Hair Loss Types and Treatments

The first choice of treatment for hair loss, or alopecia, with good clinical evidence to support its use is the topical medication minoxidil, which is available as an over-the-counter medication.

Minoxidil is very well tolerated and side effects are rare. It comes in 2 and 5 per cent concentrations and, using a syringe dispenser, a millilitre of the solution is rubbed onto the affected area of the scalp in the morning and again at night.

It could take up to a year before results could be seen from using minoxidil and patients need to be willing to commit to long-term therapy. If treatment is stopped, its effects are quickly lost and hair loss would revert to what it would have been without treatment.

In general, one-third of women experienced a significant improvement in hair growth on minoxidil, one-third would have hair loss stabilised and one-third did not respond and continued to thin. Results for men were more optimistic with up to 85 per cent showing some benefit.

A second medication, finasteride, that comes in a tablet works by inhibiting an enzyme, 5-alpha reductase (type 2). Reducing the enzyme’s activity reduces the conversion of testosterone to dihydrotestosterone in the scalp and bloodstream, which appears to inhibit the further shrinking of affected hair follicles. Studies had shown up to 9 out of 10 men on long-term, daily finasteride had improved or stabilised hair counts.

This medication is prescribed only for men. It is not licensed for use by women because it could have devastating effects on an unborn baby.

While finasteride is generally well tolerated in men, some changes in sexual function were reported by a few.

For women, anti-androgen therapy could be prescribed, namely cyproterone acetate and spironolactone. These compounds block androgen receptors and stimulate scalp hair regrowth in women.

Other medical conditions could cause hair loss and hence it is important to get a correct diagnosis before commencing any treatment.

A diagnosis requires taking a full medical history, clinical examination and tests such as a scalp biopsy. This could help determine if it is pattern hair loss or something else mimicking it.

One of the more common types of hair loss that may be caused by an underlying medical condition is known as telogen effluvium. Triggers for telogen effluvium include hormonal changes after pregnancy, or when coming off the pill, an iron deficiency, thyroid disease, zinc deficiency or major psychological and physical stress.

Stress-related hair loss could happen three to six months after a stressful event occurred.

By identifying and treating the underlying medical condition then, hair loss due to telogen effluvium would often be reversed.

Research and clinic trials are ongoing for new medications and topical solutions. Some studies are being conducted on finasteride as a gel and another medication known as flutamide had recently shown good research results although there were some concerns over toxicity.