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{{Short description|none}}
More than half of men are affected by [[male pattern baldness]] by age 50, and '''baldness treatments''' are estimated to be a US $1 billion per year industry.<ref name=50percent>{{cite web|url=http://www.intelihealth.com/IH/ihtIH/WSIHW000/9023/24253/352721.html?d=dmtContent|author=Whyche, Stephanie|accessdate=2006-07-26|title=The Bald Truth About Hair Loss In Young Men}}</ref> Since the [[1980]]s, drug therapy has increasingly become a realistic management option for [[baldness]] for men and women. 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. Coupled with chance discoveries and the ever-present lure of a breakthrough involving stem cells and hair multiplication, scientifically proven baldness treatments continue to be an area of research that receives a large amount of funding.
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{{Infobox medical intervention
| name = Management of hair loss
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| specialty =dermatology
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The '''management of hair loss''', includes prevention and treatment of [[alopecia]], [[baldness]], and [[Telogen effluvium|hair thinning]], and regrowth of hair.


==Prevention==
==General concerns==
Scratching of itchy scalp may contribute to hair loss.<ref>{{cite journal |last1=Bin Saif |first1=GA |last2=Ericson |first2=ME |last3=Yosipovitch |first3=G |title=The itchy scalp—scratching for an explanation. |journal=Experimental Dermatology |date=December 2011 |volume=20 |issue=12 |pages=959–68 |doi=10.1111/j.1600-0625.2011.01389.x |pmid=22092575|pmc=3233984 }}</ref>
It is easier to prevent the apparent 'aging' and falling out of healthy hairs than to regrow hair in [[Hair follicle|follicles]] that are already dormant. There are products that have good success rates with regrowth, including the scientifically proven [[finasteride]] (marketed in the U.S. as [[Propecia]]) and [[minoxidil]] (marketed in the U.S. as [[Rogaine (drug)|Rogaine]], and outside the U.S. as Regaine). Without preventive treatment, in three double-blind, placebo-controlled, randomized studies, 72% of the balding men on placebo had lost hair compared to baseline by 24 months. This is compared to 17% of participants on [[Propecia]].


===Health===
The prospective treatment of hair multiplication/hair cloning, which extracts self-replenishing follicle stem cells, multiplies them many times over in the lab, 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 in 2009-2015. Subsequent versions of the treatment are expected by some scientists to be able to cause these follicle stem cells to simply signal the surrounding hair follicles to rejuvenate.


====Body weight====
The below treatments are some of the most prominent. Generic brands, often with identical chemical structure or the same active ingredients, may be equally effective and are cheaper.
Prevention of [[obesity]] helps. Obesity is linked to [[Telogen effluvium|hair thinning]].<ref>{{cite journal |last1=Morinaga |first1=H |last2=Mohri |first2=Y |last3=Grachtchouk |first3=M |last4=Asakawa |first4=K |last5=Matsumura |first5=H |last6=Oshima |first6=M |last7=Takayama |first7=N |last8=Kato |first8=T |last9=Nishimori |first9=Y |last10=Sorimachi |first10=Y |last11=Takubo |first11=K |last12=Suganami |first12=T |last13=Iwama |first13=A |last14=Iwakura |first14=Y |last15=Dlugosz |first15=AA |last16=Nishimura |first16=EK |title=Obesity accelerates hair thinning by stem cell-centric converging mechanisms. |journal=Nature |date=July 2021 |volume=595 |issue=7866 |pages=266–271 |doi=10.1038/s41586-021-03624-x |pmid=34163066|pmc=9600322 |bibcode=2021Natur.595..266M |s2cid=235625692 }}</ref>


====Healthy diet====
Interestingly, [[placebo]] treatments in studies often have reasonable success rates, though not as high as the products being tested, and even similar side-effects as the products. For example, in [[finasteride]] (Propecia) studies, the percent of patients with any drug-related sexual adverse experience was 3.8% compared with 2.0% in the placebo group.<ref name=finasteride1>{{cite journal|author=Layden, J.|coauthors=Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, et al.|journal=J Am Acad Dermatol|title=Finasteride in the treatment of men with frontal male pattern hair loss|date=in press}}</ref>
{{see also|Healthy diet}}


Oils with fatty acids that has been studied to prevent dermatitis includes:<ref>{{cite journal |last1=Søyland |first1=E |last2=Funk |first2=J |last3=Rajka |first3=G |last4=Sandberg |first4=M |last5=Thune |first5=P |last6=Rustad |first6=L |last7=Helland |first7=S |last8=Middelfart |first8=K |last9=Odu |first9=S |last10=Falk |first10=ES |title=Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study. |journal=The British Journal of Dermatology |date=June 1994 |volume=130 |issue=6 |pages=757–64 |doi=10.1111/j.1365-2133.1994.tb03414.x |pmid=8011502|s2cid=25066444 }}</ref><ref>{{cite journal |last1=Callaway |first1=J |last2=Schwab |first2=U |last3=Harvima |first3=I |last4=Halonen |first4=P |last5=Mykkänen |first5=O |last6=Hyvönen |first6=P |last7=Järvinen |first7=T |title=Efficacy of dietary hempseed oil in patients with atopic dermatitis. |journal=The Journal of Dermatological Treatment |date=April 2005 |volume=16 |issue=2 |pages=87–94 |doi=10.1080/09546630510035832 |pmid=16019622|s2cid=18445488 }}</ref>
While treating hair loss most successfully is a multi-faceted, ongoing experiment for the individual, there are three principles, sometimes called "The Three P's" that are considered important to help produce success and avoid the somewhat common mistakes that can sabotage treatments. The Three P's are: '''p'''roven treatments first, take '''p'''ictures, and be '''p'''atient. The average hair loss treatment takes a minimum of 6 months to begin working, and sometimes up to 24 months to truly see optimal results. Treating hair loss takes time because of '''hair cycles'''. The process of hair loss is the process of "miniaturization," which takes many years. Hairs grow in, cycle into dormancy, and then grow in again several months later. Each time they re-emerge, they do so thinner, shorter, and less pigmented. In time, they become so small that they are no longer noticeable. This can take many years. 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.
* [[Corn oil]]: [[Linoleic acid]] (LA)
* [[Fish oil]]: [[Eicosapentaenoic acid]] (EPA) and [[docosahexaenoic acid]] (DHA)
* [[Hemp seed oil]]: [[Linoleic acid]] (LA), and [[alpha-Linolenic acid]] (ALA)


====Alternative medicine====
This difficulty can be increased because it is speculated that many (scientifically proven) treatments often cause initial periods of shedding, as some resting hair follicles are ejected and a new cycle of growth begins, hopefully with a thicker follicle. Discontinuing all treatment will cause a period of shedding, likely to one's non-treatment baseline, but probably not worse. {{Fact|date=February 2007}}
The scalp must be cleaned from [[sebum]], sweat, and dirt, prior to topical application, for agents to penetrate it.


A 2020 [[systemic review]] on agents used to treat androgenic alopecia found that:<ref name="PMID33011954">{{cite journal | vauthors = Ashique S, Sandhu NK, Haque SN, Koley K | title = A Systemic Review on Topical Marketed Formulations, Natural Products, and Oral Supplements to Prevent Androgenic Alopecia: A Review | journal = Natural Products and Bioprospecting | volume = 10 | issue = 6 | pages = 345–365 | date = December 2020 | pmid = 33011954 | pmc = 7648777 | doi = 10.1007/s13659-020-00267-9 }}</ref>
==Minoxidil==
* Oral supplementation of [[vitamin A]], [[vitamin B|B]], [[vitamin|C]], [[vitamin D|D]], [[vitamin E|E]], and trace element [[iron]], [[selenium]], and [[zinc]], will prevent androgenic alopecia caused by [[malnutrition]]. [[Multivitamin]]s can be used.
{{main|Minoxidil}}
* Topical application of [[onion]] juice, [[rosemary]] oil, [[saw palmetto]], [[pumpkin seed]] oil, [[procyanidin]], [[garlic]] gel, [[capsaicin]], [[caffeine]], amino acids, and [[curcumin]] helped prevent hair loss.
[[Minoxidil]] is a [[vasodilator]] and originally was exclusively used as an oral drug (Loniten®) to treat [[Hypertension|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 to treat baldness and hair loss as [[Rogaine (drug)|Rogaine]]. Minoxidil is applied topically to the scalp, and has been shown to promote hair growth in about 25% of men and women{{Fact|date=September 2007}}, though it may take several months to work. New hair is usually thinner and lighter, like baby hair, and grows mostly on the top of the head, not at the hairline. Its effects may fade with time. Skin irritation is the most commonly reported side effect. Dizziness and increased heart rate are listed side-effects on the UK patient information leaflet.


===Heating, ventilation, and air conditioning (HVAC)===
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 percent of men using 5 percent minoxidil, 42 percent using 2 percent minoxidil, and 13 percent of placebo users. Among these men, moderate to great increases in hair growth were seen in the frontal scalp regions of 19 percent of men using 5 percent minoxidil, 10 percent using 2 percent minoxidil, and 3 percent of placebo users. [http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp;jsessionid=GqhKXbTSppGQWLhLDmk2hbrYXGYyQD0NzWRCLBvVQLQL8YbGr8LK!2026812983?id=51115]
The method of action for Minoxidil is not known. It is clearly not just the vasodialating effects which cause hair regrowth, as no other vasodialator has been shown to be effective in treating hair loss.


==Antiandrogens==
====Humidifier====
A [[humidifier]] can be used to prevent low indoor humidity during [[winter]] (especially with indoor heating), and [[dry season]].<ref>{{cite web |title=Seasonal Shedding Hair in Summer or Winter! |url=https://mdm-communications.com/seasonal-shedding-hair-summer-winter/2/ |website=MDM Health |date=28 October 2015 |access-date=December 9, 2021 |archive-date=December 9, 2021 |archive-url=https://web.archive.org/web/20211209232940/https://mdm-communications.com/seasonal-shedding-hair-summer-winter/2/ |url-status=live }}</ref>
{{main|Antiandrogen}}
[[Antiandrogens]] block DHT already produced and present in the blood stream 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]]. [[Ketoconazole]], (often sold as [[Nizoral Shampoo]]) and is prescribed by medical professionals or available over the counter depending on the product, concentration and country.


Commonly, patients with [[seborrhoeic dermatitis]] experience mild redness, scaly skin lesions and in some cases [[hair loss]].<ref>{{cite web|url=http://www.mamashealth.com/skin/seb.asp|title=What is Seborrheic Dermatitis?|access-date=June 11, 2010|url-status=live|archive-url=https://web.archive.org/web/20100420023503/http://www.mamashealth.com/skin/seb.asp|archive-date=April 20, 2010}}</ref>
===Finasteride===
{{main|Finasteride}}
[[Finasteride]], marketed as the brand-name drug ''[[Propecia]]'' and ''[[Proscar]]'' by [[Merck & Co.|Merck]], belongs to a class of drugs called aza-steroids. Finasteride is a "[[dihydrotestosterone|DHT]] [[Enzyme inhibitor|inhibitor]]" and was originally approved by the [[FDA]] for the treatment of [[benign prostatic hyperplasia]] (BPH). It accomplishes this by blocking the production of [[5-alpha-reductase]], the enzyme responsible for the conversion of free testosterone to DHT. Propecia (1 mg of finasteride daily) blocks approximately 55% of DHT activity and Proscar (5mg of finasteride daily) blocks 70%.[http://www.hairlossadvisor.com/hairlossadvisor/165.htm] Soon after its release, it was discovered that patients who were taking finasteride were experiencing hair regrowth. In 1997, Finasteride was approved by the [[FDA]] for the treatment of [[male pattern baldness]]. A 5 year study revealed that 9 of 10 men taking finasteride (1mg daily) experienced visible results (42% of men taking Propeica experienced no further hair loss while 48% experienced no further hair loss and hair regrowth).[http://www.propecia.com/finasteride/propecia/consumer/see_the_proof/clinical_study.jsp]
In clinical studies, finasteride, like [[Minoxidil]], was shown to work on both the [[Crown (anatomy)]] area and the [[hairline]] area, but is most successful in the crown area.<ref name=finasteride1/>


Low humidity can cause adverse health effects and may cause [[atopic dermatitis]],<ref>{{cite journal | vauthors = Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP | title = The effect of environmental humidity and temperature on skin barrier function and dermatitis | journal = Journal of the European Academy of Dermatology and Venereology | volume = 30 | issue = 2 | pages = 223–249 | date = February 2016 | pmid = 26449379 | doi = 10.1111/jdv.13301 | s2cid = 12378072 | doi-access = free }}</ref> and [[seborrhoeic dermatitis]].<ref>{{cite journal | vauthors = Araya M, Kulthanan K, Jiamton S | title = Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country | journal = Indian Journal of Dermatology | volume = 60 | issue = 5 | pages = 519 | date = September 2015 | pmid = 26538714 | pmc = 4601435 | doi = 10.4103/0019-5154.164410 | doi-access = free }}</ref>
Finasteride is usually only prescribed for men and should not even be touched by pregnant or potentially pregnant women, as it has been speculated that it could cause severe birth defects in male fetuses.[http://www.fda.gov/bbs/topics/ANSWERS/ANS00842.html] Studies have shown that finasteride is ineffective for treating hair loss 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 estrogen versus a sensitivity to testosterone. Other studies have shown that finasteride is effective for many women with follicular sensitivity to androgens.{{Fact|date=February 2007}} Some doctors are now willing to prescribe finasteride to women on the condition that either the women is taking careful birth control measures or that the woman cannot become pregnant.


