Available Treatments for Men & Women
Overview:Being able to detect the beginning stages of hair loss by understanding its causes can be important for successful prevention or intervention. Unfortunately hair loss can affect people at any point in their life, sometimes beginning in their 20s. According to the Mayo Clinic, the most common cause of hair loss is a hereditary condition called male pattern baldness and female pattern baldness. The genetic predisposition causes the person to be more sensitive to specific sex hormones which trigger hair loss. The sensitivity to hormones causes the hair follicles to shrink which leads to thinning hair and eventual loss of hair. The medical term for this type of hair loss is called “androgenetic alopecia”. Androgen is a term used to describe any hormone that promotes male characteristics, testosterone being the most well-known. Hair loss can also result from another type of hormone disorder including hypo/hyper thyroid and adrenal imbalance.
TYPES OF HAIR LOSS
Male and Female Pattern Baldness, also known as “Androgenic Alopecia”, is the most common cause of hair loss and will affect up to 70% of men and 40% of women at some point in their lifetime. Men typically present with hairline recession at the temples and hair-loss on the upper surface of the head, also known as vertex balding. Women typically present diffuse, or scattered, thinning of the hair over the top of their scalps. People who suffer from this type of hair-loss have an underlying sensitivity to “hair follicle miniaturization” due to androgenic hormones. Miniaturization refers to the shrinking of the hair follicle which results in the thinning or loss of hair. Dihydrotestosterone (DHT) is the primary hormone associated with the miniaturization of hair follicles. DHT is a by-product of the hormone Testosterone, found in both men and women although typically much higher in men. Testosterone converts naturally to DHT through a hormonal pathway called 5 Alpha Reductase. Certain hairs on your head may genetically susceptible to thin if exposed to excess levels of DHT. DHT can attach to the hair follicle and prematurely make it shed while shrinking the follicle which prevents normal hair re-growth. Instead of normal, healthy hair re-growing in its place, a thinner, finer hair replaces it. According to the Foundation for Hair Restoration, the onset of miniaturization from androgenic alopecia is due to three factors.
- Genetic predisposition- Miniaturization of hair is genetic, the genes come from either parent or both.
- Presence of Dihydrotestosterone – The presence of DHT is the second factor
- Age – The older you are, the more likely you are to experience miniaturization of your hair
CAUSES OF HAIR LOSS
There are other causes of hair loss such as poor nutrition, especially lack of protein or iron in the diet. Hair returns after you change your diet to get enough of these nutrients. Other causes include certain diseases, chemical exposure, or drug use.
Androgenic Alopecia-More than 95% of hair-loss in men is due to this condition. Women can also be affected by this common type of hair loss.
Poor Nutrition-Usually complete baldness is not seen in people with nutritional deficiencies, thinning of the hair is more common. Studies show that limited food intake and deficiencies in certain nutrients can cause thinning. These include deficiencies of biotin, amino-acids (protein), zinc, and iron. Consuming a diet high in animal fat, such in fast food, can also have a negative effect on hair loss.
Stress-Stress has been shown to restrict the blood supply to capillaries which prevents oxygen and nutrients from reaching the hair follicle which can prevent hair growth. This effect is similar to having poor circulation.
Medications-Some medications can cause hair loss, especially medications which affect hormone levels. These medications include contraceptive pills, some forms of hormone replacement therapy, anabolic steroids, and acne medication. Other medications which can have an effect on hair loss include those for blood pressure problems, diabetes, heart disease, and cholesterol.
FDA Approved Treatments for Hair-Loss
There are currently two treatments approved by the FDA for the miniaturization of hair-follicles from androgenic alopecia.
- Finasteride (Propecia)- The American Hair Loss Association notes finasteride is a prescription oral treatment for male pattern baldness. It reportedly reduces the active levels of DHT in your body to prevent miniaturization of hair follicles. Women should not take oral finasteride due to its risks. In addition, many men who are prescribed Finasteride to be taken orally by tablet experience significant side effects which reduce life quality. These side effects include loss of libido, erectile dysfunction, hypogonadism, gynecomastia, and sexual dysfunction.
- Minoxidil- An over the counter topical treatment that has been used since the 1990’s to treat baldness in men and women. It reportedly promotes new hair growth by increasing cutaneous blood flow to shrinking hair follicles. It is generally safe and can be effective by itself if used during the early onset of alopecia.
