Hair Loss Beginner Resources

1. General Introduction to Hair Loss

Hair is one of the essential parts of our body. The average person has about 5 million hairs (100,000–150,000 on the scalp). Blondes typically have more (around 140,000), brown-haired individuals average around 105,000, and redheads slightly fewer at about 90,000. Hair is made of keratin, a protein also found in nails and the outer layer of the skin. Hair grows from small structures beneath the skin called hair follicles.

Hair follicles form during the fetal stage and do not regenerate after birth. Hair growth is related to hormones in the body; during puberty, androgens stimulate the growth of pubic and underarm hair and facial hair. These hormones also promote genetic male pattern baldness. Each hair strand grows for around 5 years, then enters a transitional phase before moving into the resting (telogen) phase. During telogen, the follicle stops growing, the old hair sheds, and a new growth cycle begins.

These phases repeat throughout life, and everyone loses 50–100 hairs daily without experiencing hair loss. What matters is not how many hairs fall out but how many regrow afterward.

Most hair loss begins from genetic factors. The affected scalp areas have a higher number of hormone receptors, meaning even normal androgen levels can trigger hair loss. When follicles are more sensitive, it appears as though affected individuals have higher hormone levels. DHT (dihydrotestosterone) damages hair follicles, causing hairs to thin, miniaturize, and eventually cease growing, leading to baldness.

Genetic hair loss accounts for about 95% of all cases. Another leading cause is alopecia areata, an autoimmune condition. Additional factors include medications, stress, and nutritional deficiencies.

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

2. Causes and Treatments for Female Hair Loss

Is baldness exclusive to men? Since baldness results from androgen effects, women can also experience it. This condition is referred to as female androgenetic alopecia or female diffuse hair loss. However, in such cases, the frontal hairline is preserved while hair density on the crown thins, making the parting more prominent. Complete baldness with a shiny forehead, similar to men, is extremely rare.

Causes

The cause is similar to that in men: genetics and hair follicle response to androgens. However, in women, abnormal androgen levels may originate from endocrine glands (adrenal or ovaries) or arise from medications with androgenic effects. Women may therefore experience hirsutism, masculinization symptoms, and other endocrine abnormalities. In many cases, it is difficult to detect excessive hormone production.

Chemotherapy

Physical stress: surgery, anemia, rapid weight changes

Psychological stress: severe mental trauma

Thyroid disorders

Medication side effects: excess vitamin A, antihypertensive drugs

Hormonal changes: pregnancy, contraceptives, post-menopause

Dieting: women are more sensitive to hair loss from dieting than men

Iron deficiency: low iron or protein levels may contribute

Alopecia areata: triggered by stress or immune dysfunction; may self-resolve but may also require specialist treatment

Diagnosis

Diagnosis can be based on clinical observations and hair examination (reduced hair diameter, decreased anagen ratio, increased telogen ratio), along with family history. However, blood tests for androgen levels and evaluations of ovarian and adrenal function are necessary. The chart below serves as a basis to stage female hair loss.

Ludwig classification

＊Ludwig Stage I & II

‑ Minoxidil solution is the most effective recent method for promoting hair regrowth.
‑ If used for over a year without growth or stabilization, consider anti-androgen therapy.
‑ Hair transplantation may be considered if the occipital region still has sufficient hair.

＊Ludwig Stage III

‑ Medical treatment is ineffective → hair transplantation recommended

Female hair loss is broadly classified into genetic and non‑genetic types.

If there is a bald man on either paternal or maternal side, genetic hair loss should be suspected. Unlike male pattern baldness, which typically shows regional thinning, female pattern hair loss appears as overall reduced density. Treatment involves minoxidil only; the goal is to slow down progression rather than achieve significant regrowth. Advanced cases may consider hair transplantation, but with careful consideration. Non‑genetic causes may allow hair regrowth once the cause is addressed, so treatment focuses on eliminating the cause.

Clinical cases

Case 1

Left: no androgenetic alopecia; Right: Ludwig Stage I

Case 2

Same person, Ludwig Stage II

Case 3

Left: 30‑year‑old woman with visible part line; Right: 23‑year‑old woman with crown thinning

Case 4

85‑year‑old woman – senescent alopecia

Case 5

Ludwig Stage III

Case 6

59‑year‑old woman – Ludwig Type III.

People often say hair thins with age—and that is true. However, those with androgenetic alopecia may experience more severe hair loss than their age peers. For example, a 59‑year‑old may show more hair thinning than an 85‑year‑old—highlighting the difference between aging and disease‑related hair loss.

Diagnosis & Treatment

The most common approach is topical minoxidil. Other options include direct or indirect androgen inhibitors or changing to a different contraceptive. If conditions such as thyroid deficiency, anemia, or systemic weakness are present, they should be corrected. Hair transplantation may be considered for some patients. Treatment depends on hair miniaturization and thinning stage; when vellus hair is nearly absent, surgery may be the best option. Note: There’s no need to shorten shampoo frequency—washing every day is fine, and normal perms or coloring are safe unless excessive.

* Minoxidil

Rather than just spraying, apply evenly over the scalp and massage gently. No need for excessive massage with the comb. Female satisfaction is generally lower than male, and minoxidil 5% is currently the only available drug. Consistency is key: goal is to slow progression, and noticeable results may take around 4 months. Initial shedding is temporary, so keep using steadily.