===Dutasteride===
==Treatments==
{{main|dutasteride}}
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 (adding on average 108 versus 72 hair per 1" diameter area), 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 (shown in the same study to add on average 92 hairs to the same area) is increasingly available to hair loss sufferers via the grey-market of online prescription medication, and physicians increasingly willing to prescribe drugs "off-label."


===Combination therapy===
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]]). [http://clinicaltrials.gov/show/NCT00441116] The future impact that this study will have on the [[FDA]]'s approval or disapproval of [[Avodart]] for the treatment of [[male pattern baldness]] in the United States is yet to be determined.
Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.<ref>{{cite journal | vauthors = Khandpur S, Suman M, Reddy BS | title = Comparative efficacy of various treatment regimens for androgenetic alopecia in men | journal = The Journal of Dermatology | volume = 29 | issue = 8 | pages = 489–498 | date = August 2002 | pmid = 12227482 | doi = 10.1111/j.1346-8138.2002.tb00314.x | s2cid = 20886812 }}</ref>


Combination therapy of LLLT or microneedling with finasteride<ref name="Darwin Heyes Hirt Wikramanayake 2017 pp. 425–434"/> or minoxidil demonstrated substantive increases in hair count.<ref name="Zhou Chen Qu Zhang 2020 p.">{{cite journal | last1=Zhou | first1=Yi | last2=Chen | first2=Chenglong | last3=Qu | first3=Qian | last4=Zhang | first4=Chunhua | last5=Wang | first5=Jin | last6=Fan | first6=Zhexiang | last7=Miao | first7=Yong | last8=Hu | first8=Zhiqi | title=The effectiveness of combination therapies for androgenetic alopecia: A systematic review and meta-analysis | journal=Dermatologic Therapy | publisher=Hindawi Limited | volume=33 | issue=4 | year=2020 | pages=e13741 | issn=1396-0296 | doi=10.1111/dth.13741 | pmid=32478968 | doi-access=free }}</ref>
===Ketoconazole===
{{main|Ketoconazole}}
[[Ketoconazole]] is a synthetic [[antifungal drug]] used to [[prophylaxis|prevent]] and treat skin and fungal infections, especially in [[Immune deficiency|immunocompromised]] patients such as those with [[AIDS]]. Because it is both an anti-fungal and also a [[5-alpha reductase]] inhibitor, it can help to slow the balding process.<ref name=HugoPerez>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14729013&query_hl=5&itool=pubmed_docsum
|journal = Med Hypotheses
|author = Hugo Perez BS
|date = 2004
|volume = 62
|issue = 1
|pages = 112-115
|title = Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men.
}}</ref><ref name=pierard>
{{cite journal
|url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9669136&query_hl=14&itool=pubmed_docsum
|journal = Dermatology
|author = Pierard-Franchimont C
|coauthors = De Doncker P, Cauwenbergh G, Pierard GE
|date = 1998
|volume = 196
|issue = 4
|pages = 474-477
|title = Ketoconazole shampoo: effect of long-term use in androgenic alopecia.
}}</ref>
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.<ref>{{cite web|url=http://www.fetal-exposure.org/ANTIFUNGAL.html|title=Ketoconazole-(P)|publisher=Illinois Teratogen Inforamation Service|accessdate=2006-08-09}}</ref>


===Saw palmetto===
===Medication===
{{main|Saw Palmetto}}
[[Saw palmetto]] (''Serenoa repens'') is an [[herbal medicine|herbal]] DHT inhibitor which is cheaper than most commercial drugs and is claimed to have fewer side effects than finasteride and dutasteride. Unlike other 5-alpha-reductase inhibitors, saw palmetto extract inhibits the conversion of testosterone to DHT without interfering with the cellular capacity to secrete [[Prostate specific antigen|PSA]].<ref name=habib>{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15543614&query_hl=16&itool=pubmed_docsum
|author = Habib FK
|coauthors= Ross M, Ho CK, Lyons V, Chapman K
|journal = Int J Cancer
|date = 2005 Mar 20
|volume = 114
|issue = 2
|pages = 190-194
|title = Serenoa repens (Permixon) inhibits the 5alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression.
}}</ref>
Saw palmetto extract has been demonstrated to inhibit both isoforms of alpha-5-reductase, unlike finasteride which only inhibits the (predominant) type 2 isoenzyme of alpha-5-reductase.<ref name=prager>{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12006122&query_hl=16&itool=pubmed_docsum
|author = Prager N
|coauthors = Bickett K, French N, Marcovici G
|journal = J Altern Complement Med
|date = 2002 Apr 8
|volume = 8
|issue = 2
|pages = 143-152
|title = A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia.
}}</ref><ref name=marks>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11337315&query_hl=16&itool=pubmed_docsum
|author = Marks LS
|coauthors = Hess DL, Dorey FJ, Luz Macairan M, Cruz Santos PB, Tyler VE
|journal = Urology
|date = May, 2001
|volume = 57
|issue = 5
|pages = 999-1005
|title = Tissue effects of saw palmetto and finasteride: use of biopsy cores for in situ quantification of prostatic androgens.
}}</ref>
It must be noted that DHT inhibition [[in vitro]] does not necessarily imply inhibition [[in vivo]].
A preliminary study of saw palmetto extract for treating hair loss noted improvement in six of ten subjects over a six month period. Dosages were not reported.<ref name=prager/> The small size of the study and its relatively short duration limit must be noted.


====Add-hocs====
There hasn't been a single reputable study done showing that Saw Palmetto has any effect on treating hair loss. One study can be found in PubMed, but it was run by the makers of a saw palmetto product, and was publicly labeled as "Bunk" on ''[[20/20]]'' in January 2003 on nationwide television because it only included 10 participants and lasted only 6 months.<ref name=marks>{{cite journal|url=http://www.hairlosstalk.com/newsletter/article230.htm}}</ref>
The topical [[bioavailability]] of synthetic medicines such as [[antiandrogen]]s, as well as phytochemicals such as [[quercetin]], has been improved with incorporation of drugs in [[nanoparticles]], or [[microneedling]].<ref>{{cite journal | vauthors = Cardoso CO, Tolentino S, Gratieri T, Cunha-Filho M, Lopez RF, Gelfuso GM | title = Topical Treatment for Scarring and Non-Scarring Alopecia: An Overview of the Current Evidence | journal = Clinical, Cosmetic and Investigational Dermatology | volume = 14 | pages = 485–499 | date = 2021 | pmid = 34012282 | pmc = 8126704 | doi = 10.2147/CCID.S284435 | doi-access = free }}</ref>


====Synthetic medicine====
==Copper peptides==
Treatments for the various forms of hair loss have only moderate success.<ref name=Levy2013>{{cite journal | vauthors = Levy LL, Emer JJ | title = Female pattern alopecia: current perspectives | journal = International Journal of Women's Health | volume = 5 | pages = 541–556 | date = August 2013 | pmid = 24039457 | pmc = 3769411 | doi = 10.2147/IJWH.S49337 | doi-access = free }}</ref> Three medications have evidence to support their use in male pattern hair loss: [[finasteride]], [[dutasteride]] and [[minoxidil]].<ref name=Ban2013/> They typically work better to prevent further hair loss than to regrow lost hair.<ref name=Ban2013/>
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.<ref>[http://www.drproctor.com/patents/pro876.html US patent 5,470,876, "Topical SOD for treating hair loss"]</ref>


They may be used together when hair loss is progressive or further regrowth is desired after 12 months.<ref name="webmd_treatments">{{cite web |url=http://www.webmd.com/skin-beauty/guide/hair-loss-treatments |title=Propecia & Rogaine for Treating Male Pattern Baldness |publisher=Webmd.com |access-date=May 19, 2010 |archive-date=July 9, 2008 |archive-url=https://web.archive.org/web/20080709023925/http://www.webmd.com/skin-beauty/guide/hair-loss-treatments |url-status=live }}</ref> Other medications include [[ketoconazole]], and in female androgenic alopecia [[spironolactone]] and [[flutamide]].<ref name="pmid22735503">{{cite journal | vauthors = McElwee KJ, Shapiro JS | title = Promising therapies for treating and/or preventing androgenic alopecia | journal = Skin Therapy Letter | volume = 17 | issue = 6 | pages = 1–4 | date = June 2012 | pmid = 22735503 }}</ref>
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".<ref>[http://www.drproctor.com/Archd.htm "Endothelium-Derived Relaxing Factor and Minoxidil: Active Mechanisms in Hair Growth", ''Archives in Dermatology'', vol 125, August, 1989]</ref>


===== Baricitinib =====
A product called Tricomin, released by Procyte, based on Copper Peptides was shown in FDA studies to produce results similar to 2% minoxidil. FDA studies were discontinued, according to Procyte, because of the expense. While by today's standards these results are quite sub-par, compounds based on this formula are licensed by Procyte to "cosmo-ceutical" makers, and have been shown in clinical studies to help hair grafts take after the transplant.{{Fact|date=February 2007}}
In June 2022, the FDA authorized [[baricitinib]] for the treatment of severe alopecia areata.<ref name="FDA PR 20220613">{{cite press release | title=FDA Approves First Systemic Treatment for Alopecia Areata | website=U.S. [[Food and Drug Administration]] (FDA) | date=13 June 2022 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata | access-date=13 June 2022 | archive-date=14 June 2022 | archive-url=https://web.archive.org/web/20220614051142/https://www.fda.gov/news-events/press-announcements/fda-approves-first-systemic-treatment-alopecia-areata | url-status=live }} {{PD-notice}}</ref><ref name="Lilly PR 20220613">{{cite press release | title=FDA Approves Lilly and Incyte's Olumiant (baricitinib) As First and Only Systemic Medicine for Adults with Severe Alopecia Areata | publisher=Eli Lilly | via=PR Newswire | date=13 June 2022 | url=https://www.prnewswire.com/news-releases/fda-approves-lilly-and-incytes-olumiant-baricitinib-as-first-and-only-systemic-medicine-for-adults-with-severe-alopecia-areata-301567120.html | access-date=13 June 2022 | archive-date=14 June 2022 | archive-url=https://web.archive.org/web/20220614034511/https://www.prnewswire.com/news-releases/fda-approves-lilly-and-incytes-olumiant-baricitinib-as-first-and-only-systemic-medicine-for-adults-with-severe-alopecia-areata-301567120.html | url-status=live }}</ref>


==Spin labels==
===== Minoxidil =====
[[Minoxidil]], applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with [[androgenic alopecia]].<ref name="2014AArev"/><ref>{{cite journal | vauthors = van Zuuren EJ, Fedorowicz Z, Schoones J | title = Interventions for female pattern hair loss | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 5 | pages = CD007628 | date = May 2016 | pmid = 27225981 | pmc = 6457957 | doi = 10.1002/14651858.CD007628.pub4 }}</ref> About 40% of men experience hair regrowth after 3–6 months.<ref>{{cite journal | vauthors = Goren A, Shapiro J, Roberts J, McCoy J, Desai N, Zarrab Z, Pietrzak A, Lotti T | display-authors = 6 | title = Clinical utility and validity of minoxidil response testing in androgenetic alopecia | journal = Dermatologic Therapy | volume = 28 | issue = 1 | pages = 13–16 | year = 2015 | pmid = 25112173 | doi = 10.1111/dth.12164 | s2cid = 205082682 | doi-access = free }}</ref> It is the only topical product that is FDA approved in America for androgenic hair loss.<ref name="2014AArev">{{cite journal | vauthors = Varothai S, Bergfeld WF | title = Androgenetic alopecia: an evidence-based treatment update | journal = American Journal of Clinical Dermatology | volume = 15 | issue = 3 | pages = 217–230 | date = July 2014 | pmid = 24848508 | doi = 10.1007/s40257-014-0077-5 | s2cid = 31245042 }}</ref> However, increased hair loss has been reported.<ref>{{cite web|url=https://www.drugs.com/sfx/rogaine-side-effects.html|title=Rogaine Side Effects in Detail - Drugs.com|website=drugs.com|access-date=January 28, 2018|archive-date=September 22, 2017|archive-url=https://web.archive.org/web/20170922052041/https://www.drugs.com/sfx/rogaine-side-effects.html|url-status=live}}</ref><ref name="Drugs.com">{{cite web|url = https://www.drugs.com/pro/minoxidil.html|title = Minoxidil Official FDA information, side effects and uses|publisher = Drugs.com|access-date = January 28, 2018|archive-date = September 22, 2017|archive-url = https://web.archive.org/web/20170922051930/https://www.drugs.com/pro/minoxidil.html|url-status = live}}</ref>
In animal models, the [[nitroxide]] [[spin label]]s [[TEMPO]] and [[TEMPOL]] enhance hair regrowth following radiation. National Cancer Institute-sponsored clinical trials [http://clincancerres.aacrjournals.org/cgi/content/full/10/19/6411 report] TEMPOL is similarly effective in humans. Also see United States Patent 5,714,482 "Topical spin labels and method".


