Treatment for Hair Thinning & Steroid-Related Hair Loss

Hair thinning, medically known as alopecia, impacts both genders due to various reasons. A common type among men is androgenic alopecia or male pattern baldness. This hair thinning can start any time after puberty and gradually worsens. It's a common condition in men during their life span. This article focuses on different types of alopecia, with a particular emphasis on androgenic alopecia, and discusses evidence-supported treatments for male pattern baldness.

Different Forms of Hair Loss

Androgenic Alopecia (Male Pattern Hair Loss)

About half of men by the age of 50 experience male pattern hair loss, also known as androgenic alopecia. Testosterone, produced by males, can be transformed into dihydrotestosterone (DHT) by the enzyme 5-alpha reductase. This enzyme is expressed in hair follicles in certain scalp areas, leading to inflammation and damage due to DHT, causing gradual hair thinning and loss.

Men with androgenic alopecia show varying levels of testosterone. However, the occurrence is linked to the expression of 5-alpha reductase in the scalp. Even with high testosterone and external DHT levels, if the scalp resists expressing the enzyme, hair follicles remain healthy. The variation in 5-alpha reductase expression explains why men experience balding at different rates.

Using external testosterone and anabolic steroids typically speeds up balding in genetically predisposed men, but it's not a guaranteed trigger in all. Treatments targeting 5-alpha reductase won't prevent hair loss from DHT derived from external steroids. Some steroids, not derived from DHT, have been reported to cause hair loss.

Common Misconception: The genetics for this condition are solely inherited from the mother's side. This is not true.

Telogen Effluvium

The average individual loses about 100 hairs daily. A notable increase in this number is classified as telogen effluvium, caused by various factors such as chronic health issues, stress, medication, and steroids. The hair loss typically reverses once the cause is addressed.

Alopecia Areata

This leads to localized bald patches due to an autoimmune reaction. T cells cause a focused inflammatory response on the scalp, resulting in a bald area, while the rest of the hair remains unaffected.

Anagen Effluvium

This type is related to chemotherapy and is often reversible post-treatment.

Traction Alopecia

Caused by pulling forces on the hair, it's common in styles like ponytails that exert excessive tension on hair.

Other hair loss causes include scarring alopecia, trichotillomania (hair-pulling disorder), bacterial and fungal infections, thyroid imbalances, and other less common reasons.

Treatments for Male Pattern Baldness

Various treatment methods exist for androgenic alopecia, focusing on inhibiting 5-alpha reductase, stimulating hair growth, and preserving existing hair thickness. Since hair growth takes time, effective treatments require several months to show results.

Finasteride (5-Alpha Reductase Inhibitor)

A widely used medication for male pattern baldness, it significantly reduces plasma DHT levels by inhibiting types 1 and 2 of 5-alpha reductase enzymes. The typical dose for hair loss is 1mg/day, differing from the 5mg/day dose for benign prostatic hyperplasia. Improvements are often seen around 3-4 months, with full effects after 6 months. While over 60% of users experience hair regrowth, close to 90% see prevention of further thinning.

Potential adverse effects, including sexual dysfunction, occur in a small percentage of users. Mood changes and orthostatic hypotension are other possible side effects. Decisions about this treatment should be made with a healthcare provider.

Dutasteride, stronger than finasteride, blocks all three types of 5-alpha reductase, almost completely reducing DHT. Not FDA approved for androgenic alopecia, it shares finasteride's side effect profile.

Minoxidil

Initially a blood pressure medication, when applied topically, it stimulates hair growth and preserves current hair. It's FDA approved for androgenic alopecia and typically used at 5% strength. Initial shedding, known as minoxidil-induced telogen effluvium, may occur, but most users see improvement after several months.

Ketoconazole Shampoo

Used as a DHT inhibitor, it shows positive effects for androgenic alopecia when applied topically. Mainly approved for dandruff and fungal treatments, it's available in various strengths.

Hair Transplant

For those where medical therapy is ineffective or not an option, hair transplant is a minimally invasive solution. It involves transplanting follicles from balding-resistant areas to bald spots. New, permanent hair growth occurs over several months.

Platelet Rich Plasma (PRP) Injections

PRP involves injecting concentrated platelets, obtained by centrifuging blood, into targeted areas. Used for hair growth stimulation, its efficacy requires more research for broader recommendation.

Saw Palmetto

Traditionally used for BPH, it inhibits 5-alpha reductase. Its effectiveness in mild androgenic alopecia is uncertain, with limited evidence.

Biotin

While biotin deficiency can cause hair loss, there's no strong evidence that excess supplementation promotes hair growth.

Oils

Pumpkin seed oil, coconut oil, castor oil, and peppermint oil have varying degrees of evidence supporting their effectiveness in reducing 5-alpha reductase and promoting hair growth.

Other Treatments

Beta-Sitosterol, capsaicin with isoflavone, and B vitamins are other options, though their effectiveness and safety are not well-established.

Hair loss in any form can be psychologically challenging. While various treatments are available, their effectiveness varies. It's crucial to work with a healthcare professional for an evidence-based approach to hair loss treatment.

Disclaimer: This article is for general information and educational purposes only and should not be considered medical advice. Consult your physician for any health-related advice and product use.