Hair Loss Treatments
Written by Andrew Proulx, MD
What is alopecia?
Hair loss, also called alopecia, refers to the loss of hair from any part of the human body. While losing a certain amount of hair during the course of each day is normal, up to 50% of people aged 50 years or older experience hair loss to the point of thinning or balding.
Normal hair growth cycle
Throughout our lives the body sheds, on average, 100 to 150 hairs per-day during its natural growth-cycle, which is made up of three phases:
- Anagen: the active growth stage for hair follicles. It lasts 2 to 6 years for scalp hair and typically only several months for other body hair. This length of time is genetically determined but can also be impacted by external factors such as stress and illness. At the end of the anagenic phase the follicle then enters the catagen phase.
- Catagen: a short transitional phase lasting 2-3 weeks. The follicles shrink to about 1/6 of their normal length and a new hair forms underneath the existing one before the old hair falls out.
- Telogen: the resting phase of the follicle during which the old hair is finally shed from the body. In this phase, anywhere from 100 to 150 hairs are shed during the course of each day.
Causes of hair loss
Hair loss can be caused by a number of factors, including:
- Hereditary hair loss (androgenic alopecia): This is a common form of hair loss in men, and sometimes in women. This is hereditary and can be inherited from one or both parents. While this type of hair loss is often referred to as male pattern baldness, it can occur in both males and females. Pattern hair loss is a more accurate term that can be applied to both men and women.
- Health problems: Diseases that can cause hair loss include thyroid problems, scalp infections and lupus. Treatments for cancer such as radiation and chemotherapy can contribute to hair loss as well.
- Stress: Physical stress can cause hair loss. Stressors can surgical trauma, high fever and chronic illness.
- Hair Damage: Repeated hair damage from heat, chemicals or traction can cause breakage which leads to hair loss. Hair loss resulting from traction from braiding or putting hair in ponytails is called traction alopecia.
- Aging: As we grow older our hair naturally gets thinner and more brittle causing the body to have an increased amount of hair loss.
Being aware of the factors that contribute to hair loss can help you properly treat it. Certain factors such as diet, stress and disease can be easily identified and addressed, while others, such as pattern hair loss, may require more intensive treatment.
For those experiencing hair loss, there are several non-surgical options:
- Propecia (Finasteride): This is a steroid that blocks the body’s conversion of testosterone to dihydrotestosterone (DHT), which is the primary cause of pattern hair loss. By blocking the body’s production of DHT, Propecia stops the progression of hair loss in close to 90% of those that use it. It is effective in stopping hair loss at the hairline. It is important to note that Propecia is only effective for as long as it is taken; hair loss restarts within 12 months after treatment is ended.
- Rogaine (Minoxidil): Rogaine is another recommended treatment for pattern hair loss. Rogaine is a vasodilator that is primarily effective in stopping and regrowing hair on the crown of the head. Like Propecia, Rogaine is only effective as long as it is used. Rogaine is available in varying strengths for men and women.
- Corticosteroids: While corticosteroids such as Dutasteride (Avodart) and Ketoconazole (Nizoral/Sebizole) have been shown to effectively treat hair loss, they are not yet FDA approved for administration as hair loss treatments. Avodart is used to reduce prostate growth, while ketoconazole is used to treat fungal infections.
Surgical hair loss options
There are two primary hair transplant surgery options to consider: follicular unit transplantation (FUT) and follicular unit extraction (FUE). Potential side effects of both surgical options include small white scars in the donor region, cysts in the donor region, infection and numbness.
- Follicular Unit Transplantation (FUT) procedure: A strip of hair-bearing skin is taken from the back or side of the head. The hair follicles are then taken from the strip and transplanted into the desired areas. This procedure may involve minor pain. Stitches are required. The donor area takes about 2-3 weeks to heal, while the recipient area heals in 14 days.
- Follicular Unit Extraction (FUE) procedure: Hairs are removed individually from the donor area using a special punch tool and then transplanted into the desired areas. This procedure is usually painless and does not require stitches. The donor area takes about 7 days to heal and the recipient area heals in 10-14 days.
Before hair transplant surgery, be sure to prepare appropriately. The hair will need to be grown long enough for transplantation and to cover the stitches after surgery. Don’t take blood thinners before your surgery. Stop smoking and drinking alcohol in the days leading up to the procedure in order to optimize healing.
If you aren’t interested in topical or surgical hair-loss treatments, there are some other alternative options available.
- Low-level laser therapy (LLLT): While early research on LLLT has shown conflicting results, recent reviews of research results have determined that it’s safe and effective at improving hair density and diameter for women and women.
