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Hair Loss Reversal 101: What You Need to Know

If you’re experiencing hair loss, you’re not alone. According to the American Hair Loss Association, at least two-thirds of all American men will have noticeable hair loss by the time they turn thirty-five. Women account for forty percent of all Americans experiencing hair loss. (01) Those numbers are much higher than you thought, right?

Sure, most people expect to get some gray hair, wrinkles, and a few extra pounds as they age, but hair loss? That’s not usually part of the plan. We can color our hair, use Botox for our wrinkles, and spend some extra time at the gym. But what can be done about a receding hairline? More than you think.

There are Different Types of Hair Loss

The first step is to understand the different types of hair loss. All hair loss is not the same, so not all hair loss will respond to the same treatment. We’re here to give you a crash course.

The Term Alopecia Encompasses More Conditions Than Most People Realize

When people think of alopecia, they usually think of alopecia areata, the type that Massachusetts Representative Ayanna Pressley and actress Jada Pinkett Smith have. However, if you use Dr. Google, you’ll see that WebMD defines alopecia areata as an “autoimmune disorder that causes your hair to come out, often in clumps the size and shape of a quarter.” The definition is accurate, but not all hair loss is alopecia areata. Alopecia is an umbrella term for many different hair loss conditions.

There’s a Difference Between Non-Scarring and Scarring Alopecia

Alopecia falls under two broad categories: non-scarring and scarring alopecia. There’s a big difference between the two types.

When people have non-scarring hair loss, their hair just falls out. No redness, scaling, flaking, itching, or burning occurs. The alopecia can come on fast and furiously, leaving people holding clumps of hair in their hands, or gradually over a long period of time.

Scarring alopecia is a different story. Also known as cicatricial alopecia, scarring alopecia is an inflammatory condition that occurs in otherwise healthy people. The hair follicle is destroyed and replaced with scar tissue. The hair loss can happen over time and go unnoticed, or it can happen quickly, causing symptoms such as severe itching and burning. (02) Speed is essential when it comes to treating scarring alopecias. The goal is to slow or stop further hair loss and promote hair regrowth in unaffected areas.

What Type of Alopecia Do You Have?

Many different types of hair loss fall under the categories of non-scarring and scarring alopecia. Once you know what type you have, your dermatologist will work with you to develop a treatment plan.

Examples of Non-scarring Alopecia

Telogen Effluvium

Telogen Effluvium is a form of temporary hair loss caused by stress, severe chronic illness, high fever, childbirth, thyroid disorders, major surgery, dieting, certain medications, etc. Telogen Effluvium usually resolves itself over time.

Androgenic Alopecia

Also known as male and female pattern baldness, androgenic alopecia is a genetic condition experienced by up to 50 percent of men and women. (03) Experts believe that pattern baldness is due to an excessive androgen dihydrotestosterone (DHT) response which causes hair follicles to miniaturize. When the hair follicles shrink, hair loss occurs. Androgenic alopecia typically causes frontal hair loss in men and diffuse hair loss at the crown and top of women’s heads.

Alopecia Areata

If your hair falls out in clumps around the size and shape of a quarter, you may have alopecia areata. This condition is an autoimmune disorder that occurs when your body attacks its own hair follicles. With alopecia areata, hair loss is unpredictable and can happen anywhere on your body. Sometimes the condition resolves itself. However, it can also reoccur without notice. Many research studies are currently underway to understand the cause and effective treatment. (04)

Traction Alopecia

Constant pulling on hair due to tight ponytails, buns, braids, cornrows or dreadlocks, hair extensions, weaves, and more can cause traction alopecia. This condition, that’s common among actresses and models, can cause small bumps that resemble pimples. Fortunately, traction alopecia can be reversed if you stop pulling your hair back.

Examples of Scarring Alopecia

Lichen Planopilaris

Lichen Planopilaris is the most common type of scarring alopecia. Although it can affect both genders, lichen planopilaris is more likely to affect women aged 40 to 60 than men. (05) Redness, itching, burning, and tenderness can accompany frontal or other pattern hair loss.

Central Centrifugal Cicatrical Alopecia (CCCA)

CCCA is found almost exclusively among black women aged 30 to 55 year-old. The cause is still unknown and is being researched. Women who experience CCCA experience inflammation and associated hair loss in the crown area. (06)

Effective Hair Loss Treatment Complements Your Diagnosis

After your dermatologist determines the cause of your hair loss, he or she will discuss treatment options with you. Keep in mind that hair reversal treatments are not one-size-fits-all. In some cases, “cocktails” which combine specific medications and protocols may be needed. Just to give you an idea of what’s out there, here are some of the most frequently used medications and treatments:

Minoxidil (Rogaine)

Minoxidil, also known as Rogaine, is available over-the-counter as a topical foam and liquid and by prescription as an oral pill. Minoxidil is a vasodilator reduces miniaturization of the hair follicles and elongates the growth phase.

Minoxidil has proven to promote growth among men and women with male and female pattern hair loss. Minoxidil is also often recommended to patients with scarring alopecia to promote growth in unaffected areas.

Once you start using Minoxidil, you need to continue. When you stop using the medication, any new hair that grows will most likely be shed.

Finasteride (Propecia, Proscar)

Finasteride is a 5 alpha-reductase inhibitor originally designed to treat enlarged prostates. The medication, available both as a pill and a topical solution, blocks the conversion of Testosterone to dihydrotestosterone (DHT), a hormone that inhibits hair growth.

Clinical studies have found Finasteride to be highly effective in reversing hair loss in both men and women with scarring and non-scarring alopecias. (07, 08) Topical Finasteride is often used to treat androgenic alopecia, while oral is typically recommended for scarring alopecias.

Finasteride is only available by prescription and is not recommended for women of childbearing age. Check with a board-certified dermatologist to see if you are a good candidate for the topical or oral treatment. Don’t have time to make an appointment? Don’t worry, you can get custom topical treatments and oral medications prescribed by a Happy Head board-certified dermatologist, have a consultation and get it all shipped to your door each month. Just fill out our quick questionnaire, send us a few photos, and get started on growth here.

Corticosteroids

Topical or injected steroids are often used to treat hair loss that is induced by autoimmune diseases such as alopecia areata and lichen planopilaris. The corticosteroids allow hair to grow by inhibiting the autoimmune disease.

Steroid treatments are only available by prescription and should be surprised by a qualified dermatologist.

Platelet-rich Plasma (PRP) Injections

PRP injections have become a popular treatment for healing wounds and regrowing tissue such as tendons, ligaments, and muscles.

PRP has regenerative properties and has been primarily tested on patients with androgenetic alopecia. (09) When injected into the scalp, PRP is believed to stimulate hair growth by increasing blood flow to the hair follicles and increasing the size of the hair shaft.

As the name suggests, PRP injections are made from platelets derived from your blood. Blood is first drawn, and then spun at super high speeds to separate the blood components. The resulting plasma is highly concentrated.

PRP use is still in its early stages and can be expensive. Research also indicates that PRP is most effective when used with Minoxidil, Finasteride, and other hair growth treatments.

Biotin

Biotin, also known as Vitamin B7 or Vitamin H, has become a familiar hair growth supplement. Sold in supplements or as an ingredient in hair care products, Biotin is promoted as a way to make your hair grow longer and healthier.

Does it work? Well, the jury is out. Not enough research has been conducted to say yeah or nay. (10) It won’t hurt you to try a new shampoo that contains Biotin, but there’s no evidence to indicate that it will help. Biotin deficiency is rare. (11) Most people get adequate amounts through their regular diets.

Many Biotin supplements sold are not FDA approved, and high concentrations of Biotin can interfere with the results of some lab tests. (12) As with any oral supplement, check with your doctor before testing it out.

