Can the Hair Loss Drug Propecia Safely Reverse Hair Loss?

Propecia didn't start as a hair loss treatment, but for some, it is effective.

Like Rogaine (minoxidil), Propecia -- also called "finasteride" -- is a drug that was developed for another purpose (shrinking noncancerous enlarged prostates) but, by accident, was found to be able to stimulate the growth of hair that had thinned from androgenic alopecia.

But if you are the kind of person who worries about medication side effects and unintended consequences, you need to consider those that come with Propecia.

The good news is it works for a majority of the people who try it -- about half stem further loss of hair, while the other half experience new growth. The bad news is women should not use it. In fact, women who could be pregnant should probably not be in the same house with it, owing to a specific and devastating side effect (see "Side effects on women, fetuses and young children," below).

Propecia works for a majority of those who use it

Because the manufacturer of Propecia, the first brand approved by the U.S. Food and Drug Administration (FDA) to be marketed as a treatment for male pattern baldness, is Merck Pharmaceutical, the most extensive research on efficacy of finasteride is conducted by the company. Merck's five-year clinical tracking of 279 men on Propecia revealed the following:

• 42 percent visibly halted hair loss (according to blind assessments of photos by dermatologists)
• 48 percent visibly regrew hair (according to blind assessments of photos by dermatologists)
• 66 percent regrew hair, as measured by hair counts

As with minoxidil, use of Propecia needs to be consistent and continuous for it to be and remain effective. Also, its effects are only on hair follicles found on the crown (vertex) of the head, not the forehead or other areas.

How does Propecia work?

The mechanisms for how Propecia works at restoring hair growth are better understood than those for minoxidil. But there still is a bit of uncertainty because the exact mechanisms in hair loss itself are not fully established. Androgenic alopecia is probably caused by excess DHT (dihydrotestosterone), a metabolite of testosterone (i.e., testosterone typically is converted to DHT in some areas, including the scalp). Too much DHT is believed to shrink hair follicles to the point where hair is barely visible. Propecia reduces the conversion of testosterone to DHT by 60-70 percent, which apparently reduces the negative impact of DHT on hair follicle health.

But a question lingers: How comfortable are you with ingesting a prescriptive medication, the mechanisms of which are not fully understood?

There are side effects to Propecia

Every action has a reaction, of course, particularly in the human endocrine system. By reducing the transformation of testosterone to something else, the guy taking Propecia is left with more testosterone.

That's a good thing, right? Maybe yes, maybe no or maybe it doesn't matter. As men age, testosterone levels naturally decline (more so with poor lifestyle habits such as overeating, inactivity and excessive consumption of alcohol), so a little extra testosterone might be beneficial. But too much testosterone is associated with impulsivity, aggression, irritability and depression. DHT conversion is important elsewhere in the body, and a deficiency can paradoxically lead to an overexpression of naturally present estrogen (all men have estrogen, in lower proportions than in women). In a small percentage of men, that means enlarged breasts (gynecomastia).

Other side effects seen in a small portion (less than 5 percent) of men using Propecia to address male pattern baldness are:

• Hypersensitivity (itching and hives, swelling of the lips and face)
• Testicular pain
• Increased libido (10 percent in the first months of use)
• Decreased libido (1 percent throughout its use)
• Erectile dysfunction
• Decreased volume of ejaculate

Additionally, men who ask their doctor for a Propecia prescription need also to inform him or her if they have any of the following pre-existing conditions:

• Liver disease or abnormal liver enzyme tests
• Prostate cancer
• Bladder muscle disorder
• Stricture of the urethra
• Restricted ability to urinate

Side effects of Propecia on women, fetuses and young children

The only clinical study of Propecia on women was on individuals who were postmenopausal, and the research indicated no beneficial effect from its use. It's possible to be critical of that finding, since older women may not realize the same results as younger woman with androgenic alopecia.

Why not test it on younger women? Propecia is a teratogen, which means it can cause birth defects. Specifically, exposure of even powder from a broken Propecia tablet to the skin of a pregnant woman can cause abnormalities of the external genitalia of a male fetus. There is further concern that young children similarly exposed may experience adverse affects as well.

Clearly, it's a risk to be taken seriously.

Can a guy combine Rogaine and Propecia for extra effectiveness?

Many Web sites -- particularly those selling hair loss prevention products that include Propecia and minoxidil -- advocate use of both products, a double-hit at the scalp from outside and in. The anecdotal claims are that the results are synergistic.

It should be noted that no data exist to support either efficacy or safety claims of this practice.

Cost of Propecia

A four-week supply of Propecia costs approximately $60. Most insurance plans would not cover the cost of this medication for hair loss applications.

To summarize, Propecia will be most effective if you:

• Are male
• Do not have certain pre-existing conditions such as problems with the liver, prostate or bladder
• Are comfortable taking oral medications that have a hormonal effect
• Are not in the presence of either a woman who is pregnant or younger children, or can assuredly keep the medication isolated from them
• Are comfortable with the lack of long-term use data (i.e., the product was first approved for marketing as a hair loss treatment in 1997; therefore, there is no research on adverse side effects over many years)

Can the Topical Treatment Minoxidil Solve Your Hair Loss?

Minoxidil works as a hair loss treatment, but not as easily as people think it does.

The smart brand marketing of Rogaine (minoxidil) when it was approved for over-the-counter sales led millions to expect to regain hair with ease. But 14 years later, have real experiences with the product lived up to hype?

