Hair loss treatment clinical studies were conducted in men age 18 to 41 with mild to moderate degrees of male pattern hair loss. All the men treated with Propecia received a tar based shampoo (Neutrogena T/Gel shampoo) and were instructed to wash their hair at least once per day.

Five year hair loss treatment clinical studies involving Propecia demonstrated the effectiveness of Propecia in stopping hair loss and promoting hair re-growth:

*	Some 95% of men with hair loss had visible hair re growth and/or no further hair loss following hair loss treatment with Propecia (according to an independent hair loss panel of dermatologists).
*	Propecia significaly reduces the level of dihydrotestosterone (DHT), a known cause of hair loss.
*	Almost all men taking Propecia were rated as vastly improved by a panel of physicians.
*	Almost all the men in the Propecia hair loss treatment clinical trials reported their bald spot regressing, a stopping of their hair loss and excitingly the appearance of hair re growth.
*	Propecia hair loss treatment has demonstrated an excellent safety profile.

Propecia has quickly become the number one prescription medication for hair loss treatment. Propecia, an oral medication is more effective than topical prescription ointments. Countless independent Propecia hair loss clinical trials have confirmed that Propecia is effective in promoting hair re growth while stopping hair loss.

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Minoxidil - was first approved in 1979 has hypertensive medication. However, men begin to notice the growth of hair as a side effectt of the hypertensive medication. So Upjohn went back to the lab and developed a topical version of the medication. Ten years later minoxidil was re-introduced has Rogaine. The mechanism of action of Rogaine remains unknown. The medication is known to be vasodilator, however, other medications that dilate the blood vessels do not stimulate hair growth. Rogaine is believed to work in part by partially enlarging miniaturized follicles and reversing the miniaturization process. This supposedly prolongs the growth phase of the hair cycle, allowing the hair to become thicker and longer.

Hair loss treatment clinical trials have shown with the 2% solution that 26 percent of men ages 18-49 reported moderate to dense hair re-growth following four months of treatment. An additional 33 percent had minimal hair re-growth. Approximately 20 percent of women between the ages of 18-45 had moderate re-growth, while an additional 40 percent minimal re-growth. The new extra strength 5% Rogaine solution has demonstrated slightly improved results as compared to the 2% solution in men. Currently, the extra strength 5% Rogaine hair loss treatment solution is not recommended for women.

There are some other topical hair loss treatment options that warrant some discussion at this time. Please keep in mind before you rush out to order any of the following hair loss treatment products that there has been limited clinical testing concerning the following hair loss treatments:

Retinoic Acid - was first approved for acne under the trade name Retin-A. Since then it has been discovered that retinoic acid can be used for several medical conditions, including hair loss treatment. Retinoic acid is known to increase the absorption of other medications through the skin, therefore it is hypothesized that the retinoic when used in conjunction with minoxidil should increase the amount of minoxidil reaching the hair follicles. There is also some experimental evidence that indicates that retinoic acid may play a role in hair growth by presently unknown mechanisms. There have been case reports where the use of retinoic acid alone induced a significant amount of hair growth.

However, retinoic acid, does have some unwanted side effects associated with its use including: itchiness and flaking of the scalp (further contributing to dandruff), increased sensitivity to the sun, and similar to the use of minoxidil, a small percentage of patients may experience an initial increase of hair loss at the onset of treatment. However, usually this resolves with time. When first starting the formulation, start using it every other night for one week, then increase to ever night for one week, and finally increase to twice a day. This method of use will decrease the unwanted side effects.

Azelaic acid - is a naturally occurring dicarboxylic acid found in whole grain cereals and animal products. The medication has been approved as a topical preparation to treat acne vulgaris. It is also used by dermatologist to lighten hyperpigmented skin. However, there is some scientific evidence that azelaic acid is a competitive inhibitor of Alpha-5 Reductase. Inhibiting Alpha-5 Reductase decreases the levels of DHT (dihydrotestosterone) in the scalp. Side effects associated with azelaic acid include: itchiness, tingling, or stinging sensation occurring in 1-5% of patients, redness, dryness and peeling of the skin seen in less than 1% of patients, some patients have noted a lightening of the skin.

Spironolactone is a "Potassium Sparing Diuretic" or high blood pressure medication that has been used for decades to treat high blood pressure and fluid retention. However, there is also some scientific data suggesting a beneficial effect of spironolactone on hair loss. Spironolactone has been noted to have anti-androgen activity. Androgenetic alopecia (male and female patterned baldness) is heavily influenced by androgens (most specifically- DHT). Spironolactone binds to the receptor sites on the hair follicles which blocks DHT from having its deleterious affect on the hair follicle.

