Are topicals just hype and fancy marketing?

[NikosHair]

This is a very topical question (see what I did there🙄)

I've been looking at the extortionate prices for topical finasteride/dutasteride. By my calculations, you are looking at between $300 - $360 for a 3-month supply Vs $25 (delivered) generic oral finasteride.

With reference to the study @Melvin- Moderator kindly cited. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297965/

The study does nothing to support the case for using topical finasteride, other than it was better than using nothing (placebo).

It would be interesting to hear your views and the study is a good starting point to support your views, either way.

 

[Melvin- Admin]

This doctor breaks down that study pretty darn well. The facts are that topical finasteride was almost as good as oral finasteride, statistically there the difference was negligible. The reported side effects were almost identical to the placebo. Now, I’m not saying anyone who’s getting good results with the oral version should switch. But this is obviously something of interest for those like me who suffered from side effects. 
 
Topical version reduced DHT by 30% vs. 50% in this study. That’s not a small number. It’s no wonder why there are less reported side effects. The biggest take away is that it performed almost as good as the oral version. 
 

Also, it should be noted that topical finasteride doesn’t mean “no side effects” those really sensitive still get sides. But there’s less chance of getting sides with the topical. The same is true with minoxidil.

 

[NikosHair]

1 hour ago, Melvin- Moderator said:

It’s no wonder why there are less reported side effects.

It's really important we are accurate with the information we provide. Guys that experience sexual side effects with oral finasteride are desperate to find a way to hold on to their hair (and still perform between the sheets😊). The study (you cited) concluded (and you know what comes next):

'There were no significant differences between topical finasteride and placebo in mean scores for any item on the Sexual Dysfunction Questionnaire at week 12 or 24. Mean scores for all items were similar between topical finasteride and oral finasteride at weeks 12 and 24.'

There was no statistical significance between topical & oral. I get it doesn't fit your narrative but contradicting the study (unless you can show me otherwise) doesn't advance the discussion.

[Melvin- Admin]

18 minutes ago, NikosHair said:

It's really important we are accurate with the information we provide. Guys that experience sexual side effects with oral finasteride are desperate to find a way to hold on to their hair (and still perform between the sheets😊). The study (you cited) concluded (and you know what comes next):

'There were no significant differences between topical finasteride and placebo in mean scores for any item on the Sexual Dysfunction Questionnaire at week 12 or 24. Mean scores for all items were similar between topical finasteride and oral finasteride at weeks 12 and 24.'

There was no statistical significance between topical & oral. I get it doesn't fit your narrative but contradicting the study (unless you can show me otherwise) doesn't advance the discussion.

You're hanging on to the mean score. You have to look at the percentage of reported sexual adverse events.

Treatment‐related sexual adverse events (sexual dysfunction, erectile dysfunction, libido decreased, loss of libido) were reported in 2.8% vs. 3.3% vs. 4.8% of patients treated with topical finasteride, placebo, or oral finasteride. Discontinuations due to treatment‐related sexual adverse events were reported in 0% vs. 1.1% vs. 2.4% of patients, respectively.

 

[NikosHair]

1 hour ago, Melvin- Moderator said:

You're hanging on to the mean score.

You need to understand how the mean average feeds into the overall percentage to understand why they are irretrievably linked.

I'm quoting from the study. 

3 hours ago, Melvin- Moderator said:

It’s no wonder why there are less reported side effects.

They didn't say this!

1 hour ago, Melvin- Moderator said:

reported in 2.8% vs. 3.3% vs. 4.8% of patients treated with topical finasteride, placebo, or oral finasteride.

The difference is 1.5% between the topical and oral groups. This is below the threshold of what is called statistically significant. In other words, the researchers could not predict with any certainty that if they ran the study again, they would not get a result that showed a higher percentage for topical than oral. It's just too close to call.

This isn't what the pharma company funding the study wanted to hear (or anyone else shilling topicals). They would have liked to have seen low levels of side effects in the topical group and a *much* larger percentage in the oral group. 

Edited March 22, 2023 by NikosHair

[Gatsby]

I've seen this video before (and remember it's just a video). Topical finasteride side effects was equal to placebo side effects (not oral finasteride side effects). That's a huge plus for trying topical finasteride (or even dutasteride) for those like myself that struggle with oral finasteride.

[Melvin- Admin]

11 hours ago, NikosHair said:

You need to understand how the mean average feeds into the overall percentage to understand why they are irretrievably linked.

I'm quoting from the study. 

They didn't say this!

The difference is 1.5% between the topical and oral groups. This is below the threshold of what is called statistically significant. In other words, the researchers could not predict with any certainty that if they ran the study again, they would not get a result that showed a higher percentage for topical than oral. It's just too close to call.

This isn't what the pharma company funding the study wanted to hear (or anyone else shilling topicals). They would have liked to have seen low levels of side effects in the topical group and a *much* larger percentage in the oral group. 

The difference between topicals and placebo isn’t even a 1%. That means people using the topical and placebo is virtually identical. That’s HUGE. 

[NikosHair]

3 hours ago, Gatsby said:

That's a huge plus for trying topical finasteride (or even dutasteride) for those like myself that struggle with oral finasteride.

