Baldness Treatments

More than half of men are affected by male pattern baldness by age 50, and baldness treatments are estimated to be a US $1 billion per year industry. Since the 1980s, drug therapy has increasingly become a realistic management option for baldness for men and women. Increased understanding of the role of dihydrotestosterone (DHT) in male and female pattern baldness has led to targeted intervention to prevent this hormone from acting on receptors in the scalp. Coupled with chance discoveries and the ever-present lure of a breakthrough involving stem cells and hair multiplication, scientifically proven baldness treatments continue to be an area of research that receives a large amount of funding.

Contents

• 1 General concerns
• 2 Minoxidil
• 3 Finasteride
• 4 Revivogen
• 5 Antiandrogens
• 6 Copper peptides
• 7 Spin Labels
• 8 Ketoconazole
• 9 Saw palmetto
• 10 Diet and lifestyle
• 11 Hair transplant
• 12 Hair multiplication (future treatment)
• 13 Other treatments
• 14 See also

General concerns

The prospective treatment of hair multiplication/hair cloning, which extracts self-replenishing follicle stem cells, multiplies them many times over in the lab, and microinjects them into the scalp, has been shown to work in mice, and is currently under development, expected by some scientists to be available to the public in 2009-2015. Subsequent versions of the treatment are expected by some scientists to be able to cause these follicle stem cells to simply signal the surrounding hair follicles to rejuvenate.

The below treatments are some of the most prominent. Generic brands, often with identical chemical structure or the same active ingredients, may be equally effective and are cheaper.

Interestingly, placebo treatments in studies often have reasonable success rates, though not as high as the products being tested, and even similar side-effects as the products. For example, in finasteride (Propecia) studies, the percent of patients with any drug-related sexual adverse experience was 3.8% compared with 2.0% in the placebo group. Proponents of alternative therapies believe that the majority of cases of hair loss that progress despite treatments do so because the people believe no such cure can occur. In this view, this belief, which is prevailing in the modern civilised world and continuously reinforced by medical science, is the main obstacle for effectively finding and applying a cure.

While treating hair loss most successfully is a multi-faceted, ongoing experiment for the individual, there are three principles, sometimes called "The Three P's" that are considered important to help produce success and avoid the somewhat common mistakes that can sabotage treatments. The Three P's are: proven treatments first, take pictures, and be patient. The average hair loss treatment takes a minimum of 6 months to begin working, and sometimes up to 24 months to truly see optimal results. Treating hair loss takes time because of hair cycles. The process of hair loss is the process of "miniaturization," which takes many years. Hairs grow in, cycle into dormancy, and then grow in again several months later. Each time they re-emerge, they do so thinner, shorter, and less pigmented. In time, they become so small that they are no longer noticeable. This can take many years. New hairs only grow in 2 or 3 a year, which is why it can take a year or more to be able to detect the success of a treatment.

This difficulty can be increased because many (scientifically proven) treatments often cause initial periods of shedding, as some resting hair follicles are ejected and a new cycle of growth begins, hopefully with a thicker follicle. Discontinuing treatments can also cause periods of shedding, though this hair loss is generally considered to be temporary, not affecting the baseline.

Minoxidil

Minoxidil is applied topically to the scalp, and has been shown to promote hair growth in about 25% of men and women, though it may take several months to work. New hair is usually thinner and lighter, like baby hair, and grows mostly on the top of the head, not at the hairline. Its effects may fade with time. Skin irritation is the most commonly reported side effect. Dizziness and increased heart rate have also been reported, but rarely.

Finasteride

Finasteride, marketed as the brand-name drug Propecia, is a "DHT inhibitor" drug that is FDA approved to inhibit production of DHT through the entire body. It accomplishes this by inhibiting 5-alpha-reductase, the enzyme responsible for the conversion of free testosterone to DHT. Finasteride is taken orally and has a reported 29-68% success rate (vs. 17-45% in patients receiving a placebo). It is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy (Rossi, 2004). In clinical studies, finasteride, like minoxodil, was shown to work on both the crown area and the hairline, but is most successful in the crown area.