* Anti‑androgens (Androgen‑Receptor Blockers)

Medically used for female androgenetic alopecia are cyproterone acetate and spironolactone. These reduce both testosterone and DHT, so they should only be used in women. In men, side effects can include impotence and lowered libido.

* Estrogens

→ mild 5α-reductase inhibition
Both topical and oral estrogen have been used in female androgenetic alopecia, but they mainly maintain or slow progression rather than significantly promoting hair regrowth.

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

3. Norwood-Hamilton Classification

Stage 1: Very early and mild hair loss
Stage 2: Slightly more noticeable hair loss
Stage 3: Visible progression of hair loss
Stage 4: Bald spots becoming more prominent
Stage 5: Bald areas are starting to expand
Stage 6: Most of the hair has been lost
Stage 7: Nearly complete baldness

Stages 1–2: Mild stages. Hair loss is still reversible.
Stages 3–5: Moderate stages. Treatment options are still available. Many people try various solutions.
Stages 6–7: At this stage, medication is no longer effective. Consider wigs or other medical interventions.

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

4. What is Minoxidil?

[ Rogaine ]
* Other Global Names: Regain, Minoxidil
* Product Names in Korea: MyNoxidil (Hyundai Pharm), Moxidil (Hanmi Pharm), Boldmin (JW Pharmaceutical)

Introduction

In 1988, Pharmacia & Upjohn launched the first FDA-approved product to promote hair regrowth. As of 2000, Rogaine remains the only topical treatment officially approved for hair growth. While it gave hope to patients with hair loss, its initial effects were not as dramatic as expected—partly due to excessive anticipation and because the FDA only approved the 2% solution at first.

After FDA safety approval, in 1996, Rogaine Extra Strength with 5% minoxidil was made available as an OTC (over-the-counter) men’s medication. Higher minoxidil content showed better results and met people’s expectations.

What is Rogaine?

Rogaine is an alcohol-based solution applied twice daily (spray or drops) to thinning hair areas. Before its hair growth effects were discovered, the active ingredient was used to treat hypertension.

How does it work?

The exact mechanism of minoxidil remains unclear. Initially thought to be a vasodilator that increases blood flow to hair follicles, recent research suggests it opens potassium channels in follicle cells, which helps regulate hair growth. Regardless of the method, Rogaine stimulates inactive follicles and reverses miniaturization, providing a unique, side-effect-free option for various types of hair loss.

What effects can you expect?

Effects vary between individuals, but clinical studies show about 25% experience hair regrowth, and existing hair becomes thicker and heavier. Effectiveness depends on hair loss severity and duration. Continuous use yields good results, while stopping treatment may cause new hair to fall out within six months. Tolerance can develop over long-term use; some doctors recommend taking a 1–2 week break every 3–4 months, but not within the first year.

Rogaine and DHT

Rogaine does not remove or reduce DHT (dihydrotestosterone), a male hormone causing hair loss. However, combining Rogaine with DHT blockers like Propecia can create a synergistic effect. Studies have reported better results with combination therapy.

Rogaine for Women

Some women use Rogaine, but it is not officially approved for them. Upjohn’s women’s Rogaine is identical to the men’s 2% version. Women should consult a doctor before using strengths higher than 2% because of the risk of unwanted facial hair. Consultation is also needed during pregnancy or breastfeeding.

Pre-Patent Products and Special Formulations

Rogaine 5% Extra is suitable for most men and guarantees results in 90 days. Some doctors compound up to 15%, but concentrations above 10% require a cream form due to crystallization and are only available by prescription. After the 2% patent expired, various generics entered the market, lowering the price. The 5% patent expired in 2000, further reducing prices.

Side Effects

Side effects are rare, but contact dermatitis or inflammation from the alcohol component, rapid heartbeat, or dizziness may occur with excessive use. Generally, normal usage is safe.

Discovery and Effects of Minoxidil

Minoxidil (Rogaine in the US) is the first FDA-approved hair loss treatment. It is only effective on living follicles. While it prevents hair loss well, new hair growth occurs in less than 10% of users, and thick terminal hair is rare. Combination with Propecia can have a synergistic effect. The mechanism behind its hair growth effects remains unclear.

Minoxidil was originally a vasodilator used for hypertension. Its hair growth side effect led to the development of the topical product. Both 2% and 5% solutions are available, with 5% being more effective. Studies report 30–35% moderate to significant hair growth after twice-daily application. In women with androgenetic alopecia, 63% saw mild to moderate regrowth. 5% is more effective than 2%. In Korea, a 50ml bottle of 5% costs about 15,000 KRW, and 150ml about 35,000 KRW (the pictured product may differ from those sold domestically).

Minoxidil Product Information (Directions for Use)

Korean sellers and product names: MyNoxidil (Hyundai Pharm), Moxidil (Hanmi Pharm), Boldmin (JW Pharmaceutical)

Product state

Colorless or pale yellow transparent liquid

How to use / dosage

30ml, 50ml: Attach the included spray nozzle, spray 4–8 times per use. If it doesn’t spray well, tilt your head and hold the container upright. Gently massage with fingertips.

