The age of 10 million people with hair loss. [모락모락(毛樂毛樂)]is a special article for those who are precious hair loss. Together with plastic surgery specialist Park Soo-jin (Maxwell Dermatology), we deliver clear answers to various hair loss knowledge and questions.
The representative treatment method used when treating hereditary hair loss is ‘taking drugs’. However, there are people who hesitate because of concerns regarding possible side effects from taking hair loss pills, or the burden of taking them for the rest of their lives. Director Park Soo-jin explained in detail the principles and treatment effects of typical hair loss pills.
Hair LossㅣSource: Getty Image Bank
Q. What are some of the representative drugs to treat hereditary (androgenetic) hair loss?
Drug treatments for androgenetic alopecia play a role in slowing down the hair loss process. Representative drugs for male pattern baldness include ‘Finasteride’ and ‘Dutasteride’.
Finasteride is the world’s first oral androgenetic hair loss treatment and was approved by the US FDA in 1997. By blocking the action of type 2 5-alpha reductase (5-α Reductase), it suppresses the conversion process of testosterone, a male hormone, into a hormone called DHT (dihydrotestosterone) that attacks the root of the hair follicle, reducing its concentration. By doing so, it prevents the scalp hair follicle from shrinking and suppresses the progress of hair loss.
The original drug of Dutasteride was marketed for the first time in the world in 2009 as a treatment for male hair loss in Korea. By inhibiting both type 1 and type 2 enzymes of 5-alpha reductase that convert testosterone to DHT, the reduction of DHT is higher.
Another hair loss treatment is Minoxidil. Minoxidil, which is used as a vasodilator for the treatment of high blood pressure and applied when hair grows out, was approved by the FDA as a hair loss treatment in 1988 following several clinical trials. Minoxidil acts on peripheral blood vessels to increase blood flow in the skin, activate hair follicle cells, and prolong the hair growth cycle. In the case of circular hair loss, it has the effect of preventing hair loss by normalizing immune function by reducing the level of T lymphocytes, which are the main cause, and by promoting the division of hair follicle cells, it directly acts on the proliferation of interstitial cells to promote hair growth.
When minoxidil is taken, the effect of the drug appears throughout the body, and when applied, the effect appears only on the area where it is applied. Recently, someone on YouTube commented, “If you take minoxidil, hair loss treatment is over,” many female patients come to the hospital to get a prescription for minoxidil. Of course, it is true that you can see good effects by taking minoxidil. However, following taking minoxidil, many people experience thickening of body hair on the arms, legs, and armpits.
In addition, side effects of taking minoxidil may include swelling of the whole body, reflex tachycardia, and headache. Animal studies have also reported necrosis of parts of the heart muscle and parts of the left ventricle. There was also an incident in which a 7-year-old girl developed persistent vomiting and hypotension and tachycardia for 40 hours following accidentally taking minoxidil. The effect of taking minoxidil like this is strong, but there are definitely parts to be careful regarding, so it is important to take it only when necessary following consulting with a hair loss specialist.
Q. I am curious regarding the difference in effect between finasteride and dutasteride.
Although the effects of the two drugs are similar, according to a recently published paper, dutasteride was found to be significantly more effective in inhibiting hair loss progression than finasteride in M-shaped and parietal hair loss. Considering the fact that finasteride reduces testosterone’s conversion to DHT by regarding 70%, but dutasteride, which inhibits both type 1 and type 2 enzymes, reduces DHT by regarding 90%, this can be predicted as a natural result.
The adverse events of the drug that many patients are most curious regarding were similar for both drugs. Dutasteride is also significantly more effective than finasteride in the treatment of benign prostatic hyperplasia. However, considering these facts, discussions are still ongoing as to whether it is appropriate for young patients with normal prostate size and function to take dutasteride from the beginning. In addition, since finasteride was released 12 years earlier than dutasteride and has more data, it can be thought that safety has been established. Therefore, it is recommended to receive accurate diagnosis and prescription from a specialist according to the individual patient’s progress.
Q. If there is a family history of hair loss, more and more young people are taking hair loss medicine as a preventive measure before symptoms appear. Is there really a preventive effect?
Even if there is a family history, not everyone will experience hair loss. Because even if you have the gene, it may not be expressed, so there is no need to take medicine as a preventive measure unnecessarily. In fact, there are many cases in which patients visiting the hospital say that they do not have hair loss yet, so do not take medicine and only see the comparative progress following a year. However, if the thinning seems to be decreasing or the hairline recedes, please visit the hospital to get an accurate diagnosis and take the appropriate medicine.
Many people feel burdened with hair lossㅣSource: Getty Image Bank
Q. There are many people who are burdened by the idea that they have to take hair loss medicine for the rest of their lives. If a person who has been taking hair loss pills for a long time stops, will hair loss proceed right away?
Androgenetic alopecia is a lifelong progressive disease. If 5-alpha reductase is inhibited and the conversion rate of testosterone to DHT is continuously lowered, the progression of androgenetic alopecia is greatly inhibited. When you stop taking the drug, DHT is produced once more and hair loss resumes. There are many patients who feel burdened by the fact that they have to take ‘lifelong’ medicine to suppress the production of DHT steadily.
In order to prevent diseases as we live, there are actions that we are educated from a young age and take for granted ‘lifelong’. For example, brush your teeth three times a day, apply sunscreen every day, and diabetic patients take diabetes medications to keep blood sugar levels low. In addition, hypertensive patients take ‘lifelong’ medications to keep their blood pressure at an appropriate level. Hair loss is also a disease, so it is natural to take ‘lifelong’ medicine to suppress the progress. If the right education and understanding are achieved, the resistance to the word ‘lifetime’ will decrease, and it will become a natural behavior.
If you take hair loss pills for a long time and then stop, DHT is regenerated and hair loss resumes. Therefore, if hair loss is a concern, it is right to continue taking the medicine.
Q. What nutritional supplements are good to take along with the hair loss medicine prescribed by the hospital?
In the 1960s, workers at the Carlsberg Brewery in Germany had full, shiny hair thanks to regular consumption of brewer’s yeast. Brewer’s yeast is an essential element for making beer and has a protein structure similar to hair. Medicinal yeast is a purified yeast used in beer, and a drug was released in Germany in 1978. In addition to medicinal yeast, this product contains essential nutrients for hair growth, such as L-cysteine and keratin.
L-cysteine and keratin are also the main components of hair, and have antioxidant effects and help hair growth when taken. Thiamine increases the proliferative capacity of hair-forming cells, and pantothenic acid helps metabolize energy for the proliferation of hair cells and stimulates the growth and regeneration of tissue cells. However, since it is difficult for the body to absorb these ingredients when taken as they are, it is recommended to take lactic acid bacteria at the same time. This is because lactic acid bacteria increase the absorption rate by helping the primary hydrolysis.
Recently, biotin, which has been in the limelight as a hair loss nutrient, is an essential ingredient for protein metabolism that composes scalp and hair. By supplying nutrients to the scalp and keeping the scalp healthy, the health of the hair follicles is also improved. It may be effective in the case of hair loss caused by biotin metabolism disorder or biotin deficiency, but it is not certain that it is effective for all hair loss patients. Among the products on the market, there are products with a high biotin content of 10,000mcg. There is no evidence that the higher the biotin content, the better the hair loss treatment effect. I recommend taking it.
Director Park Soo-jinㅣSource: Maxwell Dermatology
Help = Haidaq Counseling Doctor Park Soo-jin (Maxwell Dermatology Plastic Surgery Specialist)
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