- Medical and Surgical Treatment Options
- What is Working, and What is Not
- Natural Remedy
WHAT CAUSES SCALP HAIR LOSS?
Hair loss can result from many factors. Some of these include thyroid disorders, high fever,prolonged illness, diet, childbirth, and certain medications. The most common form of scalp hair loss is termed androgenetic alopecia (AGA, or male and female pattern hair loss ). This type of hairloss is NOT caused by poor circulation,excessive sweating, clogged hair follicles, frequent shampooing, or the use of hats or helmets.
AGA has 2 common presentations: Receding hairline and thinning crown. AGA is determined by a combination of hereditary factors and male hormones called androgens which include testosterone and dihydrotestosterone (DHT). The tendency for male and female pattern hair loss is genetically inherited from either side of the family and begins to develop after puberty. Hair on the scalp that is genetically affected by DHT (generally the front and top of the scalp), starts to shrink until it is lost. Whereas hair at the back and sides of the scalp is permanent because it is not affected by DHT as there are no receptors present there on which DHT act.
WHAT CAN BE DONE ABOUT MALE AND FEMALE PATTERN HAIR LOSS?
People with thinning hair now have more options available to them than ever before. Available treatment options are:
- PRP/ Stem cell treatment
- Hair Transplantation
Moderately effective medical treatments are now offered in the form of a pill and a lotion. There are only 2 drugs approved by FDA – Finasteride and Minoxidil (Topical). The efficacy is more in the crown, not so much in restoring the hairline. Merck Study in 2002 showed that after 2 years of use only 21% showed a mild improvement in the front. Nevertheless medication must be taken for life. All beneficial effect is lost once the drug is stopped.
Cosmetic enhancers include colored creams, sprays, and powders that when applied to the thinning scalp help to camouflage thinning areas, as long as there is still some hair present in the area.
Hairpieces, wigs and hair weaving are a non-surgical artificial means to restore hair by covering bald areas of the scalp. Nevertheless there is a limitation about hair style, maintenance, scalp damage and daily activities, and is very expensive in a long run. When used for longer duration they can potentially damage the existing hairs resulting in increasing the bald area of the scalp.
Hair restoration surgery is the only permanent, solution to lost scalp hair. Considerable improvement can be achieved after a single procedure. There is no maintenance cost and no hindrance to the enjoyment of all kinds of daily leisure, sport, adventure, and intimacy.
SHOULD I CONSIDER HAIR TRANSPLANT ?
Hair transplant is the best option to fill-in the front hairline; and to thicken the front half of the scalp. Medical treatments can be combined to maintain hair behind the transplants and to possibly enhance the long-term results of hair restoration surgery. Dr Prashant after examination of the condition of your scalp will design an individualized plan to fulfill your specific needs.
Patients may have hair restoration surgery at any age. It is often better to consider Hair transplant when you are not completely bald so that you can use existing hair to help camouflage the effect of the procedure. Medical treatments such as Finasteride and Minoxidil may be prescribed to men with mild to moderate hair loss to help preserve thinning hair in the crown.
WHAT IS WORKING, AND WHAT IS NOT
Hair loss therapy is a growing industry with products all over the markets. Each claims to grow hair. What kind of advice can we give to the consumers? Here we have an some general information about the available hair loss products worldwide.
HAIR LOSS REMEDIES: LOTIONS AND POTIONS
- Over the past two years, there has been a marked increase in the number of products being promoted as solutions to hair loss. These formulations and devices pander to the population’s desire to find some way to halt this visible sign of aging.
- There are only three medically proven methods of dealing with hair loss: hair transplantation, minoxidil, and finasteride. Surgical hair transplantation is the only one of these methods that provides a permanent solution. Both minoxidil and finasteride require continued use to become and remain efficacious; once discontinued, hair loss ensues.
- Despite the availability of these proven methods, there is an enormous segment of the public suffering from hair loss who tries unproven hair loss remedies. Numerous products claiming to be “natural,” “safe,” “drug free,” and effective against hair loss are heavily marketed in the media. These “buzz words,” coupled with the virtual anonymity of purchase, are attractive and are garnering huge attention.
