Hair Loss Treatment
More than half of men are affected by male pattern baldness by age 50. Consequently many hair loss treatments are available and hair loss treatment is estimated to be a US $1 billion per year industry.
There isn't a best hair loss treatment for everyone, only a best hair loss treatment for you. You need to weigh up the pros and cons of each, and decide what the end goal is, in order to find out which is most suitable and best hair loss treatment for you.
Increased understanding of the role of dihydrotestosterone (DHT) in male and female pattern baldness has led to targeted intervention to prevent this hormone from acting on receptors in the scalp.
As a general rule, it is easier to maintain remaining hair than it is to regrow. However there are new technologies in cosmetic transplant surgery and hair replacement systems that can be completely undetectable.
In the USA, there are only two drug based hair loss treatments that have been approved by the U.S. Food and Drug Administration (FDA); these are Finasteride (marketed as Propecia) and Minoxidil (marketed in the U.S. as Rogaine, and outside the U.S. as Regaine).
The prospective treatment of hair multiplication/hair cloning, which extracts self-replenishing follicle stem cells, multiplies them, and microinjects them into the scalp, has been shown to work in mice, and is currently under development, expected by some scientists to be available to the public between 2009–2015.
The average hair loss treatment takes a minimum of 6 months to begin working, and sometimes up to 24 months to see optimal results. Hair loss treatment takes time because of hair cycles. New hairs only grow in a 2 or 3 year cycle, which is why it can take a year or more to be able to detect the success of a treatment.
Minoxidil
Minoxidil is a vasodilator and originally was exclusively used as an oral drug (Loniten) to treat high blood pressure. It was discovered, however, to have the side effect of hair growth and reversing baldness, and in the 1980s, Upjohn Corporation received FDA approval to market a topical solution that contained 2% minoxidil to be used as a hair loss treatment, which is marketed as Rogaine.
Objective evidence shows that minoxidil is effective in frontal areas of the scalp, and not just in the vertex area in male-pattern hair loss. At the conclusion of a 48 week study, improvements were seen in the frontal scalp regions of 51% of men using 5% minoxidil, 42% using 2% minoxidil, and 13% of placebo users. Among these men, moderate to great increases in hair growth were seen in the frontal scalp regions of 19% of men using 5% minoxidil, 10% using 2% minoxidil, and 3% of placebo users.
The method of action for Minoxidil is not known. It is clearly not just the vasodilatating effects which cause hair regrowth, as no other vasodilatator has been shown to be effective as a hair loss treatment.
Finasteride
Antiandrogens block DHT from binding with hair follicles. Their specificity varies greatly from specific antiandrogens such as finasteride which inhibit the conversion of testosterone to DHT by interfering with 5-alpha-reductase to more broad spectrum antiandrogens (fluconazole, spironolactone, etc.) Although unusual in clinical doses, antiandrogens can have serious side effects including gynecomastia.
Finasteride, marketed as the brand-name drug Propecia and Proscar by Merck, belongs to a class of drugs called aza-steroids. Finasteride is a "DHT inhibitor" and was originally approved by the FDA for the treatment of benign prostatic hyperplasia (BPH). Propecia (1 mg of finasteride daily) blocks approximately 55% of DHT activity and Proscar (5mg of finasteride daily) blocks 70%. In 1997, Finasteride was approved by the FDA as a hair loss treatment. A 5 year study revealed that 9 of 10 men taking finasteride (1mg daily) experienced visible results (42% of men taking Propecia experienced no further hair loss while 48% experienced no further hair loss and hair regrowth). In clinical studies, finasteride, like Minoxidil, was shown to work on both the crown area and the hairline area, but is most successful in the crown area. In another study, Merck sought to find the smallest effective quantity of finasteride and test its long-term effects on 1,553 men between ages 18 and 41 with mildly to moderately thinning hair. Based on their research, 1 mg daily was selected, and after two years of daily treatment, over 83% of the 1,553 men experiencing male hair loss had actually maintained or increased their hair count from baseline. Visual assessments concluded that over 80% had improved appearances.
Finasteride is usually only prescribed for men and should not be used by pregnant or potentially pregnant women, as it has been speculated that it could cause severe birth defects in male fetuses. Studies have shown that finasteride is ineffective as a hair loss treatment in women. However, finasteride's supporters respond that the study was on post-menopausal women whose hairloss was more likely related to the loss of oestrogen versus a sensitivity to testosterone. Some doctors are now willing to prescribe finasteride to women on the condition that either they are taking careful birth control measures or that they cannot become pregnant.
