Hair Loss Treatment

FOR MEN

In the past few years, medicine has made tremendous strides in the treatment of men's hair loss. With the advent of 5-a-reductase inhibitors such as Propecia and the evolution of surgical hair restoration, for many, living with noticeable hair loss is no longer inevitable. For the first time in the history of mankind it is now possible to stop or slow the progression of hair loss and to replace lost hair through surgery with completely natural results. However, with that said the vast majority of hair loss treatments being marketed today are still nothing but "snake oils."

You've all seen the ads in the back of men's magazines, you've heard the commercials on the radio and you've seen the infomercials promoting miracle treatments for hair loss. The bottom line is that the vast majority of advertised "treatments" do not work for the prevention and treatment of hair loss. If a hair loss treatment is not approved by the FDA or recommended by The American Hair Loss Association, chances are you are wasting your precious time and money. Remember that successful treatment of hair loss is greatly dependent on early intervention. It is critical to begin treatment with an effective product as soon as you notice the onset of hair loss.

The following two treatments have been clinically proven to successfully treat hair loss in men to varying degrees.

Finasteride, Proscar/Propecia

Finasteride is the generic name for the brand name drugs Proscar and Propecia Finasteride was originally developed by Merck as a drug to treat enlarged prostate glands (Proscar). During the trials on men with prostate problems an intriguing side effect of hair growth was observed. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck and Company decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness.

On December 22, 1997 the FDA approved a 1mg dose of finasteride for the treatment of androgenic alopecia in men (male pattern baldness). Propecia is the first drug in history to effectively treat male pattern baldness in the vast majority of men who use it.

How Propeica/Finasteride Works:

Finasteride's hair-raising success is due to its ability to specifically inhibit Type II 5-alpha-reductace, the enzyme that converts testosterone into a more potent androgen dihydrotestosterone (DHT). Propecia's 1 mg dose of finasteride can effectively lower DHT levels by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness .This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking it the drug during clinical trials. 65% of trial participants experienced what was considered a substantial increase of hair growth.

At this point, the only truly effective medically proven way to arrest the hair loss process is to lower DHT levels. The American Hair Loss Association recommends finasteride as the first line of attack for all men interested in treating their male pattern baldness.

Minoxidil (loniten)

Minoxidil (loniten) was the first drug approved by the FDA for the treatment of male pattern baldness. For many years, minoxidill, in pill form, was widely used to treat high blood pressure. Just like finasteride researchers discovered a very interesting side effect of the drug. People taking the medication were growing hair in unexpected places like on their cheeks and the back of their hands, some even grew hair on their foreheads.

Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. Well it did to varying digress depending on the extent of the hair loss, but at the time it was revolutionary.

While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair, most informed experts see it as a relatively marginally effective drug in the fight against hair loss. Since minoxidil has no effect on the hormonal process of hair loss it's positive effects are at best temporary and usually yield somewhat disappointing long-term results.

With the said, The American Hair Loss Association still recommends the drug for those who have not responded favorably to finasteride treatment or for those who would like to add another product to their regime. The AHLA does not recommend minoxidil as the first line of attract for men suffering with male pattern baldness, but does recognize it as an effective treatment for a small percentage of its users.

FOR WOMEN
Women are in a "Catch-22" position when it comes to drug treatments for androgenetic alopecia. While many drugs may work to some degree for some women, doctors are reluctant to prescribe them, and drug companies aren't exactly falling over themselves to test existing or new drugs specifically for their ability to prevent and treat female pattern baldness.

Physicians are reluctant to use systemic treatment (a pill or other form of internal treatment that affects your entire system) unless they know that the hair loss is due to an excess of androgen in the system or a sensitized "over-response" to the so-called "normal" amounts of androgen in the system. That's because these systemic treatments may lower the body's androgen levels. Therefore, physicians often choose topical treatments (those that are applied directly to the scalp).

The best results from treatment happen when you begin treatment as soon as possible after the hair loss begins because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will at least help prevent further hair loss and encourage some hair regrowth from those follicles that have been dormant but are still viable, Stopping treatment will result in the hair loss resuming if the androgens aren't kept in check in some other way. Maintaining your vitamin and mineral levels helps while you're on anti-androgen medications.

As always, treatments have the best chance of being effective if they are geared to the cause of the hair loss as well as to triggering hair growth.

Currently there is only one FDA approved treatment for female pattern hair loss.

Below you will find a list of treatments currently being used to treat hair loss in women. Some of these drugs have not been approved by the FDA for this particular application, however they have all been approved for other applications and are used “off label” to treat hair loss.

The effectiveness of these agents and methods vary from person to person, but many women have found that using these treatments have made a positive difference in their hair and their self-esteem.

Minoxidil 2% Topical Treatment

Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil experienced excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth. The amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.

Women with diffuse androgenetic alopecia can use minoxidil and it actually seems to be more effective for women compared to men. The makers of minoxidil recommend women only use the 2% concentration of minoxidil and not 5%. The makers of minoxidil have not received FDA approval for promoting 5% minoxidil or minoxidil extra strength for use by women. Many dermatologists do prescribe minoxidil 5% for women with androgenetic alopecia if used under their supervision. Some small clinical trials have been conducted on 5% minoxidil for androgenetic alopecia in women showing that indeed the 5% solution is significantly more effective in both retaining and regrowing hair than the 2 % solution.