Thanks for your contribution.

In the interest of transparency, which product do you use? do you pay full price for it or get it free?

[Melvin- Admin]

18 minutes ago, NikosHair said:

Thanks for your contribution.

In the interest of transparency, which product do you use? do you pay full price for it or get it free?

Adrian doesn’t even use any topical or oral finasteride. He’s interpreting the obvious. 

But for full transparency, whats your main account? You’re a new account posting from a point of authority, which means two things. Either shill, or this is a burner account.

Do you use this account to say what you don’t want to in your main account? Or were your previously banned? 

[Rafael Manelli]

28 minutes ago, Melvin- Moderator said:

Adrian doesn’t even use any topical or oral finasteride. He’s interpreting the obvious. 

But for full transparency, whats your main account? You’re a new account posting from a point of authority, which means two things. Either shill, or this is a burner account.

Do you use this account to say what you don’t want to in your main account? Or were your previously banned? 

Just because an account seems knowledgeable despite being new doesn’t mean they are a shill or a burner alt, that would assume everyone who makes a new account is new to hair restoration. I read this forum and other resources for a long time before making an account. 
 

I don’t think Nikos is attempting to speak from authority either, he’s just trying to make sense of the study he’s discussing. I recognise it was a cheap shot for him to imply or suggest that your opinion is biased by lack of transparency.
 

Anyway, topical finasteride and dutasteride seem to be a game changer for those who get or don’t want to risk side effects from the oral form. I’ve no personal experience with them, but I know many people wear by them so I don’t see a downside. It’s one more option for those who want it.

[Melvin- Admin]

1 minute ago, Rafael Manelli said:

Just because an account seems knowledgeable despite being new doesn’t mean they are a shill or a burner alt, that would assume everyone who makes a new account is new to hair restoration. I read this forum and other resources for a long time before making an account. 
 

I don’t think Nikos is attempting to speak from authority either, he’s just trying to make sense of the study he’s discussing. I recognise it was a cheap shot for him to imply or suggest that your opinion is biased by lack of transparency.
 

Anyway, topical finasteride and dutasteride seem to be a game changer for those who get or don’t want to risk side effects from the oral form. I’ve no personal experience with them, but I know many people wear by them so I don’t see a downside. It’s one more option for those who want it.

In my experience, 99.9% of the time it’s an alt account. I have no problem, but if we’re being transparent, let’s be transparent.

[Rafael Manelli]

10 minutes ago, Melvin- Moderator said:

In my experience, 99.9% of the time it’s an alt account. I have no problem, but if we’re being transparent, let’s be transparent.

Fair enough, if you're speaking from experience I'm sure you've developed an intuition for it. But I find it surprising. 

[NikosHair]

46 minutes ago, Melvin- Moderator said:

You’re a new account posting from a point of authority

I'm not posting from a point of authority, I'm just a regular Joe like the rest of us. You cited a (very good) study and I wanted to see if topicals are a credible cost-effective alternative to oral drugs.

2 hours ago, Melvin- Moderator said:

The difference between topicals and placebo isn’t even a 1%. That means people using the topical and placebo is virtually identical. That’s HUGE.

And the difference between the placebo group and the oral group is only 2%. Hence the conclusion by the researchers that the results were 'similar'. Nothing HUGE was found. 

[NikosHair]

For the record, I've never used topicals but regularly take oral meds.

If you do get side effects from the orals then it is worth reducing your dose significantly. Finasteride is a potent DHT inhibitor. The reduction in DHT isn't directly proportional to the dose, ie. if 1mg reduces DHT by 50-70% it does not follow that 0.5mg will reduce it by 25-35%. You could take a tenth of a 1mg dose and still get a significant drop in serum DHT levels.

[Melvin- Admin]

11 minutes ago, NikosHair said:

For the record, I've never used topicals but regularly take oral meds.

If you do get side effects from the orals then it is worth reducing your dose significantly. Finasteride is a potent DHT inhibitor. The reduction in DHT isn't directly proportional to the dose, ie. if 1mg reduces DHT by 50-70% it does not follow that 0.5mg will reduce it by 25-35%. You could take a tenth of a 1mg dose and still get a significant drop in serum DHT levels.

I have no problem with this logic. The reality is there’s a threshold. 1mg daily may reduce DHT systemically too much, try 0.5mg, then 0.25. If that doesn’t work try topical. There’s no perfect treatment, and we all have to figure out what’s best for us, that may be taking nothing. Doing nothing is never a bad choice either.

[NikosHair]

On 3/22/2023 at 4:33 PM, Melvin- Moderator said:

I have no problem with this logic.

The other significant finding from the study was how much topical finasteride effects systemic levels of DHT. DHT serum levels dropped by 34.5% from base line. That's HUGE. Many people will be considering topical fin, will be sensitive to low DHT and the resulting sides. They want the blocking of DHT to be localised in the scalp and for it to not go systemic. This study debunks that claim.

