Kenneth Beer, M.D. is a board-certified dermatologist and dermatopathologist in Palm Beach, Fla., and the director of, an online skincare company. He is also the director of The Cosmetic Bootcamp, which trains physicians in best practices for cosmetic medicine. Dr. Beer is an instructor in dermatology at the University of Miami, and he is an A.B. Duke Scholar at Duke University. He obtained his medical degree from the University of Pennsylvania School of Medicine, and received his dermatology and dermatophathology training at the University of Chicago. Visit Dr. Beer's office at

Strategies to Fight Baldness

Monday, 31 October 2011 12:20 PM

All of my older relatives are bald— is hair loss inevitable or is there something I can do about it? What are the best nonsurgical alternatives to painful hair transplants? Is the laser comb effective? What are the best treatments for women with thinning hair? How do treatments for women differ from those for men?
These are great questions and ones frequently asked in my office. Hair loss can be divided into two broad categories: scarring and nonscarring. For scarring hair loss (alopecia), there are several systemic diseases that attack the hair follicle and range from lupus to other autoimmune diseases. Once the underlying disease is under control, the hair loss stops, but the scarred area will not re-grow hair. For hair loss that is not scarring, there are several categories; the largest are metabolic, hormonal, and genetic.
Metabolic causes of hair loss are common in women. Measuring iron and blood counts can help determine whether iron supplementation will help grow hair. These are easy tests, and replacing iron is something that can be done with over-the-counter supplements. One other metabolic cause of hair loss is thyroid disease. Typically, thyroid disease is also diagnosed with a blood test, and once discovered, it can be corrected.
Hormonal hair loss occurs in both men and women. In women, it may be accompanied by a change in voice, addition of facial hair, acne, and irregular periods. Typically, men with hormonal hair loss get acne. Both men and women can lose hair from taking testosterone supplements that are presently in vogue in many hormone replacement programs.
There are many treatments for hair loss. The easiest and most available is topical minoxidil. This drug works to promote hair growth and prevent future loss. It is effective in both men and women and is available without a prescription. Figuring out whether it is going to work for you requires a trial of several months, but it is worth the effort. Generic versions are available at Costco.
Another topical product that is available, but requires a prescription, is Latisse. This product is not approved for hair loss on the scalp, but there are clinical trials being conducted to determine whether it will grow hair on the scalp the same way that it does on the eyelashes (Note: Use on the scalp is not approved by the FDA, and there is currently no data to support this indication).
The lasers that are available to treat hair loss have a mixed bag of data. I have seen data showing that some re-growth occurs, but I have yet to see a patient where it actually made a significant difference. My opinion is that they can't hurt and they may help some, but there is no way to tell which patients will benefit.
Several oral medications are available to help grow hair in men. The medication that is approved for the treatment of male pattern hair loss is called Propecia. It is a medication (finasteride) that blocks the conversion of an enzyme into testosterone at the hair follicle that miniaturizes the follicle. Other medications that are stronger blockers, such as Avodart, have also been used, but there is no FDA approval for this drug in this indication.
For men, the best treatment for hair loss probably involves a Propecia pill along with topical minoxidil in a concentration of 5 percent. Women should treat their hair loss with more attention to hormones and iron. I recommend women get their iron, thyroid, and testosterone levels checked. If they are normal, I recommend iron supplementation and topical minoxidil. Some women mention that if the 5 percent concentration drips down their face, it will grow hair. If this is an issue, the 2 percent concentration may be used. The use of hormone blocking agents, such as Avodart and Propecia, in women is controversial.
Hair loss can be very troubling for both men and women. There are many different reasons why people lose their hair, and many of these are treatable. If you are having hair loss, I recommend seeing a dermatologist who can help sort out the cause and treatment options for you.
For more information about Dr. Beer's practice or his line of skin care products, go to: or

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