Actual studies on Ketoconazole (Nizoral)


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You know whats kinda strange? If you read the package insert for ketoconazole, the oral form was found to lower serum testosterone levels in men from direct action on the testis. Also "leydig cell abnormalities" were found with prolonged use. What the abnormalities were, it did not say. One of the possible and reported side effects was gynecomastia! This is only for the oral form. But what are the odds that (A) it screws with leydig cell ability to produce testosterone, and (B) it stops androgen binding at the receptor level? Pretty unusual compound. My point is that im skeptical about its hair saving benefits because of all this. Do I use it? Yep. Will I continue? Yep. Alot of people swear by it. Its a lot more promising than all the herbs that are all "proven to reduce type one and type two 5-alpha reductase by 99% Not one herb has reduced my libido. Why? because I still had the same amount of Dht as before I started the herb. And Im terrified to try Dutasteride! Finasteride was like doing tren without test.
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some promising research (in animals)

1: J Dermatol. 2005 Apr;32(4):243-7. Links
Topical application of ketoconazole stimulates hair growth in C3H/HeN mice.Jiang J, Tsuboi R, Kojima Y, Ogawa H.
Department of Dermatology, Juntendo University School of Medicine, Tokyo 113-8421, Japan.

Ketoconazole (KCZ) is an imidazole anti-fungal agent that is also effective in topical applications for treating seborrheic dermatitis and dandruff. Recently, topical use of 2% KCZ shampoo has been reported to have had a clinically therapeutic effect on androgenetic alopecia. The present study was conducted with the purpose of quantitatively examining the stimulatory effect of KCZ on hair growth in a mouse model. Coat hairs on the dorsal skin of seven week-old male C3H/HeN mice were gently clipped, and either 2% KCZ solution in 95% ethanol or a vehicle solution was topically applied once daily for three weeks. The clipped area was photographed, and the ratio of re-grown coat area was then calculated. The results demonstrated that 2% KCZ had a macroscopically significant stimulatory effect compared with the vehicle group (p<0.01, n=10). Repeated experiments showed similar effects, confirming the efficacy of KCZ as a hair growth stimulant. Although the therapeutic mechanism of topical KCZ for hair growth is unclear, our results suggest that topical applications of the substance are useful for treating seborrheic dermatitis accompanied by hair regression or male pattern hair loss.

Med Hypotheses. 2004;62(1):112-5. Links
Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men.Hugo Perez BS.
California College of Podiatric Medicine, 371 Columbus Avenue, San Francisco, CA 94133, USA.

Dihydrotestosterone (DHT) binding to androgen receptors (AR) in hair follicles is commonly accepted as the first step leading to the miniaturizing of follicles associated with androgenetic alopecia (AGA). Testosterone is converted to DHT by the enzyme 5alpha-reductase. Finasateride a 5alpha-reducase inhibitor blocks the production of DHT and is currently used to treat AGA. The inhibition is not complete but a reduction of DHT systemically and in the scalp is accomplished. Ketoconazole has been clinically shown to be effective in the treatment of AGA. In this paper, evidence is presented to support the hypothesis that ketoconazole 2% shampoo has a local disruption of the DHT pathway. It is proposed that using ketoconazole 2% shampoo as an adjunct to finasteride treatment could lead to a more complete inhibition of DHT and thus better treat AGA

human study (with finasteride)

J Dermatol. 2002 Aug;29(8):489-98. Links
Comparative efficacy of various treatment regimens for androgenetic alopecia in men.Khandpur S, Suman M, Reddy BS.
Department of Dermatology and S.T.D., Maulana Azad Meical College and Associated Lok Nayak Hospital, New Delhi, India.

Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other. One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups. Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.
macro this is about dutastride but i thought maybe you could help since you know about topicals. its not a study but the guy who runs talking about the problem with making topical dutastride

Finasteride can pass through the skin, as can dutasteride, and the main entery point is the pores, which the follicles are near, but I don't know if the path the topicals takes goes into the follicle. Minoxidil may have different permeability, and goes inside the blood vessle walls.

