Author: Dr. William Rassman

An earlier question brought up an article about a topical DHT inhibitor at HairLossTalk:

The doctor interviewed in the article made some pretty impressive claims. Paraphrasing:

1. His topical DHT blocker is as effective as Propecia as long as you could apply it to the affected area
2. Downside of topical: It’s more of a pain to apply. It would be really difficult to apply to entire scalp, whereas Propecia blocks DHT everywhere.
3. Upside of topical: it only blocks DHT near the scalp, having less of an affect on serum DHT levels. This decreases the chances of side-effects.

The claims seem to make sense to me, but this kind of stuff can sometimes be counterintuitive.

1. Do you agree with his general evaluation of topical vs. serum DHT blockers?
2. Do you have an opinion on the specific topical solution he is talking about?

We have written about topical DHT blockers before here. The doctor in the article you referenced is a web-based provider of compounded, off-label medicaments for hair loss. The use of spironolactone has been a mainstay as a treatment for female hair loss when taken orally, but there is no real evidence that it works and many studies show the controversy, saying either it works or does not work. It is tied to the belief of the doctor, but you must keep in mind that doctors who recommend it profit from its use. When you take such medications and convert it to skin (topical) use, there is no guarantee that it works, if it is absorbed through the skin and just where the medication works (if it does work at all). It is easy to make such compounds and when a doctor puts his concoction into a cream or topical, there is an implication that it is safe and effective. Spironolactones are known antiandrogens and as such should work in men, but if taken orally, men will have significant secondary sexual side effects, such as loss of libido and problems with sustaining erections (when and if they get them). The question one should ask is whether this medication has sexual side effects. Without proper scientific studies, we really can not tell.

I never understood why men chase this stuff when the rare sexual side effects from Propecia (finasteride) have been measured. I would guess that if spironolactone was taken orally, they would dwarf the side effects of Propecia in men, yet men somehow want to experiment and may find themselves swamped with side effects or ineffective treatment losing valuable time on fixing hair loss with what is known to work. Topical spironolactone has a bad smell associated with it which is claimed to have been successfully addressed by this doctor, so I don’t know if this medication stinks from the aroma or its success and without good science behind it, it becomes a real gamble with the belief of one doctor who makes his living putting topical medications together.