How to Treat Baldness at Home

Hair loss

Hair Loss: Which Treatment Will Help?

"What helps against hair loss?" For most of those affected, this is the crucial question. The answer depends on the type and cause of the excessive hair loss. For example, hereditary hormonal alopecia is treated differently than circular hair loss or hair loss due to malnutrition. Overall, the following applies: The success of a drug or other hair loss treatment is difficult to assess - the treatment works for some, but not for others.

  • Hair loss: start therapy early

    Three questions to

    Prof. Dr. med. Christoph Bamberger,
    Internist and endocrinologist
  • My dad is bald, does that mean I'll lose my hair too?

    Prof. Dr. Christoph Bamberger, MD

    Balding in young or middle-aged men (and thus the most common form of hair loss) is indeed genetic. However, this predisposition is inherited through the mother. So men should look at their maternal grandfather rather than their father to predict their future hair situation.

  • What else can trigger hair loss?

    Prof. Dr. Christoph Bamberger, MD

    Hair that falls out quickly or only in certain places on the head can indicate illnesses such as iron or zinc deficiency, hormonal disorders or circular hair loss. It is based on an immune disorder. Some chemotherapy treatments also trigger hair loss. The following applies: Anyone who finds new hair in the brush, in the shower or in the sink and / or suddenly discovers light spots on the head should have this clarified.

  • Can I prevent hair loss?

    Prof. Dr. Christoph Bamberger, MD

    Limited. Make sure you have a sufficient intake of micronutrients (lots of fruit and vegetables, nuts and oat flakes as a source of zinc, meat for the iron intake). Vegetarians and vegans should keep an eye on their iron levels. Once hair loss has started, start medical therapy as early as possible. Especially for the hereditary form of hair loss, the following applies: once hair has fallen out, it does not grow back.

  • Prof. Dr. med. Christoph Bamberger,
    Internist and endocrinologist

    In 2006, the hormone expert founded the Medical Prevention Center Hamburg (MPCH), now Conradia Medical Prevention, of which he is the director to this day.

The following table provides an overview of the most effective drugs and other therapies that are used for the various forms of hair loss:

Finasteride

Finasteride was originally only prescribed for benign prostate enlargement (benign prostatic hyperplasia). When doctors discovered that hair growth improved in some patients taking finasteride, companies developed their own preparations for hereditary hair loss (alopecia androgenetica).

Finasteride is a so-called 5α-reductase inhibitor, which means: It blocks the enzyme 5α-reductase, which normally converts the male sex hormone testosterone into its active form dihydrotestosterone (DHT). In men with hereditary hair loss, the hair roots are overly sensitive to DHT. Therefore, finasteride can stop the progression of hair loss in those affected. Sometimes the hair on the head thickens again. However, the effect usually only becomes apparent after three to six months. When the drug is stopped, the hair will fall out again.

The active ingredient requires a prescription and is taken in the form of tablets (1 mg). Higher dose tablets (5 mg) are only approved for the treatment of benign prostate enlargement.

Side effects: Finasteride can affect sexual desire (libido) and sexual responsiveness, among other things. Some men also report tenderness and / or chest pain.

This remedy for hair loss is not suitable for women, as damage to the fetus cannot be ruled out in pregnant women and women of childbearing age.

Minoxidil

Like finasteride, minoxidil was originally intended to treat a completely different condition - high blood pressure. Here, too, increased hair growth was observed as a side effect. As a result, researchers developed a hair tincture containing minoxidil, which is approved for external use in the case of hereditary hair loss. In female patients, minoxidil is currently the most effective therapy.

Occasionally, attempts are also made to alleviate circular hair loss (alopecia areata) with minoxidil, but this is not successful.

The exact mechanism of action of minoxidil is unknown, but could include increased blood flow to the scalp. The active ingredient-containing hair tincture is available without a prescription - there is a 5% solution for men and a 2% solution for women. In tablet form, the active ingredient is only used as an antihypertensive agent.

