- Best Results4-8 months
- Treatment Recovery4 - 7 days
- Procedure TimeNA
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- AnaestheticNumbing, Sedation, Gas
- Back to WorkNA
Medical Hair Loss Treatments
Medical treatments should be prescribed in all cases of hair loss. Early & effective management will preserve the remaining hair follicles. These treatments are adjunctive to follicular unit extraction hair transplant surgery, PRP & lasers. Your dermatologist will guide you as to the best options for your pattern of hair loss.
FactsFacts on Medical Hair Loss Treatments
- The initial aim of medical treatment is to slow down & preferably halt the progression of hair loss
- The secondary aim is to regrow hair
- Diagnosis of hair loss will direct dermatologists to effective treatments
- FUE hair transplantation is used for more advanced cases of hair loss
- Some forms of hair loss only require supportive management
- Other forms require a more comprehensive medical & surgical approach
- Treatments include simple compounded lotions, PRP, & lasers
Why are you losing hair?
The two most common causes of hair loss are telogen effluvium & androgenetic alopecia. The former is self-limiting & the latter is progressive.
Telogen effluvium presents 2-4 months after a stressful event including postpartum/pregnancy, trauma, operations & emotional stress.
Androgenetic alopecia also known as male/female pattern recession can present anywhere from teenage years (uncommon) to mid adult life. This form of hair loss requires urgent management to slow down the progression towards follicular miniaturization. Early-stage androgenetic alopecia responds much better to treatment compared to late stage hair loss.
What topical treatments are there for hair loss?
The mainstay topical lotions include-
Topical minoxidil: 2 to 7% +/- retinoic acid. Formulations of 2-5% are over the counter. Compounded formulations contain retinoic acid/ tretinoin with a higher percentage of minoxidil. Retinoic acid, together with propylene glycol can increase the absorption of minoxidil. Minoxidil functions to increase the anagen cycle via increased blood supply to the follicular unit.
Topical dutasteride/finasteride: these are DHT inhibitors, reducing the function of 5 alpha reductase 1 & 2 respectively. Compounded formulations are normally combined
with topical minoxidil. Topicals have less side effects compared to the oral counterpart.
Topical bimatoprost/latanoprost: these are prostaglandin inhibitors. Dermatologists frequently prescribe this for alopecia areata, hypotrichosis & disorders of pigmentation (hypo).
What about Low-Level Laser Treatments/ LEDs?
Low-level laser therapy is essentially light emitting diode therapy. Also known as red light therapy and cold laser therapy. This uses photons to treat weak / miniaturized hair follicles to encourage growth.
LLET is accepted that the procedure is safe, tolerable, & marginally effective. Biased studies have shown that low level lasers can increase hair count by 39% over 16 weeks. This study has not been replicated or reproduced since. Nevertheless, LEDs can be considered as adjunctive therapy (life-long) to medical treatments.
How: Red light therapy
Procedure: 12-15 minutes
Last: 1 months
Downtime: 0 days
What oral tablets can help with hair loss?
Oral tablets are divided into two categories, anti-hormonal & follicle stimulating / preserving.
Follicle stimulation & preservation tablets include minoxidil. This was one of the first tablets reported for hair loss over three decades ago. It is primarily used as blood pressure medication.
Anti-hormonal (antiandrogens) tablets are subdivided into tablets for men, & tablets for women.
Tablets for men include; finasteride & dutasteride. Tablets for women include cyproterone acetate, spironolactone, flutamide and bicalutamide.
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What are realistic expectations with medical treatments?
Medical treatments are designed to slow down hair loss. Ideally, they should be initiated as early as possible, & maintained, if appropriate, for life. Some elect to use topicals, most commonly minoxidil, others a combination of orals & topicals.
Certain patterns of balding respond best, including the crown / vertex areas, whilst frontoparietal areas (front/hairline) are poor responders. The latter responds nicely to FUE / FUT hair transplantation.
What is PRP, & can it help with hair loss?
PRP stands for platelet rich plasma. This treatment uses the natural growth factors found in your own platelets. PRP can be delivered through injections, microneedling, & lasers. A typical course consists of three injections spaced one month apart, followed by maintenance treatment ranging between 6 to 12 months. PRP is best used as adjunctive treatment, instilled early on in the course of hair loss.
How: PRP injections/delivery
Procedure: 10 minutes
Last: 6-12 months
Downtime: 0 days
Can Low Level Lasers be used for hair loss in darker skin types?
