- THE RAWNSLEY DIFFERENCE
In male pattern baldness, the hormone dihydrotestosterone (DHT) interacts with the cells that make up the hair follicle, causing a longer resting (telogen) phase in the hair-growth cycle, which leads to a narrowing of the hair shaft (miniaturization) and the eventual cessation of hair growth. Many of the effective medications on the market stop hair loss by minimizing this effect of DHT on the hair follicle, slowing the progression of hair miniaturization and, in some cases, even allowing hair to return to its previous degree of thickness. Once a hair follicle has stopped functioning altogether, however, no currently available medications or other non-surgical treatments can make it grow hair again. For this reason, non-surgical treatments are recommended for early stages of hair loss, but Follicle Unit Transplantation is the most effective way to treat more advanced stages of hair loss.
Propecia (finasteride) is the most effective medication to treat male hair loss available on the market today. Studies examining its effectiveness over five years found ninety percent (90%) of subjects experienced hair stability while on the drug and forty-eight percent (48%) of these actually experienced an increase in hair growth [compared with nineteen percent (19%) stability and a six percent (6%) increase in hair growth on the placebo.] Propecia (finasteride) is an oral medication taken once a day with meals. It must be taken for at least a year to determine its effectiveness, and often, within the first six months patients on it will experience increased hair loss as miniaturized hair is replaced by new, healthier hair.
Due to the effect of the drug on a developing male fetus, it should never be taken or handled by pregnant or potentially pregnant women. Studies with post-menopausal women showed no hair growth benefit, so it is not prescribed for female hair loss.
Rogaine (minoxidil) is a topical drug applied directly to the scalp area where hair loss is occurring. The drug manufacturers recommend that it be applied twice a day, although studies show tis effects last 22 hours and thus applying it once a day is almost as effective. Researchers are not exactly how Rogaine (minoxidil) works to slow hair loss and improve hair quality, but their best educated guess is that it lengthens the duration of the growth (anagen) cycle of the hair follicle. Studies show that after 48 weeks of use over seventy percent of (70%) of male test subjects and eighty percent (80%) of female test subjects showed stabilization in their rate of hair loss. However, when using Rogain (minoxidil), it can take six to twelve months before any beneficial effects are seen, and if the application is stopped these beneficial effects will wear off after three months and hair loss will resume.
Male uses of Rogaine (minoxidil) are prescribed a five-percent (5%) solution, while a two-percent (2%) solution is approved for women. Although the five-percent solution is more than twice as effective, studies show that women are more sensitive to the side effects, including hypotension (lowered blood pressure), and are more likely to have an allergic reaction.
The FDA approved Avodart (dutasteride) in 2002 for the treatment of prostate enlargement, but it is not currently approved to treat male patterned alopecia (hair loss). Avodart (dutasteride) works in the same way as Propecia (finasteride) by blocking the way the DHT hormone interacts with the hair follicle; however, preliminary studies show that due to the specific enzymes Avodart (dutasteride) affects, it appears to be significantly more effective than Propecia (finasteride) at reducing or reversing hair miniaturization and hair loss.
Oral contraceptives or birth control pills contain a varying mixture of the female hormones progesterone and estrogen. While oral contraceptives that contain higher levels of progesterone can lead to hair loss in women, those with higher doses of estrogen, like Yaz and Yasmin, can be very effective in the treatment of female hair loss.
Since the late 1970s, low-level lasers have been used to help accelerate the healing of wounds and burns and reduce pain based on the principle of photo-biotherapy. In photo-biotherapy, cells absorb low-level laser light, which stimulates cell metabolism and protein synthesis. In the early 1990s, scientists began to explore the question of whether the same process could be used to stimulate hair follicles on the scalp and reverse hair miniaturization and hair loss. In 2007, the first low-level laser devices were cleared by the FDA for use in the treatment of hair loss, but this approval was related to their safety, not their efficacy. The long-term effectiveness of laser therapy has yet to be determined.
© 2024 Jeffrey Rawnsley, M.D., board certified facial plastic surgeon
