A study published in the journal JAMA Facial Plast Surgery in 2016 suggested what for many is an absolute truth: that men are more attractive (and appear younger) with hair. If we add to this that androgenetic alopecia, the most common form of baldness, affects almost half of men and up to 10% of women , it is easy to understand the myriad of remedies, with and without scientific evidence, that we find today.
Before solving a problem, you must confirm that it exists. I’m getting bold? Hair is made of keratin, like nails and, like nails, regenerates. “It is normal for something to fall out, a day we lose about a hundred hairs,” Sergio Vañó dermatologist and trichologist at the Ramón y Cajal University Hospital in Madrid explains to Sinc. It is also not a cause for concern if this average increases, since it varies depending on stress and the time of year.
The first step is a diagnosis, an assessment of deficiencies and an analysis to check its thickness, density and the presence of miniaturized hair.
When the skin of the scalp begins to show and the capillary density decreases, it is time to take action. “If the patient clears up, it is usually because the hair that is born is very fine. Then you have to go to the doctor ”, recommends Vañó, who remembers that it is in the dermatologist’s office, and not in the hairdresser, where we should seek help.
Androgenetic alopecia is caused by the action of male hormones, but it affects young men and women at any age after adolescence, although it is more common for them to start after menopause. The strategy to combat it varies with each patient. The director of the Madrid Institute of Integral Dermatology, Miguel Sánchez, warns that “if time is wasted, it is a territory that cannot be easily recovered.”
Hormones, stress, diet, diseases, medication, vitamins, minerals … Sánchez explains that hair “has many factors that make alopecia progress faster.” That is why the first step is a diagnosis, with a global assessment of possible deficiencies and a local analysis of the hair to check its thickness, density and the presence of miniaturized hair.
The miniaturized hairs are essential to determine if a drug treatment will work: “They are viable and alive hairs, which come out again although they are smaller and finer,” Sánchez clarifies. “With long treatments it can be reversed and its density improves”, but if there are bald spots, “areas with atrophied follicles”, transplantation is the only option.
Between these two extremes there is a wide range of options. That is why we have ordered the treatments from most to least effective, from the two main groups of drugs to scams, through more recent therapies but with less scientific evidence.
Finasteride and triggers
Finasteride and dutasteride – the latter more powerful and reserved for difficult cases – are the most popular drugs against baldness. In 2017, finasteride made headlines because according to Donald Trump’s doctor, he owes his ‘great hair’. “They block an enzyme that causes the hormone testosterone to transform into another metabolite that activates baldness,” summarizes Sánchez.
This drug is used orally and has side effects that are highly feared by patients. “Between 0.5 and 1.5% suffer from decreased sexual appetite and erectile and ejaculation disorders. It scares people a lot if it touches, but statistically it is rare and reversible, so if something happens, the treatment is suspended and they recover ”.
Between 0.5 and 1.5% of those who take finasteride suffer from erection and ejaculation disorders
Vaño explains the origin of fear of a drug that in the US has associations of affected people: “It was discovered that it was useful for alopecia after its use in older patients with prostate problems, so at first many of the problems were not due to pill but by age. When young people started taking it without information, they read the leaflet, they got scared and, as a result of nocebo, they suffered a ‘trigger’ ”.
“There is a crusade against these drugs without scientific basis because medical studies have been done with thousands of patients. A young boy, whether he takes it or not, has the same risk of transient erectile dysfunction: 2%. It has an excellent safety profile ”, says Vañó.
Sánchez adds that, although some study has analyzed whether there is an irreversible case, “it is in older or younger people with prostate or psychological problems.” It is also being investigated whether finasteride could be injected a couple of times a month, instead of ingested, to avoid the dreaded trigger.
This drug was used to treat hypertension until it was seen that it also induced hair growth, by lengthening its cycles and thickness. “The problem is that orally it produces alterations in tension, that is why it is used in the form of lotions,” says Sánchez.
The dermatologist explains that today it is being investigated to see if very small oral doses would affect the hair without affecting the tension, a system that “is not yet available”. An alternative that is used today is injections: “Minoxidil is injected periodically so that it goes to the follicle with very small needles that do not bother”.
These small injections, similar to those used in aesthetics to administer collagen, solve the biggest drawback of this drug: its discomfort. “It is a lotion that must be applied twice a day and is absorbed in a very small amount, so in patients who need larger doses or more times a day we use this technique as a supplement,” adds Sánchez.
There is a third method to fight baldness effectively: transplantation. The FUE (‘Follicular Unit Extraction’) technique spearheads the advances that hair surgery has seen in recent years. Sánchez sums up the process: “It is very minimally invasive, it consists of extracting micrografts hair by hair from an area that does not have the disease, such as the neck, and implants under local anesthesia.” The operation is so laborious that today the use of robots as assistants is valued.