=====Antiandrogens=====
==Diet and lifestyle==
<!-- Finasteride -->
While there are a number of genetic factors which determine a person's susceptibility to androgenic alopecia including androgen receptor polymorphisms, 5-alpha-reductase levels in the scalp, androgen receptor density and distribution in the scalp, and other factors some of which may not have been discovered. Some speculate the increase in baldness in the population of Japan after World War II demonstrates that hair loss can be influenced by diet and lifestyle. Increased fat or caloric intake, decrease in [[aerobic]] exercise and general "westernization" was accompanied by a dramatic increase in incidence of male pattern baldness. {{Fact|date=February 2007}}
[[Finasteride]] is used to treat [[male pattern hair loss]].<ref name=PropeciaLabel>{{Cite web|url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf|title=Propecia label|access-date=June 3, 2015|archive-date=February 10, 2017|archive-url=https://web.archive.org/web/20170210151045/http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf|url-status=live}}</ref> Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.<ref name=2014AArev/> There is no good evidence for its use in women.<ref name=Levy2013/> It may cause [[gynecomastia]], [[erectile dysfunction]] and [[Depression (mood)|depression]].<ref>{{cite journal | vauthors = Andersson S | title = Steroidogenic enzymes in skin | journal = European Journal of Dermatology | volume = 11 | issue = 4 | pages = 293–295 | year = 2001 | pmid = 11399532 }}</ref>


<!-- Dutasteride -->
Daily, vigorous aerobic exercise (as opposed to short workout periods designed to raise androgen levels and build muscle, or more sporadic exercise) and a diet which is adequate yet more moderate in terms of fat and total calorie intake have been shown to reduce baseline insulin levels as well as baseline total and free testosterone<ref>
[[Dutasteride]] is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition.<ref>{{cite web|url=http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=11618|title=Avodart 0.5mg soft capsules – Summary of Product Characteristics (SmPC) – (eMC)|website=emc.medicines.org.uk|access-date=August 7, 2010|archive-date=April 26, 2006|archive-url=https://web.archive.org/web/20060426212556/http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=11618|url-status=dead}}</ref><ref name="pmid30863034">{{cite journal | vauthors = Zhou Z, Song S, Gao Z, Wu J, Ma J, Cui Y | title = The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: a systematic review and meta-analysis | journal = Clinical Interventions in Aging | volume = 14 | pages = 399–406 | date = 2019 | pmid = 30863034 | pmc = 6388756 | doi = 10.2147/CIA.S192435 | doi-access = free }}</ref><ref name="pmid17110217">{{cite journal | vauthors = Olsen EA, Hordinsky M, Whiting D, Stough D, Hobbs S, Ellis ML, Wilson T, Rittmaster RS | display-authors = 6 | title = The importance of dual 5alpha-reductase inhibition in the treatment of male pattern hair loss: results of a randomized placebo-controlled study of dutasteride versus finasteride | journal = Journal of the American Academy of Dermatology | volume = 55 | issue = 6 | pages = 1014–1023 | date = December 2006 | pmid = 17110217 | doi = 10.1016/j.jaad.2006.05.007 }}</ref> While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in [[South Korea]] and [[Japan]].<ref name="pmid27489426">{{cite journal | vauthors = Choi GS, Kim JH, Oh SY, Park JM, Hong JS, Lee YS, Lee WS | title = Safety and Tolerability of the Dual 5-Alpha Reductase Inhibitor Dutasteride in the Treatment of Androgenetic Alopecia | journal = Annals of Dermatology | volume = 28 | issue = 4 | pages = 444–450 | date = August 2016 | pmid = 27489426 | pmc = 4969473 | doi = 10.5021/ad.2016.28.4.444 }}</ref><ref name="ShapiroOtberg2015">{{cite book|vauthors=Shapiro J, Otberg N|title=Hair Loss and Restoration, Second Edition|url=https://books.google.com/books?id=bJG9BwAAQBAJ&pg=PA39|date=17 April 2015|publisher=CRC Press|isbn=978-1-4822-3199-1|pages=39–|access-date=December 9, 2021|archive-date=January 12, 2023|archive-url=https://web.archive.org/web/20230112145741/https://books.google.com/books?id=bJG9BwAAQBAJ&pg=PA39|url-status=live}}</ref>
{{cite web
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15618989&query_hl=16&itool=pubmed_docsum
|author = Daly W
|coauthors = Seegers CA, Rubin DA, Dobridge JD, Hackney AC
|journal = Eur J Appl Physiol
|date = Jan 2005
|volume = 93
|issue = 4
|pages = 375-380
|title = Relationship between stress hormones and testosterone with prolonged endurance exercise
}}</ref>, which would significantly lower baseline DHT.


<!-- Spironolactone -->
Lower insulin levels and reduced stress both result in raised levels of Sex Hormone Binding Globulin ([[SHBG]]). SHBG binds to testosterone, and prevents it from circulating free in the blood. Only free testosterone is converted to DHT. It is the level of free androgens and not total androgens which is relevant to the levels of DHT in the scalp and the progression of MPB. In short, aerobic exercise is capable of significantly lowering DHT.
There is tentative support for [[spironolactone]] in women.<ref name=Levy2013/> Due to its feminising side effects and risk of infertility it is not often used by men.<ref>{{cite journal | vauthors = Buchanan JF, Davis LJ | title = Drug-induced infertility | journal = Drug Intelligence & Clinical Pharmacy | volume = 18 | issue = 2 | pages = 122–132 | date = February 1984 | pmid = 6141923 | doi = 10.1177/106002808401800205 | s2cid = 24807929 }}</ref><ref>{{cite journal | vauthors = Sinclair R, Patel M, Dawson TL, Yazdabadi A, Yip L, Perez A, Rufaut NW | title = Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness | journal = The British Journal of Dermatology | volume = 165 | issue = Suppl 3 | pages = 12–18 | date = December 2011 | pmid = 22171680 | doi = 10.1111/j.1365-2133.2011.10630.x | s2cid = 39734527 | doi-access = free }}</ref> It can also cause [[hypotension|low blood pressure]], [[hyperkalemia|high blood potassium]], and [[cardiac dysrhythmia|abnormal heart rhythms]]. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a [[teratogen]], and can cause ambiguous genitalia in newborn children.<ref name="Spirono">{{cite journal | vauthors = Rathnayake D, Sinclair R | title = Use of spironolactone in dermatology | journal = Skinmed | volume = 8 | issue = 6 | pages = 328–32; quiz 333 | year = 2010 | pmid = 21413648 }}</ref>
<ref name=barnard1>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12458975&query_hl=10&itool=pubmed_docsum
|author = Barnard RJ
|coauthors = Aronson WJ, Tymchuk CN, Ngo TH
|date = November 2002
|volume = 3
|issue = 4
|pages = 303-308
|journal = Obes Rev
|title = Prostate cancer: another aspect of the insulin-resistance syndrome?
}}</ref>
<ref name=barnard2>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15648182&query_hl=10&itool=pubmed_docsum
|author = Barnard RJ
|coauthors = Aronson WJ
|journal = Recent Results Cancer Res.
|date = 2005
|volume = 166
|pages = 47-61
|title = Preclinical models relevant to diet, exercise, and cancer risk.
}}</ref>


<!-- Flutamide -->
Androgenic alopecia has been shown to correlate with metabolic syndrome. Medically increasing androgen levels does not worsen this condition, demonstrating that androgens do not cause metabolic syndrome. Instead, high insulin levels (and possibly chronic inflammation
There is tentative evidence for [[flutamide]] in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use.<ref name=Levy2013/><ref name="pmid28379593">{{cite journal | vauthors = Giorgetti R, di Muzio M, Giorgetti A, Girolami D, Borgia L, Tagliabracci A | title = Flutamide-induced hepatotoxicity: ethical and scientific issues | journal = European Review for Medical and Pharmacological Sciences | volume = 21 | issue = 1 Suppl | pages = 69–77 | date = March 2017 | pmid = 28379593 | doi = }}</ref> Like spironolactone, flutamide is typically only used by women.<ref>{{cite journal | vauthors = Yazdabadi A, Sinclair R | title = Treatment of female pattern hair loss with the androgen receptor antagonist flutamide | journal = The Australasian Journal of Dermatology | volume = 52 | issue = 2 | pages = 132–134 | date = May 2011 | pmid = 21605098 | doi = 10.1111/j.1440-0960.2010.00735.x | s2cid = 30128397 }}</ref> [[Bicalutamide]] is another option for the treatment of female pattern hair loss.<ref name="pmid35032336">{{cite journal | vauthors = Carvalho RM, Santos LD, Ramos PM, Machado CJ, Acioly P, Frattini SC, Barcaui CB, Donda AL, Melo DF | display-authors = 6 | title = Bicalutamide and the new perspectives for female pattern hair loss treatment: What dermatologists should know | journal = Journal of Cosmetic Dermatology | volume = 21| issue = 10| date = January 2022 | pages = 4171–4175 | pmid = 35032336 | doi = 10.1111/jocd.14773 | s2cid = 253239337 }}</ref><ref name="pmid34668238">{{cite journal | vauthors = Meyer-Gonzalez T, Bacqueville D, Grimalt R, Mengeaud V, Piraccini BM, Rudnicka L, Saceda-Corralo D, Vogt A, Vano-Galvan S | display-authors = 6 | title = Current controversies in trichology: a European expert consensus statement | journal = Journal of the European Academy of Dermatology and Venereology | volume = 35 | issue = Suppl 2 | pages = 3–11 | date = November 2021 | pmid = 34668238 | doi = 10.1111/jdv.17601 | hdl = 11585/863826 | s2cid = 239029062 | hdl-access = free }}</ref><ref name="pmid34741573">{{cite journal | vauthors = Nestor MS, Ablon G, Gade A, Han H, Fischer DL | title = Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics | journal = Journal of Cosmetic Dermatology | volume = 20 | issue = 12 | pages = 3759–3781 | date = December 2021 | pmid = 34741573 | doi = 10.1111/jocd.14537 | pmc = 9298335 | s2cid = 243801494 }}</ref> It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile.<ref name="pmid34668238" /><ref name="pmid34741573" /><ref name="pmid33334002">{{cite journal | vauthors = Cignarella A, Mioni R, Sabbadin C, Dassie F, Parolin M, Vettor R, Barbot M, Scaroni C | display-authors = 6 | title = Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS | journal = International Journal of Molecular Sciences | volume = 21 | issue = 24 | page = 9554 | date = December 2020 | pmid = 33334002 | pmc = 7765466 | doi = 10.3390/ijms21249554 | doi-access = free }}</ref> However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.<ref name="pmid34668238" /><ref name="pmid33334002" />
<ref name=joffe>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16216530&query_hl=10&itool=pubmed_docsum
|author = Joffe HV
|coauthors = Ridker PM, Manson JE, Cook NR, Buring JE, Rexrode KM
|journal = Ann Epidemiol
|date = February 2006
|volume = 16
|issue = 2
|pages = 105-112
|title = Sex hormone-binding globulin and serum testosterone are inversely associated with C-reactive protein levels in postmenopausal women at high risk for cardiovascular disease.
}}</ref>) seem the likely link in the demonstrated correlation between baldness and metabolic syndrome. This reinforces the notion that behaviors which help to keep insulin levels low and reduce chronic inflammation might also help to preserve hair. <ref name=cikim>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16295051&query_hl=1&itool=pubmed_docsum
|author = Cikim AS
|coauthors = Ozbey N, Sencer E, Molvalilar S, Orhan Y
|journal = Diabetes Nutr Metab.
|date = Oct. 2004
|volume = 17
|issue = 5
|pages = 290-295
|title = Associations among sex hormone binding globulin concentrations and characteristics of the metabolic syndrome in obese women
}}</ref>
<ref name=heald>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16235154&query_hl=1&itool=pubmed_docsum
|author = Heald AH
|coauthors = Anderson SG, Ivison F, Riste L, Laing I, Cruickshank JK, Gibson JM
|journal = Exp Clin Endocrinol Diabetes
|date = Oct. 2005
|volume = 113
|issue = 9
|pages = 522-528
|title = Low sex hormone binding globulin is a potential marker for the metabolic syndrome in different ethnic groups
}}</ref>


