Medical Treatment for Hair Loss – Effective Ways to Combat Hair Loss
Today, hair loss affects a very large population worldwide, and many people seek effective solutions for this common concern. However, the search for ways to manage hair loss dates back centuries. Modern medicine has significantly expanded the available options through advances in medical science, technology, diagnosis, and clinical experience. Medical treatment for hair loss can now be tailored to the underlying cause, hair-loss pattern, follicular condition, and individual patient needs.
Hair loss does not have a single cause or one universal treatment. Some forms are temporary and may resolve after the triggering factor disappears. Others are progressive and may require long-term medical management or hair restoration surgery. Therefore, identifying the type and cause of hair loss is the first step toward selecting an appropriate treatment.
What Causes Hair Loss?
There are many different factors that can cause hair loss from genetic problems to diseases and certain medications. Depending on what provokes hair loss, the way out may be as simple as changing one's habit. In other cases, you will need medical treatment to address the hair loss.
To choose the treatment, one should distinguish between hair line maturation and pathological hair loss. For example, a teenager boy has a low hair line, which includes fine and soft hairs across the frontal part of the head. As puberty comes to an end and male maturation continues, forehead looks larger. With further maturation, frontal hairline gradually moves backwards. Mature man's hair line differs from that of adolescent boy. A modest, age-related hairline change does not mean androgenetic alopecia or any treatment at all.
Some mature men try to go for hair transplantation to recreate very low hairline of his teenage years. However, bringing back too youthful hairline may result in disproportional look. The planning of hairline should consider facial proportionality, the age of the patient, the development of hair loss and the number of donor hairs available.
The Hair Growth Cycle
The hair of humans is renewed constantly thanks to biological cycles. There are four phases of hair cycle: anagen, catagen, telogen, and exogen. Anagen is the period of hair growing, catagen is the transitional phase, telogen is the period of rest, and exogen is related to hair falling off. [1]
Hair follicles do not go through these stages simultaneously, they follow individual cycles, which prevents the fall of all hairs at the same time. Shedding of 50–100 hairs per day can be the normal process in case of a healthy person, though it depends on the individual. [1,2]
In case of normal human condition 85–90% of the scalp hair is in the anagen phase. Anagen can last several years, though the length of other phases is determined by age, genetics, gender, hormones, health condition and others biological factors. Hair growing phase usually lasts longer in many women than in men. It may contribute to differences in maximum hair length and timing of shedding. However, individual differences are great, and the duration of hair-cycle should not be the only diagnostic criterion of hair loss.
Common Types of Hair Loss
Apart from daily shedding and hairline maturation, there are a lot of types of hair loss that require medical examination. The procedures may vary from finding out the cause of the problem, changing certain habits of the patient, taking special medications, having supportive treatments or hair transplantation.
Common types of hair loss include androgenetic alopecia, telogen effluvium, alopecia areata, traction alopecia, trichotillomania, alopecia totalis, infections of the scalp and hair loss connected with chemotherapy or other medical treatments.
The appropriate treatment depends on the diagnosis. Telogen effluvium may improve once the underlying cause is identified and managed, while androgenetic alopecia will require long-term medical treatment or hair transplantation. In case of advanced traction alopecia, permanent scaring can appear and may require hair restoration.
It is advisable to undergo examination of hair loss by a dermatologist, hair transplant surgeon or trichologist, depending on the cause of the problem. The accurate diagnosis is essential prior to medication and surgery.
Androgenetic Alopecia
Androgenetic alopecia is a genetically influenced type of hair loss, which is also called male pattern baldness. It appears due to gradual miniaturization of genetically susceptible hair follicles. Androgens, particularly dihydrotestosterone (DHT) plays a significant role in male androgenetic alopecia. [3]
The possible genetic predisposition may be revealed by investigating similar hair loss among close family members. However, family history alone cannot confirm the diagnosis because androgenetic alopecia is polygenic. Norwood-Hamilton scale is usually used for description of male pattern hair loss. Increasing stages generally correspond to further hairline recession and, at later stages, to vertex thinning. [3]
However, one should understand the difference between hairline maturation and progressing androgenetic alopecia. Hairline maturation is not necessarily a pathological hair loss. Clinical examination and, in appropriate situations, trichoscopy can help to distinguish between normal maturation and follicular miniaturization.
