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Chemotherapy-Related Hair Loss Drugs and Ointments MinoxidilFinasteride Other Medications Over-the-Counter Products Wigs and Hairpieces Partial Hair Additions

There are generally two types of hair loss:

  • Anagen effluvium - Permanent hair loss caused by the destruction of hair follicles
  • Telogen effluvium - Temporary hair loss due to transitory damage to the follicles

Anagen effluvium is generally due to internally administered medications, such as chemotherapy agents, that poison the growing hair follicles. Telogen effluvium is due to an increased number of hair follicles entering the resting stage.

The most common causes of telogen effluvium are:

  • Physical stress - Surgery, illness, anemia, rapid weight change
  • Emotional stress - Mental illness, death of a family member
  • Thyroid abnormalities
  • Medications - High doses of vitamin A (sometimes present in diet supplements), blood pressure medications, gout medications
  • Hormonal changes - Pregnancy, birth control pills, menopause
  • Androgenetic Alopecia

Up to 95 percent of permanent hair loss is due to androgenetic alopecia, a hereditary condition that affects millions of men, women and children. This condition is characterized by what we call pattern baldness. Male pattern baldness generally starts with a receding hairline at the front or thinning of the crown hair and gradually progresses until, in extreme cases, only a thin horseshoe-shaped rim of hair remains at the back and sides of the head.

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Female pattern baldness, which has received more attention in recent years, refers to general thinning of hair all over the scalp, usually beginning at around age 30 and becoming more noticeable after 40 and particularly after menopause.

Along with advancing age and an inherited tendency to bald early (a more complex link than researchers originally thought), androgenetic alopecia is sped up by an over-abundance of the male hormone dihydrotestosterone (DHT) within the hair follicle. DHT is a highly active form of testosterone, which influences certain aspects of masculine behavior, from aggression to sex drive.

Testosterone is converted to DHT by an enzyme called 5-alpha reductase, which is produced in the prostate, the scalp and various adrenal glands. Over time, DHT causes hair follicles to degrade and shortens their anagen, or active, phase.

Technically, the follicle is still alive and connected to a good blood supply (that's why it can nurture a transplanted follicle that is immune to the effects of DHT), but it will grow smaller and smaller. Some follicles will die, but most will simply shrink in size and produce weaker hairs. The progressively shorter anagen growing cycle means more hairs are shed and remaining hairs become so thin that they cannot survive daily wear and tear, experts say. Hairs in balding areas gradually change from long, coarse, thick, colored hairs into fine, unpigmented, fuzzy hairs.

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Chemotherapy-Related Hair Loss
As we mentioned earlier, chemotherapy is the administration of drugs that are poisonous to rapidly reproducing cancer cells (see How Cancer Works). Cancer cells are some of the most rapidly reproducing cells in the body (see How Cells Work). Other cells, such as those that contribute to the formation of hair shafts and nails, also reproduce quickly. So while chemotherapy drugs preferentially destroy cancer cells, the drugs also can destroy cells responsible for normal growth of hair and nails. That's why cancer patients sometimes shed their hair and nails during treatment. No hair growth stimulants, shampoos, conditioners or other cosmetic treatments can prevent or retard the hair loss. The good news is that once chemotherapy is completed, the hair usually grows back within six months to a year.

Drugs and Ointments
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. Some hair loss medications work by causing hair follicles that have shrunk or shut down to enlarge and grow hair again. Hair restoration medications are used to treat both sudden, temporary hair loss and chronic hair loss that starts slowly and becomes progressively more extreme over time.

These medications may be applied to the skin, taken by mouth or injected, and they include both prescription and non-prescription drugs. Prescription drugs are typically powerful and have the potential for some serious undesirable side effects if not used as directed and for their intended purpose.

Over-the-counter medications, like prescription drugs, contain active ingredients that affect the body's structure or function in order to treat a medical condition. These medications are intended for conditions that do not generally require skilled medical diagnosis. They are usually less powerful than prescription drugs and less likely to cause harmful side effects.

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Minoxidil (the generic name) is in a class of drugs called hair growth stimulants. Oral minoxidil, a prescription drug originally used to treat high blood pressure, was found to increase body hair growth in the majority of patients taking it daily.

This led to the development of topical minoxidil, sold over-the-counter and marketed in its 2 percent form under the brand name HealthGuard (Bausch & Lomb Pharmaceuticals), and in its 5 percent form under the brand name Rogaine (Pharmacia & Upjohn). These formulas have been shown to stimulate hair growth in men with pattern baldness. In women, these ointments can help increase growth in the forehead area, according to manufacturers.

Pregnant or nursing women should avoid minoxidil in either form and be cautioned that the use of extra-strength formulas are not designed for women and can cause facial hair growth and other problems.