=====Ketoconazole=====
==Hair Transplantation==
[[Ketoconazole]] may help in women.<ref>{{cite journal | vauthors = Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE | title = Ketoconazole shampoo: effect of long-term use in androgenic alopecia | journal = Dermatology | volume = 196 | issue = 4 | pages = 474–477 | date = 1998 | pmid = 9669136 | doi = 10.1159/000017954 | s2cid = 30635892 }}</ref><ref>{{cite journal | vauthors = Fields JR, Vonu PM, Monir RL, Schoch JJ | title = Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review | journal = Dermatologic Therapy | volume = 33 | issue = 1 | pages = e13202 | date = January 2020 | pmid = 31858672 | doi = 10.1111/dth.13202 | s2cid = 209427721 | doi-access = free }}</ref>


===Technological treatments===
[[Hair transplantation]] 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.


====Low-level laser therapy (LLLT)====
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 mimicing nature hair for hair. This recent hair transplant procedure is called "[[Follicular Unit Transplantation]]". Given the improved naturalness of hair transplantation surgery hair loss sufferers are increasingly selecting this hair loss treatment.
[[Low-level laser therapy]] or photobiomodulation is also referred to as red light therapy and cold laser therapy. It is a non-invasive treatment option.


LLLT is shown to increase hair density and growth in both genders. The types of devices (hat, comb, helmet) and duration did not alter the effectiveness,<ref name="Liu Liu Chen Chin 2019 pp. 1063–1069">{{cite journal | last1=Liu | first1=Kao-Hui | last2=Liu | first2=Donald | last3=Chen | first3=Yu-Tsung | last4=Chin | first4=Szu-Ying | title=Comparative effectiveness of low-level laser therapy for adult androgenic alopecia: a system review and meta-analysis of randomized controlled trials | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=34 | issue=6 | date=2019-01-31 | issn=0268-8921 | doi=10.1007/s10103-019-02723-6 | pages=1063–1069| pmid=30706177 | s2cid=59524423 }}</ref> with more emphasis to be placed on lasers compared to LEDs.<ref name="Gupta Carviel 2019 pp. 643–647">{{cite journal | last1=Gupta | first1=A. K. | last2=Carviel | first2=J. L. | title=Meta-analysis of photobiomodulation for the treatment of androgenetic alopecia | journal=Journal of Dermatological Treatment | publisher=Informa UK Limited | volume=32 | issue=6 | date=2019-11-20 | issn=0954-6634 | doi=10.1080/09546634.2019.1688755 | pages=643–647| pmid=31746251 | s2cid=208185306 }}</ref> Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia.<ref name="Zhang Su Ma Fu 2022 pp. 737–740">{{cite journal | last1=Zhang | first1=Yuehou | last2=Su | first2=Jianlong | last3=Ma | first3=Kui | last4=Fu | first4=Xiaobing | last5=Zhang | first5=Cuiping | title=Photobiomodulation Therapy With Different Wavebands for Hair Loss: A Systematic Review and Meta-Analysis | journal=Dermatologic Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=48 | issue=7 | date=2022-04-25 | issn=1076-0512 | doi=10.1097/dss.0000000000003472 | pages=737–740| pmid=35510860 | s2cid=248526019 }}</ref>
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.


Medical reviews suggest that LLLT is as effective or potentially more than other non invasive and traditional therapies like minoxidil and finasteride but further studies such as RCTs, long term follow up studies, and larger double blinded trials need to be conducted to confirm the initial findings.<ref name="Gupta Bamimore Foley 2020 pp. 62–72">{{cite journal | last1=Gupta | first1=Aditya K. | last2=Bamimore | first2=Mary A. | last3=Foley | first3=Kelly A. | title=Efficacy of non-surgical treatments for androgenetic alopecia in men and women: a systematic review with network meta-analyses, and an assessment of evidence quality | journal=Journal of Dermatological Treatment | publisher=Informa UK Limited | volume=33 | issue=1 | date=2020-04-13 | issn=0954-6634 | doi=10.1080/09546634.2020.1749547 | pages=62–72 | pmid=32250713 | s2cid=215405183 | url=https://figshare.com/articles/journal_contribution/12087042 | access-date=August 31, 2023 | archive-date=February 24, 2024 | archive-url=https://web.archive.org/web/20240224185232/https://figshare.com/articles/journal_contribution/Efficacy_of_non-surgical_treatments_for_androgenetic_alopecia_in_men_and_women_a_systematic_review_with_network_meta-analyses_and_an_assessment_of_evidence_quality/12087042 | url-status=live }}</ref><ref name="Darwin Heyes Hirt Wikramanayake 2017 pp. 425–434">{{cite journal | last1=Darwin | first1=Evan | last2=Heyes | first2=Alexandra | last3=Hirt | first3=Penelope A. | last4=Wikramanayake | first4=Tongyu Cao | last5=Jimenez | first5=Joaquin J. | title=Low-level laser therapy for the treatment of androgenic alopecia: a review | journal=Lasers in Medical Science | publisher=Springer Science and Business Media LLC | volume=33 | issue=2 | date=2017-12-21 | issn=0268-8921 | doi=10.1007/s10103-017-2385-5 | pages=425–434| pmid=29270707 | s2cid=23783876 }}</ref><ref name="S P Y P p.">{{cite journal | last1=S | first1=Lueangarun | last2=P | first2=Visutjindaporn | last3=Y | first3=Parcharoen | last4=P | first4=Jamparuang | last5=T | first5=Tempark |title=A Systematic Review and Meta-analysis of Randomized Controlled Trials of United States Food and Drug Administration-Approved, Home-use, Low-Level Light/Laser Therapy Devices for Pattern Hair Loss: Device Design and Technology | journal=The Journal of Clinical and Aesthetic Dermatology | date=2021 | volume=14 | issue=11 | pages=E64–E75 | issn=1941-2789 | pmid=34980962 | pmc=8675345 }}</ref>
==Hair multiplication (upcoming treatment)==<!-- This section is linked from [[Baldness]] -->


===Platelet-rich plasma (PRP)===
[[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 baldness through ''hair multiplication'', also called ''hair cloning.''{{Fact|date=February 2007}} This treatment is expected to initially work through harvesting such cells from existing follicles, multiplying them in cultures, and injecting or implanting groups of cells into the scalp. Later treatments may be able to simply signal follicle stem cells to transmit chemical signals to nearby follicle cells which have shrunk during the aging process, which respond to these signals by regenerating and once again making healthy hair.
Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata<ref name="Tejapira Yongpisarn Sakpuwadol Suchonwanit 2022 p. ">{{cite journal | last1=Tejapira | first1=Kasama | last2=Yongpisarn | first2=Tanat | last3=Sakpuwadol | first3=Nawara | last4=Suchonwanit | first4=Poonkiat | title=Platelet-rich plasma in alopecia areata and primary cicatricial alopecias: A systematic review | journal=Frontiers in Medicine | publisher=Frontiers Media SA | volume=9 | date=2022-11-24 | issn=2296-858X | doi=10.3389/fmed.2022.1058431 | page=| pmid=36507528 | pmc=9731377 | doi-access=free }}</ref> and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride.<ref name="Gentile Garcovich 2020 p=2702">{{cite journal | last1=Gentile | first1=Pietro | last2=Garcovich | first2=Simone | title=Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy | journal=International Journal of Molecular Sciences | publisher=MDPI AG | volume=21 | issue=8 | date=2020-04-13 | issn=1422-0067 | doi=10.3390/ijms21082702 | page=2702| pmid=32295047 | pmc=7216252 | doi-access=free }}</ref> It has been documented to improve hair density and thickness in both genders.<ref name="Evans Mwangi Pope Ivanic 2020 pp. 498–511">{{cite journal | last1=Evans | first1=Adam G. | last2=Mwangi | first2=James M. | last3=Pope | first3=Rand W. | last4=Ivanic | first4=Mirjana G. | last5=Botros | first5=Mina A. | last6=Glassman | first6=Gabriella E. | last7=Pearce | first7=F. Bennett | last8=Kassis | first8=Salam | title=Platelet-rich plasma as a therapy for androgenic alopecia: a systematic review and meta-analysis | journal=Journal of Dermatological Treatment | publisher=Informa UK Limited | volume=33 | issue=1 | date=2020-05-26 | issn=0954-6634 | doi=10.1080/09546634.2020.1770171 | pages=498–511 | pmid=32410524 | s2cid=218648227 | url=https://figshare.com/articles/journal_contribution/12376727 | access-date=August 31, 2023 | archive-date=February 24, 2024 | archive-url=https://web.archive.org/web/20240224185101/https://figshare.com/articles/journal_contribution/Platelet-rich_plasma_as_a_therapy_for_androgenic_alopecia_a_systematic_review_and_meta-analysis/12376727 | url-status=live }}</ref> A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance.<ref name="Gupta Cole Deutsch Everts 2019 pp. 1262–1273">{{cite journal | last1=Gupta | first1=Aditya K. | last2=Cole | first2=John | last3=Deutsch | first3=David P. | last4=Everts | first4=Peter A. | last5=Niedbalski | first5=Robert P. | last6=Panchaprateep | first6=Ratchathorn | last7=Rinaldi | first7=Fabio | last8=Rose | first8=Paul T. | last9=Sinclair | first9=Rodney | last10=Vogel | first10=James E. | last11=Welter | first11=Ryan J. | last12=Zufelt | first12=Michael D. | last13=Puig | first13=Carlos J. | title=Platelet-Rich Plasma as a Treatment for Androgenetic Alopecia | journal=Dermatologic Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=45 | issue=10 | year=2019 | issn=1076-0512 | doi=10.1097/dss.0000000000001894 | pages=1262–1273| pmid=30882509 | s2cid=81980415 }}</ref> Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted.<ref name="Gupta Bamimore 2022 pp. 943–952">{{cite journal | last1=Gupta | first1=Aditya | last2=Bamimore | first2=Mary | title=Platelet-Rich Plasma Monotherapies for Androgenetic Alopecia: A Network Meta-Analysis and Meta-Regression Study | journal=Journal of Drugs in Dermatology | publisher=SanovaWorks | volume=21 | issue=9 | date=2022-08-01 | issn=1545-9616 | doi=10.36849/jdd.6948 | pages=943–952| pmid=36074501 | s2cid=252120370 }}</ref>


Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus.<ref name="Gupta Bamimore Foley 2020 pp. 62–72"/><ref name="Evans Mwangi Pope Ivanic 2020 pp. 498–511"/><ref name="Oth Stene Glineur Vujovic 2018 pp. 438–446">{{cite journal | last1=Oth | first1=O | last2=Stene | first2=JJ | last3=Glineur | first3=R | last4=Vujovic | first4=A | title=Injection of PRP (Platelet-rich plasma) as a treatment for androgenetic alopecia : a systematic review of the literature | journal=Revue Médicale de Bruxelles | publisher=AMUB/Revue Médicale de Bruxelles | volume=39 | issue=5 | year=2018 | issn=0035-3639 | doi=10.30637/2018.17-056 | pages=438–446| pmid=29869472 | doi-access=free }}</ref> Further development of a standardized practice for procedure is also recommended.<ref name="Tejapira Yongpisarn Sakpuwadol Suchonwanit 2022 p. "/>
Unfortunately, this new approach to treating baldness appears to be taking longer than expected. The first products are now expected to hit the market in 2009/2010. However, it remains unclear how effective they are going to be. It has been suggested that only future generations of HM will allow patients to grow as much hair as they want.


