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“Lifting the Rug!”
The Consumer’s Guide to Hair Loss Treatments
& Hair Replacement.
By Tony Pearce RN.
Specialist Trichologist, National Trichology Services
Of all the physical changes we experience as human beings perhaps no other is more misunderstood, been the subject of greater deliberate misinformation, has the potential to evoke disproportionate anxiety in a sufferer, or attracted more unscrupulous operators than hair loss.
Even the great Julius Caesar was said to be sensitive about his balding scalp, and wore a laurel of oak leaves to both hide hair loss and denote his status as Rome’s premier citizen.
Obviously hair has long ceased to be merely protection and insulation for our skulls and brain. It’s an intrinsic part of our body image – how we see ourselves and wish others to see us. Our hair defines our vitality, virility, personality and sexuality. Unlike no other part of our body, the versatile, regenerative qualities of our hair allow us a certain ‘chameleon-like’ ability to continually change our appearance - and often how we feel about ourselves - by altering its length, colour, style, and wave.
It’s little wonder why many people become anxious, distressed or even depressed at the prospect of losing their ‘crowning glories’. This is often the time they become vulnerable to the promises of glib but unprincipled peddlers of bogus hair restoration programmes.
Let’s now examine who they are, what they sell, and how they sell it.
‘Studios, Centres and Clinics …’
Today’s commercial hair restoration treatments come in a number of guises. Some are national and multinational franchises that spend millions of dollars per year in advertising and celebrity ‘testimonials’. Some are little more than ‘backyard operators’ who sometimes target a particular ethnic group with a ‘wonder treatment’ that often features quasi-religious or cultural claims. Some are magazine or Internet mail order products, whilst others are sold as hairdressing retail lines. Government/medically approved products are sold in pharmacies.
The hair loss ‘consultants’ employed by these commercial centres are commonly salesmen delivering a rehearsed product presentation. Typically they have no formal trichology or health practitioner training/qualifications whatsoever, but are often expert at reading human emotions and readily able to touch the low self-esteem/confidence nerve or promote unrealistic fear that total, irreversible hair loss is imminent unless the sufferer ‘signs-up’ immediately.
They rely heavily on the customer not knowing the many different reasons for hair loss, and in order to ‘close the sale’ often given quite ridiculous explanations for the sufferer’s condition. Contrary to what is presently being said by some of these ‘consultants’, hair loss is not caused by too little sunlight and too much fluorescent lighting, nor by dandruff blocking hair follicles, and certainly not from microscopic ‘bugs’ gnawing at our hair shafts!
Generally these places only offer one treatment programme for all hair loss problems – regardless of the condition. Can you imagine going to a medical practitioner who only offered one treatment for all ailments?
Because they are unqualified, these sales people often cannot recognise the different types of hair loss; whether it is permanent or temporary, what may have triggered it, which blood tests to request - or an appreciation of their results, when to suggest a biopsy, dietary influences, the side effects/interactions of different medications, or the appropriate treatment for the individual problem.
Hair Loss Treatments …
History is replete with bizarre remedies for regrowing hair; the rough-tongued ‘lick’ of a dairy cow, manure poultices, or a brisk daily rubbing of one’s scalp with an onion or garlic clove! Absurd as those practices sound today, desperate, follicly challenged Australians still appear willing to invest substantial amounts of money for equally dodgy ‘cures’ such as battery-operated bio-stimulating helmets, oriental herbs worn under a ‘cling-wrap’ scarf, and even silt supposedly from the River Jordan!
At present, the more well known hair loss companies build their ‘treatment’ programmes around some form of Minoxidil-based topical solution. Minoxidil is presently still the only topical lotion medically approved to stimulate follicle hair growth, and a number of commercially available brands can be purchased ‘over the counter’ at pharmacies.
To give the impression their treatment programmes are somehow unique, ‘special’ shampoos, cleansers, toners, scalp stimulators etc. are included as ‘essentials’ to treatment success. These products have little if any affect on hair regrowth, and seemingly are only there to justify the exorbitant cost these companies demand.
For many years much has been made about the need to increase scalp blood flow, the rationale being that the more nutrients the hair follicles receive the better the hair growth. In one sense this is true, and for two reasons: the hair follicles that become progressively miniaturised in androgenetic alopecia do have a decreased blood supply in comparison to unaffected follicles elsewhere on the scalp. Secondly, hair growth and quality is affected by one’s nutritional status. However hair will not cease shedding or effectively regrow just by improving scalp circulation. In all cases the underlying cause of the problem, be it nutritional, metabolic, or the hormonal conversion of androgenetic alopecia, must be addressed in order to correct the condition.
Minoxidil Topical Solution …
Minoxidil topical solution was derived from oral minoxidil (Loniten), when it was found that over 80% of patients who were taking the oral drug for high blood pressure developed increased facial and body hair.
Minoxidil is a vasodilator that opens-up the blood vessels thereby increasing capillary blood flow. Studies suggest that it has a direct stimulating effect on the hair follicle cells, but exerts no antiandrogen (anti–male hormone) influences.
