Two hair restoration medications have been approved by the U.S. Food and Drug Administration after appropriate double-blind, placebo-controlled clinical trials. It is important to note that only two hair restoration medications have won such approval. Many products are advertised and marketed with a claim for hair restoration, but few have ever been subjected to the clinical trials necessary to prove efficacy and safety.
FDA Approved Drugs for Hair Loss Treatment
Minoxidil (Rogaine®) – a topical solution available over-the-counter in 2% and 5% strengths. Minoxidil is effective in some people, moderately effective in some, and ineffective in others. When effective, minoxidil can retard hair loss and stimulate new hair growth. Its mechanism of action is not well understood. Best results with minoxidil are often achieved by combining the topical solution with hair restoration surgery.
Finasteride (Propecia®) – an oral medication that treats the root cause of male-pattern hair loss by inhibiting the activity of the hormone responsible for hair loss. Finasteride is available only by prescription. Finasteride is usually not prescribed for women; women who may become pregnant are at risk for a certain type of birth defect in the unborn child. Finasteride works best for early to moderate degrees of hair loss. Men with extensive hair loss are unlikely to have much regrowth. Regrowth associated with finasteride is better over the crown of the scalp than at the frontal receding hairline. When used in conjunction with hair transplantation, finasteride may prevent further hair loss while transplantation fills in areas such as the frontal hairline.
Hair Additions and Replacements
A small number of people with hair loss are not candidates for surgical or medical hair restoration. For these persons, hair additions or total hair replacement may be considered:
- A person who is congenitally unable to grow hair may be a candidate for permanent total hair replacement (a wig, or several wigs for different occasions)
- Hair additions may be a temporary measure for the person who wants hair loss corrected but is not yet ready to undergo hair transplantation
- Hair additions or replacements may be considered by the person who has too little donor dominant hair for use in hair transplantation
- Dr. Sztulman can recommend hair additions and replacements for those persons who are not candidates for surgical or medical hair restoration
What causes hair loss?
Genetic pre-disposition plays a major role in hair loss. Most commonly, men and women alike inherit the propensity to lose their hair from either or both of their parents.
Unlike the way many of us experience hair loss in nightmares, one’s hair generally does not come out all at once or in thick clumps. Rather, it tends to occur progressively over time. The age of onset and the rate of hair loss vary due to a number of factors – again, the predominant of these factors is genetic.
Doctors and scientists are still in the early stages of researching and finding a “cure” for the unique events that determine the metabolism and programming of our hairs – from our scalps to our eyebrows and eyelashes. A better understanding of these and other physiological and pharmacological factors may allow us to provide more effective medical therapies in the future. Though some local circulatory and hormonal conditions show signs of a connection with hair loss, more research is necessary if we are to understand this unfortunate phenomenon in its entirety.
While it is true that hair loss cannot yet be prevented, certain conditions have been found to aggravate or even initiate the process. These include malnourishment, use of chemicals, hair braiding, and severe illnesses, to name a few. The good news is that we can dispel some of the negative myths about hair loss right away: wearing hats or caps, excessive shampooing, clogged pores have no effect on the process.
Facts about hair loss:
- Hair loss is not clinically apparent until 50% of hair is already lost
- Hair loss affects roughly 35 million men and 21 million women in the United States alone. Around 40% of men will have noticeable hair loss by the age of 35. Hair loss affects nearly 40% of women over 40
- Baldness is the most common complaint among men, followed by diffuse hair loss. The inverse is true for women, most of whom register their primary grievances with the experience of diffuse hair loss
- Preventative medical treatment (either Rogaine or Propecia are popular options) can prove effective when properly implemented. These treatments must be implemented in an ongoing fashion; an interruption in the treatment will likely result in a noticable step back
- Hair loss is associated with hormonal causes, or androgenetic alopecia, in more the 90% of cases. The hormone most associated with hair loss is dihydrotestosterone (DHT, for short)
Surgery Alternatives
Common questions or concerns regarding treatment options for hair restoration include some of the following:
What if you’re not ready for Surgical Hair Restoration?