Not for everyone. It works for only about 50 percent of patients who try it. Generally speaking, they are under the age of 40 and in an early phase of hair loss (i.e., thinning began less than five years ago). In other words, start using it as soon as you begin to notice a bald spot.

Note: the second pharmaceutical product available for hair loss treatment, Propecia (finasteride), is reviewed in separate articles on HairLoss.com.

Minoxidil works, but only to a certain extent

Minoxidil (brand names include Rogaine, Women's Rogaine, Rogaine for Men Extra Strength, Regaine, Apo-Gain, Gen-Minoxidol, Hairgro, Minox, Med Minoxidil, Hair Regrowth Treatment) works only on individuals, male and female, with androgenic alopecia (also known as male pattern baldness). For reasons unknown, minoxidil is slightly more effective for women than for men.

The location of where you are losing your hair seems to matter a lot as well. The crown of the head, the vertex, is much more responsive to minoxidil than is frontal or hairline loss. One study (D. S. Walsh, C. L. Dunn and W. D. James, "Improvement in Androgenetic Alopecia (Stage V) Using Topical Minoxidil in a Retinoid Vehicle and Oral Finasteride" [Arch Dermatol, 1995]) found that 36 percent of users experienced sufficient results over 30 months of use such that they felt compelled to spend time and money on the product. Of study participants, 32 percent said new hair growth was long enough that it had to be cut (often the regrowth is more of a peach fuzz than strands of hair).

Not so surprisingly, formula strength matters -- it's a situation where more is more. Regular Rogaine, a 2 percent concentration formula, and Rogaine for Men Extra Strength, a 5 percent solution, have been compared side by side in a couple of studies. One (V. H. Price and E. Menefee, "Quantitative Estimation of Hair Growth: Comparative Changes in Weight and Hair Count with 5 percent and 2 percent Minoxidil, Placebo, and No Treatment" [Elsevier, 1996]) compared hair mass, which is the weight of hair in a defined area of the scalp, in both products to find that the extra-strength formula indeed produced a 55 percent increase, compared with a 25 percent increase in the lower-concentration formula, after five months of use. Importantly, that mass-effect declined with both products after five years' use, to 25 percent and 15 percent increases, respectively.

The second study looked at actual hair counts, finding that the higher-strength formula does result in more hair shafts per square centimeter: 25 additional hair follicles per square centimeter from the 5 percent solution, versus 21 follicles in the 2 percent solution and 9 follicles in a placebo group, after a 48-week period (R. J. Trancik, "Update on Topical Minoxidil in Hair Loss" [Proceeding of the annual meeting of the American Academy of Dermatology, 1998]).

One effective application is for hair loss due to chemotherapy. Research sponsored by Rogaine's manufacturer, the Upjohn Company (now Pharmacia), on 22 women undergoing treatment for breast cancer found that the 2 percent topical solution decreased the duration of alopecia caused by chemotherapy, with no significant side effects (Duvic, Lemak et al., Division of Medicine, University of Texas, M.D. Anderson Cancer Center, 1996).

How does minoxidil work?

How minoxidil reduces hair loss is actually a mystery, since it was discovered by accident when use of the anti-hypertension drug Loniten was found to increase and darken fine body hairs. One imagines the scientists working on this had their eureka moment within one or two nanoseconds of coming upon this fact.

But two decades later, no one knows for sure how it works. It may be due to the way the medication dilates blood vessels, which on the scalp might stimulate hair growth. Minoxidil is a potassium channel opener, which causes hyperpolarization of cell membranes, possibly another reason it works.

To stem hair loss, minoxidil is applied topically (as a cream or foam). In pill form the medication is in a higher concentration and only approved for treating hypertension.

There are side effects to minoxidil

For the person first using minoxidil, there is often an initial period of paradoxical increased hair loss. Disturbing as that may be, this seems to be the scalp's way of ridding itself of weaker hair follicles to make way for stronger shafts. Other known side effects and issues are:

• Scalp irritation, likely because of the product's alcohol content
• Itchy scalp and dandruff
• Dizziness or rapid heartbeat (rare)
• Not recommended when the scalp is already irritated, injured or sunburned, which would allow the medication to be absorbed by the body at a higher and potentially dangerous level
• Formulated for scalp application and not recommended for use elsewhere on the body
• Effects on a fetus in women who are pregnant are unknown; however, women who are nursing are warned to not use it
• Rogaine users with severe, refractory high blood pressure might experience hypertrichosis, which is hair growth on the face or other bodily areas. The incidence of this occurs in about 3-5 percent of women who use the 2 percent solution and higher among women using the 5 percent solution.

Note that no animal or human studies indicate cause f or concern regarding cancer and minoxidil.

Costs of minoxidil (and beware the snake oil salespeople)

According to online stores selling Rogaine, a three-month supply of the foam product is about $50, which is much lower than when the medication was first released (and protected by its original manufacturer by its patent, which expired in 1996).

But at least one company that operated clinics and treatment centers for hair loss, Avacor (Global Vision Product, Inc.), falsely claimed superior treatments that amounted to nothing more than a minoxidil solution repackaged as a shampoo (sold alongside herbal supplements that lacked clinical studies to support claims of efficacy). A class action lawsuit was successful in driving the clinics out of business. This case serves as a reminder that any medical solutions should be investigated closely for legitimacy -- and how hair regrowth charlatans are always looking to make money from people who are experiencing hair loss.