- Historically, there have been two dramatic influxes of these types of products. The first began in 1988 and was spurred by the 1988 FDA approval of minoxidil, marketed as Rogaine, mintop etc. Copycat products could not offer clinical statistics to substantiate their claims and, eventually, the Federal Trade Commission (FTC) stepped in to regulate these products.
- In 1996, the introduction of Rogaine 5% and Rogaine’s new over-the-counter status raised further awareness in the public in addition to the 1997 introduction of Propecia® (finasteride).
- The expiration of the patent on Rogaine in December 2000 started the next big increase of hair loss products. Minoxidil (marketed as Rogaine), which had been sold over the counter since 1996, now was in the public domain and available to other manufacturers.
- These generations of non-prescription products that proclaim to be natural, safe, and effective solutions for hair loss are usually not what they claim. Products are often based on minoxidil in some form, saw palmetto (an unproven herbal remedy), and/or other products that claim to be DHT inhibitors. Propecia is the only DHT inhibitor the FDA has approved for hair loss.
- Distribution of these potentially bogus products has never been easier, and consumers can purchase them anonymously from numerous Internet sites. The governing agencies have been slow to regulate efficacy of these unproven products.
This is the first of the drugs approved for hair loss. Introduced in 1988 after the FDA gave its approval, Rogaine has been an effective medication for hair loss for both men and women. The topical formulation is now available in 2% and 5% strengths, and has been over-the-counter since 1996. The treatment is a hair growth stimulator and works by activating potassium channels in follicular cells. VEGF and prostaglandin synthase expression is indicated. Numerous clinical studies have been done and reported for both hair growth and hair maintenance end points.
This is the newest medication to be approved by the FDA for hair loss. Approved in 1997, it is a 5-alpha 2 reductase blocker and lowers DHT levels, which results in hair maintenance and may result in hair growth. Clinical studies show a remarkable 90% of the study either gained or maintained their hair over five years compared to placebo.
This is the only permanent solution for hair loss. A surgical treatment, the procedure transplants viable hair from the donor area to the recipient locations.
WHAT IS TRENDY?
Currently, the products generating the most interest are Avacor, nioxin, dutasteride, and saw palmetto.
From Global Vision 2001, is a heavily marketed product that is a three-fold system of a DHT blocker, topical solution, and scalp detoxifying shampoo. It claims to be an all-natural, herbal formulation that is effective immediately, with results shown in 4–6 months. It is a hair-growth stimulator based on a formulation of 2,4-di-amino-6d piperidino-pyrimidine 3 oxide, or, in other words, minoxidil 2%. It also contains sabal serulate, an androgen modulator, more commonly known as saw palmetto. While the company uses “clinical” data to support its claims, they are in actuality a “non-peer-reviewed, non-double-blind, seemingly scientific study subsidized by the makers of the product.” 1 The average cost is $220 for a 3-month supply.
This is a cleanser scalp therapy and scalp serum. The product contains niocidin, which inhibits demodex produced lipase.2 However, “there has never been any study, that I am aware of, that implicates demodex lipase in hair loss” or “that shows that hair will benefit from getting rid of mites or their lipase.”3 Nioxin is based on bionutrient actives and protectives.
Their primary methodology is to clean the scalp of DHT and to provide chemically enhanced hair with moisture/vitamin nourishment. Primarily available in salons, the product can now be found in other retail outlets.
From Glaxo Smith Kline, is the most promising of the products or medications outside of the three therapies mentioned above. Approved by the FDA only for use with prostate therapy, it was not submitted for male pattern baldness.
It is a DHT blocker that blocks both forms of 2-alpha reductase enzymes (type 1 and 2). Early studies show promising results, that is, slightly better than finasteride; however, the potential side effects require further trials and testing for overall efficacy and safety. Other early indications show that it has a longer half-life than finasteride and that the safety data is consistent with DHT reduction. It is still awaiting phase III trials. Dutasteride has been marketed with the brand name Avodart®.
This is available from multiple sources. It is an over-the-counter herb that has been claimed as effective as a supplement for thinning hair. It has shown to be beneficial in men with benign prostatic hyperplasia, but does not affect testosterone, DHT, or PSA levels.4 It has exhibited alpha androgenetic receptor blocking activity in vitro.5 General usage recommends taking 400mg of standardized extract with 100mg of beta sitosterol daily. It is claimed that results will appear in five months.
