This section focuses on hair loss treatments other than the two most common medications, Propecia (finasteride) and Rogaine (minoxidil). Read on for information about medications, dietary supplements, and cosmetic concealers and camouflage techniques.
Avodart, the brand name for dutasteride, is an oral medication approved by the FDA for the treatment of prostate enlargement. Like finasteride (the active ingredient in Propecia), dutasteride is an inhibitor of the enzyme 5 alpha-reductase which converts testosterone to DHT (dihydrotestosterone), the hormone responsible for genetic hair loss. Unlike finasteride, which only inhibits the Type II form of the enzyme, dutasteride inhibits both the Type I and Type II forms of 5 alpha-reductase. This dual effect makes the drug more potent, but also increases the incidence of adverse reactions.
Although it is the Type II form of the enzyme that is predominant in hair follicles, the increased potency of dutasteride is due to the fact that it significantly suppresses blood levels of DHT and well as levels in the skin. It is important to note that compared to the Type II form of the 5 alpha-reductase enzyme, the Type I variety is present in many different organs of the body, including the brain, which accounts for the increased potential side effects. As important, the half-life of dutasteride is significantly longer than finasteride (5-6 weeks vs. 6-8 hours). Read about Avodart (dutasteride).
Aldactone (the brand name for spironolactone) is an oral, potassium-sparing diuretic that comes in 25mg, 50mg, and 100mg doses. Spironolactone also has anti-androgenic effects and has been used to treat both acne and hair loss in women. It inhibits the binding of androgens to their cellular receptors and decreases the synthesis of testosterone. Because of its anti-androgenic properties, it can cause sexual dysfunction and breast enlargement in men. It is, therefore, contraindicated in male patients.
Studies suggest that spironolactone requires at least 200mg/day (100mg twice a day) to stop hair loss and that its effects on hair regrowth are inconsistent. Spironolactone may cause hyperkalemia (high levels of potassium in the blood) and other side effects at this dose, so monitoring of blood levels is important. Read about Aldactone (spironolactone).
Oral contraceptives higher in estrogen can stimulate hair growth in women by prolonging the anagen phase of the growth cycle. A problem is that estrogen-dominant birth control pills have a greater incidence of certain side effects. Your gynecologist should advise you on which BPCs should be used in your particular situation. Read about Oral Contraceptives.
Latisse (the brand name for bimatoprost) is the first FDA approved topical medication for eyelash growth. A new formulation of bimatoprost is being studied for use as a topical hair loss treatment for common baldness in both men and women, however, an FDA approved product may be several years away. Read about Latisse (bimatoprost).
Minoxidil is an oral medication that was initially FDA-approved in the 1970s to treat severe and treatment-resistant hypertension (high blood pressure). Doses used for the treatment of hypertension generally range between 10mg and 40mg daily. At this dose, patients who were taking minoxidil for blood pressure control were noted to have “hypertrichosis” or increased hair growth as a side effect. Minoxidil works to increase hair growth by causing a shortening of the telogen (resting) phase and lengthening of the anagen (growth) phase of the hair cycle, which increases the hair follicle diameter and length. Read about Oral Minoxidil.
Viviscal® supplements contain nutrients purported to nourish thinning hair and encourage the growth of existing hair. The product’s active ingredients, a group of long-chain sugar molecules called glycosaminoglycans (GAGs), may contribute to healthy hair and skin. It also contains an organic form of silica claimed to increase the strength of the hair and revitalize hair. Read about Viviscal.
Herbal Hair Loss Treatments
The most common plant-based or herbal hair loss treatment that has been claimed to grow hair is Saw Palmetto. Saw palmetto contains two types of oils; fatty acids and sterols; but the exact mechanism of action is unknown. It has also been marketed as a steroid to help build muscle tissue, and as an aid in the treatment of prostate enlargement. Saw Palmetto appears to be somewhat effective in alleviating the symptoms of prostate enlargement and is commonly recommended for this condition. However, there have not been any controlled, scientific studies to show that it can re-grow a person’s hair. It has been the experience of physicians who treat hair loss that it is not effective for the treatment of this condition.
Many other herbal remedies have been used for hair loss over the years, but none seem to have any substantial benefit in growing hair. Read about saw palmetto and herbal supplements on our hair products page.
Cosmetic Camouflage Products & Techniques
Cosmetic camouflage products are a common way of hiding hair loss in men and women whose hair is starting to thin. A number of over-the-counter products are available which can make the hair appear thicker. They come in a variety of forms, such as powders, sprays, and creams. Examples include Toppik and DermMatch. The main limitation of these products is that the person needs a relatively significant amount of hair to hold the product in place. Read about Cosmetic Camouflage products.
Scalp Micropigmentation (SMP)
Scalp Micropigmentation (SMP) is the artful application of cosmetic ink (tattoo) to the scalp as a way to make an area of thinning hair look denser or permanently camouflage scars. SMP mimics the way hair appears on a closely shaved scalp. It is primarily used as a treatment for those who are not candidates for surgical hair restoration or as a supplement to a hair transplant procedure when a person’s donor hair supply is low. SMP is most useful in darker skinned patients and in women with diffuse or localized thinning. Read about SMP.
Hair Systems and Wigs
Wigs and elaborate hair systems, attached by glue or sewn to the patient’s existing hair, are a major industry. Despite their popularity, these systems can be problematic because they must be periodically adjusted and require repeated visits to the salon at significant expense. Since they can’t be removed at night, they can cause traction hair loss, making the user even more dependent on the hairpiece over time. They are also difficult to clean and often give the wearer the appearance of having too much hair.