Side effects associated with spironolactone are minimal now that spironolactone has been made into a topical solution, instead of a pill. Rarely, a patient will develop a rash from the spironolactone solution, which resolves upon dicontinuation of the lotion. The product also has a malodorous scent which is increased if spironolactone is combined in the same container with other chemicals (i.e.- minoxidil, retinoic acid). Sprironolactone solution is be applied to the balding scalp twice a day. It should be applied and allowed to dry (few minutes) before placing on the minoxidil solution.

Hair Loss Treatment (hair piece)Hieces)

Some men prefer to sport a hair piece instead of using the pharmaceutical hair loss treatment options. Interestingly, over a million men in the UK sport a hairpiece, spending some 350 million annually on the purchases and maintenance of these products. "You would think with all his money he would have a decent hair piece," is the quite frequently stated remark concerning men with ill-fitting hairpieces. However, cost has less to do with a good-looking hairpiece than does the selection of the manufacturer combined with the grooming and care given it by the wearer. An attractive hairpiece requires careful color matching, fitting, as well as subsequent styling and replacement. Unfortunately, many individuals fail to properly care for their hairpieces as time progresses. Hairpieces can be made from synthetic materials such as nylon or actual real human hair. Prices can vary considerably, small filler pieces may cost from £200.00 up, full wig £500.00 up. The average hairpiece of good quality, synthetic or real will usually cost between £250.00-£1,800.00. The debate goes on, human hair verses synthetic hair. Human hair tends to react more to the sun and other elements such as chlorine. The most significant problem is the color of the hair fades with time. Human hair also requires more maintenance including monthly visits to the hair stylist for styling and cleaning, at a cost of £20-£30; periodic dyeing can cost another £55.00 - £75.00. Additionally, hairpieces made from human hair rarely look appropriate longer one year. Manufacturers of synthetic hair claim their products look more natural, are water resistant, hold their shape better and last longer than human hair. However, individuals must still bring their hairpiece in for maintenance every four to six weeks, at a cost of £30.00 - £50.00. Synthetic hair generally looks natural for up to two years. The decision human verses synthetic is primarily one of preference. Reputable hairpiece companies will encourage individuals to research both types of hair prior to purchasing.

Hair Loss Treatment (Hair Transplants)

The surgery team then delicately divides the donor graft into mini/micro grafts for transplant. The grafts are then implanted into the appropriate donor sites. The correct selection, placement and angle of the grafts remain the critical element in obtaining a positive result. Physicians must posses a unique artistic flare combined with surgical skill to create a natural appearance of the hair. Hair transplants have evolved to the point where they are done on an outpatient basis. Most surgeries last 3-4 hours and patients may return home a couple of hours following the procedure. A bandage is usually applied to keep the area clean and free from infection, patients are usually asked to return the next day for a follow-up appointment. Many patients return to work within 24 hours although strenuous activity is discouraged.

Fortunately the scalp is very vascular, so the healing process is relatively short. However, as with any surgery there is always risk of infection. Individuals may also experience some swelling of the forehead in the week following the surgery, some areas may also scab over. Patients should also realize that transplanted hair shaft often go into a resting phase shedding the existing hair. Usually within 3-6 months the transplanted hair follicles will begin to produce noticeable hair. There is a new approved product developed by ProCyte called GraftCyte that helps prevent transplanted follicles from going into the resting phase so the transplanted hair does not shed as often.

The number of procedures required is dependent on the surface area that needs to be covered and the expectations of the patient. The human scalp averages one follicular unit per 1mm and each unit represents approximately 2.2 hairs. So a section of healthy scalp measuring 1cm by 10 cm would represent some 1000 follicular units or around 2,200 hairs. Normally two or three sessions are sufficient to get a natural appearance. Natural appearance does not necessarily dictate natural density. Hair loss remains a dynamic process and donor sites are limited, therefore, individuals are encouraged to be realistic about the density of their transplants.

Hair Loss Treatment (surgical procedures)

Scalp reductions - involve surgically excising a section of bald scalp from the vertex of the head. Then the adjacent skin is extensively undermined so the surgeon can close the incision. Following a recover period, mini/micro grafts are later transplanted into the appropriate regions. Scalp reductions can cost between  £1,000-  £2,500 depending on the extent of the surgery.

 

 

Transpositional flaps - involve a series of procedures were a surgeon partially dissects a horseshoe section of skin containing healthy hair from the donor area. The free end is positioned over the follicular challenged area where a section of skin has been excised. The surgeon then closes the donor and recipient sites with sutures. Transplanted micro-grafts are then inserted to promote a natural look. Transpositional flaps can cost between £2,000-£5,000 depending upon the extent of the surgery.

 

Free flaps - represent an extensive surgery, first all or a portion of the bald area is excised. A section of micro vascular surgery, the blood vessels that supply nourishment to the donor flap are connected to the vessels in the new area. Sutures are then used to close both donor and recipient areas and transplanted micro-grafts are inserted to promote a natural look. There are some disadvantages to the flap procedures. Sometimes the resulting frontal hair does not appear natural and a scar along the hairline can be detected. Additionally, the hair of the flap may grow in a direction different from the natural hairs, giving an artificial look. Free flaps also cost between £1,500-£4,500 depending on the extent of the surgery.