There are numerous other products and devices available to the consumer. A random sampling of the most prominent products is shown in the following text. The products have been categorized by the operative mechanism or by their key, active ingredients.
LOTIONS, POTIONS & SHAMPOOS
From Jungle MD, is very similar to Avacor both in terms of usage and formulation. Specifically, it uses a system of DHT blocker and scalp detoxifying shampoo. Its active ingredients are minoxidil 2% and saw palmetto. It costs approximately $200 for a 3-month supply.
From Daniel Rogers Laboratory, is extremely similar to both Avacor and Folliguard. It uses a DHT blocker, nutrient serum, and scalp detoxifying shampoo. Its ingredients are composed of loniten (better identified as minoxidil), saw palmetto, tarakaci, notoptcryl, maidenhair tree, vaccinium murtillus, and equisetum. The estimated cost is $180 for a 3- month supply.
Claims to contain a DHT blocker as well as a topical solution. Its active ingredients are minoxidil (12.5% micronized), azeleic acid 5%, and betamethasone valerate. The company reports that the 12.5% micronized minoxidil works on the temple and hairlines (non-responsive areas), while they say the azeleic acid can act as a DHT inhibitor.
From Dr. Geno Marcovici and Sunset Marketing, sells for $270 for a 3-month supply. It uses a system of a special shampoo, conditioner, supplements, and a serum. It also uses “botanicals” to inhibit type I and II 5-alpha reductase and decrease DHT. Results are claimed to appear in 6 months and it is described as being safe for both men and women.
From Biotech Corp, sells for $180 for a 3-month supply. It claims to be a “supplement” for thinning hair. Its active ingredients are he shou wou, saw palmetto, horsetail, henna, rosemary, progesterone, and nettle.
From Universal Biologics, sells for $210 for a 3-month supply. It requires a regimen of shampoo, lotion, and primer to deliver “nutrients.” It has two herbal and vitamin supplement tablets containing pantothenic acid, biotin, and zinc. It claims to be a natural herbal treatment and that 9 out of 10 people have healthier hair growth.
Studied by Boston University Medical Center, is a topic product that sells for $9.50 an ounce. Its “credentials” cite a Dr. Michael Holick, who reported a clinical study showing that Emu Oil accelerated skin regeneration and stimulated hair growth. They claim that 80% of hair follicles began to grow hair in non-clinical studies.
From Biotechne Complex Inc., sells for $210 for a 3-month supply. It is a topical solution that must be massaged directly into the scalp. It contains the extract of calf thymus glands and claims to boost immune function. The company admits it is not effective for male pattern baldness or androgenetic alopecia, the most common types of hair loss.
FNS, OR FOLLICLE NUTRIENT SERUM
From Osmotics, sells for $65 for a 4-ounce tube. It is a topical solution that claims to contain a unique delivery system of nutrients. It has a three-fold mechanism that includes a growth hormone potentiator, a cell culture medium, and a vehicle. It is marketed as a cosmetic product and will not be submitted for FDA approval. No trials have been performed to date.
VITAMIN & MINERAL PRODUCTS
From Vitafree, sells for $250 for a 3-month supply. It is a three-part system including a shampoo, a topical, and a DHT blocker. It is available through the Internet and direct sales. It claims to regrow lost hair as well as to produce larger, healthier follicles.
Available in three formulations: a cream for hairlines, a lotion for denser areas of hair, and a solution therapy spray for misting over the hair. It is available through the Internet and direct sales. It is a copper peptide–based product. Its functionality is based on the theory of increasing blood supply to the scalp to combat hair loss.
This is a topical treatment. It is available through the Internet and direct sales. It is comprised of a combination of vital nutrients and vitamins and reports it has a higher level of active ingredients designed to promote new growth. It claims to help reduce DHT levels by 90% and to give users immediate results. EPM, from Sumitomo Electronics, is an over-the-counter topical treatment comprised of 10 amino acids. Its active ingredient is epimorphin. No clinical trial data is available and it is not available in the United States.
y Farmaka, sells for $650–$975, depending on the package you choose. It is available through the Internet and direct sales. It includes a topical lotion, a shampoo, and a topical “accelerator” that must be applied with applicator and massaged. It claims to block DHT or the androgen receptor. The company indicates clinical testing done in Europe.