Hair transplantation may not be the appropriate first step for younger men, or women, losing their hair. A delayed approach to hair transplantation for a young male, even when the young man is distressed by his hair loss and has expressed a desire for immediate hair transplantation may be the right approach. Alternatives to hair transplantation can provide cosmetic improvement until hair transplantation is likely to result in a satisfactory, long-term cosmetic outcome, for both men and women.
A man who begins to lose hair in his teen-age years or very early twenties finds himself developing a “middle-age look”, twenty years too early. The change in his appearance can be a cause of great concern and even emotional distress. The “look” that a young man presents to friends, colleagues, business contacts and potential sexual partners can make or break his success in the social and business worlds-or he may believe this to be the case, with negative effect on his self-esteem. The same applies for women.
Issues that affect the decision for early hair transplantation:
Family history of male pattern hair loss- A young man whose close male relatives have advanced male-pattern baldness is at high risk for experiencing moderate to severe hair loss as he ages. Undertaking hair transplantation immediately may have the negative effects of depleting the supply of donor hair [the hair at the back of the head that is used for transplantation grafts] before the young man’s hair loss has completed its course, and placing transplanted hair inappropriately if the transplanted grafts end up being “islands” in the middle of balding scalp.
Patient’s pattern of hair loss- Hair loss that begins at an early age is not predictive of how much hair will eventually be lost, or the eventual pattern of hair loss. Recession of hair in the temporal area (on the forehead, above the temples and eyebrows) may proceed no further, extend over time to include more of the forehead, extend over time to include the forehead and vertex or crown of the head, or extend over time to the maximum degree of male-pattern baldness. Hair transplantation started too early may eventually negate the long-term cosmetic benefit of hair transplantation.
What can you do if you’re not ready for hair transplantation?
A young man or woman concerned about his/her early hair loss will usually be offered alternative options for cosmetic improvement, if he/she is urged to accept a delay in hair transplantation. The hair restoration specialist will advise the patient regarding the best options for retaining cosmetic appearance while awaiting hair transplantation.
Medical Treatments for Hair Loss
In some men, hair loss may be slowed or even new hair growth stimulated by medical hair loss treatments. The two such treatments approved by the U.S. Food and Drug Administration are finasteride (Propecia®) and minoxidil (Rogaine®).
Minoxidil is topically applied and is available with out a prescription. Finasteride is a prescribed drug taken orally in pill form. The medical treatments may be used separately or in combination, as recommended by the physician hair restoration specialist.
Medical treatment may retard the rate of hair loss and preserve an acceptable appearance until the physician determines hair transplantation can be undertaken. Medical treatment is sometimes continued as a complement to hair transplantation. It is likely that, once started, hair transplantation procedures will have to be continued for some years to keep pace with progressive hair loss.
Cosmetic Cover ups, Camouflage
A number of non-prescription products offer “camouflage” for thinning hair. They are applied to the scalp and/or hair to give the appearance of “fullness” to thinning scalp hair. Some are applied directly to the scalp to disguise the appearance of bald scalp under thinning hair. Some are fibers that attach to hair to “bulk up” the appearance of thinning hair. All camouflage products are offered in a variety of colors to match natural hair color. Camouflage agents may be, for some young men, an acceptable short-term solution to improved cosmetic appearance while they wait for hair transplantation.
Hair Systems
A well-designed hairpiece/ hair system can provide an acceptable appearance for some patients with thinning hair. However, one hairpiece may not serve over a period of years if hair loss is progressive. A hairpiece requires monthly maintenance and usually must be replaced regularly. The patient and physician hair restoration specialist can determine whether a hairpiece is an acceptable short-term alternative while the patient waits for hair transplantation.
There are patients for whom a hairpiece and camouflage agents may be a long-term or even life-time solution to hair loss. A patient with these characteristics is typically a very young man with a strong family history of hair loss, and aggressive male pattern hair loss that began early. Hair transplantation may never be an option for such a patient, who will lose so much hair that none is available for transplantation.
