Hair Loss: Questions and Answers

Hair loss can be incredibly distressing and it is a topic on which we get a huge number of enquiries. Here our chief pharmacist shares some of the most frequently asked questions – and provides some much needed answers:

Q. What causes hair loss in men?

A. The most common reason for hair loss in men is Androgenetic Alopecia (AGA), more commonly known as male-pattern baldness. It occurs because of the reduction in sensitivity of the hair follicles to one of the male hormones – Dihydrotestosterone (DHT). 

Q. Is male pattern baldness genetic? 

A. The amount of DHT you produce varies according to your genetic make-up, which is why some men (and women) tend to follow their older relatives in terms of their age and pattern of hair loss, whereas others keep a full head of hair. Although male pattern baldness is genetic, it is worth noting that it is not always predictable. Just because your father or grandfather suffered does not necessarily mean you will. However, if you do suffer from male pattern baldness, genetics is likely to be the root cause. 

Q. But no one else in my family has male pattern baldness! Are there any other causes?

A. Hair growth can be affected by many external factors including: a side effect of certain medication, illness, infection, exposure to chemicals, scarring, stress, pulling on hair and damage to hair follicles. If the cause of your hair loss is worrying you, speak to your GP.

Q. Does hair loss always lead to baldness?

A. No, male pattern hair loss does not always lead to baldness.

Q. What is the best treatment for hair loss in men?

A. There are two products licensed for the treatment and prevention of hair loss in the UK – Minoxidil (Regaine) and Finasteride (Propecia). 

Minoxidil (cream) works by stimulating the hair follicles and therefore hair growth. It only works during treatment, and its positive effects stop when the treatment stops. It can cause irritation of the scalp. It is also used in tablet form for treating high blood pressure. 

Q. How does Finasteride work?

A. Finasteride is an inhibitor of the enzyme 5-alpha reductase. This is the enzyme that is responsible for the accumulation of DHT around the hair follicle. By inhibiting this enzyme, DHT around the hair follicle is reduced and its negative effect on hair growth lessens.  These tablets may need to be taken for 3-6 months before benefit is seen, and the effects are reversed 6-12 months after stopping treatment. 

Q. Should I go for a topical lotion, bought over the counter, or a prescription medication? 

A. There are OTC and prescription medications available and both are effective and licensed for the treatment of male pattern baldness. In most cases it is safe to use both together - we recommend trying one at a time to start with, then you can introduce the second, as required.

Q: Do I need to use the treatment continuously? 

A. Yes, the manufacturers recommend ongoing use of these medications for the best results.

Q. What about natural supplements? Are they effective against hair loss? 

A. There is little evidence that natural supplements are effective but some shampoos, such as Nourikin, are popular.

Q. What are the downsides of taking these medications?

A. Finasteride is known to be excreted in semen and the potential effects that that may have on a developing male foetus are unknown. So men should not take it while there may be the chance of conception or pregnancy, and pregnant women should not handle the tablets.

Q. Are there any side effects from taking Finasteride?

A. DHT also plays a role in the enlargement of the prostate gland as men get older. Finasteride is a licensed treatment for benign prostatic hyperplasia (causing problems with the waterworks as men get older). Thus a beneficial side effect of using this medicine for hair loss is less prostate enlargement and less trouble with urination.

As Finasteride is an anti-androgen, it can also cause side effects such as impotence, decreased libido and breast changes. Men are encouraged to report anything unusual to their doctor. The risks of any treatment should always be balanced with the beneficial effects.

Q. How available are these treatments?

A. None of these treatments are available on the NHS, so men should seek private treatment. Minoxidil is available to buy from a pharmacy without prescription, but Finasteride needs an assessment by a fully qualified doctor, and a prescription. More and more men are moving away from expensive hair loss clinics and seeking prescriptions from online pharmacies. It is vital that they are able to check that the online source has a GMC registered doctor and a GPhC registered pharmacist. Men should never attempt to obtain these medicines without a prescription and they should ask for the registration numbers of those who are treating them.