Minoxidil: The bottom line

To summarize, minoxidil will be most effective if you

• Use it as soon as you start to notice a thinning
• Are under age 40
• Are a woman; women get better results than men
• Use the stronger solution, as it will yield more results
• Are attentive to potential side effects, particularly if your scalp is irritated by sun or the medication itself
• Stay out of the sun or always wear a hat when outdoors
• Accept the fact the results in five years won't be as good as in one year
• Plan to continue using it to realize any beneficial effect

Laser Hair Therapy Couldn't Possibly Hurt You -- Or Could It?

Laser hair therapy has been in use in Europe for decades but the FDA only recently vouched for this hair loss treatment's safety.

The application of low-level laser therapy (LLLT), or laser hair therapy, to address hair loss was first discovered by accident -- with laboratory mice. Researchers were testing laser on wounds, where the hair around the wound was shaved. What they noticed in the mice receiving LLLT versus those who weren't (the control group) was their hair grew back faster.

Since then, and for more than 30 years, researchers and hair restoration therapists have been using the technique on humans. Popular for decades throughout Europe, laser hair therapy received approval as safe by the U.S. Food and Drug Administration in 2007. This approval is all about safety -- the FDA does not confirm or deny efficacy.

How laser hair therapy safely restores hair growth

To appreciate how LLLT is safe, it helps to understand how it works.

LLLT approaches the treatment of thinning hair from a noninvasive standpoint. Equipment varies somewhat, but between 110 and 116 laser diodes are directed at the scalp, typically applied in a head cap (it can also be administered with a handheld comb). The light is in the 630- to 670-nanometer range, which is where the color red occurs on the light spectrum. The power of the light is at low wattage, which allows it to remain cool throughout the procedure.

The exposure of the scalp to these tiny beams of light is called photobiology, which causes reactions on both physical and chemical levels. Hair follicles, in particular the very tiny hairs on follicles where loss is progressing, absorb this light. The reaction happens on an intracellular level, where cytochrome c, an enzyme, sends photochemical signals throughout the hair follicle. The result is a decrease in apoptosis, or programmed cell death. The actual efficacy ("does it work?") of laser hair therapy is subject to variations among individuals. Those variations are:

• What type of hair loss is occurring? Primarily male and female patients with androgenetic (also called androgenic) alopecia can benefit from LLLT. That means it can benefit male pattern baldness and female pattern baldness, but other causes such as alopecia universalis or trichotillomania will not be affected by it. Some claim it can be used for alopecia areata and with individuals undergoing chemotherapy.

• Is the hair loss recent or long-standing? Laser hair therapy is probably most effective where hair is actively receding, not on hair lost a long time ago. There needs to be some life left in those follicles for it to receive the laser, translate it on an intracellular level and stimulate growth.

• Did the patient get regular treatment? Twice-weekly exposures to the light, continued for a full year, seems to be essential to achieve results. Almost all LLLT proponents discourage sporadic use of the technique.

All that said, there are no peer-reviewed scholarly journals reporting double-blind studies that scientifically prove effectiveness. Most results are self-reported. Painstaking measurements in higher-priced studios where laser hair therapy is administered show an increase in hair shafts and overall thickness of those shafts in those areas where hair growth has not fully ceased.

Note that LLLT is often used in combination with minoxidil (Rogaine and other brands), finasteride (Propecia) and hair transplant surgery, reportedly with good results in all such cases.

On your own with handheld laser hair therapy combs

Self-administered laser hair therapy with handheld combs is available. These devices are typically sold at a lower power (wattage). While that may be perceived as a safety advantage, it cannot overcome the "more is more" mentality. If someone chooses to overuse his or her comb -- spending hours every day, perhaps in a desperate attempt to regrow hair quickly -- the worst outcome is ineffectiveness. The body's reaction to the light can diminish with excessive and constant use. There are no reported cases of this actually happening. Because these are cool lasers, there is no concern about overexposure causing burns.

Can the Topical Treatment Minoxidil Solve Your Hair Loss?

Minoxidil works as a hair loss treatment, but not as easily as people think it does.

The smart brand marketing of Rogaine (minoxidil) when it was approved for over-the-counter sales led millions to expect to regain hair with ease. But 14 years later, have real experiences with the product lived up to hype?

Not for everyone. It works for only about 50 percent of patients who try it. Generally speaking, they are under the age of 40 and in an early phase of hair loss (i.e., thinning began less than five years ago). In other words, start using it as soon as you begin to notice a bald spot.

Note: the second pharmaceutical product available for hair loss treatment, Propecia (finasteride), is reviewed in separate articles on HairLoss.com.

Minoxidil works, but only to a certain extent

Minoxidil (brand names include Rogaine, Women's Rogaine, Rogaine for Men Extra Strength, Regaine, Apo-Gain, Gen-Minoxidol, Hairgro, Minox, Med Minoxidil, Hair Regrowth Treatment) works only on individuals, male and female, with androgenic alopecia (also known as male pattern baldness). For reasons unknown, minoxidil is slightly more effective for women than for men.

The location of where you are losing your hair seems to matter a lot as well. The crown of the head, the vertex, is much more responsive to minoxidil than is frontal or hairline loss. One study (D. S. Walsh, C. L. Dunn and W. D. James, "Improvement in Androgenetic Alopecia (Stage V) Using Topical Minoxidil in a Retinoid Vehicle and Oral Finasteride" [Arch Dermatol, 1995]) found that 36 percent of users experienced sufficient results over 30 months of use such that they felt compelled to spend time and money on the product. Of study participants, 32 percent said new hair growth was long enough that it had to be cut (often the regrowth is more of a peach fuzz than strands of hair).

