It was Hippocrates, the “Father of Modern Medicine”, who first recognized a connection between hair loss and the sexual organs. Hippocrates’ studies of eunuchs (men castrated before puberty) observed that these men did not suffer from hair loss.

We know today that this is due to the absence of testosterone, which is normally converted into dyhydrotestosterone or DHT – the active ingredient in baldness. In March 1995, Duke University researchers came to the conclusion that " . . . while castration may be a cure, it is not commercially acceptable."

Hippocrates had a personal interest in finding a cure for baldness as he suffered from hair loss. He developed a number of different treatments including a mixture of horseradish, cumin, pigeon droppings, and nettles to the scalp. This and other treatments failed to work and he lost the rest of his hair. The area of permanent hair on the back and sides of the head (from which donor hair is taken for hair transplants) is also known as the “Hippocratic wreath.”

Ancient Rome and Hair Loss

Moving from Greece to the Roman Empire, we find that Julius Caesar employed a variety of methods to hide his thinning hair. In addition to the laurel wreath that he wore, he first grew his hair long in the back, and then combed it forward over his bald spot. Yes, the “Comb Over” is ancient.
Learn how man has treated hair loss up to modern times.
Being a Eunuch – the sure way to stop baldness

In the 1940’s, the studies of Hippocrates and Aristotle were continued. Both men had concluded that eunuchs always kept all their hair.

This finding was backed up by the work of Dr. James Hamilton.

He discovered that certain male hormones (missing in eunuchs) were critical to the development of male pattern baldness.

Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.

While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.

The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.

How our member physicians use the Lateral Slit Technique.

Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.

The graft incision determines the direction of the hair growth

The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.

Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.

Lateral slits can enable denser packing of grafts

Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.

In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.

The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.

Placing grafts to maximize their aesthetic result and coverage

The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.

Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.

Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.

In fighting hair loss, there may be certain unwelcome side effects produced. These side effects are the results of the body's natural immune response. These effects can increase hair loss, if not controlled.

But with anti-inflammatory hair loss cure products, such side effects as itching, flaking, redness, and naturally, inflammation, are reduced. These topical treatment options include Tricomin, Folligen, Proxiphen and Proxiphen-N, Betadine and T-Gel and Nizoral Shampoos.

Nizoral

Here’s one shampoo that fits in with any treatment option.

Nizoral, made for men and women, is available in any grocery store. Nizoral is effective at reducing itching, inflammation and other side effects of other treatments, such as Propecia. The shampoo also maintains scalp health. Plus, research has shown that using Nizoral for an extended period may help to treat male pattern baldness (MPB) and female pattern baldness (FPB).

It’s advised that you apply Nizoral once every three days, in rotation with your normal shampoo. However, as Nizoral’s effects can last for several days, it is a very inexpensive treatment option. After one month of use, you should then use Nizoral once every 1-2 weeks. The shampoo should be applied to wet hair and scalps. You should then leave it in for 3-5 minutes before rinsing thoroughly.

T/Gel Shampoos

T/Gel is the brand name for a variety of shampoos and hair loss cure treatments. Primarily, these products are designed to treat such scalp problems as dandruff, itching, flakiness, and excess oil.

The Original Formula shampoo contains 2% Neutar ®, which is essentially 0.5% Coal Tar. There’s also T/Gel’s Fine/Oily Hair Formula, Extra Strength Formula, and Stubborn Itch Control Formula. These varieties all feature Neutar, a patented product, which dissolves into the scalp as it treats the previously mentioned symptoms.

T/Sal® Maximum Strength Therapeutic Shampoo features 3% Salicylic Acid. This effectively treats the crusty scalp build-up of psoriasis, as well as problems caused by excessively oily skin. This product should be used at least three times a week, unless other wise directed by your physician. T/Gel’s Healthy Scalp Anti-Dandruff Shampoo also contains Salicylic Acid, specifically 1.8%. There’s also T/Scalp® Therapeutic Anti-Itch Liquid, which features 1% Hydrocortisone. This is meant for treating severe dandruff.

The prices for these products vary, but generally, a 16oz. bottle of the Original formula retails for about $13.00.

Nioxin shampoo and conditioners

If you have fine or thinning hair, you may want to consider the Nioxin family of hair products. These all-natural cleansers, conditioners, treatments and styling products are free of any drugs.

Nioxin can improve the hair’s health by cleansing the scalp’s skin, strengthening the hair follicle and energizing the cellular activity. In addition, Nioxin is supposed to restore the scalp’s proper moisture balance. On average, the Nioxin products take about 45 days to show their effects.

Nioxin has not been found to have any effect on DHT. However, by keeping the follicles healthy, these products may help delay hair loss. Because there are no side effects, the products can be used everyday. Nioxin typically costs $30-$125 per month.