Hair Transplants

Hair transplant procedures and techniques continue to improve over time. Rather than using noticeable plugs, today’s surgeries move hair strips or carefully selected hairs from one area to another to promote growth that looks natural.

When determining whether a patient is an ideal candidate for a hair transplant, dermatologists consider several factors, including:

Type of hair loss
Degree and pattern of baldness
Patient age
Hair color
Donor hair density
Patient expectations

Although hair transplants are expensive and time-consuming, they are an effective, reliable, and safe way to get lasting results.

It’s Important to Set Realistic Expectations When Treating Alopecia

We’re fortunate to live during a time when hair loss research is prolific, and the list of hair replacement options is growing. Whether you’re 25 or 55, you don’t have to live with bald spots, a receding hairline, or thinning hair, even if your genetics or immune system are working against you.

The first step is to find a board-certified dermatologist and hair specialist you trust and get diagnosed. He or she will help you select the right treatment option for your type of alopecia and lifestyle. Remember to set realistic expectations for your hair regrowth. Treatments don’t work overnight, so be patient and track your progress over time. After all, small signs of stubble today can lead to a fuller head of hair tomorrow. To get in touch with a Happy Head dermatologist and do your consultation over the phone, get started here and you can do it all from home.

Resources:

(01) https://www.americanhairloss.org/

(02) https://rarediseases.org/rare-diseases/cicatricial-alopecia

(03) https://www.ncbi.nlm.nih.gov/books/NBK430924/

(04) https://www.aad.org/public/diseases/hair-loss/types/alopecia

(05) https://www.ncbi.nlm.nih.gov/books/NBK470325/

(06) https://jamanetwork.com/journals/jamadermatology/fullarticle/2768748

(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809380/

(08) https://pubmed.ncbi.nlm.nih.gov/9951956/

(09) https://www.health.harvard.edu/blog/platelet-rich-plasma-does-the-cure-for-hair-loss-lie-within-our-blood-2020051119748

(10) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582478/

(11) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582478/

(12) https://www.fda.gov/medical-devices/in-vitro-diagnostics/biotin-interference-troponin-lab-tests-assays-subject-biotin-interference

The Surprising Connection Between Covid and Hair Loss

You’re in the shower, look down, and notice the drain is filled with hair. Is that mine, or is it my partner’s? Did the kids use my shower? Where is all of that hair coming from? Then, you notice something even worse. The hair on the side of your head is so thin that it looks like you’re going bald. What in the world is happening?

As if dealing with constant fatigue, brain fog, and other Covid long-term effects isn’t enough, if you had Covid-19, you might be experiencing Covid related hair-loss. Hair loss due to Covid can begin two to three months after having the virus and typically lasts about six months. Although the CDC doesn’t talk about hair loss as an adverse effect, observational research conducted by leading dermatologists and hair specialists indicates that post-Covid hair loss is real. (01) Both men and women are affected.

Covid-induced Hair Loss Can Be Significant

While thankful to be alive and regaining their health, many Covid long haulers are left trying to figure out why they’re shedding and how to stop it. Dr. Ben Behnam, board-certified dermatologist, and owner of Dermatology and Hair Restoration located in Los Angeles, California, has seen many patients with Covid-induced hair loss in his office. “I had a female patient in my office a few months ago who was 21 and lost 50 to 60 percent of her hair,” said Behnam. “It was devastating for her.” Some who have recovered from Covid report losses of as much as 70-80 percent of their hair. (02)

Covid’s Shocking Effects on Your Hair

According to the American Academy of Dermatology, the actual Covid virus doesn’t make your hair fall out. The culprit is the fever that’s associated with the virus. (03) A high fever can shock your system causing a condition called Telogen Effluvium. Childbirth, major surgery, crash diets, and some medications also cause the condition.

Telogen Effluvium, the most common cause of diffuse hair loss, occurs when hair prematurely goes into a resting (telogen) phase. Your hair sheds faster than normal when this happens, resulting in thinning hair or bald spots.

Anything that puts stress on your body can cause Telogen Effluvium. The condition is common after a significant health-related event.

Losing your hair can be depressing, no matter what the reason. There’s good news though. Telogen Effluvium is temporary. Typically, patients will find that their hair sheds for about six to nine months, then it stops. While the wait may seem like forever, your hair will grow back.

How to Cope with Covid-induced Telogen Effluvium

It’s not unusual to feel powerless when you don’t have control over your hair loss and don’t feel like yourself. If you are experiencing Covid-related Telogen Effluvium, here are four tips to help you get your mojo back as you wait for your hair to grow:

1. Visit your dermatologist

If you’re wondering whether you have Telogen Effluvium from Covid or another hair condition, a visit to your dermatologist will give you peace of mind. Patients who get Telogen Effluvium as a result of Covid don’t typically experience itching, redness, scaling, or other side effects like patients who have other forms of alopecia (04) such as alopecia areata and lichen planopilaris. If you have any of these symptoms, your dermatologist can give you a firm diagnosis to help you get on the right track and continue to recover.

2. Try your best to relax

Getting Covid is scary. Recovering from Covid is tough. Losing your hair is upsetting and stressful. You have been through a lot. Although it’s not easy, do whatever you can to decompress, whether that’s yoga, meditation, listening to the Calm app, or even taking a brisk walk.

Stress relief is crucial because stress triggers hair loss. “When your scalp muscles tense, you constrict your blood vessels so that the blood doesn’t flow to your scalp,” said Benham. So if you’re experiencing Telogen Effluvium from Covid and anxiety simultaneously, hair growth is going to be inhibited even more with both conditions.

3. Eat for Nutritional Value

“The cleaner you eat, the better, shinier… just more gorgeous hair you will have,” Benham explains. In addition to minimizing processed foods, he recommends increasing the amount of protein in your diet since your hair is made up of protein. Cashews, nuts, avocado, and organic, grass-fed chicken are all good choices. He also recommends pure whey protein concentrate.

You should always ensure that your vitamin levels are where they should be, but doing so is especially important after recovering from Covid. Iron and vitamin D deficiencies are common contributors to hair loss.

4. Experiment with new hairstyles and make-up

Members of Facebook’s Covid-19 Long Hauler Group report feeling more confident after a make-over. Some have shaved their heads, but others are sporting cute bobs and pixie cuts. Perhaps it’s time to do some experimenting. You may even fall in love with your new look.

If you had Covid and are currently experiencing hair loss, don’t despair. Many Covid long haulers report that their hair grew back thicker and healthier than before (05). Growth will be gradual, so don’t expect miracles right away. You may not even realize that your hair is starting to grow. Meanwhile, stay calm, make sure that you’re living the healthiest lifestyle you can, and do whatever it takes to make yourself feel confident. Better hair days are right around the corner.

Resources:

(01) https://pubmed.ncbi.nlm.nih.gov/34467470/

(02) Facebook: Covid-19 The Long Haulers Support Group – https://www.facebook.com/groups/373920943948661/

(03) https://www.aad.org/public/diseases/hair-loss/causes/covid-19

(04) https://consultqd.clevelandclinic.org/covid-19-related-hair-loss/

(05) Facebook: Covid-19 The Long Haulers Support Group – https://www.facebook.com/groups/373920943948661/

Stop Hair Loss: Prevent Hair on Pillow & Shower Drain – Effective Solutions

Image of a pillow and all the hair you may find after you've slept. This could be a sign of hair loss.

It starts with a few hairs on your pillow. Then, while you’re in the shower, you notice a few more hairs than usual flowing into the drain. Once these incidents occur more often, you start to ask yourself the difficult question, “Am I going bald?”