Telogen Effluvium
Telogen effluvium is a form of hair diffuse, connected with change in hair cycle towards telogen phase. Instead of forming clearly defined bald patches, it usually leads to hair thinning or increase of hair shedding in case of whole scalp. [4]
Possible causes include deficiencies of nutrients, weight loss, illness, surgery, stress, hormonal changes, pregnancy, thyroid problems, iron deficiency and some medications [4]. Telogen effluvium is usually a temporary problem, especially when it is possible to find the cause and solve it. Chronic or recurrent telogen effluvium may require more detailed investigation to exclude other types of diffuse hair loss.
Alopecia Areata
Alopecia areata is one of common causes of hair loss. It usually causes formation of sharply demarcated and non-scarring hair loss [5]. Alopecia areata is thought to be immune-mediated condition affecting hair follicle. Genetical and environmental factors may contribute to this condition, although the exact cause is not fully understood.
It can be located in one or several scalp areas. In more complicated cases, the entire scalp or other body-hair-bearing areas can be affected by it. Alopecia areata behaves in unpredictable way, therefore its diagnosis and treatment should be individualized.
Traction Alopecia
Traction alopecia is the type of hair loss provoked by mechanical tension on the hair follicles. Tight braids, ponytails, extensions, buns and other hairstyles that put pressure on hair can cause this type of hair loss. Early stages of traction alopecia can be reversed by removal of tension source. However, continuous mechanical action can damage the follicles and lead to formation of permanent scaring hair loss. [6]
Therefore, the treatment starts with elimination of mechanical stress on hair follicles. In case of significant follicular destruction or scarring, medical treatment alone is not able to restore hair and hair transplantation may be needed for some appropriate patients.
Trichotillomania
Trichotillomania is a mental health disorder, characterized by recurrent hair pulling. Hair pulling repeatedly may lead to hair loss in some areas of the scalp. In some patients this type of hair loss can involve eyebrows and eyelashes as well. Management of this disorder often requires psychological or psychiatric treatment, as well as scalp and hair follicles examination.
Alopecia Totalis
Alopecia totalis is an autoimmune disease that leads to hair loss on the scalp because of immune system attacking hair follicles. It is triggered by genetic factors and stress. Usually it is a permanent disease, though sometimes hair grows back spontaneously.
Because of the fact that this disease is fluctuating and spontaneous hair regrowth can happen, the decision on treatment should be made individually in accordance with the severity, duration, recurrences and clinical features of the patient.
Fungal Infections of the Scalp
People who have fungal infections of the scalp should not be concerned. Despite the fact that they should be treated, hair loss is not a permanent condition. Once the type of fungus is found and appropriate treatment started, hair loss will stop. However, severe or untreated inflammatory infections can damage follicles and lead to formation of permanent scaring alopecia.
Diagnosing the Cause of Hair Loss
Correct diagnosis is a basis for effective treatment of hair loss. First, the doctor examines patient's age, type of hair loss, duration, family history, medications, recent illnesses, nutritional status, hormonal factors and possible physical or psychological triggers.
Afterwards, the scalp and hair are examined in order to find out if hair loss is diffuse, patterned, patchy or associated with scarring. With the help of trichoscopy or dermoscopy, the information about follicular miniaturization, hair-shaft abnormalities, inflammation and scalp changes is gathered.
Depending on the clinical findings, blood tests is needed to examine such conditions as iron deficiency or thyroid disease. Sometimes scalp biopsy is needed. This diagnostic procedure helps to differentiate androgenetic alopecia from telogen effluvium, alopecia areata, traction alopecia, fungal infection and scaring alopecias.
Medications Used in the Medical Treatment of Hair Loss
Treatment of hair loss depends mainly on its causes. In case of androgenetic alopecia, treatment can slow further follicular miniaturization and support hair growing as long as medication is taken. If male pattern baldness is present in your family, you are highly likely to have it too. Luckily, you can start treatment early in order to prevent or at least delay this process.
There are many clinical treatments that can stop genetic hair loss and thinning hair caused by stress or illness (telogen effluvium). They include FDA-approved medications such as finasteride, minoxidil and finasteride's new generation, dutasteride. Natural alternative is saw palmetto; it works almost like finasteride. Though it is a supplement, it is quite effective.