This is a combination shampoo, lotion, and primer as a regimen to deliver nutrients. It is a polyphenol compound, found in apples, which is said to act on hair epithelial cells as a growth-promoting factor. Their own study indicated “an increase in the number of hairs and the diameter of hairs in the designated scalp area compared to placebo.” No statistics or data were provided.
From Advanced Skin and Hair, costs $99 for a 3-month supply. It is available over-the-counter and includes a scalp therapy formula and bio-cleansing shampoo. It says it is an anti-DHT product, and claims there are no systemic side effects and is safe for men and women. Does not have FDA approval. On their own Website, it states that it is “not a drug, medication, treatment, or cure for hair loss.” It also claims internal study performed showed significant decrease in hair loss in 3 months.
By Janssen Pharmaceuticals, is a shampoo containing ketoconazole 2% (an anti-fungal agent). Ketoconazole, taken in tablet form, has been shown to lower serum testosterone. The effect has been compared to that of minoxidil 2%. It is available in 1% form over-the-counter or in 2% form as a prescription.
This a potassium sparing diuretic, used in treatment for blood pressure, and has been found to have antiandrogen activity. It is a DHT blocker in topical form and must be applied daily followed by the application of a minoxidil solution. It is available by prescription in tablet or foam.
DEVICES/OTHER NON-MEDICAL; NON-CAMOUFLAGE
By Lexington International, claims to use photobiostimulation with low-level, cold beam laser therapy. It claims to show improvements or activation of hair in the first 5–10 weeks. It requires usage twice a day for 10 minutes per session. It has had some mixed reactions. Some of the positive responses are from respondents using other forms of hair loss remedies. It has begun FDA clinical trials. It sells for $695.
This is a hair storage service in a temperature-controlled vault. The principle involves storing hair until cloning or other reproduction methods are viable. Concerns revolve around the extraction of hair and that DNA taken from existing hair would be sufficient for any cloning or reproducing possibilities. Based in Oregon, cost is an initial $50 plus $10 per annum for storage.
By Ryan Livingston, claims to be a hair “multiplication” technique in which microscopic biopsies of hair or scalp tissue are removed without scarring or blood. Follicles are multiplied in a type of incubation chamber and a pipette then inserts surviving cells. The procedure claims immediate hair growth without any trauma or a resting phase. It is generally believed to be a hoax.
It is worth noting the similarity among most of these products in terms of their recommended treatment regimen and ingredients. Many of the so-called natural products actually contain minoxidil in some form, which is a clinically-proven hair loss remedy. Many of these “treatments” do not provide sufficient information on their formulations or will disguise some of their ingredients with terminology not usually recognized by the public. Almost unilaterally, there is a DHT-blocker listed, but with no identification. Clinical trials are alluded to, but not supplied in many instances; substantiation of claims is usually lacking. There is often no satisfactory mechanism of action that has been provided.
Over 50% of the male population has cosmetically significant male pattern hair loss in their 50s. There is pressure on individuals to look younger both socially and in the workplace. Society wants superior solutions and wants these solutions now. There is a growing interest in anti-aging treatments, herbal formulas, and holistic medicine. Businesses are attempting to take advantage of this demand. They offer products that are not efficacious and are misrepresented. Better education on the proven methods of treating hair loss is needed. Hair transplantation, Rogaine, and Propecia are the only clinically proven medical hair loss treatments. Until a new drug is found, cloning is perfected, or genetic therapy refined, they remain the best solutions for the hair loss population.
PEOPLE LIVE ON PROMISES, NOT REALITY
- They love to believe in “miraculous” cure or “quick fix”
- They do not care about the natural hair cycle and genetic factors
- They are convinced that a expensive shampoo can change their DNA
- They love to believe that celebrities have thick hair from using a shampoo
- When you ask them to take medication, they’ll say, “No, I don’t like drugs”
- They do not consider vitamin, mineral, extracts, herbs … “drugs”
FACTS ABOUT OTC HAIR PRODUCTS
Many over-the-counter (OTC) hair treatments “guarantee” to stop hair loss and stimulate growth of new hair? Has it performed as promises?