Finasteride has been shown to be ineffective for treating hair loss in women, and shouldn't even be touched by pregnant or potentially pregnant women, as it has been speculated that it could cause severe birth defects in male fetuses. However, finasteride's supporters respond that the study was on post-menopausal women whose hairloss was more likely related to the loss of estrogen versus a sensitivity to testosterone. Other studies have shown that finasteride is effective for many women with follicular sensitivity to androgens. Many doctors do prescribe it, but not without either careful birth control measures or assurance that the woman cannot become pregnant.

Revivogen

Revivogen is a non-FDA approved topical DHT inhibitor treatment applied to the scalp, with many ingredients, such as certain fatty acids, that are thought, though not proven, to inhibit DHT levels in the scalp and have a positive influence in combatting hair loss. Revivogen also contains ingredients that are thought, though not proven, to function as an antiandrogen (see below) that has a positive influence in combatting hair loss. Clinical trials are reportedly underway.

Revivogen uses simple mixtures of fatty acids (gamma-linolenic acid, alpha-linolenic acid, and others, which are thought to be inhibitors of 5-alpha reductase, both type I and type II), in their free form, that come from the bulk de-esterification of natural oils like borage seed oil and linseed oil.

Antiandrogens

Antiandrogens block DHT already produced and present in the blood stream from binding with hair follicles. Their specificity varies greatly from specific antiandrogens such as finasteride which inhibit the conversion of testosterone to DHT by interfering with 5-alpha-reductase to more broad spectrum antiandrogens (fluconazole, spironolactone, etc.) which can have serious side effects including gynecomastia. Ketoconazole, (often sold as Nizoral Shampoo) and Neutrogena T-Gel have been clinically shown to have antiandrogen properties and are prescribed by medical professionals or available over the counter depending on the product, concentration and country.

Copper peptides

Copper peptides are applied topically to the scalp, and shorten the resting phase of hairs, resulting in more hair follicles on the scalp being in the growing phase (as opposed to the resting or falling out phase) at one time. Copper peptides generally have superoxide dismutation activity. See US patent 5,470,876, "Topical SOD for treating hair loss".

SOD's likely work by destroying superoxide, the antagonist to Nitric oxide (NO), the natural form of minoxidil. Superoxide has an "agonist-antagonist" relationship with Nitric oxide or "Endothelium-derived Relaxing Factor".

Spin Labels

In animal models, the nitroxide spin labels TEMPO and TEMPOL enhance hair regrowth following radiation. National Cancer Institute-sponsored clinical trials report TEMPOL is similarly effective in humans. Also see United States Patent 5,714,482 "Topical spin labels and method".

Ketoconazole

Ketoconazole is a synthetic antifungal drug used to prevent and treat skin and fungal infections, especially in immunocompromised patients such as those with AIDS. Because it is both an anti-fungal and also a 5-alpha reductase inhibitor, it can help to slow the balding process. There has been some suggestion that ketoconazole could inhibit testosterone synthesis in utero, which could potentially inhibit genital development of a male fetus. However, this has not been documented in any controlled studies.

Saw palmetto

Saw palmetto (Serenoa repens) is an herbal DHT inhibitor which is cheaper than most commercial drugs and is claimed to have fewer side effects than finasteride and dutasteride. Unlike other 5-alpha-reductase inhibitors, saw palmetto extract inhibits the conversion of testosterone to DHT without interfering with the cellular capacity to secrete PSA. Saw palmetto extract has been demonstrated to inhibit both isoforms of alpha-5-reductase unlike finasteride which only inhibits the (predominant) type 2 isoenzyme of alpha-5-reductase. A preliminary study of saw palmetto extract for treating hair loss noted improvement in six of ten subjects. Dosages and the length of the study were not reported.