In clinical studies of mostly white women aged 18-45 years with mild to moderate degrees of hair loss, the following response to minoxidil was reported: 19% of women reported moderate hair growth after using minoxidil for 8 months (19% had moderate regrowth; 40% had minimal regrowth). This compares with 7% of women reporting moderate hair regrowth after using the placebo, the liquid without the active ingredient in it, for 8 months (7% had moderate regrowth, 33% had minimal regrowth).

The American Hair Loss Association recognizes the limitations of topical minoxidil treatment in the fight against female androgenic alopecia (female pattern baldness) therefore we recommend that you seek out the advice of an informed hair loss specialist that can provide you with information on the potential treatments listed on this website.

Androgen Receptor Inhibitors.

Aldactone / Spironolactone

Spironolactone or the more popular brand name Aldactone is in a class of drugs called potassium-sparing diuretics (water pill). It is used to reduce the amount of fluid in your body without causing the loss of potassium. It is also used to treat hypertension (high blood pressure) and edema (swelling) and used to treat potassium deficiency and hyperaldosteronism (a hormonal disorder).

Spironolactone is an antiandrogen that works in two ways. Primarily it slows down the production of androgens in the adrenal glands and ovaries. Secondly it blocks the action of androgens in part by preventing dihydrotestosterone from binding to its androgenetic receptor.

Tagamet / Cimetidine

Cimetidine sold under the brand name Tagamet, belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block dehydrotestosterone form binding the follicle receptor sites.

Cimetidine has been used to treat hirsuitism in women (excess facial hair growth) and has been studied in women with androgenic alopecia showing promising results. Because of the high doses needed to achieve it’s hair raising results, men should not take cimettidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.

Cyproterone Acetate

Cyproterone Acetate is used to reduce sex drive in men which have excessive sex drive and for the treatment of pronounced sexual aggression. It is also prescribed to treat severe hirsuitism in woman of childbearing age and also androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of DHT dihydrotestosterone to its receptors.

Cyproterone acetate is not available in the US and is thought of as one of the last resorts for treating female pattern hair loss because of its possible toxicity and long term side effects.

As with any drug side effects other than those listed may occur, contact your doctor if you are experiencing a side effect that is unusual or particularly bothersome

Estrogen/Progesterone

Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for androgenetic alopecia for women in menopause or whose estrogen and/or progesterone are lacking for other reasons.

Oral Contraceptives

Since birth control pills decrease the production of ovarian androgens, they can be used to treat women's androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers over thirty-five who take "the pill" are at higher risk for blood clots and other serious conditions. Discuss your medical and lifestyle history thoroughly with your doctor. Contraceptive pills come in various hormonal formulations, and your doctor can determine which is right for your specific needs, switching pills if necessary until you are physically and emotionally comfortable with the formulation. Note: Only low androgen index birth control pills should be used to treat hair loss. High androgen index birth control pills actually contribute to hair loss by triggering it or enabling it once it's been triggered by something else.

Nizoral/Ketoconazole

Available as a topical treatment by prescription, Ketoconazole is currently used as an antifungal agent in the treatment of fungal infections. It also has anti-androgenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs (in women, the ovaries). Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1 percent version is now available over-the-counter, but it may not be as effective as the 2 percent prescription strength. There are no significant side effects.

Propecia/Proscar

The drug finasteride inhibits the enzyme 5-alpha reductase, thereby inhibiting the production of prostate-harming, follicle killing DHT. It was first marketed to treat the prostate under the brand name Proscar in 5 mg pills. In 1998, a 1 mg version with the brand name Propecia entered the market as the first pill approved by the FDA for men's hair loss. It works quite well for most men in both preventing hair loss and triggering regrowth, and it may work for some women, although women must not take it if they are pregnant and must not get pregnant while on the drug because of the risk of birth defects in a male fetus. Less than 2 percent of men experience transient sexual side effects including erectile and libido difficulties. In women these side effects do not occur.

Cyproterone Acetate with Ethinyloestradiol

Sold under the brand name Diane 35 and Diane 50, this contraceptive tablet is prescribed in Europe for women's androgenetic alopecia. The drug works by blocking some of the actions of male hormones commonly present in women. Although it's possible for the drug to stop further hair loss and trigger regrowth of hair within about a year, it needs to be used on an ongoing basis in order to maintain regrowth and eliminate hair loss. Possible side effects include breast tenderness, headaches, and decreased libido. It does have one good side effect- it helps prevent osteoporosis. The drug is a combination of cyproterone and estradiol, an estrogen. Both Diane 35 and Diane 50 contain 2 mg of cyproterone. Diane 35 contains 0.035 mg of estradiol. Diane 50 contains 0.050 mg of estradiol. The drug is as effective as, if not more than, spironolactone. Currently this drug is not available in the US