150ml: Pour into a sub-container; use spray as above.

Efficacy, Indications

Male pattern hair loss.
a. Increases blood flow around follicles, promoting hair growth
b. Directly acts on follicular epithelium
c. Panthenol added for nourishing and moisturizing effect

Features

Originally a vasodilator for severe hypertension, minoxidil was redeveloped as a hair loss treatment due to its effect on hair growth. Superior to other hair tonics and OTC products.

Precautions

A. Do NOT use if:
a) Allergic to the product
b) Cardiovascular disease (especially hypotension)

B. Use with caution if:
a) Systemic effects like edema, tachycardia, etc., can occur if absorbed. Stop use if adverse effects occur.
b) Stop and seek treatment if serious systemic or skin reactions occur.

C. Side effects
Itching, dandruff, redness, dermatitis, dry skin, hypertrichosis, folliculitis, burning, etc. Occasionally, allergies, dizziness, headache, fatigue, fainting, neuritis, swelling, taste/vision changes, sexual dysfunction. Rarely, chest pain, BP/pulse changes, hepatitis, kidney stones, etc.

D. General precautions
Use only as directed by doctor/pharmacist. Check scalp and health before use. Avoid contact with eyes, mucosa, or broken skin.

E. Drug interactions
No known interactions. May increase orthostatic hypotension in patients on guanethidine.

F. Use in pregnancy/breastfeeding
Minoxidil may be secreted in breast milk if absorbed systemically. Do not use during pregnancy/breastfeeding.

G. Use in children
Not established for those under 18 years old.

H. Use in elderly
Not established for those over 65 years old.

I. Overdose
Overuse may cause cardiovascular effects (edema, tachycardia, hypotension). Treat with diuretics, beta-blockers as needed.

J. Application precautions
For external use only; do not apply to areas other than the scalp.

K. Storage precautions
Keep out of reach of children.

L. Others
Animal studies: mammary gland tumors in female mice and adrenal/epidermal tumors in male rats reported.

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

5. What is Dutasteride?

Regrowth.com: By John Ertel

The documentation for dutasteride is currently available on the FDA website. Upon review, the following comments and notes regarding dutasteride may be of interest to readers.

It has been reported that Glaxo is waiting for a second product approval just before the new product launch. It usually takes about 6 months to get this second approval, but Glaxo does not have to wait for it. Glaxo can launch dutasteride as soon as it is ready, and this new approval only allows more time for claims since it includes two-year research data. The pill is in a 0.5mg soft capsule form for Benign Prostatic Hyperplasia, making it much more difficult to split into smaller doses compared to the previous Proscar.

At this point, it is unclear whether the same amount is taken regardless of the stage of hair loss. There are rumors that at the time of BPH approval, Glaxo had already submitted an application for the use of dutasteride as a hair loss treatment. It is unknown whether this will affect the specific approval period for hair loss.

Researchers raised several concerns about the drug. One is whether to warn patients with liver problems or those taking CYP3A4 inhibitors. Nizoral/ketoconazole is a CYP3A4 inhibitor and has been widely used in hair loss treatments.

Since the documents do not specify which forms of use should be avoided, it is unclear at this point whether warnings will be included about using topical shampoos or if only verbal warnings will be provided.

The drug underwent large-scale testing through three phases, with three identical clinical trials conducted over two years—two in the United States and one in 19 countries outside the U.S. The documents on the FDA website include only the first year results; subsequent data will be reported later (it's unknown if it has been submitted but not disclosed, or not yet submitted).

The study included 4,324 participants, with 2,158 receiving placebo and 2,166 receiving dutasteride. Of these, 3,522 completed the first-year study (1,750 placebo, 1,772 dutasteride). The study focused on evaluating BPH, but safety and side effects were also assessed, making this information important for many who may wish to use the drug for hair loss before approval.

Safety data was evaluated using the results of several studies, including phase 3. A total of 5,305 people participated in safety studies, including over 400 who completed two years. Observed side effects are shown in the table below.

Dutasteride Phase 3 BPH Side Effects (Dosage - 0.5 mg /day)

Side Effect	Placebo (2,158)	Dutasteride (2,166)
Erectile Dysfunction	59 (3%)	117 (5%)
Decreased Libido	40 (2%)	74 (3%)
Ejaculation Disorder	14 (<1%)	40 (2%)
Gynecomastia	10 (<1%)	29 (1%)

Based on reported side effects, the actual rates are: 2% reported decreased libido, 3% reported erectile dysfunction, 1-2% reported ejaculation disorder, 1% reported sexual dysfunction, and 1% reported gynecological issues. Compared to placebo, there was no higher incidence of prostate cancer in the dutasteride group. Some may be concerned seeing prostate cancer on the list, but note that this refers to men with enlarged prostates. As shown, a certain percentage of people experienced these symptoms regardless of medication, and some issues occurred only in the placebo group, so these are due to their prostate conditions rather than dutasteride.

