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Hair Loss

Our Hair Loss section contains products and medications used to prevent hair loss due to the progression of male pattern baldness or androgenic alopecia, which is an inherited condition, but not to restore lost hair.

Principal brand name products are shown in the left column and generic alternatives are to the right. Products are generally grouped together by active ingredient.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. Dutasteride or the product name, e.g. Avodart.

Our Hair Growth Promoters class of Hair Loss products are used to promote new hair growth and prevent the progression of hair loss in male pattern baldness.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. minoxidil or the product name, e.g. Tugain.

Blood supply to hair follicles

The hair follicle is nourished by small blood vessels or capillaries in the papilla at the base of the hair follicle. This blood supply provides nutrients to the rapidly dividing cells of the hair root. The skin is also supplied by a network of capillaries around the hair follicles.

Promoting hair growth

Products like minoxidil and aminexil that act as vasodilators to dilate or widen blood vessels are used in topical applications for the scalp to help promote hair growth. They work by dilating small blood vessels in the skin and papilla of the hair follicle and increasing blood flow in the scalp, which is thought to directly stimulate hair growth, by enhancing cell proliferation in hair follicles that were in resting phase. It is also thought that minoxidil may increase the anagen phase of hair growth to allow hairs to increase in size and prevent the hair follicle entering the resting phase early.

This action is most effective when hair loss is at an early stage and can trigger new hair growth in follicles that have not been inactive for long and have not yet become dormant.
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Our DHT Inhibitors class of Hair Loss products are used to prevent miniaturisation of hair follicles in men with male pattern baldness to reduce hair loss and slow down its progression.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. Finasteride or the product name, e.g. Fincar.

Effect of DHT of hair growth

Dihydrotestosterone (DHT) is an active form of testosterone that binds strongly to the androgen receptor. DHT is found in several tissues throughout the body including the hair follicles of the scalp, and is involved in the regulation of hair growth.

Normally as old hairs fall out they are replaced by new hairs. However, increased action of DHT results in shortening of the anagen or growth phase of the hair cycle, causing the hair follicles to shrink and produce progressively smaller finer hairs that are pale and translucent and that eventually do not emerge from the follicle. These hairs are known as vellus hair and the process is known as miniaturisation of hair follicles. Vellus hair is fine hair that grows on most parts of the body except the lips, palms of the hands and soles of the feet. The miniaturised hair follicles enter a permanent state of catagen or rest phase, instead of resting before a new growth phase. They eventually stop growing and, although they are still alive, they cannot produce normal hairs.

DHT also stimulates the production of another chemical called transforming growth factor beta (TBG beta), which blocks growth of the skin cells that support hair follicles and eventually cause cell death.

5α-reductase inhibitors

Once a hair follicle is in permanent catagen and has stopped producing new hairs, the process of hair loss cannot be reversed. However, it is possible to prevent hair follicles from shrinking that are not yet affected, by inhibiting the action of the enzyme type II 5α-reductase that converts testosterone to DHT.

Finasteride and dutasteride are both 5α-reductase inhibitors that are used to prevent the progression of hair loss leading to male pattern baldness and thereby, reverse the balding process. These medications are more successful when used at an early stage of the balding process but cannot restore hair growth to areas where hair has been lost for some time.

Some natural plant products called phytosterols also have activity as inhibitors of 5α-reductase, such as saw palmetto, which are used as nutritional supplements to help prevent hair loss.
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Our Retinoids class of Hair Loss products are used to modify skin cell behaviour, including growth and differentiation, to promote hair growth and prevent hair loss in male pattern baldness..

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. tretinoin or the product name, e.g. Retin A.

Skin cell growth

As skin cells or keratinocytes divide and grow, they move through the epidermis of the skin to the upper layers where they differentiate and undergo a hardening process known as keratinisation and cornification. The hardened cells eventually die and are shed to make way for new skin cells.

Modifying skin cell behaviour

Tretinoin is a retinoid and is an active metabolite of Vitamin A that binds to intracellular receptors in skin cells and modifies the way skin cells behave. Tretinoin stimulates skin cell growth and this includes hair follicles. It also blocks skin cell differentiation and the hardening processes of the outer skin layer. It is thought that tretinoin prolongs the anagen phase of hair growth and in this way promotes hair growth. Therefore, although it does not prevent hair loss directly, tretinoin may be able to slow down the progression of hair follicle miniaturisation and even promote the growth of new hair.

Retinoids in combination hair loss products

Tretinoin is also used in combination with minoxidil and is thought to help reduce hair loss by increasing the absorption of minoxidil through the skin, as well as providing an additive effect with minoxidil to promote hair growth.
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Our Other class of Hair Loss products contains anti-fungal products that can also be used to help reduce hair loss in male pattern baldness.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. ketoconazole or the product name, e.g. Nizoral.