Side effects: The hair tincture can cause local skin reactions such as itching, reddening and inflammation of the skin. Sometimes the hair growth on the face increases. Changes in blood pressure rarely occur. Nevertheless, people with cardiovascular diseases should watch out for side effects such as accelerated heartbeat (tachycardia), water retention in the tissue (edema) and weight gain: If the scalp barrier is not intact (e.g. small cracks), the active ingredient can get into the bloodstream and possibly such cause undesirable effects.

Minoxidil must not be used during pregnancy and breastfeeding.

After stopping minoxidil, androgenetic hair loss usually progresses again.

Antiandrogens

Antiandrogens (such as cyproterone acetate or dienogest) are substances that prevent the action of testosterone or the more powerful dihydrotestosterone (DHT) by occupying their docking points (receptors). Some antiandrogens such as chlormadinone acetate also inhibit the enzyme 5α-reductase (such as finasteride), so that less DHT is produced in the cells. Based on these mechanisms of action, antiandrogens are said to help against hereditary hair loss in women.

After menopause, antiandrogens can be prescribed on their own. In pre-menopausal women, they must be used in combination with estrogens as a contraceptive. Pregnancy must be avoided during treatment: antiandrogens would disrupt the genital development of a male fetus and lead to "feminization".

The estrogen in the contraceptive can also strengthen the effect against hair loss: It increases the amount of so-called sex hormone-binding globulin (SHBG). As a result, more testosterone is bound in the blood. However, only free testosterone can get into the hair follicle cells.

Side effects: Antiandrogens can, among other things, reduce sexual desire.

Smokers are generally not advised to take sex hormone preparations because they have an increased risk of blood clots (thrombosis, embolism). The hormones also increase this.

Men with hereditary alopecia are not allowed to take antiandrogens because they would "feminize" (for example growth of the male breast = gynecomastia).

Dithranol (cignolin, anthralin)

The active ingredient dithranol is mainly used in the treatment of psoriasis. The skin-irritating substance is sometimes also applied to bald areas in the case of circular hair loss: the skin irritation is said to stimulate new hair growth.

Side effects: Possible side effects are reddening of the skin, brown discolouration of the skin, hair discoloration (with blond and gray hair) and allergic reactions of the skin to contact with dithranol (contact dermatitis).

Hair loss - what's behind it?

  • Hair loss - the causes

    If there is suddenly more hair in the brush every morning, the alarm bells will ring for most people. Hair loss is a completely normal phenomenon, around 100 hairs are lost every day. However, if the head of hair falls out in clumps or bald spots form on the head, pathological causes can be behind it. Find out more about what could be behind your hair loss here!
  • Hereditary hormonal causes

    Sometimes the hair roots are genetically sensitive to the male sex hormone testosterone. The hair growth phase becomes shorter and the follicles shrink. Only short, thin and barely visible wool hair is produced. These often fall out at some point without more hair growing back. The result: balding forehead, receding hairline and thinning hair. It mainly affects men, but also women during menopause.
  • Circular

    Bald, coin-sized spots on the head indicate so-called circular hair loss. The reasons behind this have not yet been clearly clarified. However, it is believed that an immune system disorder is to blame for the symptoms. The body's own defense cells may attack the hair roots, which could lead to hair growth being stopped and the hair to fall out.
  • Diffuse

    If the hair thins out over a large area, this indicates diffuse hair loss. The reason for hair loss is damage to the hair roots. The triggers are many. In addition to certain infectious diseases or thyroid dysfunction, poisoning, malnutrition, hormonal changes or stress are also possible causes. In some cases, thinning hair is simply a normal symptom of old age.
  • Sick scalp

    In addition to the three main forms, there are other triggers for sparse hair growth. Fungal infections on the head, for example, sometimes lead to the hair falling out in the infected areas. This mostly affects children. However, certain skin conditions that affect hair growth can also cause hair loss. Psoriasis is an example of this.
  • Congenital changes