All side effect rates are surprisingly low compared to Propecia. Another concern for all 5-alpha reductase inhibitors like dutasteride is their possible effect on pregnancy in women. Dutasteride will carry a warning for use in women who are pregnant or may become pregnant. Studies have shown that dutasteride detected in semen is far below the level that could affect women through intercourse, so no warning is needed for this. According to research, the amount required to affect women is over a hundred times what is currently detected in semen. Babies born to patients in the study were all healthy.

The level of PSA (Prostate-Specific Antigen) dropped by 50% with medication (similar to Propecia/Proscar/Finasteride). Anyone monitoring PSA should inform their physician and double the test result for proper evaluation. PSA tests are regularly conducted to measure prostate enlargement or other conditions.

Other notes: Average serum testosterone increased by 20%, but this was not considered clinically significant. Some weight trainers and athletes have regarded the testosterone boost and hair loss prevention from Propecia as a bonus.

In studies on sperm, there were no significant changes in sperm morphology, concentration, or motility. Ejaculate volume decreased by 25%, similar to Propecia, but remained within the normal range. Two patients had noticeably reduced sperm after 52 weeks, but returned to normal within 26 weeks of ending the study.

No addiction was reported with the use of this medication.

Although the study concluded that the amount of drug in blood would not affect pregnant women through transfusion, those taking the medication are advised not to donate blood until 6 months after stopping. After 12 months, the current dosage of dutasteride lowers DHT by 93-96%.

Unlike previous reports, the drug will not be named Duagen. The FDA documents state that the names Duagen and Gigara were rejected and that no name has yet been approved for the product.

Glaxo has requested a 5-year drug exclusivity period for dutasteride until it becomes a general medication not requiring trademark registration or the monopoly period can be renewed.

The full approval document can be found in the FDA’s dutasteride approval documents and also on Daedamo’s dutasteride information page.

Prepared by (jungnamee@daedamo.com)
Source: Regrowth.com, corp.gsk.com

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

6. What is Propecia?

What is Propecia?

New Data on Propecia Revealed at Surgery Workshop

Article on Clinical Trials and Safety of Propecia

Alopecia Treatment Drug "Propecia" One Tablet a Day

Special Report Part 3 - Drug Therapy: Proscar and Propecia

What is Propecia?

Propecia is the only oral treatment for hair loss officially approved by the US FDA. It is taken once daily as a pill. Taking 1mg of finasteride daily significantly reduces the hormone DHT, which is the main cause of male pattern baldness, and as a result, it either stops hair loss or promotes hair regrowth. According to Merck, about 66% of people will experience hair regrowth after treatment, although results vary by individual. The company also claims that 83% of people maintained their hair even after 2 years of treatment. Propecia works by blocking the enzyme that creates the male hormone DHT, which causes hair loss. It is effective only in men, and in women can cause severe side effects such as birth defects. Side effects like erectile dysfunction, decreased libido, and decreased ejaculation volume have been reported in about 2% of users.

Proscar: A prostate treatment containing 5mg of finasteride.

Propecia: After discovering hair regrowth as a side effect of Proscar, a hair loss treatment was developed with 1mg of finasteride.
(The main ingredient is the same as Proscar, but the finasteride content is different.)

What are Finasteride, Proscar, and Propecia?
Proscar was originally a treatment for benign prostatic hyperplasia in older men. However, some people who took this drug experienced new hair growth as a side effect, which led to further research. In the second half of 1997, the US FDA approved its efficacy and safety for the treatment of male pattern hair loss. Propecia, developed by Merck, contains 1mg of finasteride and acts as a 5α-reductase inhibitor that blocks the conversion of testosterone to DHT. Side effects like erectile dysfunction, decreased libido, and reduced semen volume have been reported, but the incidence is not significantly higher than in placebo groups, so the drug is considered safe. To date, its safety has not been established for women and children, and it is strictly prohibited in pregnant women or those who may become pregnant.

Hormonal Effects
As a selective inhibitor of type II 5α-reductase, it blocks the conversion of testosterone to DHT in peripheral tissues, drastically lowering DHT levels in both blood serum and tissues. Oral finasteride 1mg reduces scalp and serum DHT concentrations in men with androgenetic alopecia.

Therapeutic Effects
Approved by the US FDA in the second half of 1997 – Propecia was administered to men aged 18-41 with mild to moderate hair loss at the vertex and anterior mid-scalp (excluding complete baldness) for up to 2 years. Hair loss in the bitemporal recession was not evaluated. After 2 years, 83% of men taking Propecia (vs 28% in placebo) maintained or increased hair at the vertex. The initial effect of slowing hair loss (patients felt they were losing less hair) appeared around 3 months according to patient reports.

Also, 66% of men taking Propecia (vs 7% in placebo) showed clear regrowth at the vertex, based on clinical photo assessment. Researchers assessed that 80% (vs 47% in placebo) were improved. After 12 months, side effects were: reduced sexual desire 1.8% (placebo 1.3%), erectile dysfunction 1.3% (placebo 0.7%), ejaculation disorder (mainly decreased volume) 1.2% (placebo 0.7%). According to detailed sexual function surveys, there were no special problems in sexual life.

If there is no effect within one year of treatment, further use is not recommended. Continued use is necessary for ongoing effects, and if stopped, the newly grown thick hair will become thin and short again within 6 months. Therefore, it is believed that this drug does not affect the genetic causes of hair loss.

