Hair loss is mostly genetic (from both your father and mother’s side), and for men this is usually first noticed at the hairline temples or crown, whereas for women, it often appears at the centre (vertex) of the head. By the time you notice hair loss or thinning hair, up to 50% of the hairs have shed. We can’t change our genetics, but modern medicine has come a long way to slow (and occasionally halt) the process.
Note: This article is designed for general advice about the medical treatment of androgenic alopecia, for specific information about hair loss options, book a consultation with your hair loss doctor.
Minoxidil was the first FDA-approved medication for hair loss in the 1970s, and therefore has the longest track record. Initially used as a blood pressure lowering medication tablet, hair growth was an incidental side effect, and so the topical formulation was developed.
The mechanism of action of Minoxidil in hair loss is still unclear, but likely a combination of vasodilation promoting hair nutrition, as well as growth factors for collagen, blood vessels and hair follicle stem cells. For correct use, it should be massaged directly to the skin to stimulate the existing and dormant follicles.
Minoxidil can reduce hair loss and prevent hair fall in up to 2/3 of patients. Importantly, it does not directly address the cause of hair loss, which is dihydrotestosterone (DHT). Minoxidil use should be maintained with 1-2x daily use, with effects usually seen at 3 months. Ideally, it shouldn’t be abruptly ceased, as hair loss may return after 6-12 weeks.
Finasteride blocks the primary cause of hair loss- the 5aR enzyme converting testosterone (TT) dihydrotestosterone (DHT), which in turn causes hairs to shed. Finasteride helps to stabilize hairs susceptible to hair fall and is now the standard in hair loss medications. In fact, it’s the same medication used to treat enlarged prostates, too (but see your doctor about this).
A review of the studies show that Finasteride dosing for one year can cause hair stabilization in up to 80% of patients (and a further 15% grow hair where there was previously none), with effects most visible after 3 months of continued use.
Many men find the tablet more convenient and discreet than the topical Minoxidil. However, as a small percentage (<5%) will experience testicular pain, low mood or libido. It is important to speak to your doctor if you experience this, or are predisposed to these conditions.
To bypass the systemic side effects, newer studies are showing promise with topical finasteride, at 0.1-0.2% strengths, especially in combination with topical minoxidil. This is not yet widely available, but is an exciting new development for those who experience (or are worried about) the systemic side effects of the oral version.
Combination treatments of Minoxidil and Finasteride are more convenient and can bypass the side effects of oral Finasteride, such as low mood or libido.
Saw Palmetto is a naturally occurring herb, that has demonstrated some positive hair growth, especially in conjunction with Finasteride. This is due to the effect is has on both subtypes of the 5-alpha-reductase enzyme (1 and 2), rather than just 5ar2. Most men who take saw palmetto report lower adverse effects, but also slower (and less) hair growth. For this reason, it has not yet been demonstrated to be superior to Finasteride.
Biotin has also been shown to be a crucial ‘ingredient’ in growing back healthy hair. It is naturally found in eggs and meat, but can be supplemented in those who are deficient or vegan. However, in healthy patients it may not have a significant or visible effect on its own.
Low level light therapy (LLLT) has been used for years to promote collagen growth (and stimulate the hair follicles within). This occurs as the laser increases the energy and metabolic activity within the cell, using red light (usually wavelength 650nm at 5milliwatts).
Low level light therapy (LLLT) treatments can now be done with discretion and while enjoying other activities.
This low amount of energy is enough to stimulate, but not burn the scalp. Ideally this should be done at least 30 minutes at a time, several times a week. Previously, this treatment was reserved for specialist clinics using expensive equipment, but many home-based machines and caps provide the hair support with full discretion.
Medications offer a first-line solution to preventing hair loss by addressing the causes the underpin it. Hair transplantation is still the best and only cure for areas already afflicted by androgenic alopecia to fill in hairs where there were previously none, but these measures can potentially reduce the size required, saving your precious donor zone, your money and most importantly, your hair.