What are my options for men's hair loss?

Men’s hair loss is progressive and affects 40 million American men. Some men aren’t bothered by hair loss but for others it can be devastating. Over the millennia men have tried everything possible to stop hair loss including applying hippo fat to cow manure to the urine to young foals to the scalp. For some men, it’s almost as if the more crazy the concoction is the more likely it might work.

In reality there are very few proven options to treat male pattern baldness. Don’t waste your money on lotions-and-potions.

Finasteride

Known more commonly as Propecia, the drug works by lowering dihydrotestosterone (DHT) levels. This is the hormone byproduct that has been identified as the culprit in male pattern baldness. It works in most men but the amount of hair regrowth is limited. It can be effective in maintaining hair during the early stages of hair loss. There are several downsides, however. First, a limited amount of men experience the side effect of erectile dysfunction. Second, the benefits immediately reverse themselves as soon as you stop taking the daily 1mg dose.

Minoxidil

Minoxidil was initially developed to treat high blood pressure. Patients taking the treatment for high blood pressure noticed some hair growth stimulation. The branded version (Rogaine) was the first medication approved by the FDA to treat male pattern baldness. The American Hair Loss Association points out that the results of the treatment are limited but still endorse it in combination with other treatments or as an alternative to finasteride. The medication is applied as a liquid or foam. Side effects are limited to the occasional itchy scalp.

Hair Transplants

Hair transplant techniques have greatly improved over the last few decades. They have gone from large plugs that result in a “dolls head” look to transplanting one follicle at a time in a pattern that leaves a natural look. There are basically two types of hair transplants. The dirst is the strip method where a strip of donor scalp is extracted from the back of the head, divided into individual follicles and implanted into the recipient sites made by the hair transplant physician in the balding area. The second method is Follicular Unit Extraction (FUE) where individual follicle are removed from a shaved area on the back of the head and transplanted into the recipient sites.

Both of these methods are invasive and expensive. On the positive side the transplanted hairs will usually grow for decades. This is because the hair that is transplanted from the back of the head is genetically resistant to the hormone byproduct (DHT) that causes hair loss. The average cost for a hair transplant is $7,000 and sometimes a second or third procedure is necessary if you want a decent amount of hair density.

Toupees

The most inexpensive option is an old fashion synthetic toupee. With this option you get what you pay for. Expect to be ridiculed.

Custom Made Hair Systems

Custom made hair systems are much more expensive than toupees but are virtually undetectable when applied and services by a professional hair restoration specialist. They are made by knotting human hair onto a fine mesh material that matches the color of the scalp. They are typically made with human hair that is selected to match the texture and color of your existing hair and then attached with a medical adhesive and blended (effilated in stylist speak) to your natural hair on the sides of your head. Because your natural hair continues to grow you will need frequent maintenance to maintain a natural look, usually monthly. Men can expect to pay $300 - $500/month for a professional hair restoration specialist.

Laser Combs and Laser Hoods

The laser hair replacement business has grown tremendously over the last 10 years. Lasers for hair regrowth don’t have FDA “Approval” like Finasteride or Propecia but rather have FDA “Clearance”. Devices that receive FDA Clearance haven’t gone though the rigorous double blind test required to prove efficacy but are cleared based on their similarity to previously approved devices that have proven safe to use. FDA Clearance gives the seller clearance to market the device as safe but not “approved” as scientifically effective.

Low Level Light Lasers (LLT) are touted to work by stimulating blood flow to hair follicles. The process doesn’t directly affect DHT, the hormonal cause of hair pattern baldness. Unscientific studies have shown some increase in hair volume in the majority of patients. Many devices can be purchased direct from manufacturers for $500 - $800. Treatments are usually required several times a week and are required forever. The fatigue factor is high and most men eventually stop using the devices.