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The Bald Truth About Hair-Loss Treatments

Multiple options exist, though some are more rigorously studied than others, and some are far more expensive.

This article was first published in The Montreal Gazette.

There’s an old riddle that goes, “What does no one want, but no one wants to lose?” Answer: a bald head.

While decapitation is widely considered to be a suboptimal outcome in any situation, hair loss is also consistently reported as being a source of great stress for anyone who suffers from it. While some men — e.g. Patrick Stewart — can exude raw charisma with a bald head, the psychological impact of hair loss is significant and tends to affect women more intensely than men.

Unsurprisingly, treating hair loss is a big business and I recently got an e-mail from a reader asking me if platelet-rich plasma (PRP) actually works since it is so widely marketed and apparently very popular.

PRP is made of plasma, the liquid portion of your blood minus the blood cells. A patient’s blood is extracted, and then spun down using a centrifuge in order to separate and remove the red blood cells and the blood portions with no platelets. What’s left has a high concentration of platelets dissolved in the fluid, hence the name. Platelets are responsible for blood clotting and, at first, it may not be immediately obvious what blood clotting has to do with hair loss.

The theory goes that PRP also contains a number of growth factors — i.e., hormones that should stimulate the growth of hair follicles. When it was actually tested, though, the evidence was mixed. A small pilot study of 19 men showed that there was no benefit in terms of hair growth, while another study of 20 men did show an increase in hair count. There is less data in women, but a small studyof 13 women and 12 men showed an improvement in hair density six months after their treatment, which involved three injections given one month apart.

For consumers looking for large-scale clinical trials to justify the expense of this treatment, the results are a little underwhelming. A recent meta-analysis reviewed the evidence and labelled it as “suggestive but not definitive,” which is probably a fair if slightly optimistic assessment. Many initially promising treatments in medicine don’t pan out long term and some degree of caution is probably warranted.

Some may have reservations about the cost, while many people might be understandably squeamish about injecting blood into their scalp. At least the use of one’s own blood to make PRP avoids the safety concerns that come whenever one uses blood products.

There is better evidence for something like minoxidil (sold in North America under the label Rogaine), which has reasonably solid evidence to back it up. In a 2016 Cochrane Review of treatments for female pattern hair loss (the female equivalent of male pattern baldness), a summary of 17 studies found that 27 per cent of patients on minoxidil versus 14 per cent on placebo reported at least moderate hair growth.

While not miraculous in its benefit, minoxidil offers up an easier low-cost first step to help with thinning hair. Other medications like finasteride, a common prostate medication that is used to treat hair loss in men, is sometimes used in women though it has less evidence to support its use.

In fact, multiple options to treat hair loss exist, though some are more rigorously studied than others, and some are far more expensive than others. The best advice that can be given is to make sure the hair loss isn’t due to an underlying medical illness, and then try the well-established therapies first before moving on to other things like PRP or hair transplants.

It’s tempting to write off concerns about hair loss as vanity, but in truth it can be very damaging to one’s self-esteem. Hair loss treatments can be expensive if you’re on a tight budget, but feeling good about yourself is worth something too.


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