What treatments for baldness work?

A study published in the journal JAMA Facial Plast Surgery in 2016 suggested what to many is an absolute truth: that men are most attractive (and look younger) with hair. If we add to this that the androgenetic alopecia, the most common form of baldness, affecting about half of men and up to 10% of women, it is easy to understand the myriad of remedies, with and without scientific evidence, that we find today.

Before you troubleshoot a problem, confirm that there is. Am I going bald? The hair is made of keratin, like nails and, like these, is regenerated. “It is normal for it to drop something, the day we lose about a hundred hairs”, explains to Sinc the dermatologist and tricólogo of the Hospital Universitario Ramon y Cajal, Madrid Sergio Vañó. Nor is it cause for concern if this average increases, since it varies depending on the stress and the time of year.

When the skin of the scalp begins to be seen, and the capillary density decreases, it’s time to take action in the matter. “If the patient dawns it is often because the hair that is born is very slim. Then you should go to a doctor,” recommends Vañó, remember that it is in the consultation of the dermatologist, and not in the salon, where we must look for help.

Androgenetic alopecia is caused by the action of the male hormones, but affects young men and women at any age after adolescence, even though in them it is more common that it starts after the menopause. The strategy to combat it varies with each patient. The director of the Institute of Dermatology Integral of Madrid, Miguel Sanchez, warns that “if time is lost it is a territory that is not easily recovered”.

Hormones, stress, diet, illness, medication, vitamins, minerals… Sanchez explains that in the hair “is influenced by many factors that make hair progress faster.” That is why el the first step is a diagnosiswith a global assessment of any shortcomings and a local analysis of the hair to check its thickness, density and the presence of miniaturised hair.

Miniaturized hairs are essential to determine if it will work treatment with drugs: “Are the hairs that are viable and alive, who are back out although they are becoming increasingly small and fine,” says Sanchez. “With long treatments can be reversed and improve its density, but if there are bald spots, “areas with follicles atrophied,” the transplant is the only option.

Between these two extremes there is a wide range of options. That’s why we ordered the treatments from most to least effective, since the two groups of primary drugs scams, going through therapies more recent but with less scientific evidence.

Finasteride and gatillazos

Finasteride and dutasteride —the most powerful and reserved for difficult cases— are the drugs most popular anti-baldness. In 2017 the finasteride was in the news because according to the doctor of Donald Trump, he should be your ‘pelazo’. “Block an enzyme that makes the hormone testosterone is transformed into another metabolite that activates the baldness,” says Sanchez.

This drug is used orally and has few side effects much feared by patients. “Between 0.5 and 1.5% suffered from decreased appetite and sexual disorders erection and ejaculation. Scares a lot of people for touching, but statistically it is uncommon and is reversible, so that if something happens, suspends treatment and recover”.

Vañó explains the origin of the fear of a medication that in the US account with these associations: “it Was discovered that he served for alopecia after their use in older patients with prostate problems, so that at the beginning many of the problems were not by the pill but by the age. When I began to take young people without information read the leaflet, was frightened and nocebo effect suffered a ‘trouble getting hard’”.

“There is a crusade against these drugs without scientific basis because they have done medical studies with thousands of patients. A young guy, take it or not, has the same risk of erectile dysfunction in substances: a 2%. Have excellent safety profiles,” says Vañó.

Sánchez adds that, although some study has analyzed whether there is a case to be irreversible, “it is in older people or younger people with prostate problems or psychological”. It also investigates if the finasteride may be injected a few times a month, instead of being swallowed, to avoid the dreaded trouble getting hard.

Minoxidil lotion

This drug is used to treat high blood pressure until it was found that it also induced the growth of the hair, to lengthen their cycles and thickness. “The problem is that by the oral route results in alterations in the voltage, therefore is used in the form of lotions,” says Sanchez.

The dermatologist explains that today it is investigating to see if oral doses of very small affect to the hair without affecting the voltage, a system that “is not yet available”. An alternative that is used today in day are the injections: “injected minoxidil regularly for that go to the follicle with a needle too small to bother”.

These small injections, similar to those used in esthetics to administer collagen, solve the major drawback of this drug: their discomfort. “It is a lotion to apply twice a day and it is absorbed in very small quantity, so that in patients who need larger doses or more times a day you use this technique as a complement,” adds Sánchez.

