Not surprisingly, treatments with 5 percent minoxidil work better than treatments with 2 percent minoxidil. A randomized clinical trial published in the American Journal of Clinical Dermatology in 2002 found that, in men with androgenetic alopecia, “5 percent topical minoxidil was clearly superior to 2 percent topical minoxidil and placebo in increasing hair growth.” The difference was actually pretty astounding — after 48 weeks, the men who used 5 percent minoxidil experienced 45 percent more hair growth than the men who used the 2 percent treatment.
Just as pregnancy hormone changes can cause hair loss, so can switching or going off birth-control pills. This can also cause telogen effluvium, and it may be more likely if you have a family history of hair loss. The change in the hormonal balance that occurs at menopause may also have the same result. “The androgen (male hormone) receptors on the scalp becoming activated,” explains Mark Hammonds, MD, a dermatologist with Scott & White Clinic in Round Rock, Texas. “The hair follicles will miniaturize and then you start to lose more hair.”
Finasteride inhibits an enzyme that converts testosterone to DHT, or dihydrotestosterone, the hormone that causes hair loss in men, and unlike minoxidil, this drug can actually help hair grow back, as well as prevent further loss. All you have to do is take one pill a day, and according to Dr. Evan Rieder, dermatologist in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, two-thirds of men taking this treatment will see improvements in hair density over time.
A key aspect of hair loss with age is the aging of the hair follicle. Ordinarily, hair follicle renewal is maintained by the stem cells associated with each follicle. Aging of the hair follicle appears to be primed by a sustained cellular response to the DNA damage that accumulates in renewing stem cells during aging. This damage response involves the proteolysis of type XVII collagen by neutrophil elastase in response to the DNA damage in the hair follicle stem cells. Proteolysis of collagen leads to elimination of the damaged cells and then to terminal hair follicle miniaturization.
Laser treatments. Low-level laser therapy (LLLT) is used for the prevention and reversal of hair loss. Also known as red light therapy, cold laser, and soft laser, it is a form of light/heat treatment (therefore generally safer) that is used on cases of pattern baldness and alopecia areata. The procedure uses a device that emits light that penetrates into the scalp. The more commonly used lasers are the excimer, helium-neon and fractional erbium-glass. The procedure can increase the blood flow in the scalp to stimulate the follicles that are in resting or dormant phase to go into anagen, and at the same time, prevent the production of DHT, which destroys the hair follicles.
1. Collagen powder. Preliminary studies suggest that marine-sourced collagen may stimulate hair growth, says New York City dermatologist Yoon-Soo Cindy Bae. Though more research is needed, participants in studies reported thicker hair after three to six months of daily use. Crushed Tonic Original Powder ($105) easily mixes into coffee, tea, and water.
A little farther up the follicle is the mysterious feature called the bulge. That's where follicle stem cells live. When they get the right set of chemical signals, these self-renewing cells divide. They don't divide like normal cells, in which both halves become new cells that keep splitting and developing. Only one half of the follicle stem cell does that. The other half becomes a new stem cell, and stays put for future regeneration.
Hair practices. Our hair is one of the strongest and most elastic parts of our body. One strand of a healthy hair can be twice as strong as a copper wire of similar thickness. However, not all hair types are equal. Unfortunately, hair care practices and styling can lead to scalp damage and unnecessary pressure on the hair follicles, resulting in hair breakage and loss.
“If you don’t want a scar because you like to wear your hair short, you might opt for a “scarless” hair transplant,” says Dr. Joyce. Also known as follicular unit extraction (FUE), grafts are harvested one at a time with tiny punches that heal virtually undetected so you can still buzz your head. “If you’ve gone so bald that you don’t have a lot of donor hair on your head, we can do FUE extractions with body hair such as on your chest, stomach, back, and sometimes even the pubic area,” says Dr. Joyce.
Minoxidil: This medicine is applied to the scalp. It can stop hairs from getting thinner and stimulate hair growth on the top of the scalp. The U.S. Food and Drug Administration (FDA) has approved minoxidil to treat hair loss. It is the only hair re-growth product approved for men and women. A dermatologist may combine minoxidil with another treatment.
