Dr. Christine Shaver was recently interviewed by Allure magazine about the future of hair loss. In the published article, Dr. Shaver talked about why female hair loss can often be harder to treat than male hair loss. In men, the hormone DHT is the main culprit behind genetic hair loss. The main way to treat male hair loss is by blocking the formation of DHT with a medication called finasteride. However, treating female hair loss with the same medications that block that hormone for men can prove to be tricky. There are safety concerns for women, particularly if they have a history of breast cancer, are pregnant or nursing; or wish to become pregnant. Hair transplants may be more challenging in women, as thinning hair on women is typically diffuse, making it harder to find a sufficient donor area. The good news is that there are a number of effective ways to treat both female and male hair loss. Here, Dr. Shaver explains the best methods we currently have for hair restoration and what to look for in the future.
What are the most effective options we have for hair loss now?
Dr. Shaver: Medical options for treatment of genetic hair loss are mainly oral finasteride, topical minoxidil and platelet-rich plasma (PRP) scalp injections. Finasteride is a medication that can effectively block DHT production in men and help prevent further thinning. Unfortunately, it is not FDA-approved for use in women. Minoxidil and PRP can be used in both sexes. Minoxidil is a topical agent that is applied once or twice daily to the scalp and helps keep the hair in the anagen phase (growth phase) of the hair cycle, leading to thicker and longer hair. It is now being used orally (in low doses) for the same purpose. PRP is an office treatment where blood is drawn and then platelets are separated and injected back into the scalp in the regions of thinning. Platelets are essential components of this treatment because they contain granules with growth factor which can help prevent the hair from thinning further. It is not uncommon for patients to take a combined approach and use multiple therapies with different mechanisms of action to achieve the best results.
Any hair restoration technologies you predict may improve in the future?
Dr.Shaver: In the future, the hair transplant industry will likely begin to use the technology of hair cloning which will allow more people, even those with a limited donor supply of hair, to become good candidates for hair restoration. Currently, the fullness that can be achieved with surgery is limited to the patient’s natural available supply, which is redistributed from the donor to recipient area to give the best cosmetic look. However, with the advent of hair cloning, candidates will conceivably obtain a limitless supply of donor hair and be able to obtain a full head of hair, regardless of their extent of thinning. Cloning is still under development and may take some time to be readily available. In the meantime, we can expect the preference for minimally invasive FUE procedures to increase, especially those using state-of-the-art robotic technologies.
Does anything work topically for hair loss?
Dr. Shaver: Aside from topical Rogaine which is used to treat genetic thinning, there is not much evidence to support that other topicals such as shampoos or conditioners will change your general hair health. Topical Rogaine requires 4-6 hours to effectively absorb through the scalp to be effective. While it is important to wash your hair and keep your scalp free of dirt, greases, and bacteria, the type of shampoo does not matter much, and they do not affect hair growth per se. On the other hand, certain scalp conditions require a medicated shampoo to control symptoms such as using tar-based shampoos to control scaling in conditions such as psoriasis. Finasteride is compounded in a topical formulation by some doctors, but it is not FDA approved to be used in this way.
Are there other reason besides the fact that more men experience baldness that may explain why hair transplants are still fairly rare for women?
Dr. Shaver: While men often thin earlier than women, hair loss in women is quite common. In fact, approximately 50% of women will experience hair thinning by age 50. However, hair transplant in women is less common because the pattern in which women thin is often diffuse. This poses an issue with hair transplant because the donor hair in hair transplant at the back and sides of the scalp must be stable and not thinning so that when transplanted, it will not thin at the new location. If hair is thinning at the donor zone and then used for transplant, it will continue to thin at the new transplanted location. It is critical that a dermatologist with expertise in surgical hair restoration assess the stability of the donor zone in women to ensure that this region is not thinning and that a hair transplant would be successful. Although the diffuse pattern seen in women poses a limitation for surgery, it does enable women with the use of cosmetics to have the appearance of a full head of hair.
Do any supplements actually work for hair loss?
Dr. Shaver: There is little scientific support behind the ability of vitamins and supplements to promote hair growth unless the patient has a nutritional deficiency that needs to be corrected. One of the more common nutritional deficiencies seen in the U.S. is anemia from low iron. In this situation, it would be important to receive iron supplementation. Furthermore, excess vitamin supplementation can actually lead to hair loss. This is particularly a concern with excessive vitamin A intake which can result in extra hair shedding in a process called telogen effluvium. Finally, biotin is commonly marketed as a hair loss supplement, but is often found to be more helpful at improving the quality of nails rather than hair. Otherwise, most healthy people who follow regular diets do not need supplementation and will not find improvements in their hair loss with taking vitamins or other nutritional hair supplements. Overall, there is not enough scientific evidence to recommend additional homeopathic supplements or dietary changes.
Is there anything you predict we’ll eventually turn away from completely in this space for any reason?
Dr. Shaver: I predict the use of laser therapy to slowly become less popular as the results seem underwhelming for the majority of patients. While the theories behind laser caps and combs sound promising and beneficial, practically speaking, they often do not provide much improvement when patients use these devices. It is thought that the low levels of laser light energy may help to stimulate the hair follicle and cause hair growth. This may be through a variety of mechanisms such as increased production of growth factors, greater blood flow, or higher amounts of energy made in the hair cells. Overall, these lasers are rather safe to try, but other treatments are often more effective.
