Current Hair Loss Treatments
Since ancient times man has sought the solution to hair loss through countless hair loss treatment remedies. As stated elsewhere on this website the oldest known prescription for hair loss is over 3500 years old and every treatment for hair loss since has been about as effective as the first. In other words, nothing has worked. That is until around 1988.
Proven Medical Hair Loss Treatment Options
Rogaine - For years there was a blood pressure medication prescribed under the brand name Loniten, available in 2.5mg and 10mg dosages. It was produced by Upjohn Pharmaceuticals. This was a very effective antihypertensive medication that reduced systolic and diastolic blood pressure for patients with high blood pressure. The active ingredient in Loniten is known as minoxidil and with nearly all medications Loniten was noted for it's side effects, one of the more interesting of which was hair growth. This was a eureka moment in the history of hair loss medications and treatments as minoxidil became the active ingredient in the world's first government approved (U.S. FDA) hair loss treatment prevention medication. This medication was called Rogaine and is still sold today. Rogaine was a big deal when it first hit the market and it was so popular that it was difficult to keep on store shelves. It is understandable however given the impact that people thought this would have on their hair loss. Trouble is, it didn't work that well but it was the only thing going at the time and it was pretty expensive because of it. Free market consumerism 101. In 1995 the patent for minoxidil ran out and that was when the market was flooded with all manner of new hair loss prevention and regrowth formulas. The ingredients for many of these formulations were listed as "natural" and "organic" but most of them had, in small print in the list of ingredients, minoxidil 2% Currently you can find Rogaine in 2% and 5% topical formulations as well as a newer foam version. The foam version has less irritants in it's composition with the goal of reducing some of the side effects noted for Rogaine which included redness, itchiness and dry scalp. Rogaine Foam acts like a hair styling mousse in that it can be used to aid in styling your hair.
Minoxidil side effects listed are –
- Severe scalp irritation;
- Unwanted growth of facial hair;
- Chest pain, fast heartbeats;
- Swelling in your hands or feet, rapid weight gain;
- A light-headed feeling, like you might pass out;
- Headache, dizziness, confusion; or.
- Flushing (warmth, redness, or tingly feeling).
Propecia - After minoxidil the race was on to find a competitor. In 1992 there was a medication introduced to the market called Proscar. It was a 5mg prescription tablet that was used to fight benign prostate hyperplasia, or "BPH". This is a condition where the male prostate enlarges and causes a few issues such as difficulty urinating, frequent urination and potentially it is a precursor to prostate cancer. The active ingredient in Proscar is called finasteride and it too was seen to have side effects that included cessation of hair loss and even hair regrowth. The degree to which this worked was far better than what was seen with minoxidil thus the second eureka moment in the history of hair loss medications was realized. Four years later the FDA approved the medication called Propecia (Finasteride 1mg) for the treatment of male patterned hair loss. It is the first and still the only pill approved by the FDA as an effective hair loss treatment and the manufacturer determined through testing that 1mg was enough to do the job. The statistics for effectiveness were impressive with most men reported seeing quantifiable hair growth in the crown region and nine out of ten men said their hair loss actually stopped. This was a big deal and nearly 20 years later Propecia is still the most effective treatment we have against male patterned hair loss.
When Propecia first became available it too was quite expensive and of course as everything usually works out the price eventually began to fall but it is still a fairly expensive hair loss treatment to buy. It comes in 30 tablet packages, which if taken as directed, will last one month. There are two options that will allow you to drastically reduce the cost of this medication and make it more affordable for you for the long term. The first way is to get a prescription for Proscar instead. It is the exact same medication even though it is marketed to treat enlarged prostates. The only difference is the size of the dosage at 5mg vs. 1mg for Propecia but because it is the exact same medication you can buy a pill cutter at any pharmacy and simply cut the pill into four pieces and take one quarter pill per day of Proscar as opposed to one full pill of Propecia. Proscar and Propecia cost roughly the same for a box of 30 tablets but because you are quartering your Proscar you are effectively reducing the cost of your medication by a full 75%. This is the only way I’ve ever taken Propecia, which is to say I’ve never taken Propecia. I’ve always taken ¼ tablet of Proscar. Getting a prescription for Proscar to fight hair loss is known as getting an “off label” prescription. This means that your doctor is prescribing a medication for a condition it was not intended to treat however this is a very common, and legal, occurrence in the medical community and there is nothing wrong with this especially since in this case the only difference is the dosage. There are some doctors that will not prescribe Proscar for the treatment of hair loss but this is most likely because they are not familiar with the medication in the first place. Contrary to popular belief your family doctor does not know every thing about every thing. If your doctor refuses to write your prescription for Proscar find another doctor that will.