Dutasteride
Another Antiandrogen. In 2001, GlaxoSmithKline released another aza-steroid called dutasteride. Dutasteride is marketed as Avodart. Like finasteride, dutasteride was originally developed for the treatment of benign prostatic hyperplasia (BPH). While hair count studies showed that 2.5 mg of dutasteride was about 1.5 times as effective as finasteride for hair regrowth, Glaxo stopped FDA hair loss studies after phase II. Although the exact reason was never made public, it was speculated that the product was too similar to finasteride, which itself had not lived up to expectations commercially. As such, the 2.5 mg dosage was not released. The FDA trials for BPH continued, and Avodart became the first drug shown to shrink an enlarged prostate in a clinical study. The .5mg version of the drug is increasingly available to hair loss sufferers via the grey-market of online prescription medication, and physicians increasingly willing to prescribe drugs "off-label."
In December 2006, GlaxoSmithKline embarked on a new Phase III, six month study in Korea to test the safety, tolerability and effectiveness of a once-daily dose of dutasteride (0.5mg) for the treatment of male pattern baldness in the vertex region of the scalp (types IIIv, IV and V on the Hamilton-Norwood scale). The future impact that this study will have on the FDA's approval or disapproval of Avodart as a hair loss treatment in the United States is yet to be determined.
Ketoconazole
Another Antiandrogen. Ketoconazole is a synthetic antifungal drug used to prevent and treat skin and fungal infections, especially in immunocompromised patients such as those with AIDS. Because it is both an anti-fungal, a 5-alpha reductase inhibitor and a hair growth stimulant, it can help to slow the balding process.
There has been some suggestion that ketoconazole could inhibit testosterone synthesis in utero, which could potentially inhibit genital development of a male fetus. However, this has not been documented in any controlled studies.
Copper Peptides
Copper peptides are applied topically to the scalp, and shorten the resting phase of hairs, resulting in more hair follicles on the scalp being in the growing phase (as opposed to the resting or falling out phase) at one time.
Copper peptides generally have superoxide dismutation activity. SOD's likely work by destroying superoxide, the antagonist to Nitric oxide (NO), the natural form of minoxidil. Superoxide has an "agonist-antagonist" relationship with Nitric oxide or "Endothelium-derived Relaxing Factor".
Hair transplantation
This hair loss treatment involves relocating (transplanting) bald resistant hair follicles from the back and sides of the head (the donor areas) to a person’s bald or thinning areas. The transplanted hair follicles will typically grow hair for a lifetime because they are genetically resistant to going bald. In recent years hair transplantation techniques have evolved from using large plugs and mini grafts to exclusively using large numbers of small grafts that contain from between 1 to 4 hairs.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1 – 4 hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair.
Another method is scalp reduction, in which skin in the balding area of the scalp is surgically excised. The left over skin is then pulled together and sutured.
Hair multiplication
Stem cells and dermal papilla cells have been discovered in hair follicles and some researchers predict research on these follicular cells may lead to successes in treating hair loss through hair multiplication (HM), also called hair cloning.
HM is being developed by two independent companies: ARI (Aderans Research Institute, a Japanese owned company in the USA) and Intercytex, a company in Manchester (UK).
In 2008, Intercytex announced positive results of a Phase II trial for a form of cloning hair follicles from the back of the neck, multiplying them and then reimplanting the cells into the scalp. The initial testing resulted in at least two thirds of male patients regrowing hair. The company estimates that the earliest that this treatment could be on the market is 2010, pending currently ongoing clinical trials.
Low-level laser therapy
Although there is no peer-reviewed evidence to support this claim, devices are sold that use a low level laser shone directly on the scalp with the intent to stimulate hair growth through "Photo-Biostimulation" of the hair follicles. One product of these low level laser therapies is the Hairmax Lasercomb. There is some debate over the FDA's acknowledgment of the Lasercomb. Under the looser standards applicable to medical devices, the HairMax LaserComb was cleared by the FDA as being "substantially equivalent" to predicate devices legally marketed before May 28, 1978. The devices that the lasercomb proved itself equivalent to were a variety of FDA approved non hair growth/laser based devices intended for hair removal and pain relief, and two non FDA approved non laser based/hair growth devices such as the Raydo & Wonder Brush and the Vacuum Cap. These last two devices were sold in the early 1900s and are well established as medical quackery, but they were legal to market at the time which does satisfy the FDA's minimal 510k SE criteria.
The Leimo laser was recently approved by the TGA (Therapeutic Goods Administration) of Australia as a Class IIa Medical Device. It was approved for safety but not for efficacy of results. The company is advertising that this unit is TGA approved to grow hair, which is false.
Concealing hair loss
One method of hiding hair loss is the "comb over", which involves restyling the remaining hair to cover the balding area. It is usually a temporary solution, useful only while the area of hair loss is small. As the hair loss increases, a comb over becomes less effective. When this reaches a stage of extreme effort with little effect — it can make the person the object of teasing.
Another method is to wear a hat or a hairpiece — a wig or toupee. The wig is a layer of artificial or natural hair made to resemble a typical hair style. In most cases the hair is artificial. Wigs vary widely in quality and cost. In the United States, the best wigs — those that look like real hair — cost up to tens of thousands of dollars.
Consult you doctor before proceeding with any hair loss treatment.