    Hair loss in young children can be hereditary. So it happens that hair was not created on them before birth or remains in the stage of downy hair. Another inherited defect leads to changes in the structure of the hair. As a result, the hair remains thin, brittle, loose and falls out when you comb it or pull it.
  • Pulling, pushing, rubbing

    Prolonged pressure and constant rubbing and scratching in the same places on the head can also lead to hair loss. But even a strong pull on the hair roots, such as occurs with tightly tied braids, can in the long run lead to localized hair loss. This type of hair loss is called traction alopecia.
  • Compulsive hair tearing

    People with a specific impulse control disorder pull their own hair out. This disease is called trichotillomania. Some sufferers reduce stress by plucking their hair, others find it stimulating.
  • Medication

    Many active ingredients can lead to hair loss. These include anti-cancer drugs, anti-cholesterol drugs, antidepressants and beta-blockers.

Glucocorticoids ("cortisone")

Circular hair loss is usually treated externally with cortisone creams or solutions. They are designed to alleviate the inflammatory immune response in the affected areas. In some patients, this can actually stop the hair loss and sprout new hair, but not in others. If the treatment is successful, it is generally only for as long as it lasts: When the cortisone therapy is ended, the hair often falls out again.

In certain cases, the doctor may also give cortisone injections into the bald areas. Severe hair loss can also be treated with cortisone in tablet form. The risk of side effects is particularly high.

Side effects: External use of cortisone, for example, can cause allergic reactions. Especially when used internally, there is a long-term risk of systemic (affecting the whole body) side effects. These include, for example, a weakening of the immune system (with wound healing disorders, increased susceptibility to infection, etc.), weight gain, water retention in the tissue (edema), menstrual disorders and Cushing's syndrome.

Topical immunotherapy

If circular hair loss has led to larger bald areas, topical immunotherapy may help. By applying the active ingredient diphencyprone (diphenylcyclopropenone, DCP), an allergic contact dermatitis is specifically triggered and maintained through repeated treatment. This is supposed to "distract" the immune cells from attacking the hair roots. Experts suspect an autoimmune reaction in circular hair loss - i.e. an attack by immune cells on the hair roots due to a malfunction of the immune system.

Side effects: The complex therapy can, among other things, trigger the formation of excessive eczema on the treated skin areas. It should therefore only be carried out by specially trained doctors.

If the treatment works and the hair grows back, it can still relapse later.

PUVA

The treatment of circular hair loss with PUVA comprises the application of a photoxic substance (psoralen), followed by irradiation of the bald areas with UV-A light. This is supposed to stop the immune cells from attacking the hair roots. In general, the psoralen is applied externally (e.g. as a cream). The treatment method is considered to be just as successful as topical immunotherapy. However, the risk of relapse is higher.

Side effects: In general, the psoralen is applied externally as a cream (topical PUVA). If the concentration is too high, undesirable reactions such as a kind of sunburn can appear on the treated area of ​​the skin after UV-A radiation.

You could also apply psoralen internally (as a tablet) before irradiating the skin. However, this systemic PUVA is no more promising than a topical one. It also carries a higher risk of side effects such as a higher risk of skin cancer.

More treatment options for hair loss

In addition to hereditary and circular hair loss, there are other forms of hair loss. If someone loses hair more or less evenly all over their head, doctors speak of it Diffuse hair loss. It can have a wide variety of reasons: It is often caused by certain medications, for example agents against increased blood lipid levels (lipid-lowering agents), cancer drugs (cytostatics) or agents against hyperthyroidism (thyroid drugs). After the therapy has ended, the hair loss usually subsides again. Depending on the medication, it may also be possible to reduce the dose or switch to an alternative preparation that is less damaging to the hair.

Sometimes diffuse hair loss is caused by infections or other conditions (such as thyroid disease) that need treatment. If protein or iron deficiency is behind the excessive hair loss, the deficit must be compensated for through diet or substitute preparations.