Side effects from topical minoxidil are usually of a non-serious allergic nature; itchy/flaking scalp or a scalp rash. Very rarely, some sensitive individuals have experienced cardiac-like chest pain, breathlessness, or abdominal pain. Adverse reactions resolve once the drug is withdrawn.
Minoxidil remains the only topical solution approved by the US FDA to stimulate follicle hair growth. The original indication for men stated: “for male pattern baldness of the vertex” (crown). It is now known the drug works equally well on a balding frontal area, or for any hair loss condition on the body where the hair follicles are still functional.
Under various brand names, minoxidil is available ‘over the counter’ in 5% and 2% strengths. However these commercial preparations are known to be poorly absorbed, and the propylene glycol additive is the predominant cause of the itching/flaking scalp side effects.
By removing the propylene glycol, and adding penetration enhancers/androgen blockers, ‘second generation’ formulas of minoxidil are now available, which are far more effective, user friendly, and with minimal adverse reactions. Minoxidil solutions can now be formulated in 3-10% strengths, and be targeted to specific hair loss conditions.
Most significantly, the majority of women experiencing androgenetic alopecia will no longer have to take the oral ‘anti-androgen’ (anti-male hormone) medication to help suppress the problem. Males need only take Finesteride (Propecia) as a combination therapy for about 12 months.
Finesteride …
Finesteride (Proscar) was initially marketed for the treatment of non-malignant prostate enlargement. In 1997 the US FDA approved a 1mg version of the original drug (Propecia) for the management of male androgenetic alopecia.
Propecia stabilises further hair loss in over 80% of men, with a lesser percentage reporting improved scalp coverage after two years continuous treatment. The most commonly reported side effects are loss of sexual desire in about 2%, and sexual dysfunction in 1-1.5% of those taking the medication.
Finesteride assists by reducing the conversion of testosterone to dihydrotestosterone (DHT). DHT undesirably influences hair follicles across the top of the scalp to produce progressively finer (Vellus) hair within a shorter growing phase. Over time this results in an ever-decreasing scalp hair density.
In mid-2003, the findings of one US study revealed elderly men were at a higher risk of developing more aggressive prostate cancers if they’d previously taken Finesteride to treat their enlarged prostate condition. Whilst this is not statistically significant for young males taking low doses of Finesteride, further long-term studies appear warranted.
“Toupee or not Toupee”…?
“Unit, Real hair, Life system, Strand x Strand”. These are just some of the names used by Hair Replacement companies to veil the fact that what they are actually selling is a hairpiece.
A hairpiece is commonly attached to the client’s scalp by some form of bonding glue, beading/knotting to the client’s remaining hair, double-sided adhesive tape, hair clips etc.
Depending on the type of attachment, the client can remove the hairpiece for sleeping or washing of his/her scalp. Those clients in a bonding/beading attachment attend to the company’s “studio” or salon for the cutting of their own hair & re-bonding/beading of the piece. These “maintenance” programmes are often expensive, with clients paying a monthly fee of between $60-150 for a quick hair wash/cut and re-attachment. The client is also usually obliged to purchase an array of products such as shampoos/conditioners, sunscreen, tape, tape-tab adhesive, colour rinse, etc to help maintain the hairpiece between maintenance visits.
Most hairpieces are mass-produced in Asian factories using Indian or Asian hair. In a number of chemical processes the hair is stripped of its original colour, treated to remove the cuticle (the outer “scale” part of hair), re-coloured back to the required shade, and manufactured into a hairpiece. This “refined” hair has usually undergone so many chemical processes that it can no longer be defined as “human hair” at all, rather a hair “fibre-like” substance.
The wholesale price of these hairpieces are usually between $20-100 each, but are retailed by the Hair Replacement companies for amounts of $2000-$10,000 each – and more!
Hairpieces can look quite presentable when properly maintained, but need replacing at least every 12 months to remain reasonably undetectable.
Hair Transplanting …
Surgical hair restoration (transplants) is a genuine and permanent option to help increase scalp hair density or replace hair follicles destroyed from ciccatricial (scarring) processes.
Recognised transplant surgeons now use very advanced micro and or mini-grafting procedures (1-3 hairs per graft), and the old “toothbrush look” of plug grafting should not be a consideration.
Those considering a transplant option should consult with a Member of either the International or Australasian Society of Hair Restoration Surgery.
Surgical hair restoration is a very price competitive field of medicine, so consumers should not hesitate to negotiate the best price.
Those experiencing androgenetic alopecia should be aware that in most cases they would also need to continue the use of either Propecia or an androgen-blocking Minoxidil solution to maintain the remaining ‘androgen sensitive’ hair follicles’ normal hair growth.
About the Author: Tony Pearce RN is a specialist trichologist and a registered nurse. He is a founding member of the Society for Progressive Trichology. Tony has a clinical practice in Sutherland & Rozelle NSW. He is the Clinical Director for Trichology of Virginia/DC in the United States. In Australia Tony can be contacted on 02 9542 2700, or through his website at www.hairlossclinic.com.au
*References for this article available on request.
© Anthony Pearce
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