 

[Melvin- Admin]

21 minutes ago, NikosHair said:

The other significant finding from the study was how much topical finasteride effects systemic levels of DHT. DHT serum levels dropped by 34.5% from base line. That's HUGE. Many people will be considering topical fin, will be sensitive to low DHT and the resulting sides. They want the blocking of DHT to be localised in the scalp and for it to not go systemic. This study debunks that claim.

 

It reduces DHT by 30% but oral finasteride reduces it by double. Topical finasteride is statistically as effective as oral finasteride, but reduces DHT by half. That is HUGE!

[NikosHair]

18 minutes ago, Melvin- Moderator said:

It reduces DHT by 30% but oral finasteride reduces it by double.

Those figures are incorrect. 

From the study:

Quote

serum DHT concentration was lower (34.5 vs. 55.6%), with topical vs. oral finasteride

We know that if you reduce the dose of oral finasteride, you can have less impact on DHT levels. The study used a 1mg tablet.

Edited March 23, 2023 by NikosHair

[Melvin- Admin]

Just now, NikosHair said:

Those figures are incorrect. 

From the study:

We know that if you reduce the dose of oral finasteride, you can also lower DHT. The study used a 1mg tablet.

That’s one study, most studies show that oral finasteride reduces DHT by up to 70%. 

This much larger study found oral finasteride reduced DHT by a mean of 68%. 

All of the topical finasteride studies we have available (albeit small) show a 30-35% reduction. 

Oral finasteride 1 mg/day significantly reduced serum DHT levels by a median 68.4% in men with male pattern hair loss treated for 1 year.

https://link.springer.com/article/10.2165/00003495-199957010-00014

[NikosHair]

5 minutes ago, Melvin- Moderator said:

That’s one study, most studies show that oral finasteride reduces DHT by up to 70%.

We can't cherry-pick the bits of the studies we like and that support our position while discarding the bits that aren't supportive. It isn't very scientific and gets a bit silly.

The more interesting question from the study ... Is the systemic blocking of DHT by topicals the only reason for the results? The localised effect of rubbing stuff on your scalp would then just be marketing mumbo jumbo.

 

[Melvin- Admin]

1 hour ago, NikosHair said:

We can't cherry-pick the bits of the studies we like and that support our position while discarding the bits that aren't supportive. It isn't very scientific and gets a bit silly.

The more interesting question from the study ... Is the systemic blocking of DHT by topicals the only reason for the results? The localised effect of rubbing stuff on your scalp would then just be marketing mumbo jumbo.

 

You can’t cherry pick studies. I just posted a much larger study that showed oral finasteride reduces 68% DHT after one year.

Can you stop DHT locally? The question is unknown. Until you can do a large scale study that checks scalp DHT, we can’t comment. We can speculate that it’s due to systemic reduction that it works. I find it hard to believe reducing DHT by 34% is enough to give you good results, but maybe that is it. Either way, reducing DHT by 70% is unnecessary. I think there’s enough evidence to show that you don’t need to reduce systemic DHT that much. 

[NikosHair]

1 hour ago, Melvin- Moderator said:

Can you stop DHT locally? The question is unknown. Until you can do a large scale study that checks scalp DHT, we can’t comment.

It should be simple enough to test without an invasive scalp biopsy. Conduct a double blind study. Split the patients into two groups.

Group 1: Application of topical finasteride to the scalp and a placebo application to another part of the body eg. neck.

Group 2: Application of placebo to the scalp and second application of topical finasteride to another part of the body eg. neck.

We would expect serum DHT levels to be the same but with different levels of hair growth if the application of topical finasteride to the scalp was actually yielding results.

[NikosHair]

17 hours ago, Melvin- Moderator said:

Can you stop DHT locally? The question is unknown.

Given the simplicity of the test (as above), it brings us neatly back to the poll question.

Perhaps if you are raking $100+ dollars a month off each subscriber, let the hype train keep rolling and leave it as a convenient unknown🙄

 

[Melvin- Admin]

18 hours ago, NikosHair said:

It should be simple enough to test without an invasive scalp biopsy. Conduct a double blind study. Split the patients into two groups.

Group 1: Application of topical finasteride to the scalp and a placebo application to another part of the body eg. neck.

Group 2: Application of placebo to the scalp and second application of topical finasteride to another part of the body eg. neck.

We would expect serum DHT levels to be the same but with different levels of hair growth if the application of topical finasteride to the scalp was actually yielding results.

Finding a lab that tests the biopsy is extremely difficult. I haven’t been able to find one, if you can find one in California let me know. I will gladly test myself.

 

[NikosHair]

2 minutes ago, Melvin- Moderator said:

Finding a lab that tests the biopsy is extremely difficult.

No need for a biopsy - have another read of what I wrote:

18 hours ago, NikosHair said:

It should be simple enough to test without an invasive scalp biopsy. Conduct a double blind study. Split the patients into two groups.

Group 1: Application of topical finasteride to the scalp and a placebo application to another part of the body eg. neck.

Group 2: Application of placebo to the scalp and second application of topical finasteride to another part of the body eg. neck.

We would expect serum DHT levels to be the same but with different levels of hair growth if the application of topical finasteride to the scalp was actually yielding results.