Chapter 91
Medications for Hair Loss
No, hair loss is not caused by washing or brushing too much, two of the many circulating myths about hair. Among identical female twins, the sister with more stress, more marriages, more divorces or separations, and more children was the one more likely to lose her hair. Among identical male and female twins, head coverings appeared to be protective, but the research findings on exercise and caffeine consumption were conflicting. Among female twins, exercise and caffeine were associated with less hair loss; among males, with more hair loss. Perhaps because aerobic training can raise testosterone levels in men, as international studies show. Interestingly, coffee with caffeine can raise testosterone levels in men and lower them in women.
The data on tobacco were consistent. Studies with male and female twin pairs found that smoking leads to a receding hairline, consistent with results from general population studies. This is thought to be due to genotoxic substances in cigarettes that damage DNA in hair follicles and microvascularly poison their blood supply. Other toxic substances linked to hair loss include mercury, which appears to deposit in growing scalp hair at 250 times the concentration. That Shakespeare lost his hair may have been due to treating his syphilis with mercury. Fortunately, doctors no longer give their patients mercury. As the Centers for Disease Control and Prevention explain, today mercury is consumed “primarily through seafood.”
Women in menopause often seek help for supposedly hormone-related hair loss, but there are case reports in which women with high fish consumption had correspondingly high mercury levels in the blood, and their hair loss was stopped when they avoided fish. For example, if you stop eating tuna, mercury levels can fall by up to a third within two months, and then not only does new hair grow, but it can be fully back after seven months. The medical director of the Center for the Menopause, Hormonal Disorders and Women’s Health encourages physicians to measure mercury exposure in cases of hair loss, because “advising patients to eat less fish” could, in hair loss due to heavy-metal exposure, “alleviate symptoms.” (If you think of the glam bands of the Eighties, however, you might conclude that heavy metal makes hair grow excessively.)
Medications for Hair Loss
Historically, treatments for hair loss included recommendations such as sprinkling mouse droppings and the ashes of a donkey penis on the scalp. Julius Caesar supposedly used a mixture of ground mice, horse teeth, and bear fat. Today the treatments may be less exotic, but apparently no less desperate, as more than $3 billion is reportedly spent each year in the United States to save hair. The only FDA-approved drugs for hair loss at present are minoxidil, brand name Rogaine, and finasteride, brand name Propecia. In the video see.nf/hairdrugs I discuss the effectiveness and safety of the two agents.
Transplanting
There are also surgical options, although certain methods have been discredited in recent years. In the 1950s, small circles of scalp where hair was still growing—for example, from the back of the head—were transplanted to bald spots on the top and front. The result looked very unnatural, like a doll.
Today there is “follicular unit transplantation,” in which a long strip of scalp is surgically removed and divided into many smaller units for transplantation. This way, the transplanted follicles retain their androgen resistance from the original growth site. If a man has a completely bald head, hair can be transplanted from the chest, abdomen, legs, shoulders, or beard. Most of the hair follicles placed this way survive (about 85 percent), and patients are very satisfied. However, multiple procedures are necessary for good-looking results, and each carries a complication risk of up to 5 percent, including necrosis at the donor site, excessive scarring, and infections, even though serious complications are rare.
Plasma and Lasers
What can you do without medications and without surgical procedures? There have been trials with autologous platelet-rich plasma, a procedure in which concentrated autologous blood is repeatedly injected into the scalp. The effectiveness of this procedure is comparable to that of available medications, but so far the evidence is insufficient to recommend it, and in the United States and Europe it is not approved for restoring a full head of hair. Botox is also not recommended. The idea was that hair might not fall out if the scalp is relaxed through improved circulation, but when this was tested, participants in some pilot studies lost even more hair. And then there are laser beams.
In 2007, the FDA cleared the first low-level laser therapy (LLLT) device—i.e., using low-energy beams—and clinics now promote their lasers for everything from tennis elbow to “testicular rejuvenation.” In see.nf/lasers I discuss these methods. There are at least ten randomized controlled trials of LLLT devices for treating hair loss, and although statistically significant improvements in hair density and thickness were achieved, there are only minor clinically significant improvements. If you still want to put yourself through this, take a look at the video for some tips on safety and on how to choose among the dozens of FDA-cleared devices currently on the market.
Hair Loss Supplements
Is there a nutrient deficiency that causes hair loss? After bariatric surgery, hair loss is the most commonly reported symptom of nutrient deficiency, but the surgery often changes something anatomically precisely to prevent food absorption from the digestive tract. In general, there is not much to suggest that vitamin and mineral supplements provide a benefit, except when someone truly has a deficiency. This applies to vitamin C, zinc, iron, and biotin, which can even do more harm than good. Details on these studies can be found at see.nf/hairsupplements. For example, not a single clinical study shows that biotin helps with any form of hair loss unless the deficiency was brought about by consuming raw egg white, and biotin supplements can wreak havoc on a whole range of blood tests.
With the lack of oversight, some manufacturers are sloppy enough to put more than 200 times the intended selenium dose into their supplements, such that selenium poisonings have occurred that resulted in hair loss. The same thing can happen if you consume too much vitamin A or vitamin E; nevertheless, the best-selling hair supplement on Amazon.com contained both vitamin A and E, and the second most popular contained vitamins A, E, and selenium.
What can all the patented hair-growth supplements on the market these days do? A dermatology specialty journal evaluated the available data and concluded that it is, at least for now, a myth that any of them promote hair growth. Ironically, such supplements are sometimes more expensive than currently available medications—up to $1000 per year compared with $100–300 per year. Couldn’t we address hair loss from the inside, through diet?
Food Against Hair Loss
Population studies found that nonpathologic hair loss is associated with poor sleep habits and consumption of meat and processed junk, whereas benefits were found with consumption of raw vegetables and fresh herbs or soy milk. People who consume soy beverages weekly have a 62 percent lower likelihood of moderate to severe hair loss, so it is possible that certain plant components protect against hair loss.