Since hair loss can start at puberty and be ongoing throughout life, consideration upon analysis of the underlying causes will dictate the many kinds of treatments which can stabilize and reverse the progression. Therefore, a free consultation with one of The Hair Loss Recovery Program experienced physicians is necessary to provide the best combination of treatments available.
 
For example:
If you are early on in the development of hair loss and this is a genetic condition, the family history of hair loss will be important to initiate the preventative treatment. In this case, both oral and topical medication available on prescription from our doctors is the first line of defense.
 
If this category fits your description then The Hair Loss Recovery Program with its experienced doctors can develop a customized MEDICAL PROGRAM to deal with your particular condition.
When you consult family, friends, library and the Web about hair loss treatments, you will find a host of "do-it-yourself" hair loss products such as creams, ointments, lotions, nutrition supplements, scalp stimulants and other "miracle cures", all promising to stop hair loss and regrow hair.
Among all the options for nonsurgical treatment of androgenetic alopecia (pattern baldness), you will find only two that have been approved by the U.S. Food and Drug Administration, and are recommended by physician hair restoration specialists. Hair restoration products not approved by the FDA are often a waste of money and can be harmful.

Topical medication
Using Rogaine (Minoxidil) as a Hair Loss Treatment
June, 2005

 
Minoxidil 2% solution has been available since the late 1980s as a treatment for hair loss in both men and women. It is available over-the-counter (without prescription) as either a brand-name product (Rogaine®) or in less expensive generic formulations. Minoxidil is applied topically-that is, applied directly to scalp skin where cessation of hair loss and stimulation of new hair growth is desired.
When first introduced, Rogaine received a great deal of media attention as the first hair restoration medication approved by the Food and Drug Administration. Some media stories implied it was a "miracle drug". Over time, Rogaine did not live up to "miracle drug" expectations and there was disappointment that results were often less than spectacular.
What can be said about minoxidil after more than a decade of use as a hair restoration medication? It can fairly be said that minoxidil is moderately effective and can be helpful for some people with hair loss. A 5% solution of minoxidil recently became available and clinical investigators have reported it to be considerably more effective than the 2% solution in halting hair loss and stimulating new hair growth in both men and women. At all formulations, women have been shown to have a better response than men to topical minoxidil.
Used as directed, 2% minoxidil has been shown to stimulate hair growth in about 30% of male patients, with a slightly higher rate in females. The response rate is improved with use of 5% solution.
Topical minoxidil in either 2% or 5% solution is most effective in persons with recent onset of hair loss due to androgenetic alopecia and relatively small areas of hair loss. Minoxidil is less effective when hair loss is long-standing or large in area. Thus, early use of minoxidil is indicated to prevent progression of small areas of male or female pattern hair loss. Physician hair restoration specialists sometimes use minoxidil to slow hair loss in young patients, delaying hair transplantation for several years in order to conserve the supply of hair that will be needed later for transplantation.
Minoxidil is often more effective in improving hair growth in central areas of the scalp than in frontal areas. It is often effectively used by physician hair restoration specialists to complement hair transplantation, contributing to an appearance of "fullness" in scalp hair.
If minoxidil proves effective in halting hair loss and/or stimulating new hair growth, its use becomes a lifetime commitment. If regular application of minoxidil is halted, all results of therapy will be rapidly lost over the next 3 to 6 months.
Side effects of topical minoxidil are few and generally minor skin irritation or itching. A potential complication of minoxidil use is the unwanted growth of facial hair if the minoxidil solution is accidentally spilled or applied to facial skin.
How Does Minoxidil Work?
Why does minoxidil halt hair loss and stimulate new hair growth? No one knows for sure, but there are some good assumptions.
The hair-restoration properties of minoxidil were an accidental discovery. Minoxidil was developed first as an anti-hypertensive-a drug designed to lower blood pressure by vasodilation (dilating blood vessels). But minoxidil also turned out to have an effect on the structure and cellular activity of hair follicles, and on the growth rate of hair. Is the vasodilating effect of minoxidil associated with its effect on hair follicles? No one can say for sure. It also is not known why the effects of minoxidil on hair follicles varies from person to person-no effect in some people, substantial effect in others. Since the cause of the hair follicle effects are not understood, they cannot be predicted and no one can say in advance who will benefit from minoxidil therapy and who will not.
 