It’s a tough question to come to terms with, but one that many people eventually find themselves wondering.

You may be going bald. Or you might not. Whatever the case, it’s better to face the question and find the answer now than to wait it out. Because if you are going bald, you need immediate attention to slow—or stop—the process.

Four Signs of Hair Loss

About 25% of men have experienced hair loss by the age of 21. By age 50, about 50% of all the men have had some level of hair loss. Women are not immune to losing their hair, either, with about 40% of women experiencing hair loss within their lifetime. So, when it comes to going bald, you’re not alone. (01, 02)

Hair loss happens to many people and there are steps you can take to address the issue. But before you seek out treatments for possible balding, however, you should evaluate whether or not you’re losing hair.

Here are four signs that may be going bald:

1. Gradual Loss of Hair

Sometimes, hair loss occurs suddenly. In rare instances, a physical or emotional trigger can loosen hair and cause large chunks of hair to fall out. Called telogen effluvium, this type of hair loss develops when scalp hair follicles lose their hair due to a shock (stress, illness, medication, or environmental factor). Hair follicles are most susceptible to this type of hair loss while in a resting state called telogen.

Although the condition can still cause feelings of panic about losing hair, most instances of telogen effluvium are temporary. Gradual hair loss, however, is something to be concerned about as it can be a sign of going bald. According to the Mayo Clinic, hereditary hair loss is the most common cause of baldness, and it happens slowly over time. Unlike telogen effluvium, hereditary hair loss is permanent. (03)

2. Developing a Receding Hairline

One of the most common types of hereditary hair loss is male pattern baldness, and the hallmark sign of male pattern baldness is a receding hairline. (04) Because a receding hairline occurs incrementally, it’s a sign that’s easy to ignore or overlook. The following are the most common signs of a receding hairline:

You notice your forehead looks larger than usual.
Your hairline begins to make an “M” shape.
The temple area of your hairline appears thinner than before.

A receding hairline can happen due to headwear. Tight-fitting headwear like baseball caps and headbands may encourage loss of hair at the hairline by restricting blood flow and through repeated motions (taking the hat on and off). In some cases, men with male pattern baldness may attribute a receding hairline to their hats rather than a hair condition. So, if you notice your hairline is receding, you may be experiencing hair loss.

3. The Appearance of Random Bald Spots

Have you noticed bald spots or sparse areas that weren’t there before? Patchy, thinning hair and random bald spots may indicate the start of male pattern baldness or a condition called alopecia areata (03). With alopecia areata, an autoimmune disorder, hair falls out in round patchy areas or a band-like pattern around the head. Alopecia areata may also affect facial hair – creating small bald patches in the beard area or eyebrows.

Another condition that begins with bald spots is hereditary baldness. Although hereditary baldness usually starts with a receding hairline, the condition can also begin with an expanding crown. Furthermore, women who experience female pattern baldness typically see different signs than men with male pattern baldness. (05)

A few of these signs are:

Thinning at the crown or hairline.
Widening of the center part in a Christmas-tree pattern.
Front hairline typically remains unaltered.

Compared with male pattern baldness, hair loss associated with female pattern baldness doesn’t usually progress to full hair loss. Women typically keep most of their hair. Despite this, any hair loss can still be very distressing for women and may require treatment.

4. Your Hair Isn’t Growing

According to the Academy of Dermatology, hair at the top of your head grows at an average rate of about six inches every year. This means that you can expect about a half-inch of growth every month.

Your grows in three stages: (06)

Anagen Phase: Active growth lasting about 2 to 8 years.
Catagen Phase: Hair halts its growth, lasting about 4 to 6 weeks.
Telogen Phase: Resting phase, then hair falls out of the follicle, lasts about 2 to 3 months.

Only about 5-10 percent of your hair is in the telogen phase at any given time. In contrast, most of your hair is in its growth phase. Your hair’s rate of growth depends on your age, health, genetics, and environmental factors.

If your hair is thinning and you notice your hair’s growth is slowing, however, it may be because you have less hair than before. As you lose hair, you have less hair in the growth phase. The reduction in hair may make it appear as though your hair is growing more slowly.

How Likely are You to Go Bald?

People who are experiencing hair loss often want to know when and if they’ll go bald. Unfortunately, there’s no way to predict exactly if and when you will lose all your hair. Genetics plays a significant role in determining how much hair you’ll lose over time. Other factors, like stress, nutrition, and your health also affect whether or not you might lose your hair.

There’s no way to predict when you’ll go bald. You can, however, look at your family history. Genes are the primary factor that causes female and male pattern baldness. Also, women are much less likely to lose all of their hair when compared to men.

While researchers still have much to learn when it comes to hereditary baldness, its cause is thought to be polygenic – involving two or more genes. A few genes for male pattern baldness are thought to exist in the “X” chromosome (07), the chromosome inherited through a male’s mother. A 2017 literature review, however, also found 63 genes for male pattern baldness that exists in the “Y” chromosome inherited from a father (08).

These studies indicate that interplay between genes may be what leads to inherited hair loss. If you’re wondering if you’ll go bald, look at your family.

What You Should Do if You Think You’re Going Bald

There’s no timeline for how long it takes to lose all your hair. But if you really are going bald, it won’t happen overnight. Losing all your hair is a gradual process that takes years or decades. In spite of this, you should intervene as soon as you suspect you’re losing your hair. Why? Because the sooner you start managing your hair loss the better the results will be.
Think you’re going bald? Taking steps as quickly as possible to protect your hair and scalp can lead to improved hair retention. Whether managing hair loss means changing your lifestyle habits or taking a prescription-grade treatment for hair loss like Happy Head, quick intervention means keeping more of your hair.

Resources:

(01) https://health.clevelandclinic.org/why-do-men-go-bald-and-is-there-anything-you-can-really-do-about-it/

(02) https://www.medicalnewstoday.com/articles/292492

(03) https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926

(04) https://medlineplus.gov/ency/article/001177.htm

(05) https://www.mountsinai.org/health-library/diseases-conditions/female-pattern-baldness

(06) https://www.aad.org/public/kids/hair/how-hair-grows

(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308812/(08) https://pubmed.ncbi.nlm.nih.gov/28272467/

Why using Sunscreen on your Scalp is Crucial for Thinning Hair

Everyone knows sunscreen is an essential part of a healthy skincare regimen. You’re probably diligent about applying sunscreen on your arms and face, probably even the tops of your ears! As awesome as you are at applying sunscreen, you might be missing one crucial area – your scalp.

Sun Protection for Your Scalp

There are three ways you can shield your scalp from the sun.

Have thick hair.
Wear a hat.
Use sunscreen.

An article published in the journal Photochemistry and Photobiology found that your hair acts like natural sun protection, called hair ultraviolet protection factor (HUPF). (01) HUPF works as a sun barrier and helps to prevent skin cancers caused by ultraviolet (UV) radiation.

So, if you have lots of hair or intend to wear a fedora whenever you’re in the sun, then you’ve got it all covered. If your hair is thinning, cut very short, or if you’re without any hair, however, then your scalp is vulnerable. Unlike the skin on your face, your scalp lacks the same barrier strength, which makes your scalp sensitive to UV radiation and environmental toxins. Because your scalp’s skin barrier is thinner than the barrier on your body, safeguarding your scalp should be an important part of your skincare routine. (01)

Do people with hair loss conditions need sunscreen?

Hair loss affects a larger portion of the population than most people realize. According to the Cleveland Clinic, about 25% of men experience their first signs of hair loss by the age of 21. And roughly 50% of all the men undergo some level of hair loss by age 50.

