Some men regard hair loss as a mark of masculinity, but for many affected, both men and women, it is far from welcome.
With an estimated 40 per cent of men and 30 per cent of women in the UK having lost some or all of their hair, the search for the perfect hair-loss remedy continues.
Treatments can bolster thinning hair and trigger new growth, but improvements are limited and some side-effects, intolerable.
One of the best treatments is minoxidil, an over-the-counter lotion or foam that increases blood flow to the scalp, nourishing hair follicles, the tiny sacs from which hairs sprout (it costs about £40 a month).
Some men regard hair loss as a mark of masculinity, but for many affected, both men and women, it is far from welcome [File photo]
But roughly a third of users see no improvement and it can have side-effects — one in ten may suffer headaches and one in 100 might even experience a rapid heart rate (as it increases blood flow).
Another option for men is finasteride, a daily tablet (available on private prescription) which works by blocking an enzyme that converts testosterone into dihydrotestosterone (DHT), another form of the hormone which triggers baldness.
Research shows finasteride encourages some growth, but about one in 60 men experiences impotence, which prompts them to stop taking it — and, like minoxidil, hair loss recurs as soon as treatment is halted.
Hair transplants can be successful, however the cost — up to £30,000 — is prohibitive for many.
But there may be other, more effective and cheaper treatments in the pipeline. Here, we look at some of them.
Clascoterone, a lotion being clinically trialled in Germany, has been shown in initial results to be as effective as minoxidil and finasteride — but without serious side-effects. A stock image is used above [File photo]
Clascoterone, a lotion being clinically trialled in Germany, has been shown in initial results to be as effective as minoxidil and finasteride — but without serious side-effects. About 400 men were involved in the studies run by the maker (yet to be published in a peer-reviewed journal).
Rubbed on the scalp twice a day, clascoterone is designed to combat male pattern baldness, which accounts for some 90 per cent of cases.
This is inherited, caused by genes that affect testosterone levels with age, shortening the hair’s growing phase (anagen), and lengthening the period between a hair falling out and a new one starting to grow (telogen phase).
DHT binds to receptors inside the hair follicles, switching off the growth mechanism. The lotion blocks this process, so halts balding, and hair growth can resume.
This approach could also work for female pattern baldness, which causes thinning hair on the top and front of the head, and is linked to the body being oversensitive to male hormones.
Assuming trials are successful, manufacturer Cassiopea says it hopes to launch clascoterone in the UK next year.
Dr David Fenton, spokesman for the British Association of Dermatologists and a consultant dermatologist at Guy’s and St Thomas’ NHS Foundation Trust in London, says: ‘The initial results are very exciting. We know the drug gets properly absorbed into the skin as it has also been successfully trialled in the treatment of acne.
‘It stops the effects of DHT and, judging from studies, appears very safe to use.’
Cost: Not yet known.
Availability: Next year.
When scientists began testing a new class of drugs for rheumatoid arthritis about ten years ago, they noticed scalp hair sprouting in patients who also had alopecia areata, where patches of hair fall out because the immune system mistakenly attacks hair follicles.
About one in 500 Britons has alopecia areata. In most cases, the hair grows back in time, but some people develop alopecia totalis, complete loss of head hair. Both are autoimmune conditions — like rheumatoid arthritis, where joints are painful and swollen due to a malfunctioning immune system.
In most cases, alopecia can only be managed with steroid creams that suppress the immune system. These can also cause damage such as thinning bones, high blood pressure and weight gain.
In arthritis, janus kinase (JAK) inhibitor tablets block enzymes that trigger inflammation in damaged joints. It’s thought blocking the same enzymes may allow hair to regrow in alopecia areata.
In arthritis, janus kinase (JAK) inhibitor tablets block enzymes that trigger inflammation in damaged joints [File photo]
Last year, the FDA (Food and Drug Administration) — which sanctions new medicines and treatments in the U.S. — gave ‘breakthrough designation’ to one JAK inhibitor, Olumiant, in the treatment of alopecia areata. This could speed up any approval.
Now a trial involving nearly 500 alopecia areata patients is under way in America, and the results are due soon. This drug is already approved for use in the UK for arthritis, so might be available quickly if results are positive. ‘This could be good news as alopecia areata is a very distressing condition,’ says Dr Fenton.
However, about one in ten people on Olumiant have side-effects such as skin sores, infections and pneumonia. One in 100 may develop blood clots in the lungs and legs.
Cost: About £700 a month.
Availability: Two to three years.
Eating kimchi — South Korean fermented cabbage — could be a drug-free way to keep your locks, according to a 2019 study in the World Journal of Men’s Health.