Not so surprisingly, formula strength matters -- it's a situation where more is more. Regular Rogaine, a 2 percent concentration formula, and Rogaine for Men Extra Strength, a 5 percent solution, have been compared side by side in a couple of studies. One (V. H. Price and E. Menefee, "Quantitative Estimation of Hair Growth: Comparative Changes in Weight and Hair Count with 5 percent and 2 percent Minoxidil, Placebo, and No Treatment" [Elsevier, 1996]) compared hair mass, which is the weight of hair in a defined area of the scalp, in both products to find that the extra-strength formula indeed produced a 55 percent increase, compared with a 25 percent increase in the lower-concentration formula, after five months of use. Importantly, that mass-effect declined with both products after five years' use, to 25 percent and 15 percent increases, respectively.

The second study looked at actual hair counts, finding that the higher-strength formula does result in more hair shafts per square centimeter: 25 additional hair follicles per square centimeter from the 5 percent solution, versus 21 follicles in the 2 percent solution and 9 follicles in a placebo group, after a 48-week period (R. J. Trancik, "Update on Topical Minoxidil in Hair Loss" [Proceeding of the annual meeting of the American Academy of Dermatology, 1998]).

One effective application is for hair loss due to chemotherapy. Research sponsored by Rogaine's manufacturer, the Upjohn Company (now Pharmacia), on 22 women undergoing treatment for breast cancer found that the 2 percent topical solution decreased the duration of alopecia caused by chemotherapy, with no significant side effects (Duvic, Lemak et al., Division of Medicine, University of Texas, M.D. Anderson Cancer Center, 1996).

How does minoxidil work?

How minoxidil reduces hair loss is actually a mystery, since it was discovered by accident when use of the anti-hypertension drug Loniten was found to increase and darken fine body hairs. One imagines the scientists working on this had their eureka moment within one or two nanoseconds of coming upon this fact.

But two decades later, no one knows for sure how it works. It may be due to the way the medication dilates blood vessels, which on the scalp might stimulate hair growth. Minoxidil is a potassium channel opener, which causes hyperpolarization of cell membranes, possibly another reason it works.

To stem hair loss, minoxidil is applied topically (as a cream or foam). In pill form the medication is in a higher concentration and only approved for treating hypertension.

There are side effects to minoxidil

For the person first using minoxidil, there is often an initial period of paradoxical increased hair loss. Disturbing as that may be, this seems to be the scalp's way of ridding itself of weaker hair follicles to make way for stronger shafts. Other known side effects and issues are:

• Scalp irritation, likely because of the product's alcohol content
• Itchy scalp and dandruff
• Dizziness or rapid heartbeat (rare)
• Not recommended when the scalp is already irritated, injured or sunburned, which would allow the medication to be absorbed by the body at a higher and potentially dangerous level
• Formulated for scalp application and not recommended for use elsewhere on the body
• Effects on a fetus in women who are pregnant are unknown; however, women who are nursing are warned to not use it
• Rogaine users with severe, refractory high blood pressure might experience hypertrichosis, which is hair growth on the face or other bodily areas. The incidence of this occurs in about 3-5 percent of women who use the 2 percent solution and higher among women using the 5 percent solution.

Note that no animal or human studies indicate cause f or concern regarding cancer and minoxidil.

Costs of minoxidil (and beware the snake oil salespeople)

According to online stores selling Rogaine, a three-month supply of the foam product is about $50, which is much lower than when the medication was first released (and protected by its original manufacturer by its patent, which expired in 1996).

But at least one company that operated clinics and treatment centers for hair loss, Avacor (Global Vision Product, Inc.), falsely claimed superior treatments that amounted to nothing more than a minoxidil solution repackaged as a shampoo (sold alongside herbal supplements that lacked clinical studies to support claims of efficacy). A class action lawsuit was successful in driving the clinics out of business. This case serves as a reminder that any medical solutions should be investigated closely for legitimacy -- and how hair regrowth charlatans are always looking to make money from people who are experiencing hair loss.

Minoxidil: The bottom line

To summarize, minoxidil will be most effective if you

• Use it as soon as you start to notice a thinning
• Are under age 40
• Are a woman; women get better results than men
• Use the stronger solution, as it will yield more results
• Are attentive to potential side effects, particularly if your scalp is irritated by sun or the medication itself
• Stay out of the sun or always wear a hat when outdoors
• Accept the fact the results in five years won't be as good as in one year
• Plan to continue using it to realize any beneficial effect

Hair Loss Prevention Means Being a Friend to Your Hair

If you are losing hair, learn to prevent hair loss and protect your hair in the shower!

Does incorrect shampooing techniques lead to hair loss? Should you use hot or cold water when shampooing? What is the best way to dry your hair to avoid damaging it? Take this hair loss shampoo quiz to separate the facts from the myths of shampooing hair and hair loss. Good luck!

1. True or false? I should brush my hair 100 times a day with a natural bristle brush, just like my grandma always said.

2. The right water temperature for shampooing and conditioning my hair should be...

a. Hot
b. Warm
c. Cold

3. True or false? A cool water rinse is a great way to end my shower, especially for my hair.

4. The best way to shampoo my hair is to...

a. Pile all my hair on top of my head and rub until it's very sudsy.
b. Use my fingertips to massage shampoo gently on my scalp.
c. Rub the shampoo all over my scalp and hair, making sure the lather gets down to the ends.