However, it’s not just men who are affected by hair loss. About 30 million women have a condition called female pattern hair loss (FPHL). It could happen to anyone. In many cases, people may have hair loss only in very specific areas on their scalp, while other parts remain flush with hair. Hair loss varies from person to person, and it’s the exposed scalp areas that need sun protection the most. (02, 03 )

Sunscreen for the scalp is a relevant consideration for all people, but especially for people with hair loss conditions. The following are few examples of hair conditions that may benefit from sunscreen use.

Androgenetic alopecia
Alopecia areata
Cicatricial alopecia
Folliculitis Decalvans
Frontal fibrosing alopecia
Central centrifugal cicatricial alopecia
Discoid Lupus erythematosus
Male pattern baldness
Loose anagen syndrome
Hypotrichosis
Lichen planopilaris
Anagen effluvium
Telogen effluvium

Even people who don’t have a hair loss condition may need to use sunscreen on their scalp. Most people are unaware that they have sections of their scalp showing. For example, people have a whorl of hair at the crown, often showing a bit of exposed scalp. Spend enough time outdoors without sun protection, and this small patch of unshielded scalp can become sunburnt.

Can your scalp get a sunburn?

Just like the rest of the skin on your body, your scalp can burn from too much sunlight. For this reason, protecting your scalp from the sun is crucial to reducing skin damage, lowering your risk of developing skin cancer, and preventing painful sunburns.

Sunburns and Your Hair Follicles

In general, if you’re already dealing with hair loss, injury from the sun can create more challenges. Third and fourth-degree sunburns, for instance, may damage and physically stress hair follicles, causing a temporary condition of hair loss called telogen effluvium. Maintaining your scalp health means potentially keeping more of your hair, which makes sun protection paramount. (03)

Sunburns and Skin Cancer

Sun damage may cause further hair loss, but it can also lead to something life threatening — skin cancer. The American Academy of Dermatology Association (AADA) reports that about one in five people will develop some form of skin cancer in their lifetime. (04) Out of that population, about 2% to 18% affect the scalp. (05) Furthermore, cases of skin cancer continue to rise each year. Keeping this information in mind, your scalp should receive the same – if not more – sun protection as the rest of the skin on your body.

What is a Sunburn?

Environmental pollutants and UV radiation accelerate the signs of aging, injure cells, and damage DNA within the skin barrier and deeper tissues. Sunburns are an inflammatory response to excessive UV radiation, which destroys the upper layers of skin. (06) Melanin, which darkens skin with exposure to sunlight, helps to protect your skin cells from the sun’s damage. Contrary to popular belief, a glowing tan doesn’t indicate healthy skin. A tan means that your skin cells have reacted to the sun’s radiation!

How your skin reacts to UV radiation is primarily based on your genetic makeup. Some people undergo gradual skin darkening, while others immediately experience a sunburn. While both are signs of skin damage, people with sunburns experience more pain and visible skin cell injury. Repeated sunburns or exposure to UV radiation can place individuals at a higher risk of skin cancers like squamous cell carcinoma, basal cell carcinoma, and melanomas. (07)

What does a scalp sunburn feel like?

Whether or not a person feels pain with a scalp sunburn depends on the severity of the burn. Most sunburns are first or second-degree burns, but they can still cause some discomfort. With a first or second-degree sunburn, you might experience signs and symptoms like:

Redness
Swelling
Irritation
Flaking
Itching
Burning

Pain from a sunburn is typically at its worst 6 to 48 hours after exposure to the sun. (07) Severe cases of scalp sunburn may result in significant pain and blistering, which may take longer to heal. Fortunately, most sunburn symptoms are temporary and go away after three days to a week. The damage to cells and DNA, however, can remain for decades.

Treating a Scalp Sunburn

Caring for sunburn on the scalp takes a little TLC. To encourage healing, moisturize the area while the scalp is damp. Keeping the scalp moisturized cuts down on unsightly peeling and flaking. If you’re searching for sunburn medication, products that contain aloe vera may help to reduce inflammation and soothe irritation.

Avoid oil or petroleum-based products because their ingredients can aggravate the scalp and cause more pain.
Use shampoos that are sulfate-free and gentle on the scalp.
Instead of hot water, run cool water over your scalp to cleanse the area.
Stay hydrated and well-nourished to prevent further water loss and promote wound healing.

Choosing the Right Sun Protection for Your Scalp

Fortunately, you have a variety of options when it comes to shielding your scalp from the sun. It may take some trial and error to find what suits your needs and lifestyle the best, but the effort is worthwhile.

Hats and Hair Loss

If you’re using headwear to protect your scalp, then you’ve got an array of style choices. From beanies to cowboy hats, your options are endless. However, wearing hats do come with a few drawbacks.

Here are a few things to consider before you start your hat collection.

Remember that hats with openings in them, like snapback and trucker caps, allow sunlight to penetrate through parts of the hat.
Hats retain heat, and your head is one of the primary ways your body regulates its temperature. Wearing a hat in the sun may make you feel excessively warm.
Hats that are hot or are too tight may reduce blood to hair follicles, depriving them of nutrients and causing stress — which can encourage further hair loss! (08)
Be wary of developing traction alopecia when choosing a hat. Constant pulling or tension of hair can lead to traction alopecia hair loss, so choose a loose-fitting hat. (08)

Don’t like hats? Don’t want to risk any more hair loss? Then you’ll need sunscreen.

Helpful Hints for Choosing a Sunscreen for Your Scalp

Keep in mind that finding the right sunscreen for your scalp can be tricky. If you have thinning hair, you’ll want a formula that’s thick enough to protect your delicate scalp but won’t cake into your strands of hair. Finding the right sunscreen for your scalp is a bit like Goldilocks looking for the happy medium – you want something “just right.”

Here are a few factors to think about when you’re on the lookout for a good scalp sunscreen: (09)

Sunscreens for the skin on the body tend to be oily. You may not want an oily sheen covering your scalp and hair.
Stick sunscreen is excellent for small areas (like your crown or part) but not ideal for use over large areas with thinning hair.
Powder sunscreen options for the hair are convenient and can make hair appear thicker. However, powder sunscreen can be twice the price of other types of sunscreen.
Sunscreen sprays or mist are practical and are reasonably priced, though they can sometimes weigh hair down.
Chemical sunscreens absorb the sun’s rays and prevent radiation from reaching your scalp and skin. These kinds of sunscreen don’t typically leave that white cast on the skin that sunscreen is known for.

A few ingredients found in chemical sunscreens are:

Avobenzone
Octisalate
Oxybenzone
Octocrylene
Octinoxate
Homosalate

Mineral sunscreen physically blocks or shields UV radiation. This sunscreen blocks the rays of the sun and deflects them back out. People with sensitive scalps or chemical sensitivities may find mineral sunscreen less irritating.

A few ingredients found in mineral sunscreens are:

Titanium dioxide
Zinc oxide

What is the best sunscreen?

According to the AADA, the sunscreen that’s best for you is the one you will use consistently. Whatever sunscreen you choose, make sure it meets the following criteria: (09)

Broad-spectrum for both UVA and UVB rays
Consists of an SPF of 30 or higher
Water-resistant

In short, if you have thinning hair, you need sun protection for your scalp. Whether you’re looking for some fun in the summer sun or you’re working outdoors, remember that you – quite literally – have skin in the game. Protect it!

