The Different Hair Loss Treatments Explained. A Complete Guide
This is obviously a very big topic, and it can be a bit overwhelming! In the last few years hair loss research has really expanded, and there are some exciting new developments on the horizon. For now, though, I thought I’d summarise current management options for male pattern hair loss. It is important to note that only prescription medications and hair transplantation have evidence to support significant hair regrowth, though other treatments show some benefit and may be used in parallel.
Wigs and cosmetic tattooing
These are the easiest and least invasive ways to manage hair loss. They do not regrow or rejuvenate hair but instead act to disguise hair loss.
Over the counter therapies
These are treatments that you can buy directly without the need for a prescription. It is important to remember that though these over the counter products do have some
effectiveness, the effect will be modest when compared to prescription treatments.
Caffeine
Topical caffeine counteracts the DHT-induced suppression of hair growth by
decreasing inflammation and increasing cAMP in cells. cAMP is very important in the growth phase of the hair follicle.
Ketoconazole
This is an antifungal treatment that reduces scalp inflammation caused by fungal
overgrowth and provides mild anti-androgenic effects (blocking the effect of DHT). If you are treating hair loss, you should always be addressing dandruff (an overgrowth of the fungus Malassezia) and other sources of scalp inflammation at the same time.
Saw palmetto
These are the berries of the plant contain compounds that mildly inhibit 5 alpha
reductase (the enzyme that converts testosterone to DHT). DHT is responsible for the
miniaturisation of hair follicles.
Low-level laser therapy (LLLT)
LLLT uses wavelengths of light between 600 and 1100nm to encourage hair growth, either in a clinic or with caps at home. It is comparatively cheaper than other options as LLLT caps can be bought online, which can then continue to be used at home. LLLT is easy to use and only requires use 2-3 times per week. It is however less effective than prescription medications and is generally only effective in the earlier stages of hair loss.
Microneedling
Tiny needles cause controlled tissue microinjury which promotes healing and growth. There are many microneedling hair rollers and stamps available for purchase that can be used easily at home, though it is important to follow the instructions and be delicate with their use. Microneedling can be used with topical therapies to improve absorption through the skin.
Prescription medications
Minoxidil
Minoxidil is a vasodilator, it widens blood vessels to allow more oxygen and nutrients to the hair follicles and prolongs the growth phase of the hair follicle. In the scalp, minoxidil needs the enzyme sulfotransferase to convert it to its active form minoxidil sulfate. Some people won’t respond to minoxidil, and this is generally because they don’t have enough of this enzyme in their scalp.
Finasteride
Finasteride is a type II 5-alpha reductase inhibitor, meaning it blocks the enzyme type II
alpha reductase. This enzyme converts testosterone to dihydrotestosterone (DHT), which is the main hormone responsible for the miniaturization of hair follicles that results in male pattern baldness. By blocking this enzyme, there is less DHT to act on the hair follicles, and thus less hair loss. This is also however where the side effects come in, as blocking the production of DHT can result in side effects such as decreased libido, erectile dysfunction, gynaecomastia (growth of breast tissue), testicular pain, and mood changes. This risk is overall quite low and is also much less with topical finasteride than it is with oral finasteride. Studies have shown that topical finasteride lowers serum DHT (the amount of DHT in the blood) by only 15% whilst lowering scalp DHT by 70%. In contrast, oral finasteride acts via the bloodstream, and so reduces serum DHT by 60-70%.
Dutasteride
Dutasteride, like finasteride, is a blocker of the enzyme 5 alpha reductase. It is, however,
much more potent than finasteride, as it blocks both type I and type II of this enzyme and
does so much more strongly (3 times more with the type II enzyme and 100 times more with the type I enzyme). It does thus carry a proportionally high increase in risk of side effects. Dutasteride is currently only available as a tablet, though studies are currently underway looking into use of topical dutasteride for male pattern hair loss. Results so far are looking good, and – as an added bonus – because it stays on the scalp longer, it only needs to be applied a few times a week rather than every day.
Platelet rich plasma
This involves isolating plasma from the patient’s blood and injecting it into the scalp. The
plasma contains beneficial platelets, growth factors and signalling molecules involved in hair regrowth. There is some evidence to show improvement in hair regrowth, though PRP tends to be less effective than prescription medications. It can also be expensive as it requires expert administration, and painful due to the injections into the scalp.
Hair transplant surgery
This involves surgical relocation of healthy hair follicles from the back or sides of the scalp to the thinning areas of hair. The transplanted hair follicles will remain permanently thick and healthy, and as such transplantation is the only definitive treatment for male pattern hair loss. It can however be quite costly, and there are surgical risks such as infection, scarring and swelling. It is also important to note that if only part of the affected scalp is transplanted, medications may still be needed to maintain healthy hair over the rest of the scalp.
Conclusion
As you can see, there are many options available to treat male pattern hair loss and
choosing the best option for you can get overwhelming! Speaking to a hair loss doctor can help you decide on a solution that works best for you, giving you the safest and most
effective option to keep you feeling confident with your hair. If you want to speak to a hair loss doctor about your hair situation, book a free online consultation with one of our team. We will be able to chat to you about which treatments are available, and what will be the most safe and appropriate one for you. If you can’t see a time that
suits you, get in touch with our team and we’ll find a way to assist you.
Articles
Overview of treatments:
Information on finasteride:
Overview of hair transplantation: