Treating hair loss

Hair loss affects more than half of all men and some women. We separate the successful treatments from the snake oils.
 
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01 .Introduction

Hair loss

There are plenty of practitioners out there promising to restore your hair and self-esteem, but in this vanity-driven industry with more than its fair share of sharks, it’s very much a case of caveat emptor. The facts are:

  • Hair loss and balding is not uncommon - androgenetic hair loss affects more than half of all men as well as many women at some point in their lives.
  • There are treatments which can slow or stop hair loss, and in some cases reverse it. However, there are plenty of shonky operators and products out there, which can be trap for the desperate.
  • You'll have more treatment options available to you if you see your doctor as early as possible in the hair loss process.

The treatments available

Finasteride (Propecia) is a prescription medicine usually taken to treat an enlarged prostate, and works by blocking one of two enzymes (called 5-alpha reductase) that convert testosterone to dihydrotestosterone (DHT). It’s the DHT that causes hair follicles on the temples and crown to shrink, so finasteride’s action helps prevent or slow hair loss, and taken in the early stages may even regrow hair. Clinical trials have found it helps nine out of 10 men. Side effects are uncommon but may include impotence, breast cancer and depression. . It may also cause birth defects so is not recommended for women. Costs: $65-$70 per month, although your hair-loss medical specialist may determine you need it less often, which reduces the cost and  risk of side effects. You’ll need to take it for at least a year to know whether it’s proving effective.

Dutasteride (Avodart) has a similar action to finasteride, but blocks both DHT-making enzymes instead of one. It may be a more effective option if finasteride isn’t working for you, although at present it’s only prescribed ‘off-label’ for hair loss.

Saw Palmetto is a herbal remedy sometimes taken instead of finasteride for treating an enlarged prostate. It was hoped it might prevent hair loss too, and is often promoted as such, but this hasn’t been shown in clinical trials so far.

Minoxidil (for example Regaine) is applied to your scalp twice daily. No one really knows how it works, but it’s thought that it increases the supply of blood and nutrients to the hair follicle, which helps strengthen existing hair, prevent loss and in some people can stimulate growth. It works best on people with recent or mild hair loss, but less effectively on people who’ve had large areas of baldness for a long period of time. It may take up to a year to see results. Hair loss will rapidly restart when you stop the medication. Costs: $15-50 per month.

Some hair loss clinics promote a pharmacist-compounded solution of minoxidil with retinoic acid, which supposedly helps the minoxidil penetrate the skin. However, there’s no good evidence it increases minoxidil’s effectiveness, and it’s more likely to irritate your scalp. 

The results are in

To help consumers faced with hair loss who were tempted to try treatments, CHOICE’s sister US publication, Consumer Reports, recently surveyed more than 6000 men and close to 2000 women who’d experienced hair loss, to investigate what worked for them and what didn’t. Here’s what they found:

  • Two-thirds of respondents who’d taken finasteride (Propecia) were completely or somewhat satisfied with the results.
  • Less than a quarter of those who’d taken monoxidil (Regaine) were completely or somewhat satisfied with the results, with about half saying it wasn’t effective (although this may reflect unrealistic expectations
  • About half the patients who’d had hair transplant surgery were completely or very satisfied with the results.
  • Some people found changing their diet, increasing exercise and certain (unspecified) supplements, lotions or shampoos helpful.

What does surgery involve?

Hair transplant surgery has changed a lot in the past 20 years, and the tufty plug transplants of yesteryear have been replaced with implants of individual follicles. A surgeon cuts a strip of scalp from the side or back of your head, and the follicles are separated and inserted into the crown and temples. Sometimes, instead of a strip, individual follicles are removed and implanted.

Because the implanted follicles aren’t susceptible to DHT, the hair growing from them is permanent. However, it’s likely you’ll need to use medication to maintain remaining DHT-susceptible hairs.  Some people have complained about scarring from the strip procedure, so always research the surgeon you’re thinking of using beforehand. Costs: $12,000-$18,000 on average – about $6-9 per graft, with 2000 grafts the typical scenario. The process may also need to be repeated if hair keeps thinning.

What about laser therapy?

Some clinics offer laser therapy to halt hair loss and regrow hair, while handheld devices for home use are also available. The therapy may include using minoxidil and finasteride, as well as shampoo, thickening conditioners and other products that disguise hair loss. This not only adds hundreds of dollars in ongoing costs, but also makes it difficult to tell what improvement – if any – is from which treatment, and what is merely a temporary cosmetic effect.