- Topical minoxidil fortified with finasteride:An account of maintenance of hair density after replacing oral finasteride. Finasteride acts by reducing dihydrotestosterone levels, thereby inhibiting miniaturization of hair follicles in patients with androgenetic alopecia (AGA). Oral finasteride is associated with side effects such as decreased libido, sexual dysfunction, and gynecomastia. Topical finasteride can be considered for hair density maintenance after initial improvement with oral finasteride, thereby obviating the indefinite use of oral finasteride. Topical finasteride may absorb less systemiacally than oral finasteride, therefore reducing the side effects associated with oral finasteride. Read More
WARNING: Oral Finasteride (Propecia) is commonly prescribed to men with male pattern baldness with the intent to block the production of the hormone Dihydrotestosterone (DHT). The problem with taking Finasteride is that it may cause a condition called hypogonadism in men resulting in side effects including impotence, low sperm count, depression, anxiety and many other significant side effects which can last long after the drug is discontinued. We recommend that men do not take Finasteride orally to treat MPB and to try other available options first.
Platelet-Rich Plasma Injections for Hair Restoration
Defy Medical provides Platelet-Rich Plasma (PRP) injections as part of an integrative approach to restore your hair and prevent the further loss of your hair.
PRP therapy has established itself to be effective as a medical treatment modality in the specialty fields of oral surgery, neurosurgery, plastic and cosmetic surgery, sports medicine and orthopedics. It has been used extensively in these specialties for the last twenty years with generally positive outcomes and success. In the field of hair restoration, evidence supports PRP therapy as a promising treatment option to promote hair growth.
Platelet rich plasma (PRP) is a concentrated blood sample that contains high levels of platelets, a critical component of the wound healing process. Platelets contain growth factors that are responsible for stimulating tissue generation and repair. Growth factors derived from platelets are responsible for soft tissue repair, bone regeneration, development of new blood vessels, and stimulation of the wound healing process. Platelets can theoretically cause growth of the hair follicles by stimulating the stem cells and other cells in the microenvironment of the hair follicle. The primary purpose of using PRP in hair restoration is to stimulate inactive or newly implanted hair follicles into an active growth phase.
PRP Specific Growth Factors that influence hair growth include:
- Platelet-Derived Growth Factor (PDGF)—promotes blood vessel growth, cell replication, skin formation;
- Transforming Growth-Factor-Beta (TGF-b)—promotes growth of matrix between cells, bone metabolism;
- Vascular Endothelial Growth Factor (VEGF)—promotes blood vessel formation;
- Epidermal Growth Factor (EGF)—promotes cell growth and differentiation, blood vessel formation, collagen formation;
- Fibroblast Growth Factor-2 (FGF-2)—promotes growth of specialized cells and blood vessel formation; and,
- Insulin Like Growth Factor - (IGF)—a regulator of normal physiology in nearly every type of cell in the body
Inside the Platelets are many intracellular structures such as glycogen, lysosomes and alpha granules. These granules within the PRP contain clotting and growth factors that are eventually released during the healing and repair process.
Terumo Harvest Smart Prep System
Defy Medical uses the Harvest SmartPrep system which is the gold standard in PRP and Stem Cell harvest technology.
With its patented Cell Capture™ Technology, the Harvest SmartPrep® System consistently delivers the optimal cellular composition and concentration of autologous platelet product to optimize conditions for healing & restoration.
- Recovers the highest percentage of platelets and corresponding growth factors – up to 80% of available platelets
- Contains increased concentrations of stem cells
- Reduces the granulocyte levels to deliver a non-inflammatory product
- Generates the greatest level of reproducibility – only 5% coefficient of variance
- Only 15 minutes processing time for the highest quality PRP
- In addition the Harvest system has documented sterility of concentrated platelet product when following the manufacturer’s instructions for use
Harvest PRP delivers a concentration of autologous platelets and growth factors that is roughly 4-6 times greater than that found in whole blood. Unlike other products, it delivers a broad range of growth factors in the proper concentration and ratios to help optimize conditions for healing. Clinical studies have shown that application of PRP can help reduce bleeding, minimize pain, reduce infection rates, and optimize overall healing.
Harvest is a leader in products used to process and concentrate platelets, bone marrow aspirate, and adipose tissue.
Click here to learn more about the Harvest PRP technology.
How PRP Hair Restoration Works
Initial Laboratory Tests
We will require a few lab tests prior to your first treatment. The purpose is to provide a review of your overall health in addition to blood characteristics including platelet count prior to receiving PRP treatment. The tests included in this panel will also detect common hormonal causes of pattern baldness in both men and women allowing for the customization of hair restorative treatments. All tests are included with the initial treatment.
- Testosterone Free & Total
- Dihydrotestosterone (DHT)
- Estradiol (Estrogen E2)
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel
- Thyroid Stimulating Hormone (TSH)
Blood work is not required for follow up PRP treatments
Step 1: Harvest
A nurse will perform your phlebotomy (blood draw). A specific amount of blood will be drawn depending on the amount of PRP needed for your treatment
Step 2: Separate - Platelet Concentration
Immediately following the phlebotomy your blood will be processed to recover the highest percentage of platelets with corresponding growth factors and high concentration of stem cells.
