Drug treatments for hair loss
What it is
Affecting the follicle structure or function: Pharmaceutical hair restoration treatments use manufactured chemical substances to affect the structure or function of the hair follicles in an effort to stop hair loss and promote hair growth. Pharmaceuticals are medications and drugs. Some hair loss medications work by causing hair follicles that have shrunk or shut down, to enlarge and again grow hair. Hair restoration medications are used to treat both sudden temporary hair loss, as well as chronic hair loss that starts slowly and becomes progressively worse over time. The medications used for hair restoration may be applied to the skin, taken by mouth, or injected. Pharmaceutical treatments include the use of both prescription and non-prescription drugs.
Prescription medication: Prescription pharmaceutical treatments use drugs that must be prescribed by a licensed Medical Doctor (M.D.). Prescription medications are intended for disease conditions that require skilled medical diagnosis to properly identify the specific cause of the condition. Prescription drugs are typically powerful substances, with the potential for causing serious undesirable side effects if not used as directed and for their intended purpose. Sometimes more potent versions of non-prescription medications are available by prescription only.
Prescriptions for Hair loss? Prescription medications sold in the United States are approved for use by the US Food and Drug Administration (US FDA) only after extensive testing to assure that they are both safe and effective for their intended use, and can be manufactured with consistent high quality. Although prescription medications are approved by the FDA as treatments for specific conditions, and none are specifically approved at this time to treat hair loss, licensed Medical Doctors are able to prescribe almost any medication for any condition, as they see fit as medical professionals. Medications approved for other uses, that may also stop hair loss or stimulate hair growth, are prescribed by M.D.'s for treating hair loss.
OTC medication: Pharmaceutical treatments that can be purchased withouta prescription are categorized as over-the-counter medications, because they can be purchased "over the counter" from a pharmacy or personal care products retailer. Like prescription drugs, OTC medications contain "active ingredients" which affect the body's structure or function in order to treat a medical condition. OTC medications are intended for conditions that do not generally require skilled medical diagnosis, are generally less powerful than prescription drugs, and are less likely to cause harmful side effects. Minoxidil is the best known pharmaceutical hair loss treatment, and it is now available in the US as an OTC medication. At this time, minoxidil is the only pharmaceutical approved by the US FDA as being safe and effective for treating hair loss.
It's still medicine: Although they do not require a prescription, OTC medications are still medicine, and they should used only as directed. OTC medications sold in the United States are approved for use by the US Food and Drug Administration only after becoming generally recognized as safe, or after extensive testing to assure that they are both safe and effective, and that they can be manufactured to US FDA purity standards to assure high quality.
Drug combinations: Pharmaceutical treatments for hair loss may include combinations of drugs, including both prescription and non-prescription medications, to achieve better results than using individual drugs alone.
Extensive testing: Before any medication can be sold in the United States, it must either be generally recognized as safe, or it must successfully undergo years of extensive (and very expensive) testing, first on animals in laboratory tests, and then on people in clinical trials. The testing helps to determine the medication's safety, side effects, and most effective dosage for its intended use.
Purity: The United States Pharmacopeial Convention (USP) is a non-profit organization that sets quality standards for all prescription and OTC medications sold in the United States. USP standards help to assure consistent potency and dosage of medications. The USP seal also indicates that the ingredients in the medication are exactly as stated on the label, and that the medication is pure and uncontaminated.
Effectiveness: Some medications do indeed stop hair loss, and some help regrow hair with continuous use. Actual results vary considerably from person to person. Many people will not experience any benefits. Some will have a reduced degree of hair loss. Others will see a modest amount of regrowth. And some people will respond to certain pharmaceutical treatments with substantial regrowth of their own hair.
Own hair: Pharmaceutical treatments affect one's own hair follicles, and encourage the regrowth of one's own hair. When pharmaceutical treatments do have a positive effect, there is nothing artificial about the regrown hair and nothing to fall off.
Risks of drug treatments for hair loss
Continuous treatment required: Pharmaceutical treatments for hair loss are not permanent cures. Medications prescribed for hair regrowth do not cause a permanent change in the conditions causing hair loss. In almost every case, the pharmaceutical treatment must be continued in order to keep the new hair. If treatment is discontinued, the new hair will be shed, and hair loss will resume. Those using pharmaceutical treatments for hair loss must think about treating their hair loss every day.
Limited results: The overall effectiveness of pharmaceutical treatments for treating hair loss is modest at best. Many people show no response or only a minimal response to particular medications.
Delayed results: Pharmaceutical treatments usually take considerable time to achieve results, often requiring many months of continuous treatment before the first effects are realized, and many more before the best results are seen.
Side effects: Sometimes hair loss treatment medications cause undesired reactions unrelated to the problem being treated. Medications applied to the scalp that are not absorbed easily into the blood stream, but that do affect the hair follicles generally have fewer serious side effects than those that require medicating the entire body.
Cost: Pharmaceutical treatments for chronic hair loss are generally inexpensive when measured on a daily basis, however when these costs are added up over a lifetime, pharmaceutical treatments can be considered costly.
