What can be done to increase hair growth?

Strategies to Increase Hair Growth

Topical minoxidil 5% is the most effective first-line treatment for increasing hair growth, with established efficacy for pattern hair loss and recommended by multiple clinical guidelines. 1, 2

First-Line Treatments

Topical Minoxidil

• Dosage and application: Apply 5% solution twice daily to the scalp
• Mechanism: Promotes hair regrowth by prolonging the anagen phase and increasing blood flow to hair follicles
• Evidence: FDA-approved for hair regrowth on the vertex (top of scalp) 2
• Expected results: May take 4 months of consistent use before visible results 2
• Side effects: Scalp irritation, unwanted hair growth on face (rare) 2

Nutritional Optimization

• Correct deficiencies: Check and address deficiencies in:
  • Iron (ferritin levels should be ≥60 ng/mL) 3
  • Vitamin D
  • Zinc
  • Biotin (2.5 mg daily) 4
  • Orthosilicic acid (10 mg daily) 4

Second-Line Treatments

Platelet-Rich Plasma (PRP)

• Procedure: Autologous platelet concentrates injected into the scalp
• Mechanism: Induces proliferation of dermal papilla cells and increases perifollicular vascularization 4
• Evidence: Clinical trials show significant increase in hair density per cm² 4
• Note: Higher platelet concentration correlates with better outcomes in terms of hair density and follicle diameter 4

Scalp Stimulation

• Microneedling: Creates controlled micro-injuries that stimulate growth factors
• Evidence: Superior to injection techniques for improving anagen hair phase and hair length 4
• Can be combined with topical treatments for enhanced absorption

Monitoring Treatment Response

Objective Measures

1. Trichoscopy: Examine scalp and hair follicles with specialized magnification
2. Hair counts: Count number of hairs in specific scalp areas before/after treatment
3. Hair diameter measurements: Assess changes in hair shaft thickness
4. Pull test: Evaluate hair fragility and shedding 1

Subjective Measures

• Photography: Before-and-after comparisons
• Patient self-assessment: Track satisfaction with treatment

Important Considerations and Pitfalls

Diagnosis First

• Rule out underlying conditions causing hair loss:
  • Endocrine disorders (thyroid dysfunction, PCOS) 5
  • Autoimmune conditions (alopecia areata) 1
  • Nutritional deficiencies (especially iron deficiency, which accounts for 70.3% of female alopecia cases) 3

Treatment Expectations

• Timeline: Minimum 4 months of consistent treatment before evaluating efficacy 2
• Variable response: Hair regrowth differs between individuals 2
• Maintenance: Continued treatment required to maintain results

Contraindications

• Minoxidil: Not for use by women (5% formulation), on inflamed/infected scalp, or in patients with heart disease 2
• Scalp cooling: Contraindicated in hematological malignancies, cold sensitivity disorders, and post-chemotherapy whole-brain radiation 4

Special Populations

Women

• Consider lower concentration minoxidil (2%) for female pattern hair loss 1
• Iron levels: Women require higher ferritin levels (≥60 ng/mL) for optimal hair growth compared to the threshold for anemia (12.0 g/dL hemoglobin) 3

Post-Chemotherapy

• Minoxidil 5%: May aid in hair regrowth after completion of chemotherapy 4
• Scalp cooling: Can prevent chemotherapy-induced alopecia during treatment 4

By following this evidence-based approach to increasing hair growth, patients can maximize their chances of achieving visible improvement in hair density and quality while minimizing potential side effects.