When it comes to treating baldness, it is medicinal pills and topicals that spring to most peoples' minds as the options holding the greatest promise. There are also other available treatment options, such as surgical and non-surgical hair replacement, but to date only oral and topical medicinal treatments have been proven to reduce and reverse hair loss naturally. Hair surgery, though providing the best cosmetic results, cannot slow or reverse hair loss. Natural and herbal hair loss treatments seek to mimic medicinal treatments in their mode of action but their effectiveness in treating hair loss has never been confirmed in any serious clinical study and too many of them are associated with hair scams.
The two medicinal treatments that have been approved by the FDA (Food and Drug Administration) in the US for treating hair loss are topical minoxidil (trade name Rogaine/Regaine) and oral finasteride (Propecia). These two hair loss drugs have been also approved by national health supervisory authorities in many other countries. Topical minoxidil is suitable for both sexes, whereas finasteride can only be prescribed to male patients. Minoxidil is a vasodilator, originally used to treat high blood pressure, which was later found to stimulate new hair growth when applied topically to the scalp. Its exact mechanism of action is not known, though.
Finasteride is an antiandrogen that was first applied to treat prostate enlargement, also known as benign prostatic hyperplasia (BPH). It acts by inhibiting conversion of the male hormone testosterone to the follicle harming didydrotestosterone (DHT). The discovery of finasteride's positive effects on hair growth led to finding the true cause of hereditary baldness, which are the harmful attacks of DHT on our hair follicles. Since making this discovery, a search for other alternative DHT blockers has begun, especially amongst antiandrogen drugs and herbs that have, in the past, been used to treat urinary problems.
Dutasteride (trade name Avodart) is a drug very similar to finasteride and has been studied extensively for treating hair loss. It is currently undergoing phase III clinical testing. It has been approved for treating BPH and is thus available in pharmacies in many countries around the world. Although it has not yet been approved for hair loss by any country, it is being prescribed by some clinics and doctors to male patients who no longer respond to finasteride. Dutasteride is considered to be a more powerful hair loss drug than finasteride but also with more severe side effects.
Flutamide (trade name Eulexin) is an extremely powerful antiandrogen used to treat prostate cancer. It works by binding to the androgen receptors and thus competing with DHT. Oral use of flutamide can cause serious side effects but it is believed that topical applications might have less adverse side effects and could be, in the future, used to combat hereditary hair loss. More research is needed to verify such claims.
Spironolactone (trade name Aldactone) is another antiandrogen that acts by binding to androgen receptors, competing with DHT. It is used in women to treat acne, hair loss and hirsutism (excess body hair) and although there are some generic topical applications out there for treatment of male pattern baldness containing spironolactone, it has never been approved to treat hair loss in men and should better be avoided.
Aminexil, was developed by L'Oreal to treat baldness in men and women and its molecule is quite similar to that of minoxidil. Its mode of action is not exactly known and it is considered to be a weaker weapon in the fight against hereditary baldness than minoxidil.
The most promising novel drug under development is called NEOSH101. It happens to be in phase II clinical trials and is supposed to be a hair growth stimulant, distantly related in its actions to minoxidil. Although not expected to become an ultimate cure for baldness, it could improve the chances of hair loss sufferers of regrowing some of their lost hair.
The above list of medicinal treatments for hair loss is not exhaustive. There are some other drugs that are believed to help treat hereditary baldness, such as superoxide dismutase, fluridil, ketoconazole, alfatradiol, etc. but none of them has ever been proven in any serious clinical study to promote hair growth and further studies will be needed to evaluate their effects on hair loss. Therefore, for the time being, minoxidil and finasteride remain the main weapons in the fight against genetically-determined hair loss conditions in male patients.
By Dody Gasparik MSc.
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