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Hair – here and there

Drugs to increase Hair Growth

Pills to grow hair have been around for decades. Each year, numerous medications, herbs, spices and nutritional supplement are being cited as the panacea for hair loss. Annually, North America men spend more than 2-4 billion dollars in the quest for the magic drug to look younger, sexier and grow more hair. So here is the latest on the horizon of medications to grow more hair.

Today there are two FDA approved medications for hair growth: minoxidil which is sold over the counter as Rogaine, for both men and women, and Finasteride, a prescription pill sold as Propecia, for men only. Two other drugs have been recently approved for hair growth and include a high-estrogen oral contraceptive and Aldactone (spironolactone). However, these two medications are only for women due to their feminizing side effects.

Drugs to treat hair loss

Both Rogaine and Propecia can slow the rate of inherited hair loss, and in many cases they can help hair follicles that have recently stopped growing to regenerate again. However, this simple fact is not always true and individual results are very variable. Propecia (Finasteride) is available for men only, due to possible side effects when taken by pregnant women. Rogaine (minoxidil) is useful for treating both men and women.

Propecia (Finasteride)

The most effective medication proven to treat genetic pattern hair loss is Propecia (Finasteride). It is prescribed for men with a genetic predisposition to hair loss (male pattern baldness). Propecia is a prescription medication that was first approved by the FDA for treating benign prostate hypertrophy (enlarged prostate glands). Serendipitous discovery revealed that besides reducing the size of the prostate gland, it also decreased hair loss, and often caused regrowth of recently lost hair.

Ten years ago, Finasteride was approved as a low dose pill for the treatment of male pattern baldness. For the treatment of the prostate enlargement, the drug is sold as a 5 mg pill, whereas for hair growth it is sold as a 1 mg pill.  Finasteride acts by blocking the synthesis of a male hormone which plays a role in hair growth. To maintain continued growth of hair, the drug has to be taken indefinitely.  Even though manufacturers claim that stopping Propecia does not prevent hair loss, there is no data to support this. In fact most users of Propecia claim that stopping the drug, decreases hair growth and is associated with greater hair loss.

After Propecia use, the rate of hair loss slows, and in many cases stops. In many individuals, some recently miniaturized hair follicles begin to grow back to normal size, and begin to grow to normal size hairs again. Propecia can also help regrow recently lost hair and the drug is often used by hair transplant surgeons.  

Besides increasing hair growth, a beneficial side effect of even the low dose Propecia is an arrest of the prostate gland enlargement.

Dosing

A single 1-milligram Propecia tablet is taken everyday. Propecia is a treatment, not a cure. This means that a pill must be taken every day for the benefits to continue. When Propecia is discontinued, the hair loss process resumes. Propecia is for men only, and is not approved by the FDA as a hair loss treatment for women or children.

Side effects

Propecia treatment may decrease libido in some men because the drug is known to decrease the synthesis of the sex hormone, DHT. To counteract this decrease in libido, Viagra has been recommended or one may stop the use of Propecia.  A few individuals also complain of a reduction in the volume of ejaculate but the sperm count remains normal.

Rogaine (minoxidil)

Twenty years ago, Rogaine (minoxidil) lotion was the first medication approved by the FDA for treating genetic hair loss. The medication is colorless and odorless liquid applied to the scalp. Minoxidil was initially prescribed as a treatment for high blood pressure and a coincidental finding was that many individuals started to have new hair growth as a side effect. This serendipitous discovery that hair growth did occur on the scalp quickly led to a billion dollar industry to satisfy the men’s demands.

Availability

In the past, Rogaine lotion was available only by prescription, and only in a 2% concentration. In 1995, the FDA decided that minoxidil lotion was safe for use without a prescription and the product was soon available over-the-counter. Since the patent on Rogaine has expired, numerous generic versions of Rogaine have become available and the range of concentrations has increased up to 5%. Most individuals use the higher concentration of Rogaine (5%) lotion claiming that it producers more hair growth than the 2% lotion.

Action

Rogaine only works on active hair follicles which are capable or generating more hair. Those who are completely bald are wasting time and money with Rogaine. Rogaine appears to maintain a longer growing phase for the hair and increases the recycling phase.