Also there are new experimental treatments such as clascoterone %5 and PP405. These medications can not be considered established FDA-approved hair-loss treatments until they are regulated completely.
Finasteride
Finasteride is a medication used for treatment of male androgenetic alopecia. It is an inhibitor of type II 5-alpha reductase enzyme, which catalyzes testosterone conversion into dihydrotestosterone (DHT). DHT plays an important role in miniaturization of genetically susceptible scalp follicles in male pattern baldness.
Finasteride increases proportion of hair in anagen phase and decreases proportion of hair in telogen and catagen phases. Therefore, it helps to make hair of the user stronger and denser. It is an effective medication for androgenetic alopecia and telogen effluvium. The dose of this drug is from 1.00 mg to 1.25 mg. Finasteride is taken orally, though there are topically applied forms in some countries.
There are two important points regarding continued treatment:
The effectiveness of finasteride depends on continuous use. If a patient stops using this drug, hair loss caused by androgenetic process can start again and the result of treatment will gradually be lost. Therefore, finasteride is considered a long-term maintenance therapy, rather than a short course of treatment, which can permanently eliminate androgenetic alopecia.
Finasteride may cause adverse effects such as decreased libido, which has been found in approximately 1–2% of men, as well as some men may develop breast enlargement, which is called gynecomastia. The adverse effects and their intensity can vary from person to person. In recent years, the usage of finasteride after hair transplantation is becoming more widespread. However, some adverse effects such as depressive symptoms have also been reported and discussed in relation to the use of finasteride.
Finasteride is a medication used in medical practice since the early 1990s. It has been invented and used for treatment of benign prostatic hyperplasia (BPH). Finasteride has been used for treatment of male pattern hair loss since 1997. It has been used for many years, therefore, the therapeutic effects and possible adverse effects of this drug have been thoroughly studied and are well-known in medical literature. Finasteride is usually not associated with permanent adverse effects in most patients. In case of adverse effects, it usually disappears after discontinuing of the medication. In many cases, symptoms disappear within several weeks to months after stopping the treatment. Therefore, this reversibility should be taken into account when estimating long-term safety profile of finasteride.
The reported rate of decreased libido is relatively low, but sexual adverse effects may affect the decision of some men to start taking this medication. These concerns can vary from person to person and may be affected by culture and geography. In some Asian, Arab, Turkish, and Eastern European cultures, concerns about sexual side effects may be the reason for refusal from finasteride treatment. Therefore, cultural beliefs and individual attitude towards possible adverse effects may affect acceptability of finasteride treatment.
Men who are going to have children should discuss use of finasteride with the doctor. Sometimes, doctor may advise to stop taking this medication temporarily depending on individual circumstances, fertility issues and treatment goals. Finasteride is a prescription drug, so its use should be decided after consultation with qualified healthcare professional.
Dudastaride
Dutasteride is also 5-alpha reductase inhibitor, belonging to the same family as finasteride. However, it blocks both type I and type II 5-alpha reductase and gives wider inhibition of DHT synthesis. According to studies, the incidence of side effects in case of dutasteride use is lower comparing with finasteride. Therefore, dutasteride can be used by patients, who want to avoid side effects of finasteride. The dose of this drug is from 1.00 mg to 1.25 mg and there are topical formulations. Though topically applied form can decrease the adverse effects, allergic reaction and irritation of skin can limit its long-term use.
Minoxidil
Minoxidil is originally developed for the treatment of hypertension. Later increased hair growth was discovered as an adverse effect of this drug. After developing its topical forms, this drug became widely used for hair loss treatment. Now it is rarely used for hypertension and is widely known topical treatment for hair loss.
Main function of this medication is dilation of blood vessels and increase of blood flow. Improved nutrition of hair makes it grow better. Minoxidil affects also 5-alpha reductase enzyme. These two effects are considered to give this drug its efficiency in hair loss treatment. Though vasodilation is more popular in comparison with 5-alpha reductase effect. Like finasteride, minoxidil remains efficient while it is used. If a person stops taking minoxidil, hair loss will start in approximately 2–3 months. Though topical form is more popular, there is also oral form of minoxidil.
