How Effective Are Hair Loss Treatments?

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Few cosmetic issues strike fear in the hearts of men more than hair loss. According to the American Hair Loss Association, two-thirds of men will experience some degree of appreciable hair loss by age 35, and 85 percent will have significantly thinning hair by age 50. While some men are unfazed by the prospect of losing hair or going bald, others are devastated by the change and are willing to try just about anything to maintain their manes.

What causes hair loss?

Although the exact cause isn’t fully understood, hair loss occurs when the natural cycle of growth and shedding is disrupted and the hair follicle is destroyed and replaced by scar tissue. Heredity, hormonal changes, medical conditions, and certain medications may be behind the root cause of loss. Age, poor nutrition, and stress can also be significant risk factors. In the vast majority of men, hair loss is a normal part of the aging process and not indicative of any problem.

Are hair loss treatments effective?

You’ve likely seen advertisements and drugstore displays extolling the benefits of various pills, liquids, and procedures that promise to regrow hair. Some treatments can be effective, but results vary and are not always guaranteed.

So far, “natural” remedies for hair loss that don’t include pharmaceuticals or surgery haven’t proven to be effective. Although several small studies have indicated that capsaicin (the compound that makes hot peppers hot) and onion juice may be beneficial for hair regrowth, more research is necessary to evaluate the effectiveness of these methods. And although a 2013 review in the Journal of Dermatology noted that sage, rosemary, and aloe vera have also historically been used to promote hair growth, there is little evidence to support claims that these remedies actually work.

Here’s a look at some of the most popular hair loss treatments:

Minoxidil (Rogaine)

  • What it is: An over-the-counter liquid or foam rubbed into the scalp twice a day to grow hair and prevent further loss. It’s available for men and women and takes about 16 weeks to work. The medication must be applied continually to retain benefits.
  • How does it work?: The first drug approved by the FDA for male pattern baldness, minoxidil “reactivates your hair’s natural growth cycle by reinvigorating hair follicles that are shrunken due to hereditary hair loss,” according to the Rogaine website. The site claims that over time, the product can reduce hair loss and help regrow “natural, thicker-looking hair.”
  • How effective is it?: In a 16-week, double-blind, placebo-controlled trial of 5% minoxidil topical foam in 352 men, there was a statistically significant increase in the amount of hair and improved hair loss in the minoxidil group versus the placebo group. Many experts, however, consider the drug a temporary fix because it doesn’t act directly on the hormonal process of hair loss.
  • Possible side effects: Scalp irritation, unwanted hair growth on areas close to face and hands, rapid heart rate.

Finasteride (Propecia)

  • What it is: Propecia is a prescription drug available only for men; it is taken in pill form to slow hair loss and possibly regrow hair. Users must continue to take the medication in order to retain benefits.
  • How does it work?: The first drug in history to effectively treat male pattern baldness in the majority of men who use it, Propecia inhibits 5-alpha-reductase, the enzyme that converts testosterone into dihydrotestosterone (DHT). DHT shrinks the hair follicle, which eventually leads to baldness, so lowering the levels in the scalp can stop the progression of hair loss.
  • How effective is it?: Clinical trials have found that Propecia’s 1-milligram dose of finasteride can lower DHT levels in the scalp by 60 percent when taken daily, and this can stop the progression of hair loss in 86 percent of men taking the drug. Sixty-five percent of participants had substantial increase of hair growth.
  • Possible side effects: Diminished sex drive and sexual function, increased risk of prostate cancer (both are rare). Women who are or may become pregnant should not touch the tablets. In some men who experience sexual side effects, these side effects persist even after stopping the drug.

Steroid Injections

  • What it is: Some doctors use steroid injections to speed recovery of hair loss due to alopecia with corticosteroid injections in the scalp or oral steroids like prednisone. This treatment is not used for baldness associated with aging; it is only appropriate for individuals who have been diagnosed with alopecia.
  • How does it work?: Steroid injections into bald patches of the scalp suppress the local immune reaction that occurs in alopecia areata, an autoimmune disease that causes hair loss. They can allow the hair follicles to function normally again so hair can re-grow.
  • How effective is it?: In a study of 84 patients, 92 percent of participants with patchy alopecia areata and 61 percent of participants with alopecia totalis (total baldness) experienced regrowth on treated areas.
  • Possible side effects: The injection may cause temporary skin thinning and the prednisone may cause weight gain, metabolic abnormalities, acne, and menstrual problems. The positive effects are only temporary.

Hair Transplant/Restoration Surgery

  • What it is: A surgical technique that involves moving hair follicles from a “donor site” (usually the back of the scalp) to a thinning area of scalp.
  • How does it work?: A surgeon removes plugs of skin, each containing a few hairs, from the donor site, and then implants the plugs into bald sections of the scalp.
  • How effective is it?: Primarily used to treat male pattern baldness, most hair transplants result in excellent hair growth within several months, according to MedLine Plus, although more than one treatment may be necessary, and the results depend on the number of hair follicles that remain healthy after transplant.
  • Possible side effects: Infection and scarring.

Laser Therapy

  • What it is: An FDA-approved low-level laser is used to treat pattern baldness in men and women.
  • How does it work?: The low laser light is absorbed by the cells of the scalp, which, according to advocates, will repair them and encourage regrowth.
  • How effective is it?: According to the New York Times, laser hair restoration won’t bring back dead hair follicles, but it may stimulate declining follicles so that existing hair is thicker and fuller.
  • Possible side effects: Researchers said there were no side effects in a study of 128 male and 141 female subjects, but there needs to be further study to look at long-term effects.

If you’re looking to re-grow hair, your safest bet is to discuss your concerns with your primary care provider and discuss the options in detail. He or she can help you weigh the pros and cons of each method in depth.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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