Fertil Steril. 2003 Jan;79(1):91-5.

Treatment of hyperandrogenic alopecia (pattern hair loss) in women.

Carmina E, Lobo RA.

OBJECTIVE: To determine the effectiveness of various antiandrogens for the treatment of premenopausal women with hyperandrogenic alopecia or pattern hair loss. DESIGN: Randomized, unmasked trial of three treatments in 36 hyperandrogenic women with alopecia and observation, without treatment, in 12 other similar patients. SETTING: Endocrinologic outpatient practice in Italy. PARTICIPANT(S): A total of 48 hyperandrogenic women with alopecia and 30 age- and weight-matched controls for the assessment of androgen levels. INTERVENTION(S): Randomization to cyproterone acetate (50 mg) with ethinyl estradiol (EE) in a reverse sequential regimen; flutamide (250 mg) or finasteride (5 mg) daily; all for 1 year. Twelve similar patients were observed without treatment for 1 year. MAIN OUTCOME MEASURE(S): Ludwig scores for hair thinning as well as patient and investigator assessments of treatment effectiveness. RESULT(S): Flutamide resulted in a reduction of 21% in Ludwig scores (2.3 +/- 0.2 to 1.8 +/- 0.1). The other treatment effects were not statistically significant. Patient and investigator assessments showed a similar trend. CONCLUSION(S): Flutamide at a dose of 250 mg daily induced a modest improvement in alopecia after 1 year, whereas cyproterone acetate and finasteride were not effective. Treatment for more than 1 year may be required for better results.

Eur J Dermatol. 2002 Jan-Feb;12(1):32-7.

Finasteride improves male pattern hair loss in a randomized study in identical twins.

Stough DB, Rao NA, Kaufman KD, Mitchell C.

OBJECTIVES: This study compared the efficacy of finasteride with placebo in the treatment of male pattern hair loss (androgenetic alopecia) in nine pairs of male identical twins. METHODS: In this randomized, double-blind, placebo-controlled, single-center study, one twin from each identical twin pair received finasteride 1 mg/day for one year while the other received placebo. Hair growth was evaluated from standardized clinical photographs, hair counts and patient self-assessment questionnaires. Serum dihydrotestosterone and testosterone levels were analyzed and adverse events recorded. RESULTS: Finasteride significantly improved hair growth at one year compared to placebo based on analysis of photographs of the vertex and superior-frontal scalp. These results were consistent with the hair count change measured in the finasteride group, which was superior to the change measured in the placebo group. Patient self-assessment demonstrated that treatment with finasteride, in comparison to placebo, led to improvements in scalp hair growth and patients’ satisfaction with appearance of hair. No drug-related adverse events were reported during the study. CONCLUSION: Through the use of identical twins, this study provides further evidence that finasteride significantly reduces hair loss progression and restores hair growth in men with male pattern hair loss.

J Urol. 1999 Oct;162(4):1295-300.

Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men.

Overstreet JW, et al

PURPOSE: Finasteride, an oral type 2, 5alpha-reductase inhibitor, is used in 1 mg. daily doses for the treatment of male pattern hair loss. A dose of 5 mg. finasteride daily reduces ejaculate volume by approximately 25%, and reduces prostate volume by approximately 20% and serum prostate specific antigen (PSA) by approximately 50% in men with benign prostatic hyperplasia. To our knowledge no data exist on the effect of 1 mg. finasteride daily on ejaculate volume or other semen parameters, or on the prostate in young men. Therefore, we studied the potential effect and reversibility of effect of 1 mg. finasteride daily on spermatogenesis, semen production, the prostate and serum PSA in young men. MATERIALS AND METHODS: In this double-blind, placebo controlled multicenter study 181 men 19 to 41 years old were randomized to receive 1 mg. finasteride or placebo for 48 weeks followed by a 60-week off-drug period. Of the 181 men 79 were included in a subset for the collection and analysis of sequential semen samples. RESULTS: There were no significant effects of 1 mg. finasteride on sperm concentration, total sperm per ejaculate, sperm motility or morphology. Ejaculate volume in subjects on finasteride decreased 0.3 ml. (-11%) compared to a decrease of 0.2 ml. (-8%) for placebo, with a median between treatment group difference of -0.03 ml. (1%, 90% confidence interval -10.4 to 13.1, p = 0.915). There were significant but small decreases in prostate volume (-2.6%) and serum PSA (-0.2 ng./ml.) in the finasteride group, which reversed on discontinuation of the drug. CONCLUSIONS: Treatment with 1 mg. finasteride daily for 48 weeks for pattern hair loss did not affect spermatogenesis or semen production in young men. The effects of 1 mg. finasteride daily on prostate volume and serum PSA in young men without benign prostatic hyperplasia were small and reversible on discontinuation of the drug.