Many chemicals are used for diluting of minoxidil. Therefore, spray minoxidil consists of several chemical substances. This form of preparation is not considered very suitable for long-term use because of the fact that constant application of the medicine containing different chemicals to living tissues such as scalp can cause allergic reactions, eczema and irritation. However, foamed form of minoxidil reduces effects of chemicals. After applying of foam, one should wait a little bit because some chemical substances will dissipate into air with foam. Active substance of minoxidil will stay on the skin. Oil solutions for minoxidil can be more preferable for long-term use. There are 2.5 mg oral solutions of minoxidil and 2%, 5% and 10% minoxidil foam. In Turkey, there are 2% and 5% foam formulations of minoxidil.
As minoxidil has antihypertensive effect, it should be noted that it decreases blood pressure slightly. Due to lack of effect on DHT, androgenic side effects like decreased libido can be not observed. Those people who suffer from such side effects tend to prefer oral forms of minoxidil. Minoxidil spray can be used for hair twice per day. After that, it should be waited for absorption of the substance into the scalp. It takes about 6 hours to penetrate the spray. That is why it is better not to wash hair at least for 6 hours after the spray and foam application. Topical minoxidil can be purchased without prescription, but oral minoxidil needs prescription in many countries.
Saw Palmetto
Saw palmetto is botanical extract derived from fruit of Serenoa repens. This natural ingredient attracts attention due to laboratory and clinical research which suggests the possibility of influencing androgen metabolism and DHT pathway. However, its evidence is not equivalent to that of finasteride. Saw palmetto can be used as another option to avoid side effects of finasteride and reduce DHT.
Using Saw palmetto and Biotin together makes this combination very good for preventing hair loss. These natural supplements are also very suitable for pre- and post-surgery use.
Biotin
Biotin is B vitamin involved in various metabolic processes and important for normal skin, hair and nails. Biotin supplements can be beneficial in case of real deficiency. However, only biotin supplements have not been established as the way of treatment for androgenetic alopecia. That is why biotin cannot be used automatically as hair loss treatment. Combination of such supplements as biotin and saw palmetto is often promoted as hair health, but evidence of hair loss prevention is not so strong as for approved medical treatment.
Clascoterone 5%
Clascoterone 5% topical solution is investigational treatment of male androgenetic alopecia. Its mechanism of action is based on local androgen-receptor antagonism, which is alternative mechanism to 5-alpha reductase inhibitors like finasteride and dutasteride. Positive topline results were reported for phase III studies regarding target-area hair counts in men with androgenetic alopecia. But these are clinical development results. Not FDA-approved hair loss treatment. Regulatory submission and review are required before considering this treatment as approved one.
PP450
PP405 is investigational topical treatment under development for androgenetic alopecia. Its mechanism of action is proposed to be activation of dormant hair-follicle stem cell activity rather than androgen signaling inhibition. Positive results were reported for the primary safety endpoint and hair-density improvement in the Phase 2a randomized clinical study. But these are just clinical development results, not approved hair loss treatment. Further clinical trials are required to evaluate long-term effectiveness, safety, appropriate treatment duration and position in future hair loss treatment protocols.
Hair Restoration and Non-Surgical Hair Loss Treatments
Hair Transplantation
Hair transplantation is surgical procedure of transferring healthy follicular units from donor area to hair loss areas. This procedure is commonly used for androgenetic alopecia when there are enough donor hair and appropriate diagnosis. Modern procedures involve using FUE or DHI techniques depending on patient's donor characteristics, hair loss pattern, previous procedures and surgical goals.
Red-Light Therapy
Low-level light therapy (LLT), also known as low-level laser therapy (LPT) or photobiomodulation is non-invasive method used mainly for androgenetic alopecia. Researches prove the increased hair density in some patients in comparison with sham treatment. However, there are lots of protocols and devices used for LLLT. More research is required to establish optimal parameters.
Mesotherapy
Mesotherapy of hair involves intradermal injections of selected medications, vitamins, growth factors or other substances into the scalp. Although minoxidil and dutasteride are used in studies of mesotherapy, protocols in them differ a lot. Current evidence shows the possible benefits of mesotherapy.
Platelet-Rich Plasma
Platelet-rich plasma (PRP) involves usage of patient's own blood-derived platelet concentrate that contains various growth factors. PRP was extensively studied as supportive treatment for androgenetic alopecia. Systematic reviews proved the improvement of hair density and, in some studies, hair thickness.
