Combing Through Hair Loss Treatments

Posted on November 30, 2015

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Source: U.S. News & World Report

What to do when there's more hair in the drain and less on your head.

Hair loss is a natural but unloved part of aging. If you're concerned about thinning hair, here's what Dr. Holly L. Thacker and other experts say about prevention, effective treatments and realistic goals.

HAIR LOSS IS A NATURAL but unloved part of aging. But sometimes bald spots or thin patches are signs of a medical condition or dietary deficiency. The first step in seeking a remedy is finding out the cause. Male or female pattern balding, or androgenetic alopecia, is the most common type of hair loss. If you're concerned about thinning hair, here's what experts say about prevention, effective treatments and realistic goals.

Check out the cause: Before you rush to the drugstore to buy some Rogaine, talk to your doctor or dermatologist, says registered dietitian Jim White, a spokesman for the Academy of Nutrition and Dietetics. Medical conditions or drug side effects or reactions may be underlying causes of temporary hair loss. Blood tests can also uncover nutritional deficiencies.

If you're vitamin-deficient: A dietitian can help by addressing nutritional gaps, pointing out foods that promote hair growth ​and suggesting supplements if needed. Food is always the first choice, says White, who owns several fitness and nutrition studios in the Virginia Beach area.

Be smart with supplements: Don't go overboard on supplements in efforts to save hair, White says. For instance, while vitamin A promotes hair growth, too much vitamin A could lead to hair loss. Biotin (a B vitamin) is often recommended to treat hair loss and nail problems, but people often take doses that are much higher than they need, he says.

Hair may regrow: One form of hair loss called "telogen effluvium" resolves on its own without treatment, although it can take a few months because of hair's long growth cycle, says Dr. Holly Thacker, director of the Center for Specialized Women's Health​ at Cleveland Clinic and executive director of Speaking of Women's Health.

Stress and shedding hair: "There's a normal resting phase with the hair and the growing phase," Thacker says. "Sometimes where there are stressors or low iron or low zinc or low vitamin D, those phases can get a little out of whack and someone may notice more shedding than growth."

Hormones and hair: Hormones affect women's hair in various phases of life, Thacker says. "One of the best things for hair, nails and skin is estrogen. That's why during pregnancy, when women have really high levels of estrogen, they have great skin and hair," she says.

Midlife stress: "Sometimes at midlife, when women start to lose their sex hormones – they're under stress because they're raising kids [and] taking care of elderly people and relatives – and they have more stress hormones," Thacker says. "They start getting adult acne or hair shedding."

Menopause effects: Men have more testosterone than women, which is why thinning hair is more common in men. Even so, women can also inherit a sensitivity to testosterone, which affects hair follicles at the crown of the head and temples. With menopause, women lose estrogen but continue to make testosterone, Thacker says. "Some of them notice more hair loss," she says. "They notice chin whiskers or a deepening of their voice."

High anxiety: Women with hair thinning are usually very anxious about it, Thacker says, sometimes even "obsessed," and their anxiety makes it worse. Dermatologists may recommend anti-anxiety medicine.

Low estrogen levels: Estrogen therapy can help treat hair loss in women with hormonal deficiencies, she says. Birth control pills can be prescribed to premenopausal women with hair loss. Estrogen therapy, alone or with progesterone, is used by women past menopause who aren't subject to blood clots or other risks.

Tackling testosterone: A diuretic drug called spironolactone is another way to treat hair loss. It works by reducing active testosterone's effect on the hair follicle, Thacker explains. Dermatologists sometimes recommend Nizoral shampoo to block testosterone's effects on the hair follicles.

Cosmetic fixes: Products like Toppik hair spray​ or powder makes the hair look thicker. Even parting hair differently can make thin spots less noticeable. And people can always turn to hats, extensions, weaves and wigs.

Medications for regrowth: Rogaine (or generic minoxidil) or Propecia (finasteride) are widely used to help hair regrow. Propecia, a prescription drug, is approved by the Food and Drug Administration for use in men only. Rogaine, a topical medication in foam or liquid, is available over the counter and approved for men and women. "We like the foam," Thacker says, "because we don't want [the medication] dripping down and causing hair on the face."

Laser combs: Laser devices have been FDA-approved to treat hereditary hair loss in men and women by stimulating the scalp. New research presented in November at the annual World Congress for Hair Research in Miami explores the effects of laser light energy on hair growth.

Hair from stem cells? Findings from clinical trails and experimental treatments featured at the Miami meeting include efforts to regrow hair follicles from stem cells and the effects of prostaglandins (proteins in the body) to promote hair growth. Scientists are also working on new treatments for alopecia areata, the most common form of autoimmune hair loss.

Like brushing your teeth: The trick is to prevent hair loss early – before half your hair is gone, says Dr. Paul McAndrews, ​a dermatologist who specializes in medical and surgical treatment of hair loss in his Pasadena, California, practice. "Just like toothpaste – the sooner you start brushing your teeth, the better," he says. "The sooner you get started on Propecia and minoxidil, the better." However, these drugs require an ongoing commitment: If you stop, hair loss moves full speed ahead.

Filling in hair cavities: Hair transplant is a surgical procedure usually done under local anesthesia. Grafts of hair and follicles from the back of the head, where hair growth is strong, are used to fill in bald or thin spots at the crown. How do you know if hair transplant is for you? "When someone comes to my office, my role is not to tell the patient what to do," says McAndrews, a clinical professor in dermatology at the Los Angeles County-USC Medical Center. "My role is to tell the pros and cons, what I know and don't know, and let them make an educated decision."

Transplant realities: The procedure, which usually takes about four to 10 hours, does not come cheap. In McAndrews' practice, the cost runs from $14,000 to $24,000. It can be significantly less expensive in other parts of the country, starting at about $4,000. The best transplant candidates have realistic goals, he says. A balding young man in his 20s may have visions of a full, thick head of hair that will last forever. But there's only so much good replacement hair available to fill in a bare circle at the crown, which will continue to widen over the years and may need transplant updates.

Peace with baldness: "There are times when hair transplants are not in the best interest of the patient," McAndrews says. "Some patients leave my office after our talk and say, 'Doc, thanks so much, but I'm not going to do anything. I'll just shave my head and I'll be happy.' It's a very personal choice."