Contraindications
Pregnancy: It should not be used in women who are pregnant or who may become pregnant. If a woman takes the drug, as a 5α-reductase inhibitor, it prevents testosterone from converting to DHT and may cause abnormal development of external genitalia in male fetuses. If a woman takes the drug during pregnancy or becomes pregnant while taking it, the risk to a male fetus increases. In studies on pregnant rats, administration of low doses of finasteride caused abnormalities in the external genitalia of male offspring.

Warning
Safety in children and women has not been established. If a pregnant woman or a woman who may become pregnant handles crushed or powdered tablets, there is a risk of absorption and increased risk to a male fetus. However, Propecia tablets are coated so that, when handled normally, they do not break or produce powder.

<< Propecia Case Photos >>

Before	After 6 Months	After 24 Months
Best effect		15 %
Moderate effect		31 %
Slight effect		30 %
Hair loss stopped		33 %
Hair loss increased		1 %

New Propecia Data Released at Workshop

Orlando, Florida – On March 8, 2002, Merck announced new research results on the effect of finasteride on hair weight. Finasteride, also known under the brand name Propecia, is the only oral medication for hair loss approved by the FDA. The new data, presented in conjunction with a hair loss surgery workshop, showed that after 48 weeks of use, net hair weight increased by 26%, after 96 weeks by 36%, and after 192 weeks by 46%. Measuring hair weight is a new method of evaluating the results of hair loss treatments like Propecia, and calculates the actual weight of hair. This allows researchers to assess thickening of existing hairs, not just count new hairs.

“Combined with the 5-year study results published last April, this new information demonstrates the diverse benefits that finasteride provides to the 50 million Americans suffering from hair loss,” said Dr. Matt Leavitt. “The 5-year study showed that users of finasteride had 277 more hairs per square inch of scalp compared to non-users. This increase in hair count means more people are benefiting from this medication. This is great news for the field of hair restoration. In the US, it is estimated that 50 to 70 million people suffer from hair loss, but only about 3% seek treatment.”

The 8th Annual International Live Surgery Workshop was held in Orlando from March 6 to 9, 2002. World-renowned specialists and researchers attended, and the meeting included comprehensive sessions, live surgeries, new research, new technology demonstrations, and surgical instrument exhibits.

Of particular note was the focus on female hair loss. Topics included causes, psychological impact, hair transplantation, and the use of minoxidil in women, with live surgeries conducted. There were also sessions on considerations for different ethnicities, including African, American, Asian, and Hispanic patients.

New hair transplantation research projects were launched, including studies on hair shaft diameter, follicle density and direction, transplant site, and post-transplant hair characteristics. Updates were provided on graft angle, survival probability, size, and follicle regeneration.

Translated & edited by Daedamo reporter Woongsub Choi (woongsub@daedamo.com)
Source: Hairlosshelp.com.

Article on Propecia Clinical Trials and Safety

Medication

Related Information:

Propecia is the only FDA-approved oral medication for male pattern baldness. It selectively inhibits DHT (Dihydrotestosterone), which causes male pattern hair loss, preventing further hair loss and promoting hair growth. In a clinical trial involving 1,879 people in 16 countries over 2 years, 83% experienced no further hair loss and 66% showed increased hair count. Side effects like decreased libido were reported in 1–2% of users but were not significantly higher than in the placebo group. Continuous use led to most side effects disappearing, and all side effects reversed within a few weeks after stopping the medication. Because Propecia suppresses DHT, women of childbearing age should not take the drug or be exposed to crushed tablets, as it may affect the development of male fetuses' external genitalia. This is noted as a contraindication or precaution.

Sales Information:

After being launched in Korea in April 2000, Propecia achieved sales of 7 billion won in the first year, establishing itself as the only prescription drug for male pattern baldness. This year, it is expected to become the market leader among all hair loss products, including OTC and quasi-drug products.

FAQ:

⊙ Is it true that you must use contraception because finasteride in semen could affect a fetus during sex while taking Propecia?

:: In two clinical studies, 69 healthy subjects took 5mg/day of finasteride for 6–24 weeks. The concentration of finasteride in semen ranged from undetectable (<1ng/ml) to 10.54ng/ml. Previous less sensitive tests found concentrations up to 21ng/ml in 16 men taking 5mg/day. Assuming 5ml of semen per ejaculation, the amount of finasteride in semen is about 1/50–1/100 of the 5μg/day that would affect adult DHT levels.
In 2- and 5-year clinical trials of Propecia, there were no contraception requirements for participants. Even after more than 10 years on the market, there have been no official reports of fetal effects.

⊙ Can Propecia be used for alopecia areata?

:: Alopecia areata and male pattern baldness have different causes, so Propecia is not effective for other types of hair loss. If both conditions are present, combination treatment may be considered by a physician.

⊙ How long should I take Propecia to see effects?

:: Hair grows about 1cm per month. So, it is physiologically impossible to expect immediate effects. After about 3 months, hair loss will slow or stop, and hair regrowth can be observed.

