There are two classes of medical hair loss treatments.
- Direct Hypertrichotic.
- Medicine affecting the male hormone pathway.
It was approved for use as an Antihypertensive medicine, its side effect was hypertrichosis. Minoxidil is a potassium channel opener and a vasodilator.
- Minoxidil mechanism of action for increase in hair growth is unknown.
- Minoxidil 5% for men twice a day use, result in 45% greater hair growth.
- Minoxidil 2% for women increase hair count by 29% and weight by 42%.
Side effect, Facial hypertrichosis was reported in 3-5% of women treated with minoxidil 2%, it is little higher with minoxidil 5%, that’s why 5% is not advised for women.
FDA has cleared laser phototherapy for promoting the hair growth in male with androgenetic alopecia for class 2 to 5 type. Mechanism of action is unknown. It is hypothesized ,laser phototherapy increase the blood supply, provide more nutrient to hair and provide ATP ,the energy source . Only hairmax laser phototherapy has FDA clearance.
Medicines affecting the Male Hormone Pathway
Only two pathways work for blockade of Male Hormone effect on Hair.
- Inhibition of 5 Alpha Reductase
- Inhibition of Androgen Receptors inside the hair cells
There are two types of 5AR, type I and type II
Type I 5AR, is found throughout the body including skin, kidney, liver and brain
Type II 5AR, is most commonly found in scalp hair, prostate and liver.
Male hormone Testosterone is circulating in the blood. In Blood 97% is bound to the plasma proteins and 3% is free. Protein bound testosterone size is big and it cannot cross the blood vessels. Free testosterone size is smaller, it cross the blood vessel and enter into the hair cells.
Type II 5AR enzyme is mostly present in outer root sheath and papilla cells of the hair. Type II 5 alpha reductase convert the testosterone into DHT (Di Hydro Testosterone) in the outer root sheath cells and in the papilla cells of the hair.
DHT binds to Androgen Receptor inside the outer root sheath cells, papilla cells, and pilosebaceous cells. This DHT Androgen Receptor complex enter the nucleus of these hair cells and act on the DNA to produce Specific mRNA ,messenger RNA dictate the hair cell to produce hair damaging proteins , through these damaging proteins Hair go through miniaturization process and finally dies.
Every healthy hair on the head goes through a life cycle of an average 3-5 years. After completing its life the hair falls and grows back. In Hair loss the life cycle of the hair gradually gets reduced. Under the damaging affect of DHT the healthy hair become weaker and weaker with each successive cycle and finally dies. Healthy hair is called terminal, its diameter is more than 0.06 mm. When its diameter become less than 0.06 mm and still more than 0.03 mm, it is called intermediate. When the hair diameter is less than 0.03 mm, it is called vellus. Vellus hair become more and more thinner and finally dies.
Inhibation of Type II 5AR,
Finesteride inhibit the Type II 5 Alpha Reductase. Free testosterone which enters into hair cells cannot get converted into DHT. So in individuals with hair loss, blocking the DHT formation slows the progression of hair loss and even reverses the miniaturization process. Vellus and intermediate hair can become terminal healthy hair.
Side effects, In 0.3 % there is loss of libido or erectile dysfunction. That percentage reflects, if 300 men take Finesteride, there is no side effects for 299 men, only one man out of 300 experience loss of libido or erectile dysfunction. Finesteride reduces the serum PSA level by 30-50%.
Finasteride tablet 1mg/ day is approved by FDA for men 18-41 yrs of age , who have mild to moderate male pattern hair loss in mid frontal scalp area. Finasteride work best to prevent the ongoing hair loss. No change in hair density over the years during Finasteride treatment in balding men is considered a treatment success.
What is good time to start Finasteride
Any men who start losing more than average 100 hair a day , or even think he is losing more than average and have a family history of hair loss, go and see a Doctor specializing in hair .
Normally on scalp without any hair loss average 90% of the hair are off equal length on top of scalp and 90% hair roots are of equal depth of average 4 mm. Average 10% hairs are small and of variable length and 10% of hair roots are at average depth of 2 mm.
Hair Loss Test
Approximately 50 hairs are grasped in a rubber tipped surgical clamp and hairs are quickly jerked out of the scalp. The goal is to obtain telogen count. If 5 hair roots are found with average depth of 2 mm, it’s normal out of 50 hair. If 10 hair out of 50, have hair root depth of 2 mm, it’s means 20 % hair are in Telogen Phase, which represent the beginning of hair loss. If this person is advised to take finasteride 1 mg tablet daily and apply Minoxidil 5% twice daily. This man most likely retains his hair for life.
Normally most of men going through hair loss never consult with Doctor specializing in hair, unless hair start looking thin. No one,s hair look thin unless they lose more than 50% of their hair in thinning area. If this person with thin look is advised Finasteride and Minoxidil, most likely he can maintain this thinning look for life, which is still better than going bald.
Medical option of Finasteride, Minoxidil and laser photo therapy is great early on. As annual medical check up can safe us from many life threatening conditions by finding and treating them early, same hold true, find hair loss early by simple pluck test every two year, hair loss will be history .