5. True or false? Squeaky-clean hair is the healthiest hair.

6. True or False? Don't brush your hair at all if it's stiff or sticky from styling products.

7. The best way to dry my wet hair is...

a. Twisted in a turban.
b. By rubbing a towel back and forth.
c. Pressing a towel over hair starting from the top.

8. True or false? The more lather on my head the better the shampoo is working.

9. What's the best tool for detangling wet hair?

a. A natural bristle brush
b. A wide-toothed comb.
c. A cushioned paddle brush

10. True or False? Sodium Lauryl Sulfate is an ingredient in shampoo that's necessary.

SCORING: Give yourself 10 points for each correct answer and 5 points for each wrong answer.

100 points: "Your doing everything you can to protect your hair in the shower!"

80-100 points: "Heads up! Change the way you shampoo and your hair will thank you!"

60-80 points: "You could be causing hair breakage and thinning just by the way you are treating your hair in the shower! Learn proper shampoo techniques to protect your hair, especially if you are having thinning or hair loss issues.

Under 60 points: "You are your hair's worse enemy. Forgive yourself for not learning the proper way to treat your hair (We can't learn everything!) but stop abusing your hair and treat it with kindness.

Nick Arrojo, TV makeover hairstylist star of TLC's "What Not to Wear" gives us the straight talk on how to shampoo the right way.

1. False. Too much brushing causes breakage and split ends.

2. B. Hot water dries out your scalp and hair and cold water does not dissolve dirt as well.

3. True. A cool water rinse closes the cuticle (the outer most layer of each hair shaft) to keep hair smooth and shiny.

4. B. Shampoo belongs on the scalp to dissolve oil and dirt there. Hair length gets clean just by rinsing the shampoo out. Use a dime-sized dollop and rub the product in your hands first, then massage gently over scalp. Don't pile hair up or rub shampoo down through hair ends because both cause damage. A gentle finger-tip massage cleans scalp best without hair damage. Never use fingernails because they scratch and can cause infections!

5. False. 'Squeaky clean' means natural oils that keep hair shiny and healthy are stripped from your hair.

6. True. Brushing stiff, sticky hair will cause breakage. Try to switch from sticky styling products that contain alcohol to crème-based styling products, to protect brittle or thin hair.

7. C. Press a towel over your head and hair starting at the top and working your way down to absorb the moisture, letting gravity work. Twisting or rubbing a towel on wet hair inflicts major damage.

8. False. Lather is just soap which dries hair out. Just a dime-sized dollop will get your scalp clean, and you never need to lather twice, no matter what shampoo bottles say!

9. B. Always keep a wide-toothed comb in your shower to comb conditioner throughout hair and detangle hair afterwards.

10. False. Sodium Lauryl Sulfate is a very harsh detergent that causes thin hair to become even drier and more brittle. Look for shampoo formulations without this damaging ingredient.

A Wig Is a Fantastic Hair Loss Treatment Option If Done Right

Choosing the right wig isn't a simple matter. Fortunately, we've done the research for you.

Whether you are experiencing a hair loss condition or you just desire a new look, a wig is a simple, affordable and fantastic option.

The cost of a wig

The first thing you'll want to consider is your budget. High-end wigs can cost thousands of dollars. While they are worth the money, you may not have that type of cash to spend on a wig. If that's the case, you will be glad to know there are other options that offer cheaper solutions.

Wigs usually feature either synthetic hair or real human hair. Additionally, the wigs are either machine-made or handmade. The cheapest wigs use synthetic hair and are machine-made, while the most expensive wigs use 100 percent human hair and are handmade.

Real versus synthetic hair

Authentic human hair has one big advantage: It looks and acts natural. You can style it just like you would your own hair. Its versatility is a major selling point. For example, if you want to add curls, straighten it or change color, it's easy to do.

Even though synthetic hair isn't nearly as versatile, its durability is actually better than real human hair. If you lead an active lifestyle, synthetic could be a better option. Maintaining a wig that uses synthetic hair is a breeze, and the wig itself will last longer. Also remember that synthetic hair is much cheaper than human hair.

Handmade or machine-made wigs

When you are comparing wigs, you may notice that handmade wigs often look more natural than machine-made ones. Most handmade wigs are sewn one strand at a time, which adds a realistic appearance. That said, technology is rapidly advancing in this field, so modern machine-made wigs are looking better and better. You will need to compare the two options side by side to determine whether the increased cost of the handmade version is worth it to you.

A custom fit wig

Another big decision when you are shopping for a wig is whether you are going to order a custom wig. You may opt to purchase a premade wig, which will save you time and money. A custom wig could take months to construct and could be exponentially more expensive; however, the advantages are numerous. Not only will a custom wig fit perfectly, but also it can be made to blend with your current hair to create the hairstyle of your dreams.

When shopping for a premade wig, never make a purchase without trying it on. Ask a lot of questions so that you know exactly what you are buying. If you want real human hair, beware of wigs that claim to be human hair but are actually blended with synthetic hair. Look in the mirror from all angles and also make natural movements to ensure that the wig will stay in place.

Color me beautiful

Selecting the color of your wig is the real fun! Don't limit yourself to colors to which you are accustomed. Instead, consider going a few shades darker or lighter. Sometimes making a drastic change -- such as going from brunette to blonde -- can make your wig appear even more natural because the color change will stand out, not the fact that you are wearing a wig.

