Hair Loss Treatment

Hair loss is common, with healthy individuals shedding between 50 and 100 hairs per day. However, it becomes a concern when your body loses more hair than it regrows.

Hair loss can manifest in many ways, including:

• gradual thinning
• receding hair line
• patchy bald spots

Several factors can contribute to hair loss, including:

• genetics – especially in male and female pattern baldness
• hormonal changes – hormone fluctuations, such as during pregnancy or menopause, can trigger hair loss
• certain medications – some medications, like chemotherapy and blood thinners, can cause hair loss as a side effect
• stress – physical and psychological stress can interrupt the hair growth cycle, resulting in hair loss
• medical conditions – thyroid issues and some autoimmune conditions can cause hair loss

The most common type of hair loss that affects men is male pattern baldness, also known as male androgenetic alopecia (MAA). Male pattern baldness affects up to 80% of men in their lifetime with:

• 30% of white men affected by the age of 30
• 50% by age 50
• 80% by age 70

Research shows that white men are 4 times more likely to be affected by male pattern baldness than black men. The average age of onset is usually between 20 and 25 years of age.

Male pattern baldness progresses in stages, which are usually predictable and begin with a receding hairline and thinning at the crown, eventually leading to a horseshoe-shaped pattern of hair.

The Hamilton-Norwood Scale is a commonly used tool which categorises hair loss into 8 stages, ranging from minimal recession to extensive baldness.

The 8 stages of the Hamilton-Norwood Scale are:

• Stage 1 – known as the control stage because there is no hair loss or receding hairline, and is the stage that later stages are compared to.
• Stage 2 – slight recession had taken place, usually around the temples, and this stage is known as an adult or mature hairline.
• Stage 3 – classified as the first stage of balding and is where the first noticeable signs of hair loss appear, with more recession at the temples, forming an M, U, or V shape.
• Stage 3 Vertex – similar to stage 3 but with more noticeable thinning or a bald spot on the crown.
• Stage 4 – hairline recedes further back on the scalp, with the bald spot on the crown becoming more noticeable, although there will be a strip of hair between the receding hairline and the bald spot.
• Stage 5 – hair continues to recede towards the back of the head and the line between the vertex and bald spot gets thinner.
• Stage 6 – there is now little to no hair on the top of the head, but there may be some on the sides of the head.
• Stage 7 – hair starts to be lost on the side of the head and the head is encircled by a ring of thin, sparse hair.

What are some less common symptoms of hair loss?

Besides increased shedding, thinning, and a receding hairline, less common symptoms of hair loss can include:

• patchy baldness
• burning or stinging sensations
• itchy scalp
• redness, swelling, and sores that may itch or leak pus
• nail changes

Hair loss can be caused by various factors, including:

Genetics

Male and female pattern baldness are often inherited. Research suggests that men are 5 to 6 times more likely to experience balding if their fathers did. However, multiple genes are involved in hair loss, including those inherited from your mother’s side.

Hormones

Hormone fluctuations, especially those linked to oestrogen and androgens can affect hair growth and contribute to hair loss.

For example, in male pattern baldness, dihydrotestosterone (DHT), a metabolite of testosterone, binds to the androgen receptor and causes hair follicles to shrink. With each hair growth cycle, the follicles become smaller, and hair becomes shorter and finer, eventually causing hair loss.

Ageing

Getting older is a significant contributing factor to hair loss because the natural ageing process leads to hair follicle activity slowing, which, alongside changing hormone levels, can lead to thinner hair and increased shedding.

Medical conditions

Several medical conditions and treatments can contribute to hair loss, including autoimmune conditions, thyroid disorders, stress, and certain medications. Some of the conditions that can cause hair loss include:

• alopecia areata – an autoimmune condition that causes patchy hair loss and is caused by the body’s immune cells mistakenly attacking its own hair follicles, resulting in hair loss
• thyroid disorders – the thyroid gland produces hormones that regulate many bodily functions, including hair growth, so an over or underproduction of thyroid hormones can affect hair growth and health, and contribute to thin hair or loss
• iron deficiency – not getting enough iron in your diet can cause a condition called telogen effluvium which causes increased hair shedding
• stress – stress can trigger a temporary type of hair loss called telogen effluvium, which causes many hairs to enter the resting phase at the same time, resulting in increased shedding

During your hair loss treatment journey with finasteride (Propecia), you can expect the following results:

1 to 3 months

During the first 3 months of treatments, finasteride will begin to lower the levels of DHT in your blood. During this time, the hair follicles should start to revert back to their normal size and function.

It can help to take photos of your hairline before you start treatment to help you compare results further into your treatment.

You may not see noticeable signs of hair regrowth, but it’s likely your hair follicles are becoming healthier and preparing for stronger, thicker hair strands.

