Hair loss affects people from all walks of life. Most people will experience hair loss naturally as a result of aging, but a significant portion of the U.S. population will find themselves dealing with the symptoms far earlier than they would feel comfortable with. Indeed, according to the American Hair Loss Association approximately 85% of men will experience significant hair thinning or loss by age 50, while 80% of women will experience some form of it by age 60.
While many learn to live with this affliction, many others would instead prefer to keep their hair one way or another. From cosmetic solutions such as wigs and hair pieces, to medical options like topical and oral treatments or hair restoration surgery, many hair loss sufferers express interest in regaining their former appearance. It’s no surprise then, that the hair loss treatment industry generated close to 4 billion USD in 2019.
And yet, despite the evidence that many would prefer to keep their head of hair, there is a surprisingly small number of options for combating and reversing the hair loss process. Perhaps due to the fact that hair loss is not a life-threatening condition, it is possible that it has not been taken as seriously as other afflictions, even though it has been documented that it can have significant psychological effects on those who face it.
Do the existing treatment options work? The answer is not as straightforward as it might seem. Unfortunately, due to the lack of authoritative research into the matter, the available remedies can range from only moderately effective to not at all, depending on each individual case.
Splitting Hairs
The difficulty of treating hair loss stems from the fact that there are myriad possible causes for it, and they affect people in many different ways. Men, women, and even children of all ages are affected by different types of alopecia. This lack of a single root cause means that there is no universal solution to hair loss. Each case requires careful examination in order to properly manage the symptoms.
It is useful to note that alopecia is the broader, clinical term for hair loss disorders. Normally, people lose anywhere from 25-100 hairs on a daily basis, with that rate increasing as one ages. Some, however, begin experiencing hair loss at a much faster rate. It is this abnormal rate of hair loss that is generally referred to as alopecia.
Within its many subclassifications, androgenetic alopecia is the most common, responsible for up to 95% of cases in men and 40% of women overall by age 50. In a nutshell, androgenetic alopecia, or hereditary hair loss, causes your hair follicles to shrink over time, slowing down the pace of hair growth. This causes your hair to thin out at first, until the follicle is completely closed, unable to produce new hairs after they fall out.
While the term “androgenetic alopecia” is used when talking about both male and female hereditary hair loss, there is a difference in how they manifest. Male pattern baldness starts manifesting around the temples and works its way to the back of the head, forming an ‘M’ shape. Eventually, the crown or center of the head starts thinning out as well, until eventually most or all hair is gone.
Female pattern baldness, on the other hand, rarely results in complete hair loss, limiting itself to thinning on the crown in most cases. Incidentally, this is also the type of alopecia responsible for the myth that baldness is only inherited from the mother’s side of the family, given its genetic component.
The other major type of hair loss is alopecia areata. This particular variant of alopecia affects two percent of people at some point or another throughout their lives. Although research into the various types of alopecia is still ongoing, alopecia areata is currently classified as an autoimmune disorder. This means that the hair loss is caused by the hair follicles being attacked by a person’s immune system, as opposed to the accelerated shrinkage caused by androgenetic alopecia.
Given its autoimmune nature, there is also the possibility of alopecia areata being a symptom of something larger, as is the case with polycystic ovary syndrome and certain thyroid disorders, to name a few scenarios.
Aside from the previously mentioned types, there are other forms of alopecia that are caused by damage to the hair follicles under various circumstances. Chemotherapy, for example, is famously associated with hair loss. Abrasive hair styling techniques such as tightly pulling one’s hair, excessive coloring, perming or relaxing of hair could also lead to hair loss. Other factors such as trichotillomania, a condition where a person pulls their hair unconsciously due to stress, can also lead to permanent hair loss.
We spoke with a nurse who wished to remain anonymous, and she confirmed that stress can also cause hair to fall out, even if you’re not actively pulling it due to trichotillomania. She shared the story of a patient whose stress levels were so consistently high that the Finasteride regimen the patient was going through was ineffective. It later turned out that once the patient found a way to reduce their stress levels, their hair gradually grew back as intended.
Gone Today, Hair Tomorrow?
As has been mentioned earlier, there are many causes for hair loss, and just as many alleged “cures” for it. However, as of this writing, there are only two FDA-approved treatments that have been properly tested and vetted.
