Given the large number of people who are affected by common genetic balding and for whom traditional treatments, like surgical hair restoration or hair loss medications, may not be indicated, could low-level laser therapy (LLLT) be a viable and effective treatment option?
New research published this year (2014) in the American Journal of Clinical Dermatology says yes. ((Jimenez J.J, Wikramanayake T.C, Bergfeld W, Hordinsky M, Hickman J.G, Hamblin M.R, Schachner L.A. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol. 2014 Apr;15(2):115-27.))
Androgenetic Alopecia, The Most Common Hair Loss
Androgenetic alopecia will affect half of all men over the age of 50 and half of all women over the age of 80, and its severity increases with age. ((Olsen E.A, Messenger A.G, Shapiro J, Bergfeld W.F, Hordinsky M.K, Roberts J.L, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol. 2005;52(2):301–11.)) It is characterized by a gradual miniaturization of the terminal (adult) hair into vellus (short, fine, almost invisible) hair.
While this miniaturization has no cure, this type of hair loss can be effectively addressed by surgical hair restoration techniques (FUT or FUE) and it can be treated with the medications finasteride (Proscar®) and dutasteride (Avodart®) in men or with anti-androgens (spironolactone) and estrogens (OCAs) in women.
However, as effective as these surgical techniques and medications are, some men, and most women, are not qualified candidates for a hair transplant, and the medication treatment options available for women are sometimes not as effective as the medication treatment options available for men.
How Laser Therapy Treats Male and Female Pattern Hair Loss
Laser therapy, also referred to as photobiomodulation or photobiostimulation, works in androgenetic alopecia in both men and women by both stopping miniaturization and stimulating hair growth. Specifically, past studies have suggested that LLLT increases terminal hair density by reversing the miniaturization process and causing follicles in a telogen (resting) phase to shift into an anagen (growth) phase.
The exact mechanism by which low-level laser therapy might protect and promote hair growth isn’t clear, but various researchers ((Lubart R, Eichler M, Lavi R, Friedman H, Shainberg A. Low energy laser irradiation promotes cellular redox activity. Photomed Laser Surg. 2005;23(1):3–9.)) have proposed that LLLT may accelerate mitosis (new cell growth), reduce the inflammation associated with androgenetic alopecia, stimulate follicular stem cells, and/or alter follicular cell metabolism for greater ATP production.
Based on anecdotal experience, practitioners report that LLLT in the range of 650–900nm wavelengths at 5mW appears to both promote new hair growth and protect existing hair against the effects of androgenetic alopecia.
But Is Laser Therapy Effective For Both Male and Female Pattern Hair Loss?
So far, only a few peer-reviewed studies ((Rangwala S, Rashid R.M. Alopecia: a review of laser and light therapies. Dermatol Online J. 2012;18(2):3.)) have produced data about the efficacy of LLLT for male pattern hair loss and only one published study ((Satino J.L, Markou M. Hair regrowth and increased hair tensile strength using the HairMax LaserComb for low-level laser therapy. Int J Cosmetic Surg Aesthetic Dermatol. 2003;5(2):113–7.)) has demonstrated, with limitations, LLLT efficacy for female pattern hair loss.
In other words, past research has demonstrated the efficacy of LLLT in men, but evidence that low-level laser therapy works for women has been comparatively weaker.
In order to convincingly address the efficacy of low-level laser therapy for both men and women, researchers conducted one of the most comprehensive, randomized, sham device-controlled, double-blind clinical studies to date.1
They found that LLLT, using the FDA-cleared HairMax Lasercomb, significantly increased hair density in both men and women diagnosed with androgenetic alopecia.
Efficacy of Low-Level Laser Therapy For Androgenetic Alopecia
The researchers included 128 men and 141 women, all diagnosed with androgenetic alopecia. Half the men and women used a real HairMax lasercomb and the other half used a sham, or fake, HairMax lasercomb device that appeared to emit laser light but in fact only emitted colored white light. However, none of the study participants knew if the lasercomb they were using was real or a sham.
After 26 weeks, men using the real lasercomb gained an average of 21.6 new terminal hairs/cm2 compared to an average 5.2 hairs/cm2 for men using the sham device; women using the real lasercomb gained an average of 20.4 new terminal hairs/cm2 compared to 2.9 new hairs/cm2 for women using the sham device. As a reference, the average non-balding person has approximately 220 terminal hairs/cm2.
In other words, men and women in the real lasercomb groups gained significantly more new hair than men and women who received no treatment, and men and women benefited, on average, equally from using the HairMax lasercomb.
Not only were these gains in terminal hair density for the real lasercomb groups significant, these gains were comparable to significant gains in terminal hair density seen in short-term trials of 5% minoxidil topical solution and 1 mg/day finasteride; however, the gains in this study were less than the gains seen in long-term trials of minoxidil and finasteride.
In sum, the benefit of LLLT for men and women appears equal to the benefit of hair loss medications, at least over the short term. This comparison between LLLT and hair loss medications should be of particular interest to women for whom drug treatment options are limited compared to men.
Posted by Robert M. Bernstein M.D. 