Diet and lifestyle

While there are a number of genetic factors which determine a person's suceptibility to androgenic alopecia including androgen receptor polymorphisms, 5-alpha-reductase levels in the scalp, androgen receptor density and distribution in the scalp, and other factors some of which may not have been discovered, the dramatic increase in baldness in the population of Japan after World War II demonstrates that hair loss can be influenced by diet and lifestyle. Increased fat or caloric intake, decrease in aerobic exercise and general "westernization" was accompanied by a dramatic increase in incidence of male pattern baldness.

Daily, vigorous aerobic exercise (as opposed to short workout periods designed to raise androgen levels and build muscle, or more sporadic exercise) and a diet which is adequate yet more moderate in terms of fat and total calorie intake have been shown to reduce baseline insulin levels as well as baseline total and free testosterone, which would significantly lower baseline DHT.

Lower insulin levels and reduced stress both result in raised levels of Sex Hormone Binding Globulin (SHBG). SHBG binds to testosterone, and prevents it from circulating free in the blood. Only free testosterone is converted to DHT. It is the level of free androgens and not total androgens which is relevant to the levels of DHT in the scalp and the progression of MPB. In short, aerobic exercise is capable of significantly lowering DHT.

Androgenic alopecia has been shown to correlate with metabolic syndrome. Medically increasing androgen levels does not worsen this condition, demonstrating that androgens do not cause metabolic syndrome. Instead, high insulin levels (and possibly chronic inflammation) seem the likely link in the demonstrated correlation between baldness and metabolic syndrome. This reinforces the notion that behaviors which help to keep insulin levels low and reduce chronic inflammation might also help to preserve hair.

Hair transplant

Surgery is another method of reversing hair loss and baldness, although it may be considered an extreme measure. The surgical methods used include hair transplantation, where patches of skin with hair are moved from one part of the head to another. Current hair transplant patient, Seth Garon, writes a blog called Battle Against Bald about his experiences of undergoing a hair transplantation procedure. Another method is scalp reduction, where parts of the scalp are removed, the skin is stretched over the area that had been removed, and everything is stitched back together. Hair transplants generally cause scarring, sometimes severe, which may be especially visible if hair loss continues over the rest of the scalp.

Hair multiplication (future treatment)

Stem cells have been discovered in hair follicles and some researchers predict research on these follicle stem cells may lead to successes in treating baldness through hair multiplication, also called hair cloning within three or four years . This treatment is expected to initially work through taking stem cells from existing follicles, multiplying them in cultures, and implanting the new follicles into the scalp. Later treatments may be able to simply signal follicle stem cells to transmit chemical signals to nearby follicle cells which have shrunk during the aging process, which respond to these signals by regenerating and once again making healthy hair.

Unfortunately, this new approach to treating baldness appears to be taking longer than expected. The first products are now expected to hit the market in 2009/2010. However, it remains unclear how effective they are going to be. It has been suggested that only future generations of HM will allow patients to grow as much hair as they want.

HM is being developed by two independent companies: ARI (Aderans Research Institute, a Japanese owned company in the USA) and Intercytex, a company in Manchester (UK).

Other treatments

• Azelaic acid - A study found a 90% inhibition of 5-alpha-reductase activity in vitro with an azelaic acid and zinc combination. There was an additive effect between the two compounds.
• Spironolactone
• Retin-A (Retinoic acid; chemical peel stimulation of scalp)
• Avacor - claims to restore hair in nearly all balding men and women. In March, 2003, the UC Berkeley Wellness Letter concluded that if Avacor works at all, it's because it contains minoxidil and possibly saw palmetto.
• LLT or Low-level Laser Therapy - Not FDA approved for hair regrowth, but only as a cosmetic hair enhancer. Treaments are administered at either a clinic or salon (most of which are in Europe), or by the individual user via a home-based portable system (for example, "The Laser Comb"). No official results have been proven or published regarding hair regrowth.
• Pumpkin seed - Used to aid in the breakdown of DHT by the liver. An extract is often used, as unprocessed pumpkin seeds are high in fat which can exacerbate hair loss in susceptible patients.
• Stinging nettle
• Zinc - While oral zinc supplementation may help prevent the conversion of testosterone to DHT, it also increases total testosterone levels.

See also

baldness