With Hair Regrowth Therapy, There’s Much to Understand




If you see increasing amounts of hair in the shower drain on a daily basis or are finding you can no longer style your hair the way you wish, this may be due to a progressive and potentially permanent loss of hair. Perhaps you already pay closer attention to advertising for hair regrowth products and therapies (of which there is no shortage). Naturally, you will wonder why there are so many different products and whether they can live up to their claims.

Following is a list of frequently asked questions and answers on hair regrowth therapies. We hope this helps you to see if and how you can stop your own hair loss and perhaps regain some of the hair you thought was gone.

Q: Which hair loss conditions are progressive and irreversible?

The most common form of progressive and irreversible hair loss is androgenic alopecia (also called androgenetic alopecia). For men this is male pattern baldness (MPB), seen in a receding hairline on the forehead and thinning at the crown. For women, female pattern baldness is a generalized thinning with no distinct pattern. For men and women with this condition, catching the problem early yields the greatest success in stopping its progression. In many men, the loss begins in their early 20s and by age 60 about two-thirds have noticeable MPB. Women may have thin hair from childhood that gets progressively worse with time, or it may be a result of a thyroid disorder or a postpartum or postmenopausal condition that occurs in adulthood.

Q: Which hair loss conditions are temporary, reversible naturally or with effort?

Factors that disrupt the hormonal system, reduce nutrient absorption or cause psychological stress tend to cause temporary hair loss. These include thyroid conditions, postpartum hair loss and loss due to malnutrition (hyperlow caloric intake, as in anorexia or bulimia, imbalanced diets or dire economic conditions). Traction alopecia — the pulling of hair caused by tight styling — and CCCA (central centrifugal cicatricial alopecia: hair loss due to chemical and heated styling treatments) can also lead to temporary or permanent hair loss. In cases of trichotillomania, the individual has an uncontrollable urge to pull out his or her own hair, which is most effectively addressed with counseling.

Patients with alopecia areata (bald patches), alopecia totalis (complete hair loss on the scalp) and alopecia universalis (total loss of hair on the head and body) suffer from these conditions in both genders across a spectrum of age. Efforts to address each of these are best made under the supervision of a board-certified medical doctor, quite often a dermatologist.

As should be clear, each of these comes with an important caveat: All individuals are unique, and how their hair responds to changing medical, environmental or psychological stress is unique as well. Qualified, licensed hair loss specialists should be able to provide an individualized analysis and treatment program, including the recommendation to see a medical doctor if the condition appears to be outside their purview.

Q: What are the most-used hair regrowth therapy strategies?

The two FDA-approved treatments for male pattern baldness are minoxidil (Rogaine and other brand names) and finasteride (Propecia), which are by far the most-used approaches to halting male hair loss. Rogaine for women is used also to some effectiveness; however, Propecia is strictly forbidden for women because it can cause birth defects, and it is found to largely be ineffective in postmenopausal women. Laser hair therapy is also commonly used. Scalp treatments, shampoos and nutrition supplements, although lacking efficacy data or known outright to be ineffective, are sold worldwide.

Q: Which hair regrowth therapies are the least invasive?

The most invasive therapy, short of hair transplants, is Propecia, a prescription medication taken internally. According to a report summarizing multiple studies on Propecia that was published by the American Academy of Family Physicians (“Medical Treatments for Balding in Men,” Dean Thomas Scow et al., April 15, 1999), about 3.8 percent of men experienced sexual side effects: decreased libido, decreased volume of ejaculate or erectile dysfunction, as well as breast enlargement and tenderness. That report also found that finasteride alters prostate-specific antigen (PSA) tests, a standard diagnostic for identifying prostate cancer.

A more recent survey, of 71 men aged 21 to 46, conducted at George Washington University found indications of something more worrisome. The study author states that 94 percent of participants reported lower libido as a result of taking finasteride. The same number reported decreased erectile dysfunction, while 69 percent claimed problems with orgasm. Participants’ pre-finasteride level of sexual activity was 26 episodes per month, and on average declined to eight episodes per month after taking finasteride. Some of these effects lasted five years, including a year or more after discontinuing the medication.

Other on-label warnings are that finasteride (the generic name for Propecia) can lead to “severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); breast enlargement, lumps, pain, or tenderness; depression; nipple discharge; testicular pain.”

Minoxidil (Rogaine) is used in pill form in higher doses to treat high blood pressure. This is not recommended for hair loss, since it can have many side effects, including chest pain, swelling and rapid weight gain (among other adverse effects). If applied topically in lower dosages for hair loss, it may cause scalp irritation but is far less invasive.

