Hair loss is often associated with men and aging, but it can happen to women and children, too. Many people have thinning hair or bald areas on their head.

You can lose hair slowly or quickly. Whether or not your hair will eventually grow back depends on the cause. A family history of baldness, medical conditions or their treatments, and many other things cause hair loss.

The most common type of hair loss is called androgenetic alopecia¹ , also known as male- or female-pattern baldness. It tends to run in families and causes your hair to fall out gradually. As men get older, they may start to lose hair in the front of their scalp. The pattern of hair loss for women is different. Their hair may thin out all over their scalp but is often most obvious along the part.

According to the American Hair Loss Association, androgenetic alopecia or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men² . By the age of thirty-five two-thirds of American men will experience some degree of appreciable hair loss, and by the age of fifty approximately 85% of men have significantly thinning hair. Approximately twenty-five percent of men who suffer from male pattern baldness begin the painful process before they reach the age of twenty-one.

Dihydrotestosterone (DHT) is an enemy of Hair Strands

Dihydrotestosterone³  (DHT), a derivative of the male hormone testosterone, is the enemy of hair follicles on your head. Simply put, under certain conditions DHT wants those follicles dead. This simple action is at the root of many kinds of hair loss, so we’ll address it first.

Both men and women with androgenetic alopecia can apply medicines to their scalp to slow the progression of their hair loss. However, some medications are only FDA-approved for men. Some men (and occasionally women) opt for hair transplant surgery, in which tiny plugs of hair are moved from the back of the head to the front. This option depends on how much hair is available for a transplant.

Hair Loss Treatments for Androgenetic Alopecia for Women⁴ 

1. Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil experienced excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth. The amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.
2. Spironolactone or the more popular brand name Aldactone is in a class of drugs called potassium-sparing diuretics (water pill). It is used to reduce the amount of fluid in your body without causing the loss of potassium. It is also used to treat hypertension (high blood pressure) and edema (swelling) and used to treat potassium deficiency and hyperaldosteronism (a hormonal disorder).Spironolactone is an antiandrogen that works in two ways. Primarily it slows down the production of androgens in the adrenal glands and ovaries. Secondly, it blocks the action of androgens in part by preventing dihydrotestosterone from binding to its androgenetic receptor.
3. Cimetidine sold under the brand name Tagamet belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block dehydrotestosterone form binding the follicle receptor sites.Cimetidine has been used to treat hirsutism in women (excess facial hair growth) and has been studied in women with androgenic alopecia showing promising results. Because of the high doses needed to achieve it’s hair-raising results, men should not take cimetidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.
4. Since birth control pills decrease the production of ovarian androgens, they can be used to treat women’s androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness.
5. Available as a topical treatment by prescription, Ketoconazole is currently used as an antifungal agent in the treatment of fungal infections. It also has anti-androgenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs (in women, the ovaries). Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions but also in combination with other treatments for androgenetic alopecia.
6. The drug finasteride inhibits the enzyme 5-alpha reductase, thereby inhibiting the production of prostate-harming, follicle-killing DHT.

Treatments for Men⁵ 

1. Finasteride is the generic name for the brand name drugs Proscar and Propecia. Finasteride was originally developed by Merck as a drug to treat enlarged prostate glands (Proscar). During the trials on men with prostate problems, an intriguing side effect of hair growth was observed. Since finasteride had already been approved by the FDA to treat enlarged prostates in men, Merck and Company decided to pursue the possibility of developing finasteride as the first pill to treat male pattern baldness.On December 22, 1997, the FDA approved a 1 mg dose of finasteride for the treatment of androgenic alopecia in men (male pattern baldness). Propecia is the first drug in history to effectively treat male pattern baldness in the vast majority of men who use it.
2. Minoxidil (Loniten) was the first drug approved by the FDA for the treatment of male pattern baldness. For many years, minoxidil, in pill form, was widely used to treat high blood pressure. Just like finasteride researchers discovered a very interesting side effect of the drug. People taking the medication were growing hair in unexpected places like on their cheeks and the back of their hands, some even grew hair on their foreheads.Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. Well, it did this to varying degrees depending on the extent of the hair loss. For its time, this treatment was revolutionary.While minoxidil has been clinically proven to slow the progression of hair loss and regrow some hair, most informed experts see it as a relatively marginally effective drug in the fight against hair loss.

Another common type of hair loss is known as alopecia areata. Scientists recently discovered what causes this type of hair loss. Alopecia areata is an autoimmune disease. The immune system, which normally helps protect your body from disease, starts attacking hair follicles. Hair follicles are the part of the skin that hairs grow from. Usually, only small patches of hair on the scalp are lost. But in severe cases, hair all over the body may be lost. The hair loss may not be permanent because hair follicles are not destroyed. They are just stuck in a resting state.

Currently, there are no approved drugs for alopecia areata. However, an NIH-funded study recently discovered that a class of drugs called Janus kinase (JAK) inhibitors can stop, and even reverse, the disease. Dr. Angela Christiano, a skin disease expert at Columbia University, showed that JAK inhibitors block the damaging effects of the immune system on hair follicles. Many people who took the drug had their hair grow back in her study. More clinical trials are now underway to determine how safe and effective JAK inhibitors are for treatment of alopecia areata.

Hopeful Time for People with Hair Loss?

“I think it’s a hopeful time for patients with alopecia areata,” says Christiano, who also has the disease. She hopes that the excitement around alopecia areata research will carry over to other types of hair loss, which tends to be understudied diseases.

If you start losing clumps of hair or notice your hair thinning, check in with your doctor. They can help identify the cause, suggest possible treatments, and help you learn how to manage the condition.

Coping with the effects of hair loss on your head can be difficult, but there are many things you can do. “Find somebody that you trust and just talk about what’s going on,” advises Kathleen Baxley, who is the chief of social work at the NIH Clinical Center. She oversees a team that counsels people in clinical studies, including those who lose their hair because of treatment. “It really helps folks a lot of the time just to tell their story. You can speak with a family member or close friend. Or, you can reach out to a counselor.”

“Sometimes finding support groups helps,” Baxley adds. Support groups meet in person or have discussions online. For other tips on how to manage hair loss, see the Wise Choices box.

Take Care of Your Hair and Yourself

1. Be gentle. Use your comb or brush carefully.
2. Cover up. Wear a hat, scarf, wig, or hairpiece. It can protect your scalp from the sun.
3. Use sunscreen. Protect bald, uncovered areas from sun damage.
4. Try a new style. Ask your barber or hairstylist to make the most of your remaining hair.
5. Get support. Share your feelings and get tips for coping with hair loss from others with the same challenge. Or, ask for support from a counselor.

Hair loss can cause a lack of self-esteem and is the subject of a tremendous amount of study. The American Academy of Dermatology⁶  website on hair loss a good starting point. Please carefully discuss potential treatments with your doctor

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Bibliography

1. https://newsinhealth.nih.gov/2017/08/missing-strands
2. http://www.americanhairloss.org/men_hair_loss/introduction.asp
3. http://www.americanhairloss.org/women_hair_loss/causes_of_hair_loss.asp
4. http://www.americanhairloss.org/women_hair_loss/treatment.asp
5. http://www.americanhairloss.org/men_hair_loss/treatment.asp
6. https://www.aad.org/public/diseases/hair-and-scalp-problems/hair-loss