If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Everyone loses approximately 100 hairs a day (AAD, n.d.). The problem arises when this hair loss causes overall thinning or bald patches, a condition known as alopecia. This is very common with up to 50% of men and women affected (Mounsey, 2009). Alopecia usually affects the hair on your head but may disrupt other body hair, such as eyebrows, eyelashes, etc. There are many different causes and types of hair loss, including medications, illnesses, and genetics. The most common type is androgenic alopecia which leads to male pattern baldness and female pattern baldness. Depending on the cause of your hair loss, your dermatologist may recommend one or a combination of treatments to improve hair growth.
- Minoxidil and finasteride are the only FDA-approved medications for the treatment of the most common cause of hair loss, androgenic alopecia.
- Low-level laser therapy and microneedling are FDA-cleared medical devices for hair loss treatment.
- A hair transplant is an effective surgical option for hair restoration.
- Cosmetic treatments camouflage thinning hair and include wigs, powders, and micropigmentation.
Medication treatments: prescription and over-the-counter (OTC)
- Minoxidil (brand name Rogaine): This treatment works on the hair follicles on the crown of the head (not on a receding hairline) to stimulate hair growth. It is the only FDA-approved medication for androgenic alopecia in both men and women. You apply it directly to the scalp twice a day continually; once you stop using it, your hair loss will return within three to four months (Suchonwanit, 2019). Some people notice mild side effects like itching or irritation after application. Minoxidil is available over-the-counter.
- Finasteride (brand name Propecia): This oral prescription medication is FDA-approved to treat men with androgenic alopecia. It can slow baldness and hair loss in over 86% of men and can stimulate hair growth in more than 65% of men (American Hair Loss, n.d.). Finasteride works by decreasing a man’s production of dihydrotestosterone (DHT), a male hormone. Women and children should not take finasteride, and women who are pregnant should not touch any broken tablets because of the risk of birth defects. Finasteride can also be taken at higher doses for enlarged prostate. When used at this dose, side effects include decreased sex drive, erectile dysfunction, and gynecomastia (male breast enlargement) (American Hair Loss, n.d.). There are reports that these side effects occur at the hair-loss dose as well, but more studies need to be done.
- Immunosuppressants: This class of prescription medication decreases the body’s immune response and slows hair loss. Corticosteroids, methotrexate, sulfasalazine, and cyclosporine have been used to treat hair loss due to inflammation. Most of these drugs are taken by mouth, but corticosteroids can also be given by injection or by using a cream at the areas of inflammation. Some common side effects from injectable steroids include skin thinning and color changes, while oral medications can lead to problems with weight, blood pressure, and blood sugar, among other issues.
- Scalp sensitizers: These medications stimulate inflammation in the skin of the scalp to try to redirect the body’s immune system away from attacking its hair cells and causing hair loss, as in the case of alopecia areata. This type includes anthralin and diphencyprone (DPCP) (Spano, 2015). With both of these medications, you can expect some irritation; in some cases, it can cause severe irritation with itching and blisters. Scalp sensitizers cannot be used to treat androgenic alopecia.
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Hair transplant surgery
Hair transplant surgery takes hair from part of the scalp with good hair growth and moves it to areas of thinning or balding. Both women and men may benefit from this procedure. There are two main techniques used to harvest hair: follicular unit transplantation (FUT) and follicular unit extraction (FUE). A follicular unit is a group of one to four hair cells that naturally grow together. Both techniques are effective at hair restoration but differ in procedure length, scarring, and cost. On average, hair transplantation surgery transfers 700-1500 follicular units (Bicknell, 2014). After a hair transplant, your hair may look thinner for three to four months after the transplanted hairs fall out and before the new hairs start growing. Full restoration usually takes anywhere from 6-12 months. Afterward, most people continue to use medication to prevent any further hair loss.
For people who do not want to use medications or undergo procedures, there are cosmetic options for camouflaging hair loss. Many of these options can be used alongside medical treatment if desired.
- Many men choose to shave their heads rather than treat hair loss.
- Wigs, made of synthetic or human hair; in cases of thinning, they can be integrated into a person’s natural hair, giving a fuller look.
- Concealing powders, lotions, and sprays can be used to decrease the color contrast between the scalp and the hair to give the illusion of a more robust head of hair. These usually need to be applied daily.
- Micropigmentation, or tattooing, is used most often for recreating eyebrows lost to alopecia (Saed, 2016). It can also be used to color the scalp or to disguise scalp scars from hair transplantation surgery. This has relatively permanent results but is not without its drawbacks. Since micropigmentation uses a standard tattooing needle, it carries the same risk of infection as recreational tattooing. Also, your hair may need to be dyed to match the color of the micropigmentation ink.
Natural remedies/Unproven treatments
While minoxidil and finasteride are the only FDA-approved medications, other treatments have been shown to be effective in some cases, and there is ongoing research into their ability to improve hair loss.
- Low-level laser therapy (LLLT) is one of the few FDA-cleared medical devices for the treatment of hair loss. How it works is not well understood, but LLLT may trigger the hair follicle stem cells to stimulate new hair growth (Nazarian, 2019). The devices can be used at home or your provider’s office and are options for both men and women.
- Microneedling is another technique that has an FDA-cleared medical device for treating hair loss. Small needles are used to puncture the outer layers of the skin. This procedure is thought to promote hair regrowth by triggering a wound healing response, causing a release of factors into the tissues that encourage hair growth (Nazarian, 2019). Microneedling can be used in conjunction with minoxidil or platelet-rich plasma therapies (described next). People do not report side effects with this treatment, but there is the possibility of bleeding, pain, redness, and infection.
- Platelet-rich plasma (PRP) is made by taking your blood and separating the plasma from the red and white blood cells. Your provider injects your plasma into the dermis (deep skin layers) in areas of hair loss; this plasma has many different growth factors that can stimulate hair growth. Studies have shown varying results, and PRP is not FDA-approved at this time (Nazarian, 2019).
- Stem cell therapy is a promising area of hair loss treatment. In one study, the stem cells were injected into the scalp, and an improvement in hair growth was noted six months later (Nazarian, 2019). More studies are needed in this field, and stem cell therapy is not FDA-approved for the treatment of hair loss.
- Nutritional supplements have been touted as a natural way to combat hair loss. These are not FDA-approved, nor have they been extensively tested, but small trials have had positive results (Nazarian, 2019). Vitamin D and iron are two supplements that might help those who are deficient in them.
- Scalp massage is thought to increase hair thickness in non-balding men by possibly improving blood flow to the hair follicles. One study looked at men’s perception of their hair loss after performing daily self scalp massage over several months; over 37% thought that their hair loss stabilized and around 30% saw regrowth (English, 2019). There is limited data as to whether this has any effect on thinning hair.
- Acupuncture treatments involve the insertion of needles into acupressure points to relieve various conditions. It may work by increasing blood flow and stimulating the hair follicles, but there is limited objective evidence.
- Hairstyle changes may improve or reverse hair loss, especially if your alopecia is due to wearing hairstyles that pull excessively on the hair strands (called traction alopecia). Also using harsh hair products or high heat on your hair over long periods can result in hair loss. Changing these practices may allow your hair to regrow.
Treating hair loss is a personal decision. For some, their hair is tied to their identity, and its loss has negative psychosocial impacts. For others, it is just a part of aging and does not bother them. Regardless of how you feel about losing your hair, talk to your provider about it, and make sure that there is not an underlying medical issue to consider. Discussing the treatment options and their risks/benefits will help you make an informed decision regarding the best course of action for you to manage your hair loss.