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Dec 09, 2021
6 min read

Hair loss treatments, causes, and diagnosis

Hair loss is a very common experience, especially as we age. Minoxidil and finasteride are the only FDA-approved medications for the treatment of the most common cause of hair loss, androgenetic alopecia. Additional treatment options include low level laser therapy, microneedling, platelet-rich plasma, hair transplant, wigs, and more.

Disclaimer

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.

If you’re concerned about hair loss, you’re not alone. Hair loss, also called alopecia, is quite common. In fact, the most common type of hair loss—androgenetic alopecia—affects up to 50% of men and 15% of women (Al Aboud, 2021). While everyone loses approximately 100 hairs a day, alopecia is when excessive hair loss causes overall thinning or bald patches over time (Murphrey, 2019).

Thankfully, there are many treatment options available for hair loss. Read on to learn about the choices you have when it comes to addressing your thinning hair.

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Hair loss causes

The first step in treating hair loss is finding out its cause. The most common cause of hair loss is androgenetic alopecia, often called male pattern baldness or female pattern baldness. However, there are many different causes of alopecia, including medications, illnesses, stress, and genetics. Even wearing tight hairstyles can cause some degree of hair loss, a process called traction alopecia

To determine what’s causing your hair loss, your healthcare provider or dermatologist will begin by asking questions about your health and family history. They’ll ask about your diet, any medications or supplements you’re taking, medical conditions, stress levels, and whether any relatives have also experienced hair loss. 

Your provider will then examine your areas of hair loss, paying close attention to patterns that might be a clue to specific causes. They may perform a pull test, gently pulling on hair in different areas to see how much comes out easily. If an infection is suspected, they may scrape or biopsy your scalp. Blood tests may also be considered to rule out other causes of hair loss (Al Aboud, 2021).

Depending on the cause of your hair loss, your healthcare provider may recommend one of the treatments below (or a combination) to improve hair growth.

Medications for hair loss

There is a range of medications available to treat common causes of hair loss. Some are over-the-counter (OTC), while others will require a prescription.

Minoxidil (brand name Rogaine) 

Minoxidil is an OTC topical treatment that stimulates the growth of hair follicles on the crown of the head—the top and back of the head, not a receding hairline in the front. 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. 

Finasteride (brand name Propecia)

Finasteride (see Important Safety Information) is an oral prescription medication that is FDA-approved to treat men with androgenic alopecia. 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 harm to a fetus. Finasteride can also be taken at higher doses to treat an enlarged prostate (under the brand name Proscar). Side effects of finasteride include decreased sex drive, erectile dysfunction, and gynecomastia (male breast enlargement) (Zito, 2021). 

Immunosuppressants 

This class of prescription medication decreases the body’s immune response and may slow hair loss for certain causes of alopecia. 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 others. 

Scalp sensitizers

Medications such as anthralin and diphencyprone (DPCP) take an opposite approach from immunosuppressants and actually stimulate inflammation in the skin of the scalp. The aim is 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. It’s important to know that scalp sensitizers cannot be used to treat androgenic alopecia, the most common cause of hair loss. With scalp sensitizers, you can expect some irritation; in some cases, it can cause severe irritation with itching and blisters (Spano, 2015). 

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 transplant 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.

Cosmetic treatments for 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 can be used. In cases of thinning, wigs 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.
  • Scalp 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.

Newer hair loss 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. Some newer treatments for alopecia include (Nazarian, 2019):

  • 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. These devices can be used at home or your provider’s office and are options for both men and women.
  • Microneedling is another technique that uses 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. 
  • 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 for hair loss at this time.
  • 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. More studies are needed in this field, and stem cell therapy is not FDA-approved for the treatment of hair loss.

Treating hair loss is a personal decision. For some people, their hair is tied to their identity and losing it 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, speak with your healthcare provider to determine whether there is an underlying medical issue causing your hair loss, and what treatment options you may have. Discussing the different hair loss treatments and their risks and benefits will help you make an informed decision that is best for you.

References

  1. Al Aboud, A. M. & Zito, P. M. (2021). Alopecia. [Updated Aug. 11, 2021]. In: Statpearls [Internet]. Retrieved on Dec. 1, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK538178/
  2. American Academy of Dermatology (AAD). (n.d.). Do You Have Hair Loss or Hair Shedding? Retrieved from https://www.aad.org/hair-shedding.
  3. Bicknell, L. M., Kash, N., Kavouspour, C., & Rashid, R. M. (2014). Follicular unit extraction hair transplant harvest: a review of current recommendations and future considerations. Dermatology Online Journal, 20(3). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24656268
  4. Mounsey, A. L., & Reed, S. W. (2009). Diagnosing and Treating Hair Loss. American Family Physician, 80(4), 356–362. Retrieved from https://www.aafp.org/afp/2009/0815/p356.html
  5. Murphrey, M. B., Agarwal, S., & Zito, P. M. (2019). Anatomy, hair. [Updated Aug 11, 2021]. In: Statpearls [Internet]. Retrieved on Dec. 1, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK513312/
  6. Nazarian, R. S., Farberg, A. S., Hashim, P. W., & Goldenberg, G. (2019). Nonsurgical hair restoration treatment. Cutis, 104(1), 17–24. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/31487342
  7. Phillips, T. G., Slomiany, W. P., & Allison, R. (2017). Hair Loss: Common Causes and Treatment. American Family Physician, 96(6), 371–378. Retrieved from https://www.aafp.org/afp/2017/0915/p371.html
  8. Saed, S., Ibrahim, O., & Bergfeld, W. F. (2016). Hair camouflage: A comprehensive review. International Journal of Women’s Dermatology, 2(4), 122–127. doi: 10.1016/j.ijwd.2016.09.002. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28492045/
  9. Spano, F. (2015). Alopecia areata: Part 2: treatment. Canadian Family Physician, 61(9), 757–761. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569105/
  10. Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development and Therapy, 13, 2777–2786. doi: 10.2147/dddt.s214907. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31496654/
  11. Zito, P. M., Bistas, K.G., & Sayed, K. (2021). Finasteride. [Updated March 27, 2021]. In: Statpearls [Internet]. Retrieved on Dec. 1, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK513329/