A 42-year-old man recently asked us an important question. His hair is entirely white, and there is not much of it. He has tried everything — every kind of vitamin, every treatment from the drugstore, the laser cap — and he has read a great deal about hair loss. He is reluctant to have a hair transplant, because it is expensive and painful.
He asks: what can I do? Can this only be solved with doctors, or is there something I can do on my own? Do the hair bulbs disappear and never come back? Is there any hope that they will return and grow, or is that not possible at all, and can we only treat the hair that is still there?
This article answers his questions.
Understanding hair loss: what is alopecia?
First, the types of hair loss need to be distinguished.
Alopecia is the medical term for hair loss. It is not a single condition. It has many causes, and each requires a correct diagnosis.
The types of hair loss include:
- Androgenetic alopecia, which is very common in men, including those who previously had thick hair
- Hair loss following illness or surgery
- Hair loss after pregnancy and breastfeeding, in women
- Deficiencies of vitamins and minerals
- Certain medications
- Physical pulling, or the use of unsuitable products that damage the hair
- Fungal, inflammatory or bacterial infections of the scalp itself
- Glandular disorders, such as thyroid conditions
All of these need to be diagnosed correctly.
What about grey or white hair?
Hair turns grey or white because the hair bulb stops producing melanin, the pigment that gives hair its colour.
There are many reasons for this:
- Genetics, which is the most important one
- Ageing
- Stress, although not every grey or white hair is caused by stress
- In some cases a lack of vitamin B12, copper or iron, particularly when other symptoms are present as well
- Certain autoimmune diseases and thyroid disorders
- Smoking, which increases the likelihood of going white early
- Oxidative stress
Where the cause is genetic or simply ageing, there is at present no proven treatment that restores the colour permanently.
Where the cause is a treatable illness or a deficiency of certain minerals or vitamins, treatment can help, particularly if the white hair appeared recently.
Vitamins, biotin and the supplements marketed against white hair are not proven treatments for patients who are not deficient in those substances.
Do hair bulbs disappear permanently, or can they come back?
If the hair bulb is still present and not scarred, it will normally produce hair again.
In androgenetic alopecia the hair bulb becomes progressively smaller. This is called miniaturisation. The bulb does not disappear outright.
Treatment can therefore help it to produce thicker hair again, provided the bulb is not scarred, severely damaged or destroyed.
Scientifically proven treatments for androgenetic alopecia in men
The scientifically proven treatments for androgenetic alopecia in men are:
- Topical minoxidil
- Oral (systemic) finasteride
- Oral (systemic) dutasteride, which is used in some countries under a doctor's supervision
- *What is DHT, and why do we mention it?**
DHT is the hormone that acts on the hair bulb. It drives the miniaturisation that leads to hair loss in androgenetic alopecia.
- *How do these medications work against DHT?**
Finasteride reduces DHT and thereby slows the miniaturisation of the hair bulb. Dutasteride inhibits DHT more strongly still.
These are the strongest treatments for androgenetic alopecia if the patient does not want a transplant.
The drawback of finasteride and dutasteride is that in some patients they cause:
- Reduced sexual desire
- Erectile dysfunction
- Ejaculation disorders, such as delayed or absent ejaculation
This is why many patients hesitate to take them.
- *Why do we not use oral minoxidil instead of topical minoxidil, and why are dutasteride and finasteride not applied topically?**
Oral minoxidil is used in some patients, but it was developed as a medication for high blood pressure. Low blood pressure can therefore occur as a side effect, and unwanted hair may grow elsewhere on the body.
Some doctors inject dutasteride or finasteride intradermally into the scalp, as mesotherapy, to reduce the systemic effect. This remains weaker than oral treatment or topical minoxidil.
The genetic nature of androgenetic alopecia
Androgenetic alopecia is genetic.
This means there is no permanent solution: once minoxidil, oral treatment or any other therapy is stopped, the genetic process resumes and the hair begins to fall again.
The only treatment with a longer-lasting result is a hair transplant. Transplanted hair needs care as well, just as hair unaffected by alopecia does.
What about PRP, laser, microneedling and mesotherapy?
PRP, low-level laser therapy, microneedling, mesotherapy, proteins and supplements, and shampoos can support the main treatments, but they cannot treat the condition on their own. They are useful as a routine to maintain and support the hair, not as a treatment.
A final word
Hair loss and white hair can be frustrating, particularly after trying many things on your own. The most important step is a correct diagnosis by a dermatologist. Only then is it clear which type of hair loss you have, whether the hair bulbs can recover, and which treatment or combination of treatments is right for you.
- This article is for information only and does not replace a personal consultation with a dermatologist. Every patient's skin and hair are different, and treatment plans have to be tailored individually.*