Maybe you are in this situation, your skull is slowly but surely thinning out, and your hair is becoming increasingly scarce. For those who are inconvenienced too much by this, multiple solutions exist.

This phenomenon is not abnormal; it is usually an «androgenetic baldness,» widespread in men after 50 years. For some, hair loss even begins much earlier, sometimes before the age of 20. ‘Androgenetic alopecia is the accentuation of a natural physiological process, which manifests simply earlier than normal,’ recalls Professor Wolf-Henning Boehncke, Chief Medical Officer of the Department of Dermatology and Venerology at the University Hospitals of Geneva. (HUG). “It is not a disease”.

However, if it becomes complex, baldness can be treated. From natural treatments to transplants to drugs, there are many solutions.

The market for natural remedies.

Whether it is through a «grandmother’s recipe» transmitted from generation to generation, a home made hair lotion or a cure of dietary supplements, some nutrients are known for their beneficial action on the hair. Wheat germ, millet, green tea, brewer’s yeast, castor oil, cedar essential oil, and proteins, vitamins, and minerals, are thus known to boost blood flow, accelerate the capillary cycle, or strengthen the hair, giving it a denser appearance. A very profitable market has therefore been organized around the fight against baldness: the offer is promising, the access is easy and does not require a medical prescription, and the risks, almost non-existent. But if these products find many followers, Professor Boehncke warns against their ineffectiveness on androgenetic alopecia: By definition, it is not related to any deficit but a natural phenomenon. You can find anything and everything on the Internet. Still, these supplements are not standardized, and no controlled study has made it possible to highlight their effectiveness on this type of baldness».

The drugs, in which cases?

Since the 1990s, several drug solutions have been developed. Among them, Finasteride, which is undoubtedly one of the most prescribed drugs. Originally used to treat benign prostatic hypertrophy, it was subsequently formulated to combat baldness. By inhibiting the action of the enzyme responsible for the transformation of testosterone into DHT, hormone responsible for hair loss, it effectively slows down the process, not without risk of side effects (read box).

Simply put, it modifies the hormonal signal to ask the follicle to continue producing hair. On paper, Finasteride could therefore revive the production of inactive hair follicles and make hair grow back even after their disappearance. But Professor Boehncke tempered: You can’t do miracles. I always warn my patients that the treatment does not usually allow hair to grow back where it has disappeared, but simply slows down the inevitable physiological process of the fall, allowing the situation to stabilize for a few years».

Therefore, the beneficial action is not definitive: in case of discontinuation of the drug, hair loss resumes immediately.

Therefore, the specialist prefers to focus on other solutions: ‘Finasteride is the most effective drug solution, but when a patient wants to treat androgenetic baldness, I suggest a local solution, with fewer side effects, such as Minoxidil. ‘

Unlike Finasteride, Minoxidil is a lotion that is applied directly to the scalp on a daily basis. Originally developed to treat hypertension, it causes vasodilation of the blood vessels, which promotes the activity of the hair follicle. Its few side effects (local irritation, eczema, low blood pressure, etc.) remain rather benign and stop when treatment is stopped.

What about the transplant?

Another solution for those who do not accommodate their baldness: the transplant. We even now speak of «micro-grafting» because the patient’s hair is no longer re-implanted in groups but individually, on the bald areas. To do this, follicular grafts are taken from the occipital zone – at the back of the head – by excision. ‘This is an area spared from baldness in most men,’ explained Dr Michael Mühlstädt, head of the HUG Dermato-Surgical Unit. “The procedure is performed under local anesthesia. There is a small scar, but the hair will hide it.”

In the short term, the result of a micro-graft is stunning. But the dermatologist warns: ‘It is imperative that the one who does the graft has good technical expertise and is also able to predict the evolution of baldness and to position the grafts so that the appearance remains natural, otherwise, the risk is to end up with a grafted area isolated from other hair, which will eventually disappear. ‘

In addition to the micro-graft, some specialized clinics praise the technique of PRP (rich plasma platelet), which involves injecting blood plasma into the scalp with the promise of slowing down the fall and stimulating regrowth. A rather expensive technique, like the graft, can require several sessions and a few hundred francs depending on the severity of baldness.

Note also that no medical or surgical treatment is reimbursed in the case of an androgenetic «natural» alopecia, the problem is considered as purely aesthetic.

Remains then an inexpensive alternative and without adverse effects: accept the inexorable aging of the body (and hair), ignoring social pressure and idealized male stereotypes. Bruce Willis, Seal or Zinédine Zidane did it… why not you?

Finasteride: watch out for side effects

Finasteride (also known by its trade name PROPECIA), widely prescribed for its notable effectiveness on hair loss, has recently been the subject of legal battles, particularly in Canada where victims’ associations are calling for its withdrawal from the market. They involve the severity of the adverse effects on sexual and psychological health. In the image of young Theo (contacted through the French association AVFIN), who detailed the effects of which he is victim: All of a sudden, it was as if my body had died out. On the one hand, my sexuality, with a loss of desire, total impotence, the genitals affected. From a mental point of view too, with a loss of motivation and personality, an inability to concentrate, atrocious mental mists, suicidal urges…” Contacted about the side effects of PROPECIA, Merck Sharp & Dohme, the manufacturer of the drug and owner of the patent, told us that it communicated “proactively with health authorities and service providers to provide timely and comprehensive information on all medicines.” The notice of PROPECIA 1 mg[1], regularly updated, thus warns against the possibility of adverse effects: erectile dysfunction, decreased libido, abnormal ejaculation, or breast swelling.
Effects – particularly sexual disorders – that may persist for several years[2] after discontinuation of treatment. ‘This is the paradox of this drug: it must be used early enough to be effective, but its effects can have a lasting impact on the sex life and morale of young men in particular,’ explains Prof Boehncke. It is our responsibility as a doctor to propose the right solution on a case-by-case basis, to inform about the risks and to advise discontinuation of treatment at the first adverse effects. ‘