Resources:

(01) https://pubmed.ncbi.nlm.nih.gov/25682789/

(02) https://pubmed.ncbi.nlm.nih.gov/25682789/

(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320655/

(04) https://www.aad.org/media/stats-skin-cancer

(05) https://onlinelibrary.wiley.com/doi/full/10.1111/ddg.13546

(06) http://skincancer.org/risk-factors/uv-radiation/

(07) https://jamanetwork.com/journals/jama/fullarticle/2383280

(08) https://health.clevelandclinic.org/can-wearing-a-hat-make-you-go-bald/

(09) https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs

Hair Therapy Podcast Featuring Hair Loss Specialist Dr. Ben Behnam

Dr. Ben Behnam, Los Angeles-based board-certified dermatologist, hair loss specialist, and co-founder of Happy Head prescription grade hair loss solutions, was recently a guest on The Hair Therapy Podcast with Kate Holohan. The podcast was loaded with information about the causes of hair loss and treatment options. It’s amazing how many options both men and women suffering from hair loss now have. If you missed it or are looking for a recap, we’re sharing the highlights from the discussion below. You can find the full podcast here.

It’s No Longer Taboo to Talk About Hair Loss

Thanks to bloggers and influencers, it’s easier than ever for people to come forward with their hair loss and talk honestly about their issues. People are showing candid photos of their alopecia on Instagram and other social media sites so others can follow them and say, “Hey, it’s not just me. Other people are losing their hair also.” They share what works for them, and they are talking more openly. That’s really good to see.

Women are Seeking Hair Loss Treatment Too

The ratio of male to female patients that we’re seeing in our office has also changed over the years. Five to seven years ago, about 80 percent of our patients were men. We rarely had female patients make appointments to address their hair loss. Now, our patient base is almost about 50-50. A lot of women are currently seeking treatment, which is wonderful.

Men are more likely to accept that they’re going to go bald. We have Michael Jordan to thank for that. About ten years ago, he shaved his head, making the look popular for guys. But not too many women I know will plan to shave their heads and say, “I’m excited about this.”

Losing Your Hair Can be Devastating

Hair at every age and every level matters because it’s part of who you are. I see my patients affected socially, emotionally, and even economically. And honestly, patients’ mentality is very important. Some of my patients already have anxiety. When hair loss becomes another trigger, it makes the anxiety and hair loss even worse.

When patients start to see hair regrowth, it helps them feel better about themselves. They get the boost of confidence they need to become more emotionally stable.

Early Hair Loss Treatment Can Lead to a Better Outcome

There are two ways you can lose your hair. One, it’s going to fall out. Two, is due to miniaturization. Miniaturization is when the hair follicles literally shrink. As the hair follicles shrink, the hair itself shrinks as well. We have a big magnifier in our office, so we can actually show patients what the shrinking looks like. Now, if you allow too much shrinking, then your hair goes to the point of no return. So, if you can do something to revive the follicle, you can reverse the aging process.

Hair Loss in Men and Women Happens for Many Different Reasons

Many patients are genetically predisposed to hair loss, but they don’t know it. Their hair is perfectly fine, and all of a sudden a stressful event such as a divorce or a bad break-up occurs, activating the underlying genetic predisposition.

In some cases,Telogen Effluvium occurs. Typically, 90 percent of your hair is in the anagen phase, which is a growth phase. Only five to ten percent is in the telogen phase, which is a resting phase when your hair falls out. When people experience trauma, about 50 percent of their hair can shift into that telogen phase. That’s why when some women experience a traumatic event they lose 50 to 60 percent of their hair in six months.

Other hair loss triggers include:

Rapid weight loss
Illness (Thyroid, Covid, etc.)
Hormonal changes from pregnancy or menopause
Vitamin deficiencies (Vitamin D and iron are the most common)
Smoking & vaping
Poor diet with too many processed foods
Playing with or tugging on your hair
Bleaching and other harsh chemical treatments
Stress

Stress Wreaks Havoc on Your Hair

Stress is one of the hair loss triggers we, unfortunately, see all the time. We’ve especially seen this during Covid.

My patients tell me all the time, “When I get mad and angry, I lose my hair.” I could never find a scientific reason until I came across the Scalp Tension Theory. Most people, even dermatologists, have not heard of it. The theory is that when you tense up, and you can really see this on a guy who’s balding or who is bald, you turn red, the scalp muscles tense, and your blood vessels constrict so blood does not flow to your scalp.

Studies have shown that when you have a lack of blood to your scalp, a few things happen:

Less nutrition goes to your hair
No oxygen or decreased oxygen goes to your hair
Less Dihydrotestosterone (DHT), a form of testosterone, is produced, resulting in hair loss.

The Scalp Tension Theory has been tested with Botox injections into the scalp. Studies have been conducted over the past 20 years, but nobody talks about them. A recent study that was conducted on women confirmed that the theory is correct. When Botox was injected into the scalp every six months, the muscles relaxed, blood flow to the scalp increased, and growth was observed.

Minoxidil is an Effective Hair Growth Treatment

Minoxidil is a blood pressure medication that is a vasodilator. It works a bit like Botox. It increases the blood flow to the scalp, which is how it makes hair grow.

Initially, Minoxidil was only available as an oral medication. Today, topical two and five percent formulas are available over-the-counter under the name Rogaine. I don’t recommend the two percent any more for women. Instead, I recommend that women use the five percent for men twice per day. In clinical studies, 48 percent of female patients see significant hair growth.

One of the important things you need to know about Minoxidil is that you have to keep using it. Once you start, you have to use it forever.

There’s a Secret to Applying Rogaine, Minoxidil, and other Topical Treatments

To make Rogaine work better, I recommend a derma roller. I find derma rollers especially effective for womens’ frontal hairline areas.

A derma roller is just a roller with about 540 spikes at the tip. It creates holes in the scalp, and the topical solution penetrates through those holes to give better results. We tell our patients to wet their hair and then gently roll back and forth, left and right, for a few minutes. Don’t hold it in one place in one area because that could cause scarring. You don’t have to go very deep either. We recommend just .25, a very mild depth.

I like the electronic derma roller as well as the derma stamp. With the derma stamp, you’re just stamping the medication on, which is less likely to drag your hair out.

There are Ways to Reduce Irritation from Topical Treatment

One of the most common side effects of Minoxidil is irritation. This is because alcohol is in the formula and can be drying. Some sensitive people experience redness and flaking. The Minoxidil we use in Happy Head is prescription-grade at six percent for women and eight percent for men, which is higher than the over-the-counter doses. To minimize irritation, we added an aloe base and a small amount of topical steroid to Happy Head.

We have a few tips we tell our patients if they still get irritated:

Wash off the topical Minoxidil after one or two hours. You don’t have to use it all day to be effective.
Purchase a topical serum from Amazon to use
Use a leave-in-conditioner

I also recommend easing into using topical medications, so your skin has time to adjust. Make a calendar. Week one, only use it on Monday. Week two, use it on Monday and Friday. Week three, use it on Monday, Wednesday, and Friday. Go slowly, and remember it’s not a race.

It’s Common to Need a Multi-treatment Approach to Reverse Hair Loss

Some people can see hair growth from just one medication, but it’s not unusual to need multiple prescriptions simultaneously. We call it the kitchen sink approach when we strategically use a few different treatment options at the same time to get optimal results. That’s what Happy Head, a hair growth formula that my brother and I created, is designed to do. It combines multiple medications, Minoxidil, Finasteride, retinoic acid and hydrocortisone, in an aloe formula to work better than just one single prescription. Since patients’ needs vary, the solution can be customized.

Clinical Studies Tell Us that Finasteride Promotes Hair Growth

Finasteride, an ingredient we include in Happy Head, is a prostate medication used off-label to promote hair growth. Both oral and topical formulas are available. Finasteride works by blocking testosterone from converting to DHT in your scalp. Documented clinical studies prove that oral and topical Finasteride is highly effective for treating both male and female pattern baldness.

