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Medication

Therapy

Early stages of hair loss can be slowed or reversed with medication. FDA-approved drugs include minoxidil and finasteride. Finasteride is an oral medication taken for hair loss, and it works by reducing the level of DHT produced by the 5-alpha reductase type 2 enzyme by 85-90%, thereby reducing total serum DHT by 65-70% and protecting the hair follicles from further DHT damage. Dutasteride, a similar drug, is used off-label as a hair loss treatment. Dutasteride lowers DHT levels more potently than finasteride by inhibiting the production of DHT by the 5-alpha reductase type 1 in addition to type 2 enzyme, and is, therefore, in theory, more effective. However, it is not FDA-approved as a hair loss treatment, and its long-term side effects (including possible neurological damage) are unknown. Minoxidil is a growth stimulant that stimulates already-damaged hair follicles to artificially produce normal hair. Minoxidil does not, however, provide any protection to the follicles from further DHT damage, and when a follicle eventually becomes completely destroyed by DHT, minoxidil will no longer be able to have any more regrowth effects on that follicle. Topical formulations of finasteride have been argued to be of similar efficacy to systemic, though prostate weight and serum PSA levels were not measured to exclude systemic absorption of topical application as the cause of hair growth.Other treatment options not already mentioned include tretinoin combined with minoxidil, ketoconazole shampoo, and spironolactone.

More advanced cases may be resistant or unresponsive to medical therapy, and require hair transplantation. Naturally occurring units of one to four hairs, called follicular units, are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either follicular unit transplantation (FUT) or follicular unit extraction (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites. Specialized scalp tattoos can also mimic the appearance of a short, buzzed haircut.

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