===Surgical treatments===
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]]).<ref name=webmd>
{{cite web
|url=http://my.webmd.com/content/article/96/103836.htm?z=3734_00000_1000_qd_01
|accessdate = 2006-08-10
|title = Hair Cloning Nears Reality as Baldness Cure
|date = November 4, 2004
|publisher = Webmd.com
}}</ref>
<ref name=cbs2chicago>
{{cite web
|url=http://cbs2chicago.com/health/health_story_075114234.html
|title = Big Baldness Breakthrough?
|accessdate=2006-08-10
|publisher = Associated Press
|date=Mar. 15, 2004
}}</ref>


====Hair transplantation====
On [[October]] [[2006]], [[UK]] [[biotechnology]] firm ''Intercytex'' announced they have successfully tested a method of removing [[hair follicles]] from the back of the neck, multiplying them and then reimplanting the cells into the scalp. The initial testing resulted in 70% of male patients regrowing hair. This treatment method is expected to be available to the public by 2009 [http://news.bbc.co.uk/2/hi/health/5413382.stm][http://uk.news.yahoo.com/06102006/325/baldness-treating-robot-gets-funding.html].
{{main|Hair transplantation}}
On October 6, 2006, the company was awarded a £1.85 million ($3.63 million) grant by the UK Department of Trade and Industry (DTI) through the Technology Programme to develop an automated manufacturing process for ICX-TRC, Intercytex’s novel hair regeneration therapy. The grant will be used primarily to develop a dedicated robotic system to support the commercial-scale production of dermal papilla (DP) cells, the main cells involved in hair regeneration and the key component of ICX-TRC. Preliminary reports of efficacy of ICX-TRC in hair restoration are expected in fall of 2007.
{{multiple image
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| image1 = Man before receiving hair transplant.jpg
| width1 = 150
| alt1 =
| caption1 =
| image2 = Man after receiving hair transplant.jpg
| width2 = 130
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| footer = A man before and after a hair transplant.
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Hair transplantation is a [[surgery|surgical]] technique that moves individual [[hair follicle]]s from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore [[eyelash]]es, [[eyebrow]]s, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from [[skin graft]]ing in that grafts contain almost all of the [[Epidermis (skin)|epidermis]] and [[dermis]] surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.


Since hair naturally grows in follicles in groups of 1 to 4 hairs, [[Organ transplant|transplant]]ation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through [[Follicular unit transplantation]] (FUT).
In January 2007, Italian stem-cell researchers say they've come up with a new technique for curing baldness. Pierluigi Santi of a Genoa clinic said stem cells could be used to "multiply" hair roots. He said the clinic would be ready to perform its first hair transplants on priority patients - those who have lost their hair in fires or other accidents - within a few months. After that, he said, "we'll open our doors to paying customers". Santi's approach works by splitting roots and growing new follicles.


Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called [[Hair follicle|follicular units]], can be moved to balding areas of the [[hair restoration]]. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or [[Follicular Unit Extraction]] (FUE), in which follicles are transplanted individually.
In [[May]] [[2007]], U.S. company [[Follica Inc]], announced they have licensed technology from the [[University of Pennsylvania]] which can regenerate [[hair follicles]] by reawakening [[genes]] which were once active only in the [[embryo]] stage of human development.[http://news.independent.co.uk/uk/health_medical/article2553928.ece] [http://www.guardian.co.uk/science/story/0,,2081129,00.html?gusrc=rss&feed=networkfront] [http://www.timesonline.co.uk/tol/life_and_style/health/article1800306.ece] [http://www.channel4.com/news/articles/society/health/baldness+cure+may+be+on+horizon/514157] [http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/05-16-2007/0004590099&EDATE=][http://www.msnbc.msn.com/id/18703259/]


In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp.<ref>{{cite journal | vauthors = Rashid RM, Morgan Bicknell LT | title = Follicular unit extraction hair transplant automation: options in overcoming challenges of the latest technology in hair restoration with the goal of avoiding the line scar | journal = Dermatology Online Journal | volume = 18 | issue = 9 | pages = 12 | date = September 2012 | pmid = 23031379 | doi = 10.5070/D30X57S71R }}</ref> After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.<ref name="pmid22808618"/>
==FDA-approved treatments==
There are only 2 [[FDA]]-approved treatments for male baldness: [[Minoxidil]] and [[Finasteride]]. <ref>http://www.webmd.com/skin-beauty/guide/hair-loss-treatments.</ref> <ref>http://www.fda.gov/cdrh/pdf6/K060305.pdf</ref>


====Scalp reduction====
There is some debate over the [[FDA]]'s acknowledgment of the Lasercomb, but it has been accepted by the FDA as effective in the submitted claims. <ref>[http://tressless.com/wiki/Lasercomb#Controversy LaserComb Controvery at Tressless: The Hairloss Encyclopedia]</ref>
{{main|Scalp reduction}}
Scalp reduction is a surgical procedure in which the hairless region of the scalp of a [[Pattern hair loss|bald man]] is reduced. This procedure can reduce the area of the scalp without hair.<ref>{{cite journal | vauthors = Bell ML | title = Role of scalp reduction in the treatment of male pattern baldness | journal = Plastic and Reconstructive Surgery | volume = 69 | issue = 2 | pages = 272–277 | date = February 1982 | pmid = 7054796 | doi = 10.1097/00006534-198202000-00016 | s2cid = 20731930 }}</ref><ref>{{cite book |last1=Unger |first1=Martin G. |last2=Toscani |first2=Marco |year=2016 |chapter=Scalp reduction |editor1-last=Scuderi |editor1-first=Nicolò |editor2-last=Toth |editor2-first=Bryant A. |title=International Textbook of Aesthetic Surgery |chapter-url=https://www.springer.com/gp/book/9783662465981 |publisher=[[Springer Nature|Springer]] |pages=555–556 |doi=10.1007/978-3-662-46599-8 |isbn=978-3-662-46598-1 |access-date=7 December 2016 |archive-date=August 3, 2017 |archive-url=https://web.archive.org/web/20170803211713/http://www.springer.com/gp/book/9783662465981 |url-status=live }}</ref>


==Other treatments==
==Regrowth of hair==
* [[Azelaic acid]] - A study found a 90% inhibition of 5-alpha-reductase activity ''in vitro'' with an azelaic acid and [[zinc]] combination. There was an additive effect between the two compounds.<ref name=azelaic>
{{cite journal
|url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3207614&itool=iconabstr&query_hl=7&itool=pubmed_docsum
|author = Stamatiadis D
|coauthors = Bulteau-Portois MC, Mowszowicz I
|journal = Br J Dermatol
|date = November 1988
|volume = 119
|issue = 5
|pages = 627-632
|title = Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid
}}</ref>
* [[Spironolactone]]
* [[Tretinoin]] (aka Retinoic acid and as tradename Retin-A); chemical peel stimulation of scalp)
* [[Regenix]]
* [[RU58841]]
* [[Avacor]]
* [[Pumpkin seed]] - Used to aid in the breakdown of DHT by the liver.{{Fact|date=February 2007}} An extract is often used, as unprocessed pumpkin seeds are high in fat which can exacerbate hair loss in susceptible patients.
* [[Procapil]] manufactured by Croda International Plc
* [[Stinging nettle]]
* [[Zinc]] - While oral zinc supplementation may help prevent the conversion of testosterone to DHT, it also increases total testosterone levels{{Fact|date=February 2007}}.


==See also==
===Facial hair===
*[[baldness]]
*[[comb over]]
*[[toupee]]


==Footnotes==
====Eyebrows====
[[Bimatoprost]] 0.03% has been used to grow [[eyebrow]]s.<ref>{{cite journal |last1=Riahi |first1=RR |last2=Cohen |first2=PR |title=Topical Treatment of Eyebrow Hypotrichosis with Bimatoprost 0.03% Solution: Case Report and Literature Review. |journal=Cureus |date=21 May 2018 |volume=10 |issue=5 |pages=e2666 |doi=10.7759/cureus.2666 |doi-access=free |pmid=30042917 |pmc=6054329}}</ref>
{{Reflist|2}}


==External links==
====Eyelashes====
The FP receptor agonist, [[bimatoprost]], in the form of an 0.03% ophthalmic solution termed [[Latisse]], is approved by the US [[Food and Drug Administration]] to treat [[hypotrichosis]] of the [[eyelash]]es, in particular to darken and lengthen eyelashes for cosmetic purposes.<ref>{{cite journal |last1=Choi |first1=YM |last2=Diehl |first2=J |last3=Levins |first3=PC |title=Promising alternative clinical uses of prostaglandin F2α analogs: beyond the eyelashes. |journal=Journal of the American Academy of Dermatology |date=April 2015 |volume=72 |issue=4 |pages=712–6 |doi=10.1016/j.jaad.2014.10.012 |pmid=25601618}}</ref> Also, bimatoprost may be used to treat small or underdeveloped [[eyelash]]es.<ref name="Bimatoprost label">{{cite web | title=Bimatoprost solution/ drops | website=DailyMed | date=18 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27bef7e1-750a-4ac1-ab5f-e4c0121ffcbc | access-date=4 January 2020 | archive-date=September 21, 2020 | archive-url=https://web.archive.org/web/20200921171858/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27bef7e1-750a-4ac1-ab5f-e4c0121ffcbc | url-status=live }}</ref><ref name="Lumigan label">{{cite web | title=Lumigan- bimatoprost solution/ drops | website=DailyMed | date=31 July 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5e67c75-db88-4372-bb07-c8dd15c97631 | access-date=4 January 2020 | archive-date=September 21, 2020 | archive-url=https://web.archive.org/web/20200921171612/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5e67c75-db88-4372-bb07-c8dd15c97631 | url-status=live }}</ref>
*[http://www.ishrs.org International Society of Hair Restoration Surgery] Resources for finding doctors, and more information about hair loss. This is one of the leading organizations in the world on hair loss.
*[http://www.aafp.org/afp/990415ap/2189.html "Medical Treatments for Balding in Men,"] April 1999, ''American Family Physician'' (medical journal)
*[http://nahrs.org/faqs/mphl.aspx North American Hair Research Society] Frequently asked questions
*[http://www.timesonline.co.uk/article/0,,8125-1584988,00.html Health Alternatives:] zinc, silica, methylsulphonylmethane (MSM) and cod-liver oil, to slow down the process.
*[http://people.howstuffworks.com/hair-replacement.htm How Hair Replacement Works] Covers oral medications, hair transplant surgery, and topical treatments.
*[http://www.hairscientists.org/index.htm The Trichological Society]


===Scalp hair===


====Alternative medication====
[[Category:Dermatology]]

[[Category:Hair loss]]
=====Topical=====
Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including [[6-gingerol]] found in [[ginger]].<ref>{{cite journal | vauthors = Miao Y, Sun Y, Wang W, Du B, Xiao SE, Hu Y, Hu Z | title = 6-Gingerol inhibits hair shaft growth in cultured human hair follicles and modulates hair growth in mice | journal = PLOS ONE | volume = 8 | issue = 2 | pages = e57226 | date = 2013 | pmid = 23437345 | pmc = 3578824 | doi = 10.1371/journal.pone.0057226 | doi-access = free | bibcode = 2013PLoSO...857226M }}</ref>

=====Topical crude onion juice=====
[[File:CSIRO ScienceImage 2782 Brown Onions.jpg|thumb|Topical crude onion juice from Australian brown onion was used in a 2002 study to regrow hair in bald people.<ref name="Crude onion juice from Australian brown onion" />]]

