Hair loss

Updated 28 June 2016

How is hair loss treated?

Finding treatments or a cure for hair loss is a vast industry that offers a variety of options, including shampoos and lotions, medicines such as Finasteride and Minoxidil, hair surgery and follicular regeneration.

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Millions of men and women worldwide are affected by hair loss (alopecia), which can cause extreme anguish and affect overall psychological wellbeing.

There are many types of hair loss, each with different causes, so correct diagnosis by a doctor with specialised knowledge and expertise in hair loss is essential.

Depending on the cause, up to 80% of people with limited hair loss will have spontaneous hair regrowth over several months and don’t require treatment. Some people may have relapses or have to wait several years for hair to return to normal.

In others – especially those with large areas affected by hair loss – hair never regrows.

Treatment for the most common form of progressive hair loss – called male and female pattern baldness (androgenetic alopecia/female pattern hair loss) – focuses on preventing hair loss, enhancing hair growth and covering bald areas of the scalp.

While researchers are continually working to develop new drugs and advanced surgical procedures to reverse the appearance of pattern hair loss, there is not yet a permanent cure.

Beware of various alternative products and potions claiming to offer a miracle cure!

Make sure to discuss your own needs, concerns and the emotional impact hair loss has on you with your doctor.

Here are the five most common hair loss treatment options: 

1. Finasteride

(Finpecia or Propecia) 1mg.  This oral tablet is taken once daily.  Only available on prescription. Not a cure for hair loss.

Uses

Male pattern baldness (androgenetic alopecia)

How it works

Finasteride blocks the enzyme that converts testosterone to dihydrotestosterone (DHT) in the follicle.  As the main culprit in androgenetic alopecia, DHT causes a shortening of the growth phase and thinning of the hairs.

Effectiveness

Clinical trials have shown Finasteride to be highly effective.  It stops hair loss in 99% of men within a year.

A third have a slight increase in hair while a third show marked improvement in hair growth.

In medical practice, the drug slows hair loss in most men and reverses hair miniaturisation in some.

Benefits

Shrinking the prostate gland in men susceptible to an enlarged prostate is a beneficial side effect. Can be used alone or in conjunction with other hair loss treatments including surgery. 

Drawbacks

Only works over the long term when used daily and consistently. Stopping the drug is likely to lose any hair gained within 12 months of discontinuing medication. Not approved for use by women. May cause sexual side effects e.g. decreased sexual desire (less than 0.5%). 

Find out more about Finasteride and how it helps with hair loss

2. Minoxidil

(Regaine) 2% topical medication. (5% dosage more effective, but only 2% dosage available in South Africa without a prescription).

USES:

Minoxidil solution is applied topically to the scalp skin twice daily.  It is used to treat both male and female pattern baldness (androgenetic alopecia).  Also available in foam formulation (used only once daily).  Generic forms available under other brand names and it is also included as ingredient in some over-the- counter products.

How it works

Minoxidil's mode of action is not completely understood. It appears to prolong the anagen (growth) phase of the hair follicle.

Effectiveness

Results of its effectiveness in slowing or halting hair loss to some degree in men and women range from 50% to 80% of those treated at both 2% and 5% formulations. Only about 20% of patients report new hair growth. More effective when applied to defined areas of hair loss.

Benefits

No prescription needed for 2% dosage. Achieves excellent results in stabilising and improving hair growth when used daily and consistently. Most effective with correct diagnosis, and when used as part of a doctor-guided hair restoration programme.

Drawbacks

Less effective when applied to large areas of hair loss. Usually ineffective for some who continue to lose hair.

The more effective 5% solution is unavailable in South Africa on prescription but has a significantly higher incidence of side effects e.g. contact dermatitis. 

Read what our expert has to say about Minoxidil and hair loss

3. Steroids

(e.g. cortisone) – available in injection and topical application.

USES

Alopecia Areata (condition in which immune cells destroy hair follicles).

How it works  

Steroids are usually injected into bald patches every 4-6 weeks until hair growth is complete.

Effectiveness

Good outcome for injected steroid treatment when hair loss process present for less than one year. Limited success with topical steroids applied to the skin.

Benefits

Results may already be visible within a month of starting a course of injections.

Drawbacks

Ineffective in adults affected by alopecia areata for a long period of time. Painful – may need anaesthetic cream before injections. 

4. Platelet-Rich Plasma (PRP) or Stem Cell therapy


Minimally invasive, non-surgical treatment. In South Africa this procedure, called Follicular Regener-8 Hair Loss Program
(FR-8) is offered by the Medical Hair Restoration Clinic.

USES

Treats hair loss and thinning hair in both men and women.  Effective for androgenetic alopecia (genetic balding) and other types of hair loss including Alopecia areata (AA) and Alopecia universalis (AU).  

