Treating Hair loss: The ‘next move’ is not a guessing game!

Treating Hair loss: Logical. Ordered. Structured.

There are over 100 reasons for hair loss. Each of the causes has different treatment.  In my mind, for every patient I see, there is one or two “best’ treatments, and then the third best treatment. If that treatment does not help, I have a next (fourth) treatment in mind.  The choice of treatment is not random.

Just like in a game of chess,  there is logic to planning each phase of treatment.  There is order. There is structure. Every treatment has a specific ‘chance’ or specific ‘odds’ that it will help.  Part of the intellectual stimulation of treating hair loss comes from understanding these odds.  I don’t leave the office each day with the false hope that I’ve helped everyone I’ve seen that day with hair loss. Not at all. For example, this week I know that 40-60 % of patients I saw will get benefit from the treatments I recommended. But I also know, that unfortunately 40 % of the patients I saw will not.  Do I know which will benefit and which will not? Not at all.  In the present day, there is no treatment that helps 100 % of patients.

How do you determine the order of treatments?

Planning the order of  treatments is not a guessing game.  Even if there are five accepted treatments for a given type of hair loss,  one should never choose their treatments by pulling one of these five treatment out of a hat. The order of treatments should be based on previous studies that have been published in medical journals. In medicine, we call this ‘evidence.’ The order of treatments should be based on published medical evidence.    

What happens when ‘medical evidence’ does not factor into decision making? Chaos.

But in the ‘real world’, most individuals do not like to speak in terms of ‘medical evidence’.  In the public’s eye, knowing that there have been over 25 well conducted studies of treatment A but none of treatment B does not necessarily make drug B less appealing than drug A.   I know that sounds strange but I have heard it nearly everyday of my professional career. Had you asked me that 10 years ago, I would have said this concept was impossible. But provided information on treatment B can be presented in a manner that sounds convincing, it can quickly find it’s way to the top of the patient’s list of preferred treatments. Sales & marketing not science & evidence frequently rule decision making in the real world.

Chaos.

Chaos is a term which refers to a state of confusion and disorder.  When medical evidence is left out of the decision making on hair loss treatments, the result is chaos. Patients with hair loss want nothing more than to have some control over a situation (i.e. hair loss) in which they deem to have little or no control. But by leaving medical evidence out of the decision making process about what hair loss treatment to choose, the result is chaos. 

This week alone, several phone calls and e-mails I received from individuals with hair loss drew attention to this chaos.

“I have scarring alopecia and was advised to start carboxytherapy.” What do you think doctor?

“I have a few patches of hair loss from  alopecia areata and was recommended to start a daily application of an oil mixture? What do you think doctor?

“I have genetic hair loss and was recommended to start treatment with scalp massage? What do you think doctor?

What I think is that in the world of hair loss treatments, there is needless confusion and disorder.  There is chaos.  

Conclusion and Final Thoughts.

In the chaos that exists out there in the real world of treating hair loss,  we need to remember that many hair loss treatments have already been carefully studied.   Statistics can readily be given on how well they ‘work.’  Clear statistics can be given on the proportion of patients that are expected to benefit from the treatment.  Newer treatments may have less evidence, but if they are truly effective, they quickly accumulate medical evidence and published studies.

It’s not practical or possible for individuals in the general public to know all the medical evidence behind various treatments. However, there are two simple questions that every patient with hair loss should ask their treating physician. If every patient asked these questions,  I believe that many treatments would never be started.

1) For the type of hair loss I have, how many scientific studies with this treatment you are suggesting have been published in the medical journals?

Is it zero? Is it one?  Two? 10 ? I encourage patients to begin with treatments that have several published studies. If a treatment is truly beneficial, why would it not be published in the medical journals?

2) What proportion of patients benefitted when they took the treatment you are suggesting?

Is it 2%?  Is it 50%  I encourage patients to begin with treatments that are likely to benefit 30 % or more patients.  It’s rare in the present day to have treatments that lead to an improvement in hair density in more than 50 % of patients. So, if a treatment is offered that helps 100 % of patients, be cautious!

There is logic to treating hair loss. What I hope for many patients entering my office or reading my blogs is that they find some calmness and clarity amongst the chaos.  Treating hair loss is not a guessing game.  For most types of hair loss, there is a best first step, a second step and third step.