3 to 6 months

It’s during this period that some people will start to notice visible changes in their hairline or regrowth. You may notice that your hairline has stopped receding, that bald or thinning spots look thicker, or that your hair loss has stopped.

One study found that after 12 weeks, there was a significant effect following finasteride therapy. It can take up to 6 months to see the full effect of finasteride, so it is important to continue with your treatment unless your doctor advises you to stop.

6 months to 1 year

Between 6 months and 1 year of finasteride treatment, most men observe increases in hair count, thickness, and a reduction in hair loss.

A 48-week study demonstrated that finasteride increased total and anagen hairs with a 47% improvement in anagen to telogen hair ratio. This suggests that finasteride promotes the conversion of hair follicles into their active growing phase.

If you have reached the 1-year mark and haven’t noticed any changes in your hair growth or are still losing your hair, you should contact your doctor.

1 year+

Research shows that finasteride is effective for 90% of men and after 5 years of treatment:

• 48% rated their hair growth as improved
• 42% reported no additional hair loss

A Japanese study found finasteride improved hair loss in 99.4% of men over 5 years.

You should continue to use finasteride, unless your doctor advises you otherwise, for as long as you want to maintain positive results.

There are several things you can do to promote healthy hair and prevent hair loss. Even if your hair loss is genetic, these lifestyle changes will be useful alongside hair loss treatment and to promote your general health and well-being:

1. Healthy diet

Eating a diet that is rich in essential nutrients, including protein, iron and zinc, will promote healthy hair and support the health of your hair follicles.

2. Stress management

Chronic stress can contribute to hair loss, so practising mindfulness and stress-reducing techniques such as exercise, meditation, getting outdoors, and socialising can all be beneficial.

3. Exercise

Regular physical activity will improve your overall health and may indirectly support hair growth by increasing blood flow to your hair follicles and scalp and reducing stress.

4. Quit smoking

Some research suggests that men who have smoked are 1.8 times more likely to experience male pattern baldness than men who have never smoked. So, quitting smoking is likely to be an effective way to prevent hair loss if you are a man.

5. Wear sun protection

Although the sun doesn’t directly cause hair loss, excessive sun exposure can damage your hair and scalp, which may lead to finer, more brittle hair and increased shedding. It’s important to wear sunscreen, especially if you have bald patches, or wear a head covering, such as a hat, to protect your scalp from the sun’s rays.

6. Manage medical conditions

Managing any underlying medical conditions that may contribute to hair loss, such as thyroid disorders, may prevent or control hair loss. It’s also important to attend regular check ups with your doctor about your condition or any medication you are taking.

7. Gentle hair care routine

Follow a gentle hair care routine by using a soft bristle brush or a comb to style thinning hair. You should also wash with a mild shampoo and pat your hair dry rather than rubbing it. If possible, avoid any harsh hair styling products and heat which can damage your hair.

8. Try supplements

Taking a daily supplement, such as biotin or zinc, may help to promote healthy hair growth, although evidence is limited on how effective this is.

What happens if I stop using my hair loss treatment?

If you stop using your hair treatment, your natural hair growth cycle will return which means you could experience increased shedding and a return to your previous hair loss pattern.

What should I do if I forget to use my hair loss treatment one day?

If you miss your hair loss treatment for a day, do not take a double dose. If it is:

• less than 6 hours late, take your finasteride dose as soon as you remember
• more than 6 hours late, skip the missed dose and take the next one at your usual scheduled time

Can you regrow hair?

Yes, hair regrowth is possible. However, it will depend on the original root cause of your hair loss. For example, if it was caused by a reversible factor like illness, stress, or a nutrient deficiency, or is genetic but the treatment was started early, regrowth or prevention of further hair loss is possible.

Do hair loss treatments make your hair thicker?

Yes, some hair loss treatments, particularly topical solutions like minoxidil, can thicken your hair and promote regrowth.

Can vitamin deficiency cause hair loss?

Yes, deficiency in certain vitamins and minerals can contribute to hair loss. Vitamins D, B12 and minerals such as iron, and zinc are a few examples of nutrients that can contribute to thinning hair or hair loss.

How do you know if you’re shedding too much hair?

It is usual to shed between 50 and 100 hairs per day. However, if you notice more hair than usual in your brush, comb, or in the shower or bath plughole, or you notice thinning or bald patches, it could be a sign that you are experiencing excess hair loss. It is important to consult your doctor or pharmacist as soon as possible to start effective treatment.

Can low testosterone cause hair loss?

Yes, although high testosterone levels are associated with hair loss, low levels may also contribute to thinning hair or hair loss. That’s because it’s not the amount of testosterone in the body that’s important for hair loss, it’s how receptive your body is to DHT. If you have lots of DHT in your system, it can cause your hair follicles to shrink, contributing to hair loss.