Click to learn more about Hair Cover Ups

Para-Aminobenzoic Acid (PABA) has been called the anti-gray hair vitamin and is considered one of the lesser known members of the vitamin B complex family (despite the fact that it’s not really a vitamin at all).  PABA is a non-protein amino acid and isn’t essential in the human body.  It can be found in foods such as liver, whole grain, yeast, and kidney and is listed as an active ingredient in several popular herbal hair loss treatments such as Provillusfor women and Procerin. 

The potassium salt in PABA called POTABA is available on prescription. POTABA is indicated for Peyronie’s Disease and scleroderma. The dose for Peyronie’s disease and scleroderma is very high (12 grams daily in 4 to 5 distributions) and must only be used under medical supervision. Because of the high doses needed to achieve clinical efficacy, patient compliance is typically poor.

But can PABA actually treat male pattern baldnessor genetic female hair loss?

Some tests conclude that PABA when combined with other elements such as folate, biotin, and pantothenic acid, may restore pre-maturely graying hair to its natural color.  Some anecdotal reports suggest it might also stop hair loss, however; there are at least as many reports that contradict this.  Moreover, we haven’t seen any evidence to suggest it can stimulate new hair growth or hair regrowth.

PABA comes in doses of 100mg, 250mg, and 500mg as a standalone product.  However, since no formal clinical studies have been performed on PABA for hair loss, a suitable dosage is mostly speculation.  Additionally, since no regulations have been placed on herbal medication, one should proceed with extreme caution before taking any herbal supplement.  Consulting with a doctor is advised.

Side Effects and warnings:

Some manufacturers of herbal replacements to medication would have you believe that herbal treatments come without potential side effects.  However, this is a farce. 

The following side effects have been reported from consumers of PABA: Anorexia, vomiting, nausea, hypersensitivity, fever and rash (particularly with larger doses). These symptoms went away when PABA is stopped.

Ironically, Provillusonly includes PABA in the woman’s formula.  However, women should know that pregnant women, nursing mothers, and children should avoid using PABA.

For those with renal disease, PABA should be used with caution.  PABA should be stopped if hypersensitivity develops. Those taking pharmaceutical doses of PABA must be under medical supervision.

Rogaine for women is the most recommended treatment for hair loss on the market for women today, and the only FDA approved and clinically proven treatment available for female hair loss sufferers.

Note: Despite what the insert says, Rogaine works just as well for frontal hair loss, recession, and thinning hair.

This product includes the original 2% minoxidil solution manufactured over 15 years ago. While it only reports a 46% success rate as opposed to the 5% liquid solution's 64% and the foam's impressive 85%, Rogaine for women reduces the possibility of unwanted side effects, including the unpopular unwanted facial and body hair growth.

How It Works:

Rogaine works by stimulating the hair follicles and revitalizing them. This sometimes stimulates the regrowth of miniaturizing hairs, promoting a thicker and fuller appearance of hair.

Developing Realistic Expectations:

Rogaine for women is a good starting point for women with thinning hair. While it's not as effective as the 5% liquid solution or Rogaine foam, the possibility of side effects are reduced. Thus, women may want to start small and work their way up to the more advanced Rogaine solutions.

Don't expect immediate results. Just as hair loss is a slow process, regrowing it is too. Thus, it's recommended to use Rogaine for approximately 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you better evaluate the results.

Hair shedding is a common symptom the first few months and a sign that the medication may be working for you. It's crucial to push past this stage with continued use for the recommended period of time.

To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultationwith one of our prescreened hair restoration physicians.

An Active Ingredient in Several Topical Hair Loss Treatments

Azelaic acid is a naturally occurring substance found in whole grains that contains a mild antibiotic designed to “clean” skin.  It is also said to be a potential inhibitor of 5-alpha-reductase in human skin.  A reduction of this enzyme may reduce the amount DHT (dihydrotestosterone) in the body and therefore, have a similar effect to finasteride; the active ingredient in FDA approved oral hair loss solution Propecia (finasteride). In theory, applying azelaic acid to the scalp may prevent or eliminate the binding of DHT to the hair follicle receptor, preventing hair loss and potentially stimulating hair regrowth.  Azelaic acid can be found in many prescription acne medication and topical hair loss products like Xandrox and Provillus. 

Combining azelaic acid with FDA approved hair regrowth solution minoxidil in a single topical product in theory, may prove to be a more powerful hair loss treatment for androgenic alopecia than minoxidil alone.  This is why some conjecture that Xandrox may be a more effective treatment than Rogaine (minoxidil). 

Azelaic acid has not been clinically proven effective as a standalone treatment for treating genetic female hair loss and male pattern baldness. It has also been known to irritate the scalp when applied topically.  Though there is a low percentage, azelaic acid may interact with other medications.  Be sure to consult your physician before using azelaic acid while on other medications.