How it works

A specialist draws 120ml of patient’s own blood, similar to blood taken for a routine lab procedure. Blood is placed into a sophisticated centrifugation technique centrifugal machine that separates the protein-rich platelets from other components. These are then injected directly into the sparse recipient area to promote hair growth. Most effective when used in combination with other transplant procedures.

Effectiveness

Blood platelets and plasma are rich in various growth factors (GF’s) and cytokines (biologically active molecules). While PRP has the ‘potential’ to stimulate and repair hair growth, this procedure is ‘not proven or approved’, according to the International Society of Hair Restoration Surgery (ISHRS).  

Benefits

Simple, quick and painless.  No recovery or down time period. Claims to have enduring, long-lasting effects.

Drawbacks

Procedure can take up to three months to show results. Many patients have shown immediate improvement in hair growth and thickening. Booster treatments needed every 3-4 months.

5. Hair transplantation surgery

(Lateral Slit Technique)

USES

Male and female pattern baldness (androgenetic alopecia/female pattern hair loss)

How it works

Tiny individual micro and mini follicular units not affected by the hair-loss process are relocated from the sides of the head (donor area) into the area of bald skin (recipient site). Transplanted hair needs to be cut, washed and styled like normal hair.

Effectiveness

Transplanted hair follicles (roots moved from their original location to a donor area) act in the same way as they did in their original site.

Thus, they will continue to grow and not fall out due to pattern baldness because hair in this area is not sensitive to the male hormone DHT.

Benefits

Fairly simple procedure using local anaesthesia. Transplanted follicles start to grow 3-4 months after surgery. 

Transplanted hair won’t ever fall out - it originates from the donor area on the sides of the scalp.

Drawbacks

Expensive. Takes 10-12 days before stitches can be removed post surgery.  Full results apparent only 8-12 months later.

Hair loss is a lifelong process – further procedures may be necessary to fill in ongoing hair loss.

Read more about hair transplant surgery for hair loss

6. Follicular transfer is a more advanced form of hair transplant surgery, which uses a sophisticated restoration robotic system called ARTAS to transplant hairs in groups of 1-4 hairs as they grow naturally.

This minimally invasive procedure creates increased hair thickness with a natural pattern and appearance.

Unfortunately it is expensive (up to R150, 000) and is not widely available since only a few surgeons worldwide have mastered or have experience in all aspects of the technique.

Read more about follicular transfer for hair loss

Other treatments

There are many products (shampoos, lotions) and supplements on the market that claim to reduce or reverse hair loss. Some work and some don't, and outcomes often depends on the individual and the cause of hair loss

There are also home-use devices that promise to stimulate hair growth, such as hair loss laser bands, brushes and combs. 

One of the best ways to preserve your hair and health is to life a healthy lifestyle. As a start, take a look at the role of a healthy diet in preventing hair loss

Read more:

Understanding types of hair loss

Alopecia from Natural Medicines, including integrative therapies

Strange remedies and cures for hair loss

Bob martins? Horse shampoo? Health24's pharmacist weighs in

Sources:

1. A randomized clinical trial of 5% topical Minoxidil versus 2% topical Minoxidil and placebo in the treatment of androgenetic alopecia in men. Olsen EA1, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJ. J American Academy of Dermatology.

2. Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review Mella JM, Perret MC, Manzotti M, Catalano HN, Guyatt G.  Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Archives of Dermatology 2010; 146(10): 1141-1150.

3. The Finasteride Male Pattern Hair Loss Study Group – A world-wide study group includes amongst others (South Africa – J Cilliers, Cape Town; M Sher, Johannesburg; G Todd, Cape Town). 2002. Long-term (5-year) multinational experience with Finasteride 1 mg in the treatment of men with androgenetic alopecia. European Journal of Dermatology 12:38-49.

4. International Society of Hair Restoration Surgery, 7 Innovative techniques for hair transplantation http://www.ishrs.org/article/7-innovative-techniques-hair-transplantation

5. Treatments for male-pattern baldness, Dr Maria Bonnici, International Journal of Aesthetic and Anti-Ageing Medicine http://content.yudu.com/web/1wzd1/0A1radk/PRIMEIntVol6Issue1/flash/resources/18.htm

6. Med hair Cape town, Hair restoration surgery http://www.medhair.co.za/treatments/hair-surgery-options/restoration-surgery/

7. International Society of Hair Restoration Surgery, Hair loss cures and treatments,  http://www.ishrs.org/content/hair-loss-cures-and-treatments

8. South African Hair Foundation, Causes of hair loss, http://southafricanhairfoundation.co.za/causes_hair_loss.htm

9. Dermatology times, Managing female pattern hair loss: What works?  http://dermatologytimes.modernmedicine.com/dermatologytimes/content/tags/alopecia/managing-female-pattern-hair-loss-what-works?page=full

10. Med hair Cape town, Hair loss can affect anyone at any age, http://www.medhair.co.za/blog/hair-loss-articles/platelet-rich-plasma-or-prp/