Treatment of genetic hair loss: Can it ever make my hair worse?

Treating AGA: Will I be worse off with treatment?

Androgenetic hair loss is a type of hair loss that affects about 85 % of men and 50% of women in their lifetimes. In men, androgenetic alopecia is also known as male balding and male pattern balding. In women, this type of hair loss is known as female pattern balding and female pattern hair loss.

I’m often asked if using treatment for genetic hair loss can ever make one worse off than not using it at all. Overall, this is rare although not impossible. There are two scenarios that one needs to consider: short term and long term.

When can treatment make things worse?

Generally speaking, a treatment has the potential to make someone’s hair loss worse if 1) the patient has rapidly progressive androgenetic alopecia to begin with AND 2) the patient is a non-responder to the given treatment AND 3) the treatment provokes significant shedding AND 4) the treatment provides prolonged shedding. Generally all 4 of these need to be present.

It’s the patients with more rapid forms of genetic hair loss that have the potential to be worse off if a treatment provokes shedding and does not work. This is because shedding can speed up the progression of genetic hair loss. I have referred to this phenomenon in the past as AFMPS - accelerated follicular miniaturization from prolonged shedding. Unfortunately it takes about 9 months of treatment to really get a sense if a patient is a non-responder to treatment.

Prolonged shedding itself in patients who don’t have a rapidly aggressive form of genetic hair loss (i.e. criteria 1) doesn’t necessarily make things worse. There are some patients who shed with minoxidil for example and don’t seem to benefit and simply stop. They are not harmed by trying.

Common Misconceptions and Myths

There are a number of errors in judgement that patients make when thinking about whether a treatment can make their hair worse. For example, a patient might ask

“If I use a treatment for 5 years, and decide to stop, will I be worse off than if I didn’t use the treatment at all?

It’s important to understand that this answer is typically “no.” If a patient stops after 5 years they will simply return to the density they were supposed to have. This may of course be much less than they started with - but that’s because they were genetically determined to have that amount of hair loss.

Let’s say for the sake of discussion that a person decides to startstreatment at age 35 with 70,000 hairs on the scalp. They use a treatment and after 5 years they are pleased because they have 70,000 hairs on the scalp at age 40. Now, they stop treatment and find that one year at age 41 later they have 50,000 hairs on the scalp. Did stopping treatment make things worse? Yes, stopping made the hair loss worse, but it wasn’t the fault of being on the drug that did it. The patient was genetically programmed to have 50,000 hairs on the scalp at age 41. They are also genetically programmed to have 30,000 hairs on the scalp at age 49 so if they chose to remain off treatment, this is likely the density they are headed towards.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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