A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on [[alopecia areata]] (spot baldness) in 86.9% of the 23 participants.<ref name="Crude onion juice from Australian brown onion">{{cite journal | vauthors = Sharquie KE, Al-Obaidi HK | title = Onion juice (Allium cepa L.), a new topical treatment for alopecia areata | journal = The Journal of Dermatology | volume = 29 | issue = 6 | pages = 343–346 | date = June 2002 | pmid = 12126069 | doi = 10.1111/j.1346-8138.2002.tb00277.x | s2cid = 24116769 }}</ref> Twice as many [[flavonols]] are found in [[red onion]] than in [[yellow onion]].<ref name="Onions: a source of unique dietary">{{cite journal | vauthors = Slimestad R, Fossen T, Vågen IM | title = Onions: a source of unique dietary flavonoids | journal = Journal of Agricultural and Food Chemistry | volume = 55 | issue = 25 | pages = 10067–10080 | date = December 2007 | pmid = 17997520 | doi = 10.1021/jf0712503 }}</ref> Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth:
* [[Quercetin]]:
**[[Quercetin]] (a flavanoid found in vegan food) supplements, has been suggested to treat baldness.<ref name="Quercetin" /> A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice.<ref name="Quercetin">{{cite journal | vauthors = Wikramanayake TC, Villasante AC, Mauro LM, Perez CI, Schachner LA, Jimenez JJ | title = Prevention and treatment of alopecia areata with quercetin in the C3H/HeJ mouse model | journal = Cell Stress & Chaperones | volume = 17 | issue = 2 | pages = 267–274 | date = March 2012 | pmid = 22042611 | pmc = 3273564 | doi = 10.1007/s12192-011-0305-3 }}</ref> Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh.<ref>{{cite journal | vauthors = Kwak JH, Seo JM, Kim NH, Arasu MV, Kim S, Yoon MK, Kim SJ | title = Variation of quercetin glycoside derivatives in three onion (''Allium cepa'' L.) varieties | journal = Saudi Journal of Biological Sciences | volume = 24 | issue = 6 | pages = 1387–1391 | date = September 2017 | pmid = 28855836 | pmc = 5562462 | doi = 10.1016/j.sjbs.2016.05.014 }}</ref> Onion [[surface area|bulb size]] or weight does not appear to be affected by quercetin concentration.<ref name="Onions: a source of unique dietary"/>
** A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.<ref>{{cite journal | vauthors = Kim J, Kim SR, Choi YH, Shin JY, Kim CD, Kang NG, Park BC, Lee S | display-authors = 6 | title = Quercitrin Stimulates Hair Growth with Enhanced Expression of Growth Factors via Activation of MAPK/CREB Signaling Pathway | journal = Molecules | volume = 25 | issue = 17 | page = 4004 | date = September 2020 | pmid = 32887384 | pmc = 7504764 | doi = 10.3390/molecules25174004 | doi-access = free }}</ref>
* Volatile compounds responsible for pungency and tearing in onions when they are cut (e.g. [[syn-Propanethial-S-oxide|''syn''-propanethial ''S''-oxide]] gas). However, no formal studies have conducted to evaluate if these compounds promote hair growth or if they help other compounds to penetrate the skin to form hair follicles.
** To use the volatile compounds: Onions must be extracted and applied topically quickly before the volatile compounds evaporates. The extract will cause tearing eyes, but it can be prevented with a [[shower cap]], or a pair of swimming goggles.
** To discard the volatile compounds: The onion juice is extracted and stored for a short while to evaporate the volatile compounds. The extract will not cause tearing eyes. Also, both [[genetically modified food|genetically modified]], and [[plant breed]] onions have been produced with significantly reduced levels of tear-inducing lachrymatory factor.<ref>{{cite journal | vauthors = Eady CC, Kamoi T, Kato M, Porter NG, Davis S, Shaw M, Kamoi A, Imai S | display-authors = 6 | title = Silencing onion lachrymatory factor synthase causes a significant change in the sulfur secondary metabolite profile | journal = Plant Physiology | volume = 147 | issue = 4 | pages = 2096–2106 | date = August 2008 | pmid = 18583530 | pmc = 2492635 | doi = 10.1104/pp.108.123273 }}</ref><ref>{{cite news |title=Cutting this new type of onion won't make you cry |url=https://www.independent.co.uk/life-style/onion-no-crying-cut-up-tears-sting-juice-a8149821.html |work=The Independent |date=9 January 2018 |language=en |access-date=September 7, 2021 |archive-date=September 7, 2021 |archive-url=https://web.archive.org/web/20210907223821/https://www.independent.co.uk/life-style/onion-no-crying-cut-up-tears-sting-juice-a8149821.html |url-status=live }}</ref>

=====Dietary supplements=====
Dietary supplements are not typically recommended.<ref name=Roger2008>{{cite journal | vauthors = Rogers NE, Avram MR | title = Medical treatments for male and female pattern hair loss | journal = Journal of the American Academy of Dermatology | volume = 59 | issue = 4 | pages = 547–66; quiz 567–8 | date = October 2008 | pmid = 18793935 | doi = 10.1016/j.jaad.2008.07.001 }}</ref> Many people use unproven treatments,<ref name=Ban2013>{{cite journal | vauthors = Banka N, Bunagan MJ, Shapiro J | title = Pattern hair loss in men: diagnosis and medical treatment | journal = Dermatologic Clinics | volume = 31 | issue = 1 | pages = 129–140 | date = January 2013 | pmid = 23159182 | doi = 10.1016/j.det.2012.08.003 }}</ref> but there is little evidence of the effectiveness of [[vitamin]]s, minerals, or other dietary supplements regrowing hair or retaining hair.<ref name=Levy2013/> There is no evidence for [[biotin]] (vitamin B7).<ref name=Roger2008/> While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin.

However, one small trial of [[saw palmetto]] which shows tentative benefit in those with mild to moderate androgenetic alopecia.<ref name=Roger2008/> There was no good evidence for [[gingko]], [[aloe vera]], [[ginseng]], [[bergamot essential oil|bergamot]], or [[hibiscus]] as of 2011.<ref name=Blu2011>{{cite journal | vauthors = Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, Trakatelli M, Finner A, Kiesewetter F, Trüeb R, Rzany B, Blume-Peytavi U | display-authors = 6 | title = Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men | journal = Journal der Deutschen Dermatologischen Gesellschaft | volume = 9 | issue = Suppl 6 | pages = S1-57 | date = October 2011 | pmid = 21980982 | doi = 10.1111/j.1610-0379.2011.07802.x | s2cid = 29821046 }}</ref>

==Radiation-induced hair loss==
Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression.<ref>{{cite journal | vauthors = Nanashima N, Ito K, Ishikawa T, Nakano M, Nakamura T | title = Damage of hair follicle stem cells and alteration of keratin expression in external radiation-induced acute alopecia | journal = International Journal of Molecular Medicine | volume = 30 | issue = 3 | pages = 579–584 | date = September 2012 | pmid = 22692500 | doi = 10.3892/ijmm.2012.1018 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Kamiya K, Sasatani M | title = [Effects of radiation exposure on human body] | journal = Nihon Rinsho. Japanese Journal of Clinical Medicine | volume = 70 | issue = 3 | pages = 367–374 | date = March 2012 | pmid = 22514910 }}</ref> Radiation therapy has been associated with increased [[mucin]] production in hair follicles.<ref>{{cite journal | vauthors = Takeda H, Nakajima K, Kaneko T, Harada K, Matsuzaki Y, Sawamura D | title = Follicular mucinosis associated with radiation therapy | journal = The Journal of Dermatology | volume = 38 | issue = 11 | pages = 1116–1118 | date = November 2011 | pmid = 22034994 | doi = 10.1111/j.1346-8138.2010.01187.x | s2cid = 31876890 }}</ref>

Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.<ref>{{cite journal | vauthors = Kalia S, Lui H | title = Utilizing electromagnetic radiation for hair growth: a critical review of phototrichogenesis | journal = Dermatologic Clinics | volume = 31 | issue = 1 | pages = 193–200 | date = January 2013 | pmid = 23159188 | doi = 10.1016/j.det.2012.08.018 }}</ref>

==Cosmeses==
[[File:Wigs on display.jpg|thumb|There have been advances in the [[fashion industry]] in [[wig]] design.]] Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle.<ref>{{cite journal | vauthors = Davis MG, Thomas JH, van de Velde S, Boissy Y, Dawson TL, Iveson R, Sutton K | title = A novel cosmetic approach to treat thinning hair | journal = The British Journal of Dermatology | volume = 165 | issue = Suppl 3 | pages = 24–30 | date = December 2011 | pmid = 22171682 | doi = 10.1111/j.1365-2133.2011.10633.x | s2cid = 21918537 }}</ref> There have also been developments in the fashion industry with [[wig]] design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion".<ref>{{cite journal | vauthors = Zannini L, Verderame F, Cucchiara G, Zinna B, Alba A, Ferrara M | title = 'My wig has been my journey's companion': perceived effects of an aesthetic care programme for Italian women suffering from chemotherapy-induced alopecia | journal = European Journal of Cancer Care | volume = 21 | issue = 5 | pages = 650–660 | date = September 2012 | pmid = 22339814 | doi = 10.1111/j.1365-2354.2012.01337.x | doi-access = free }}</ref> Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.<ref>{{cite journal | vauthors = Inui S, Inoue T, Itami S | title = Psychosocial impact of wigs or hairpieces on perceived quality of life level in female patients with alopecia areata | journal = The Journal of Dermatology | volume = 40 | issue = 3 | pages = 225–226 | date = March 2013 | pmid = 23252418 | doi = 10.1111/1346-8138.12040 | s2cid = 43795003 }}</ref>

Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut.<ref>{{cite news |title=Considering a hair tattoo? Pros and cons to consider before you commit |author=Elisabeth Leamy |url=https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |newspaper=ABC News |date=May 31, 2012 |access-date=December 16, 2012 |archive-date=April 11, 2019 |archive-url=https://web.archive.org/web/20190411205715/https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |url-status=live }}</ref>

==Human hair growth==
{{main|Human hair growth}}

[[File:Skin.png|thumb|[[Hair follicle]] with mesenchymal [[dermal papilla]], labelled at top, location of hair follicle [[stem cell]]s and thought to be site of action of [[Dihydrotestosterone|DHT]].]]

[[5-alpha reductase|Type 1 and 2 5α reductase enzymes]] are present at [[Sebaceous gland|pilosebaceous units]] in papillae of individual [[hair follicle]]s. They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate [[Insulin-like growth factor 1|IGF-1]] at facial hair, causing hair regrowth, but stimulate [[TGF beta 1|TGF β1]], [[TGF beta 2|TGF β2]], [[DKK1|dickkopf1]] and [[Interleukin 6|IL-6]] at the scalp, causing hair follicle miniaturisation.<ref name=Inui2013>{{cite journal | vauthors = Inui S, Itami S | title = Androgen actions on the human hair follicle: perspectives | journal = Experimental Dermatology | volume = 22 | issue = 3 | pages = 168–171 | date = March 2013 | pmid = 23016593 | doi = 10.1111/exd.12024 | s2cid = 33521841 | doi-access = free }}</ref>

Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to [[Alopecia totalis|total hair loss]].<ref name="Female pattern baldness"/> [[Finasteride]] and [[minoxidil]] are usually first line therapy for its treatment. Other options include topical or systemic [[spironolactone]] or [[flutamide]], although they have a high incidence of [[Feminisation (biology)|feminising]] [[side effects]] and are better tolerated in female androgenic hair loss.