The Government of Turkey tried to promote hair transplant tourism with very cheap prices, but not all its clinics offer guarantees
Rejection is non-existent as it is your own cells and only one intervention is necessary, but the experts consulted by Sinc warn: “The hair that is grafted does not have the disease and remains, but if you do not control your own, the one that remains continues to disappear and in a few years the balance is negative, ”says Sánchez.
The solution is simple: either wait for your hair to stabilize, or treat it with one of the drugs mentioned in this article. “Many young patients are ‘sold’ the implant but due to lack of time or lack of time they do not do the treatment and they continue to lose hair even though the implant is well done,” says Sánchez. “In that case it is bread for today and hunger for tomorrow.”
Vaño clarifies that “not all patients are susceptible to transplantation”, either because of the “poor raw material of the donor” or because “the pattern of alopecia is not adequate”. If it is carried out, in these cases “it will not look as good as others”.
Hair transplantation has been associated in recent years with Turkey, where the Government tried to promote medical tourism at more affordable prices than those in the rest of Europe. Sánchez confesses that his “hairs stand on end” when he sees images of what looks like a “war hospital”, with “huge rooms where patients lying on mats on the floor are treated ten by ten by technicians supervised by a single doctor”.
“Now we receive patients with rare infections and complications that we did not see before,” adds Sánchez. Vañó talks about prices: “There a good place is 6,000 euros and a doubtful one, 3,000; in Spain they are between 6,000 and 12,000 euros because it is an eight-hour intervention that requires six people ”.
Stem cells, plasma and lasers
The remedies named up to this point are the most widely used for their results, but in recent years other novel treatments have been used without yet much scientific evidence.
Sánchez defines them as “alternatives” for patients for whom conventional treatments do not work, although they do not always work: “When there is more data, some will go to more and others will disappear.”
There is no scientific evidence yet to support the efficacy of the newest treatments
Vaño adds that some are fashionable “because they are expensive, they are made privately and the clinic is interested in promoting them because they make the patient loyal” and does not consider them as “ideal” although some patients can benefit from them.
One of these alternatives is platelet-rich plasma. Sánchez explains its scientific basis: “It is extracted from the patient’s blood, processed to concentrate growth factors, and injected into the scalp.” According to the doctor, although it does not always work and its usefulness is still debated, some professionals already use it.
The injection of stem cells is an alternative with “even less experience”, in the words of Vañó. It consists of extracting tissue from an unaffected area, such as the neck, to inject the stem cells. Another option is laser treatments, of which Sánchez advises that little is known: “It seems that they help stabilize if they are used continuously, but it is heavy because you have to do it three times a week.”
Vitamins, shampoos and other tall tales
Professor Bacterio’s growth does not exist, ask Mortadelo. Vañó lists the long list of miraculous solutions that neither stop alopecia nor improve capillary density: “Vitamins have a cosmetic but not a medical effect. There is no anti-hair loss shampoo because it is a product that cleanses your scalp and hair but does not penetrate to the roots, which are 3 millimeters under the skin ”.
Baldness is an aesthetic condition and there are those who prefer to assume it, like Bruce Willis. / Wikipedia
Carboxytherapy, ozone therapy, massages, capillary botox, brewer’s yeast … The doctor regrets that many patients spend 20,000 euros on treatments “with a lot of marketing but without logical or scientific evidence.”
“You don’t fight a genetic disease with vitamins,” adds Sánchez, who warns that if only these products are used, baldness will continue to advance.
Androgenic alopecia is genetic in origin and therefore has no cure. “As soon as you start generating testosterone during adolescence, the process will be activated,” explains Sánchez. “It is like diabetes, familial hypercholesterolemia or essential arterial hypertension: as long as we cannot modify the genes involved, the treatment only stops the problem.”
This means that the drugs mentioned in this text must be taken for life or, as Sánchez says, “as long as the patient is concerned.” The important thing, according to Vañó, is that if it is done, “the more the better” and ensures that “50% of what was gained” is lost after stopping taking them. “It is useless to do it for three months, at least a couple of years”, and adds that “many people start using minoxidil, which is not noticeable until six months and they stop after a couple because they think it does not work for them. ”.
Another option: be bald
“I like to insist that it is an aesthetic issue that does not affect health. Conservative treatment can be done or not. There are those who have assumed that he will go bald like his father, although in women it is more difficult to accept ”, Sánchez concludes. Perhaps the key is to accept oneself with humor, as a phrase attributed to the Roman philosopher Seneca says: “I don’t consider myself bald, I’m just taller than my hair.”