Treatment of Hair Loss
Hair transplantation can restore lost hair but it doesn’t prevent ongoing hair loss in the surrounding areas. This is where medication comes is so helpful. Medications play a critical role in preventing further hair loss and when combined with hair transplantation produce the best results. Propecia® (finasteride) and over the counter Rogaine® (minoxidil 2% and 5%) are the two FDA approved medications for preventing hair loss.
Finasteride works by inhibiting the conversion of testosterone into dihydrotestosterone (DHT) by binding to the 5-alpha-reductase enzyme:
In general you do not need DHT to be healthy. In adults, DHT causes hair loss and overgrowth of the prostate. It is however very important during male fetal development to ensure normal genital development which is why pregnant women shouldn’t take or even touch finasteride because a birth defect. In our experience at the Carolina Dermatology Hair Center, the majority of men will see a cessation of hair loss and will sometimes see regrowth and thickening of existing hair. Studies show that most men have more hair five years after starting finasteride than they did when they began. Although we do not know what happens over a lifetime of taking this medication, we assume that the patient will always have more hair and less hair loss than they would if they hadn’t taken finasteride. Although many men will see some thickening of their hair while taking finasteride, the main reason to take this medication is not for regrowth but to stop further hair loss.
Side effects with finasteride are uncommon but can occur. A small number of men may notice decreased libido and other issues with sexual performance we can discuss these issues in greater
detail during your consultation and encourage you to make an informed decision because for most men the benefits outweigh the risks.
Minoxidil stimulates the cells of the hair follicle and can be thought of as a hair fertilizer. Although by itself it is only mildly effective by itself, we find that when it is combined with finasteride, the results are
better than with either one by itself. Many men do not like the idea of having to rub minoxidil into their scalp every day. We liken it to using toothpaste which you use everyday so
your teeth don’t fall out; you use minoxidil daily so your hair won’t fall out. It is definitely worth considering if you can commit yourself to using minoxidil daily and for men, to combine it with finasteride.
Besides finasteride and minoxidil there are some other treatments which may be helpful. For example the over
the counter dandruff shampoos, ketoconazole and zinc pyrithione, have been shown in clinical studies to support healthy hair growth. There are several different brands of shampoos which have these ingredients and during your consultation at the Carolina Dermatology Hair Center, we can discuss these with you. In addition, we recommend camouflaging products such as Toppik® and similar products, which can be sprinkled into the hair to give it a thicker appearance.
Camouflaging Hair Fibers
Low Level Laser Therapy-LLLT
People often ask us about laser therapy and whether it works. LLLT uses a low-level visible red light laser to stimulate the cells of the hair follicle to promote hair growth; this does not cause any tissue damage, unlike other types of laser. LLLT is available in handheld devices (combs, brushes) which patients can use at home. While we have seen some patients claim that it has helped their hair, we have seen many more which have been disappointed with the results. On the other hand, much stronger units are available in doctors’ offices and specialized salons which deliver the laser treatment through large hoods attached to a stand. Repeated treatments are necessary on an ongoing basis but this may be a worthwhile consideration for some people, especially women who may not be candidates for hair transplantation. New types of LLLT helmet or hood devices are being developed which may provide physician strength treatment with the convenience of at home use. More scientific evidence is accumulating about the helpful biological effects of LLLT and we anticipate hearing more about this in the future.