Treating Androgenetic Alopecia (Male/ Female Pattern Hair Loss)

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Not many men can embrace a skinhead look (and still look dashing!) like Bruce Willis

Androgenetic Alopecia – commonly known as male pattern hair loss, is the most common cause of hair loss in both men and women (when it is known as female pattern hair loss), as described in my previous post.

Although the impact of hair loss is mainly cosmetic, it can be distressing, affecting self esteem. (For every Bruce Willis, there are a hundred balding men who are not yet ready to embrace the shaven look!) Fortunately, there are numerous effective methods to help slow down the progression, or even reverse the hair loss process.


Lotions and Potions: Minoxidil

Minoxidil is an topical lotion available in 2% or 5% formulations (I always recommend the 5% as it works better and costs about the same). It is thought to work by prolonging the growth (Anagen) phase of hair follicles, and by increasing blood flow, stimulating them to grow. Minoxidil has been shown to effective in about 50% – 75% of users. The main problem is that it needs to be applied twice a day, and can feel sticky, which many do not like.

Minoxidil also works better for hair loss at the crown, and not so great for receding hairlines. Hence, in women, where the hair loss is often diffuse at the crown, it is a good choice. Another bad news is that once the lotion is stopped, its anti-balding effects wear off in  4 – 6 months.


Hairy Elixir: Finasteride?

At some point in their crusade against hair loss, most men will cross paths with Finasteride (brand name: Propecia), a once-daily oral medication which works by inhibiting 5 Alpha Reductase, an enzyme which converts Testosterone into the more powerful Dihydrotestosterone (DHT) – thus reducing the levels of DHT in the body (people who suffer from Androgenetic Alopecia are thought to have increased sensitivity to DHT).

As Finasteride targets the hair loss at its cause, it works better than Minoxidil, with better results. For the receding hairline, 90% of users respond, with 40% experiencing hair regrowth (compared to 25-30% with Minoxidil users). Again, Finasteride, like Minoxidil, works better on the crown: up to 99% treated respond, with 66% showing some regrowth. That is pretty impressive!

If you have heard about Finasteride, chances are, you would have heard about its notorious side effects- on sexual function. These can range from impotence, to decreased libido, to ejaculation disorders. The good news is that these side effects, although widely spoken of, affect only about 4% of patients. Studies also show that with long term use, the incidence of these side effects decrease as well. The bad news, is that there have been documented cases of persistent sexual side effects even after stopping the medication – although this has never been confirmed in studies.

It gets trickier for women: Finasteride is FDA approved to treat MALE pattern hair loss. Results on women have also been disappointing and often conflicting – hence, it is not recommended to be used in women (especially pregnant ladies where it can wreck havoc on the baby’s hormonal physiology!)

High Tech Help: Revage 670 Hair Laser

Fancy sparing 30min, 1-2 times a week, to restore
your crowning glory?

More recent hair loss treatments have gotten even more interesting. The Revage 670 laser is an FDA approved, low level diode laser which uses rotating diode lasers to stimulate blood flow to the hair follicles.The enhanced blood flow propels dormant hair follicles into the active growth phase, while encouraging cellular and tissue regeneration for thicker, suppler and more durable hair shafts.

The treatment involves, well, sitting there for 30 minutes, and has to be done 2 times weekly for 6 weeks, then weekly for the next 16 weeks, followed by periodic touch-ups after to maintain the results.

Studies have shown that Revage produces an 85% success rate in halting the progression of hair loss and up to a 39% increase in fullness, making this somewhere between Minoxidil and Finasteride in terms of efficacy.

The great advantage is of course that there is no need to worry about the dreaded side effects associated with Finasteride, or the stickiness and twice daily application required with Minoxidil. Revage also works for both men and women. The downside? Cost: Revage costs more, at SGD $200 a session, but for many, it is still the treatment of choice due to the safety profile. Many also combine treatments – depending on the individual’s response. We find that combination treatments work synergistically, giving better outcomes than any one treatment used alone.

For all the above 3 methods, remember that prevention is always better than cure – it is important to start treatment early rather than late; as they all work better in preventing further hair loss rather then reverse it.

Surgical Options: Hair Transplant

ARTAS Robotic System for extraction of
Follicular units in hair transplantation

Manchester United star Wayne Rooney made headlines when he openly admitted to undergoing a hair transplant procedure last year, posting on Twitter: “Just to confirm to all my followers I have had a hair transplant. I was going bald at 25 why not. I’m delighted with the result…. It’s still a bit bruised and swollen when it dies down u will be first to see it. Anyone recommend any good hair gel. Haha.”

A hair transplant is the treatment of choice when the hairline has receded too far back, such that lotions, pills and lasers will no longer give a good result.

You can think of hair transplant as a “Robin Hood” procedure: involving robbing the hair rich areas in the occipital region to help the hair-poor areas in the front where the hairline is receding. The total number of hairs on the head remain the same, but with skillful repositioning of hair follicles, a good aesthetic result is achieved.

Hair transplant is considered a minor surgical procedure. The hair is harvested from the donor site either in a strip (where a whole strip with its hair is cut out) or in individual units – Follicular unit extraction (FUE), which involves removing individual strands of hair from the donor site. The hair is then painstakingly implanted into the recipient site one by one.

Both methods have their pros and cons, which will be discussed in a later article.
The important take-away message is: Male/Female pattern hair loss is a treatable condition. If you notice thinning hair, speak to your doctor, and find out what you can do. And remember not to sit on it – once the hair is gone, it is more difficult to bring it back, unless you are ready to undergo a hair transplant procedure.

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