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Hair Replacement Products

It is no surprise that hair replacement products have been around for a long, long time, well over 200 years. For the most part, hair replacement products have been nothing more than scams - waste of money and a waste of time. Yet, in the last decade or so, some hair replacement products have actually been discovered that really do help, and therefore qualify as genuine hair replacement options for you to seriously consider. Most of the modern hair replacement products that work, were, interestingly enough, discovered by accident! Most helpful hair replacement products are medical drugs, that were found to have the side effect of generating hair growth, while treating another condition.

Nearly all herbal hair replacement products or all natural hair replacement products are a waste of money and of time, when it comes to pattern hair loss or baldness. To understand why the drug based hair replacement products are much better than the herbal and natural, we need to discuss what pattern hair loss is and how it can affect people greatly. Even the best hair replacement products today, are not considered to be anywhere as near as good as hair replacement surgery, but they are a worthwhile alternative.

Why bother at all with hair replacement products?

Hair loss can have a significant impact on a person’s self esteem and well being. Across most cultures, especially Western cultures, the presence of hair on the scalp is strongly associated with attractiveness, virility, and social competence—something that has been demonstrated in a number of studies. Baldness also affects the way in which people with hair loss view themselves. Perhaps because of the commonness of the disorder (30% of men affected by age 30 and 50% by age 50) the psychological effects of hair loss are underappreciated. As bad as the psychological effect of hair loss is in men, it is far worse in women. Ask almost anyone that is losing their hair if it affects them mentally, physically, and emotionally and they will answer in the affirmative.

Why do you have to know the type of hair loss you have to chose an appropriate hair replacement product?

Simple, hair replacement products are often tailored to the type of hair loss you have. For example, herbal and natural hair replacement products are normally useless for most people's hair loss, but some people's hair fall out for other reasons than genetics, and for the non-genetic causes, these natural and or herbal hair replacement products can work a treat. For example, a hair replacement product that contains a vitamin you may be deficient in, may totally reverse the hair loss. It can be that simple.

Mens hair replacement products

Hair replacement products for pattern baldness or pattern hair loss

Most people, however, experience genetic hair loss - pattern baldness.

The reason that hair is lost in pattern baldness is not terribly clear. We know that hair follicles go through a three phase cycle: anagen, catagen, and telogen. Anagen is the phase of active hair growth. Catagen is simply a transition period to the third phase, telogen, which is a resting, dormancy phase for the hair. Telogen is also the phase in which a hair normally falls out. This cycle occurs in all people, but in balding people the anagen phase shortens and the telogen phase lengthens. Over time this means that lost hair is not replaced at the same rate that it is lost.

We also know that androgens—male hormones—are involved with hair growth and hair loss. In fact Hippocrates (the Hippocratic oath guy) noticed that male eunuchs did not lose their hair. One of the main androgens that affects the hair follicle is dihydrotestosterone or DHT. In the body, DHT is made from testosterone by an enzyme called 5-alpha-reductase. The Type 2 version of 5α-reductase seems to be the one that is involved in pattern baldness, specifically. Like eunuchs, men born without 5α-reductase do not lose their hair.

While it is not clear how DHT or 5α-reductase is supposed to function in normal hair growth, we do know that blocking this enzyme can slow the balding process by decreasing levels of DHT near the hair follicle.

The hair replacement product finasteride - eg Propecia

In fact, the way that one of the main hair replacement products works, is by blocking 5α-reductase. Finasteride, marketed for hair loss under the brand name Propecia, is known to block the conversion of testosterone to dihydrotestosterone. Finasteride can cut DHT levels at the scalp in half.

In clinical trials with finasteride, men were able to regrow hair. This new hair growth peaked between one and two years of taking this hair replacement product. After that, as long as men keep taking finasteride, the progression of baldness is slowed or halted. Just as impressive, the ratio of hairs in the anagen phase (growth phase) to hairs in the telogen phase (dormancy phase) increased with Propecia treatment. Interestingly, the weight of the hair also increased. In fact, men taking this hair replacement product enjoyed an increase in hair weight even more than an increase in hair count. This means that finasteride was able to thicken each hair and increase the hair shaft diameter. It also made the hair grow faster and longer.