More advanced cases may be resistant or unresponsive to medical therapy, however, and require [[hair transplantation]]. Naturally-occurring units of one to four hairs, called [[Hair follicle|follicular units]], are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either [[Follicular unit transplantation|Follicular Unit Transplantation]] (FUT)&nbsp;–&nbsp;colloquially referred to as "strip harvesting"&nbsp;– or [[Follicular Unit Extraction]] (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites.<ref name="pmid22808618">{{cite journal | vauthors = Caroli S, Pathomvanich D, Amonpattana K, Kumar A | title = Current status of hair restoration surgery | journal = International Surgery | volume = 96 | issue = 4 | pages = 345–351 | year = 2011 | pmid = 22808618 | doi = 10.9738/cc31.1 | doi-access = free }}</ref><ref name="pmid 21792780">{{cite journal | vauthors = Rose PT | title = The latest innovations in hair transplantation | journal = Facial Plastic Surgery | volume = 27 | issue = 4 | pages = 366–377 | date = August 2011 | pmid = 21792780 | doi = 10.1055/s-0031-1283055 | s2cid = 260138453 }}</ref> Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut.<ref>{{cite news |title=Considering a hair tattoo? Pros and cons to consider before you commit |author=Elisabeth Leamy |url=https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |newspaper=ABC News |date=May 31, 2012 |access-date=December 16, 2012 |author-link=Elisabeth Leamy |archive-date=April 11, 2019 |archive-url=https://web.archive.org/web/20190411205715/https://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |url-status=live }}</ref> Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to [[Alopecia totalis|total hair loss]]. Treatment options are similar to those for men, although topical or systemic estrogen is used more often.<ref name="Female pattern baldness">{{cite web |url=https://www.nlm.nih.gov/medlineplus/ency/article/001173.htm |title=Female pattern baldness |access-date=December 15, 2012 |date=December 15, 2012 |publisher=MedlinePlus |archive-date=December 1, 2012 |archive-url=https://web.archive.org/web/20121201014315/http://www.nlm.nih.gov/medlineplus/ency/article/001173.htm |url-status=live }}</ref><ref>{{cite journal | vauthors = Kovalevsky G, Ballagh SA, Stanczyk FZ, Lee J, Cooper J, Archer DF | title = Levonorgestrel effects on serum androgens, sex hormone-binding globulin levels, hair shaft diameter, and sexual function | journal = Fertility and Sterility | volume = 93 | issue = 6 | pages = 1997–2003 | date = April 2010 | pmid = 19394598 | doi = 10.1016/j.fertnstert.2008.12.095 | doi-access = free }}</ref>

==Research==

===Bimatoprost and latanoprost===
[[Latanoprost]] and [[bimatoprost]] are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes,<ref>{{cite journal | vauthors = Law SK | title = Bimatoprost in the treatment of eyelash hypotrichosis | journal = Clinical Ophthalmology | volume = 4 | pages = 349–358 | date = April 2010 | pmid = 20463804 | pmc = 2861943 | doi = 10.2147/opth.s6480 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Tosti A, Pazzaglia M, Voudouris S, Tosti G | title = Hypertrichosis of the eyelashes caused by bimatoprost | journal = Journal of the American Academy of Dermatology | volume = 51 | issue = 5 Suppl | pages = S149–S150 | date = November 2004 | pmid = 15577756 | doi = 10.1016/j.jaad.2004.05.002 }}</ref> darken hair pigmentation<ref>{{cite journal | vauthors = Wand M | title = Latanoprost and hyperpigmentation of eyelashes | journal = Archives of Ophthalmology | volume = 115 | issue = 9 | pages = 1206–1208 | date = September 1997 | pmid = 9298071 | doi = 10.1001/archopht.1997.01100160376025 }}</ref> and elongate hair.<ref name="pmid22735503"/> Bimatoprost is available as treatment for eyelash growth.<ref>{{cite journal | vauthors = Banaszek A | title = Company profits from side effects of glaucoma treatment | journal = CMAJ | volume = 183 | issue = 14 | pages = E1058 | date = October 2011 | pmid = 21876012 | pmc = 3185096 | doi = 10.1503/cmaj.109-3919 }}</ref> Latanoprost has shown ability to promote scalp hair density and pigmentation,<ref>{{cite journal | vauthors = Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N | title = A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia | journal = Journal of the American Academy of Dermatology | volume = 66 | issue = 5 | pages = 794–800 | date = May 2012 | pmid = 21875758 | doi = 10.1016/j.jaad.2011.05.026 }}</ref> and is theorized to function at the [[dermal papilla]].<ref>{{cite journal | vauthors = Johnstone MA, Albert DM | title = Prostaglandin-induced hair growth | journal = Survey of Ophthalmology | volume = 47 | issue = Suppl 1 | pages = S185–S202 | date = August 2002 | pmid = 12204716 | doi = 10.1016/s0039-6257(02)00307-7 }}</ref> A study found latanoprost ineffective on eyelashes in a patient with [[alopecia areata]].<ref>{{cite journal | vauthors = Roseborough I, Lee H, Chwalek J, Stamper RL, Price VH | title = Lack of efficacy of topical latanoprost and bimatoprost ophthalmic solutions in promoting eyelash growth in patients with alopecia areata | journal = Journal of the American Academy of Dermatology | volume = 60 | issue = 4 | pages = 705–706 | date = April 2009 | pmid = 19293023 | doi = 10.1016/j.jaad.2008.08.029 }}</ref> It has also been found ineffective in treatment of eyebrow hair loss.<ref>{{cite journal | vauthors = Ross EK, Bolduc C, Lui H, Shapiro J | title = Lack of efficacy of topical latanoprost in the treatment of eyebrow alopecia areata | journal = Journal of the American Academy of Dermatology | volume = 53 | issue = 6 | pages = 1095–1096 | date = December 2005 | pmid = 16310083 | doi = 10.1016/j.jaad.2005.06.031 | doi-access = free }}</ref>

===Hormones===
Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with [[oral contraceptives]]. Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in [[Europe]].<ref name=Blu2011 /> Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in [[North America]].<ref name="pmid22735503"/>

There is tentative evidence for [[cyproterone acetate]] in women.<ref name=Levy2013/>

===IGF-1===
In December 2012, topical application of [[Insulin-like growth factor 1|IGF-1]] in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans.<ref>{{cite journal | vauthors = Castro RF, Azzalis LA, Feder D, Perazzo FF, Pereira EC, Junqueira VB, Rocha KC, Machado CD, Paschoal FC, Gnann LA, Fonseca FL | display-authors = 6 | title = Safety and efficacy analysis of liposomal insulin-like growth factor-1 in a fluid gel formulation for hair-loss treatment in a hamster model | journal = Clinical and Experimental Dermatology | volume = 37 | issue = 8 | pages = 909–912 | date = December 2012 | pmid = 22924775 | doi = 10.1111/j.1365-2230.2012.04441.x | s2cid = 21021986 }}</ref> Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells.<ref name="pmid22164296">{{cite journal | vauthors = Yoon SY, Kim KT, Jo SJ, Cho AR, Jeon SI, Choi HD, Kim KH, Park GS, Pack JK, Kwon OS, Park WY | display-authors = 6 | title = Induction of hair growth by insulin-like growth factor-1 in 1,763 MHz radiofrequency-irradiated hair follicle cells | journal = PLOS ONE | volume = 6 | issue = 12 | pages = e28474 | year = 2011 | pmid = 22164296 | pmc = 3229574 | doi = 10.1371/journal.pone.0028474 | editor1-last = Najbauer | doi-access = free | bibcode = 2011PLoSO...628474Y | editor1-first = Joseph }}</ref> Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors [[FGF7]], [[Basic fibroblast growth factor|FGF-2]] and [[Vascular endothelial growth factor|VEGF]]. [[Beta-catenin|β-catenin]] transcription increased, which promotes dermal papillae as well.<ref name="pmid22164296"/> Dietary [[isoflavones]] increase IGF production in scalp [[dermal papillae]] in transgenic mice.<ref>{{cite journal | vauthors = Zhao J, Harada N, Kurihara H, Nakagata N, Okajima K | title = Dietary isoflavone increases insulin-like growth factor-I production, thereby promoting hair growth in mice | journal = The Journal of Nutritional Biochemistry | volume = 22 | issue = 3 | pages = 227–233 | date = March 2011 | pmid = 20576422 | doi = 10.1016/j.jnutbio.2010.01.008 }}</ref> Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP.<ref>{{cite journal | vauthors = Okajima K, Harada N | title = Promotion of insulin-like growth factor-I production by sensory neuron stimulation; molecular mechanism(s) and therapeutic implications | journal = Current Medicinal Chemistry | volume = 15 | issue = 29 | pages = 3095–3112 | year = 2008 | pmid = 19075656 | doi = 10.2174/092986708786848604 }}</ref> Ascorbic acid has led to increased IGF expression ''in vitro''.<ref>{{cite journal | vauthors = Kwack MH, Shin SH, Kim SR, Im SU, Han IS, Kim MK, Kim JC, Sung YK | display-authors = 6 | title = l-Ascorbic acid 2-phosphate promotes elongation of hair shafts via the secretion of insulin-like growth factor-1 from dermal papilla cells through phosphatidylinositol 3-kinase | journal = The British Journal of Dermatology | volume = 160 | issue = 6 | pages = 1157–1162 | date = June 2009 | pmid = 19416266 | doi = 10.1111/j.1365-2133.2009.09108.x | s2cid = 42210965 }}</ref>

===Stem cell therapy===
{{Main|Hair cloning}}
Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the [[stem cell]]s from which the follicles arose.<ref>{{cite journal | vauthors = Garza LA, Yang CC, Zhao T, Blatt HB, Lee M, He H, Stanton DC, Carrasco L, Spiegel JH, Tobias JW, Cotsarelis G | display-authors = 6 | title = Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells | journal = The Journal of Clinical Investigation | volume = 121 | issue = 2 | pages = 613–622 | date = February 2011 | pmid = 21206086 | pmc = 3026732 | doi = 10.1172/JCI44478 }}</ref> Research on these follicular stem cells may lead to successes in treating baldness through ''hair multiplication'' (HM), also known as ''[[hair cloning]]''.

Per a May 2015 review, no successful strategy to generate human&nbsp;hair&nbsp;follicles, for hair regrowth, from adult&nbsp;stem cells&nbsp;has yet been reported.<ref>{{cite journal | vauthors = Balañá ME, Charreau HE, Leirós GJ | title = Epidermal stem cells and skin tissue engineering in hair follicle regeneration | journal = World Journal of Stem Cells | volume = 7 | issue = 4 | pages = 711–727 | date = May 2015 | pmid = 26029343 | pmc = 4444612 | doi = 10.4252/wjsc.v7.i4.711 | doi-access = free }}</ref> However, in April 2016, scientists from Japan published results of their work in which they created human skin from [[induced pluripotent stem cell]]s; implanted into laboratory mice, the cells generated skin with hair and glands.<ref>{{cite journal | vauthors = Takagi R, Ishimaru J, Sugawara A, Toyoshima KE, Ishida K, Ogawa M, Sakakibara K, Asakawa K, Kashiwakura A, Oshima M, Minamide R, Sato A, Yoshitake T, Takeda A, Egusa H, Tsuji T | display-authors = 6 | title = Bioengineering a 3D integumentary organ system from iPS cells using an in vivo transplantation model | journal = Science Advances | volume = 2 | issue = 4 | pages = e1500887 | date = April 2016 | pmid = 27051874 | pmc = 4820374 | doi = 10.1126/sciadv.1500887 | bibcode = 2016SciA....2E0887T }}</ref>

===Genetics===
From 2005 to 2007, Curis and [[Procter & Gamble]] collaborated on developing a topical [[Hedgehog signaling pathway|hedgehog]] [[agonist]] for hair loss; the agent did not meet safety standards, and the program was terminated.<ref>{{cite news|last1=Weintraub|first1=Arlene|title=Curis and Genentech Unleash the Hedgehog to Fight a Deadly Skin Cancer|url=http://www.xconomy.com/boston/2011/06/28/curis-and-genentech-unleash-the-hedgehog-to-fight-a-deadly-skin-cancer/?single_page=true|work=Xconomy|date=28 June 2011|access-date=November 9, 2016|archive-date=November 9, 2016|archive-url=https://web.archive.org/web/20161109221622/http://www.xconomy.com/boston/2011/06/28/curis-and-genentech-unleash-the-hedgehog-to-fight-a-deadly-skin-cancer/?single_page=true|url-status=live}}</ref><ref>{{cite web|title=Curis Form 8-K: Termination of a Material Definitive Agreement.|url=https://www.sec.gov/Archives/edgar/data/1108205/000119312507109693/d8k.htm|publisher=SEC EDGAR|date=May 10, 2007|access-date=November 9, 2016|archive-date=November 9, 2016|archive-url=https://web.archive.org/web/20161109222303/https://www.sec.gov/Archives/edgar/data/1108205/000119312507109693/d8k.htm|url-status=live}}</ref> In 2008, researchers at the [[University of Bonn]] announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene [[P2RY5]] causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first [[Receptor (biochemistry)|receptor]] in humans known to play a role in hair growth.<ref>{{cite journal | vauthors = Pasternack SM, von Kügelgen I, Al Aboud K, Lee YA, Rüschendorf F, Voss K, Hillmer AM, Molderings GJ, Franz T, Ramirez A, Nürnberg P, Nöthen MM, Betz RC | display-authors = 6 | title = G protein-coupled receptor P2Y5 and its ligand LPA are involved in maintenance of human hair growth | journal = Nature Genetics | volume = 40 | issue = 3 | pages = 329–334 | date = March 2008 | pmid = 18297070 | doi = 10.1038/ng.84 | s2cid = 20241237 }}</ref><ref>{{cite journal | vauthors = Shimomura Y, Wajid M, Ishii Y, Shapiro L, Petukhova L, Gordon D, Christiano AM | title = Disruption of P2RY5, an orphan G protein-coupled receptor, underlies autosomal recessive woolly hair | journal = Nature Genetics | volume = 40 | issue = 3 | pages = 335–339 | date = March 2008 | pmid = 18297072 | doi = 10.1038/ng.100 | s2cid = 1635950 }}</ref><ref>{{cite journal | vauthors = Sprecher E | title = Disentangling the roots of inherited hair disorders | journal = Nature Genetics | volume = 40 | issue = 3 | pages = 265–266 | date = March 2008 | pmid = 18305473 | doi = 10.1038/ng0308-265 | s2cid = 2311629 }}</ref> Researchers found that disruption of the [[gene]] [[SOX21]] in mice caused cyclical hair loss. Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models.<ref>{{cite journal | vauthors = Kiso M, Tanaka S, Saba R, Matsuda S, Shimizu A, Ohyama M, Okano HJ, Shiroishi T, Okano H, Saga Y | display-authors = 6 | title = The disruption of Sox21-mediated hair shaft cuticle differentiation causes cyclic alopecia in mice | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 106 | issue = 23 | pages = 9292–9297 | date = June 2009 | pmid = 19470461 | pmc = 2695080 | doi = 10.1073/pnas.0808324106 | doi-access = free | bibcode = 2009PNAS..106.9292K }}</ref> Deletion of SOX21 dramatically affects hair lipids.<ref>{{cite journal | vauthors = Kawaminami S, Breakspear S, Saga Y, Noecker B, Masukawa Y, Tsuchiya M, Oguri M, Inoue Y, Ishikawa K, Okamoto M | display-authors = 6 | title = Deletion of the Sox21 gene drastically affects hair lipids | journal = Experimental Dermatology | volume = 21 | issue = 12 | pages = 974–976 | date = December 2012 | pmid = 23171466 | doi = 10.1111/exd.12050 | s2cid = 205126099 | doi-access = free }}</ref>

