Medical Treatments Options

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

Some men choose to attempt to treat hair loss with Rogaine.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.

Propecia is an alternative some men try when treating hair loss.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 with temporary total hair loss due to radiation or chemotherapy may be a candidate for temporary total hair replacement (a wig).
  • 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.

Common questions about hair loss include:

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:

1. Hair loss is not clinically apparent until 50% of hair is already lost.

2. 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.

3. 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.

4. 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.

5. 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).