When a man starts losing his hair, it’s not just the follicles you see going down the drain. Often, a man’s confidence and identity go with it. A man’s head of hair is tied to his masculinity and function in life, which is why keeping it is such a high priority for most guys. The team of board-certified dermatologists at Vorteil recommend these six key strategies to protect your mane.
1. Seek the correct diagnosis
Hair loss in men is not as straight forward as it sounds. In fact, there are over 100 different hair loss conditions that affect men. These can range from the common to the very rare and include (but are not limited to) genetic syndromes, thyroid conditions, side effects to medications, and scalp infections. These and many other human ailments can affect hair growth and result in hair loss. In other words, never assume it is just genetic in nature. For example, a recent study showed that low iron levels can result in hair shedding. It is really important to seek a diagnosis from a board-certified dermatologist who specializes in hair loss.
In general, determining the cause of hair loss is usually based on a man’s personal medical history, family history, physical examination of pattern of hair loss, past use of hair treatments and prescription drug history. In general, since different types of hair loss can take years to fully mature, the correct diagnosis can take time to pin-point. Vorteil recommends getting evaluated as soon as you notice signs of thinning.
Sometimes the classic male pattern baldness is straightforward to diagnose based on visual inspection. However, sometimes a scalp biopsy is necessary to examine the hair follicles under the microscope and to rule out a more serious scalp condition, such as an autoimmune disease. Simple blood tests are sometimes also helpful and include: a thyroid test, iron levels, and blood counts.
2. Make it less obvious
There are a few “Vorteil tricks” to make hair loss less noticeable. First, make sure your hair color is optimized. It turns out that the greater the color contrast between your scalp skin color and your hair color, the more noticeable hair loss will be. For example, a man with a fair skin complexion will look balder with jet black hair than with light brown or blonde hair, simply because the color contrast draws a person’s attention to the scalp that is visible between the hair strands.
Secondly, get a hair-cut that correctly frames your face. Seek a stylist that frequently cuts men’s hair and ask for his/her opinion. Often times the right hair-style can play to your hair strengths (such as a full hairline) and downplay your weaknesses (such as a thinning crown).
It turns out that diet can also play a role in hair loss. Numerous studies have shown that balding men are more likely to be overweight and have a higher risk of heart disease. Start by cutting fried foods out of your diet; as fried foods have been shown to increase the conversion of T to DHT in the scalp by reducing the concentration of oil in the skin.
In addition, skip the processed carbohydrates, as they spike insulin levels which causes your T (and conversion of DHT) to spike. What’s more, increased insulin can cause diabetes. This supports recent studies that have linked hair loss in men and an increased risk of non-insulin dependent diabetes.
In addition to hair color, hair styling, and diet, exercise can also help stave off baldness. Cardio exercise has been shown to lower androgen levels in the blood. This could translate to weight loss and more hair, a win-win scenario.
3. Go over-the-counter
There are many safe and effective over-the-counter hair loss solutions, the key is to know which ones to use and how to use them properly. By far the most effective product is Minoxidil 5% foam. Dermatologists have not pinpointed exactly how it works, but many experts think it stimulates potassium channels on the hair cells. Minoxidil is known to increase the duration of the growth phase of the hair cycle and gradually enlarge the “peach fuzz” hair into the mature, dark hair.
Whether you buy the brand name (Rogaine) or the generic at Costco (Kirkland), they work exactly the same. Vorteil recommends to use the foam and not the liquid formulation because the latter contains an ingredient called propylene glycol, a known cause of allergic reactions. Minoxidil for men works best on the crown of the scalp. Although not FDA approved for the hairline, studies have shown it works there as well.
In general, Minoxidil works best on areas of thinning (not complete bald spots) and on smaller bald spots (not large ones). In order to reap the benefits of Minoxidil, you have to use it twice per day for a good 6 months to see any benefit. Don’t fret if it actually causes more hair loss in the first month or two. If you experience this, count your lucky stars. “Hair loss in the first few months of Minoxidil treatment is actually a good sign because it means the hair is cycling back to its active, growth phase”, says Vorteil board-certified dermatologist Ryan Goerig, MD, FAAD. In other words, keep using even if you start shedding more than usual or you don’t see immediate results.
Another over-the-counter product that can slow hair loss is zinc pyrithione. This ingredient is most commonly seen in anti-dandruff shampoos, such as Neutrogena Daily Control 2 in 1. Zinc, a natural mineral, is thought to work by reducing inflammation in the scalp and promoting hair growth by killing bacteria and yeast in the oil glands and hair follicles. According to a study in the British Journal of Dermatology, 1% zinc pyrithione showed that subjects had thicker hair twelve months later.
While you are at the drugstore, pick up some biotin supplements. This water-soluble B vitamin is like fertilizer for the hair, similar to calcium for your bones. Although biotin won’t grow hair, it can strengthen the hair follicles and reduce breakage. This will add more volume to the hair because less will be breaking off. 2.5-5.0 mg per day is enough for hair loss purposes (just make sure not to take mega doses of this vitamin).
