MEDICAL HAIR RESTORATION
Only two hair restoration medications have been approved by the FDA after testing for safety and efficacy in clinical trials. These are the topical medication minoxidil (Rogaine®) and the orally administered prescription medication finasteride (Propecia®). Safety and efficacy information for these medications is clearly stated, as required by the FDA in product information provided with the product. Neither product “guarantees” to stop hair loss or stimulate growth of new hair because hair loss can be due to many causes that may or may not be treatable by the medications. Finasteride (Propecia®) is available only by prescription from a physician. While minoxidil (Rogaine®) is available as an over-the-counter topical medication, both finasteride and minoxidil are most effective when used as recommended by a physician hair restoration specialist after the cause of hair loss is correctly diagnosed.
Determining which medicine or combination of medicines is right for you will depend on your age, degree of hair loss, and budget. For many people, the best results will be achieved by combining Rogaine or Propecia treatments with hair restoration surgery.
Using Rogain® For Hair Loss Treatment
Minoxidil (Rogaine®) is applied topically to the scalp in 2% or 5% solution. Minoxidil is available over-the-counter in 2% solution, but is best and most effectively used in a treatment program planned and supervised by a physician hair restoration specialist. Rogaine tends to be more effective in women than in men.
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-hypersensitive. 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 Propecia® For Hair Loss Treatment
Finasteride (Propecia®) is an orally-administered medication that influences the response of scalp hair follicles to androgenic hormones. Finasteride is available only by prescription to men.
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. See Finasteride and Prostate Cancer for more information.
Finasteride for treatment of hair loss should be prescribed only after examination by a physician hair restoration specialist.
Finasteride is not approved for 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.
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