Unsure of the color and style of wig you want? You can find software online that allows you to upload your picture and digitally "try on" different hairstyles and colors with a few clicks of your mouse. Check out: TheHairStyler.com, Taaz.com and other virtual makeover Web sites. If you find a look that you love, print it out and take it with you when you go wig shopping.

The most important thing to remember is to be patient. Buying a quality wig is an investment; you will want the wig to last at least a few years. Shop around, look for stores that specialize in wigs and consider all your options.

These Hair Loss Treatments Aren't Worth the Apparent Risk

The chorus of concerned voices warning the public about the potential adverse side effects of hair loss medications Propecia and Avodart have been getting louder recently.

The latest voice to join the chorus comes from Boston University School of Medicine whose research has shown that Propecia and Avodart, two drugs frequently prescribed to treat hair loss, can cause irreversible sexual dysfunction in men.

That sexual dysfunction is listed as a potential side effect of these medications and that physicians continue to prescribe them - and that furthermore, men are willing to take on that risk - is nothing short of shocking. It speaks to the desperation of those who lose their hair and who seek out this type of treatment that offers negligible results in the first place.

It seems that our modern culture should have evolved long past this level of shortsightedness where we undermine our most basic human functions and drives in a desperate attempt to gain back our hair. To mate, to procreate, to enjoy our sexuality is one of the most basic pleasures of being human. Why would we risk losing that even temporarily for something non-life threatening? It begs the question: Why would the FDA approve such a drug?

If you watch and analyze the marketing messages coming from the biggest players of the hair loss industry (Hair Club for Men, Bosley) you would swear that hair restoration is all about increasing sex, not taking it away. The carefully presented images of a man with a full head of hair, with a woman in each arm is undermined when we know what the women don't know.  He's lost his libido.  Now he has to take Viagra and an anti-depressant.

At present, there is no known cure for what is termed "genetic hair loss", or androgenetic alopecia, hair loss that is caused by a variety of genetic factors in both men and women. For this type of hair loss, only cosmetic "solutions" such as nonsurgical hair replacement will restore one's natural appearance and restore a full head of hair.

It's time to stop considering any treatment that essentially offers desperate people a "quid pro quo" approach to improving heath that silently states: "You can have some negligible hair growth back in exchange for your sex drive."

Even the best cosmetic hair loss treatment presents a "this for that" tradeoff but to a dramatically lesser degree. The position of HairLoss.Com is a no-brainer. Risking the very function and foundation of human life to gain negligible hair growth is a crapshoot that has virtually no odds of winning. Once you've paid for Propecia or Avodart, you've already lost.

Rogaine Treatment for Men & Women: The Differences

Rogaine 2% is for women, and Rogaine 5% is for men, but there's more ...

Rogaine originally received FDA approval for Men's Rogaine and Women's Rogaine with a 2 percent minoxidil solution and Men's Rogaine Extra Strength Topical Solution and Men's Rogaine Foam with a stronger 5 percent minoxidil solution for men only. But, many doctors use them for both sexes, so what's the difference?

"Simply stated," says New York City board-certified dermatologist and hair transplant surgeon Dr. Eric Schweiger, "that's just how Rogaine currently has the FDA approvals, and it would be very costly and time consuming for them to go through the clinical trials to approve the 5 percent minoxidil solution for women. I use both for women in my practice, depending upon the specific hair loss, sensitivity and scalp situation," he states.

According to the U.S. National Library of Medicine's National Center for Biotechnology Information, the generic active ingredient minoxidil was approved by the Federal Drug Administration (FDA) for use topically in Rogaine for men's hair regrowth in 1988, and later, in 1992, the same 2 percent minoxidil formula was approved for women. This identical Rogaine 2 percent minoxidil formula for both men and women was approved in 1996 for over-the-counter sale. The stronger (5 percent minoxidil solution) Men's Rogaine Extra Strength Topical Solution was introduced, tested and FDA-approved for men only in 1997, and in 2006 Men's Rogaine Foam was introduced.

According to Schweiger, another difference in the formulas aside from concentration of the minoxidil hair regrowth ingredient is that the 5 percent solution contains propylene glycol for better skin penetration, which makes the medication more effective, whereas the 2 percent solution is alcohol based. Although both the alcohol- and propylene glycol-based preparations can irritate the scalp, propylene glycol can cause actual allergic reactions in those who are sensitive, which is where evaluating a patient's skin and scalp carefully becomes important.

Rogaine testing for women

A 2002 clinical trial conducted on men only at the Duke Dermatopharmacology Study Center in Durham, North Carolina, compared the 5 percent minoxidil to results using the 2 percent minoxidil solution. The study showed that men experienced 45 percent more hair regrowth with the stronger solution. Additionally, users of the stronger solution experienced results sooner than did users of the 2 percent one. And although those study results were published in the Journal of the American Academy of Dermatology, according to Dr. Schweiger, preliminary trials on women had not shown any increased effectiveness with the stronger 5 percent minoxidil solution, so the product was never further developed for women.

But a 2004 study by the Cincinnati, Ohio-based Dermatology Research Associates tested 381 women to find out whether the 5 percent minoxidil solution would be more effective in the treatment of female pattern hair loss than the 2 percent minoxidil solution. The study results also were published in the Journal of the American Academy of Dermatology, and it was determined that the 5 percent topical minoxidil group's hair regrowth results were superior to those in the 2 percent topical minoxidil group. It should be mentioned that both studies were "funded by Pfizer Inc., original maker of Rogaine products.