Like the other medications we’re discussing, Finasteride can be customized for each patient. Make sure you talk to your doctor to find out if Finasteride is right for you. It is not safe to use if you are a woman of childbearing age. Some men also experience side effects such as decreased libido when they take Finasteride orally. Studies show that the topical formula could reduce the risk of sexual side effects.

As mentioned previously, I always recommend starting slowly and working your way up to full dosage.

Topical Hair Growth Treatments Like Happy Head Do Work

I have patients come back six months after their initial visits and tell me they don’t see any improvement. I take a photo, and compare it to the previous one, and I swear that some patients have had so much hair growth that it’s unbelievable. It’s difficult to see the progress because you can’t see the day-to-day changes. Photos help, though, and patients are often shocked to see how thin their hair was before treatment and how thick it is now. I recommend taking photos monthly and monitoring progress over time.

Focus on Being the Best Version of Yourself

It’s difficult not to compare your hair to other people’s, but you really can’t. Everyone’s hair is different. If you have fine hair, you will always have fine hair. That won’t change. The important thing to remember is that you want to have the best hair that you can have.

About Dr. Ben Behnam

Dr. Ben Behnam specializes in medical hair loss management and medicine. He practices in Los Angeles, California, with his twin brother, Dr. Sean Behnam, who is also a board-certified physician, specializing in hair transplants. The brothers have had their own clinic on the westside of LA called Dermatology and Hair Restoration since 2009.

About Happy Head Prescription Grade Hair Loss Solutions

Two years ago, Dr. Ben Behnam and Dr. Sean Behnam launched the Happy Head website. Happy Head was designed to make it easier for people to see doctors online and access prescription grade topical hair loss products such as Finasteride.

Happy Head solutions can be purchased as is or can be customized to individual patients’ needs. Since the medications are only available via prescription, doctors are available to review each patient’s case. The process is fast, easy, and personalized.
We’re pleased to offer patients who visit www.happyhead.com a coupon for 60 percent off of their first purchase. Be sure to check us out and let us know if we can answer any questions.

What Are the Results of Finasteride?

Male pattern baldness is something that exists commonly and everywhere. It is something that many men experience in their lifetime. This is backed by the fact that at least 85% of men are affected by this when they are about to turn 50. These findings were recorded by the American Hair Loss Association. Finasteride is something that can help. We’ll take a look at the results of Finasteride.

This is a cause of concern for many men because they don’t want to turn bald. However, there is not much that can be done to stop this from happening except hair loss treatments. One of these treatments is known as Finasteride, whether it’s oral Finasteride or topical Finasteride.

What Is Finasteride?

What is it and what are the results of results of Finasteride? This is a small pill that one has to take daily. It is used to treat male pattern baldness and is used by many men around the globe. However, one thing to remember here is that it is not a magic pill that will solve your problems overnight. Instead, you have to take it daily and you have to be consistent. In many cases, you will start seeing results after at least 4 – 6 months of taking this pill daily. If you don’t see any results even after a year of taking this then it is time you prepare a visit to your doctor because this medicine is highly effective.

Get Customized Topical Finasteride Just for You

How Does It Work?

Are the results of Finasteride worth the taking? The Finasteride medication interacts with the testosterone in the body. It is responsible for converting testosterone into DHT (dihydrotestosterone) that is responsible for the male pattern baldness. When your body is producing more DHT your hair follicles will reduce and this will cause your hair to become thin and fall out. However, what Finasteride does is that it reduces the production of this hormone. In the long run, your follicles will stop shrinking and your hair will not thin or fall. Do remember that this medication is only suitable for men as it interacts differently with female hormones and so they are not advised to take it.
In many cases, this medication has worked towards reducing the production of DHT in the scalp by at least sixty-percent! This is a significant number and any male experiencing hair loss or hair thinning problems can make the use of this medication. From this process, you will start seeing the results of Finasteride.

Is It Effective?

Is Finasteride effective and when will I be able to see the results of Finasteride? One study was done on men who took Finasteride daily for two years. These were the results that were found in this study:

Sixty-six percent of men showed a boost in the growth of their hair
Five percent of men showed an even greater increase
Thirty-one percent of men had a fairly moderate increase in hair growth
Thirty percent of men exhibited a slight increase
Eighty-three percent of men did not experience any more hair loss after taking the pill

This shows that if you are consistent with taking the pill, it will fix your hair loss problems by a significant amount. It does three things to men with problems of male pattern baldness and hair loss:

Increases growth of hair
Halts male pattern baldness
Halts hair loss

Of course, these results vary individually as some may experience one of these and some may experience all. This is because individuals have different reactions to the same medicine. And this is the way the results of Finasteride are described as. For some people, this pill may not even work. However, this is something that happens rarely but it does happen. One thing to remember here is that this medication is only extremely effective when it comes to hair loss and thinning. If you have an area on your head that has completely lost hair then Finasteride may not work as effectively. This is because this medication does not reverse hair loss.

Topical Finasteride Made for You

How Effective Is It In Growing Back Hair?

The main function of Finasteride is to reduce the thinning and falling out of hair. However, in many cases, it has been observed that it also encourages the growth of hair. So what is the results of Finasteride, or even Propecia, and how can it help? This depends on the individual, however, studies done have shown that the medication has the potential to aid regrowth of hair. It is said to grow hair again faster and in many cases thicker as well. One note to take here is that it will not magically change the quality of your hair neither the texture. This is because the main function of this medicine is to halt hair loss and thinning. It may only grow back faster and thicker but there will no dramatic changes in the way your hair feels or appears. It is important that you do your research first and read reviews from other people before deciding to take this medication. The best course of action is to first talk to your doctor and if they approve then you can start this daily pill to fix your hair problems.

How You Can Use It Effectively for Amazing Results

This is something many people wonder as they want the medication to be as effective as possible on their hair. The only way it will be effective for you is if you consult your doctor first.
Once you do, you have to follow the instructions they have given to you. You need to remember that this is a process that takes time and consistency. In the first few months, you may not even see any noticeable changes. However, if you keep at it then by 6 – 7 months you will start seeing the results of finasteride and changes that will just keep on increasing. Another thing to keep in mind is that you should also be consistent in the time you take the medication. For example, if you take it in the morning then that is the time you should take it daily. This is because having a gap between doses that is too wide may impact the Finasteride you have in your body i.e. it may reduce. Once it reduces it will not be as effective. This is why it is essential to take the dose at the same time every day so the level of Finasteride in your body can stay consistent.

Results of Finasteride Compared to Other Treatments for Hair Loss

Firstly, this is an effective treatment because it directly tackles the hair loss issue and it is not too heavy on the pocket either unlike other treatments. There are many other treatments that you can get at pharmacies. These can take other forms as well such as creams, lotions, and capsules. Some are prescription based and some you can get over the counter. It entirely depends on what you want and what your doctor has recommended. One other effective treatment is a capsule that has shown promising results of Finasteride over time known as Avodart. However, this is the only prescription based so you need to talk to your doctor first. There are also other options available such as hair supplements. These are not as effective as other methods. If you want something effective, safe, and cheap then Finasteride is your best bet. You will just have to wait and be consistent so if you are willing to do that then this will prove to be the most effective treatment for your hair loss problems. The results of this treatment are extremely positive from almost all its users.

Prescribed Finasteride

Can You Speed Up the Results from Finasteride?

When we take medication, we always want the results to be apparent fast. How fast can I see the results of Finasteride? This is something many people wonder because no one wants to wait a long time for their hair problems to go away. Here are some effective ways you can speed up the results from Finasteride. Do remember that these may not work for everyone.

Diet

Be mindful of what you eat. Did you know that more than 20% of men who have male pattern baldness also have an iron deficiency? Another reason is that your body may be lacking the fatty acids it needs for hair growth. This is why it is important to fulfill your nutritional needs so that your hair can also do better.

