What works - and what doesn't - to prevent follicle fall out
Going bald is one of the first signs of physical decay that men experience. Hair loss can strike as young as 18, and almost all men will be balding by age 70.
Typically, it starts with a loss of hair at the crown and temples. These bare patches gradually spread, eventually laying waste to most of the skull, but leaving a low band of hair above the neck and ears comparatively unaffected. This is classic so-called 'male-pattern baldness' - or 'androgenetic alopecia' (AGA).
What about women? It's widely believed that one advantage of being female is keeping one's hair, but that's a myth.
In fact, it's not that unusual for women to suffer from a number of hair-loss problems, such as general hair-thinning, patchy bald spots called 'alopecia areata' (AA) and even AGA. Female AGA strikes predominantly at the top and sides of the head, usually after the menopause.
AA is thought to be an autoimmune disorder, where the body attacks the hair follicles. It 's not clear why this happens, but one theory involves a species of mites, Demodex follicularum, present in virtually all hair follicles by the time a person reaches middle age. In most cases, they cause no harm. But in some people, the scalp reacts to the mites, initiating an inflammatory response to reject the mites. This may close down the hair follicles, which kills the mites - but this also kills the hair.
AA and hair-thinning in general may also be caused by prescribed drugs, protein or iron deficiency, thyroid problems and childbirth. While women suffer from this too, it seems to be a predominantly male problem. The culprit is the male hormone testosterone. Paradoxically, while testosterone creates hair on the chest and face, it destroys hair on the scalp. Studies show that AGA is almost invariably associated with a potent version of testosterone called dihydrotestosterone (DHT) in the scalp - the higher the DHT levels in the skin, the more hair loss.
But there is also a much less well-known factor in hair loss. Numerous clinicians believe that balding may have a psychosomatic component, for both hair loss and hair growth. There 's already evidence that AA is stress-related (J Dermatol, 2003; 30: 871-8), and some experts believe the same may apply to AGA.
A positive attitude is now known to grow hair. This was discovered almost by accident during clinical trials of hair-loss products against 'dummy' products.
For example, Phytopharm, the botanical pharmaceutical company, recently ran a full-scale placebo-controlled trial using a herbal AGA remedy based on a Mediterranean lily. The lily extract was mixed in with an inert cream and rubbed into the scalp. The results were astonishing: a surprising 38 per cent of the male volunteers improved with the placebo - more than with the real plant extract product (Phytopharm press release, 18 January 2001).
This considerable placebo response turns out to be a feature of alopecia. So, when assessing the claims of any hair-loss product, it is crucial that they are backed by solid evidence - preferably long-term placebo-controlled clinical trials. At the very least, the products should be so good that a placebo effect can be ruled out. In our survey, therefore, we have only included products that have made some attempt to provide supporting clinical evidence.
As losing one's hair can be traumatic for both men and women, it's hardly surprising that there is a plethora of hair-restoring products in the marketplace. Some of the most widely promoted hair-loss remedies, such as minoxidil and finasteride, have potential adverse effects - such as impotence - that make them much less attractive (see box on page 9).
We have scoured the world for the best alternative hair-loss products available, rating them according to five basic criteria: effectiveness; the scientific evidence behind them; adverse effects; value for money; and money-back guarantees. All of the products in our road test are available either by mail-order or via the Internet.
Hair-loss products are a minefield of unpublished data, anecdotal evidence and smallish studies. In addition, the language of hair loss research can be deceiving. To scientists, any hair growth is considered a positive effect, but a closer look at the evidence often reveals that, in some cases, the quality of the new hair is poor. Furthermore, the hair growth ceases when you stop using the product. Nevertheless, a few of the products do show promise.
Unfortunately, all of the products included in our road test are rather expensive. Yet, what is surprising is the number of remedies that do attempt to support their claims with a) science, and b) apparently cast-iron offers of a refund if the product doesn 't work.
Manufacturer: Universal Biologics
Price: $575/lb320 (one-year supply)
This Californian company wins pole position as it's the only non-pharmaceutical manufacturer to have tested its products in what appears to be a 'proper' clinical trial. If the results are to be believed, Hair-Prime is remarkably effective - although probably only for men.
The exact formula of this herbal hair cream is a proprietary secret, but the company literature implies that the major ingredients are Chinese herbs - including at least six that directly affect the hair, four that ''nourish the blood'' and two that strengthen the ''energy needs of the body''. Universal Biologics says its formula has ''natural DHT inhibition properties'' that ''establish a healthier environment for hair to grow in''.
A clinical trial was conducted about eight years ago, involving 24 men under 55, all of whom had moderate-to-severe AGA. Half were randomly chosen to receive the real treatment, the other half were given a cream without the herbs.
The overall results were striking: after 40 weeks, the hair counts of the men who had used HairPrime increased by about 170 per cent compared with 34 per cent in the placebo group. However, it did not work for everyone; almost a third of the study participants experienced only a modest response (J Dermatol Treat, 1996; 7: 159-62).
Universal Biologics says women have used the formula, but the results were ''mixed''. Compared with other treatments, the cost is fairly high and, like all of these remedies, you have to keep on using the formula indefinitely to maintain your hair growth.