The above mentioned procedures may be performed using local or general anesthesia depending upon the extent of the surgery. Surgical risk is similar to the mini/micro transplant procedures, there is always a risk of infection. Any licensed physician may perform hair surgery, many individuals end up with unsatisfactory results i.e. excessive scarring, patches of thin transplanted hair partially covering areas that continue to lose hair, loss of hair leaves the scars from previous surgeries visible, etc. Carefully and cautiously select a surgeon, beware of seductive marketing brochures showing after photos of men thick, full heads of hair. Ask for referrals, actually talk with individuals who the surgeon has treated.

Hair Loss Treatment (Products)

What about all the other products that are so cleverly marketed including mousses, volumizers , hair sprays, shampoos, conditioners, hot oils, etc? The first thing to remember is that many unethical companies are going to play on the emotions of individuals with hair loss. Companies will claim that their products have "secret constituents" that make an individual's hair "thicker and fuller" in hopes that sub-consciously the individual will believe that the product does actually grow hair. I doubt if there will ever be a  "secret constituent" that actually acts as a hair loss treatment miracle. However, there are effective ways to reduce hair loss while promoting the growth of new hair follicles, Propecia remains the most effective hair loss treatment. Propecia is recommended by more doctors than any other hair loss treatment option.

The following is a list of some common hair loss myths that companies exploit to sell their concoctions:

*	Blocked follicles - contributing to hair loss. Although individuals with hair loss may have an increase in the amount of sebum associated with their scalp. No study has ever indicated that the sebum could block a hair follicle from actually growing
*	Parasites - such as ringworm is responsible for hair loss. Ringworm is actually a fungus. Although it does cause hair loss, it usually effects children. In addition, the hair loss associated with the fungus does not have the characteristic male pattern.
*	Toweling off - your head lightly rather than vigorously. This technique will postpone the inevitable around two or three days.
*	Poor circulation - in the scalp produces hair loss. This is false, hair loss treatment clinical studies have shown repeatedly that the blood supply to an individual's scalp with hair loss is not compromised.
*	Vitamin deficiencies - are a cause of hair loss. Hair loss secondary to vitamin deficiencies is very rare the UK. In fact, vitamin toxicity (vitamin A) is responsible for more cases of hair loss than deficiencies in vitamins.

There are reputable products on the market that do not promote hair growth but they can help give the illusion that you have more hair. Regular shampooing is an important concept for individuals experiencing hair loss. The sebaceous glands continue to produce the same quantity of sebum even has hair follicles shrink. Therefore, the thinning hair shaft is subjected to more oil, which results in flat and/or dull looking hair. DHT is also found in high concentration sebum and is secreted with the oil onto the scalp. Regular shampooing prevents the scalp from reabsorbing the DHT so it cannot be recycled into the follicle, thus, preventing further damage. As a physician, patients commonly ask for a recommendation when it comes to shampoo. There are literally hundreds of shampoos currently on the market with a new product being introduced every day. The problem is each one of these products has a different marketing ploy that can be very confusing to consumers.

Neutrogena is a name that has become synonymous with quality products in the hospital. Merk Pharmaceuticals must also have some confidence in the Neutrogena products because that is the brand of shampoo they used in their clinical trials while testing the effectiveness of Propecia.

Hair Loss Treatment Conclusions

Doctors agree that the best way to treat hair loss is to take the offensive, that is, begin a treatment with a strong hair loss treatment prescription medication i.e Propecia, prior to extensive thinning.  Multiple clinical tests have shown that Propecia will significantly reduce the hair loss process, as well as, promote new hair growth.

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Clinical tests have shown that Propecia has significantly reduce the hair loss process as well as promote new hair growth. Studies have also shown that thinning hair shaft is subjected to more oil, which results in flat and/or dull looking hair. DHT is also found in high concentration sebum and is secreted with the oil onto the scalp. Regular shampooing prevents the scalp from reabsorbing the DHT so it cannot be recycled into the follicle, thus, preventing further damage. Frequent shampooing also prevents hair from appearing flat and dull. Probably the best shampoo on the market for men with thinning hair is the product Merk Pharmaceuticals trusted in their clinical trials with Propecia, Neutrogena T/Gel shampoo.

Propecia remains the most prescribe prescription medication for the treatment of male hair loss. Propecia has been proven in Hair Loss Clinical Studies to promote the growth of new hair, stopping current hair loss while increasing the length and diameter of your hair. 

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Remember, Propecia is the only oral drug that promotes hair growth, slows hair loss while increasing the length and diameter of your hair.