Is Men' s Rogaine Extra Strength Topical Solution too strong for women?

The 2004 study also found an increased occurrence of local irritation and the observation of facial hair growth with 5 percent topical minoxidil that were not experienced in the 2 percent topical minoxidil or the placebo. Schweiger agrees that the stronger concentration can irritate women's more delicate skin tissues, and therefore he evaluates each patient accordingly. "A small percentage of female patients experience facial hair growth as a side effect of using either Rogaine, which is more common when using the 5 percent solution, but this side effect subsides once the medication is discontinued."

Effective Rogaine usage for both men and women

Dr. Schweiger says, "The most important consideration is that the active hair regrowth ingredient minoxidil, no matter what the concentration, must reach the scalp twice per day in order to be effective. For some women, the foam formula will not be as effective as the liquid formula because it gets caught in the hair and does not reach the scalp." In addition, the stronger 5 percent minoxidil propylene glycol formula is greasier than the 2 percent minoxidil alcohol-based formulation. Because of this, he states, "For patients who complain of the greasiness, we advise minoxidil 5 percent at bedtime and 2 percent in the morning."

Learn the Risks and Benefits of Propecia and Hair Loss

Knowing the ins and outs of Propecia can help you decide if this hair loss treatment is for you.

Propecia (generic name: finasteride) has been in use as a means to stem hair loss since 1994, per approval of the Food and Drug Administration (FDA). It is taken internally and has a higher success rate than minoxidil (Rogaine), which is applied topically. It is effective in a majority of men, in varying degrees, but comes with at least one significant side effect that warrants concern.

Q. Does Propecia work?

A. Efficacy studies by the manufacturer (Merck & Co., Inc.) shows that Propecia halts hair loss in eighty percent (86%) of men taking it. Additionally, forty-eight percent (48%) regained some hair lost already.

Q. What is Propecia made of?

A. Finasteride (17beta-(N-tert-butylcarbamoyl)-4-aza-5 alpha-androst-1-en-3-one) is an orally active testosterone Type II 5-alpha reductase inhibitor. In a 1-mg dose it is Propecia, prescribed for hair loss. In 5-mg doses it is Proscar, a medication that offers a small reduction in the chance of developing an aggressive type of prostate cancer and is also prescribed for BPH (benign prostatic hyperplasia), noncancerous prostate enlargement that comes with age).

Q. How does Propecia work?

A. Finasteride/Propecia prevents the formation of DHT (dihydrotestosterone), which is in excess supply in men who are losing their hair, by blocking the enzyme that metabolizes DHT. Most patients report a slowing of hair loss in three months and regrowth of hair (if at all) by the six-month point.

Q. Does Propecia have side effects?

A. Men need to be concerned with a small chance (about 3.8 percent in one study) of experiencing one or more adverse effects: erectile dysfunction, decreased libido and decreased volume of ejaculate. Additionally, some patients experienced pruritus (strong itch), urticaria (hives), testicular pain and swelling of the lips and face.

Of arguably greater concern is how finasteride/Propecia can have serious effects on unborn fetuses. When a pregnant woman has mere skin contact with the drug -- for example, when touching a broken pill -- it can result in significant genital abnormalities in male offspring.

Men who have had the following conditions should speak with their doctor about using Propecia out of caution: liver disease, abnormal liver enzyme test results, bladder muscle disorders, prostate cancer, difficulty urinating and known strictures of the urethra.

Q. Will Propecia continue to work as a person ages?

A. Individuals using Propecia must continue using it to keep their hair, and it appears to remain efficacious with consistent long-term use.

The drug has been on the market for more than 16 years, and there are no reported negative effects in the long term outside of the known risk of side effects from short-term use. Tests on the incidence of male breast cancer among long-term users have been inconclusive and do not suggest a high risk. There may be a benefit among long-term users with a family history of prostate cancer in preventing its incidence.

Q. Will the texture of the hair be the same?

A. A series of small studies on hair texture indicates no change from taking Propecia. A review of blogs suggests that nonprescriptive copycat supplements claiming to deliver similar results may actually cause abnormal texture and other side effects. But of course those observations are not substantiated by research because supplements are not held to the same standards as prescriptive medicine.

Q. Can't women who are postmenopausal use Propecia?

A. Merck (Propecia's manufacturer) studied the drug on women who were no longer in danger of becoming pregnant (postmenopause), but after one year the study was discontinued because there was no measurable hair growth. This is believed to be because hair loss in women is due to the enzyme aromatase -- over which finasteride has no effect -- versus DHT, the cause of male pattern baldness.

Q. Can Propecia be used together with Rogaine?

A. There appears to be no clinical downside to using the two medications in combination, and proponents suggest that together there is a synergistic effect. The FDA does not track or comment on the safety or efficacy of this two-hit approach.

Q. Is finasteride available only under the brand name Propecia?

A. As a 1-mg treatment (for hair loss, versus the 5 mg of Proscar for treating prostate issues), it is currently available as Propecia or the generic finasteride.

Q. Does a person need to have a prescription?

A. Yes, Propecia requires a doctor's prescription. Some online retailers provide their own doctors who supply the prescription. The reader is advised to exercise all necessary caution with regard to pre-existing conditions and the appearance of side effects after beginning a regimen of treatment.

Q. How was Propecia discovered?

A. Like minoxidil, finasteride was discovered by accident. The Proscar version of finasteride, at 5 mg per dose, was found to regrow hair in men in early studies. Appropriate testing was conducted to get FDA approval for this secondary use at a lower dosage.