Types of Alopecia

l Androgenetic Alopecia (Male pattern hair loss)
l Alopecia Areata
l Telogen Effluvium
l Anagen Effluvium
l Hirsutism
l Hypertrichosis

Hair Loss Treatment 'Propecia' - Take One Pill a Day

[Health/Life, Series] 2001.09.27 (Thu) 10:05

<Kim Tae-geun> Medications proven effective for hair regrowth include oral finasteride (brand name: Propecia) and topical minoxidil.

Finasteride is currently sold in Korea by MSD as a prescription medication. OTC minoxidil products are sold by JW Pharmaceutical, Hanmi Pharmaceutical, and Hyundai Pharmaceutical.

Recently, Propecia has been getting a lot of attention.

■ Product Overview & Dosage ■

Propecia was developed by Merck, a multinational pharmaceutical company, and contains 1mg of finasteride. It is taken once a day, and usually must be taken continuously for at least 3 months to see results.

It is particularly known for its effectiveness in preventing further hair loss. In Korea, it is classified as a prescription drug, available only with a doctor's diagnosis and prescription.

The drug is prohibited for children and women. Pregnant women or those who may become pregnant should not handle broken tablets, as even touching crushed tablets may be harmful to a fetus.

Because it is extensively metabolized in the liver, those with liver disorders should be cautious when taking it.

In 12-month clinical trials, 1.4% of users were excluded due to drug-related side effects, and 1.2% were excluded due to sexual side effects.

■ Mechanism of Action ■

The main ingredient, finasteride, prevents further hair loss and promotes hair regrowth. The male hormone testosterone is converted by the enzyme "5α-reductase" to a more potent androgen, dihydrotestosterone (DHT), which is the main cause of male pattern baldness.

Finasteride inhibits the activity of this enzyme, preventing the onset of male pattern baldness.

There are two types of 5α-reductase: type 1 is mainly in the skin, type 2 is in the liver, prostate, and hair follicles. Finasteride is known to selectively inhibit the type 2 enzyme.

■ Clinical Trials ■

According to data presented at the 59th Annual Meeting of the American Academy of Dermatology last March in Washington, DC, 95% of Propecia users had no further hair loss, while 100% of placebo users experienced worsening hair loss compared to the start of the study.

The study followed 1,553 men aged 18–41 for five years, using questionnaires, investigator assessments, and photographs.

Results showed that Propecia users had 277 more hairs per square inch after 5 years than non-users.

At the Asia-Pacific Scientific Hair Forum in Shanghai, China, a clinical trial in Chinese men showed a 70.75% efficacy rate for Propecia. This was the first Asian clinical data released. Korean MSD said that in a study of 228 Chinese men (aged 18–41) over 24 weeks, Propecia had a 70.75% efficacy rate compared to 25.47% for placebo.

In Korea, a clinical trial of 9 pairs of identical twins with male pattern baldness is underway, and the results are expected to be reported this November.

Feature Article 3 – Medical Treatments: Proscar & Propecia

The US FDA officially approved “Propecia” as a treatment for hair loss on December 19, 1997, and it was launched in the US in January 1998. The active ingredient in Propecia is finasteride, the same as in “Proscar,” which was previously used for treating benign prostatic hyperplasia.

The difference is that Proscar is taken at 5mg once daily, while Propecia is taken at 1mg once daily. Essentially, finasteride 1mg is marketed as Propecia for hair loss, and finasteride 5mg as Proscar for prostate disease—a marketing strategy.

Before Propecia 1mg tablets were available in Korea, dermatologists would cut Proscar 5mg tablets into fifths, and before drug price reforms, people sometimes bought Proscar and used it as a substitute for Propecia.

The FDA approval was based on clinical data from more than 1,800 men with hair loss who took finasteride for 2 years. Among 1,215 men with vertex hair loss, 83% maintained or increased hair count, while 17% continued to lose hair. In the placebo group, 72% continued to lose hair. Photo assessments of 508 patients after 2 years found clear increases in hair in 66% of the finasteride group, versus 7% in the placebo group.

>> Placebo Effect Is Also Significant.

Looking at the data, while 72% of the placebo group continued to lose hair, 28% maintained or increased hair even on placebo. Similarly, 7% of the placebo group saw increased hair in the photo assessment, suggesting that stress or psychological state can have a considerable impact, just as with antidepressants or erectile dysfunction treatments. In drug trials, the strong response to placebo can make it difficult to demonstrate the statistical superiority of the active drug.

Propecia generally requires at least 3 months of use to show effects. The most frequently reported side effects are reduced libido and warnings for use during pregnancy.

Of course, side effects such as erectile dysfunction, reduced libido, and decreased semen volume were reduced compared to 5mg Proscar, but the overall pattern is similar. Nevertheless, there have been no fatal side effects reported among the millions using Proscar or Propecia for hair loss, so the drug’s safety is considered reliable.

>> Dutasteride, the Next Generation After Finasteride

Recently approved dutasteride has a similar mechanism to finasteride—as indicated by the "-steride" in their names. The main difference is that while finasteride inhibits only type 2 5α-reductase, dutasteride inhibits both type 1 and type 2, thus maintaining testosterone levels even more effectively.

In addition, it is said to have fewer sexual side effects and better safety.