Unfortunately, there’s no definitive answer as to whether or not laser therapy works. It appears to stimulate follicles, and your hair will probably look healthier. However, clinical trials showing hair loss prevention and regrowth are fewer than the hairs on Homer Simpson’s head, and the ideal laser wavelength, power, length of time and frequency of application hasn’t been established.

Costs: Ongoing clinic treatment involves regular visits and amounts to thousands of dollars. Hand-held devices cost from a few hundred dollars to more than $1000.

What does Ashley & Martin do?

Ashley & Martin Medical Hair Centres have been around for more than 40 years. They offer several programs to treat hair loss, including a medications-based regime (with optional laser treatment) and follicular transplants. 

According to Ashley & Martin CEO Richard Bond, the medications-based program is the most popular. Clients are given an individualised prescription-based treatment and the program costs from $1920 up to $4000. Regular fortnightly visits to the clinic are recommended and optional laser therapy is offered at no extra cost. CHOICE suggests that at these prices, it would make sense to try what your doctor has to offer before signing up for one of these programs.

 
 

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About hair loss

Androgenetic alopecia, also called male-pattern hair loss, is a hereditary pattern of hair loss affecting about 30% of men in their 30s to about 50% of men in their 50s. In men who have inherited the condition, testosterone is converted to dihydrotestosterone (DHT) in large amounts, actively targeting the hair follicles from temples to crown. Over time, the hair follicles shrink and the hair shaft is reduced until it is short, fine and downy.

Many women can also experience androgenetic alopecia, which causes general thinning on the crown. However, it appears there are a number of different hormones involved, rather than just the one, so diagnosis and treatment is less straightforward.

Other less common kinds of hair loss include alopecia areata, where hair is lost in spots or patches, and hair loss due to illness, stress or dietary issues. In this article, however, we focus on androgenetic alopecia.

Losing hair? Now what

  • See your doctor early in the hair loss process. There are many more options available when hair loss first starts, and medication can be quite successful in the early stages. Your doctor can also rule out illness and other causes of hair loss. Too many people wait too long before doing anything, or go down the snake oil route for several years before realising their hair loss is getting worse, not better.
  • Don’t expect miracles. One of the main reasons people are dissatisfied with finasteride and minoxidil is that they are hoping for significant or at least some hair regrowth. However, preventing or slowing the hair loss process is the more likely outcome, with any regrowth a bonus. 
  • There is no certifying body for medical professionals specialising in hair transplants, though the major players in Australia are highly skilled. So if you’re looking for a hair transplant surgeon, do your own research – there are plenty of online forums on the topic.
  • If you choose to go to a private clinic, don’t sign any contract until you are very clear on what you are getting. You may simply be paying a lot of money upfront for products you could get for a lot less via your doctor and pharmacist. Definitely don’t be pressured into signing a contract with the enticement of discounts if you ‘sign today’. Take it away and think about, and thoroughly research the company.
  • If you’re offered unusual medications or herbal treatments, ask for the evidence from clinical trials. Verify these findings with your own research. Client testimonials are worthless.

A lot of consumers lose a lot of money – and a lot of hair – dealing with charlatans offering balding treatments that don’t work. If you feel you’ve been misled or ripped off, complain to your state fair trading department and file a claim with the small claims tribunal in your state. Unfortunately these companies keep getting away with it because people feel embarrassed about being scammed, reluctant to draw attention to their thinning hair and/or unwilling to invest the time in taking action.

Advanced Hair Studio warning

Advanced Hair Studios has been slapped on the wrist by British advertising regulators for several ads featuring Shane Warne over the last few years. In each case, the regulator determined that the ads could be construed to imply laser therapy stopped or reversed hair loss, for which there is no hard evidence, and were therefore misleading.

Here in Australia, Consumer Affairs Victoria has received a number of complaints about Advanced Hair Studio over the years. In its annual report of 2007-8, it provides some examples of the kinds of issues faced by consumers.

“Advanced Hair Studio offers two types of procedures: a ‘strand-by-strand hair replacement program’, which involves gluing a hair piece to the customer’s head, and a laser therapy program, which involves laser treatment and the application of medication onto the scalp in the hope that hair will regrow.

“The complaints included a man who was refused a refund for the strand-by-strand treatment after he was forced to remove the hair piece on medical advice as it was causing him pain and nausea. His case was taken to [the small claims tribunal] which ordered a full refund.

“Another case involved a customer who was denied a refund after unsuccessfully undergoing the laser therapy program at a cost of $5,500, despite the advertised guarantee. Instead, he was offered a discount on the strand-by-strand treatment, which he did not want to undergo.

“We advise consumers that if they intend to deal with Advanced Hair Studio, they need to be fully aware there is no guarantee the laser therapy treatment will be successful.”


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