Thank you for requesting me to answer this question. I have answered
2 prior questions for you (on lexapro/hair loss and selsun blue/hair
loss) - I know that this is a topic of great concern to you. I have
also noticed that you have been focusing on shampoos specifically - I
wanted to give you information on alternative methods of hair
restoration other than the rogaine that you have been using.
I am going to provide an overview of the medical treatment of hair
Of the different types of hair loss, I will focus on what is called
androgenic alopecia - the most common type of hair loss, affecting
approximately 30 to 40 percent of adult men and women (1). I can
answer questions on other types of hair loss (alopecia areata, telogen
effluvium, traumatic alopecia) in seperate questions.
Description of androgenic alopecia
"The hair follicle is a structure that encases the lower part of the
hair shaft. Each follicle contains blood vessels that nurture new hair
growth. All of our hair follicles are present at birth, and throughout
our lifetime each follicle grows and sheds single hairs in a
repetitive cycle. The growth phase for a single new hair lasts two to
three years. At the end of this time, growth ceases and the follicle
enters a resting phase. After three to four months in the resting
phase, the hair is shed and the next growth cycle begins. On a normal
scalp, approximately 80 to 90 percent of follicles are growing at any
time. And each day, about 75 follicles shed their hair and the same
number enter a new growth phase.
Men and women experience androgenetic alopecia with equal frequency,
although it may be camouflaged better in women. People who experience
this type of hair loss have some hair follicles with a shorter than
normal growth phase and produce hair shafts that are abnormally short
and thin. These follicles are said to be "miniaturized." They develop
because of a hormonal changes that occur in the hair follicle itself,
although men with male pattern balding also may have higher levels of
dihydrotestosterone (a byproduct of testosterone) in the blood." (5)
Oral finasteride (Propecia) and topical solutions of minoxidil
(Rogaine) are the only drugs approved by the United States Food and
Drug Administration for treatment of androgenetic alopecia in men.
1) Minoxidil (Rogaine)
Minoxidil 2% or 5% should be applied twice daily for at least a year.
Reduced hair shedding is common after 6 to 8 weeks; visible hair
regrowth occurs in one third of cases after 3 to 9 months and may
continue for up to 18 months before it reaches a plateau; slight
regrowth occurs in another one third of cases. Topical minoxidil is
more effective as a preventative than a restorative measure, in that
it appears to limit shedding in 80% of cases. If helpful, minoxidil
treatment should be continued indefinitely. In mild-to-moderate female
androgenetic alopecia, topical 2% minoxidil produces visible regrowth
in one third of cases, minor regrowth in one third of cases, and no
regrowth in the remainder. Topical minoxidil 2% and 5% are now
available over the counter. In male androgenetic alopecia, topical 5%
minoxidil can regrow hair more quickly than a 2% solution.
"Minoxidil promotes hair growth by increasing the duration of anagen
and enlarging miniaturized and suboptimal follicles; the mechanism by
which this occurs is unclear (1). Topical minoxidil is available over
the counter in both 2 and 5 percent solutions.
Both 2 and 5 percent minoxidil have consistently demonstrated benefit
in men with androgenetic alopecia compared with placebo, and the 5
percent preparation is more effective than the 2 percent solution (2).
In the largest controlled trial, for example, 393 men with
androgenetic alopecia were randomly assigned to treatment with 5 or 2
percent topical minoxidil solution or placebo (2). After 48 weeks of
therapy, 5 percent minoxidil was significantly superior to the 2
percent solution or placebo in terms of change from baseline in
nonvellus hair count, patient rating of scalp coverage and treatment
benefit, and investigator rating of scalp coverage. Treatment with 5
percent minoxidil was also associated with an earlier therapeutic
response and an improvement in the patients' psychological perceptions
of hair loss. Patients treated with 5 compared with 2 percent
minoxidil reported more pruritus and local irritation." (3)
Patients considering use of minoxidil should be advised of the
- A normal, healthy scalp is required to use this medication.
- Hair shedding usually decreases within two months of starting
treatment. Hair growth may be seen within four to eight months and
stabilizes at 12 to 18 months.
- Treatment must be continued indefinitely; once discontinued, any
hair maintained or regrown as a result of the medication will be lost.
- Side effects most common, although infrequent, are contact and
irritant dermatitis. Neither 5 percent nor 2 percent solution of
minoxidil alters systolic or diastolic blood pressure, pulse rate, or
body weight when applied daily. Nevertheless, patients with a history
of cardiovascular disease should be educated to watch for tachycardia,
edema, or weight gain, because systemic absorption can occur if the
scalp skin barrier is not intact.
- Topical minoxidil 5 percent solution may be more effective than the
2 percent solution in men; there are no data yet in women.