**Tip** – If you cannot find a doctor that will prescribe the medication for you then you can simply schedule a consultation with your local hair transplant clinic. There may be a fee (100.00 or so) but almost all of them will write a prescription for you if they agree you are losing your hair. You can use this as an opportunity to meet a local hair transplant doctor and learn about how consultations are performed. Do NOT allow the doctor to talk you into a hair transplant, as you should be on the medication first before you ever consider the surgical option.
There is a second alternative to Proscar. Both 5mg Proscar and 1mg Propecia are available as generics. The box will have the name Finasteride on the side as well as the name of the manufacturer, such as Cipla, and it may be made in India, which is common. This will save you a bunch of money especially if you get the 5mg version The average cost for 30 tablets of 5mg Finasteride is about 20 dollars so when you cut the pills into quarters you are paying about 5.00 per month. That is about as cheap as you can get for any hair loss treatment medication. The problem is that generics are not always as good as the original they are trying to replace. I first started to notice this several years ago when I had a patient call me to tell me his Proscar was no longer working. I thought this was unusual because I had never had any of my patients tell me this and by this time I had already dealt with several thousand. Regardless, I was intrigued so after about thirty minutes of discussing the issue on the phone I finally asked what I felt was a silly question. I asked him if he started getting his medication from a different source. This was a pivotal moment as his response was “yes”. He did in fact switch from buying his medication locally at a brick and mortar pharmacy to buying his medication from an online pharmacy. The medication was a generic version of Proscar. As the only recommendation I could make I told him he should consider throwing the box into the garbage, march down to his local pharmacy, and get a new supply of the name brand Proscar and then call me in six months. He did exactly that and in six months when he called me he could not stop thanking me because he said that his hair came back. This was a very valuable lesson to learn and since that time I have heard from many other patients that were having the same experience with generic medication. The first question I always ask is if they are taking the name brand Proscar or Propecia or if they are taking generic. If they are taking generic I tell them to consider paying for name brand because without being on the name brand they cannot be sure they are taking the real medication and if they cannot be sure if they are taking the real medication then they don’t have a solid foundation in which to work from. Any claims of Finasteride not working cannot be valid, in my opinion, if the medication is not name brand Proscar or Propecia. This is not to say that generics don’t work at all because they of course do work for many people, and I’ll even say they work for MOST people, but the issue is one of consistency and reliability and in this regard generic medication, at least with regards to Finasteride, is not as consistent or as reliable in efficacy as the original name brand. Period.
Finasteride side effects listed are –
- Decreased interest in sexual intercourse
- Inability to have or keep an erection
- Loss in sexual ability, desire, drive, or performance
This is not a complete list of side effects but are the ones that are of the greatest concern to most men.
Avodart – Turns out that Merck Pharmaceuticals wasn’t the only company making a medication to treat BPH. GlaxoSmithKline makes a medication called Avodart (.5mg Dutasteride) which has been shown to be more effective for the treatment of BPH. Both Finasteride and Dutasteride are known as DHT inhibitors in that they inhibit or reduce the formation of DHT which is the main cause for BPH and for male patterned hair loss. However, the mechanisms in which they work are different from each other in that Finasteride blocks 5αR Type II enzyme whereas Dutasteride blocks 5αR Type I and Type II enzymes. Studies show that Type I enzyme has more to do with the production of DHT than TypeII enzyme thus it is theorized that Dutasteride is more effective at fighting male patterned hair loss. Dutasteride is not currently approved by the FDA for the treatment of MPH but it is prescribed off label by many doctors for this purpose. The only form of this medication is in a gel cap which means it cannot be cut with a pill cutter and the higher overall expense has made it financially prohibitive for many men to warrant consideration.
