Other Treatment Modalities

The consultation begins with a review of relevant past medical history and family history including the history of familial hair loss. Before undergoing any surgical procedure, it is imperative to rule out any underlying conditions which need to be treated medically. Patients are encouraged to come to the office with the results of previous blood work, biopsies, or other test results. 

Of all symptoms caused by generalized health issues, hair loss is often the "final straw" which actually motivates a patient to seek medical advice: for this reason, the HRS has a unique opportunity to help a patient with their overall health, in addition to their hair loss. Conditions which may cause hair loss are extremely varied, but most commonly include: severe emotional or physical stress (temporary); low or high thyroid; low iron, zinc, or protein; changes in hormone status; polycystic ovarian syndrome. All medical conditions should be under control and stable before surgical treatment for hair loss begins, and topical minoxidil may be used in the interim to try to speed the re-growth or slow the loss. Some medical treatments for underlying conditions may even help reverse some types of hair loss, but this depends on the particular condition and the length of time the patient remained un-diagnosed. 

The most common reason for hair loss is of course genetics. A history of male pattern baldness (MPB) or female pattern hair loss (FPHL) is usually present among family members.

MPB can be treated with one of two FDA approved medications; Finasteride and Minoxidil. The studies to date have followed patients for a five year period, therefore these potentially very helpful treatments need to be looked upon as “stalling” measures – not lifetime cures. 

Finasteride is an oral medication taken daily which blocks the conversion of testosterone to dihydrotestosterone (the hormone which causes hair loss in men and sometimes in women with elevated levels of androgens). The medication has been shown to slow hair loss and actually increase hair growth in some responsive patients. The largest study examined the vertex area only, a second smaller study showed some positive effect in the mid-scalp region (although the results were less impressive than those seen in the vertex). The frontal area and temporal recessions have not been shown to improve with finasteride. The side-effects occur in less than 2% of patients, an in depth discussion can be found in greater detail in other sources; briefly, the side effects may include erectile dysfunction, decreased sex drive, and decreased semen volume. These effects disappear completely if the drug is stopped. Reports have also included gynecomastia as a possible side-effect.

Minoxidil is a foam or liquid medication that is applied on the scalp twice daily. It has also been shown to be quite effective in slowing the progress of vertex hairloss and some mid-scalp thinning. The side-effects are mild, but may include a localized irritation on the skin, extra hair growth on the face, and possible headaches (potentially due to lowering of blood pressure in susceptible patients). This drug can be quite effective in both men and women, however patients are often not very diligent about using regularly and this seems to affect its success in the general population of users.

Women present a special challenge to hair restoration surgeons. There are many women with a genetic predisposition to hair loss and these women may find minoxidil helpful to slow hair loss. If tolerated, minoxidil 5% foam is the most effective option. In addition, Dr. Unger refers patients to endocrinologists for a full work-up and treatment if there is any question of potential underlying causes such as subclinical hypothyroidism, polycystic ovarian syndrome, abnormalities in androgen levels, or other causes linked to hair loss. The treatment of these conditions will effectively slow future hair loss and although the use of finasteride “off-label” has not been proven to be effective, many women with elevated levels of androgens have responded positively to this treatment by endocrinologists.