2) Finasteride (Propecia)
Finasteride is an inhibitor of 5-alpha-reductase type II, thereby
inhibiting conversion of testosterone to dihydrotestosterone. Taken
orally at a dose of 1 mg/day, finasteride rapidly lowers serum and
scalp dihydrotestosterone levels by more than 60 percent. It has no
affinity for the androgen receptor, and does not interfere with
testosterone action nor have any steroidal effects of its own.
"The efficacy of finasteride for treatment of androgenetic alopecia
was demonstrated in two one-year trials of 1553 men ages 18 to 41
years who were randomly assigned to oral finasteride (1 mg/day) or
placebo for one-year, with blinded extension studies for a second year
in 1215 of the subjects (4). Finasteride treatment resulted in
clinically significant increases in hair count and improved scalp
coverage while treatment with placebo resulted in progressive hair
loss. About two-thirds of men taking finasteride had improved scalp
coverage at two years; one-third had the same amount of hair as they
did at the start of the study. About 1 percent of patients on
finasteride lost hair.
Although treatment for more than two years has not been systematically
studied, the clinical impression is that scalp coverage continues to
increase as the hairs recruited to grow in the first year continue to
get thicker, more pigmented, and longer (1). This impression is
supported by a study which found that net improvements in hair weight
with finasteride therapy were greater than improvements in hair count,
suggesting that factors other than hair count, such as increased hair
length and thickness, contribute to the beneficial effects of
This statement from UptoDate may be of specific interest to you:
"While there are no direct head-to-head comparisons between
finasteride and minoxidil, clinical observations suggest that
finasteride is easier for patients to use and thus may increase
compliance with therapy and may have better outcomes." (3)
3) Hair transplant surgery
The following site gives good information on hair transplant surgery:
"You're a good candidate for hair replacement if you have any of the
You've lost hair due to an inherited trait
You've lost hair due to trauma or burns
You have healthy hair growth at the back and side of your head
Surgical hair replacement procedures always involves taking hair from
where you have it and surgically "moving" it to where you don't. So,
in order to be able to have this procedure, you must have healthy hair
growth at the back and sides of your head. These areas are called
"donor" areas; they're the places on the head from which grafts are
taken and surgically transplanted to an a place on the head that's
bald or where the hair is thinning."
Descriptions of various forms of hair grafting is described here:
"Hair transplantation surgery has improved in leaps and bounds over
the past decade. The days of the "plugs and corn rows" are gone and
the age of single hair-, micro-, and mini- grafting has arrived.
Through the use of the these variable sized hair grafts along with new
and improved instrumentation, the accomplished hair transplantation
surgeons can create a natural hair appearance that is appropriate for
each individual patient. Single hair-grafts have the finest and
softest appearance. Although they do not provide much density, they do
provide the critical soft hairline that is the transition to thicker
hair. Reconstructing a new hairline is a skill requiring surgical as
well as artistic skill. It is critically important to get it right the
first time and thus requires considerable forethought and planning.
Getting it Right. Examining the hairline of a nonbalding person will
show the presence of numerous single hairs in the very frontal
hairline. Micrografts are small grafts containing 2-3 hairs that are
placed behind the hairline to provide a gradually increasing hair
density. Lastly, minigrafts contain 4 or more hairs are placed well
behind the hairline so that the single hair and micrografts can blend
naturally into the density provided by these larger grafts."
Side effects of hair transplant can be found here:
"The side-effects of hair transplantation surgery are relatively minor
consisting of mild pain and discomfort after the operation, swelling
which may move down to the eyes, and the formation of scabs over the
grafts which take approximately one week to resolve. Serious problems
of bleeding, scarring, and infection are rare. Modern hair
transplantation surgery is comfortable, predictable, and the results
are pleasing to most patients."
Regarding HGH and hair loss - I have answered a previous question on
I can research a specific connection between HGH and hair loss in a
seperate question if you wish.
Although androgenic alopecia his the most common cause of hair loss, I
can explain the others (alopecia areata, telogen effluvium, traumatic
alopecia) in seperate questions.
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
Internet search strategy:
No internet search engine was used in this research. All sources were
from objective physician-written and peer reviewed sources.
1) Price, VH. Treatment of hair loss. N Engl J Med 1999; 341:964.
2) Olsen, EA, Dunlap, FE, Funicella, T, et al. A randomized clinical
trial of 5% topical minoxidil versus 2% topical minoxidil and placebo
in the treatment of androgenetic alopecia in men. J Am Acad Dermatol
3) Goldstein. Hair loss. UptoDate, 2002.
4) Kaufman, KD, Olsen, EA, Whiting, D, et al. Finasteride in the
treatment of men with androgenetic alopecia. Finasteride Male Pattern
Hair Loss Study Group. J Am Acad Dermatol 1998; 39:578.
5) Goldstein. Patient information: Male pattern hair loss (androgenic
alopecia). UptoDate, 2002.
Mayo Clinic - Baldness
American Academy of Dermatology
Hair Loss and Its Causes
Medline Plus - Hair Disease and Hair Loss
Hair Transplant Medical