Cutis. 2004 Feb;73(2):107-14.
Hair loss remedies–separating fact from fiction.
Bandaranayake I, Mirmirani P.

Hair loss is a common complaint in the outpatient setting. Frequently, patients conduct their own research on hair loss diagnosis and treatment and are faced with a number of manufacturers’ claims that their products will benefit hair loss. This paper explores the truth behind those claims of hair regrowth. We intend for this information to serve as a “consumer report” for healthcare providers and patients and to help separate some of the valid claims for hair regrowth from those that are purely fiction.

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J Am Acad Dermatol. 2005 Feb;52(2 Suppl 1):8-11.

Congenital alopecia areata.

Lenane P, Pope E, Krafchik B.

Alopecia areata, the alleged autoimmune process leading to nonscarring hair loss, is not uncommon. It has been classified as an acquired cause of alopecia; however, recently it has been reported in the neonatal period. We report 4 cases of congenital alopecia areata with follow-up from 3 to 5 years. The diagnosis was made clinically in all cases. All patients had prolonged periods of quiescence of hair loss ranging from 6 to 24 months. Treatments used included minoxidil 2% and a range of topical steroids including hydrocortisone 1%, betamethasone valerate 0.05%, fluocinonide 0.05%, and clobetasol propionate 0.05%. The best regrowth observed resulted from the use of clobetasol propionate 0.05%, giving full regrowth in 50% of those treated. Alopecia areata can occur at all ages and, thus, can be classified as both an acquired and a congenital disorder resulting in hair loss.

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Med Hypotheses. 2002 Nov;59(5):522-6.

Androgen-related hair growth: implications in autoimmune disease.

Foote SI.

Androgen-related changes in hair growth represent something of a mystery. Through the action of dihydrotestosterone (DHT), hair growth is increased in specific areas of the body. Elevated levels of DHT produce a general increase over the larger part of the body, often accompanied by hair loss in specific areas of the scalp. Because of this ‘opposite’ effect, a genetic difference in the hair follicles is proposed. This view is supported through the success of the ‘plug graft’ transplantation technique. However, this is unsatisfactory, because transplantation procedures that should work well according to this theory, ultimately fail. There is an alternative ‘mechanism’, that demonstrates its origins in the prime function of hair as an insulator. This simple mechanism makes sense of all the recognized effects of DHT in the dermal system, and throughout the body. In DHT-related hair growth it can be directly observed. The implication is that DHT achieves its effects through a primary physiological action that can be easily tested given the necessary expertise. Given existing knowledge, such a proven action of DHT would have serious implications for further understanding of female susceptibility to autoimmune disease.

Am Fam Physician. 2003 Mar 1;67(5):1007-14

C. CAROLYN THIEDKE, M.D.,

exerpt:

Telogen Effluvium

Telogen effluvium is diffuse hair loss caused by any condition or situation that shifts the normal distribution of follicles in anagen to a telogen-predominant distribution.3 Women with this disorder usually note an increased number of loose hairs on their hairbrush or shower floor. Daily loss may range from 100 to 300 hairs. If hair loss is at the lower end of the range, it may be inapparent. Telogen effluvium may unmask previously unrecognized androgenetic alopecia.

A number of conditions are associated with telogen effluvium (Table 2).19 Although stress is the most common underlying cause, the disorder also can develop because of normal physiologic events (e.g., lengthening of telogen in the postpartum state), some medications,20 and several endocrinopathies (thyroid, pituitary, and parathyroid disease). Telogen effluvium usually begins two to four months after the causative event and lasts for several months. If telogen effluvium is suspected, a thorough history should be obtained.

Cutis. 2001 Jul;68(1):35-40.L

Management of male pattern hair loss.
Sinclair RD.

The management of androgenetic alopecia (AGA) has been materially altered by the availability of the 5 alpha-reductase type 2 inhibitor, finasteride. Nevertheless, this agent is only one component of successful management, and an understanding of the role of camouflage agents, surgical options, and other medical treatments is important. Because no treatment completely reverses baldness, it is important to communicate the limitations of each modality to the patient so that he has appropriate expectations of the outcome of any intervention. Patient counseling and support are also often relevant.

Eur J Dermatol. 1999 Dec;9(8):606-9.

