Medical Hair Restoration: A Comprehensive Guide

Medical Hair Restoration: A Comprehensive Guide

Medical hair restoration involves comprehensive treatment strategies that address hair loss or thinning in men and women, primarily caused by alterations in androgen metabolism. In this article, we explore various hair restoration approaches, explaining their mechanisms and effectiveness in promoting hair growth.

Androgen Metabolism and Hair Loss

The metabolism of the hormone androgen (testosterone) involves an enzyme called 5-alpha reductase, which combines with androgen to form Dihydrotestosterone (DHT). DHT is a natural metabolite responsible for 95% of hair loss due to its ability to enter hair follicles and roots (dermal papilla). This process prevents proteins, vitamins, and minerals from nourishing hair follicles, leading to a shortened growth phase (anagen) and extended resting phase (telogen) of the follicle.

Certain individuals, both men and women, may have a genetic predisposition to producing more DHT than others. The accumulation of DHT in hair follicles and roots contributes to male pattern hair loss (MPHL) and female pattern hair loss (FPHL).

DHT Blocking and Medical Hair Restoration

Addressing hair loss involves blocking DHT at a molecular level. Numerous natural DHT blockers and drugs have been developed to achieve this goal. Two of the most widely used drugs for hair restoration are Minoxidil and Finasteride.

Minoxidil

Minoxidil was the first drug used to promote hair restoration. Initially approved by the FDA in 1988 as a 2% solution for men, the concentration increased to 5% in 1997. For women, a 2% solution was approved in 1991; although a 5% solution has not been approved, many dermatologists worldwide continue to use it in their treatments.

Mechanism of action: Minoxidil is believed to have a direct mitogenic effect on epidermal cells. It enhances potassium ion permeability by converting to minoxidil sulfate, preventing calcium ions from entering cells which would otherwise inhibit hair growth. Restoring normal hair growth cycles may take a few months.

Caution should be exercised when using Minoxidil in patients with cardiovascular diseases. Pregnant and nursing mothers should avoid Minoxidil.

Finasteride

Previously used for treating prostate enlargement under the name Proscar, Finasteride was approved by the FDA in 1998 for medical hair restoration in MPHL.

Mechanism of Action: Finasteride inhibits type II 5-alpha-reductase, an intracellular enzyme that converts androgen into DHT. This leads to a significant decrease in serum and tissue DHT levels. Finasteride stabilizes hair loss in 80% of patients with vertex hair loss and 70% of patients with frontal hair loss. Its effect is more pronounced in the crown area than in the front.

As a surgical hair restoration adjunct, many hair restoration surgeons find Propecia (finasteride) to be highly effective.

Combination Therapy and Anti-Androgen Therapy

For mild to moderate MPHL, a combination of finasteride and topical minoxidil is often more advantageous. Many hair restoration doctors have started using this combination therapy to achieve better hair growth results.

For women with hyperandrogenism, anti-androgen therapy is a viable alternative if they do not respond well to minoxidil. In the UK, the most commonly used anti-androgen for women is cyproterone acetate (CPA), which is combined with ethinyl-estradiol. In the United States, where CPA is unavailable, the aldosterone antagonist spironolactone is the alternative choice.

Flutamide

For hyperandrogenic premenopausal women, flutamide is a better medical hair restoration agent compared to CPA or finasteride. It has demonstrated improved hair loss restoration treatment in women with hirsutism.