In the United States alone, pattern hair loss affects over forty million men. Less well known is that hair loss also occurs in twenty million women. Until recently, few viable options existed for women experiencing this problem. Today, great strides in research and treatment are occurring. In this article we will focus on the latest and greatest treatments as well as future therapies looming just around the corner.
But first, a short discussion to lay the framework for gender-based similarities and differences. In both sexes it’s called “pattern” hair loss because hair inside zone of loss is subject to thinning and fallout. Hair outside the zone is generally considered to be immune. This single fact has driven hair transplant surgery for more than fifty years because hair transplanted into the thinning zone retains its genetic immunity and continues to thrive. But there is an important caveat.
In men, pattern hair loss tends to leave a healthy dense area of hair bearing scalp available for transplantation. In women, this does not always occur. Often, women lose hair across the entire scalp to a degree that renders hair transplant surgery a non-starter because you’d be trading one region of sparse hair for another. Another point of differentiation between the sexes is that women with thinning hair tend to retain their juvenile or feminine hair line while bi-temporal recession is a very common finding in men. Thus, concisely, in men, the area of hair loss tends to be more severe but anatomically limited — while in women the degree of loss may not be as severe but the extent of affected territory may be much more extensive.
In this article, we will not delve into the biochemical hallmarks that differentiate male from female pattern hair loss. Suffice to say, the common biochemical features linked to pattern hair loss generally outweigh the gender-specific differences.
Okay, we’ve set down a reasonable foundation for the problem. Now what is there to be done? Let’s start by touching on the options that honestly just don’t work and then we’ll get into therapies that do. The first thing that doesn’t work is also usually the first thing that women try, i.e. “thickening” the hair. Using thickening sprays, gels, mists etc. on thinning hair is a bit like putting makeup on a corpse. Eventually, the jig is up. In hair loss affected women, eventually the hair thins to a point where no amount of flocking spray will be able to disguise what’s happening. This is because the visible hair above the scalp also happens to be the non-living part of the system. That’s why you don’t scream bloody murder when your stylist takes a scissor to your hair. It’s also why plumping up the hair shaft with thickening shampoos and volumizing hair spray ends up addressing precisely the wrong end of the problem. It is the hair follicle, buried several millimeters below the skin surface, where we need to focus attention.
Another thing that just doesn’t work is scalp massage, and/or variously, products designed to increase blood flow to the scalp. Pattern hair loss is not a function of compromised blood supply. So massaging the scalp or using products purported to “invigorate” the scalp do basically nothing but invigorate a disreputable hair company’s bank account. Next on our list of “things that just don’t work” are hair vitamins. Your hair isn’t starving. You aren’t missing trace elements or vitamin C. Your hair is being shut down by genetic and epigenetic factors that hair vitamins simply can’t fix.
By now, you’re probably saying to yourself, well then, if none of these things works, then I’m basically out of luck, right? Wrong. From a therapeutic standpoint, there has actually never been a time in human history with better options than today. For starters, just as there are male-indicated hair loss treatment drugs that are off limits for women, there are female-indicated hair growth treatment pharmaceuticals that are not appropriate for use by men. The first drug on the list is spironolactone.
Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Aldactazide, Spiractin, Spirotone, Verospiron or Berlactone) is a diuretic and is used as an antiandrogen.
It is a synthetic 17-lactone drug that is a renal competitive aldosterone antagonist in a class of pharmaceuticals called potassium-sparing diuretics, used primarily to treat heart failure, ascites in patients with liver disease, low-renin hypertension, hypokalemia, secondary hyperaldosteronism (such as occurs with hepatic cirrhosis), and Conn’s syndrome (primary hyperaldosteronism). Due to its antiandrogen effect, it can also be used to treat hirsutism, and it is a common component in hormone therapy for male-to-female transsexual and transgender people. Interestingly, it is also used for treating hair loss and acne in women, and has been used off label as a topical medication for treatment of male baldness. Spironolactone is commonly used to treat symptoms of polycystic ovary syndrome (PCOS) such as excess facial hair and acne. It can also cause gynecomastia in males and should never be given with potassium supplementation for fear of the development of hyperkalemia.
The next female hair loss drug is flutamide. Flutamide is an oral nonsteroidal antiandrogen drug primarily used to treat prostate cancer. It competes with testosterone and its powerful metabolite, dihydrotestosterone (DHT) for binding to androgen receptors in the prostate gland. By doing so, it prevents them from stimulating the prostate cancer cells to grow. Flutamide has been largely replaced as a cancer drug by bicalutamide, due to a better side-effect profile. Flutamide may also be used to treat excess androgen levels in women, and it is here that the drug has also been used to treat female hair loss. It is marketed by Schering-Plough under the brand name Eulexin, also known as Flutamin. Like spironolactone, flutamide has the potential to cause feminizing side effects in men such as gynecomastia, and so this is a hair loss treatment drug that is generally useful only for hair challenged women.
Drugs are great. Thank goodness for drugs. Surely, the greatest achievement of the Twentieth Century was the creation of miracle drugs, such as streptomycin and penicillin. But drugs also come with common but sometimes highly significant negative side effects. Interestingly, it is also a fact that more than 50% of the pharmaceutical drugs in worldwide use today were originally derived from natural substances, either all or in part. For instance one of the earliest TB drugs was extracted from a bacillus found in cranberry bogs. Mother nature has been busy creating biochemically active molecules for many millions of years. Human beings have been at it for a somewhat shorter period of time.
The elegance of natural phytochemicals both staggers and ignites the imagination. And while natural medicine has been in use for thousands of years, it is only recently that evidence-based scientific analysis has been applied to validate these ‘nutraceuticals’ as such substances are sometimes called. A new field is emerging where sophisticated tools of molecular biology and protein chemistry are being harnessed to test, concentrate, and generally improve naturally-derived compounds, all without turning them into synthetic drugs.
In this lab, the focus of our work is directed toward the development of naturally-based hair loss treatment formulations. Here, the goal is to take all we’ve learned and find safe, botanically-based substances that can offer testable benefit in the setting of pattern hair loss.