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Home arrow Basics arrow Hair loss arrow Possibilities of treatment
Therapy of androgenetic alopecia


We distinguish the following methods: (a) medical treatment, (b) operation, (c) hair substitutes like wigs, hair pieces, parts of hair, hair weaving, special compression sprays and contrast adapters. Let's acquaint ourselves with each method:


Medical treatment

There are different methods applied in the medical treatment of androgenetic alopecia.


5-alpha-reductase inhibitors: Finasterid and Dutasterid

The formation of the enzyme 5-alpha-reductase (there are 2 subtypes of it) is blocked and this leads to a great extent to the reduction of testosterone and formation of DHT. DHT, in effect, causes the atrophy of genetically oversensitive hair follicles.

Finasterid (trademark "Proscar®" and "Propecia™“ of the pharmaceutical company Merck), which is obtainable in the market for a long time now, blocks only one subtype of the enzyme. Dutasterid (trademark "Avodart™" of the firm GlaxoSmithKline), which is on sale since 2002, blocks both subtypes of the enzyme at a much higher proportion, possessing at the same time a longer half-life than Finasterid.

Finasterid and Dutasterid must be taken daily in tablet form. Pregnant women must not come in contact with this substance, for it can lead to a disturbance in the development of the reproductive organs of the male fetus.

finasterid 
Finasterid, active substance of ...

 Propecia™ und Proscar®
Propecia™ and….

Propecia™ und Proscar®
  Proscar®

 

Dutasterid 
Dutasteride, active substance of...

 Avodart™
Avodart™


Antiandrogens: Spironolactone and Flutamide
Originally, spironolactone was developed to enhance urine excretion (= diuretic), since it is first of all an aldosterone-antagonist. Aldosterone, as we know, is an endogenic hormone, which regulates the flow of urine. It was, however, found out that spironolactone also inhibits the formation of androgens (male sex hormones, in the first place testosterone).

Flutamide is also an anti-androgen.

Because of the anti-androgens, it is expected that there will be only few free testosterone in the blood. Consequently, the amount of the metabolite DHT is also reduced. Males may use this anti-androgen in the treatment of hair loss, provided they take it in form of a diluted solution and apply it only locally on the affected scalp. Oral intake of this preparation would lead to feminization, since the drug will circulate in the blood and would, obviously, work not only on the scalp.  

The application is done twice daily - once in the morning and once in the evening.

spironolakton 
Spironolactone, active substance of Spironolactone 5 % lotion


 Flutamid
Flutamide



Enhancement of blood circulation: Minoxidil
During the process of developing and testing the hypotensive properties of Minoxidil, it was accidentally discovered having a side effect expressed in pronounced hair growth. This excessive hair growth was observed on that part of the skin regularly or accidentally applied with it. Aside from this, oral intake of the drug led to a general growth of strong hair in all parts of the body and the scalp.

In other words, it can stimulate the atrophied hair usually found in androgenetic alopecia to grow much stronger and more firm.

The exact mechanism has not been verified up to this day. Nevertheless, one postulates that the cause of this intensive hair growth is better blood circulation, which facilitates better transfer of nutrients and oxygen to the atrophied hair follicles.

Minoxidil (trademark "Rogaine®“ or "Regaine®“ of the firm Upjohn) may be used for the treatment of hair loss locally or as diluted solution. It should only be applied locally on the affected scalp. Otherwise, an oral intake would cause systemic effects on blood pressure.

The preparation is applied twice daily: in the morning and in the evening. 

MinoxidilRegaine® Männer 
Minoxidil, active substance of ...          Regaine® Men



All medicines mentioned above have the following things in common:    
Only male pattern baldness can be treated by application of these drugs. The use of these drugs is aimed at reduction or putting a stop to hair loss in man. A strong new growth of hair cannot be attained though through the use of these drugs. Indeed, reports on increased hair growth have been occasionally made but this is exceptionally moderate. Thick new hair, say at the lateral sides of the hairline, cannot be attained through oral intake of these medicines.

They work at best in cases of hair loss at the tonsure (also known as vertex). And they work the least or not at all in the lateral sides of the hairline and the backwards receding hairline, since the hair follicles here are most sensitive. Only after 3 to 6 months can we expect to see the first positive effects - a reduced rate in falling hair and, eventually, sturdiness of hair still available.

In order to maintain these effects, these drugs should be taken daily and till the rest of your life. Accordingly, the accumulated expenses are high.

If the application of the medicine is stopped, a worsening of the condition is expected after a few months. And this is expressed in the renewed atrophy of the strengthened hair and renewed fall of hair. In the end, the condition that existed before the start of the medical therapy recurs.The amount of work connected with the daily application of preparations can be perceived as to be tiring. Depending on the composition of a liquid solution, flaky or fluffy residues may form.  It may leave an oily hair or scalp as in the case of Rogaine. Or it may leave an intensive odour as in the case of Spironolactone.
Naturally, all mentioned drugs cause some side effects. But they are usually very seldom and, if they do occur, mostly of temporary nature.

