I wanted to talk to you about the influence of medication on hair and how that factors into the hair transplantation procedure. For those people who are not considering a surgical option and really just want to go down the solely medical route, medication is very important.
What medication provides that a hair transplant doesn’t is insurance against the loss of your existing hair over the course of your life. If you’re not on anything that stops you from losing your hair, you’re just going to keep losing it. There are some instances where we can transplant our way out of hair loss, but if you’re going to continue losing hair, there’s only so much hair on the back and sides of your head. We’re not going to be able to return significant thickness to the top.
The donor area at the back and sides of the head is not a pantry we can just keep raiding whenever we want; it’s a finite resource. So one of the best “bang for buck” options you’ve got as a patient is to be on medication to try and prevent further hair loss.
Medications are broadly divided into blocking agents and stimulatory agents. There are a couple of medications on the market (which I can’t mention by name due to laws in Australia) that block the conversion of testosterone to dihydrotestosterone (DHT). They don’t affect your testosterone levels per se, but they stop the peripheral conversion of testosterone to DHT, particularly in the scalp where there is an enzyme called 5-alpha reductase that performs that conversion.
This medication inhibits the effect of that enzyme so you don’t get such a buildup of DHT in the scalp. The significance of DHT is that it’s toxic to follicles. Some men are more susceptible to DHT toxicity than others, and in those men, this medication is particularly beneficial because it blocks that conversion.
That’s why they call these medications “blocking agents.” What these medications do is stop you from shedding hair. They don’t promote new hair growth, they just stop the shedding.
The other medication that we tend to start people on (again, I can’t mention the name due to legal restrictions in Australia) is what we call a stimulatory medication. This medication stimulates increased blood flow and nutrient delivery, oxygenation to the follicles in the scalp, and thereby promotes healthier hair growth.
This medication works particularly well on hairs that are not less than 50% of their normal caliber. If a hair has lost more than 50% of its caliber, it’s probably too far gone to be revived. However, if a hair has lost less than 50% of its caliber, then this stimulant can be very beneficial in promoting thickness in that hair. In some instances, if the hair has only been lost very recently (say, within the last 6 to 12 months), we may even be able to regrow that hair.
Let’s not forget that the thickness of hair is influenced by two factors: the number of hairs and the caliber (or thickness) of each hair. The thicker each hair is, the more it will contribute to the overall appearance of fullness. The stimulatory medication really contributes to promoting new growth and increasing the caliber and thickness of the hairs that are already there.
There are some parts of the scalp that tend to respond better to medication than others. The hairline and bare skin don’t tend to respond as well to medication. If you’re trying to regrow hair in an area that’s completely bald, that ship has sailed. Unfortunately, we’re not going to get that hair back, and that’s where we move into transplant territory. However, the crown and mid-scalp tend to respond better to medication.
The crown is the area at the back of the head, and the mid-scalp is just behind the hairline, between the crown and the hairline. These areas tend to respond better to medication over time. Also, we need to consider age groups when it comes to medication. Younger men tend to respond better to blocking agents than older men, say, an 80-year-old. People with a well-balanced diet who are non-vegetarian, have adequate iron levels, and have sufficient vitamin D levels tend to have better results. Vitamin D and iron are important for hair growth, and as long as these factors are covered off, medication tends to work well.
One last adjunct to medication is the use of platelet-rich plasma (PRP). At Hair Transplants Melbourne, we have one of the best PRP systems on the market. We use the Luro system, which generates high numbers of platelets. The more platelets we can get in a PRP sample, the more growth factors those platelets release when injected into the scalp. These growth factors promote stem cell activation and follicle growth. However, PRP is not necessarily designed to be a standalone treatment for hair regrowth and thickening.
PRP works best in people who are already on maximum effective doses of medication. We add PRP into their monthly routine to enhance and kickstart hair growth. We usually prescribe a course of six PRP treatments in the context of medication. Once we’ve reached a point where we’ve maximized those treatments, we may recommend a hair transplant, particularly for areas like the hairline or bald spots, where we’re trying to regrow hair.