Unpleasant delivery: Pharmaceutical treatments for hair loss may involve unpleasant delivery methods for getting the drugs into the body. Some treatments involve lotions applied to the scalp which may feel or look unpleasant. Others require injections, and some pharmaceutical treatments require pills or liquids to be taken by mouth.
Prescription medicine: In the United States, a Medical Doctor must prescribe these drugs for hair loss treatment. In other countries, some of these medications may not require a prescription for purchase.
Anti-androgens: Anti-androgens are prescription medications that decrease the action of androgen hormones that occur naturally in the body. Androgen hormones play key roles in triggering hair loss in people with a genetic predisposition to androgens, a condition known as androgenetic hair loss. In men androgenetic hair loss is commonly referred to as "male pattern baldness" and in women it is "female pattern baldness". Anti-androgens act in a variety of ways, including reducing androgen production, and blocking androgens from attaching to androgen receptor sites on hair follicle cells.
Finasteride (Proscar): Finasteride is a prescription anti-androgen medication prescribed for men with enlarged prostrate glands, and is sold under the brand name Proscar. It inhibits an enzyme called 5-alpha-reductase-1 that converts testosterone into DHT, which is the androgen that triggers hair loss in those with a genetic predisposition to androgenetic pattern hair loss. Finasteride can stop further hair loss, and may be combined with other medications such as minoxidil to promote hair growth.
Spironolactone: Spironolactone is a prescription anti-androgen medication prescribed for people with high blood pressure, and is sold under the brand name Aldactone. It decreases adrenal gland production of testosterone and, as the medication is broken down by the body, one of its break down products also interferes with DHT binding at hormone receptor sites on hair follicle cells. It has been used as a hair loss treatment in tablet form and as a topical lotion for women with elevated androgen levels and a genetic predisposition to androgenetic alopecia. Spironolactone may cause irregular menstruation, mood swings, and may feminized a male fetus in pregnant women.
Cyproterone acetate: Cyproterone acetate is a prescription anti-androgen medication that stops the activity of the ovaries and testes, including the production of both androgens and estrogens. Cyproterone acetate also interferes with DHT binding at hormone receptor sites on hair follicle cells. When used to treat androgenetic hair loss in women, it is combined with a powerful estrogen hormone called ethinyl estradiol.
Estrogens: Estrogens are a class of hormones that are prescription anti-androgens. Estrogens counterbalance and help regulate androgens. Estrogens compete with androgens at hormone receptor sites on hair follicle cells, but do not trigger hair loss. Women generally have higher proportions of estrogens than androgens when compared to men. The high levels of estrogen hormones in women usually protects those women who have a genetic predisposition for androgenetic hair loss from losing their hair. When women with a genetic predisposition to androgenetic hair loss produce reduced amounts of estrogens, or increased levels of androgens, they may experience pattern hair loss. Estrogen treatments for hair loss attempt to elevate estrogen levels in the body. Estrogen treatment may cause irregular menstrual cycles, and possibly increased risk of cancer in women. Men may experience decreased sex drive.
Cimetidine: Cimetidine is a prescription anti-androgen medication prescribed for stomach ulcers. It inhibits DHT and increases estrogen hormone activity. It has been used as a hair loss treatment for women with elevated androgen levels and a genetic predisposition to androgenetic alopecia. Cimetidine may cause women to experience breast milk production not related to pregnancy or nursing. When used by men, cimetidine may cause of enlarged breasts, loss of sex drive, and impotence.
Antibiotics: Antibiotics are a general class of medications designed to kill a variety of living microorganisms that invade the body. Some microorganism infections can cause hair loss. Antibiotic treatments for hair loss include drugs designed to control certain bacteria, viruses, and fungi.
Anti-bacterial: Bacteria are single-cell microorganisms that invade the body when there are open wounds or the immune system is otherwise compromised. Bacterial infections of just the hair follicles usually do not cause permanent hair loss. Some bacterial infections of the entire scalp can lead to tissue death and also hair loss. Severe bacterial infections of the entire body can in some cases cause permanent hair loss. One extreme example is syphilis, a sexually transmitted bacterial infection which can cause hair loss within 2 months to 2 years of infection. If untreated, syphilis results in premature death. Syphilis is treated with penicillin. Other bacterial infections that may cause hair loss are treated with a wide variety of powerful prescription anti-bacterial medications.
Anti-viral: Viruses are tiny organisms that can only live in the cells of other organisms. Some viral infections of the scalp can lead to tissue death and hair loss. Shingles, called herpes zoster by doctors, is a painful viral infection that may involve the scalp and may cause permanent hair loss in these cases. Acyclovir is an anti-viral medication that may reduce the degree of hair loss when used in the early stages of herpes zoster infections of the scalp.