Sometimes, the positive effect of most of these drugs subsides after a period of 2 to 5 years.

Interesting is the fact, that most of the above-mentioned drugs have not been purposely developed for the treatment of hereditary hair loss. Their effectiveness towards hair growth was discovered absolutely by chance (as side effects!)

 

Remarks:
Important hint: The above list of drugs is not to be considered as a recommendation from the side of FUE- Hairtransplant Hamburg. It is merely an informative overview about the present medical therapy applied in androgenetic alopecia.

Most of these drugs can be obtained only with a prescription from your doctor. You are held responsible for it. Should you ever be interested in one of these drugs, please ask qualified advice from a specialist (for example, a dermatologist) or from a pharmacist.  


The effectiveness of all drugs stated above against male pattern baldness has been scientifically proven. There even exist several lengthy scientific investigations on male pattern baldness. Licenses for its cure have been given by health authorities.
In contrast, various food supplement preparations combined with a balanced diet, biotin capsules, silica preparations, beer yeast tablets, etc. have been proven to have positive effects on the general well-being and growth of the skin and its appendages (hair and nails). But they are not in a position to prevent the progress of a hereditary hair loss, since the causes are not eliminated.

 

Operative Therapy 

Hair transplant surgery:

Hair transplant surgery is one form of operative therapy applied in the treatment of hair loss.

During hair transplant surgery, donor hair follicles, which are genetically not sensitive to DHT, are taken from a donor area in the back and lateral head area. They are then transplanted to the bald areas of the scalp, where they grow further a life long.  

However, a hair transplant should not be interpreted as something which eradicates the cause of androgenetic hair loss. In this method no new hair is produced whatsoever. It is merely a skilful distribution of hair follicles not affected by hair loss.

In the part "hair transplantation in detail " of our website, you will find full information and lots of details regarding this theme.


Artificial hair implantation:

Artificial hair usually made of plastic is implanted into the bald scalp. A small knot at the bottom of the artificial hair (root loop) provides for the anchorage in the scalp. Strongly rubbing down the hair with a towel creates a problem, for artificial hair cannot grow again. Even with great care, much of the artificial hair falls out during the next coming months. The reason behind this is the fact that the body recognizes it as a foreign body and are rejected. Numerous small scars, infections and inflammations are to be seen spread throughout the treated part of the scalp (meaning, at every point where artificial hair has been implanted). Even the implantation of specially prepared "bio-hair fibres" is very difficult and cannot be recommended at all. Leading textbooks also do not advise artificial hair transplants.

Because of all these disadvantages, less and less institutes offer artificial hair implantation nowadays. In some countries, this method is even prohibited.


Scalp reductions:

Scalp reductions arose from the idea of reducing the surface of bald scalp through cutting it out and then suturing both edges of the wound together. Through a reduction in the area of bald scalp, it is expected that the number of grafts to be transplanted in a succeeding hair transplant can be saved.

Till the end of the 1990's, scalp reductions have been regularly practiced throughout the world. But, nowadays, it is only seldom performed. Many different incision techniques and cuts were developed during the past years.
 
Oftentimes, an inflatable expander would be implanted underneath the scalp months before the actual scalp reduction takes place. This was done in order to make the scalp gradually more elastic and more flexible. The result of this quite invasive method is, indeed, a small bald surface. However, this benefit is not in relation to the oftentimes striking and disfiguring scars spread all over the upper head. And these scars take different geometrical forms. In addition to the many possible complications, the corners of the remaining hair are changed due to the so-called lifting effect (the whole scalp of the lateral and back part of the head is shifted from its original position towards the upper head through contraction). The resulting growth direction of the remaining hair looks very unnatural in this case.

To reduce the size of big bald areas, many scalp reductions were carried out in successive intervals.

Halbschematische Darstellung einer Scalp- Reduktion 
Half-schematic drawing of a scalp- reduction during and shortly after the procedure.

 

Schnittführungen bei der Scalp- Reduktion 
various cutting possibilities in a scalp reduction


Scalp lifts:

Scalp lift is the most radical kind of scalp reduction.

Its difference from the scalp reductions lies in the fact that an extremely great part of the scalp is cut out.  The latter has usually the shape of a horseshoe.  As a result of this extreme lifting, the lower hairline of the nape is moved very far upwards, which caused a child- like lower hairline. The hairs on the sides are moved, too, resulting in a pronounced change in angle.

The scalp is subjected to immense pull, stretch and tension. The face changes its features (in special the region of the eyelids).

If you are interested in knowing more about how a scalp reduction or a scalp lift really takes place, we recommend you to refer to the following websites:  

http://www.angelfire.com/indie/hairtransplant/scalp.html

http://www.angelfire.com/indie/hairtransplant/scalp2.html

Warning: The photos therein are bloody!
 

Flaps:

The flap technique originated from the idea of transplanting in just one session the biggest possible number of hair to be used for the hairline with a very high natural density. Up to now, this is a fact that has not yet been attained in the field of hair transplant surgery.
 