Results

Not all individuals have the same results with Rogaine. Some individuals have no response to Rogaine. For others, there is a reduced rate of hair loss but there is no new growth of hair. Others experience minimal new hair growth which is not enough to cover the thinned scalp. A very few individuals enjoy dense new hair growth, with areas that had previously been thin, and ultimately develop a scalp full of hair- these are the exceptions to the rule.

The individuals who are most likely to benefit from Rogaine are those who are in the early stages of hair loss and do not have complete baldness. On average, younger men show a more positive response than the elderly. Individuals who have thinning or baldness on the top of their heads have better results than those with hair loss at the sides and frontal scalp. Any area on the head where the hair has been replaced by frank baldness never responds to Rogaine.

Dosing

Rogaine should be applied on the scalp daily. It causes the hair to grow only on the area it is applied. The drug rarely will cause hair growth in other areas of the body from where it was not applied. Topical application of Rogaine has no affect on blood pressure. Like Propecia, Rogaine is not a cure for male pattern baldness. For the best results, Rogaine should be applied daily. Missing application for a day or two has no consequences, however, after several months of discontinued use, the re grown hairs are likely to be shed.

Safety

Rogaine is a safe drug.  When used as directed and applied to the scalp, only minute levels reach the blood. The risk of serious side effects is very small. The most common side effect when used as directed is minor scalp irritation or itching. A few patients may experience heart palpitations.

Women who use extra strength minoxidil lotion (5%) may experience increased facial hair growth. This hair growth tends to diminish after the first few months of treatment, or one may use the lower dose of minoxidil (2%). When Rogaine treatment is discontinued, normal scalp and facial hair growth stops.

Which part of the head is affected by Rogaine

Rogaine treatment does not work on everybody with thinning hair. It is less effective for hair loss in the frontal scalp area. It is less effective on large bald areas than smaller areas with less hair and has almost no effect on long established bald areas. The results after Rogaine application are not immediate.  There is a gradual change and this may take months. The maximum benefit if it occurs is seen at 12 months when hair re-growth has stabilized.

Rogaine formulations

A variety of Rogaine formulations are available. Sometimes, Rogaine is mixed with Retin A or corticosteroids to reduce the risk of inflammation and increase absorption. Rogaine applied with low concentrations of these drugs have been shown to promote greater hair growth, and possibly better results, than Rogaine used alone. Tretinoin may increase the absorption of Rogaine through the skin, as well as having additional hair growth promoting effects. The corticosteroid reduces the scarring, and helps keep the hair follicles active for more hair growth cycles.

Sometimes Rogaine is combined with Propecia. The results are better than when either medication is used alone. Rogaine use can be combined in those individuals who have had a hair transplant. The medication is often recommended by hair transplant surgeons to promote the growth of the transplanted hair follicles.

ANTIANDROGENS           

Newer drugs are currently being developed against the male sex hormones. These drugs are effective in decreasing hereditary hair loss but have potent side effects. Various types of drug preparations have been tested but the feminizing side effects have been a major limitation in their approval for men. Growing breasts, decrease libido, lack of sexual desire and having a head full of hair are is not a great option for a good many men. So the research continues.

Hair today

For those intent on having hair, the time to start drug therapy is when there is still some hair left on the head. For completely bald people, the options are limited to wigs and wearing a hat or accept a hairless scalp. Few insurance plans cover drug therapy and one needs to take the drugs forever to get the benefits and maintain them. The drugs are not cheap and there is no guarantee of hair growth. For a years supply, Rogaine may cost 2-300$ and Propecia can cost 7-1000$. Neither of these medications is covered by any medical insurance.

While current research efforts are making some headway, a cure for baldness is light years away. Various drugs are available but less than 10% of individuals have any significant hair growth. The treatment can become expensive in the long run with no guarantee on the results. While accepting baldness may not be appealing solution to all men, it may save one the aggravation of searching for an illusive cure. The best is to save one’s money and know that some big, blonde or bald- it is not the hair that makes a men but the soul.