Finding the right hair-loss treatment
Hair loss can be devastating for both men and women, even more so when there are loads of products on the market that don't work. According to the American Hair Loss Association (AHLA), two thirds of American men experience some degree of hair loss by the age of 35. By the age of 50, approximately 85 percent experience significantly thinning hair. Balding is commonly associated with aging, but for 25 percent of men the process begins before the age of 21. What's more, hair loss is not limited to men: The American Hair Loss Association reports that women make up about 40 percent of hair-loss sufferers in the United States.
Types of hair loss
The majority of American men and women are affected by hair loss, known as alopecia, at some point in their lives, according to experts. Androgenetic alopecia (AGA), commonly referred to as male- or female-pattern baldness, accounts for about 95 percent of hair loss in the U.S., according to Better Nutrition magazine. Experts say pattern baldness is genetic and inherited equally in men and women. However, the hair-loss gene can only express itself when dihydrotestosterone (DHT), a male hormone, is present. Because estrogen usually suppresses male-hormone production, women don't typically experience pattern baldness until after menopause has begun; although, even the slightest hormone shift can cause hair loss in women.
The causes behind other types of hair loss -- including alopecia areata, telogen effluvium, anagen effluvium and traction alopecia -- and their treatment can be dramatically different. Hair loss is best treated in association with its underlying cause; therefore, it's recommend to seek medical help. Abnormal hair loss can also be a symptom of a more serious disease -- early diagnosis is strongly suggested in these cases.
Hair-loss treatments that work
For the past two decades, scientists have made strides in developing hair loss treatments that are both safe and effective. However, the market is inundated with ineffective products; "99 percent of all products being marketed in the less than ethical hair loss treatment industry are completely ineffective for the majority of those who use them," according to the AHLA.
Topical treatments like Rogaine use the active ingredient minoxidil -- originally used to treat high blood pressure. After researchers discovered that it also promoted hair growth, it was the first drug approved by the FDA to treat male pattern baldness. It is used topically on the scalp, and the success of treatment is dependent on the user's extent of hair loss. Researchers at the AHLA find its efficacy to be marginal in the long run since it has no effect on the hormonal process.
Like minoxidil, finasteride, the active ingredient in Propecia, was originally created with a different purpose in mind -- to treat enlarged prostate glands -- and researchers observed it came with a side effect of hair growth. Unlike topical minoxidil, finasteride requires a prescription, is taken orally and addresses hormonal causes of hair loss. It inhibits the enzyme type II 5-alpha reductase, which converts testosterone into DHT. As it was the first truly effective treatment for hair loss that provided nearly guaranteed results, finasteride revolutionized the hair-loss-treatment industry.
Both minoxidil and finasteride require a lifelong commitment, but for users looking for a treatment with permanent results, hair transplant surgery may be the solution. Over the years, surgeons have developed techniques to deliver natural-looking results that are a far cry from early hair transplants, which had a cornrow-like appearance. These procedures are costly and may require multiple sessions depending on the patient.
To select the best hair-loss treatments on the market, we turned to the experts. Medical studies and clinical trials test various treatments, pointing out which are more effective than others. The AHLA also proved to be very informative. User reviews from Amazon.com and Drugstore.com offered helpful feedback on long-term use of these treatments.
We detail proven hair-loss treatments that offer good performance by promoting the growth of natural-looking hair, and we take a hard look at all possible side effects associated with the treatments.
Best Hair Loss Treatments
Over-the-counter topical treatments prove effective in treating hair loss
Experts say that Men's Rogaine Extra Strength Hair Regrowth Treatment (Est. $45 per 3-month supply) is a good starting place for men, and some women, in the early stages of pattern baldness. Studies show that approximately 90 percent of the time Rogaine at least slows the progression of hair loss and, for many, hair loss stops completely. It contains 5 percent minoxidil, which studies show to be more effective than the original strength of 2 percent (Est. $25 per 1-month supply). Both forms have been approved by the FDA for topical treatment of pattern baldness, but only the 2 percent strength has been approved for women; although, studies suggest that both forms are more effective on women than they are on men. Minoxidil is also available in several generic store brand products.