- Platelet-rich plasma (PRP): A non-surgical treatment that utilizes the stem cells and growth factors from the patient’s own blood to trigger the growth of hair from resting or miniaturized hair follicles.
- Cosmetic Aids: Tinted powders, lotions and sprays can help camouflage hair loss by covering thinning spots on the scalp. Wigs, hair pieces, and hair extensions can also help to disguise hair loss.
Cost of hair loss treatments
The cost of hair loss treatments will vary greatly depending on the type of treatment and the extent of hair loss.
- Non-surgical treatments: On average patients spend between $30-$45 for a 3 month supply of Minoxidil.
- Hair transplant surgery: The cost of hair transplants varies, but usually ranges from $6,000 to $15,000. FUT is usually less expensive than FUE.
- Additional treatments: The cost of PRP and laser therapy for hair loss typically ranges from $1,500 to $3,500. The cost for cosmetic aids such as wigs can range from $99 to $500.
Ready to take the next step?
To determine the best treatment option for you, contact a qualified hair loss specialist near you.
- Rathnayake, D., Sinclair, R. Male androgenic alopecia. Expert Opinion on Pharmacotherapy. 2010; 11(8): 1295 – 1304.
- Harrison, S., Bergfeld, W. Diffuse hair loss: Its triggers and management. Cleveland Clinic Journal of Medicine. 2009 June; 76(6): 361-367.
- Phillips, T.G., Slomiany, P., Allison R. Hair loss: Common causes and treatment. Am Family Physician. 2017 Sep 15; 96(6): 371-378.
- Alonso, L., Fuchs, E. The hair cycle. Journal of Cell Science. 2006; 119: 391-393.
- Lee, W., Ro, B., Hong, S., et al. A new classification of pattern hair loss that is universal for both men and women: Basic and specific classification. Journal of the American Academy of Dermatology. 2007 July; 57(1): 37-46.
- Aging changes in hair and nails. medlineplus.gov. https://medlineplus.gov/ency/article/004005.htm. Accessed October 17, 2020.
- McClellan, K., Markham, A. Finasteride A Review of its Use in Male Pattern Hair Loss. Adis Drug Evaluation. 2012 Oct 10; 57: 111-126.
- Kaufman, K., Olsen, E., Whiting, W., et al. Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology. 1998 Oct; 39(4): 578-579.
- Suchonwanit, P., Thammarucha, S., Leerunyakul, K. Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy. 2019 Aug 9; 13: 2777-2786.
- Adil, A., Godwin, M. The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. Journal of American Academy of Dermatology. 2017 July; 77(1): 136-141.
- Zhou, Z., Song, S., Gao, Z. et al. The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: a systematic review and meta-analysis. Clinical Interventions in Aging. 2019 Feb 20; 14: 399-406.
- Thompson, A. Dutasteride: an evidence-based review of clinical impact in the treatment of benign prostatic hyperplasia. Core Evidence. 2005; 1(2): 143-156.
- Ellis, J., Sinclair, R. Male pattern baldness: current treatments, future prospects. Drug Discovery Today. 2008 Sep; 13(17-18): 791-797.
- Avram, M., Rogers, N., Watkins, S. Side-effects from follicular unit extraction in hair transplantation. Journal of Cutaneous and Aesthetic Surgery. 2014 Jul-Sep; 7(3): 177-179.
- Chaffoo, R. What causes hair loss and what hair restoration procedures are available? plasticsurgery.org. https://www.plasticsurgery.org/news/blog/what-causes-hair-loss-and-what-hair-restoration-procedures-are-available. Published May 15, 2018. Accessed October 17, 2020.
- Bernstein, R, Rassman, W. Follicular Unit Transplantation – 2005. Dermatologic Clinics. 2005; 23(3): 393-414.
- Dua, A., Dua K. Follicular unit extraction transplant. Journal of Cutaneous and Aesthetic Surgery. 2010 May-Aug; 3(2): 76-81.
- Rassman, W., Bernstein, R., McClellan, R., et al. Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation. Dermatologic Surgery. 2002; 28(7): 720-728.
- Egger, A., Resnick, S., Aickara, D., et al. Examining the safety and efficacy of low-level laser therapy for male and female pattern hair loss: A review of the literature. Skin Appendage Disorders. 2020 July; 6: 259-267.
- Khatu, More, Gokhale, Chavhan, Bendsure Platelet-Rich Plasma in Androgenic Alopecia: Myth or an Effective Tool. J Cutan Aesthet Surg. 2014 Apr-Jun 7(2): 107–110.