Dutasteride side effects listed are –
- Abnormal ejaculation
- decreased interest in sexual intercourse
- decreased sexual performance or desire
- inability to have or keep an erection
- loss in sexual ability, desire, drive, or performance
- pain, soreness, swelling, or discharge from the breast or breasts
- Chest pain or discomfort
Bimatoprost – This is the newest member of the prescription level of hair loss treatments available but you should continue reading to find out how. Bimatoprost is available under the brand name Latisse (FDA approval in 2008) and originally it was known as Lumigan (FDA approval in 2001), which first came to market as a treatment for intraocular pressure problems in patients with glaucoma. However, it turns out that it is also effective in treating patients with thinning eyelashes and eyebrows, which is where Latisse comes into the picture. The use of bimatoprost lengthens the anagen phase of hair growth which in turn allows the hair in these regions to become longer and thicker. However, as a treatment for male patterned hair loss, well, not so much. There was some promise for bimatoprost as being the next big thing in medical hair loss treatments but alas it has stumbled and fallen half-way through it’s most recent trials with Allergan, the manufacturer, stating that the results are not very promising at this stage however continued testing is underway so maybe they can make it work out to our advantage.
Bimatorprost side effects listed are –
- May cause blurred vision.
- May cause eyelid redness.
- May permanently darken eyelashes.
- May cause eye discomfort.
- May eventually cause permanent darkening of the iris to brown.
- May cause a temporary burning sensation during use.
- May cause thickening of the eyelashes.
Alternative Hair Loss Treatment Options
As I’ve mentioned before there is no end to the list of hair loss treatments being offered by companies with the claims of being able to treat, reverse, cure or slow your hair loss but there is evidence that some of these treatments do in fact work. Some of them are not even promoted as hair loss remedies but have other intended purposes.
Ketoconazole – When researching this I was somewhat surprised to learn about its effectiveness. First off, ketoconazole is a common ingredient found in medicated dandruff shampoos that you can buy over the counter. In North America one can purchase Nizoral with 2% ketoconazole for the treatment and prevention of dandruff and other fungal based scalp conditions. However, in several studies it was shown that ketoconazole 2% solution is an effective hair loss treatment and is in fact as effective at treating hair loss as is 2% Minoxidil. That’s kind of a big deal as it is, from what I understand, the only real option to the other preventive hair loss treatments that are on the market. I’ve used it for a few years now and while I can’t say it has regrown any hair I do believe my hair is better overall because of it’s use. I have had no side effects that I know of from using this shampoo but some of the potential side effects are listed below.
Ketoconazole side effects listed are –
- Back, leg, or stomach pains
- Black, tarry stools
- Bleeding gums
- Blood in the urine or stools
- Blurred vision
- Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- Change in color vision
- Change in the ability to see colors, especially blue or yellow
- Chest pain
- Dark urine
- Difficulty seeing at night
- Difficulty swallowing
- Fast heartbeat
- General body swelling
- Increased sensitivity of the eyes to sunlight
- Joint pain, stiffness, or swelling
Acell - Acell is an interesting treatment. I remember well how it got it's start in that it all began with a story on 60 Minutes on CBS. In this story there was a man that was an avid model plane enthusiast and one day when he was working on one of his planes he started up the motor and inadvertently cut the tip of his finger off with the propeller. The cut was at the last knuckle. To make a long story short he wound up calling his brother who was working on a product that was intended to speed wound healing. His brother gave him a vial of a white powder that was a special mixture of porcine bladder (pig bladder) and some sort of stem cell inducement formula. I honestly have forgotten a lot about it but regardless, the brother told him to apply it a few times a day to his finger tip and over the course of two weeks the fingertip actually regrew, fingernail and all! I remember being astonished by this. And then I forgot about it. But then a while later there was news about a company called Acell that had a product that made something similar to what I saw on 60 Minutes and as it turns out, it was the same thing. After going through lots of testing and even patent battles Acell was finally able to release it's Matrix line of products to treat wounds. Turns out the product has already been used by veterinarians for years and some of the results show drastic and incredible healing powers that avoided the creation of scar tissue by actually growing new skin, INCLUDING HAIR! Once it received FDA clearance for human use I got excited and I was the first one to realize it's potential.