Scientists at Dankook University, Seoul, investigated claims that kimchi boosted hair growth by helping blood vessels dilate, increasing blood flow to the scalp.
They studied 23 men with hair loss. Each was told to drink a small bottle of liquidised kimchi before breakfast and at bedtime.
After a month, the average number of hairs had risen from about 85 per square centimetre of scalp to 90. And in four months, it reached 92.
Dr Fenton says: ‘This is interesting research, but the numbers involved are far too small to conclude that eating kimchi is going to tackle hair loss.’
Cost: A jar of kimchi costs £2.75.
Eating kimchi — South Korean fermented cabbage — could be a drug-free way to keep your locks, according to a 2019 study in the World Journal of Men’s Health
Transplanting bacteria from the bowel of one person to another could be a radical new way to treat alopecia areata.
A clinical trial is under way at Columbia University in the U.S., involving 40 alopecia patients, after reports of sudden hair growth in those who had the transplant.
A 38-year-old man with alopecia areata had lost all his body hair ten years beforehand. But within weeks of a faecal transplant, he was sprouting new hair all over. Three years on, it was still growing, according to a report in the American College of Gastroenterology Case Reports Journal.
The patient was being treated with faecal microbiota transplantation for C. difficile — a bug that causes diarrhoea and destroys the healthy bacteria that form part of the gut’s immune system.
This bacteria transplant involves tiny poo samples from the bowel of a healthy person being treated and delivered by colonoscope (a flexible tube) or capsule to the patient to restore their gut bacteria.
After the treatment, some patients reported hair growth. The theory is that gut bacteria, which play an important part in the immune system, also help improve autoimmune conditions such as alopecia areata, where the immune system mistakenly attacks healthy hair follicles and causes hair to fall out.
This prompted the Columbia University study, which is now under way. It will follow up with patients until December 2023.
Dr Fenton says: ‘Alopecia areata is an autoimmune condition, so if this treatment has a positive effect on the immune system then it could help.’
Cost: About £3,000.
Availability: Within five years.
6p hay fever pill
Two recent studies suggest cetirizine — a hay fever drug that costs just 6p a pill — could be a cheap and easy solution for male and female pattern baldness.
Earlier this month, the Journal of Cosmetic Dermatology reported a study that showed men who rubbed 1ml of a specially prepared liquid version of the drug on their heads daily for six months saw significantly more hair growth than those given an identical-seeming dummy lotion.
It followed a similar investigation in 2018 by doctors at the University of Rome, in Italy, involving 67 men given cetirizine liquid to rub on to their scalps for several months. It showed the hay fever drug boosted total hair numbers and the thickness of hair.
In hay fever, cetirizine blocks histamine, a compound released by the body that, in excess quantities, causes itchy, watery eyes and a running or blocked nose.
But in hair loss, it’s thought that the drug blocks the production of a compound called prostaglandin D2, which is found in excess levels in the scalps of bald men and is known to stunt hair growth by shrinking hair follicles.
Laboratory studies have shown that cetirizine can reduce prostaglandin D2 production.
The researchers stress that swallowing hay fever pills won’t have the same benefit because it’s a different dose and formulation to that being developed to treat hair loss.
Dr Fenton says: ‘Anything that works better than a placebo is worth further research, but the increase in hair numbers needs to be significant enough to improve the patient’s quality of life.’
Cost: For the liquid treatment, the cost is not yet known.
Availability: Two to three years.
Popular, but do these cures work?
UK consumers buy more than a million bottles of caffeine-enriched shampoo a year to try to boost hair growth. Manufacturers say caffeine improves blood flow to hair follicles.
‘It’s illogical to suggest that applying a caffeine shampoo will stimulate sustained hair growth,’ says consultant dermatologist Dr David Fenton. He adds that most studies showing a benefit are from small patient groups — undermining the findings.
THE ‘VAMPIRE’ THERAPY
Platelet-rich plasma therapy, costing more than £1,000, is offered at private clinics. Dubbed ‘vampire therapy’, it involves taking patients’ blood and ‘spinning’ it in a machine to separate the platelets, cells high in proteins thought to trigger hair growth. These are then injected into the scalp. ‘Studies suggest it can increase hair density but I’ve seen numerous patients for whom it has not worked,’ says Dr Fenton. ‘It also needs costly repeat treatments.’
STEM CELL TREATMENT
Costing about £2,000 a time at private clinics, this involves extracting thousands of stem cells — said to develop into new hair cells — from a patient’s roots, skin or fat, which are then injected into the scalp to form new follicles. Animal tests suggest this works, but Dr Fenton says: ‘Stem cell research has been promising a great deal for a long time, but this is still not proven.’