== References ==
{{Reflist|30em}}

== External links ==
* [http://www.aafp.org/afp/990415ap/2189.html "Medical Treatments for Balding in Men"], April 1999, ''American Family Physician'' (medical journal)
{{Human hair}}
{{Other dermatological preparations}}

<!--?: {{DEFAULTSORT:Baldness Treatments}}-->

[[Category:Dermatologic procedures]]
[[Category:Plastic surgical procedures]]

Latest revision as of 18:52, 24 February 2024

Management of hair loss
SpecialtyDermatology

The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.

Prevention

Scratching of itchy scalp may contribute to hair loss.[1]

Health

Body weight

Prevention of obesity helps. Obesity is linked to hair thinning.[2]

Healthy diet

See also: Healthy diet

Oils with fatty acids that has been studied to prevent dermatitis includes:[3][4]

Alternative medicine

The scalp must be cleaned from sebum, sweat, and dirt, prior to topical application, for agents to penetrate it.

A 2020 systemic review on agents used to treat androgenic alopecia found that:[5]

Heating, ventilation, and air conditioning (HVAC)

Humidifier

A humidifier can be used to prevent low indoor humidity during winter (especially with indoor heating), and dry season.[6]

Commonly, patients with seborrhoeic dermatitis experience mild redness, scaly skin lesions and in some cases hair loss.[7]

Low humidity can cause adverse health effects and may cause atopic dermatitis,[8] and seborrhoeic dermatitis.[9]

Treatments

Combination therapy

Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.[10]

Combination therapy of LLLT or microneedling with finasteride[11] or minoxidil demonstrated substantive increases in hair count.[12]

Medication

Add-hocs

The topical bioavailability of synthetic medicines such as antiandrogens, as well as phytochemicals such as quercetin, has been improved with incorporation of drugs in nanoparticles, or microneedling.[13]

Synthetic medicine

Treatments for the various forms of hair loss have only moderate success.[14] Three medications have evidence to support their use in male pattern hair loss: finasteride, dutasteride and minoxidil.[15] They typically work better to prevent further hair loss than to regrow lost hair.[15]

They may be used together when hair loss is progressive or further regrowth is desired after 12 months.[16] Other medications include ketoconazole, and in female androgenic alopecia spironolactone and flutamide.[17]

Baricitinib

In June 2022, the FDA authorized baricitinib for the treatment of severe alopecia areata.[18][19]

Minoxidil

Minoxidil, applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with androgenic alopecia.[20][21] About 40% of men experience hair regrowth after 3–6 months.[22] It is the only topical product that is FDA approved in America for androgenic hair loss.[20] However, increased hair loss has been reported.[23][24]

Antiandrogens

Finasteride is used to treat male pattern hair loss.[25] Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.[20] There is no good evidence for its use in women.[14] It may cause gynecomastia, erectile dysfunction and depression.[26]

Dutasteride is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition.[27][28][29] While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in South Korea and Japan.[30][31]

There is tentative support for spironolactone in women.[14] Due to its feminising side effects and risk of infertility it is not often used by men.[32][33] It can also cause low blood pressure, high blood potassium, and abnormal heart rhythms. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a teratogen, and can cause ambiguous genitalia in newborn children.[34]

There is tentative evidence for flutamide in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use.[14][35] Like spironolactone, flutamide is typically only used by women.[36] Bicalutamide is another option for the treatment of female pattern hair loss.[37][38][39] It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile.[38][39][40] However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment.[38][40]

Ketoconazole

Ketoconazole may help in women.[41][42]

Technological treatments

Low-level laser therapy (LLLT)

Low-level laser therapy or photobiomodulation is also referred to as red light therapy and cold laser therapy. It is a non-invasive treatment option.

LLLT is shown to increase hair density and growth in both genders. The types of devices (hat, comb, helmet) and duration did not alter the effectiveness,[43] with more emphasis to be placed on lasers compared to LEDs.[44] Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia.[45]

Medical reviews suggest that LLLT is as effective or potentially more than other non invasive and traditional therapies like minoxidil and finasteride but further studies such as RCTs, long term follow up studies, and larger double blinded trials need to be conducted to confirm the initial findings.[46][11][47]

Platelet-rich plasma (PRP)

Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata[48] and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride.[49] It has been documented to improve hair density and thickness in both genders.[50] A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance.[51] Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted.[52]

Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus.[46][50][53] Further development of a standardized practice for procedure is also recommended.[48]

Surgical treatments

Hair transplantation

Main article: Hair transplantation
A man before and after a hair transplant.

Hair transplantation is a surgical technique that moves individual hair follicles from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.

Since hair naturally grows in follicles in groups of 1 to 4 hairs, transplantation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through Follicular unit transplantation (FUT).

Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called follicular units, can be moved to balding areas of the hair restoration. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or Follicular Unit Extraction (FUE), in which follicles are transplanted individually.

In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp.[54] After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.[55]

Scalp reduction

Main article: Scalp reduction

Scalp reduction is a surgical procedure in which the hairless region of the scalp of a bald man is reduced. This procedure can reduce the area of the scalp without hair.[56][57]

Regrowth of hair

Facial hair

Eyebrows

Bimatoprost 0.03% has been used to grow eyebrows.[58]

Eyelashes

The FP receptor agonist, bimatoprost, in the form of an 0.03% ophthalmic solution termed Latisse, is approved by the US Food and Drug Administration to treat hypotrichosis of the eyelashes, in particular to darken and lengthen eyelashes for cosmetic purposes.[59] Also, bimatoprost may be used to treat small or underdeveloped eyelashes.[60][61]

Scalp hair

Alternative medication

Topical

Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including 6-gingerol found in ginger.[62]

Topical crude onion juice
Topical crude onion juice from Australian brown onion was used in a 2002 study to regrow hair in bald people.[63]

A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on alopecia areata (spot baldness) in 86.9% of the 23 participants.[63] Twice as many flavonols are found in red onion than in yellow onion.[64] Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth:

  • Quercetin:
    • Quercetin (a flavanoid found in vegan food) supplements, has been suggested to treat baldness.[65] A 2012 study demonstrated that alopecia areata could be used to prevent ant treated with quercetin in mice.[65] Quercetin is found in onions primarily in the peel and the first scaly leaf but not in the flesh.[66] Onion bulb size or weight does not appear to be affected by quercetin concentration.[64]
    • A 2020 study demonstrated that quercitrin stimulated hair shaft growth in cultured human hair follicles.[67]
  • Volatile compounds responsible for pungency and tearing in onions when they are cut (e.g. syn-propanethial S-oxide gas). However, no formal studies have conducted to evaluate if these compounds promote hair growth or if they help other compounds to penetrate the skin to form hair follicles.
    • To use the volatile compounds: Onions must be extracted and applied topically quickly before the volatile compounds evaporates. The extract will cause tearing eyes, but it can be prevented with a shower cap, or a pair of swimming goggles.
    • To discard the volatile compounds: The onion juice is extracted and stored for a short while to evaporate the volatile compounds. The extract will not cause tearing eyes. Also, both genetically modified, and plant breed onions have been produced with significantly reduced levels of tear-inducing lachrymatory factor.[68][69]
Dietary supplements

Dietary supplements are not typically recommended.[70] Many people use unproven treatments,[15] but there is little evidence of the effectiveness of vitamins, minerals, or other dietary supplements regrowing hair or retaining hair.[14] There is no evidence for biotin (vitamin B7).[70] While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin.

However, one small trial of saw palmetto which shows tentative benefit in those with mild to moderate androgenetic alopecia.[70] There was no good evidence for gingko, aloe vera, ginseng, bergamot, or hibiscus as of 2011.[71]

Radiation-induced hair loss

Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression.[72][73] Radiation therapy has been associated with increased mucin production in hair follicles.[74]

Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.[75]

Cosmeses

There have been advances in the fashion industry in wig design.

Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle.[76] There have also been developments in the fashion industry with wig design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion".[77] Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.[78]

Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut.[79]

Human hair growth

Main article: Human hair growth
Hair follicle with mesenchymal dermal papilla, labelled at top, location of hair follicle stem cells and thought to be site of action of DHT.

Type 1 and 2 5α reductase enzymes are present at pilosebaceous units in papillae of individual hair follicles. They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate IGF-1 at facial hair, causing hair regrowth, but stimulate TGF β1, TGF β2, dickkopf1 and IL-6 at the scalp, causing hair follicle miniaturisation.[80]

Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to total hair loss.[81] Finasteride and minoxidil are usually first line therapy for its treatment. Other options include topical or systemic spironolactone or flutamide, although they have a high incidence of feminising side effects and are better tolerated in female androgenic hair loss.

More advanced cases may be resistant or unresponsive to medical therapy, however, and require hair transplantation. Naturally-occurring units of one to four hairs, called follicular units, are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either Follicular Unit Transplantation (FUT) – colloquially referred to as "strip harvesting" – or Follicular Unit Extraction (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites.[55][82] Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut.[83] Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to total hair loss. Treatment options are similar to those for men, although topical or systemic estrogen is used more often.[81][84]

Research

Bimatoprost and latanoprost

Latanoprost and bimatoprost are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes,[85][86] darken hair pigmentation[87] and elongate hair.[17] Bimatoprost is available as treatment for eyelash growth.[88] Latanoprost has shown ability to promote scalp hair density and pigmentation,[89] and is theorized to function at the dermal papilla.[90] A study found latanoprost ineffective on eyelashes in a patient with alopecia areata.[91] It has also been found ineffective in treatment of eyebrow hair loss.[92]

Hormones

Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with oral contraceptives. Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in Europe.[71] Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in North America.[17]

There is tentative evidence for cyproterone acetate in women.[14]

IGF-1

In December 2012, topical application of IGF-1 in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans.[93] Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells.[94] Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors FGF7, FGF-2 and VEGF. β-catenin transcription increased, which promotes dermal papillae as well.[94] Dietary isoflavones increase IGF production in scalp dermal papillae in transgenic mice.[95] Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP.[96] Ascorbic acid has led to increased IGF expression in vitro.[97]

Stem cell therapy

Main article: Hair cloning

Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the stem cells from which the follicles arose.[98] Research on these follicular stem cells may lead to successes in treating baldness through hair multiplication (HM), also known as hair cloning.

Per a May 2015 review, no successful strategy to generate human hair follicles, for hair regrowth, from adult stem cells has yet been reported.[99] However, in April 2016, scientists from Japan published results of their work in which they created human skin from induced pluripotent stem cells; implanted into laboratory mice, the cells generated skin with hair and glands.[100]

Genetics

From 2005 to 2007, Curis and Procter & Gamble collaborated on developing a topical hedgehog agonist for hair loss; the agent did not meet safety standards, and the program was terminated.[101][102] In 2008, researchers at the University of Bonn announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene P2RY5 causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first receptor in humans known to play a role in hair growth.[103][104][105] Researchers found that disruption of the gene SOX21 in mice caused cyclical hair loss. Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models.[106] Deletion of SOX21 dramatically affects hair lipids.[107]

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