Anti-fungal: Fungi are primitive plants that lack chlorophyll, and reproduce by spores. Yeast, mold, mildew, and mushroom are all fungi. Some fungal infections of the scalp can lead to hair loss. Ringworm, called tinea capitis by doctors, is a common fungal infection of the scalp that if untreated may just go away, or may lead to hair loss. Oral griseofulvin, a powerful prescription anti-fungal medication, and the use of a selenium sulfide shampoo, combine to make a common treatment program for ringworm.
Insecticides: Certain insects such as lice can invade the scalp. Lice lay their eggs on hair and feed on blood from the scalp. Lice cause itching, scratching, and open wounds that easily become infected. This can lead to hair loss. Lice infestations are treated with prescription insecticide shampoos that are designed to kill both the adult lice and their egg cases, called nits.
Immune suppressants: Immune suppressants are prescription medications that are designed to reduce the body's immune reaction in situations where the immune system seems to be attacking the body's own hair follicles. Many skin diseases without known causes that include hair loss among their symptoms are suspected to be immune-system related.
Steroids: Steroids are a type of hormone, called corticosteroids by doctors because they are made by the cortex of the adrenal gland. Steroids, like other hormones, regulate body functions. When used to treat certain conditions that cause hair loss, they may be used to "confuse" the immune system and allow the body to regrow hair. Steroids are used to treat alopecia areata, a hair loss condition suspected to be caused by an immune system disorder. Steroids may be applied to the scalp, may be taken as tablets, may be injected into the affected areas, or a combination of delivery methods may be used.
UV light: Ultra violet light has been used to treat alopecia areata, a hair loss condition suspected to be caused by an immune system disorder. Bursts of light sufficient to cause inflammation, similar to mild sunburn, have resulted in some regrowth of hair. Some UV treatments include the use of psoralens, which are compounds that make the skin more sensitive to light.
Liquid nitrogen: Liquid nitrogen is a very cold liquid form of nitrogen gas that instantly freezes on contact whatever it touches. Liquid nitrogen has been used to treat alopecia areata, a hair loss condition suspected to be caused by an immune system disorder. Liquid nitrogen is applied to the affected scalp by spraying or with a cotton swab until the surface of the skin freezes, and the skin is then allowed to thaw. Sometimes after just a one or two treatments spaced a week apart, there is some hair regrowth.
Thyroid hormone replacement: Thyroid hormone replacement is a hair loss treatment for people who have hair loss as a result of an under-active thyroid gland, a condition doctors call hypothyroidism. In some cases, diffuse hair loss may be the only symptom of hypothyroidism, but in many people with hypothyroidism the hair is not affected. Thyroid hormone is administered to elevate the level of thyroid hormone to normal levels. Regrowth of hair occurs in approximately 8 weeks.
Prescription strength minoxidil: 2% topical lotion Minoxidil is available without a prescription. Stronger concentrations are prepared by some Pharmacologists and Medical Doctors who specialize in pharmaceutical hair loss treatment. These specially prepared formulas are available by prescription only.
Tretinoin (Retin-A): Tretinoin is medication for reducing skin wrinkles, and is sold under the brand name Retin-A. It increases collagen production and causes inflammation on the skin when applied topically. Tretinoin is not approved for use as a hair loss treatment, however when used on the scalp in combination with minoxidil, it has been shown to increase hair growth more than minoxidil used alone.
Over-the-counter medications: These are drugs that are controlled in the United States by the Food and Drug Administration. A prescription is not required for their purchase. Presently, minoxidil is the only FDA approved OTC pharmaceutical treatment for hair loss.
Minoxidil (Rogaine): Minoxidil is a medication originally prescribed in tablet form for certain extreme high blood pressure conditions, and now is also sold as a medicated hair growth lotion under the brand name Rogaine. Minoxidil reduces blood pressure by dilating blood vessels, however how it helps to regrow hair is not exactly determined. Other vasodilators do not grow hair. Hair growth was discovered as a side effect of minoxidil treatments for high blood pressure. After years of studies to prove effectiveness, in 1988 minoxidil became the first medication approved by the US FDA for treating hair loss. At present, it is still the only medication approved for this purpose. Minoxidil is applied as a lotion on the scalp two times each day. In 1995 the US FDA declared that a prescription was no longer required for the purchase of minoxidil in the United States.
Adequate health: Other than pregnant and nursing women, who are rarely included in clinical trials to determine the safety and effectiveness of drugs, most people are acceptable candidates for pharmaceutical treatments for hair loss. Each medication has unique chemical properties however, and each has possible side effects which have to be considered.
Indicated condition: Medications selected must be appropriate for the specific condition causing hair loss. Many pharmaceutical treatments for hair loss are intended for specific disease conditions, and are not effective for treating inherited pattern hair loss.
Early intervention: The best time to medically treat hair loss is as early as possible. Those just beginning to have thin hair will get a better response to pharmaceutical treatments than those with large and well established bald spots.
Ask your pharmacist: Pharmacists are experts in drug chemistry, including both prescription and OTC medications. Often they are very pleased to provide counseling on medications, and answer your questions about medication effectiveness. Pharmacists can advise about possible drug interactions with food and other medications, and also possible side effects of various medications.