Current management of androgenetic alopecia in men.

Wolff H, Kunte C.

Androgenetic alopecia (AGA) or male pattern hair loss is a common dermatological condition affecting both men and women. Until recently there has been little interest in AGA as a clinical condition, largely due to the lack of any genuinely effective treatment for it. A number of “remedies” exist, such as vitamin supplements, which are not generally harmful but which have no proven efficacy in promoting hair growth or preventing further hair loss. Hair systems and surgery provide camouflage for the symptoms but do not effect a cure. By far the most promising approaches to the treatment of AGA are drug therapies, such as minoxidil and finasteride. Finasteride, an inhibitor of the type II 5alpha-reductase that converts testosterone to dihydrotestosterone, has been shown to prevent further hair loss, and promotes new hair growth in the majority of the men taking part in clinical trials. Tailored drug approaches like this offer the greatest hope for the successful future treatment of AGA.

Edited

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Br Med J (Clin Res Ed). 1983 Oct 8;287(6398):1015-7.

Topical minoxidil in the treatment of alopecia areata.

Fenton DA, Wilkinson JD.

A modified double blind crossover study was performed to assess the effect of 1% topical minoxidil as compared with placebo in 30 patients with alopecia areata and alopecia totalis (complete hair loss). The active preparation produced a highly significant incidence of hair regrowth. A cosmetically acceptable response was noted in 16 patients. No side effects were seen. The study confirmed that topical minoxidil will induce new hair growth in alopecia areata but that it is less likely to do so in more severe and extensive disease. Furthermore, patients with alopecia universalis and totalis may not respond at all. Nevertheless, as compared with other drugs minoxidil applied topically is relatively non-toxic, is easy to use, and has no systemic or local side effects.

Drugs. 1988 Jan;35(1):83-91

Alopecia and hirsuties. Current concepts in pathogenesis and management.

Barth JH.

Hirsuties and androgenic alopecia are the patterns of hair growth in women which develop in a similar manner to that normally seen in men. This process is mediated by androgens. It may be due to increased hormone production or increased target organ sensitivity. The majority of patients with hirsuties may be adequately managed with a careful explanation of their condition and advice about depilatory techniques. Some will benefit from a course of systemic antiandrogen therapy, but hair growth will resume on cessation of therapy. There have been few objective studies to evaluate the benefits of antiandrogen therapy in female baldness and none with minoxidil.

Acta Derm Venereol. 1989;69(3):190-4.

An experimental study evaluating the effect of minoxidil on the growth cycle of hair follicles.

Gobé GC, Strutton GM.
.

The possibility that topically-applied minoxidil might affect the growth cycle of hair follicles was studied in inbred Herston white mice and HRA/Skh1 hairless mice. In the normal follicular cycle, the anagen or growth phase can be followed by autoradiographic demonstration of [3H]thymidine uptake in proliferating matrical cells, and the catagen or regression phase can be recognised, using light microscopy, by the presence of greatly increased death of matrical cells by apoptosis. Using these two markers, the effects of topically-applied minoxidil on follicular kinetics were studied, during neonatal hair growth and the spontaneous wave of hair loss that occurs 16 to 17 days after birth. Minoxidil at strengths of either 1% or 3%, applied daily to the dorsal skin of newborn mice from birth until 25 days of age, was found to have no recognisable effect. Despite this negative result, however, the study does show the potential for the use of apoptosis as a marker for catagen in research in dermatopathology.

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MMW Fortschr Med. 1999 Sep 16;141(37):38-40

Therapy of androgenetic alopecia (male pattern hair loss) with finasteride.

Wolff H, Kunte C
.
Androgenetic alopecia in men is genetically determined, but occurs only when the testosterone metabolite dihydrotestosterone (DHT) is present in normal levels. The drug, finasteride, inhibits the enzyme 5-alpha-reductase II, which is responsible for converting testosterone to DHT. One 1 mg tablet (Propecia) of finasteride daily lowers serum DHT levels by about 70%, and increases serum testosterone by 10%. The efficacy of finasteride 1 mg has been demonstrated in a randomized, double-blind, placebo-controlled clinical trial involving more than 1,500 men in whom a significant increase in hair density over a specified area of the scalp, and a significant improvement in appearance was noted. Following one year to treatment 48%, and following 2 years 66%, of the finasteride patients (placebo group 7% after both treatment periods) presented with visibly thicker hair growth. Side effects such as decreased libido, ejaculation disorders and erectile dysfunction were seen in fewer than 2% of the men in both the finasteride and placebo groups.

