Q: Dr. Bernstein, I am experiencing side effects on Propecia, are there alternative treatments? — J.D. ~ Roslyn, N.Y.
A: Yes, minoxidil (Rogaine), low level laser therapy (LLLT), and Platelet Rich Plasma (PRP). Unfortunately, none of these will be as effective as finasteride.
Posted byCurrently, only two FDA approved medical treatments exist for androgenic alopecia — minoxidil (Rogaine) and finasteride (Propecia) — but these drugs are not effective in all individuals, and to remain effective, both require consistent, daily, life-long use. Additionally, finasteride is not FDA approved for use in women.
Because of the need for additional hair loss treatment options, researchers have begun to look at low-level light laser therapy (LLLT), specifically red and near-infrared LLLT, due to its ability to promote hair growth by stimulating hair follicle cells ((Mester E, Szende B, Tota JG. Effect of laser on hair growth in mice. Kiserl Orvostud 1967;19:628–631.)) — a process called cellular photo-biostimulatiostimulation.
While many studies have investigated the effects of red and near-infrared LLLT on hair loss, specifically in the ranges of 635 to 780nm, there’s been no comprehensive survey of these studies to see if this treatment option has a consistent, positive effect on androgenic alopecia (genetic balding) for men and women.
To answer this question, researchers from the Harvard Medical School surveyed ((Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers Surg Med. 2014 Feb; 46(2):144-51.)) five clinical studies designed to measure the effects of LLLT on androgenic alopecia in both men and women. In each case, they found that red and near-infrared LLLT was a safe and effective treatment option for both men and women with genetic balding.
The authors propose that LLLT may work by supporting the anagen (growth) phase of the hair follicles affected by androgenic alopecia while also protecting them from alopecia’s inflammatory effects.
While the results in the studies were positive overall, the authors did note that the most therapeutic light wavelength and dosing remain to be determined.
Read more about Laser Therapy for Hair Loss
Posted byEvidence that low-level laser therapy (LLLT) could be used to promote hair growth, possibly by stimulating cellular function which leads to cell proliferation, a process called photobiomodulation, was first presented by Endre Mester, a Hungarian physician, in 1967. ((Mester E, Szende B, Tota JG. Effect of laser on hair growth in mice. Kiserl Orvostud 1967;19:628–631.))
Since then, many studies investigating the effects of LLLT on patients with pattern baldness (androgenic alopecia) have found a positive therapeutic effect, but most of those studies have not been properly controlled so as to rule out other, alternative, explanations for any observed hair growth.
However, a recent study ((Lanzafame R, Blanche R, Bodian A, Chiacchierini R, Fernandez-Obregon A, Kazmirek E. The growth of human scalp hair mediated by visible red light laser and LED sources in males. Lasers in Surgery and Medicine 2013; Vol. 45, Issue 8: 487-95.)) published in the journal of Lasers in Surgery and Medicine tested both the safety and effectiveness of a LLLT device in a randomized, blinded, controlled study and found that low-level laser light in the 655nm range significantly promoted hair growth in male patients with androgenic alopecia.
Specifically, 20 male subjects with pattern baldness were treated with low-level laser light for 25 minutes per day every other day for 16 weeks. After 16 weeks, a 35% increase in hair growth was observed in these subjects compared to an untreated group of males with pattern balding.
The researchers suggest that LLLT may stimulate the mitochondria in the cells of the hair follicle, leading to an increase in biological activity in those cells that promote hair growth. They also suggest that low-level light in the range used in the study might affect a hair follicle’s stem cells, which may also contribute to hair growth.
Read more about Laser Therapy for Hair Loss
Posted byGiven 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.
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