You might have joined a very large club made up of people who elected to “do something” about hair loss by purchasing and using OTC medication you heard about from a friend, read about in advertisements, or came across on the World Wide Web. Perhaps you were also attracted by claims that the medication is “all natural”, “herbal”, “based on an ancient formula”, “iscovered by a doctor”, etc.
Here are some facts you should know about when using these products. Very few, if any, have ever been rigorously tested for safety and efficacy in well-designed clinical trials. Claims or “guarantees” of efficacy are rarely based upon good science. Claims are more likely to be so-called testimonials from presumably satisfied users of the product.
The chemistry and pharmacodynamics are not known in most OTC products that promise hair restoration. There are few studies of the clinical effects of the “natural” or “herbal” ingredients in these products. Only two hair restoration medications have been approved by the FDA after testing for safety and efficacy in clinical trials. These are the topical minoxidil and the oral finasteride. Still neither product “guarantees” to stop hair loss or stimulate growth of new hair because hair loss can be due to many causes that may or may not be treatable by the medications. Proper treatment may require a proper diagnosis by a physician or hair restoration specialist.
SCIENCE & COMMON SENSES
Claim: A special formulated shampoo that can stop hair loss
Do you really believe a expensive shampoo that you apply on the scalp for 1 minutes and then quickly rinsed off, can really penetrate all the way through the skin and change the hair follicles DNA?
If yes, then this is no longer a shampoo, but a mutating agent. Don’t forget the function of the human skin is to act as a barrier to stop chemical penetration.
Claim: Topical application that delivers nutrients and vitamin to the hair root.
Sorry, but we all know that the hair root does not take in nutrition from the scalp surface. The entire follicle is nourished by the capillary vessels situated in the deep connective tissue.
Claim: Medicine that improves circulation to the scalp can restore hair.
There is no scientific proof that reduced circulation to the scalp causes hair loss.
It is true that a bald scalp shows reduced circulation compared to a hairy scalp. However this is the result of the reduced metabolic needs of a bald scalp, whose hair follicles are much smaller.
Claim: Chinese herbs are more effective in treating hair loss.
Well, we have encountered a lot of bald Chinese Herbalists …
Traditional Chinese Medicine believes that diseases are caused by a imbalance between Yin-Yan and the 5 Elements. Treatment for each individual is different. There is no rationale to use ready-made universal herbal formulation without knowing your own imbalance.
Claim: Hair treatment that clean your scalp to grow healthy hair.
Wirth (1982) found that when no shampooing was done for 1 month, the only noteworthy finding was the building up of dandruff and oil to form a thick mat of surface scales. However the health of the scalp was not affected.
Most scientific studies agree that excessive secretion of the oily sebum has no influence on the growth of scalp hair (Inaba 1996).
Have you ever wondered why beggars who hardly shampoo have long thick hair?
Claim: Vitamins & Minerals Supplement can promote growth of health hair.
The deficiency of vitamins and minerals can produce diffuse hair loss. However supplement only restore hair when there is a deficiency. Increasing their body content of an readily adequate diet does not promote hair growth (Gummer 1985).
Points to Consider when using Natural Hair Remedies
- Most natural remedies has no effect on Androgenetic Alopecia
- There is no definition for being “Natural”. Over the years several so-called “natural remedies” were discovered to contain Minoxidil
- Best way to tell if a natural remedy really works is to look at the boss of the manufacturing company. If he is also losing hair, what can you expect?
- Any manufactured product taken by mouth to alternate body functions is a drug, no matter how you call it
Drug manufacturers should provide the following information about their products:
- Active ingredients and preservatives
- Pharmacodynamics and metabolism in body
- Mechanism of action
- Side-effects and adverse reactions
- Drug interaction
- Safety use in pregnancy and lactation
- Safety use in children and elderly
- Possible allergic reaction
ome may claim that the remedies are so natural that they would not do harm to your body. But think about it:
- If it’s not potent enough to affect your body, it’s not potent enough to grow hair
- If it’s potent enough to grow hair, then it is affecting your body
- Clinic trials and statistic remain the best evaluators of drug efficacy, not celebrities