Antifungals for reducing hair loss

Ketoconazole is an antifungal medication that has other actions including treatment for seborrheic dermatitis and dandruff. There is also some evidence that it can be used to help reduce hair loss in male pattern baldness by acting as an anti-androgen. Ketoconazole is thought to work by blocking the androgen receptor and competing with androgens like testosterone and DHT for androgen receptor binding. It also inhibits the 5α-reductase enzyme that converts testosterone to DHT. It has also been suggested that due to the ability of ketoconazole to reduce inflammation caused by infection with the fungus Pityriasis (also called Malassezia) that is common to the scalp, this anti-inflammatory property may help slow down hair loss.

Combination hair loss products

Azaleic acid is used in combination with other hair loss medications like minoxidil and and retinoids like tretinoin. Preliminary studies with topical azaleic acid suggest that it may help slow down the progression of hair loss in male pattern baldness.
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Hair growth cycle

Hairs grow from hair follicles in the skin, and new growth begins in the dermal papilla at the base of each hair follicle, which is nourished by blood capillaries. Normally hairs grow and fall out to be replaced by new hairs, following a hair growth cycle, with the following phases:
  • Anagen or active growth phase, where the cells at the root of the hair are actively dividing and the hair grows in length by approximately 1cm in 28 days, over a 2-6 year period.
  • Catagen or transition phase, which is the end of the growth phase and within the next 2-3 weeks, the fully formed hair becomes detached from the dermal papilla and its blood supply.
  • Telogen or resting phase lasting 6-8 weeks, in which the old hair is shed from the hair follicle or remains until pushed out by a new hair that forms when the hair follicle enters anagen again and begins another cycle of hair growth.

What causes hair loss

Hair loss in men is due to an inherited condition called male pattern baldness or androgenic alopecia and this condition accounts for 99% of hair loss in men. This form of hair loss is caused by an inherited increased sensitivity to the male sex hormone dihydrotestosterone (DHT), which is an active form of testosterone. DHT is converted from testosterone in the hair follicles by the action of the enzyme 5-alpha reductase and men with androgenic alopecia usually have higher levels of this enzyme, which is found mainly in the scalp and prostate. Increased conversion of testosterone to DHT is also responsible for hair loss. Male pattern baldness is based on disruption of the normal hair growth cycle by DHT.

Loss of hair usually begins with a receding hairline followed by thinning of hair on the crown of the head and temples, which are areas of the scalp that have greatest sensitivity to DHT. Gradually the pattern of hair loss continues over the scalp leaving a rim of hair around the base of the scalp.

Baldness in women

Inherited baldness can also occur in women, and is known as female pattern baldness. It is seen in women with high levels of the male hormone testosterone, which is normally present in women but at much lower levels. The balding pattern is different in women, with a general thinning of the hair that gives an appearance of balding over the entire scalp.

Preventing hair loss

There is no cure for baldness but it is possible to prevent further balding in men with mild to moderate hair loss but not restore hair that has been lost for a long time. There are medications available that slow the progression of male pattern baldness and prevent further hair loss from all areas of the scalp, including the front.

Types of hair loss treatment

Several classes of hair loss treatment are available that work in different ways to prevent hair loss. These include:
  • the 5α-reductase inhibitors finasteride and dutasteride, which are taken in tablet form and work by inhibiting the action of the enzyme type II 5α-reductase, which is found hair follicles and converts the male hormone testosterone to DHT.

  • Tretinoin is a retinoid, which is an active metabolite of Vitamin A and has been found to stimulate skin cell growth including hair follicles, and this action promotes new hair growth. However, tretinoin does not prevent hair loss directly.

  • Minoxidil and aminexil are both vasodilators that widen blood vessels and are used in topical applications for the scalp. They work by dilating small blood vessels in the skin, thereby increasing the blood supply to the hair follicles. Minoxidil is thought to work by stimulating cells that support hair follicle growth and trigger new hair growth in follicles that have not been inactive for long and have not yet become dormant.

  • Saw palmetto is a dietary supplement of herbal extracts rich in fatty acids and phytosterols (plant sterols) that works as an anti-androgen in a way similar to the 5α-reductase inhibitors finasteride and dutasteride, blocking the convertion of testosterone to DHT.

  • Ketoconazole is an antifungal that can be used as a shampoo and is thought to work as an anti-androgen to inhibit the production of testosterone in the skin; also it may inhibit the 5α-reductase enzyme thereby inhibiting the production of DHT.
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