Manufacturer: Lexington International
Price: lb590/550 euros
A totally different, high-tech approach to hair loss, this uses low-power laser beams. At first blush, the whole idea smacks of quackery, but reputable hair-loss clinics have apparently been successfully using lasers for years. Professional laser devices are about the size of salon hairdryers, but now the technology has been miniaturised for home use.
The LaserComb resembles a hairbrush, but shines nine beams of red laser light down its ''comb-like teeth'' onto the scalp. HairMax says the laser light ''sends nourishing light into your hair follicles to energize them and improve circulation''. Just 10 minutes three times a week should produce results - in less than two months.
HairMax has tested the device in something approaching a clinical trial. For six months in 2002, 35 men and seven women with AGA used LaserComb for 5-10 minutes every other day; their hair counts were compared from start to finish.
All bar one of the 42 test subjects showed an improvement in hair growth. The men 's results were especially impressive, with one participant achieving a staggering 350-per-cent increase in hair count. The average male increase was just under 100 per cent, with relatively more new hair around the crown area and less at the temples. Hair strength also improved, by an average of nearly 80 per cent.
Women fared less well, with an average increase of about 60 per cent (Int J Cosmet Surg Aesthet Dermatol, 2003; 5: 113-7).
There was no placebo arm in this trial, but the response in the LaserComb group was considerably greater than placebo-effect levels, giving it some credibility.
The cost of the device looks steep, but spread over the estimated 10-year life of the device works out to around lb40 a year.
New Hair Biofactors
Distributor: Nisim International
Price: $54.95/lb33 lotion; $13.95/lb8 shampoo
This herbal product from Canada is mostly saw palmetto (Serenoa repens). The plant is widely used for prostate problems, as it appears to have similar antitestosterone effects as finasteride (see Propecia below), but with fewer adverse effects (Drugs Aging, 1996; 9: 379-95). It may even better finasteride at eliminating the hormones believed to cause baldness (J Steroid Biochem Mol Biol, 1995; 54: 273-9).
Nisim has carried out a semi-formal test of its shampoo and lotion on nearly 150 men. According to the results, 40 per cent had significant hair growth (a more than 100-per-cent increase), and 45 per cent showed moderate growth (increases between 30 and 100 per cent). As with the LaserComb, these figures seem too high to be due to just a placebo effect.
Nisim says hair will stop shedding in a week, and start to regrow in about six months. After two years ' use of the lotion, hair growth should be complete, after which the shampoo alone should maintain the hair gain. It is claimed to work for women, too.
The lotion lasts for six to eight weeks and the shampoo for four to six weeks. To put that in perspective, two years of application will cost about $1000/ lb560 - a comparatively high figure.
Manufacturer: SIM Inc
This hand-held device looks like a square hairbrush, with 21 ''elastic needles'' that deliver ''non-invasive acupuncture therapy along with electromagnetic pulses'' to the scalp. Made in China, it claims to in-crease cerebral blood flow, thus preventing hair loss and stimulating growth. It has been tested in what is purported to be clinical trials involving more than 100 patients at ''the No. 209 Hospital of the Chinese People 's Liberation Army''. However, what results are reported would not pass muster in Western medicine.
Anecdotally, the Hair Stimulator claims to produce 7 mm of new hair growth within a month, and a full head of hair after three months. The ''total effective rate'' is claimed to be 96.37 per cent.
Despite the somewhat dubious reporting by the Chinese, the overall concept of using electromagnetic pulses for hair loss has been endorsed by New Zealand clinicians who have used pulsed electrostatic fields to prevent hair loss during chemotherapy (Psychooncology, 2002; 11: 244-8).
Manufacturer: Advanced Restoration Technology
Price: $29.95/lb88.48 (30-day supply)
This herbal product is taken by mouth like a food supplement. Among its ingredients are beta-sitosterol, and Pygeum africanum and nettle extracts, both of which also contain beta-sitosterol, a compound that inhibits testosterone, and so may help to prevent DHT formation in the scalp.
Although still speculative, a similar supplement containing beta-sitosterol derived from saw palmetto was tested in a small-scale 'pilot' clinical trial. It was found to increase hair counts in six out of 10 men with ''mild to moderate AGA'' (J Alt Complement Med, 2002; 8: 143-52).
Manufacturer: Thymuskin Cosmetic
Price: $626.90/lb325 (eight-month supply of shampoo, lotion and gel)
This hair-loss lotion was developed by no fewer than nine German university professors of medicine. In the early 1990s, they were on the lookout for something that would stop cancer patients ' hair falling out after chemotherapy. What they found was an extract of animal thymus glands which, when rubbed onto the scalp before chemotherapy, completely prevented hair loss (Onkologie, 1986; 9: 285-6).
After testing it - with anecdotal success - on their own balding pates, a lotion containing the animal gland extract together with a few herbs was marketed as Thymuskin.
But when Thymuskin was tested in an open trial (which means there was no placebo for comparison), the results were unimpressive, especially in men. The best the product achieved was a ''subjective improvement'' in only 33 per cent - and even that took as much as nine months of treatment. Worse, an objective count of daily hair loss showed no improvement at all after a whole year.
However, in an unpublished 1991 study of women with AA, an average daily hair loss of 245 hairs fell to a mere 10 hairs after one year, with 86 per cent noting an improvement.
Thymuskin clearly can do with more research for all but those with hair loss due to chemotherapy - but it 's not cheap and the guarantee is poor.