Using Rogaine as a Hair Loss Treatment in Women
 
Many women experience a form of androgenetic alopecia known as female-pattern hair loss.
The only nonsurgical hair restoration treatment available for women is topical Minoxidil (Rogaine®). Finasteride can have under-masculinizing effects on a male fetus; therefore, finasteride should not be taken by a woman who is pregnant or who may become pregnant during a course of treatment. A woman who is experiencing hair loss should consult a physician hair restoration specialist for examination, diagnosis and recommendation for treatment based on diagnosis.
At all formulations, women have been shown to have a better response than men to topical Rogaine. The reason for this is not well understood.
 
Oral Medication
Using Finasteride (Propecia®) as a Hair Loss Treatment
June, 2005

 
Finasteride (brand name Propecia®) is an orally administered medication for male pattern hair loss (MPHL). It is the only specific MPHL treatment approved by the U.S. Food and Drug Administration for prescription by a physician. Several years of investigation and use by more than a million patients show that finasteride has long- term effectiveness and safety in treating MPHL in men of all ages and all ethnic backgrounds. Finasteride is sometimes used alone or in combination with minoxidil to complement hair transplantation. Finasteride is not recommended for use in women.
Finasteride's effects in slowing hair loss and stimulating new hair growth work best for early to moderate degrees of hair loss. Men with extensive hair loss are unlikely to experience much regrowth with finasteride; these men are better candidates for hair transplantation or other surgical approach to hair restoration.
Finasteride is most effective in stimulating hair regrowth over the crown of the scalp. It is less effective in stimulating regrowth at the front of the scalp-where hair loss is commonly called a "receding hairline". Physician hair restoration specialists may prescribe finasteride to prevent further hair loss by the patient, and carry out hair transplantation to provide coverage at the frontal hairline.
Finasteride: How It Works
Finasteride works at the molecular level to halt hair loss and stimulate new hair growth. It is a medication that selectively inhibits the activity of an enzyme that converts the "male hormone" testosterone into a form that is active in hair follicles.
Androgenic ("male") hormones such as testosterone have multiple effects in the body, including actions in the skin, hair follicles and prostate gland. Hair follicles and sebaceous (oil-producing) glands in the skin are particularly responsive to androgenic hormones.
Testosterone is the most potent of the androgenic hormones. Its actions on hair follicles, skin and prostate tissue is not direct however; These tissues are responsive to a form of testosterone called dihydrotestosterone (DHT); testosterone is converted to DHT by the enzyme 5-alpha-reductase. Finasteride acts by inhibiting the action of 5-alpha- reductase and thus inhibiting the conversion of testosterone into DHT.
Investigators over a number of years found that 5-alpha-reductase occurs in two forms identified as Type I and Type II, and that finasteride is effective in inhibition of Type II. Type I of the enzyme predominates in sebaceous glands. Type II occurs most abundantly in hair follicles and prostate tissue. Investigators found that:
 
  • Men with normal to high levels of Type II of the enzyme (and thus normal to high levels of DHT) are more likely to develop MPHL and benign enlargement of the prostate gland;
  • Men with low levels of Type II enzyme (and thus low levels of DHT) are less likely to develop MPHL and benign enlargement of the prostate; and thus
  • Inhibition of Type II 5-alpha-reductase could lower levels of DHT in hair follicles and prostate tissue and decrease the likelihood for development of MPHL and benign prostate enlargement.
 