Minoxidil is what pharmacists call dose-dependent. This means that treatment must be continued in order to maintain or increase hair growth benefits. Regular-strength Rogaine must applied on a dry scalp at least twice daily (and left in place for at least four hours) and for at least four months to see results. Extra strength formulas work much more quickly (in about 45 days), manufacturers say.

Oral minoxidil can cause a fall in blood pressure, an increase in the heart rate, and weight gain (fluid retention). An increase in the absorption of topical minoxidil from the scalp can occur in users with inflamed or abnormal scalps and can lead to the same side effects as those of the oral minoxidil. This means that people with heart failure or major coronary heart disease should avoid the drug in either form, and those with high blood pressure should consult their doctors. In addition, topical minoxidil should not be used with other ointments or topical creams. Skin side effects might include irritation, itching, hives, swelling and sensitivity.

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Finasteride, a prescription drug marketed in a 1-mg tablet as Propecia (Merck Pharmaceutical), was approved by the FDA in 1998 for the treatment of androgenetic alopecia. (Finasteride, in a 5-mg tablet, was manufactured and marketed earlier as Proscar, which is still used to treat prostrate abnormalities.)

Propecia works by decreasing the concentration of the male hormone DHT by about 60 percent in people taking one tablet per day. Since finasteride inhibits this hormone, which is a key factor in the miniaturization of scalp hair follicles, this allows for a reversal of the balding process. Results are usually seen in about three months, and this drug is also dose-dependent. Generally, finasteride is not beneficial in the treatment of female pattern baldness.

Some researchers say that a combination of minoxidil and finasteride provides hair growth that is superior to that resulting from the use of either single drug. Talk to your doctor about this. Side effects that have been attributed to finasteride include decreased libido and groin aches.

Other Medications
Other less familiar options include using Retin-A (brand name, Ortho Pharmaceutical) alone and in combination with minoxidil to treat male pattern baldness. It is thought that the combination works because the increased absorption caused by Retin-A increases the amount of minoxidil reaching the hair follicle cells. (Since Retin-A is degraded by strong light, you should only use it at night. If you're using a combination formula, wear a hat or stay in the shade.)

Xandrox solutions, which are alternatives to Rogaine, come in formulas with varying amounts of minoxidil, Retin-A and azelaic acids. Ask your doctor or pharmacist to help you choose the right formula.

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Over-the-Counter Products
If the shampoo bottles marked "for thicker hair" grab your attention in the store, you might want to think again before tossing one into your cart. According to the FDA, none of the shampoos or hair products that claim to give you thicker, fuller hair can actually do that. What these products do, instead, is to create the appearance of greater fullness by plumping up hair follicles.

There's another interesting product on the market -- make-up that colors your scalp the same color as your hair. It's cheap, it's fast and it's safe. (Manufacturers say it won't run when wet but easily washes off with normal shampooing.) You can't create a frontal hair line with this product, but if you can't afford surgery or a new wig, why not check it out?

Wigs and Hairpieces
For thousands of years, wigs have been called wigs. Today, wigs are called many different things, and they've come a long way in terms of offering a more natural appearance. Temporary usage of hair additions while undergoing lengthy hair transplant sessions is becoming more popular among men and women who don't want to advertise their work-in-progress, especially since many transplants take one or two years to complete.

A non-surgical hair addition is any external hair-bearing device added to existing hair or scalp to give the appearance of a fuller head of hair. In this category are hair weaves, hair extensions, hairpieces, toupees, non-surgical hair replacements and partial hair prostheses. Devices may consist of human hair, synthetic fiber or a combination of both.

Partial hair additions -- now more popular than wigs -- are attached in a variety of ways. All techniques use either the existing hair or the skin as anchor sites. Weaving, fusion, bonding and cabling generally describe the techniques used to attach the new hair to the existing hair. All are used to provide more security for the active lifestyle, and they are all dependent on the growing existing hair and therefore must be reattached or tightened as the existing hair grows. (Techniques that stress your existing hair, such as weaves, can cause permanent damage if done incorrectly or on an inappropriate candidate. Even temporary clips attached too tightly can cause permanent hair loss.)

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Techniques that use the skin as the anchor site include adhesives such as two-sided tapes and water-proof liquids. Most adhesives are safe, but it's a good idea to have your dermatologist do a patch test to check for skin allergies.

IiIf your hair loss is due to illness or chemotherapy or physical abnormalities, these devices are your best solution (you should probably opt for a full wig).

Although insurance generally does not cover male or female pattern hair loss, it may cover the cost of a hair addition when hair loss is caused by disease or other abnormalities.

The industry is seeing a growing number of people using wigs and hair systems to cover the results of a bad hair transplant, and to combine partial transplantation with a partial hair addition. The Hair Loss Council offers this example: An individual with severe baldness who wants to wear his hair straight back may opt for a transplanted hairline only (due to lack of donor hair available). Behind the newly transplanted front hairline, this person might have a hair addition designed so that he can now comb his own hair straight back.

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