Laser therapy stimulates blood flow to the scalp and is ruled safe by the FDA (note: the FDA rules on safety only, not efficacy). Scalp treatments and shampoos also are considered noninvasive and at worst might cause irritation to the skin in some individuals.

Q: What kind of success can a person expect from hair regrowth therapy?

By and large, the person who addresses hair loss early will see the best results. As a rule, hair loss treatments of all kinds are most effective at halting progression of the loss, less so at restoring growth in hair that is already lost. In some cases, the therapy can increase hair shaft thickness, creating fuller hair without restoring follicles that have expired.

Q: How much does it cost to try to regrow your hair with laser therapy?

Laser hair treatments require a committed approach, often two 20-minute sessions per week for a year. Depending on where you live, costs range between $2,000 and $6,000 for a full year’s treatment, with additional expenses related to scalp massage treatments and products and special shampoos.

Costs for Propecia and Rogaine also vary. At least one online retailer advertises Propecia at $60 for a one-month supply, and another offers Rogaine at $20 for a three-month supply (generic and competing brands for minoxidil help reduce the price of this topical treatment).

Q: Would laser therapy cause trauma or risk other side effects?

Because the FDA has reviewed the laser therapy technology, the treatment is certified as safe. It is applied gradually, typically in twice-weekly treatments, which enables patients and technicians to identify if there are any adverse effects. Self-administered, at-home laser combs are on the market and depend on user prudence in following instructions.

Q: What are the hair loss treatments that are known to not work?

The world of hair loss remedies is littered with hair restoration scams. A spectacular case occurred in 2009, when a judge returned a $50 million verdict against the marketers of a product called Avacor on the basis that it could not live up to its marketing claims. In Illinois the state attorney general filed a lawsuit in 2009 against a multiunit hair restoration center for making exaggerated claims on what its program could deliver.

There are some companies that attempt to market products on the basis of hair strengthening and regrowth, including ordinary teas and shampoos or conditioners. Where such products are harmless or have other benefits (e.g., green tea), the question could be a simple “What can it hurt?” However, if these products are used in lieu of something more effective, valuable time may be lost as the hair loss progresses.

Q: How much of a role does nutrition play in hair regrowth?

Hair and skin are enhanced by healthy nutrients, without question. Keratin protein is actually manufactured by the body but optimally so when you ingest quality proteins: beef, turkey, eggs, tuna, shrimp, cod, halibut and salmon are among the better animal sources. But you can also get valuable protein from beans and nuts, seeds and whole grains. Note that Western diets have migrated to excessive protein intake since the 1950s, which can lead to other health problems. A variety of protein sources in moderate quantities — more for people who engage in strength training and other strenuous exercise, less for sedentary individuals – is what health experts recommend.

Sadly, some things work against your absorption of these nutrients: carbonated beverages, caffeine, tobacco smoke and excess processed sugar (found in most processed foods and drinks).

Beware, however, any nutritional supplement that claims it will restore hair growth, either through ingestion or topical application. Supplements as a rule are isolated nutrients, removed from other nutrients in their natural source and thus less likely to have a beneficial effect. A balance of nutrients that occurs naturally is more likely to yield a positive effect than will a megadose of one or two nutrients in isolation.

Q: Why do most people choose to regrow hair versus simply accepting the loss?

Of course, this is entirely a matter of personal taste. But for some, a shaved head can be judged attractive while hairlessness on other people detracts from their appearance. Western culture affords greater acceptance of hair loss in men than in women — even though 40 percent of women experience some hair loss during their lifetimes.

Q: Who are the people who regrow their hair, and why?

As explained above, all individuals experience hair loss in their own way from their own causes. Some conditions naturally allow regrowth, yet certain others — primarily androgenetic alopecia (male and female pattern baldness) — do not. Interventions made early generally yield the best results for all conditions.

Q: Do more women than men succeed at regrowing their hair?

There is not a simple answer to this question. Women more frequently suffer from reversible hair loss conditions than do men, for whom male pattern baldness is the most common cause of loss (it can be slowed with medication but is nearly impossible to reverse). According to Melissa Green, a hair regrowth specialist at Transitions of Indiana in Indianapolis, “There is an 85 percent success rate with laser hair therapy. Typically, most men and women have success because even if that person looks the same after a program, that is great. Hair loss is progressive, and if that person would not have done a treatment program, they understand that [their hair loss] would worsen.”