Step 3: Activate
PRP is activated.
Step 4: Platelet Injection
A topical numbing block will be applied to the top of your head to. Additional anesthetic is available by injection for complete numbing. Result - eliminates any pain during the procedure.
At this time the doctor will inject the Platelet Rich Plasma (PRP) at specific intervals and depth to ensure the entire treatment area has been thoroughly exposed to the PRP.
PRP Safety and Contraindications
PRP has been used successfully in other medical and surgical disciplines for many years. The decision to use PRP is a personal decision and should be made after careful research, consideration and consultation with a physician. PRP is safe and natural because the procedure concentrates the good cells from your own blood and injects them directly back into the area where it is needed. PRP is immunologically neutral and poses no danger of allergic, hypersensitivity or foreign-body reactions.
Who is a good candidate for PRP Hair Restoration?
In the medical treatment of male and female pattern baldness (androgenetic alopecia), PRP can be injected into the balding scalp to potentially stimulate thin (miniaturized) hair to grow into thicker (terminal) hairs. Patients with thinning, but not totally bald, areas would be the best candidates.
Who is not a good candidate for PRP?
Patients with history of heavy smoking, drug and alcohol use. Medical diagnosis such as platelet dysfunction syndromes, thrombocytopenia, hypofibrinogenaemia, hemodynamic instability, sepsis, acute and chronic Infections, chronic liver disease, anti-coagulation therapy, chronic skin diseases or cancer, metabolic and systemic disorders.
If the hair follicles are entirely lost, the treatment will not work. Patients who have lost their hair follicles require hair transplant surgery.
A brief period of inflammation at wound sites may be experienced by a patient after application of PRP. Inflammation may be associated with release of platelet-associated factors at the wound site. In addition, the scalp is usually tender for a few days after the procedure.
After the initial treatment, a second treatment is recommended at 4 weeks and then repeated every three months for the first year. After the first year, treatments are administered every 6-12 months depending upon your response.
PRP Hair Restoration Price
First treatment- $1250
- Laboratory testing
- Lab review & physician evaluation
- Platelet Rich Plasma Injections
- Latanaprost Topical Foam
- Follow-up treatment- $795
- Platelet Rich Plasma Injections
The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial
Platelet-rich plasma (PRP) has emerged as a new treatment modality in regenerative plastic surgery, and preliminary evidence suggests that it might have a beneficial role in hair regrowth.
DOWNLOAD FULL PDF
Hormone Testing & Treatment for Hair Loss
The most common type of hair loss experienced by men and women is caused by a sensitivity to androgenic hormones like Dihydrotestosterone (DHT). Dihydrotestosterone (DHT) is the primary hormone associated with the miniaturization of hair follicles. DHT is a by-product of the hormone Testosterone and is found in both men and women, although typically much higher in men. Testosterone converts naturally to DHT through a hormonal pathway called 5 Alpha Reductase. Finasteride is an FDA approved medication commonly prescribed to block 5-Alpha Reductase therefore significantly reducing DHT production. Although this method may slow hair loss, reducing DHT can lead to unpleasant symptoms and side effects leading to a decreased quality of life. DHT is an important hormone that plays a role in the regulation of libido, body composition, bone density, cardiovascular function, and positive mood. Therefore it is optimal to reduce DHT activity directly on the hair follicle while preserving a healthy level of this important hormone in the body. Other hormones can influence hair health and regeneration including hormones produced in the thyroid and adrenal glands.
A simple blood test can help determine androgen levels including testosterone and dihydrotestosterone (DHT). Thyroid and adrenal hormones will also be analyzed along with other important bio-markers so that treatment can be customized to restore any hormone imbalance while protecting hair follicles and preserving quality of life.
Compounded thyroid restoration is available for patients diagnosed with hypo or hyper thyroid. We also offer bio-identical hormone restoration for aging men and women who have a deficiency or imbalance of sex, adrenal, thyroid, and pituitary hormones.
Effective Compounded Topical Medications
There are medications available which have shown to be effective for the treatment of alopecia when applied topically. These medications are available at compounding pharmacies who specialize in making custom medication formulas.
Doctors who specialize in hair loss have partnered with various compounding pharmacies to design topical formulas which effectively treat, prevent, and reverse hair thinning and loss depending on the cause. These formulas are available a Defy Medical and can be customized based on your condition, and the cause of that condition. A prescription is required to purchase these formulas.
Here is a list of ingredients which can be included in your custom formula;
Latanaprost-A double-blind scientific study published in the May 2012 issue of the Journal of the American Academy of Dermatology has found that latanoprost, a drug that mimics naturally-derived compound molecules called prostaglandins, significantly increases hair density on the scalp after 24 weeks of treatment in young men with mild hair loss. Latanoprost, like the eyelash restoration drug bimatoprost (better-known by its brand name Latisse), has been used to treat glaucoma. And like bimatoprost, latanoprost has been used to treat eyelash alopecia. The scientists who conducted the study sought to determine if latanoprost could stimulate hair growth when applied topically on the scalp.
