Your Diabolical Follicles: Treating Male Pattern Baldness

Find out what goose droppings, beer, and mustard oil have in common, and how they affect your hair.

Are you one of the 70% of men who is suffering from male pattern baldness (MPB)? Do you want to stop it and even, possibly, reverse it? Boil a cup of mustard oil with four tablespoons of henna leaves, let it cool, then massage it daily onto the balding areas. Better yet, create a paste from honey, beer, and boiled wheat, and have it applied gently (to your scalp, of course) by the hands of a virgin. Or you could rub goose droppings onto your dome, the way the Vikings did. Other types of animal excrement could work as well: Cow feces and pig urine are both good topical solutions. And if the business end of a cow doesn't provide relief, turn her around and have her lick a combination of molasses and oats off your head. There's a baldness clinic in South America that swears it will return your hair to its teenage luster.

Sound crazy? Not to everyone. A full head of hair is associated with strength, virility, youth, and power. Though men aren't encouraged to openly discuss their emotional reaction to hair loss, it's there. Frustration, depression, loss of self-esteem, social withdrawal, even suicide. It's not just about looks, although that's certainly a part of it; it's about a loss of control, the passage of time, mortality. "When men lose their hair, it can be devastating," says Spencer Kobren, founder and president of the American Hair Loss Association and founder of thebaldtruth.com. "Most guys would do just about anything to keep from going bald. We'd rather regrow our hair than lose body fat. If you told a balding guy he could keep his hair if he were to run five miles a day and eat a specific diet, he'd absolutely do it. An overweight guy? Maybe. Hair is different."

Kobren should know. He started losing his hair in his early 20s, and he panicked. He reasoned that women would rather date a man with all his hair. (He might have been correct. During an online dating experiment conducted in the U.K., two photographs with identical descriptions of the same man were used--except one had been digitally altered to show him with thinning hair, while the other showed a full head--the thick-haired profiled received nearly five times as many responses from women). So he hung upside down with gravity boots after taking niacin capsules to create a flushing sensation; rubbed cayenne pepper on his scalp to stimulate hair growth; and wrapped his head in scalding-hot towels to draw out the oily matter called sebum from the sebaceous glands, because he'd heard the theory that oil buildup beneath the scalp's surface can damage hair follicles.

None of it worked, of course. "There are as many desperate home remedies as there are receding hairlines," Kobren says. "If any of them really worked, it would be prime-time, head-line news. You really think some guy in his basement in Wisconsin has the cure to hair loss? You want to believe it, but come on." Of the seemingly infinite treatment options to slow or reverse baldness, there are only three that are widely accepted as valid. But before you learn how to keep your hair, you need to understand why you're losing it.

Hair loss treatment

Physicians are reluctant to use systemic treatment (a pill or other form of internal treatment that affects your entire system) unless they know that the hair loss is due to an excess of androgen in the system or a sensitized "over-response" to the so-called "normal" amounts of androgen in the system. That's because these systemic treatments may lower the body's androgen levels. Therefore, physicians often choose topical treatments (those that are applied directly to the scalp).

The best results from treatment happen when you begin treatment as soon as possible after the hair loss begins because prolonged androgenetic alopecia may destroy many of the hair follicles. The use of anti-androgens after prolonged hair loss will at least help prevent further hair loss and encourage some hair regrowth from those follicles that have been dormant but are still viable, Stopping treatment will result in the hair loss resuming if the androgens aren't kept in check in some other way. Maintaining your vitamin and mineral levels helps while you're on anti-androgen medications.

As always, treatments have the best chance of being effective if they are geared to the cause of the hair loss as well as to triggering hair growth.

Currently there is only one FDA approved treatment for female pattern hair loss.

Below you will find a list of treatments currently being used to treat hair loss in women. Some of these drugs have not been approved by the FDA for this particular application, however they have all been approved for other applications and are used “off label” to treat hair loss.

The effectiveness of these agents and methods vary from person to person, but many women have found that using these treatments have made a positive difference in their hair and their self-esteem.

Minoxidil 2% Topical Treatment

Minoxidil was first used in tablet form as a medicine to treat high blood pressure (an antihypertensive). It was noticed that patients being treated with minoxidil experienced excessive hair growth (hypertrichosis) as a side effect. Further research showed that applying a solution of minoxidil directly to the scalp could also stimulate hair growth. The amount of minoxidil absorbed through the skin into the bloodstream is usually too small to cause internal side effects.

Women with diffuse androgenetic alopecia can use minoxidil and it actually seems to be more effective for women compared to men. The makers of minoxidil recommend women only use the 2% concentration of minoxidil and not 5%. The makers of minoxidil have not received FDA approval for promoting 5% minoxidil or minoxidil extra strength for use by women. Many dermatologists do prescribe minoxidil 5% for women with androgenetic alopecia if used under their supervision. Some small clinical trials have been conducted on 5% minoxidil for androgenetic alopecia in women showing that indeed the 5% solution is significantly more effective in both retaining and regrowing hair than the 2 % solution.

In clinical studies of mostly white women aged 18-45 years with mild to moderate degrees of hair loss, the following response to minoxidil was reported: 19% of women reported moderate hair growth after using minoxidil for 8 months (19% had moderate regrowth; 40% had minimal regrowth). This compares with 7% of women reporting moderate hair regrowth after using the placebo, the liquid without the active ingredient in it, for 8 months (7% had moderate regrowth, 33% had minimal regrowth).