From the graphs i looked at, which did not have very good detail for one day, it looked like fin takes about 1-3 hours to fully complex with 5ar2. That means for best results, you need your topical to deliver it for at least 2 hours.

The type of topical you use depends on your motive. If your using topicals to avoid internal side effects, then you don't want to leave the topical on your head more than 3 hours and don't want to use too much.

For slower absorption, you can use PPG or oleic acid or some oils, instead of ethanol/water. You can add the oleic acid to your minoxidil. Also, octyl salicate will increase absorption of fin by 10x. Old Baldy posted a link for where to buy it. Do a search.

While these suggestions may help, I don't know the actual absorption rates since I don't have any studies. When you use this, you could get too much and get side effects, or you could get not enough and find out that you lose your hair 6 months from now.

Men who don't get side effects but are just irrationally afraid of fin will have no way to know how much they are getting. But men who get side effects and just don't want them can use their side effects to know if they are getting fin in their body. If they are getting the effects, they are probably getting a therapudic dose for their hair as well, and a higher one at the site. They just need to tinker a bit and make sure somehow that they are getting a continuous dose for at least 2 hours and not more than 4, and that a slightly lower dose does give side effects.

There have been studies that show finasteride only has systemic effects, but the vehicle is very critical. If it dumps the fin in all at once, or for two long, then of course the same effects will be seen everywhere. I'd like to hear more details of the study before I would take it as law.

There is a good chance that we will not find the right topical method. I encourage people to use green tea extract instead, which only has a local effect, and appears to be very effective.

When finasteride (fin) enters the pore, and maybe enters the follicle, there is no reason for it to not leak out into the blood. All the fin that enters the follicle will enter the blood eventually, and you must use a small enough amount to not get side effects. So this limited amount must be there for 2-3 hours. That means delivering it slowly. Fortunately, the scalp has a much smaller volume than the rest of the body. So while the fin passes through, it will have a higher concentration that it will in the body, where high concentrations cause side effects. Also, if it takes 5ar2 with it in complex, it will have less systemic effects. However, this depends on the fin actually entering the follicle before going back to the heart. I don't know if it does this. While some studies showed topical fin to work, I don't know if those tested whether it affected other areas as well.
i take that drug left a little pigment loss on my arm..
the skin disorder i have ..i took to long to take the it left pigment loss in my arms...
Wait. Half of what's written above has either nothing to do with Ketoconazole, or when it does it's another study on hairy little mice. No one has any input? Is a 2% topical solution of Ketoconazole useful? What are the sides? How much is too much?
yeah i know what your talking about im on novo ketoconazole 200mg now oral
Sorry,,,,I am very tired and didn't even read the studies. But I use the Nizoral and still have my hair. Maybe it doesn't help at all. But I will still use it.
It's main role in preventing hair loss is reducing inflammation and providing a healthy scalp environment in which fin/dut and minoxidil can hopefully re-grow or atleast maintain some hair. It's anti-DHT effects are minimal, as it's only a shampoo which sits on your scalp for what, 5 mins tops?
I have 15-30min showers so it soaks in nicely, I also barely rinse my hair so I have quite a bit left's never given me a rash or anything. Now i have to much hair :D
you think i should try leaving it in my hair over night. i currently use spiro and topical fin over night but am curious how affective niz has proven to be?
simpllyhuge said:
you think i should try leaving it in my hair over night. i currently use spiro and topical fin over night but am curious how affective niz has proven to be?

I would not leave it in your hair overnight. There's a reason why the manufacturers recommend using it as a shampoo only 2x per week. It's the fact that nizoral is a very strong medicated shampoo. It would probably aggravate your scalp causing inflammation and dryness which in and of itself could lead to accelerated hair loss.