4. Get prescription strength hair growth medications
Finasteride (1 mg) is the only FDA cleared oral medication for hair loss in men. It works by blocking an enzyme that converts testosterone to DHT, lowering it by 71%. It has the most scientific data to back it up and Finasteride delivers results no other medication can: 85% of guys see a stabilization in hair loss, 65% see an actual increase in hair numbers, and the majority will see an increase in hair weight (ie: thicker hair). What’s more, Finasteride is synergistic with Minoxidil. This means that the two work together better than each does alone. Finasteride gets a bad rap because it has been reported to cause erectile dysfunction. Most guys never experience this and your sexual performance returns to normal if you stop the medication. It is important to start finasteride as soon hair loss is first noticed, as the medication is much better at stabilizing hair loss than at regrowing hair.
Ketoconazole 2% shampoo is the most effective shampoo for hair loss on the market.“ This potent, prescription only medication was originally used to treat dandruff, but now is considered a necessary ingredient to any serious hair loss regimen. Ketoconazole fights hair loss by reducing the level of DHT in the scalp and, by reducing dandruff, enhances the penetration of Minoxidil into the scalp (which makes it work better).
Dutasteride, the stronger, more potent cousin of Finasteride, also blocks the conversion of T to DHT. Compared to finasteride, which decreases DHT in the scalp by 71%, dutasteride lowers DHT by 95%. This results in less shedding and more hair growth. Although dutasteride is FDA approved only for prostate enlargement, it is commonly prescribed by Vorteil for hair loss. In fact, a recent 2014 study in the Journal of the American Academy of Dermatology not only showed that dutasteride works better than Finasteride, but also showed that it’s just as safe.
5. Ignore the hype
Although lots of lotions and potions claim to make your hair look thicker, only finasteride and minoxidil are FDA approved to treat hair loss and actually re-grow hair. Most of the devices, pills, supplements and shampoos have not been rigorously studied in peer-reviewed medical journals, let alone have the thumbs-up from the FDA. Any product that is hawked in infomercials or on the internet is a waste of money and definitely a “buyer beware” scenario.
Low-level light therapy (LLLT) is an FDA cleared device that claims to grow hair and make it thicker. “FDA cleared” medical devices (as opposed to medication) means that it is safe to use, not that it actually works. There have been very few high-quality studies demonstrating that LLLT actually gets the results it claims. Most of the studies were funded by the manufacturers of the actual devices themselves.
6. Get on the transplant list
Hair transplants have come along way since the “plugs” of 1980’s. Plugs, or little tufts of hair, made the hairline look completely unnatural, resulting in a doll’s head appearance that looked like a toothbrush. These poor results of the past were mainly caused by a technique that placed too many hair follicle clumps together. Fortunately, the recent techniques developed and employed by skilled board-certified dermatologists produce an undetectable, natural result. Today, rather than using unnatural plugs containing 10-12 hair follicles, the new techniques create micro-mini grafts–basically individual hair follicle grafts. This mimics a natural hairline so well that your barber won’t even notice.
If you are considering a hair transplant, you have two options: Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE). Both methods take hair from the back of the scalp and move it to the bald areas in the front of the scalp. In our experience at Vorteil, both methods have the same amount of downtime (about 2-3 days). The difference lies in how the hair is removed from the back of the scalp.
FUT: FUT involves removing a strip of scalp from the back and cutting it into tiny pieces, resulting in individual hair follicle grafts. The strip of scalp is closed together, and, thanks to a recently developed scar technique called trichophytic closure, results in a very thin 1 mm line scar. The line scar is usually never seen because most men’s hair in the back covers it completely. The line scar is only an issue for men who cut their hair very short or who want to shave it in the future.
FUE: FUE involves using a motorized or robotic device to remove hair follicles from the back of the scalp. Instead of a line scar, there are up to 2,000 tiny white dots. It is true that you have no stitches with FUE, but, contrary to what is marketed, the total amount of scarring is actually more with FUE than with FUT. FUE is best for guys who keep their hair very short (like military style) or have had multiple FUT procedures in the past.
Having more than five FUT’s in the past creates too much scar tissue to create a thin line scar. Consequently, FUE is a better choice for these men. The main downside of FUE is that the entire back of the head needs to be buzzed prior to the procedure. FUT or FUE, performed with excellence, can be expected to produce a natural, undetectable result that will last a lifetime.
It is important to note that hair loss is a progressive process, meaning that a man will continue to lose hair over the course of his lifetime. A hair transplant does not prevent future loss (only the medication mentioned above can accomplish this). That being said, transplanted hair, not being susceptible to DHT, is permanent and will never fall out.
Go here to find out more information on hair loss solutions for men.