Yes. LLLT can be used on ethnic skin with absolute safety. This is because most devices for laser hair restoration have both LED and low output red light laser.
Can lasers help with hair loss?
Yes. Lasers including ablative & non-ablative lasers can actually grow hair. They function to stimulate hair growth via stem cells generation from the area of the bulge of the hair follicle. Lasers can also increase the absorption of topicals including growth factors, cytokines, & platelet rich plasma.
Lasers do not provide a permanent solution for hair loss, however, they can be useful as an adjunctive to medical management. I also employ this treatment post FUE/ hair transplantation to reduce redness & improve graft uptake. I normally start thulium lasers 4-8 weeks post transplants.
How: LaseMD 1927 thulium laser
Procedure: 15 minutes
Last: 3-6 months
Downtime: 0 days
What are permanent solutions for hair loss?
The truth is that hair loss will progress with time, no matter what the solution. The good news is that we can markedly slow down this process. A summary of timelines is as follows-
- Follicular unit transplantation / extraction: longest solution.
- PRP for hair-loss: needs to be repeated 6 to 12 months.
- Laser therapy for hair loss: needs to be repeated 4-6 months.
- Minoxidil oral tablets/topically: regression at 3-4 months once ceased.
- Finasteride /Dutasteride: regression at 3-4 months once ceased.
- Cypertorone acetate/ Spironolactone: regression at 3-6 months once ceased.
Can vitamins & supplements help grow hair?
Vitamins can be of benefit if there are nutritional deficiencies. Iron supplementation is a classic example as this may speed up or accelerate hair growth from telogen effluvium.
There are recent studies suggesting that saw palmetto can improve hair growth in patients with androgenetic alopecia (male pattern hair loss). More robust growth has been demonstrated with a combination of saw palmetto & topical minoxidil.
As vitamin supplements are cost effective & banal, you could start on a hair-nail & skin multivitamin if you so desire.
How much are treatments?
Medical treatments are very affordable.
- Topical minoxidil 1-5%: approximately 30 cents per day.
- Oral minoxidil 1-2 mg, approximately 35 – 45 cents per day.
- Saw palmetto supplementation: approximately 30 cents per day.
- Finasteride, dutasteride, bicalutamide, spironolactone, c. acetate ranges from 30 cents to 90 cents per day
Can medical treatments help with other forms of alopecia/hair loss?
Yes. This depends on the type of hair loss. Telogen effluvium is self-limiting. Vitamins & tablets can help, especially if there are deficits including low iron. Alopecia areata can respond to local or systemic steroids.
Inflammatory conditions like lichen planopilaris, lupus, & frontal fibrosing alopecia can respond to hydroxychloroquine, corticosteroids, & other immunosuppressive agents. Hair transplantation in this group can be considered if inflammation is dormant for at least 12 to 24 months.
How do I know what is the correct solution for me?
The type of medical treatment will depend on your pattern of hair loss. Most dermatologists will commence patients on both a topical & oral medication.
The risk benefit ratio will be discussed during the consultation.
Disclaimer: I am a procedural dermatologist, though I deliver lectures on hair loss disorders I do not practice medical dermatology. Please consult my medical colleagues @cliniccuits
Davin’s Viewpoint on medical management for hair loss
It is accepted that medical management is Gold Standard for all hair loss disorders, with telogen effluvium excepted (as this is self-limiting).
Early & effective management will preserve the hair follicle & reduce the transition or regression toward follicular miniaturization (shrinkage). In many cases medical therapy not only slows down hair loss, but can actually grow new terminal hair.
For males, the usual medical therapy includes minoxidil, topically or orally, together with a dihydrotesterone or DHT inhibitor, usually finasteride or dutasteride. Topical formulations have less side effects compared to oral medications. Risk benefit ratio to be discussed with your dermatologist, including PSA testing intervals.
For females, antiandrogens include the use of cyproterone acetate, spironolactone, & new flutamide analogues known as bicalutamide. The majority of dermatologists will also prescribe minoxidil topical or oral. Some may prescribe off label finasteride, often in combination with minoxidil topically.
In the context of follicular unit extractions / transplantations, medical treatments are always prescribed as adjunctive management. The aim of therapy is to preserve the transplanted hair following surgery, & to reduce regression or miniaturisation of the hair follicle.
Disclaimer: Davin Lim is a procedural dermatologist. I do not prescribe medication for hair loss disorders. For medical management, please discuss with your dermatologist. Alternatively book an appointment with one of my colleagues at Clinic Cutis.
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