Am Fam Physician. 1999 Apr 15;59(8):2189-94, 2196.

Medical treatments for balding in men.

Scow DT, Nolte RS, Shaughnessy AF.

Harrisburg Family Practice Residency, PA 17105-8700, USA.

Two drugs are available for the treatment of balding in men. Minoxidil, a topical product, is available without a prescription in two strengths. Finasteride is a prescription drug taken orally once daily. Both agents are modestly effective in maintaining (and sometimes regrowing) hair that is lost as a result of androgenic alopecia. The vertex of the scalp is the area that is most likely to respond to treatment, with little or no hair regrowth occurring on the anterior scalp or at the hairline. Side effects of these medications are minimal, making them suitable treatments for this benign but psychologically disruptive condition.

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Clin Exp Dermatol. 1990 Jan;15(1):34-6.

Natural history of androgenetic alopecia.

Olsen EA, Buller TA, Weiner S, Delong ER.

Twenty-two men with patterns III-Va androgenetic alopecia were entered into a 10-month study aimed at establishing information on the natural progression of hair loss over a period of time typical of studies of hair regrowth promoters. The methodology employed was the same as that in published clinical trials of topical minoxidil, but the men refrained from application of either active drug or vehicle to their scalps. As one of the potential explanations for the observed ‘placebo-effect’ seen in non-vellus hair counts in the topical minoxidil trials was a learning curve of novice hair counters, we were particularly interested in evaluating this in our ‘no-treatment’ trial. To that end, both a novice (Observer I) and an experienced (Observer II) hair counter independently performed the hair counts. There was a mean decline in the number of vertex target area non-vellus hairs (-17.2 +/- 80.3 for Observer I and -26.6 +/- 63.5 for Observer II) at the end of 10 months; this was not significant. The novice’s hair counts were lower than the experienced observer’s counts at baseline, and the difference remained relatively constant during the study. Without the application of a placebo, there was no increase in hair regrowth, making it unlikely that the methods of hair counting led to the ‘placebo-effect’ seen in prior topical minoxidil studies.

The effects of finasteride on scalp skin and serum androgen levels

J Am Acad Dermatol. 1999 Oct;41(4):550-4.

The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia.

Drake L, et al

BACKGROUND: Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and
improve hair growth in men with androgenetic alopecia. OBJECTIVE: We attempted to determine the effect of finasteride on scalp skin and serum androgens.

METHODS:
Men with androgenetic alopecia underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days. RESULTS: Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.

CONCLUSION: In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.

Dermatol Online J. 2008 May 15;14(5):24.

Alopecia universalis with twenty-nail dystrophy (trachyonychia).

Chien P Jr, Kovich OI.

A 43-year-old man presented with long-standing trachyonychia of all 20 nails, which worsened after the onset of alopecia universalis 18 months ago. Trachyonychia can be associated with alopecia universalis although the treatment strategies of both conditions differ. The principle of treating trachyonychia may involve regulating the differentiation of keratinocytes and/or reducing inflammation in the nail fold or nail matrix while treatment of alopecia universalis involves immunomodulation.

Dermatol Surg. 1995 Jun;21(6):523-38.

The isolated frontal forelock.

Marritt E, Dzubow L.

BACKGROUND. The progression and extent of male pattern baldness is statistically unpredictable. OBJECTIVE. An approach to the patient with male pattern baldness is suggested, which results in a product that changes appearance in a positive way, is natural, requires no maintenance, and does not deconstruct with progression of alopecia. METHODS AND RESULTS. A technique is described for transplantation of the frontal forelock allowing creation of a soft anterior zone and a dense posterior component. CONCLUSION. The utilization of donor hair to create a transplanted forelock will eventuate in a product that maintains naturalness regardless of the progression or extent of future hair loss.

Australas J Dermatol. 1995 May;36(2):51-5; quiz 56-7.

Female androgenetic alopecia: an update.
Callan AW, Montalto J.

Androgenetic alopecia is an androgen dependent disorder occurring in genetically susceptible individuals. The pattern of hair loss in women differs from that of classical male pattern alopecia, being more diffuse and with retention of the frontal hair line in most cases. Characteristic histopathological changes occur but biopsy is rarely helpful in diagnosis. Although research has shown subtle alterations in the androgen status of women with androgenetic alopecia, most patients presenting with this disorder are normal endocrinologically. Anti-androgen therapy will result in some improvement in up to 50% of patients after 6 to 12 months of therapy, but in practice will usually only decrease the rate of hair loss and not result in new hair growth.

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