Management of hair loss
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Since the 1980s, drug therapy has increasingly become a realistic management option for baldness for men and women, as increased understanding of the mechanisms of normal and pathologic hair growth has pointed the way to improved treatments. Scientifically proven baldness treatments continue to be an area of research that receives a large amount of funding. More than half of men are affected by male pattern baldness by age 50, and baldness treatment is estimated to be a US $1 billion per year industry.[1]
General concerns
It is easier to prevent the aging and falling out of healthy hairs than to regrow hair in follicles that are already dormant. Propecia is the only treatment that has been demonstrated as an effective maintainer. 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, and some places 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 83% of participants on Propecia experiencing either no more hair loss or regrowth. See Prevent Hair loss, don't Regrow?
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.
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.
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.[2] Proponents of alternative therapies believe that the majority of cases of hair loss that progress despite treatments do so because the people believe no such cure can occur. In this view, this belief, which is prevailing in the modern civilised world and continuously reinforced by medical science, is the main obstacle for effectively finding and applying a cure.
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.[3] The Three P's are: proven treatments first, take pictures, and be patient. The most recommended treatments, in order of proven effectiveness, greatest to least, is as follows: (1) Propecia (2) Rogaine (3) Tricomin (4) Topical Spiro 5% (5) Revivogen (6) Crinagen (7) Folligen (8) Everything else.
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 2 or 3 a year, which is why it can take a year or more to be able to detect the success of a treatment.
This difficulty can be increased because 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 treatments can also cause periods of shedding, though this hair loss is generally considered to be temporary, not affecting the baseline.
Propecia
Propecia, also called by its non-brand name Finasteride, is a "DHT inhibitor" pill that is FDA approved to inhibit production of DHT through the entire body (called systemic). It does this through inhibiting the conversion of testosterone to DHT. Finasteride is taken orally and has a reported 29-68% success rate (vs 17-45% in patients receiving a placebo). It is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy (Rossi, 2004). In clinical studies, Propecia, like Minoxodil, was shown to work on both the crown area and the hairline,[4] but is most successful in the crown area. For those in the early stages of hair loss, it is generally recommended to start slow, using propecia alone for at least a year, as it has very good maintenance rates, then adding other products, such as minoxidil, if regrowth is desired.
Propecia is the same as the oral prescription drug, Proscar, used in higher doses to treat an enlarged prostate. Some users save money by buying Proscar instead of Propecia , and split the pills in quarters using a pill-splitter to ensure the same amount as is present in Propecia is taken.
Propecia has been shown to be ineffective for treating hair loss in women, and shouldn't even be touched by pregnant or potentially pregnant women, as it causes severe birth defects in male fetuses.
Possible health concerns
The UC Berkeley Wellness Letter in March 2003 states they don’t recommend Propecia "because its long-term safety is unknown. This is disquieting, since young men are the prime candidates, and the drug has to be taken for a lifetime. If you do decide to take it, you should know that although the standard dose is one milligram, there is some evidence that one-fifth that amount also works. If you cut the pill into quarters, you will save money."[5]
While they point out Propecia must be taken for a lifetime to avoid losing hair, it should be counterpointed that future treatments are widely expected by baldness specialists to replace Propecia, which would end the need for continued use. Additionally, Propecia is widely considered safe enough to prescribe by health professionals, and is one of the only two FDA-approved baldness treatment products on the market.
Propecia's effects in detail
Summarized from: DHT: the full story
DHT is a derivative hormone (metabolite) of testosterone that is considered to be the main cause of miniaturization and eventual destruction of hair follicles in male pattern baldness. DHT is a steroid hormone just like testosterone but more powerful.
Many dermatologists and research scientists specializing in hair loss believe DHT molecules may diffuse into the interior of hair follicle cells (the cytoplasm or cytosol) and bind with androgen receptors. This complex, both the receptor and the DHT molecule, then enters the nucleus of the cell. In the nucleus of the hair follicle cell this complex could then alter the rate of protein synthesis in men who are genetically predisposed to baldness.
However, DHT also plays an important role in the functioning of the central nervous system (the brain), the testicles and prostate, and almost everything but muscle tissue. In muscle tissue testosterone is the dominant hormone. (Some bodybuilders inject testosterone derivatives to gain muscle fast.)