After three and a half years of taking finasteride, the weight of the hair was 20 percent over baseline. People taking placebo (sugar pill) lost 25 percent of their hair’s weight over that time. In terms of number of hairs, the hair replacement product-treated men had a seven percent increase from baseline while the untreated group had a 13 percent decrease.

The hair replacement product dutasteride - eg avodart

A more potent (but similar) hair replacement product to finasteride is dutasteride. Dutasteride has been approved by the Food and Drug Administration (FDA) for the treatment of benign prostatic hypertrophy or BPH. The brand name of dutasteride for BPH is Avodart. Currently, dutasteride is not marketed as a treatment for baldness; however, some research has been performed on dutasteride as a hair replacement product. Dutasteride is about 100 times more potent at blocking 5α-reductase than finasteride. It can reduce DHT levels about ten fold. While clinical studies of dutasteride in patients with pattern baldness are limited, initial results indicate that it is superior to finasteride in terms of hair growth. Despite this success, phase III clinical trials of dutasteride as a hair replacement drug were halted for reasons that are unclear. For this reason, dutasteride is not widely used as a hair restoration product despite its availability as an off-label use of Avodart.

The hair replacement product saw palmetto

Saw palmetto or Serenoa repens (also known as Permixon) - a herb - was able to increase hair growth in 60 percent of men with pattern hair loss in a double-blind, randomized, placebo controlled trial. This supplement has been shown to block 5α-reductase and is believed to prevent hair loss by this mechanism. This is the only only herb known to work as a hair replacement product, so when checking out the vast array of herbal and natural remedies, look for the ones with this herb as the main active ingredient.

The hair replacement product minoxidil - eg Rogaine

Another hair replacement product that has been successfully used in some men is minoxidil (brand name: Rogaine), although the reason why it works is not clear. Hair growth was first recognized as a side effect of minoxidil when it was used for its initial indication, high blood pressure treatment. Minoxidil can do a number of things biologically, like open potassium ion channels, increase blood flow, increase cell proliferation, and suppress the immune system; none of these things has been shown to grow hair definitively.

Minoxidil is applied directly to the scalp as a liquid or foam. When applied topically, minoxidil does not have an appreciable effect on blood pressure (but it would if taken orally). The five percent solution (marketed as “Maximum Strength”) appears to be more effective hair restoration medication than the two percent solution. Both solutions appear to be significantly better than placebo.

Minoxidil can regrow and maintain hair for the time that it is consistently and continually applied to the scalp. This hair replacement drug works primarily by thickening and maintaining existing hair rather than causing much in the way of new hair growth. One particularly useful indication for minoxidil is as an adjunct to surgical hair replacement. Patients that have had follicular unit extraction and transplant use minoxidil to increase the speed at which their hair grows. This topical hair replacement product has reduced the regrowth time of hair transplant surgery from seven months to seven weeks in one study.

The hair replacement product ketoconazole

Ketoconazole is a drug used to treat fungal infections but may also work as a medical hair replacement product. It is not entirely clear how ketoconazole treats hair loss but it is assumed that the drug’s ability to lower DHT levels contributes to the effect. It also has a strong anti-inflammatory effect, but it is not known how this would beneficially affect patients that are losing their hair. Alone, ketoconazole does not regrow hair as effectively as some other medical hair replacement products; however, when it is used in combination with finasteride it may have a synergistic effect. Ketoconazole can be taken orally in a dose of 400 mg per day or as a 2% topical cream or shampoo.