Ketoconazole-Ketoconazole, an anti-fungal medication, can also be effective in stimulating new hair growth if you suffer from androgenetic alopecia. Androgenetic alopecia, also called male and female pattern baldness. Dihydrotestosterone is the hormone responsible for shrinking hair follicles in people who have this condition. In addition to killing fungi, ketoconazole is also helpful in countering the effects of Dihydrotestosterone.
Spironolactone-If you have female pattern baldness caused by excessive androgens and do not respond well to minoxidil, Defy’s physician will also prescribe spironolactone. Spironolactone is usually prescribed as a tablet which helps reduce water retention (edema). It will also lower testosterone and androgen levels produced in the ovaries and adrenal glands. Typically this would be a therapy specific for woman who experience pattern baldness. Spironolactone can be also used in a topical scalp solution in combination with other ingredients designed to treat hair loss. Men can also use Spironolactone topically for the same objective, to reduce the effect of androgen hormones on the scalp. This is a great option for men who do not want to take any risk using Finasteride.
Azelaic Acid-a naturally occurring substance found in whole grains that contains a mild antibiotic designed to reduce harmful bacteria from the skin. It is also said to be a potential inhibitor of 5-alpha-reductase in human skin. A reduction of this enzyme reduces the amount DHT (Dihydrotestosterone) in the body and therefore, have a similar effect to finasteride; the active ingredient in FDA approved oral hair loss solution Propecia (finasteride).
Minoxidil-the number one treatment prescribed for male and female pattern baldness. It helps to increase blood flow bringing more nutrients and oxygen to the hair follicle. Minoxidil is best applied topically
FACT:Most people normally shed 50 to 100 hairs a day. But with about 100,000 hairs in the scalp, this amount of hair loss shouldn't cause noticeable thinning of the scalp hair- The Mayo Clinic
FACT:Almost half of all people have inherited hair loss by about 50 years of age.
Defy Medical Custom Topical Formulas
Level 1- For thinning hair
Minoxidil 3%/Ketokonazole 1% Scalp Solution 60ml (30-45 day supply)- $120.00
Level 2- For mild to moderate hair loss
Minoxidil 5%/Azelaic Acid 12.5% 60ml - $120.00
Level 3- For noticeable hair loss
Minoxidil 5%/Ketoconazole 2%/Spironolactone 2%/Azelaic Acid 12.5% 60ml - $135.00
Minoxidil 5%/Ketoconazole 2%/Finasteride 0.01%/Azelaic Acid 12.5% 30ml/60ml- $156/$275
Minoxidil 5%/Ketoconazole 2%/Latanaprost 0.003%/Azelaic Acid 12.5% 30ml/60ml- $156/$275
Minoxidil 5%/Ketoconazole 2%/Latanaprost 0.003%/Azelaic Acid 12.5%/Finasteride 0.01% 30ml/60ml- $156/$275
Prevention and Re-Growth
Latanaprost Topical Foam 30ml - $156
Finasteride/Latanaprost Topical Foam 30ml- $156
McElwee, K. J.; Shapiro, J. S. (2012). "Promising therapies for treating and/or preventing androgenic alopecia". Skin therapy letter 17 (6): 1–4. PMID 22735503.
Proctor, P. H. (1999). "Hair-raising. The latest news on male-pattern baldness". Advance for nurse practitioners 7 (4): 39–42, 83. PMID 10382384.
Leavitt, M. (2008). "Understanding and Management of Female Pattern Alopecia". Facial Plastic Surgery 24 (4): 414–427. doi:10.1055/s-0028-1102905. PMID 19034818.
Drugs.com | Propecia Side Effects Bernard, B. A. (1994). "Molecular approach of hair biology". Comptes rendus des seances de la Societe de biologie et de ses filiales 188 (3): 223–233. PMID 7834505
"Propecia (Finasteride) Drug Information: User Reviews, Side Effects, Drug Interactions and Dosage". RxList. Mar 13, 2010. Retrieved Nov 28, 2010.
Foitzik, K.; Hoting, E.; Förster, T.; Pertile, P.; Paus, R. (2007). "L-Carnitine–L-tartrate promotes human hair growth in vitro". Experimental Dermatology 16 (11): 936–945.
University of Maryland Medical Center: Alopecia (http://umm.edu/health/medical/altmed/condition/alopecia)
Hajheydari, Z.; Akbari, J.; Saeedi, M.; Shokoohi, L. (2009). "Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia". Indian journal of dermatology, venereology and leprology 75 (1): 47–51.