For many men — and some women — thinning hair is a consequence of aging. But when is hair loss something more severe? What remedies are best to treat it?
As with many kinds of loss, losing one’s hair can cause a lot of grief. Though the sight of shedding or thinning hair can understandably send people scrambling for a solution, only a handful have proven to be effective. The condition may also be a sign of a bigger problem and warrants a trip to the doc to be sure.
“Hair loss is very distressing socially and changes a person’s social identity,” according to Raja Sivamani, MD, MS, CAT, an assistant professor of clinical dermatology at the University of California, Davis. “For that reason, it’s really important to my patients to have open communication about treatment options.”
Fortunately, such options do exist – but not in all cases. There are two major types of hair loss: non-scarring, in which the hair follicles are still present, and scarring, which destroys the hair follicle.
“While hair loss is typically treatable when the follicles are still present, in scarring hair loss, it is not possible to regrow hair in follicles that are already destroyed,” notes Sivamani.
Within those categories, there are many different forms and causes of hair loss – technically called alopecia – and the right treatment approach depends on which kind you have. The most common type is androgenetic alopecia, also known as male and female pattern hair loss. This is the form that people are usually referring to when they talk about hair loss.
Another type is telogen effluvium, which is shedding in response to mental or physical stress, and there is also alopecia areata, an autoimmune disease in which inflammation of the hair follicles leads to patches of baldness or total baldness, says Joseph C. English, MD, a dermatologist at the University of Pittsburgh Medical Center.
“My first recommendation is to get a correct diagnosis, because not all forms of alopecia are created equal,” he advises. Though your specific treatment will depend on the type of hair loss you have, below are some common treatments for the condition.
1. Minoxidil (brand name: Rogaine): This is a treatment for androgenetic alopecia. “The exact mechanism is not known, but it is believed that this medication can stimulate the hair follicle to enter into a growth cycle or to stay in it longer,” Dr. Sivamani explains. “Scalp irritation is a potential side effect, and in women, it can cause facial hair growth,” says Dr. English, who notes that androgenetic alopecia is a progressive disorder and does not go away. Rogaine can stop or slow hair loss, and may result in some regrowth, but if you stop using it, the hair loss will start again.
2. Finasteride (brand name: Propecia): This FDA-approved oral medication is used to treat male pattern hair loss. It is “believed to work by blocking the conversion of testosterone to dihydrotestosterone (DHT), a hormone that would normally move the hair follicle into a resting phase,” says Dr. Sivamani. So, the medication is thought to reduce the number of hair follicles that go into the resting phase. Because it blocks testosterone, common side effects include sexual issues such as erectile dysfunction, which affects an estimated 1-6% of users, according to Dr. English.
3. Steroids: If the hair loss is caused by inflammation, steroids are a treatment option. They can be injected or used topically to reduce the inflammation that leads to hair loss in alopecia areata. “Steroids can thin the skin with overuse or if injected at too high of a dose. It is important to see a board-certified dermatologist to discuss how steroids can be used appropriately during treatment,” Dr. Sivamani advises.
4. Oral supplements: Many patients also like to take oral supplements, adds Dr. English. The ones he likes best are biotin, Viviscal and BioSil, but he notes that “all the supplements on the market will not regrow, but they can make it stronger and thicker.” Regarding biotin, Dr. Sivamani explains that research has not shown it to improve hair growth in generally healthy hair, but “it has been reported to improve hair growth in those with certain genetic conditions such as ‘uncombable hair syndrome,’” in which hair is so unruly that it can’t be combed flat. “Biotin does not have many side effects, but it may not be effective if not used for the correct reason.” An upset stomach is the most common side effect of taking supplements, according to Dr. English.
If you experience troublesome side effects, stop taking the medication and see your doctor to discuss alternatives.
In addition to these more common treatments, Dr. English says that a newer treatment is low-level laser therapy, which may stimulate hair regrowth. This can be done in certain salons that offer it, or people can buy a machine and use it on their own.
Another more recent option for men is platelet-rich plasma, though it is very expensive and results have been mixed in terms of its effectiveness. This is more of a surgical procedure that some doctors and hair transplant companies offer.
It’s important to seek the advice of a dermatologist before starting a treatment regimen. In addition to the importance of finding the most effective option, thinning strands can be a sign of a bigger problem, like various medical conditions, vitamin deficiencies, excess stress or hormonal imbalance. Dr. English recommends that people with hair loss have a thorough evaluation that includes a check of their thyroid, iron, vitamin D and zinc levels.
“I look at hair loss as a systemic disease,” and people that have it may be at risk of more serious disorders, he points out. For example, androgenetic alopecia has been linked with conditions like heart disease, prostate cancer and high blood pressure in men, and polycystic ovarian syndrome (PCOS) in women. That means that in addition to the scalp, the imbalance may be affecting internal organs and may signal the need for further medical treatment.
“There are a lot of factors that go into choosing treatments for hair loss, and these decisions must be made on an individual basis,” Dr. English emphasizes.