Some physicians make their own treatments for pattern baldness by mixing tretinoin (Retin-A or Renova) with minoxidil. Tretinoin is often prescribed as an acne treatment, but studies suggest it increases the effect of minoxidil by 10 percent. This type of hair-loss therapy is only available with a prescription.
One common side effect of minoxidil is a red, itchy scalp, but users claim that merely switching brands can sometimes alleviate that symptom. Another possible side effect is excess hair growth in unwanted places, including the face. It is important to point out that unwanted hair growth and other side effects go away once treatment is discontinued.
Experts say the biggest drawbacks with minoxidil/Rogaine are that it has to be applied twice daily and that treatment must be continued for the rest of the patient's life in order to maintain results. All growth resulting from minoxidil use will fall out approximately three months after treatment is stopped.
Many physicians recommend that patients engage in a combination therapy that includes minoxidil and Propecia (Est. $75 per 1-month supply) with prescription. Propecia is an oral medication with finasteride being the active ingredient. Finasteride was originally developed by Merck to treat enlarged prostate glands. Excess hair growth was a surprise side effect of the drug and led to the development of Propecia, which was approved by the FDA for treatment of male-pattern baldness in 1997. It has not been approved for women.
Studies show that Propecia is effective for 86 percent of men who use it, but doctors interviewed by USA Today say that "anyone who expects miracles will be disappointed." They explain: Only about one-third of men in the early stages of hair loss will regrow some with Propecia. These doctors say that it "primarily slow(s) down hair loss and improve(s) hair quality." As reported at HairLossHelp.com, a five-year study published in 2001 found that Propecia continued to prevent hair loss but there was a "progressive decrease in the amount of hair grown over the five-year period." Experts say that it is effective at growing back more hair than minoxidil (Rogaine) but that it can take up to a year to see results.
Men taking Propecia run the risk of sexual side effects, but most experts say that it only affects a small minority. The risks are greater for women, especially those who are pregnant or may become pregnant. Experts warn that so much as handling the tablets can lead to serious birth defects. Like minoxidil, Propecia use must be continued for as long as results are desired.
Off-label treatments show promise
Some doctors prescribe Avodart off-label (meaning to treat something other than illnesses or conditions listed on the drug's label) to patients suffering from male-pattern baldness. Dutasteride, the active ingredient in Avodart, like finasteride, is used to treat enlarged prostate glands, but it blocks both types of the enzyme that create DHT, instead of just one. Studies show that dutasteride is superior to finasteride in treating AGA, but it has yet to be approved by the FDA for that purpose.
Ketoconazole is another off-label treatment that stands out for treating hair loss. Ketoconazole is the active ingredient in Nizoral shampoo, and 2 percent strength is often prescribed to treat dandruff -- a 1 percent formula is sold over the counter, but reviewers say that it's not as effective. Many men choose to triple-treat their hair loss with minoxidil, Propecia and Nizoral shampoo. Studies show promising results with ketoconazole, though not any better than minoxidil or Propecia, but experts insist that further study is needed.
Other off-label products that show possibilities are Tagamet (an antacid treatment), azelaic acid (a rosacea and acne treatment) and some birth control pills. Experts say that these products require further study into their effectiveness, as well as any possible side effects.
Treating hair loss in women
Unfortunately, there has been little research into female-pattern baldness. The AHLA says, "While many drugs may work to some degree for women, doctors are reluctant to prescribe them, and drug companies aren't exactly falling over themselves to test existing or new drugs specifically for their ability to prevent and treat female-pattern baldness." The only FDA-approved treatment for hair loss in women is 2 percent minoxidil, although some doctors will prescribe other drugs off-label.
A commonly prescribed treatment for women is hormone replacement therapy (HRT). HRT is only prescribed to women with AGA during menopause or women who have low estrogen and/or progesterone for other reasons. These female hormones suppress male hormone production and seem to keep hair loss at bay. Physicians, however, do not recommend long periods of HRT treatment because of the increased risk of breast cancer, heart disease and stroke.
Oral supplements like Viviscal Extra Strength dietary supplements (Est. $50 per month) have also been proven to have a measurable effect on hair regrowth; a double-blind, placebo-controlled study in the Journal of Clinical and Aesthetic Dermatology found that the nutritional supplement significantly increased hair growth among women with thinning hair.