Non-surgical options for the treatment of hair loss

By clinical professor of dermatology, Robert M. Bernstein, M.D., F.A.A.D

Hair loss can be devastating for some of the nearly 30 million men and women in the Unites States alone who are going bald. Throughout the world, hair loss has been perceived as a sign of aging, loss of virility and, for women in particular, a sign of poor health. While none of this is necessarily true (hair loss can actually happen at any age and for numerous reasons) dealing with the chronic embarrassment and self image issues can take an emotional and psychological toll.

The search for new ways to help those suffering from hair loss has captured word-wide attention. Some new non-surgical hair loss treatment techniques and products have been proven to be of benefit, while others have simply played on the emotional strings of those who suffer from the problem.

Alopecia (baldness) is not just a manís issue, it affects a significant amount of women as well, but unfortunately women have a harder time finding an appropriate therapy. Women experience a different type of hair loss than most men, and this makes it more difficult to treat. Women often do not have a stable, permanent area for donor hair and, therefore, may not be suitable candidates for surgical hair restoration. And not all hair loss medications have been approved for use in women, although therapies such as low-level laser therapy may be helpful.

FDA Approved Medications

There are two FDA approved medications for hair loss, the oral medication Propecia (that contains finasteride 1mg) and the topical medication Rogaine (that contains minoxidil). Minoxidil is generic and no longer requires a doctorís prescription. Finasteride still requires a prescription but is also available in the less expensive 5mg generic form that can be divided up into the smaller 1mg doses using a pill cutter.

Medications can be useful in two ways. They can be used to reverse hair loss when used early in the balding process and can retard further hair loss at almost any stage. Drugs work well for some patients, but not for others. They can be used alone, or can be used as part of a hair loss treatment plan that includes hair transplantation. Generally the earlier medications are started, the more effective they are. In about 1/3 of the cases, there is a visible amount of hair regrowth and in about 85% of patientsí, it can significantly slow down further hair loss.

There is a common misconception that drugs work only on the crown. In contrast to what people think, both Rogaine and Propecia do work in the front and top part of the scalp, it is just that they work better in the crown. Both medications thicken fine, miniaturized hair and both are unable to grow hair in areas that are completely bald. The crown usually has hair in the thinning phase for longer periods of time than the front part of the scalp. This helps to explain the relatively better response to medication in this area. Although, Propecia is significantly more effective than Rogaine in treating hair loss, and they seem to have additive effects when used together.

Medications take time to work and it usually takes six months to a year to see the results. In the first few months they may cause shedding, so patients need to be patient and continue to use the medication. The effects will wear off if the drugs are discontinued and the patient will soon revert to the degree of hair loss they would have had if they had not used the medications at all.

Herbal Hair Loss Treatments

The most common herb that has been claimed to grow hair is Saw Palmetto. This is a small plant that contains two types of oils, fatty acids and sterols. It has also been marketed as an aphrodisiac, a steroid to help build muscle tissue, a treatment for natural breast enlargement, and as an aid in the treatment of prostate enlargement.

The exact mechanism of action is unknown. Saw Palmetto appears to be somewhat effective in alleviating the symptoms of prostate enlargement and is commonly recommended for this condition. However, there has never been a controlled, scientific study to show that it can re-grow a personís hair and it has been the experience of physicianís who treat hair loss that it is not effective for the treatment of this condition. Many other herbal remedies have been used for hair loss over the years, but none seem to have any real benefit in growing hair.

Low-Level Laser Therapy

This technique is designed around a scientific concept known as photo bio-therapy. This involves the use of laser lights to stimulate cell growth. As with drug treatments, patients who seem to respond to this form of therapy have areas of thinning, rather than areas of the scalp that are completely bald. Laser therapy for hair loss can be administered in a doctorís office and is also available in a smaller home version.

The home version works like a comb to spread the hair so the laser light can more easily reach the scalp. More powerful laser systems that utilize a rotational therapy process are available for use under a doctorís supervision.

Camouflage Techniques

Using cosmetics is a common way of hiding ones hair loss and is often used by persons who are just starting to thin, especially in the crown. A number of over the counter products are now available that can make the hair look thicker. They come primarily in powders, sprays and creams. The main limitation of all of these products is that unless the person has a significant amount of hair to hold the cosmetics in place, it doesnít look natural.

Wigs, hats (particularly baseball caps) and scarves are all used to hide oneís balding. In recent years, elaborate hair systems, attached by glue or sewn to the patientís existing hair, have evolved into a major industry. The problem with these systems is that they must be periodically adjusted, requiring repeated visits to the salon and significant expense. Because they canít be removed at night, they cause traction hair loss, making the user even more dependent on the hair piece. They are also difficult to clean and often give the wearer the appearance of having too much hair.

The final option to hide oneís hair loss is to simply shave the head. For many men, and for a small percentage of women, this solves the problem in its entirety. While it may take people time to adjust to this new look, some patients simply feel more free by eliminating the hair loss problem in this way.

More information

For more information about hair transplantation and a list of the clinics performing the procedure, please refer to our hair loss guide:

Robert M. Bernstein M.D., F.A.A.D. is Clinical Professor of Dermatology at Columbia University in New York and founder of the New York Hair Transplant facility: Bernstein Medical - Center for Hair Restoration. Recognized world-wide for developing Follicular Unit Hair Transplantation, the procedure that has revolutionized modern hair restoration surgery, you can visit his award winning Hair Transplant Blog for answers to all of your hair loss questions.