Medical hair restoration in the literal sense includes the
hair loss treatment which depends upon the use of medicines.
Unusual hair loss both in men and women is caused by the
alterations in the androgen metabolism. Androgen is a male
hormone which has a major role to play in regulation of hair
growth or hair loss. The dermal papilla is the most important
structure in a hair follicle which is responsible for
hair-growth. It is the dermal papilla, the cell of which divides
and differentiates to give rise to a new hair follicle. The
dermal papilla is in direct contact with blood capillaries in
the skin to derive the nutrients for the growing hair follicle.
Research has shown that dermal papilla got many receptors for
androgens and there are studies which have confirmed that males
have more androgenic receptors in dermal papilla of their
follicles as compared to females.
The metabolism of androgen involves an enzyme called 5 alpha
reductase which combines with the hormone androgen(testosterone)
to form the DHT (Dihydro-testosterone). DHT is a natural
metabolite of our body which is the root cause of hair loss.
Proper nutrition is critical for the maintenance of the hair.
When DHT gets into the hair follicles and roots (dermal
papilla), it prevents necessary proteins, vitamins and minerals
from providing nourishment needed to sustain life in the hairs
of those follicles. Consequently, hair follicles are reproduced
at a much slower rate. This shortens their growing stage (anagen
phase) and or lengthens their resting stage (telogen phase) of
the follicle. DHT also causes hair follicle to shrink and get
progressively smaller and finer. This process is known as
miniaturization and causes the hair to ultimately fall. DHT is
responsible for 95% of hair loss.
Some individuals both men and women are genetically
pre-disposed to produce more DHT than the normal individuals.
DHT also creates a wax-like substance around the hair roots. It
is this accumulation of DHT inside the hair follicles and roots
which is one of the primary causes of male and female pattern
Blocking the synthesis of DHT at molecular level forms the
basis for the treatment of MPHL ( male pattern hair loss) and
FPHL ( female pattern hair loss). There are many natural DHT
blockers and a number of drugs which are used for medical hair
Let us see the main drugs which are available for medical
hair restoration in men and women.
Minoxidil has the distinction of the first drug being used
for promoting the hair restoration. This medical hair
restoration treatment drug was used earlier as an oral
antihypertensive drug, but after its hypertrichosis (excessive
body hair) effects were noticed, a topical solution of the drug
was tested for its hair growing potential. Minoxidil was then
approved as medical hair restoration treatment drug for men by
the US Food and Drug Administration (FDA) in 1988 as a 2%
solution, followed by 5% solution in 1997. For women, the 2%
solution was approved in 1991. Though 5% solution is not
approved for women, it is used as a medical hair restoration
treatment by many dermatologists worldwide. Both solutions are
available without a prescription in the US.
Mechanism of action
Minoxidil is thought to have a direct mitogenic effect on
epidermal cells, as has been observed both in vitro in vivo.
Though the mechanism of its action for causing cell
proliferation is not very clear, minoxidil is thought to prevent
intracellular calcium entry. Calcium normally enhances epidermal
growth factors to inhibit hair growth, and Minoxidil by getting
converted to minoxidil sulfate acts as a potassium channel
agonist and enhances potassium ion permeability to prevent
calcium ions from entering into cells.
Thought the exact action of minoxidil preventing the
formation of DHT has not been shown but the drug has been shown
to have a stabilizing effect on the hair loss. The result of the
drug takes about few months time to be evident since it is the
time which is necessary for restoring the normal growth cycle of
Use of Minoxidil has approved by FDA for men (Norwood II-V)
and women (Ludwig I-II ) older than 18 years. It is used as a
medical hair restoration treatment either for frontal or vertex
scalp thinning. It brings about an increase in density which is
mostly caused by conversion of miniaturized hairs into terminal
hairs rather than a stimulated de novo re-growth. The hair loss
becomes stabilized after continued use of drug, which takes
about a year’s time for the medical hair restoration treatment
to show its complete results.
Hair loss restoration treatment with 0.05% betamethasone
dipropionate and 5% topical minoxidil are found to be superior
to minoxidil alone.
Topical minoxidil is very well tolerated and adverse effects
are mainly dermatologic. The most frequent adverse effect is an
irritant contact dermatitis.
Though minnoxidil does not have any effect on blood pressure,
it should be used with caution in patient with cardiovascular
diseases. It is also contraindicated in pregnant and nursing
The drug finasteride was earlier used as treatment for
prostate enlargement, under the medical name Proscar. But in
1998, it was approved by FDA for the Medical hair loss
restoration in MPHL.
Mechanism of Action
Medical hair restoration treatments with Finasteride depends
upon its specific action as an inhibitor of type II
5α-reductase, the intracellular enzyme that converts male
hormone androgen into DHT (Dihydro Testosterone). Its action
results in significant decrease in serum and tissue DHT levels
in even in concentration as low as 0.2mg. Finnasteride is able
to stabilize hair loss in 80% of patient with Vertex hair loss
and in 70% of patients with frontal hair loss. Most of these
patients are able to grow more hair or retain the ones they
have. The peculiar thing about Propecia is that its effect is
more pronounced in crown area than in the front. The hair that
grow after the medical hair restoration treatments are better in
texture and are thicker, more like the terminal hair.
The best thing about medical hair restoration treatment with
the finnasteride is that it is well tolerated and has minimal
side effects. Sexual dysfunction (decreased sex drive, erectile
dysfunction, and decreased semen volume) are observed in about
3.8% of cases. But these side-effects subside within few months
of Medical hair restoration treatments or disappear within a
week’s time as soon as the treatment is stopped.
It generally requires about 6 to 12 months for the m edical
hair restoration treatment to be apparent but the side effects
appear earlier. So even after the medicine is stopped, there is
no possibility of loosing the hair that has been gained, but the
side effects are sure to disappear.
Many hair restoration surgeons find Propecia (finasteride) to
act as an excellent adjunct to the surgical hair restoration.
There are several benefits of this kind of combination therapy.
As the Medical hair restoration with Propecia brings about a
hair re-growth in the crown area, it has a complementary action;
it allows the surgeon to have more donor hair to be available
for frontal hair transplant and design the hairline at his own
will. Since finasteride has no effect in the frontal area of the
scalp, it does not have any interference with the surgical hair
There are reports which say that use of finasteride and
topical minoxidil combination therapy as a Medical hair
restoration treatment is of more advantage in cases of mild to
moderate MPHL. Further studies are in progress. Many hair
restoration doctors have already started the use of combination
therapy in order to obtain better hair growth.
Anti Androgen Therapy
For women with hyperandrogonism( with increased levels of
androgen) who do not respond well to minoxidil, antiandrogen
therapy is another option of Medical hair restoration. In UK the
most commonly used anti-androgen for women is CPA (cyproterone
acetate), which is used in combination with ethinyl-estradiol.
However, in United States, where CPA is not available, the
aldosterone antagonist spironolactone is the alternative choice
of hair restoration doctors.
Medical hair restoration with flutamide has shown improvement
as hair loss restoration treatment in women with hirsutism. For
hyperandrogenic premenopausal women, flutamide is a better
medical hair restoration agent than both the CPA or finestride.
Hair loss restoration management is a structured process
which depends upon many factors along with the medical hair
restoration. For more details on the topic you can refer to
section medical hair restoration or article on male pattern hair
loss or female pattern hair loss at our site