Two of the most common LLLT products in the market are the Hairmax Lasercomb and the Capillus 272. The Lasercomb is a hand-held device that is used to comb the hair for 10-15 minutes every treatment, and takes about eight weeks of use in order to see a noticeable improvement in the thickness and quality of the hair. The Capillus is a laser cap that must be worn, and is more convenient because this can be used at home or even out in public (it can be worn underneath a cap or a turban).
None of these need be life threatening, nor does hair loss usually follow them. (Moreover, it can happen after one pregnancy, but not the next.) But when the hair falls out, it's all over the place -- covering the pillow, clogging the drain, and so forth. Paradoxically, the more dramatic the hair loss, the better the prognosis, because when the body gets back into normal rhythm, most if not all of that hair comes back; these people need no special treatment. Normal shampooing can continue, because this only loosens hairs that were going to come out anyway.
As they age, men tend to lose the hair on top of their head, which eventually leaves a horseshoe-shaped ring of hair around the sides. This type of hair loss is called male-pattern baldness. It's caused by genes (from both parents -- the idea that men take after their mother's father is a myth) and it's fueled by the male hormone, testosterone. In female-pattern baldness, the hair loss is different -- it thins throughout the top of the scalp, leaving the hair in front intact.
While pregnant, many women notice that their mane becomes thicker, fuller, and shinier, thanks to a surge of pregnancy hormones. However, once they deliver, this flood of hormones leaves their body at a rapid pace, often leaving them with little time to adjust. One side effect of this depletion of hormones is hair loss. Thankfully, for many women, their hair goes back to normal a few months postpartum. Check out these other surprising ways you look different when you’re pregnant.
3. Surgical hair replacement. If you opt for hair transplantation (which runs $5,000 and up), your dermatologist or hair-replacement surgeon will remove single hair follicles from the back of the head, near the nape of the neck, where your hair is fullest. Once those follicles are harvested, they are then dissected and reimplanted into an area of the scalp where hair is thinning. The procedure takes anywhere from three to six hours, and newly implanted hair will usually begin to grow on its own 3 to 12 months after the treatment session. Traditionally, hair transplantation required removal of an entire strip of scalp, Sadick says, but this new follicle-by-follicle technique looks more natural when it heals and allows patients to get heads of hair as dense-looking as before they started losing it.
The test involves plucking about 50 hairs from the head, typically at the back of the scalp, so your dermatologist can look at them under a microscope and determine how much of the hair is in the resting, growth, and fall-out phases. Next, a vial of blood is sent to a lab to check hormone and nutrient levels ($100 and up, depending on insurance). If low levels of iron, or high levels of male hormones, like androgens, are contributing to your hair loss, for example, both can be treated through oral supplements or medication.
Natural hair that is subjected to constant physical trauma from excessive brushing or combing, tight braids or ponytails, or extreme scratching or massage can cause hair at the temples to become weak and to stop growing to its normal length. Clean shaving, especially for men, can cause white bumps to appear on the area where the hair was shaved short, and at times can become infected with pus and leave permanent scarring, affecting hair growth.
This is a short-term cure, applied while waiting for hair to grow, and therefore recommended for those with a mild to medium case of hair loss. In addition to being non-invasive, hair concealers and hair fibers are instant and affordable. Like wigs and hairpieces, they are used to effectively cover up balding spots while not getting in the way of growing hair. Compared to wigs, however, they are more natural looking and blend well with your natural hair, therefore drawing less attention when you're out in public.
George Cotserelis, MD, is director of the University of Pennsylvania's Hair and Scalp Clinic. He agrees that there's no evidence these alternative hair loss treatments have any effect. "If any of it did work," he says, "I'd be very worried about using that product. The fact that it’s working would mean it's doing something to the testosterone and could be having adverse effects."
To us, that meant any product with zero proven ingredients, case studies, or FDA clearance — which shrunk our list by a whopping 180 contenders. That’s right, there are only three treatments that have actually been cleared by the FDA and supported with clinical studies: finasteride (commonly marketed as Propecia), minoxidil, and laser treatments. And, since finasteride is prescription-only, it left us with two.
The third and fourth stages are known as telogen and exogen, respectively. In telogen, the hair is supposed to be at "rest" until it finally detaches itself from the follicle and enters the exogen or shedding stage. Once the hair is detached from the follicle, the follicle remains inactive for about three months, after which a new cycle begins again.