- Propecia and Avodart cause a rise in testosterone levels because testosterone that would normally be converted into DHT remains testosterone. Continual high levels of testosterone in the body could possibly have negative side effects.
- Artificially low levels of DHT in the body could cause some unwanted conditions. DHT is an antagonist of estrogen. Men’s bodies also produce the female hormone estrogen in the adrenal glands although this is just one-tenth of the estrogen that premenopausal women produce in their ovaries. By reducing DHT with drugs a man’s protection from the effects of estrogen may also be reduced. Gynecomastia could be one result of this. Gynecomastia is abnormally large breasts in a male.
- Even though both finasteride and dutasteride were developed to combat benign prostatic hyperplasic by reducing DHT in prostate tissue, some scientists question the wisdom of using these 5-alpha reductase inhibitors in younger men who have no problem with their prostates. A research chemist, Pat Arnold - “Evidence is mounting that the existence of a high estrogen/androgen ratio - a condition common in older men - is highly correlated with the development of benign prostatic hyperplastic.”
Revivogen
Revivogen is a non-FDA approved topical DHT inhibitor treatment applied to the scalp, with many ingredients, such as types of fatty acids, that are thought, though not proven, to inhibit DHT levels in the scalp and have a positive influence in combatting hair loss. Revivogen also contains ingredients that are thought, though not proven, to function as an antiandrogen (see below) that has a positive influence in combatting hair loss. Clinical trials are reportedly underway.
Revivogen uses simple mixtures of fatty acids (gamma Linolenic acid, alpha Linolenic acid, Linolenic acid, and a few others, which are thought to be potent inhibitors of 5AR, both type I and type II[6][7][8][9]), in their free form, that come from the bulk de-esterification of natural oils like borage and flaxseed. This methodology is considered just as effective as using purified fatty acids, but saves considerable expense. There are other products that contain fatty acids from natural oils, such as black currant oil and emu oil, but virtually all natural oils, including these two, contain only insignificant amounts of free fatty acids.
Antiandrogens
Antiandrogens block DHT already produced and present in the blood stream from binding with hair follicles. Nizoral Shampoo and Neutrogena T-Gel have been clincally shown to have antiandrogen properties and are prescribed by medical professionals.
EDIT
Minoxidil
Minoxidil dilates blood vessels, and is sometimes called a "potassium channel opener." In the brand name Rogaine, it is FDA approved to stimulate regrowth and thicken hairs. Minoxidil is applied topically to the scalp, and has been shown to promote hair growth in about 25% of men and women, 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 have also been reported, but rarely.
Copper peptides
Copper peptides are topical, 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 dismutate activity. They likely work by destroying superoxide, the antagonist to Nitric Oxide (NO), the natural miNOxidil.
Ketoconazole
Because Ketoconazole is both an anti-fungal and also a 5-alpha reductase inhibitor, it can help to slow the balding process. [10] [11] [12]
Herbal Medicine
Saw Palmetto
Saw Palmetto (Serenoa repens) is an herbal DHT inhibitor often claimed to be cheaper and have fewer side effects than finesteride and dutasteride. Unlike other 5alpha-reductase inhibitors, Saw Palmetto extract works without interfering with the cellular capacity to secrete PSA. [13] Saw palmetto extract has been demonstrated to inhibit both isoforms of alpha-5-reductase unlike finesteride which only inhibits the (predominant) type 2 isoenzyme of alpha-5-reductase. [14] [15] [16]
Nettle Root
Nettle root is a DHT inhibitor and is often used in conjunction with Saw Palmetto. The leaves of the plant should be generally be avoided as they contain formic acid, which is metabolized by the body to formadehyde.
Pumpkin Seed
Used to aid in the breakdown of DHT by the liver. An extract is often used, as unprocessed pumpkin seeds are high in fat which can exacerbate hair loss in susceptible patients.