Rest

Getting enough sleep and rest is important for maintaining and healthy lifestyle. If you’re are experiencing stress in your life, try ways to control and reduce stress. Just like with many of the other medications we use, getting enough rest is important and can affect the results of Finasteride on your head.

Stress

Hair loss and stress can be related. There are three types of hair loss that is associated with stress. These three are telogen effluvium, trichotillomania, and alopecia areata.

Telogen effluvium

Telogen effluvium is when a notable amount of stress pushes large numbers of hair follicles into a resting phase which causes the the hair growth process to stop.

Trichotillomania

Trichotillomania is when you constantly have the urge to pull out hair from your scalp. This may be a problem to take care which will not have the results of Finasteride.

Alopecia areata

This is when your immune system attacks the hair follicles, which in result will cause hair loss. If you do use topical Finasteride, you may see the results of Finasteride.

Scalp Massage

This is already known to be effective when it comes to stimulating your hair growth. This is because blood circulation is increased which encourages the growth of hair. Relax and help your hair grow faster with a daily scalp massage.

Take Finasteride With Minoxidil

Minoxidil usually comes in a liquid form and it is supposed to be rubbed on the scalp two times a day. It has shown promising results because more than 40% of men have re-growth once they start using this. This is why both of them combined can be an extremely effective treatment for hair loss prevention and in seeing results of Finasteride. This is probably by far the most effective treatment out there for males who are dealing with hair loss problems or male pattern baldness. It takes time but it is also safe.

Conclusion

This is why if you want to treat your male pattern baldness then you can opt for Finasteride. However, you must consult your doctor first before taking any kind of medication. Using or taking finasteride may be worth the results of Finasteride. They will advise you the best and also give you a set of instructions that you need to follow while taking this medication. Once you start taking it all you have to do is be patient and consistent and the amazing results will automatically come!

Disclaimer: The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment.

Get custom made topical Finasteride just for you by a Happy Head board-certified dermatologist.

Side Effects of Topical Finasteride: Review of Current Medical Literature

Oral Finasteride, also known as Propecia, is an oral medication that has been prescribed by physicians for decades for hair loss. It works in the majority of patients by reducing hair loss and stimulating hair growth, however there can be side effects. One of the most concerning side effects are the sexual side effects, which occur only in 1.8% to 3.8% of patients who take it. As a result, many physicians have been switching to topical Finasteride as an alternative. In recent years, there have been many studies on the efficacy and side effects of topical Finasteride. In this article, we will review the clinical trials and scientific data to evaluate the side effect profile of topical Finasteride.

In one of the first single-blind, placebo-controlled clinical trials of topical finasteride, Mazarella et al.¹ (1997) published a study of 52 subjects ranging from 19 to 28 years of age. The patients were treated with topical finasteride 0.005% vs placebo for 16 months. These were the results:

There was a significant reduction in the rate of hair loss after 6 months of treatment.
There were no reports of local or systemic side effects in the patients who received topical Finasteride for treatment.

In another double blind, randomized clinical trial study conducted with 45 male patients, Hajheydari et al.² (2009), compared oral Finasteride 1mg vs topical Finasteride 1% for a total of 6 months.

Authors concluded that “the therapeutic effects of both Finasteride gel and Finasteride tablet/oral were relatively similar to each other.”
One person had erythema of the scalp after application of the topical Finasteride.

In a prospective pilot study conducted in 15 patients for 9 months by Rafi and Katz³ (2011), patients applied a topical solution called NuH Hair, which is a novel topical combination of Finasteride, Dutasteride, and Minoxidil, with the option to add oral Finasteride, Minoxidil and/or Ketoconazole shampoo for 9 months.

Significant growth was demonstrated after 3 months of use of the topical solution.
There were no reports of sexual side effects or irritation or redness reported.

In a randomized clinical study by Tanglertsampan C.⁴ (2012), 33 male patients ranging between 27 to 49 years old were enrolled to compare the efficacy and safety of a 24 weeks application of Minoxidil 3% lotion versus Minoxidil 3% combined with 0.1% Finasteride lotion.

This study showed that Finasteride combined with Minoxidil is superior to minoxidil alone by itself.
Contact dermatitis and redness was observed in 4 patients (24%) using the Finasteride + Minoxidil combination. No sexual side effects were observed.

Caserini et al. conducted two pharmacokinetic studies on topical finasteride. In a randomized clinical study of 23 males, Caserini et al.⁵ (2014) compared topical Finasteride 0.25% twice daily vs oral Finasteride 1mg once daily for seven days. They measured Dihydrotestosterone (DHT) and Testosterone levels in the serum (systemic DHT levels).

Similar reduction in serum DHT was observed by the use of topical 0.25% Finasteride twice daily (68-75% ) and oral Finasteride 1mg (62-72%).
No sexual side effects were observed.

In another randomized clinical trial, Caserini et al.⁶ (2015) did another study involving 50 male patients studying DHT in both the serum and the scalp.

This pharmacokinetic study confirmed that topical Finasteride 0.25% (1ml application twice daily) and oral Finasteride 1mg (once daily) both have similar reduction in scalp (47-51%) and serum DHT levels (74-76%). No changes in testosterone were observed.
In the portion of the study where patients used 1ml of topical finasteride 0.25% twice daily, there were 2 patients (11%) that had the following side effects. Elevated ALT levels, pollakiuria and testicular pain.
About 37-54% when 0.1ml, 0.2ml, 0.3ml and 0.4ml of topical 0.25% Finasteride was used, showing relatively similar results to 1ml twice a day application of topical 0.25% Finasteride. Serum DHT was reduced by 24% with the use of 0.1ml, 26% with 0.2ml, 44% with 0.3ml and 48% with use of 0.4ml of 0.25% topical Finasteride. This testing suggests that lower dosage of topical Finasteride may lead to lower reduction of serum DHT levels and thus lower sexual side effects (assuming that serum DHT is solely responsible for the sexual side effects).

	Scalp DHT	Serum DHT
Oral FInasteride 1mg	51%	76%
1ml (twice daily) of 0.25% Topical Finasteride	47%	74%
1ml (once daily) of 0.25% Topical Finasteride	71%	76%
0.1ml (once daily) of 0.25% Topical Finasteride	52%	24%
0.2ml (once daily) of 0.25% Topical Finasteride	47%	26%
0.3ml (once daily) of 0.25% Topical Finasteride	37%	44%
0.4ml (once daily) of 0.25% Topical Finasteride	54%	47%

Oral vs Topical Finasteride

In a retrospective assessment and prospective crossover cohort study of 50 male between 20 to 40 years old by Chandrashekar et al.⁷ (2017), all 50 patients used Minoxidil 5% and oral 1mg Finasteride for 2 years.They then stopped and their treatment differed.

Results showed that 80% to 84.4% of these patients maintained good hair density while on the topical combination of Minoxidil 5% + Finasteride 0.1% treatment for 1 year.
No sexual side effects were reported.

The studies⁸ above demonstrate that topical finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair and that it has a lower side effect profile compared to oral finasteride. Out of the 7 clinical studies reported above, only one study showed one event with sexual side effects (testicular pain). This is 1 out of 268 subjects in all of the studies, which equates to a rate of 0.37%. In contrast, oral finasteride is associated with sexual side effects in 1.8% to 3.8% of patients, which means that in the above 268 subjects, there should have been about 5 to 10 subjects experiencing some form of sexual side effects. However, this was not the case. Only 1 person had sexual side effects as opposed to 5 to 10 individuals.