Womans hair replacement products

Pattern baldness in women appears to be fundamentally different than it is in men. Also, the treatments available to women are mostly different. Topical minoxidil can be used in both genders but the female dose is usually limited to the lower concentration (2%). Hair replacement products like finasteride and dutasteride may be effective in women except that if these hair replacement drugs are taken during pregnancy they could cause severe abnormalities in the developing fetus. Therefore they are not usually prescribed.

Other medications have been tried in female pattern hair loss with less than spectacular results. Cyproterone acetate, a drug that blocks androgen and other hormone receptors, is not terribly effective in treating female hair loss. In fact, minoxidil was better in a head-to-head trial. Spironolactone is a bit better as a hair replacement product, but it has a number of unsatisfactory side effects. Over time spironolactone can cause problems with low blood pressure, fatigue, breast tenderness, and lead to abnormalities in circulating blood cells. Flutamide blocks androgens very potently and seems to do reasonably well in preventing hair loss in women. Unfortunately the drug can cause severe liver damage (rarely) in some people. Anyone treated with flutamide as a hair replacement product must submit to routine blood tests to monitor liver function.

Hair replacement products costs

Since medical hair replacement products are for the treatment of a cosmetic issue (regardless of the psychological damage caused by hair loss in either gender), the cost of these treatments are essentially always the full responsibility of the patient.

The generic form of minoxidil can be purchased for as little as $10 per month while the brand name Rogaine costs around $30 per month. The foam version of Rogaine may be as expensive as $50 per month.

Propecia (finasteride) is only available by prescription and currently costs around $60 per month. The generic form of finasteride may be as inexpensive as $15 per month.

The oral treatment dose of ketoconazole can cost over $100 per month while the topical shampoo can cost $30 per bottle. The ketoconazole cream costs $20 per 15mg tube.

Flutamide at a dose of 250 mg per day (the hair replacement dose) could cost over $40 per month.

Saw palmetto is likely to be the least expensive hair replacement product ($5 per month) but the difficulty is finding sufficiently pure and concentrated Serenoa repens in the unregulated supplement market.

Hair Replacement Products References

Cash TF. Losing hair, losing points? the effects of male pattern baldness on social impression formation. J Appl Soc Psychol. 1990;20(2, pt 1):154-167.

Cash TF. The psychological effects of androgenetic alopecia in men. J Am Acad Dermatol. 1992;26:926-931.

Girman CJ, Rhodes T, Lilly FR, et al. Effects of self-perceived hair loss in a community sample of men. Dermatology. 1998;197:223-229.

Gosselin C. Hair loss, personality and attitudes. Pers Individ Dif. 1984;5: 365-369.

Habib FK, Ross M, Ho CK, Lyons V, Chapman K. Serenoa repens (Permixon) inhibits the 5-alpha-reductase activity of human prostate cancer cell lines without interfering with PSA expression. Int J Cancer 2005;114:190-4.

Kassimir JJ. Use of topical minoxidil as a possible adjunct to hair transplant surgery. A pilot study. J Am Acad Dermatol 1987;16:685-7.

Moerman DE. The meaning of baldness and implications for treatment. Clin Dermatol. 1988;6:89-92.

Prager N, Bickett K, French N, Marcovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alphareductase in the treatment of androgenetic alopecia. J Altern Complement Med 2002;8:143-52.

Price VH, Menefee E, Sanchez M, Kaufman KD. Changes in hair weight in men with androgenetic alopecia after treatment with finasteride (1 mg daily): three- and 4-year results. J Am Acad Dermatol 2006;55:71-4.

van der Donk J, Passchier J, Dutree-Meulenberg RO, Stolz E, Verhage F. Psychologic characteristics of men with alopecia androgenetica and their modification. Int J Dermatol. 1991;30:22-28.


ABOUT THE AUTHOR: Michael T. Spako is an M.D. who chose to pursue a medical writing career instead of a doctors practice. I am pleased to have him as the principal writer for this hair replacement / hair restoration site, and look forward to his further contributions. Donald Urquhart, Psychologist, Editor.

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