Conclusion
Medical treatment of hair loss should start from the accurate diagnosis rather than generic treatment protocol. Androgenetic alopecia can be treated with long-term medical therapy, but telogen effluvium requires the investigation of underlying trigger. Alopecia areata, traction alopecia, fungal infections and other hair loss forms require other approaches.
After hair transplantation, some surgeons and physicians recommend medical treatment to preserve native hair. Postoperative medical treatment can include such options as finasteride, minoxidil or their combination depending on patient's diagnosis and risk profile. Dutasteride or saw palmetto can be considered in some cases.
The most suitable treatment should therefore be determined after evaluating the cause, severity, hair-loss progression, donor capacity, medical history, and treatment expectations.
Frequently Asked Questions About Medical Treatment for Hair Loss
What is the most common medical treatment for hair loss?
Finasteride and topical minoxidil are established medical treatments of male androgenetic alopecia. Depending on patient's diagnosis, age, medical history, contraindications and treatment goals, other medical treatments can be used under supervision.
Can hair loss be stopped permanently with medication?
Some forms of hair loss can be stopped or improved with medications. But treatment benefit depends on its continuous usage. Interruption of effective treatment can lead to the resumption of hair loss process.
Is losing 50 to 100 hairs every day normal?
Yes, daily shedding of approximately 50-100 hairs can happen due to hair cycle. Each follicle has its individual cycle; that is why not all scalp hairs are shed simultaneously.
Is a receding hairline always a sign of hair loss?
Not necessarily. Some recession can happen during the male hairline maturation after adolescence. Recession in combination with follicular miniaturization, vertex thinning or characteristic family pattern is a sign of androgenetic alopecia.
What causes androgenetic alopecia?
Androgenetic alopecia occurs because of genetic susceptibility and androgen-dependent follicular miniaturization. In men, DHT plays very important role. Genetically susceptible follicles become smaller and produce shorter and finer hairs.
Does finasteride permanently cure male pattern hair loss?
Finasteride does not cure androgenetic alopecia. This drug helps to decrease DHT-related follicular miniaturization and helps to maintain or improve hair while it is taken. Benefits of this drug can gradually decrease after stopping its intake.
Can minoxidil regrow lost hair?
Minoxidil can stimulate hair growth and improve hair density in some patients with pattern hair loss. However, reaction of each person can differ. Continuous treatment is necessary to maintain the therapeutic benefit.
Can hair transplantation treat every type of hair loss?
No, hair restoration is used for selected types of hair loss including androgenetic alopecia. Active alopecia areata, untreated scalp infections, unstable inflammatory disease or insufficient donor hair make hair transplantation inappropriate.
References
[1] Paus R. Principles of hair cycle control. J Dermatol. 1998;25(12):793–802. doi:10.1111/j.1346-8138.1998.tb02507.x. https://pubmed.ncbi.nlm.nih.gov/9990771/
[2] Natarelli N. et al. Integrative and Mechanistic Approach to the Hair Growth Cycle and Hair Loss. J Clin Med. 2023 Jan 23;12(3):893. doi: 10.3390/jcm12030893. https://pmc.ncbi.nlm.nih.gov/articles/PMC9917549/
[3] Piraccini BM, Alessandrini A. Androgenetic alopecia: a review. G Ital Dermatol Venereol
. 2014 Feb;149(1):15-24. https://pubmed.ncbi.nlm.nih.gov/24566563/
[4] Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R. Telogen Effluvium: A Review of the Literature. Cureus. 2020;12(5). doi:10.7759/cureus.8320. https://www.cureus.com/articles/32514-telogen-effluvium-a-review-of-the-literature#!/
[5] Trüeb RM, Dias MFRG. Alopecia areata: a comprehensive review of pathogenesis and management. Clin Rev Allergy Immunol. 2018 Feb;54(1):68-87. doi: 10.1007/s12016-017-8620-9. https://pubmed.ncbi.nlm.nih.gov/28717940/
[6] Billero V., Miteva M. Traction alopecia: the root of the problem. Clin Cosmet Investig Dermatol. 2018 Apr 6:11:149-159. doi: 10.2147/CCID.S137296. https://pubmed.ncbi.nlm.nih.gov/29670386/
