigmentation (https://scalpmicropigmentation.com/ and look at the men on the front page. Also drill down on the bold men in the gallery). Either way, it is more what is in your head than what is on top of it.

Balding Triggered by Placebo!

/by William Rassman, M.D./0 /

I know this is going to sound weird, but my hairloss really started only 1 or 2 weeks after I began obsessively taking pictures of my temples, crown, etc and becoming anxious over it. Back then I seriously panicked thinking I had MPB as a teen, leading me to this sub. In retrospect, it looked perfectly fine. It then suddenly became much thinner, and since then my hairline, primarily the temples, has been steadily receding and my hair turned thinner, like a self-fulfilling prophecy.

MPB is certainly genetic, but what factors (like stress) could trigger it to start occurring earlier?

Some men practice denial, and one day they look and there it is! Are you really balding? See a good doctor and find out.

How Much Weight Do You Need to Lose Rapidly to Trigger Shock Hair Loss? Can It Recover?

/by William Rassman, M.D./0 /

I weighed around 85-86kg before this, and now, two weeks and two days later from the initial depression episode starting, ended two days ago, I weigh around 80-81kg apparently according to the scales. I am concerned, thats alot of weight to lose in such a short time.

It is different with different people, but 15 pounds per months could trigger hair loss with the genes for balding on board. When the genes kick in, it rarely reverses.

Does Balding Change Your Personality?

/by William Rassman, M.D./0 /

There is no doubt that personalities change with balding, and when I do a hair transplant, they often change for the better radically. I see that in many celebrities I have done. They feel that the hair transplant not only changed their appearance but changed their effectiveness in their acting careers.

How Effective Is Minoxidil at Restoring Hairline Recession Caught Early?

/by William Rassman, M.D./0 /

I’m sitting at about a Norwood 1.25 or so right now, and was wondering if I could restore it to at least a 1 reliably with only min since I caught it early. I’m also horrified of the dreaded shed making it appear worse, will this be lessened since I caught it early?

The younger you are, the better the chance that finasteride might work on the hairline. This does not mean restoring the juvenile hairline and reversing the mature hairline, but I am referring to real hairline recession in men under 22 years old.  Although, I have seen this happen in older men under 30 less frequently.