Finasteride-an agent that inhibits the activity of Type II alpha-reductase and thus lowers the level of DHT in target cells-was first developed more than a decade ago to treat benign prostate enlargement. Prescribed under the brand name PROSCAR®), at a dose of 5 milligrams a day it is used in treatment of benign prostate enlargement in men.
Following the lead of finasteride's effectiveness in treating benign prostate enlargement, investigators studied its use in treating MPHL. These studies confirmed that at a dose of 1 milligram per day, finasteride (brand name Propecia®) is effective in treating MPHL in some but not all men.
Questions about the potential for Propecia® to be associated with development or progression of prostate cancer have been addressed in a study reported in 2003. 
Finasteride for treatment of hair loss should be prescribed only after examination by a physician hair restoration specialist. 
Finasteride is not approved the use in women, and particularly in women who are pregnant or who become pregnant. The drug has potential for interfering with sexual development of a fetus.
Low-Level Laser Therapy (LLLT) for Treatment of Male and Female Pattern Hair Loss
January 2011
 
The Cold Laser: A Newer Medical Treatment for Pattern Hair Loss
 
Laser light generated by low-powered (cold) lasers has recently come into use as a non-surgical hair restoration treatment for pattern hair loss. Hand-held "comb", "brush" or "cap" laser devices are marketed for use at home. Larger "hood" or "cap" devices are used in hair restoration clinics.
Laser light is not approved or recommended for treatment of hair loss due to any other cause. If the cause of hair loss is questionable, you should see a physician hair restoration specialist for appropriate examination and diagnosis before using a LLLT laser.
The use of lasers for medical purposes is not new. Lasers have been in use for medical purposes for many years and the physics, chemistry and biology of laser light interaction with human tissue are well documented. Medical uses range from surgery using high-powered lasers to stimulation of tissue repair. Use of laser light for treatment of hereditary hair loss is a newer application of laser technology.
The "cold" lasers used for treatment of androgenetic alopecia deliver what is called low- level laser therapy (LLLT). The LLLT lasers are called "cold" because their light is absorbed by target tissue but does not heat the target tissue as occurs with lasers used to cut and remodel tissue.
 
The Mechanics of a Laser
 
The laser is a device for producing and emitting light of a very specific wavelength and power (wattage). The specificity (coherence) of wavelength is what makes lasers unique. The wavelength (color) of laser light and the wattage are selected for the specific purpose to be accomplished. Thus, lasers that emit narrow wavelengths of green, red, infrared, etc., are selected and paired with appropriate wattage for specific purposes. The laser light used for treatment of pattern hair loss is visible red light with wavelength of 630-670 nanometers and low power (wattage).
 
LLLT in Hair Restoration: How It Works
 
The interaction between laser light and living tissue is defined as photobiology. Photobiology can be subdivided into laser-tissue reactions defined as photochemistry and photophysics—that is, stimulation of chemical or physical reactions by laser light. The use of light of any wavelength for medical purposes is defined as phototherapy.
Why is visible red light in the narrow spectrum of 630-670 nanometers and low power crucial for treatment of pattern hair loss? The answer is: because red light in that narrow spectrum at low power is absorbed by hair follicle molecules critical to stimulating hair growth or regrowth. Absorption of light by the hair follicle molecules is essential in order for biological reaction to be stimulated in the molecules. If light is not absorbed, no photobiological reaction will occur.
Why is visible red light in the narrow spectrum of 630-670 nanometers and low power crucial for treatment of pattern hair loss? The answer is: because red light in that narrow spectrum at low power is absorbed by hair follicle molecules critical to stimulating hair growth or regrowth. Absorption of light by the hair follicle molecules is essential in order for biological reaction to be stimulated in the molecules. If light is not absorbed, no photobiological reaction will occur.
An accidental observation in laboratory mice in 1967 led to discovery that visible red laser light stimulates hair growth. A Hungarian scientist investigating the effect of laser light in treating skin cancer noticed that hair grew back more quickly on the skin of shaved mice treated with visible red laser light.
Research has shown that visible red laser light in the 630-670 nanometer spectrum is absorbed by an intracellular enzyme (cytochrome c). Photobiological reactions stimulated in cytochrome c sends signals throughout cells of the hair follicle, stimulating enhanced gene activity, decreased apoptosis (gene-regulated cell death), and other changes that enhance cell activity and survival.
LLLT does not stimulate hair regrowth in every person. If intracellular molecules are unable to absorb laser light, or unable to adequately respond to absorbed light, no stimulation of hair regrowth will occur.
Experience has shown that stimulation of hair regrowth by LLLT is more likely to occur when hair loss is minimal to moderate, less likely when hair loss is major and/or long standing.
Physician hair restoration specialists who use LLLT in a treatment plan for a patient’s pattern hair loss have often noted that LLLT is more effective when used in conjunction with other medical therapies such as minoxidil or finasteride. Some physician hair restoration specialists have reported that LLLT may enhance hair growth and reduce inflammation after hair transplantation.
LLLT is not a "one time only" treatment for pattern hair loss. As with other medical therapies, treatment must be repeated at intervals to maintain hair regrowth results. Hair transplantation is the only permanent treatment for pattern hair loss.
 
