Medical hair restoration in the literal sense includes the hair loss treatment which depends upon the use of medicines.

Unusual hair loss both in men and women is caused by the alterations in the androgen metabolism. Androgen is a male hormone which has a major role to play in regulation of hair growth or hair loss. The dermal papilla is the most important structure in a hair follicle which is responsible for hair-growth. It is the dermal papilla, the cell of which divides and differentiates to give rise to a new hair follicle. The dermal papilla is in direct contact with blood capillaries in the skin to derive the nutrients for the growing hair follicle. Research has shown that dermal papilla got many receptors for androgens and there are studies which have confirmed that males have more androgenic receptors in dermal papilla of their follicles as compared to females.

The metabolism of androgen involves an enzyme called 5 alpha reductase which combines with the hormone androgen(testosterone) to form the DHT (Dihydro-testosterone). DHT is a natural metabolite of our body which is the root cause of hair loss.

Proper nutrition is critical for the maintenance of the hair. When DHT gets into the hair follicles and roots (dermal papilla), it prevents necessary proteins, vitamins and minerals from providing nourishment needed to sustain life in the hairs of those follicles. Consequently, hair follicles are reproduced at a much slower rate. This shortens their growing stage (anagen phase) and or lengthens their resting stage (telogen phase) of the follicle. DHT also causes hair follicle to shrink and get progressively smaller and finer. This process is known as miniaturization and causes the hair to ultimately fall. DHT is responsible for 95% of hair loss. Some individuals both men and women are genetically pre-disposed to produce more DHT than the normal individuals. DHT also creates a wax-like substance around the hair roots. It is this accumulation of DHT inside the hair follicles and roots which is one of the primary causes of male and female pattern hair loss.

Blocking the synthesis of DHT at molecular level forms the basis for the treatment of MPHL ( male pattern hair loss) and FPHL ( female pattern hair loss). There are many natural DHT blockers and a number of drugs which are used for medical hair restoration.

Let us see the main drugs which are available for medical hair restoration in men and women.

Minoxidil

Minoxidil has the distinction of the first drug being used for promoting the hair restoration. This medical hair restoration treatment drug was used earlier as an oral antihypertensive drug, but after its hypertrichosis (excessive body hair) effects were noticed, a topical solution of the drug was tested for its hair growing potential. Minoxidil was then approved as medical hair restoration treatment drug for men by the US Food and Drug Administration (FDA) in 1988 as a 2% solution, followed by 5% solution in 1997. For women, the 2% solution was approved in 1991. Though 5% solution is not approved for women, it is used as a medical hair restoration treatment by many dermatologists worldwide. Both solutions are available without a prescription in the US.

Mechanism of action

Minoxidil is thought to have a direct mitogenic effect on epidermal cells, as has been observed both in vitro in vivo. Though the mechanism of its action for causing cell proliferation is not very clear, minoxidil is thought to prevent intracellular calcium entry. Calcium normally enhances epidermal growth factors to inhibit hair growth, and Minoxidil by getting converted to minoxidil sulfate acts as a potassium channel agonist and enhances potassium ion permeability to prevent calcium ions from entering into cells.

Thought the exact action of minoxidil preventing the formation of DHT has not been shown but the drug has been shown to have a stabilizing effect on the hair loss. The result of the drug takes about few months time to be evident since it is the time which is necessary for restoring the normal growth cycle of hair fibers.

Use of Minoxidil has approved by FDA for men (Norwood II-V) and women (Ludwig I-II ) older than 18 years. It is used as a medical hair restoration treatment either for frontal or vertex scalp thinning. It brings about an increase in density which is mostly caused by conversion of miniaturized hairs into terminal hairs rather than a stimulated de novo re-growth. The hair loss becomes stabilized after continued use of drug, which takes about a year