Losing Your Hair? Here's What Actually Works

If you’re not familiar with Derek from More Plates More Dates, he’s a well-known figure in the fitness and health community. His platform focuses on hormone optimization, fitness, and aesthetics, and he’s become a go-to source for no-nonsense advice on everything from building muscle to addressing hair loss. On The Drive podcast with Dr. Peter Attia, Derek broke down the landscape of hair loss treatments in a practical and relatable way.

Why Hair Loss Happens

The root cause of male pattern baldness typically comes down to one thing: DHT (dihydrotestosterone). For men genetically predisposed to hair loss, DHT binds to receptors in the scalp, causing hair follicles to shrink over time. Derek pointed out that, while some people brush it off with the “just shave it” mentality, for many men, hair loss can be more than a cosmetic issue.

“There are lots of people who care more about their hair loss than they do about heart disease,” Derek remarked. He acknowledged how psychological stress from hair loss often gets dismissed, even though it’s a real and valid concern for many.

The Big Players in Hair Loss Treatments

Derek laid out a wide range of options for treating hair loss, ranging from tried-and-true solutions to experimental approaches. Here’s what he had to say:

5-Alpha Reductase Inhibitors (Finasteride and Dutasteride)

Medications like finasteride and dutasteride block the enzyme responsible for converting testosterone into DHT. This can significantly slow or stop hair loss for many men. Derek explained, “Finasteride is the go-to for most people—it’s simple, effective, and widely available.” Propecia is a well-known Finasteride brand.

Dutasteride, while more powerful, is usually reserved for those who don’t respond to finasteride. “It wipes out systemic DHT almost entirely,” Derek said, adding that he personally uses it now for convenience.

However, he cautioned against jumping in blindly. Side effects such as reduced libido or erectile dysfunction, while rare, can occur. “If these side effects don’t show up within the first six months, the data suggests you’re probably fine long-term,” Derek explained. But for those just starting out, he recommended exploring alternatives before going straight to systemic medications.

Minoxidil (Topical and Oral) 

Another key player is minoxidil, a treatment that stimulates hair follicles and promotes regrowth. Derek noted that topical formulations, like Rogaine, are often effective for most users with minimal side effects.

“Oral minoxidil is definitely an option for people who don’t respond well to topical forms, but it’s less predictable in terms of dosing,” Derek said. While powerful, he warned that it should be reserved for those who have already tried the topical route.

Emerging and Experimental Treatments

For those looking beyond standard options, Derek shared some of the more experimental treatments he’s used or researched:

Topical Anti-Androgens 

In his early 20s, Derek experimented with an off-label topical anti-androgen called RU58841, which blocks DHT activity directly in the scalp without affecting the rest of the body. “It’s not FDA-approved, but it was one of the biggest needle movers for me when I was trying to salvage my hair,” he explained.

He’s now watching clinical trials for newer, safer alternatives like Kintor’s Pyrilutamide, which shows promise for providing targeted scalp treatment without the systemic side effects of oral medications.

Microneedling and PRP 

Derek also highlighted microneedling—a process that creates tiny punctures in the scalp to stimulate growth—and PRP (platelet-rich plasma) injections. “Microneedling can turn a non-responder into a responder when used with minoxidil,” he noted, while PRP may work as a supplementary treatment for some men.

Ketoconazole Shampoo 

Although not a game-changer on its own, ketoconazole shampoo is often included in hair loss regimens due to its mild anti-DHT properties and ability to reduce scalp inflammation. “It’s mostly just a solid shampoo, but it does have mild anti-androgenic effects that can help in combination with other treatments,” Derek said. While it won’t singlehandedly reverse hair loss, it’s an easy, low-risk addition to a broader treatment strategy. There are OTC 1% and Prescription 2% available, the latter being more effective.

Why Timing Matters

One of Derek’s key takeaways is the importance of starting treatment early. “By the time you notice thinning or recession, you’ve probably already lost 20 to 30% of your hair,” he explained. Regaining that hair is significantly harder than maintaining what you still have, so taking action early is crucial.

“You’re almost rowing against a current,” Derek said, describing how hair loss progresses. “Once hair follicles miniaturize, there’s no guarantee they’ll come back, so prevention is always easier than reversal.”

Derek’s Personal Regimen

When Derek started noticing hair loss in his early 20s—exacerbated by high doses of anabolic steroids—he took a multi-pronged approach to halt it:

Finasteride: Initially, he used a daily 1mg dose to block DHT. Topical Anti-Androgens: He added experimental treatments like RU58841 to block DHT activity locally. Ketoconazole Shampoo: Although mild, it helped reduce scalp inflammation and acted as a supplementary anti-DHT measure. While this combination significantly slowed his hair loss, Derek admitted that reversing it entirely wasn’t realistic. “I managed some regrowth, but expecting to go back to having the hair you had at 17 is unlikely once you’ve experienced noticeable loss.”

Key Takeaways

Derek emphasizes that hair loss treatment is not a one-size-fits-all approach. The key is to understand your options, weigh the risks and benefits, and act before significant loss occurs.

“There’s no shame in caring about your hair,” Derek said. “For some guys, it’s a huge part of their confidence and identity, and that’s valid.”

Whether you start with over-the-counter treatments like minoxidil or explore more advanced options, the most important thing is to take a proactive approach. As Derek put it, “Preventing loss is always easier than trying to regrow what’s already gone.”

By combining science, personal experience, and practical advice, Derek offers a balanced perspective for men navigating the sometimes overwhelming world of hair loss treatments. Take the first step today—because your hairline won’t wait.

I’m here to support you on your journey to a healthier, fitter life. As always, I appreciate your feedback and suggestions. Let me know what topics you’d like me to cover in future issues by replying to this email.

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Be well,

Dave

Please note: This newsletter is designed for informational purposes only and should not be taken as professional medical advice. Always consult with a healthcare provider for advice tailored to your health and fitness needs.