Pharmacokinetic studies by Caserini et al. suggest that lower doses of topical finasteride result in lower reduction of serum DHT compared to oral finasteride and thus lower sexual side effects. No study has conclusively shown the reason of how finasteride can cause sexual side effects. Certainly serum DHT is a contributing factor but may not be the only factor. The reason for this conclusion is because there are studies that patients were on high dosage of topical finasteride and still had no sexual side effects.

In conclusion, the majority of studies on topical finasteride show no to only a few sexual side effects. However, this does not mean that sexual side effects can not happen. It just suggests that risk of sexual side effects are lower due to the fact that the finasteride is not taken orally. Additional larger clinical studies are needed to address the sexual side effects of topical finasteride.

References:

1. Topical finasteride in the treatment of androgenic alopecia. Preliminary evaluations after a 16-month therapy course. GF Mazzarella, GF Loconsole, GA Cammisa, GM Mastrolonardo & Ga Vena; Pages 189-192 | Received 23 Aug 1996, Accepted 18 Mar 1997, Published online: 12 Jul 2009

2. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Hajheydari Z1, Akbari J, Saeedi M, Shokoohi L. .Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

3. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. Rafi and Katz. SRN Dermatol. 2011;2011:241953. doi: 10.5402/2011/241953. Epub 2011 Apr 11.

4. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil / 0.1% finasteride in male pattern hair loss: a randomized, double-blind, comparative study. Tanglertsampan C1. J Med Assoc Thai. 2012 Oct;95(10):1312-6.

5. A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers. Caserini M, Radicioni M, Leuratti C, Annoni O, Palmieri R. Int J Clin Pharmacol Ther. 2014 Oct;52(10):842-9. doi: 10.5414/CP202119.

6. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R. Int J Clin Pharmacol Ther. 2016 Jan;54(1):19-27. doi: 10.5414/CP202467.

7. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. B. S. Chandrashekar, T. Nandhini, Vani Vasanth, Rashmi Sriram, and Shreya Navale. Indian Dermatol Online J. 2015 Jan-Feb; 6(1): 17–20. Doi: 10.4103/2229-5178.148925

8. A Systematic Review of Topical Finasteride in the Treatment of Androgenetic Alopecia in Men and Women. Sung Won Lee, MD,1 Margit Juhasz, MD,1 Pezhman Mobasher, MD,1 Chloe Ekelem, MD,1 and Natasha Atanaskova Mesinkovska, MD, PhD1. J Drugs Dermatol. 2018 Apr 1; 17(4): 457–463.

The information in this article does not constitute medical advice and should only be used for informational purposes only. The information in this article is not a substitute for professional medical advice and please do not rely on this information to make medical decisions. Please make sure to discuss the risks and benefits of any treatment with your medical doctor before beginning treatment.

Efficacy of Topical Finasteride: Review of Current Medical Literature

In one of the first single-blind, placebo-controlled clinical trials of topical finasteride, Mazarella et al.¹ (1997) published a study of 52 subjects ranging from 19 to 28 years of age. The patients were treated with topical finasteride 0.005% vs placebo for 16 months. Here were the results.

There was a significant reduction in the rate of hair loss after 6 months of treatment.
There was slight to marked reduction of the balding areas in the patients using the topical finasteride.
73% of the patients using the topical finasteride reported moderate effectiveness.

In another double blind, randomized clinical trial study of 45 male patients, Hajheydari et al.² (2009) compared oral finasteride 1mg vs topical finasteride 1% for a total of 6 months.

Both the oral finasteride 1mg and the topical finasteride 1% showed statistically significant increase in total and terminal hair count after 4 months.
There was no significant difference between the two groups in hair thickness, total hair counts and the size of bald area.
Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.”

In a prospective pilot study conducted in 15 patients for 9 months by Rafi and Katz³ (2011), patients applied a topical solution called NuH Hair, which is a novel topical combination of finasteride, dutasteride, and minoxidil, with the option to add oral finasteride, minoxidil and/or ketoconazole shampoo for 9 months.

Significant growth was demonstrated after 3 months of use of the topical solution.
In those patients who utilized the NuH Hair along with either Rogaine foam, Propecia, and ketoconazole shampoo saw significant growth was achieved in as little as 30 days.

In a randomized clinical study by Tanglertsampan C.⁴ (2012), 33 male patients ranging between 27 to 49 years old were enrolled to compare the efficacy and safety of a 24 weeks application of minoxidil 3% lotion versus minoxidil 3% combined with 0.1% finasteride lotion.

Hair count increased in both groups but was only significant in the finasteride + minoxidil group.
This study showed that finasteride combined with minoxidil is superior to minoxidil alone by itself.
Finasteride combined with minoxidil showed significantly higher efficacy by global photographic assessment compared to the minoxidil group.

Caserini et al. conducted two pharmacokinetic studies on topical finasteride. In a randomized clinical study of 23 males, Caserini et al.⁵ (2014) compared topical finasteride 0.25% twice daily vs oral finasteride 1mg once daily for 7 days. They measured DHT and testosterone levels in the serum (systemic DHT levels).

Similar reduction in serum DHT was observed by the use of topical 0.25% finasteride twice daily (68-75% ) and oral finasteride 1mg (62-72%).
No relevant changes occurred for serum testosterone.

In another randomized clinical trial, Caserini et al.⁶ (2015) did another study involving 50 male patients studying DHT in both the serum and the scalp.

Scalp DHT was reduced by 71% with the use of 1ml topical finasteride 0.25% once daily application vs 51% reduction in scalp DHT with the use of oral finasteride 1mg once daily.
Interestingly, once a day application of the 1ml topical finasteride 0.25% lead to a higher reduction of scalp DHT (71%) vs twice a day application of 1ml topical finasteride 0.25% (47%).
Serum DHT decreased by 60 – 70% with the use of both 1ml topical finasteride and 1mg of oral finasteride.
This pharmacokinetic study confirmed that topical finasteride 0.25% (1ml application twice daily) and oral finasteride 1mg (once daily) both have similar reduction in scalp (47-51%) and serum DHT levels (74-76%). No changes in testosterone were observed.

In a retrospective assessment and prospective crossover cohort study of 50 male between 20 to 40 years old by Chandrashekar et al.⁷ (2017), all 50 patients used minoxidil 5% and oral 1mg finasteride for 2 years.They then stopped and their treatment differed.

45 of the patients that stopped the above treatment immediately started topical minoxidil 5% + finasteride 0.1% treatment for 1 year.
Results showed that 84.4% of these patients maintained good hair density while on the topical combination.
5 of the patients stopped all treatments for 8-12 months and then started the topical minoxidil 5% + finasteride 0.1% for 1 year.
Results showed that 80% of these patients maintained good hair density.

The studies⁸ above demonstrate that topical finasteride has clinically proven, evidence-based, scientific data to show its efficacy in growing hair. Firstly, pharmacokinetic studies suggest that topical finasteride results in a similar reduction in scalp DHT as oral finasteride. Studies also suggest that topical finasteride causes a statistically significant increase in total and terminal hair count. Additionally, when topical finasteride was compared to oral finasteride, both the oral finasteride 1mg and the topical finasteride 1% showed statistically significant increase in total and terminal hair count and that no significant difference was observed with respect to hairthicknes and hair counts. Authors concluded that “the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.” When topical finasteride was combined with topical minoxidil, the combination of finasteride with minoxidil was superior to minoxidil alone by itself. Finally, 84.4% of patients who were on oral finasteride for about 2 years and then switched over to topical finasteride with minoxidil maintained good hair density. Thus far, these studies with a total patient count of 268 show that topical finasteride can cause hair growth and have similar efficacy as oral finasteride. Additional large cohort studies are still needed to better evaluate the efficacy of topical finasteride vs oral finasteride.