One of these products is Minoxidil, known commercially as Rogaine. Minoxidil—when used as an alopecia treatment—is a topical solution, sometimes presented as a foam that helps promote hair regrowth in whichever area of the body it is applied to. Officially, the FDA has only approved Minoxidil for use in treating androgenetic alopecia and female pattern hair loss, however, research shows that it is often used for off-label treatment of other types of alopecia.
Minoxidil is of particular interest to hair loss researchers, since even though it has been proven effective to a certain degree, the exact mechanism through which it achieves hair regrowth is not yet fully understood. It is also the only one of two treatments that is safe for women to use when treating hair loss.
The other approved hair loss treatment is Finasteride. This is a drug that was originally created to treat benign prostatic hyperplasia, which it achieved by reducing the size of an abnormally enlarged prostate. However, it was eventually discovered that Finasteride also promoted scalp hair growth in men by blocking the very same enzymes that caused the enlarged prostate symptoms it was originally created to combat.
While Finasteride is ostensibly a more consistently effective treatment than Minoxidil, with some studies showing up to 48% of their participants actually regrowing hair rather than just slowing down the hair loss process, it is not without noticeable side effects. One of these is a notable decrease in libido, or outright erectile dysfunction in some cases. Given the fact that one of the main concerns in treating male pattern baldness is the psychological impact such a condition can have on men, these particular side effects are not insignificant.
Because Finasteride interacts with enzymes closely associated with testosterone and the role it plays in the development of male traits, it is often accompanied by a warning that it should not be used by women under any circumstances.
There is also, of course, the option of hair transplant surgery. Hair transplant surgery is a fairly popular, if expensive option for combating hair loss. As with the other available treatments, there are different methods of performing hair transplant surgery for different cases of alopecia, but the principle remains largely the same. Healthy hair follicles from other parts of the patient’s body—normally the back of the scalp, although alternatives are being researched—are transplanted into the impacted areas so that hair can begin to grow anew.
One common concern about this procedure is the fact that it requires incisions be made into the scalp, leaving visible scars that seem counterproductive to the goal of making your head of hair look whole again. This is acknowledged by experts in the field and ways to minimize the scarring is being researched, although the outcome will depend largely on the skill and competence of your surgeon.
When considering this sort of treatment, however, it is important to recognize a few key details. It is a surgical procedure, meaning that this is something that requires extensive consultation with a qualified physician prior to choosing to go ahead with it. This cannot be emphasized enough: some hair transplant procedures are being performed by unqualified individuals exploiting loopholes in state medical board requirements.
One also needs to keep in mind that success rates are largely self-reported and choosing a reputable and experienced surgeon is key when making this type of decision.
The actual effectiveness of the procedure is also a mixed bag in terms of results. While it no doubt has worked for a great number of people since its inception, it is important to be prepared for the possibility that it might not work for you.
As with all things related to medicine, it is incredibly important to consult a physician before interacting with these treatments in any way shape or form. A medical professional will be able to properly determine the exact nature of your baldness symptoms and chart out the appropriate treatment plan for you.
The Trouble with Supplements
There is still much research to be done on the topic of hair loss. Because it can often be a symptom and not the actual condition itself, there is no definitive way to tackle it and no way to guarantee that you’ll be able to stave off its advance well into your later years.
The currently approved and tested hair loss remedies were not initially developed with hair loss in mind, and even then they only address very specific aspects of the condition which may or may not be a viable alternative for certain types of hair loss.Perhaps due to the currently limited scope of vetted treatments, you may notice that there are a staggering number of products that advertise themselves as being a natural alternative to combat hair loss.
Many will make claims that they are “FDA approved.” Given that most, if not all of these are supplements, they are not under the direct purview of the FDA and as such, not subject to the same scrutiny as Minoxidil and Finasteride. If the companies that manufacture and market these alternative treatments are being transparent, they will state that their supplements are manufactured in FDA-approved facilities, which means they operate in an environment deemed safe by the FDA. That does NOT, however, say anything about the effectiveness of their products.
The nurse we spoke with mentioned that some dermatologists and hair transplant experts do use supplements as a means to promote healthier hair in their patients, but it is not the main focus of the hair loss treatments and are not the mechanism through which hair growth is achieved.
Sometimes blood work is performed to determine which compounds the patient is low on, so their doctors can recommend the appropriate supplements. While there is some evidence that being deficient in certain vitamins and minerals can be a contributing factor in hair loss, the physician in charge must first evaluate the patient prior to recommending the use of these supplements.