Q. Is Propecia expensive?

A. Online sources show a range in price from $28 to $71 (U.S.) per month. Dosage is 1 mg per day.

Understanding Minoxidil Is Vital to Making the Right Choice

Knowing the ins and outs of minoxidil can help you decide if this hair loss treatment is for you.

Available first by prescription and subsequently over the counter, minoxidil (Rogaine is the predominant U.S. brand) has been in widespread use for a generation. It works in varying degrees, with some side effects, so it makes sense to study it before you decide to use it.

Q. Does minoxidil/Rogaine work?

A. Rogaine is sold in regular (2 percent) and extra-strength (5 percent) variations. The regular variation claims a success rate of 30 to 40 percent, while, unsurprisingly, extra-strength achieves its users' objectives with a 50 to 60 percent success rate.

But success happens in degrees. Actual dense hair growth is experienced by 8 percent of those who use it, while moderate growth has been documented in about 30 percent of users. Studies strongly indicate that the product's best result is in halting further hair loss.

It is most successfully applied by people under age 40 to the crown (apex/top) of the head in early stages of thinning; it is relatively ineffective with receding frontal hairlines, above the forehead. Women have greater success with Rogaine than men do (with a 2 percent solution only).

One clinical study published in the Journal of the American Academy of Dermatologists (M. Duvic et al., "A Randomized Trial of Minoxidil in Chemotherapy-Induced Alopecia" [Department of Medical Specialties, University of Texas, 1996]) found that use of minoxidil "decreased the duration of alopecia caused by chemotherapy" with no significant side effects.

Q. What is minoxidil/Rogaine made of?

A. The commercial product, Rogaine, is minoxidil (2, 4-diamino-6-piperidino-pyrimidine-3-oxide) in a solution of alcohol, propylene glycol and water. It is sold as both a solution and a foam.

Q. How does minoxidil/Rogaine work?

A. As people begin to lose hair, in actuality their existing hair follicles shrink. Rogaine revitalizes those shrunken hair follicles, effectively making them larger. In some individuals the follicles may grow longer as well.

Exactly what causes that is subject to some speculation, since scientists aren't fully able to determine how it works. They've determined that the product increases blood flow in the scalp (i.e., it is a vasodilator). But less understood is whether it opens potassium channels in hair root cells, which would restore hair growth.

Q. Does minoxidil/Rogaine have side effects?

A. Side effects generally are related to skin irritation, such as itchiness, dryness, flakes, scaling or burning. For that reason people using Rogaine should avoid excessive sun exposure. In rare cases it may cause weight gain, chest pain, swelling (hands, ankles, stomach or face), difficulty breathing, rapid heart rate and lightheadedness.

The Food and Drug Administration (FDA) considers it a category C medication, which means women who are pregnant, who could become pregnant or who are breast-feeding should not take it, as research does not definitively rule out whether the drug can have an effect on a fetus or an infant. Women also are advised to use only the 2 percent solution (regular Rogaine), because the extra-strength (5 percent) solution may cause decreased blood pressure, lightheadedness and excessive body hair growth.

Because higher concentrations of minoxidil are taken for hypertension (high blood pressure), people with known cardiovascular disease are advised to speak with their physician regarding use of Rogaine.

Q. Will minoxidil/Rogaine continue to work as a person ages?

A. The peak efficacy for Rogaine, a 35 percent increase in hair volume, is found to continue up to 96 weeks in the longest-term study available. Anecdotally, its hair-retention effects reportedly last longer but only on the crown of the head, not elsewhere.

Importantly, cessation of use of the product will result in hair loss, probably to where the individual would be if he or she had never used the product.

Q. Will the texture of the hair be the same?

A. In most cases the texture is diminished as compared with intact hair surrounding it. It tends to be shorter, curlier (fuzzy) and less dense. But that is a function of how early in the hair loss process the product is applied.

Q. Is there a difference in how minoxidil/Rogaine works for men versus women?

A. Yes. Women get a greater increase in hair volume (hair counts and hair weight) than men do and are advised to use only the lower percentage (2 percent)_solution because that effect can lead to unwanted body hair growth. In general, women have an increased sensitivity to both the intended and (adverse) side effects.

Q. Can Rogaine/minoxidil be used together with Propecia/finasteride?

A. There are no prohibitions from the FDA against using these drugs in combination, nor are there data tracking efficacy or safety issues. Many Web sites (run by commercial interests) advocate doing so, claiming synergistic effects in individuals.

Q. Is minoxidil available only under the brand name Rogaine?

A. In the United States only variants on the Rogaine brand (Men's Rogaine, Rogaine for Men Extra Strength, Women's Rogaine) are available, in addition to proprietary store brands. In Canada the product is sold under several other brand names: Apo-Gain, Gen-Minoxidol, Hair Gro, Hair Regrowth Treatment, Med Minoxidil and Minox.

Q. Does a person need to have a prescription?

A. Since 1998 the product in both solution strengths has been available over the counter (no prescription required).

Q. How was minoxidil discovered?

A. Minoxidil was originally developed as a treatment for hypertension (high blood pressure) by Upjohn Corporation in the 1980s. When hair growth was found to be an unanticipated side effect, the company successfully sought FDA approval for that use.

Q. Is minoxidil/Rogaine expensive?

A. Major U.S. retailers (Target, Walgreens, Walmart) sell generic 5 percent solution minoxidil for about $19 for a three-month supply. It needs to be applied twice daily without interruption.