Transplant to the Turkish

There is a third method to fight baldness effectively: the transplant. The technique WAS (‘Follicular Unit Extraction’) is spearheading the advances that have been seen hair surgery in recent years. Sánchez summarized the process: “it Is very little invasive, involves removing hair to hair grafts from an area that does not have the disease, such as the nape of the neck, and with local anesthesia is implanted”. The operation is so laborious that today is valued the use of robots as helpers.

The rejection is non-existent since the cells own and only intervention is necessary, but the experts consulted by Sinc warn: “The hair that is grafted does not have the disease and is maintained, but if you don’t control the own the you it is still disappearing and in a few years the balance is negative,” says Sanchez.

The solution is simple: either wait for the hair to own stabilize, or treat it with any of the drugs mentioned in this article. “Many young patients they sell the implant but by carelessness or lack of time don’t do the treatment and continue to lose hair even if the implant is well done,” says Sanchez. “In that case, it is bread for today and hunger for tomorrow“.

Vañó he adds that “not all patients are amenable to transplantation”, either by the “bad raw material of the donor” or because “the pattern of alopecia is not suitable”. If it is carried out, in these cases, “it’s not going to be as good as others.”

The hair transplantation has been associated in recent years to Turkey, where the Government attempted to promote medical tourism with prices more affordable than those in the rest of Europe. Sanchez confesses that he “will put the willies” to see images of what appears to be a “war hospital”, with “huge halls where patients lying on mats on the floor are taken care of ten in ten by technicians supervised by a single doctor.”

“We are now receiving patients with rare infections and complications that before we couldn’t see,” adds Sánchez. Vañó speaking of prices: “There a good site are 6,000 euros and one doubtful, 3,000; in Spain they are between 6,000 and 12,000 euros because it is an intervention of eight hours, which requires six people“.

Stem cells, plasma, and lasers

The remedies named up to this point are the most used for their results, but in recent years they have used other new treatments without still too many scientific evidence.

Sanchez defines them as “alternatives” for patients who have failed conventional treatments, although it does not always work: “When you have more data, some will go to more and others will disappear.”

Vañó adds that some are out of fashion “because they are expensive, are made privately and at the clinic you are interested in to reinforce them because client loyalty to the patient” and are not regarded as “ideal” while any patient can benefit from them.

One of these alternatives is the platelet rich plasma. Sanchez explains their scientific basis: “Is extracted from the patient’s blood is processed to concentrate the growth factors and injected into the scalp”. According to the doctor, although not always gives a result, and there is still debate about its utility, some professionals already employ.

The injection of stem cells is an alternative with “even less experience”, in the words of Vañó. In which tissue is removed from an area not affected, as the nape of the neck, to inject the stem cells. Another option is treatment with lasers, Sanchez warns that little is known: “it Seems that help stabilize if used continuously, but it is heavy because you have to do it three times a week”.

Vitamins, shampoos, and other chinese tales

The crecepelo the professor bacterio the series evolved does not exist, that we ask Mortadelo. Vañó enumerates the long list of miraculous answers that neither hamper the alopecia or improve the density of hair: “The vitamins have a cosmetic effect but not a doctor. The shampoo anti-hair loss does not exists because it is a product that will clean the scalp and hair but does not penetrate up to the root, which is 3 millimeters under the skin”.

Carboxytherapy, ozone therapy, massage, botox hair, brewers yeast… The doctor laments the fact that many patients will spend € 20,000 on treatments “with a lot of marketing but without evidence logical nor scientific”. “A genetic disease, not fighting it with vitamins,” adds Sanchez, who warns that if you use only these products, the baldness will continue.

Androgenic alopecia is genetic in origin and, therefore, has no cure. “As soon as you start to produce testosterone during adolescence trigger the process”, explains Sánchez. “It’s like diabetes, familial hypercholesterolaemia or essential hypertension: while we may not be able to modify the genes involved, the treatment only slows down the problem.”

This means that the drugs mentioned in this text should be taken for life, or, as he says Sanchez, “while the patient will worry”. The important thing, according to Vañó, is that if it is done “the more the better” and ensures that “lost” 50% of what was gained” after you stop taking them. “There is nothing to do for three months, a minimum of a couple of years”, and adds that “a lot of people start to use minoxidil, which is not noticed until six months and leave after a couple because he believes him that serves him not”.

Another option: be bald

“I like to stress that this is an aesthetic issue that does not affect the health. You can do a conservative treatment or not to do so. There are those who have assumed it was going to be bald as his father, but in women it is more difficult to accept,” he Sanchez. Perhaps the key is accepting oneself as humor, as expressed in a phrase attributed to the roman philosopher Seneca: “I do not consider myself bald, I am just taller than my hair”.

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