LLLT Devices
 
Hand-held LLLT devices for home use are marketed to the individual consumer. Larger LLLT devices are used in hair restoration clinics.
Hand-held LLLT devices for home use that are currently marketed on the World Wide Web and by advertising in print media include:
 
  • The HairMax LaserComb has comb teeth and embedded lasers that deliver laser light to the scalp as the comb teeth part the hair. The HairMax Laser Comb has been cleared by the U.S. Food and Drug Administration (FDA) for marketing as a device to treat androgenetic alopecia. The HairMax Laser Comb is available by direct order or from a physician's office. The cost of a HairMax Laser Comb is several hundred dollars.
  • The X5 Laser uses laser diodes to deliver light directly to the scalp. It is marketed as a cosmetic device and needs no additional FDA clearance for that use; status of clearance may change with completion of clinical studies that meet FDA guidelines. The X5 Laser is sold for about $200.
  • The Sunetics Laser Hair Brush
  • The Laser Cap uses 224 lasers embedded in a wearable hat. It is available through physician offices, is marketed as a cosmetic device and needs no additional FDA clearance for that use. Status of clearance may change with completion of clinical studies that meet FDA guidelines. The Laser Cap is sold for about $2000.
The potential consumer should compare hand-held devices not only for price, but also for features such as scalp coverage and power.
LLLT devices used in a medical clinic are hoods much like a beauty salon hair dryer.
The effectiveness and most advantageous use of LLLT for hair restoration has not yet been investigated in large, long-term, well-designed clinical trials. The first randomized, double-blind, multi-center trial, published in 2009, compared use of the HairMax Laser Comb with use of a "sham" device (Leavitt, M,, Charles G, Heyman E, Michaels D. Clinical Drug Investigation. 2009; 29:283-292).
The ISHRS takes no official stand on LLLT as a treatment for hair loss. On the one hand, it recognizes that some members strongly believe in LLLT as a complement to other treatments such as finasteride, minoxidil and hair transplantation. On the other hand, the ISHRS is aware that there is currently a lack of good support from large, well- designed double-blind studies to support the effectiveness of LLLT as a treatment for hair loss. Some ISHRS member physicians believe that this lack of evidence should make us cautious about recommending LLLT to our patients until more good scientific studies are performed.
In summary, LLLT may be an appropriate treatment for some patients with male or female pattern hair loss. Patients should discuss this option with a qualified physician hair restoration specialist.
Since hair loss can start at puberty and be ongoing throughout life, consideration upon analysis of the underlying causes will dictate the many kinds of treatments which can stabilize and reverse the progression. Therefore, a free consultation with one of The Hair Loss Recovery Program experienced physicians is necessary to provide the best combination of treatments available.
 
For example:
If you are early on in the development of hair loss and this is a genetic condition, the family history of hair loss will be important to initiate the preventative treatment. In this case, both oral and topical medication available on prescription from our doctors is the first line of defense.
 
If this category fits your description then The Hair Loss Recovery Program with its experienced doctors can develop a customized MEDICAL PROGRAM to deal with your particular condition.

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