Even with one scarring hair loss (cicatricial alopecia), the treatment of the underlying disease (lupus erythematosus, nodular lichen, etc.) is the best strategy against hair loss.

A mechanically induced hair loss can be stopped by avoiding excessive pulling on the roots of the hair. This means, for example, not having a tightly tied ponytail and often wearing your hair open.

  • Hair loss: start therapy early

    Three questions to

    Prof. Dr. med. Christoph Bamberger,
    Internist and endocrinologist
  • My dad is bald, does that mean I'll lose my hair too?

    Prof. Dr. Christoph Bamberger, MD

    Baldness in younger or middle-aged men (and thus the most common form of hair loss) is indeed genetic. However, this predisposition is inherited through the mother. So men should look at their maternal grandfather rather than their father to predict their future hair situation.

  • What else can trigger hair loss?

    Prof. Dr. Christoph Bamberger, MD

    Hair that falls out quickly or only in certain areas on the head can indicate illnesses, such as iron or zinc deficiency, hormonal disorders or circular hair loss. It is based on an immune disorder. Some chemotherapy treatments also trigger hair loss. The following applies: Anyone who finds new hair in the brush, in the shower or in the sink and / or suddenly discovers areas of light on their head should have this clarified.

  • Can I prevent hair loss?

    Prof. Dr. Christoph Bamberger, MD

    Limited. Make sure you have a sufficient intake of micronutrients (lots of fruit and vegetables, nuts and oat flakes as a source of zinc, meat for the iron intake). Vegetarians and vegans should keep an eye on their iron levels. Once hair loss has started, start medical therapy as early as possible. Especially for the hereditary form of hair loss, the following applies: once hair has fallen out, it does not grow back.

  • Prof. Dr. med. Christoph Bamberger,
    Internist and endocrinologist

    In 2006, the hormone expert founded the Medical Prevention Center Hamburg (MPCH), now Conradia Medical Prevention, of which he is still director today.

Hair transplant

The receding hairline and bald patch on the back of the head that develop in men with hereditary hair loss can be concealed with a hair transplant. Small pieces of tissue with hair follicles, which are usually not sensitive to testosterone, are cut out from the even more hairy back of the head and "transplanted" to the bald spots. The procedure should be performed by an experienced dermatologist.

A hair transplant is often unsuitable for women with hereditary hair loss because they usually do not develop any circumscribed bald areas (such as bald spots), but rather the hair generally thins out (especially on the top of the head). There is usually no complete baldness.

Even with circular hair loss, a hair transplant is not appropriate because after a few months the hair often grows back on its own (spontaneous healing).

What you can do yourself

The trade offers numerous over-the-counter products against hair loss. There are, for example, caffeine shampoo against hair loss, burdock root and saw palmetto extract, products with vitamin H, millet extract or taurine. For example, they promise to stimulate hair growth and maintain hair by stimulating the scalp and blood circulation. Most of these agents have not yet been proven to be effective.

The same applies Hair lotions with alfatradiol (17-α-estradiol). Similar to finasteride, the active ingredient can inhibit the enzyme 5α-reductase and thus the formation of highly effective dihydrotestosterone (DHT). This is why it is recommended for men with hereditary hair loss. However, the effectiveness has not been clearly scientifically proven.

Often times, too Preparations containing zinc Taken against hair loss. However, they rarely lead to success, but at least have no side effects. Often will too Biotin for hair loss recommended, especially in the case of circular hair loss, which is often accompanied by nail changes. Because biotin (like zinc) is generally important for healthy hair and nails. However, the effectiveness of biotin against hair loss is controversial.

The correct haircut or one different hairstyle can hide bald spots or thinning hair. Get advice from your hairdresser!

Hair replacements can also hide the affected areas. There is today Wigs and toupees Made of real and synthetic hair in all shapes and colors that can be attached temporarily or permanently. With some hair replacements, you can even go swimming. In any case, seek professional advice in a second hair salon! Also ask your health insurance company whether they will contribute to the cost of a hair replacement in the event of hair loss.