How do I know I was the first to realize the potential? Because when I called the company and spoke to the Vice President, Rodney Bosley (yes, I know), he told me they never thought of the potential as I laid it out for him and he told me I was the first person to call and ask about this potential. The company had only considered it for use in burn victims but I could hear Mr. Bosley getting excited. After I had time to relax and think further however I remembered that I need to remember reality when it comes to these kinds of things so I realized after a while that it most likely would not grow hair on patients like we hoped. My hope however had evolved to simply reducing the size of even the best donor scars. No matter how good a donor scar is it is still a donor scar so if something was available to make them look better or even invisible then that would be fantastic. But alas, while I may have been the first to recognize the potential of the product I certainly was not the last. Before I knew it, there were clinics offering Acell for donor wound revisions to adding it in with scalp microdermabrasion to induce new hair growth. To be honest, the amount of dialogue on the subject got kind of embarrassing because there were a lot of people making some pretty serious claims and a lot of patients making a lot of assumptions. At this point the hysteria had reached critical mass and all I could do was sit back and ride out the storm. It came, it went, and nothing really changed because of it.
Platelet Rich Plasma Therapy - PRP is another short lived hair loss treatment that is fairly unnecessary. I will admit however that there is potential for at least some benefit from this procedure but it should absolutely, under no circumstances, be considered a reliable hair loss treatment much less should it cost hundreds or even thousands of dollars. PRP therapy has been pretty effective in other arenas such as sports medicine as it seems to help with recovery from injuries and sports related surgeries.
It is a very simply procedure in that you go to a clinic and have several vials of blood drawn from your arm. The vials are then placed into a centrifuge and spun for several minutes to let gravity do it's thing. Once the centrifuge is finished your blood plasma is separated from your red blood cells. They are then separated and the plasma is injected into the scalp to induce hair growth and hair thickening. In even the best case scenarios where some thickening and/or growth is noted it is agreed that any results are temporary so it is a recurring treatment. The use of PRP isn't necessarily a bad thing and at worst will most likely only lighten your wallet but beware of clinics that sell this and/or the use of Acell (as they are commonly used together) as stand alone treatments because the most you will see from this is that you get locked in to returning over and over for moderate to zero gains that cost you a lot of money.
Saw Palmetto – This is where the list of alternative treatments for male patterned hair loss starts to get a little less credible. Saw Palmetto is a plant extract that comes from the Southeastern United States. The plant looks like a tiny palm tree and in fact is sometimes referred to as a palm bush. I remember when I was a kid in Florida when my grandfather and I would be walking in the woods behind his house and he’d stop and pull a “palm branch” out of the ground, clean it off, and start eating it. He’s share it with me and I remember it tasting sweet and it was a refreshing treat in the hot Florida sun. Turns out it was Saw Palmetto and it has been used for centuries for a variety of treatments. As an all natural treatment for BPH it has shown to be no more effective than placebo but because it is used to treat BPH it has naturally been used to also fight male patterned hair loss. The degree of efficacy varies but few studies show any real impact regarding hair loss.
Saw Palmetto side effects listed are –
- Weakness or fainting;
- Black, bloody, or tarry stools;
- Coughing up blood or vomit that looks like coffee grounds;
- Pain or swelling in your breasts or testicles;
- Chest pain;
- Fast, slow, or uneven heart rate;
- Easy bruising or bleeding; or
- Nausea, stomach pain, loss of appetite, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Nettle, onion juice, carrots, egg whites?. Seriously? None of these have enough credibility to go into and I barely agreed to mention them to begin with.
*NOTE* Everything listed here is for informational purposes only and should not be taken as medical advice. I'm not a doctor and I don't play one on TV.
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