Diet and Lifestyle
While drugs rather than lifestyle changes are frequently reccomended to treat baldness in the United States, the dramatic increase in baldness in the population of Japan after World War II suggests that the prevalence of baldness can be influenced by diet and lifestyle. Increased fat intake, decrease in aerobic exercise and general 'westernization' was accompanied by a dramatic increase in incidence of male pattern baldness. The results of an investigation by Jin-Rong Zhou et al., Harvard Medical School, suggest that components of traditional Japanese diet, soy products such as tofu and green tea, work synergistically to dramatically inhibit the conversion of testosterone to dihydrotestosterone (DHT). Reducing or abandoning these major elements of the traditional diet may have been the main reason for the increase of male pattern baldness in Japanese men after World War II - including a probable increase in the rate of prostate cancer. (J. Nutr. 133:516-521, February 2003)
Aerobic exercise (as opposed to short workout periods designed to raise androgen levels and build muscle) and a diet which is more moderate in terms of fat intake may help alleviate the metabolic conditions which contribute to male pattern baldness.
Stress reduction can restore healthy levels of SHBG.
One explanation for the relationship between lifestyle and male pattern baldness is that lower caloric intake along with more aerobic exercise can decrease insulin levels, preventing a host of metabolic problems which contribute, in part, to hair loss. Insulin downregulates sex hormone binding globulin. In individuals with moderate levels of SHBG, SHBG would bind to testosterone and helps prevent its conversion into DHT in the scalp via 5-alpha reductase. But in individuals with lower levels of SHBG, more testosterone is left to float free in the bloodstream and thus be converted into DHT in the scalp. Levels of DHT in the scalp are a key factor in male pattern baldness. This link between diet, insulin, SHBG, androgens and baldness helps to explain recent studies which have shown that early male pattern baldness is an indicator for various metabolic and cardiovascular problems. In other words, diabetes, hairloss and cardiovascualr disease may all be linked to high caloric intake and low exercise.
Others
- Azelaic acid - promoters claim it is "Proven to inhibit up to 100% of DHT where applied." The evidence for this claim is uncertain. A study titled "Inhibition of 5a-reductase activity in human skin by zinc and azelaic acid" found a 90% inhibition of 5a-reductase activity in vitro with an azelaic acid and zinc combination. There was an additive effect between the two compounds.
- Spironolactone
- Retin-A (Retinoic acid; chemical peel stimulation of scalp)
- Avacor - discredited[19]
- LLT or Low-level Laser Therapy; Not FDA approved for hair regrowth, but only as a cosmetic hair enhancer. Treaments are administered at either a clinic or salon (most of which are in Europe), or by the individual user via a home-based portable system. For example, "The Laser Comb". No official results have been proven or published in regards to hair regrowth.
- Stinging nettle –
Hair transplant
Surgery is another method of reversing hair loss and baldness, although it may be considered an extreme measure. The surgical methods used include hair transplantation, where patches of skin with hair are moved from one part of the head to another. Another method is scalp reduction, where parts of the scalp are removed, the skin is stretched over the area that had been removed, and everything is stitched back together. Hair transplants generally cause scarring, sometimes severe, which may be especially visible if hair loss continues over the rest of the scalp.
Hair multiplication (future treatment)
Stem cells have been discovered in hair follicles and some researchers predict research on these follicle stem cells may lead to successes in treating baldness through hair multiplication, also called hair cloning within three or four years (as of November 2004). This treatment is expected to initially work through taking stem cells from existing follicles, multiplying them in cultures, and implanting the new follicles 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. [20]
- Stem Cell Research Update (March 2004) - Covers a study by Dr. George Cotsarelis and his team of researchers at the University of Pennsylvania.
See also
External links
- "Medical Treatments for Balding in Men," April 1999, American Family Physician (medical journal)
- North American Hair Research Society Frequently asked questions
Consumer information pages
Hair loss specialist directories
- Directory of Specialists by Region from the American Hair Loss Council
- (Smaller) Directory of Specialists by Region (U.S.) from hairlossdocshop.com
Baldness news
- Health Alternatives: zinc, silica, methylsulphonylmethane (MSM) and cod-liver oil, to slow down the process.
References
- ^ "Uncovering the bald truth about hair loss." Springfield News-leader, May 10, 2005. "Half of men" estimate is made by the American Academy of Dermatology and specifically estimates prevalence in the U.S. population, though this should reflect prevalence in other populations.