There are plenty of practitioners and products out there promising to restore your hair, but in this vanity-driven industry with more than its fair share of sharks, its very much a case of caveat emptor (let the buyer beware).
The facts are:
* Hair loss and balding is not uncommon – androgenetic hair loss affects more than half of all men, and many women, at some point in their lives.
* There are treatments that can slow or stop hair loss, and in some cases reverse it. However, there are plenty of shonky operators and products out there, which can be traps for the desperate.
* You will have more treatment options available to you if you see your doctor as early as possible in the hair loss process.
We review the main hair loss treatments available, including:
Finasteride and dutasteride
Hair transplant surgery
Low level laser therapy (LLLT)
About hair loss
Androgenetic alopecia, also called male-pattern hair loss, is a hereditary pattern of hair loss affecting about 30% of men in their 30s, and about 50% of men in their 50s. In men who have inherited the condition, testosterone is converted to dihydrotestosterone (DHT) in large amounts, actively targeting the hair follicles from temples to crown. Over time, the hair follicles shrink and the hair shaft is reduced until it is short, fine and downy.
Many women can also experience androgenetic alopecia, which causes general thinning on the crown. However, it appears in women that there are a number of different hormones involved, rather than just the one, so diagnosis and treatment is less straightforward. Other less common kinds of hair loss include alopecia areata, where hair is lost in spots or patches, and hair loss due to illness, stress or dietary issues. In this article, however, we focus on androgenetic alopecia.
Hair loss treatments
Finasteride (Propecia) Finasteride is a prescription medicine usually taken to treat an enlarged prostate, and works by blocking one of two enzymes (called 5-alpha reductase) that convert testosterone to dihydrotestosterone (DHT). Its the DHT that causes hair follicles on the temples and crown to shrink, so finasterides action helps prevent or slow hair loss, and taken in the early stages may even regrow hair. Clinical trials have found it helps nine out of 10 men. Side effects are uncommon but may include impotence, breast cancer and depression. It may also cause birth defects so it is not recommended for women. It costs about $30-40 per month, although your hair-loss medical specialist may determine you need it less often, which reduces the cost and risk of side effects. You will need to take it for at least a year to know whether its proving effective.
Dutasteride has a similar action to finasteride, but blocks both DHT-making enzymes instead of one. It may be a more effective option if finasteride isnt working for you, although at present its only prescribed off-label for hair loss.
Saw palmetto is a herbal remedy sometimes taken instead of finasteride for treating an enlarged prostate. It was hoped it might prevent hair loss too, and is often promoted as such, but this has not been shown in large-scale clinical trials so far.
Minoxidil (for example Regaine)
Minoxidil is a topical treatment applied to your scalp twice daily. It works best on people with recent or mild hair loss, but less effectively on people who have had large areas of baldness for a long period of time. There is also a genetic basis for its effectiveness: some people produce the enzyme to convert the minoxidil in solution to the active compound minoxidil sulphate, while others do not, making it less effective for them. It may take up to a year to see results. Hair loss will rapidly restart when you stop the medication. Some hair loss clinics promote a pharmacist-compounded solution of minoxidil with retinoic acid, which supposedly helps the minoxidil penetrate the skin. However, there is no good evidence it increases minoxidils effectiveness, and it is more likely to irritate your scalp.
Hair-transplant surgery has changed a lot in the past 20 years, and the tufty plug transplants of yesteryear have been replaced with implants of individual follicles. A surgeon cuts a strip of scalp from the side or back of your head, and the follicles are separated and inserted into the crown and temples. Sometimes, instead of a strip, individual follicles are removed and implanted. Because the implanted follicles arent susceptible to DHT, the hair growing from them is permanent. However, it is likely you will need to use medication to maintain remaining DHT-susceptible hairs. Some people have complained about scarring from the strip procedure, so always research the surgeon you are thinking of using beforehand.
What about laser therapy?
Some clinics offer low level laser therapy to halt hair loss and regrow hair, and there are also handheld devices for home use. Laser is often used as part of a regime including minoxidil and finasteride, special shampoos, thickening conditioners and other products that disguise hair loss. This makes it difficult to tell what improvement – if any – is from which treatment, and what is merely a temporary cosmetic effect.Unfortunately, there is no definitive answer as to whether or not laser therapy works. There have been some clinical trials, but these have been criticised in the past for being too small, funded by laser product manufacturers, and not published in peer reviewed journals. More recently, however, a better quality clinical trial of the various HairMax brand handheld devices showed some evidence it may help regrow hair in some people. We could not find trials of the larger helmet or panel type products found in clinics, and it is unclear whether the clinic laser devices are as effective, or more effective, than the handheld ones tested: the ideal laser wavelength, power, length of time and frequency of application has not been definitively established. Laser treatment in clinic settings is often combined with other treatments, such as finasteride and/or minoxidil. Consumer experiences are widely varied. While some people feel it works, others find it made no difference, and others found that the hair lost early in the process (which is quite normal) was not replaced, and they ended up with less hair than they started with. This could be because their stage of hair loss was not suited to laser therapy or they were not using the device as recommended.
Hair system, Strand by Strand, non-surgical hair replacement and hair replication are among the various synonyms used for hairpieces – a partial wig or toupee that is attached to the scalp by glue or double-sided tape. They are extremely effective at covering a large area of thin or lost hair, and can be matched with and worked into existing hair. Forget the 'rugs' of old – by matching the colour (including grey hairs), strand thickness, curl and hair density to your existing hair, these days hairpieces can be made so well that they are undetectable to the casual observer, even at the hairline.
1. No one treatment will suit everyone. Your doctor ca not predict if it will work for you, and your hair loss clinic salesperson ca not predict if it will work for you. It is a case of try it and see.
2. This being the case, your best bet is to choose from among therapies that have good quality evidence that they may work, then decide which suits you according to cost and convenience.
I am losing hair. What do I do?
See your doctor early in the hair-loss process. There are many more options available when hair loss first starts and medication can be quite successful in the early stages. Your doctor can also rule out illness and other causes of hair loss. Too many people wait too long before doing anything, or go down the snake-oil route for several years before realising their hair loss is getting worse, not better.
Do not expect miracles. One of the main reasons people are dissatisfied with finasteride and minoxidil is that they are hoping for significant, or at least some, hair regrowth. However, preventing or slowing the hair-loss process is the more likely outcome, with any regrowth just a bonus.
Do your research. There is no certifying body for medical professionals specialising in hair transplants, though the major players in Australia are highly skilled. So if you are looking for a hair transplant surgeon, do your own research – there are plenty of online forums on the topic.
Where is the evidence? If you are offered unusual medications or herbal treatments, ask for the evidence from clinical trials. Verify these findings with your own research. Don't rely on client testimonials.
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