By this method, a long and wide stripe is cut off from the sides just above the ear. The front end of the stripe is spared by not cutting it with the use of a scalpel for the purpose of guaranteeing blood circulation and nutrient supply to the resulting flap, thus preventing possible tissue decay.

Afterwards, the flap is rotated and placed onto a hollow, which is especially cut out for this purpose just above the forehead. This procedure is done by moving the entire length crosswise from one side of the head to the other onto the hollow region, where it is later on sewn.
 
If necessary, a flap from the other side can be put behind this new hairline later on by using the same procedure. As an alternative to this, the flap at the frontal hairline must not be forcibly taken completely from one side, but can be also done in an analogous manner by taking two tissue stripes (in this case, measuring only half the length of the former) taken from the left and right sides.

Likewise, this rather traumatic technique has lots of disadvantages. A well-visible scar is to be seen directly around the whole circumference of the implanted flap. A similar picture can also be seen on that part situated directly in front of the future hairline. Hence, this scar must be later on covered, making an additional hair transplant necessary. Scars can also be seen at the lateral fringe of the scalp, from where the flap has been taken earlier.

Advantage: The hair to be found in the flap continues to grow further. In contrast to transplanted grafts in hair transplant surgery, the follicles no longer undergo a rest period. However, if the flap tissue ever dies, this can lead to extremely dangerous inflammations and reactions similar to that seen in host-graft type. After the ensuing medical emergency care, disfiguring scars located directly at the upper end of the forehead usually remain for life.

On account of the needed rotation of the flap, the growth direction of the hair of sewn flap does not correspond to the natural growth direction of the hair. It greatly differs from the geometrically expected dimensions. Therefore the hair- style- possibilities are reduced.    

Flaptechnik 
Flap- technique for creating a new hair line during and shortly after the procedure.


Hair pieces and hair substitutes:

Wigs / Toupees:

We talk about wigs, when the whole area of the scalp has to be covered (for example, after the loss of all hair as a result of chemotherapy; for carnivals; or for quick change of hair styles during a fashion show). And we speak of toupees, when only a certain part of the scalp should be covered (for example, in cases of baldness of the forehead or of the tonsure).

The hairpieces may be either of natural or artificial hair. There is a row of different materials used, into which the hair pieces are attached. Examples of such materials are (a) transparent membranous foil or (b) fine cellular nets. These materials have both advantages and disadvantages. The artificial hairpieces are attached either with a clip or glue and can be worn in various lengths. During the last few years, the quality of hairpieces has improved greatly. Often they are taken for natural hair, allowing persons to do such normal activities like swimming or driving with a convertible. However, there are still many disadvantages as long as one does not want to be noticed by the public. To get rid of a toupee once and for all is quite impossible without the public noticing it. Lots of people wearing wigs or toupees complain of the fact that the scalp underneath it is usually full of dandruffs and the rest of the hair becomes unsightly. This also increases one's dependence on a toupee. It is also worthy to mention the other disadvantages associated with it: (a) the necessity of a regular maintenance check and care of the hairpieces, (b) constantly having the same hairstyle, (c) new acquisition in case of theft or loss, (d) oftentimes, restraint about not being able to scratch an itchy part of the scalp for fear of the toupee slipping down, (e) the fact, that it is nothing but an artificial thing on top of the head.


Hair weaving:

In contrast to wigs and toupees, hair weaving is applied by interlacing hairpieces around a naturally intact hair for the purpose of covering bald areas of the scalp. Since the hair naturally grows by 1 to 1.5 cm monthly, it is expected that the hair piece would stick only for a short time. With the growth of the natural hair, the hair piece moves away from the scalp accordingly and this calls for fixation at regular intervals often with costs. Many disadvantages typical of using hair parts also hold true to hair weaving.


Thickening sprays and powder:

Thin hair can be optically thickened to a certain degree with the use of special thickening sprays or powders like „Toppik™“ or „Super- Million- Hair™“.  Microscopically small artificial particles and artificial fibres are wrapped around the hair shafts making the hair appear stronger and thicker. These sprays and powders are available in different hues depending on the desired natural hair colour.

Disadvantages of thickening sprays and powders: by non-specific application, the substance can leave tracks of it on hand towels, wall papers and bath furniture; really high costs. Swimming and strong rain are problematic, if no fixation spray is included in the set.   
 

Toppik™ 
 Toppik™

Mikroskopische Aufnahme von Toppik™ 
Microscopic photo of Toppik™ fibers, which are juxtaposed with normal hair


Contrast adapter:

By means of a fine pigment-containing cream (for example, Couvre™), similar to make-up, the contrast is minimized.

The normal skin colour is covered with a colour similar to the physical colour of the hair and is therefore contrast adapted. The thin and sparse areas are optically less obvious. Many TV presenters and Hollywood stars use this kind of make-up. Swimming and strong rain are problematic. In every day life, say, while queuing in a supermarket, the coloured scalp would possibly strike someone's attention.  

Couvre™ 
 Couvre™

 

 

 
 

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