The approved dose for dutasteride as a prostate treatment is 0.5mg, so the dosage for hair loss is expected to be much lower. Since dutasteride comes in soft gelatin capsules, unlike finasteride tablets, it cannot easily be divided for use, which is unfortunate for hair loss patients. But this is unlikely to deter most users.

A major showdown between finasteride and dutasteride is expected in both prostate and hair loss markets, but dutasteride is clearly the next-generation version of finasteride.

So far, we have reviewed the general characteristics of hair loss and oral medications for hair loss, such as minoxidil and finasteride, but there is still no guaranteed miracle cure.

The secretion of human hormones is influenced by many factors, and feedback effects can vary by situation, so it is difficult to find a complete scientific cure for hormonal and neurotransmitter-related diseases. It is well known that stress is a contributing factor to hair loss because stress affects hormone secretion and metabolism.

In any case, it will likely take significant time and research to discover a revolutionary hair loss cure. Hopefully, dutasteride will finish clinical trials and soon be approved as a hair loss treatment, and new biotechnology-based treatments will become available as the era of the human genome advances.

Reporter: Eun Yi-gyeong, Daedamo (eun@daedamo.com)

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

7. Hair Transplant

To briefly define hair transplantation, it is a surgical procedure in which your own hair is transplanted to the desired area. The most common method involves transplanting hair from the back of the head, which is not affected by male hormones, to the front or crown of the scalp.

The hair on our body retains its original properties even if it is transplanted to another area, so hair from the occipital region does not go bald even after transplantation. Hospitals say the survival rate of transplanted hair is about 90%, but it varies from person to person, so nothing is guaranteed. Patient satisfaction ranges from extremely satisfied to extremely regretful, even to the point of resenting the doctor.

It is recommended to try medication treatment sufficiently before surgery and choose transplantation only as a last resort. When choosing a clinic, you should consider various factors such as pre-information about the clinic, surgical team, cost, experiences of previous patients, and even aftercare. Generally, some of the transplanted hair starts to fall out about 2-3 weeks after surgery.

Hair has a lifespan of about 5 years, and when it reaches the end of its life or is in the resting phase, it may fall out due to the shock of surgery. If you look closely, you will see that the root remains and only the hair shaft falls out. In other words, this is a natural phenomenon where the transplanted hair root produces new hair, pushing out the old hair. It takes about 4 months for new hair to grow out of the skin from the transplanted root, so you need to forget about it for about 5-6 months and wait patiently.

If you look closely at the scalp, you will find that hair does not grow only as single strands, but sometimes in groups of 2 or 3 hairs. This natural grouping of 1-3 hairs is called a follicular unit, and the transplantation method using these units is called follicular unit transplantation (FUT).

For reconstructing eyebrows, eyelashes, pubic hair, beard, etc., single-hair transplantation is the most ideal method. When reconstructing eyebrows, sometimes a large surgery is performed where the scalp is shaped into the form of an eyebrow, a tunnel is made under the skin, and the shaped scalp is moved to the eyebrow area with its blood vessels. In this case, cosmetic problems may occur after reconstruction. If you look closely at your eyebrows, the direction of each hair is different, but if you move a piece of scalp all at once, all the hair will grow in the same direction and look unnatural. However, with single-hair transplantation, you can adjust the direction of each hair, resulting in a much more natural appearance.

Transplanted hair retains the characteristics of its original location, so if scalp hair is transplanted to the eyebrow, it will grow about 1cm per month as scalp hair normally does, meaning it will need to be trimmed regularly. In the surgical process, local anesthesia is performed on the back of the head, and a surgical knife is used to cut out the hair and scalp to be transplanted, then the area is sutured. The separated scalp is then divided into individual hairs, and the hairs are implanted into the desired area using a hair transplant injector.

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

8. Information about Wigs

Wigs are usually the very last option chosen by people experiencing hair loss. The biggest advantage of wigs is that they can instantly cover hair loss, but if not managed properly, it can easily be exposed that you are wearing a wig.

Although manufacturers claim that the lifespan of a wig is five years, in reality, the lifespan is usually no more than a year, making it quite short. Most current users generally prefer human hair over synthetic hair and detachable wigs over fixed ones.

There are about ten wig companies in Korea, and Korean wig-making technology is considered the best in the world, accounting for about 80% of the global market share. However, customer satisfaction still lags far behind. Wig prices range from about 400,000 won to 1,200,000 won, but most are heavily overpriced, with the actual production cost being less than 200,000 won. Therefore, prices should be normalized as soon as possible. So, don’t hesitate to negotiate at wig shops. Depending on your degree of hair loss or the type of wig, the price may vary, but you should also bargain boldly considering the cost. The best way to choose a wig is to ask for advice from existing users through the Wig Board, then visit multiple stores and check with your own eyes before purchasing. Although the manufacturing technology is similar between companies, there are differences in price, wig designers, company know-how, and after-sales service.

Types of Wigs

By Wearing Method	Fixed	Detachable
By Area Worn	Full Wig	Partial Wig
By Attachment Type	Adhesive	Clip Type
By Hair Type	Synthetic	Human Hair

Characteristics by Hair Type
1. Human Hair: Made by processing real human hair, these wigs are excellent for styling and dyeing, allowing for bleaching and various color expressions, and creating very natural hairstyles. However, they can get tangled during washing, fade over time, and lose hair, so aftercare can be complicated.

