About half of women and even more men experience age-related thinning of the hair, but recent advances can slow the loss and, in some cases, even help hair regrow.
The most common type of hair loss is called androgenetic alopecia, a.k.a. male-pattern baldness (a receding, M-shaped hairline plus thinning at the top of the head) or female-pattern baldness (all-over thinning). It’s caused by age, hormones, and genetics. Chronic underlying illnesses such as untreated thyroid disorders or anemia can accelerate hair loss, but when the illness is treated, that hair loss usually reverses.
When it comes to slowing or reversing hair loss, therapies fall into two main categories: medical and surgical. Here are the most common medical treatments:
Minoxidil (Rogaine). Applied twice daily to thinning areas, topical minoxidil keeps hair in the growing phase, which means that treated hairs don’t shed as frequently as they normally would. It also stimulates regrowth.
For patients who experience scalp irritation, there is an oral formulation. Oral minoxidil was originally used as a high blood pressure medication, but when used in very low doses (around 1 milligram [mg]/day or less, versus the standard 10 to 30 mg/day dose for blood pressure), it stimulates hair regrowth and reduces shedding. It can improve existing high blood pressure, too. Patients with heart failure should avoid oral minoxidil.
Dandruff shampoo. When lathered into hair and left on for five minutes a day, two to three times a week, dandruff shampoo may calm hair-
damaging inflammation while killing a common yeast, Malassezia, that causes hair loss, itching, and dandruff. Ask your doctor for a prescription for an antifungal shampoo containing 2 percent ketoconazole, which a 2019 Biomedical Dermatology study found to be as effective as 2 percent minoxidil in women with female-pattern hair loss. (Ketoconazole is the active ingredient in the OTC dandruff shampoo Nizoral AD, but it contains only 1 percent ketoconazole.) Other options include Head & Shoulders, Selsun Blue, and Neutrogena TGel, which contain different active ingredients with similar effects.
Finasteride (Propecia) and dutasteride (Avodart). These daily oral medications are a mainstay of treatment for male-pattern hair loss. They block dihydrotestosterone, a naturally occurring steroid that promotes hair thinning. Like minoxidil, they can help maintain and possibly regrow existing hair, but they won’t work with complete baldness. Combining Propecia or Avodart with Rogaine can enhance effects. Postmenopausal women may be candidates for use, but women of childbearing age shouldn’t even touch these drugs, let alone use them, as they can cause fetal abnormalities during pregnancy.
Scalp micropigmentation (SMP). This camouflage technique uses medical-grade ink to create hundreds of tiny dots on the scalp, mimicking the look of individual hairs. SMP differs from tattooing in that the pigment is different and isn’t deposited as deeply.
In someone with complete baldness, this can be done in a way that resembles a buzz cut, almost like a permanent 5-o’clock shadow on the skull. For all-over or patchy thinning, it creates the illusion of fullness. Results are instant and last five to 10 years. No recovery is needed. Because UV light breaks down the pigment, wearing a hat when outdoors can reduce the need for touchups. Depending on the area treated, expect to spend one to three hours with your SMP specialist, with a total cost of $3,000 to $6,000.
If medical management isn’t effective, there are two surgical procedures: follicular unit extraction (FUE) and follicular unit transplantation (FUT or “strip method”). In both, hair is surgically removed from the back and sides of a patient’s head (the “horseshoe” region) and strategically transplanted to areas of baldness or thinning. The patient is under local anesthesia. This hair in this area is genetically different from the hair on the top of the head in that it rarely thins with age, so once it’s moved to the top, it can grow there for decades.
In FUE, the donor site is shaved before individual follicles (each follicle usually contains one to four hairs) are removed and transplanted. You can expect small scars where follicles are removed, which usually end up concealed by existing hair. Recovery takes three to five days.
With FUT, which doesn’t require shaving, a long, thin strip of scalp is removed before individual follicles are harvested and transplanted. The donor area is stitched back up, leaving a barely visible scar (unless you buzz your hair shorter than a #2 on a pair of standard clippers or razor shave your head), and stitches are removed after seven to 10 days. FUE may be better suited to patients with moderate hair loss and FUT for more significant loss.
Both FUE and FUT are day-long procedures that typically cost between $10,000 and $20,000, depending on where you live and the amount of hair transplanted. Results are permanent and, with a skilled surgeon, appear very natural. There is no more “hair plugs” look.