The American Hair Loss Association recognizes the limitations of topical minoxidil treatment in the fight against female androgenic alopecia (female pattern baldness) therefore we recommend that you seek out the advice of an informed hair loss specialist that can provide you with information on the potential treatments listed on this website.

Androgen Receptor Inhibitors.

Aldactone / Spironolactone

Spironolactone or the more popular brand name Aldactone is in a class of drugs called potassium-sparing diuretics (water pill). It is used to reduce the amount of fluid in your body without causing the loss of potassium. It is also used to treat hypertension (high blood pressure) and edema (swelling) and used to treat potassium deficiency and hyperaldosteronism (a hormonal disorder).

Spironolactone is an antiandrogen that works in two ways. Primarily it slows down the production of androgens in the adrenal glands and ovaries. Secondly it blocks the action of androgens in part by preventing dihydrotestosterone from binding to its androgenetic receptor.

Tagamet / Cimetidine

Cimetidine sold under the brand name Tagamet, belongs to a class of histamine blockers used mainly to treat gastrointestinal ulcers. The histamine blocking action prevents the stomach from producing excess acid, allowing the body to heal the ulcer. Cimetidine also has a fairly powerful anti-androgenic effect and has shown to block dehydrotestosterone form binding the follicle receptor sites.

Cimetidine has been used to treat hirsuitism in women (excess facial hair growth) and has been studied in women with androgenic alopecia showing promising results. Because of the high doses needed to achieve it’s hair raising results, men should not take cimettidine to treat their hair loss due to possible feminizing effects including adverse sexual side effects.

Cyproterone Acetate
Cyproterone Acetate is used to reduce sex drive in men which have excessive sex drive and for the treatment of pronounced sexual aggression. It is also prescribed to treat severe hirsuitism in woman of childbearing age and also androgenetic alopecia in women. Cyproterone acetate exerts its effects by blocking the binding of DHT dihydrotestosterone to its receptors.

Cyproterone acetate is not available in the US and is thought of as one of the last resorts for treating female pattern hair loss because of its possible toxicity and long term side effects.

As with any drug side effects other than those listed may occur, contact your doctor if you are experiencing a side effect that is unusual or particularly bothersome

Estrogen/Progesterone
Also known as hormone replacement therapy (HRT) and commonly prescribed at menopause, estrogen and progesterone pills and creams are probably the most common systemic form of treatment for androgenetic alopecia for women in menopause or whose estrogen and/or progesterone are lacking for other reasons.

Oral Contraceptives

Since birth control pills decrease the production of ovarian androgens, they can be used to treat women's androgenetic alopecia. Keep in mind, however, that the same cautions must be followed whether a woman takes contraceptive pills solely to prevent contraception or to treat female pattern baldness. For example, smokers over thirty-five who take "the pill" are at higher risk for blood clots and other serious conditions. Discuss your medical and lifestyle history thoroughly with your doctor. Contraceptive pills come in various hormonal formulations, and your doctor can determine which is right for your specific needs, switching pills if necessary until you are physically and emotionally comfortable with the formulation. Note: Only low androgen index birth control pills should be used to treat hair loss. High androgen index birth control pills actually contribute to hair loss by triggering it or enabling it once it's been triggered by something else.
Nizoral/Ketoconazole
Available as a topical treatment by prescription, Ketoconazole is currently used as an antifungal agent in the treatment of fungal infections. It also has anti-androgenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs (in women, the ovaries). Because of this action, it can be used to help treat hair loss. Nizoral shampoo contains 2 percent Ketoconazole and is prescribed not only for the treatment of scalp conditions, but also in combination with other treatments for androgenetic alopecia. A 1 percent version is now available over-the-counter, but it may not be as effective as the 2 percent prescription strength. There are no significant side effects.
Propecia/Proscar

The drug finasteride inhibits the enzyme 5-alpha reductase, thereby inhibiting the production of prostate-harming, follicle killing DHT. It was first marketed to treat the prostate under the brand name Proscar in 5 mg pills. In 1998, a 1 mg version with the brand name Propecia entered the market as the first pill approved by the FDA for men's hair loss. It works quite well for most men in both preventing hair loss and triggering regrowth, and it may work for some women, although women must not take it if they are pregnant and must not get pregnant while on the drug because of the risk of birth defects in a male fetus. Less than 2 percent of men experience transient sexual side effects including erectile and libido difficulties. In women these side effects do not occur.

Cyproterone Acetate with Ethinyloestradiol

Sold under the brand name Diane 35 and Diane 50, this contraceptive tablet is prescribed in Europe for women's androgenetic alopecia. The drug works by blocking some of the actions of male hormones commonly present in women. Although it's possible for the drug to stop further hair loss and trigger regrowth of hair within about a year, it needs to be used on an ongoing basis in order to maintain regrowth and eliminate hair loss. Possible side effects include breast tenderness, headaches, and decreased libido. It does have one good side effect- it helps prevent osteoporosis. The drug is a combination of cyproterone and estradiol, an estrogen. Both Diane 35 and Diane 50 contain 2 mg of cyproterone. Diane 35 contains 0.035 mg of estradiol. Diane 50 contains 0.050 mg of estradiol. The drug is as effective as, if not more than, spironolactone. Currently this drug is not available in the US.