2. Synthetic Hair: Developed to improve the inconveniences of human hair wigs, they offer a more natural look and easier maintenance. There are various qualities of synthetic hair. Synthetic wigs used for fashion or dolls are vulnerable to heat, deform easily, and have a short lifespan. On the other hand, special functional synthetic wigs have excellent heat resistance and durability, do not tangle, fade, or lose hair, and can easily regain their style after washing or showering just by combing. Thus, they are easy to maintain and the natural look lasts a long time. However, since they cannot be dyed into new colors, it is important to select a color that matches your own hair when first ordering.

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.

9. Natural Remedies

Green Tea Good for Hair Loss Herbal Teas Good for Hair

Green Tea Good for Hair Loss
Hair Loss Prevention Effect

*A natural tea with anti-androgen properties
*Recent studies have found that catechins extracted from green tea leaves have anti-androgenic properties
*There are reports and research showing that it is effective in preventing hair loss.
*Related research papers

1) Title: Epicatechin-3-gallate and epigallocatechin-3-gallate in green tea selectively inhibit 5-alpha reductase enzyme.
2) Research conducted at Ben May Institute, University of Chicago, USA
3) These two components inhibit type 1 5-alpha reductase (not type 2).
4) Drinking 5-6 cups of green tea a day is effective for preventing hair loss and dieting.

(Source: Regrowth.com)

Dandruff Prevention Effect

If you rinse your hair with green tea after shampooing, the tannins and flavonoids in the tea leaves tighten pores and cleanse the scalp. Especially, rinsing with green tea makes your hair softer, shinier, and reduces dandruff.

Hair Beauty Effect

If you have a lot of dandruff or lack luster in your hair, it is good to provide green tea nutrients to your scalp. Also, foods high in animal fat and sugar can increase blood levels of DHT, a main cause of hair loss, so they should be avoided. On the other hand, seaweed and proteins rich in iodine and minerals, as well as green tea which inhibits DHT production, are good for preventing hair loss.

* Tip (How to Make Green Tea Rinse)

Green tea rinse eliminates dandruff. If you have a lot of dandruff or your hair is static and frizzy, rinsing your hair with green tea after shampooing is effective. Mix 50g of green tea powder with 2 eggs, massage onto the scalp, and press with your fingertips. Finally, rinse lightly with water. You can also use a comb to apply, leave for about 30 minutes, and then wash off.

Herbal Teas Good for Hair
Mulberry Leaf Tea

Mulberry trees are originally cultivated for silkworms, but the root bark (Sangbaekpi), fruit (Sangsim), and leaves are all used as valuable herbal medicines. Mulberry leaves contain many active ingredients that strengthen weak constitutions. They help with night sweats and frail bodies, and drinking regularly can improve eyesight. Mulberry leaf tea is also effective for high blood pressure, neuralgia, stroke prevention, and is a tonic.

Sangbaekpi Tea

The root bark of the mulberry tree is called Sangbaekpi in oriental medicine. It removes heat from the lungs, has anti-inflammatory and expectorant effects. People with cold bodies or those who often get diarrhea from cold foods should avoid it. Boil about 30g and take 3-4 times divided throughout the day.

Mulberry Fruit Tea

The dried fruit of the mulberry tree is called Sangsimja in oriental medicine. Mulberry fruit tea is sweet, nutritious, and especially popular with children. It is used for thirst, dizziness, and constipation, and is rich in nutrients to strengthen the body.

Omiguji Tea

This tea is good for those who are weak, always tired, have kidney deficiency, or swelling. Especially effective for people who sweat from yang deficiency. It protects the kidneys and strengthens the body, improving such constitutions.

He Shou Wu Tea

He Shou Wu is made by drying the root of the fleeceflower plant. It is used in herbal medicine for its strong tonic effect and is called an elixir of youth.

Cornelian Cherry Tea

The cornelian cherry tree is a deciduous tree that grows up to about 7 meters tall. It blooms yellow in March-April and its fruit ripens red in October. The fruit without seeds is called Cornelian Cherry. It is harvested in autumn, seeds are removed, and it is dried in the sun or under low heat, and stored in a dark place.

- Nourishing and tonic effect
- Promotes blood circulation
- Used for impotence, dizziness, hearing loss, or cold sweats
- Acts on the liver and kidneys, invigorates yang energy, and preserves vital essence

Goji Berry Tea

Goji berries have long been known as a tonic for longevity and are widely used in both oriental medicine and folk remedies, though sometimes overhyped. The leaves and berries can be made into tea or liquor, and leaves can be used in salads. The goji plant is a deciduous shrub from the nightshade family that grows well along streams and embankments.

- Helps the liver and spleen, relieves fatigue
- Strengthens the stomach and improves digestion, also effective for weight loss
- For nervous exhaustion, decreased stamina
- Breaks down fat in fatty liver, lowers blood sugar
- For women, beautifies the skin and removes pigmentation
- Also effective for blood formation and growth hormone stimulation

Note

This content is based on certified academic sources with properly cited references. Treatment methods without validated clinical results from recognized institutions are excluded to avoid confusion. The information is for reference only and does not substitute professional medical advice.