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Understanding medication-induced hair loss

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Man Worried about medicine-induced Hair LossWith new medications arriving on the market all the time that patients may be unfamiliar with, prescription requests are often accompanied by a flurry of questions. Understandably, the prescribing doctor does not always have the time to go through all the side effects of the medications. Part of our function as dispensers is to provide answers to questions and share evidence-based resources. Medication-induced hair loss is one of the most common subjects we deal with. This article aims to provide a comprehensive overview of the most common questions in this area. Please keep in mind that serious concerns about medications should be discussed with the prescribing doctor because there are no hard-and-fast rules that can predict whether or not a specific drug will induce hair loss in a person. Everyone reacts differently to medications, so it’s impossible to state unequivocally that a side effect will or will not occur for any particular individual. This piece addresses the more commonly reported results.  

A short introduction to the cycle of hair growth and loss

There are two main types of hair. The more visible, longer, and thicker hair is called terminal hair. It covers about 90% of the body in adult men and about 30 percent of the body’s surface in adult women. It is found mostly on the head and face and forms eyelashes, eyebrows, pubic, chest, and belly hair. There are also shorter and thinner vellus hairs on the body, sometimes called peach fuzz. This article mainly addresses terminal hair. We will be focusing on the scalp since this is the main area of concern regarding hair loss as a side effect of medications. There are some instances where hair loss can occur in other parts of the body. Still, usually, this happens along with scalp hair loss, so understanding medication-induced hair loss on the scalp should be enough to cover all aspects of body hair loss.

What is the main hair growth cycle?

New cells are constantly forming in the hair follicles. About one million hair follicles are in the top two layers of skin covering the scalp. Individual follicles usually live for between seven and eight years. A follicle comprises a group of cells forming a tube-like pore. The cells stick together and harden. The full strand of hair grows from this group of hardened hair cells. While the root is active, hair growth occurs in a continuous process characterized by four phases:
  • Anagen – Growth of hair. In this phase, new hardened cells attach to the hair strand from below, so it is gradually being pushed out of the skin.
  • Catagen – Regression of the follicle. This phase usually lasts two weeks, during which hair growth slows down and finally stops. The hair follicle detaches from the blood supply, leading to the formation of a new follicle in the root. The hair strand is no longer actively growing during this phase. It loses 20-30% of its diameter but remains firmly anchored in the hair follicle.
  • Telogen – The resting phase, which can last several months. Without blood supply, the hair strand is gradually pushed out and finally falls out. A new hair strand then starts to form at the base of the “empty” hair follicle to form a new hair, and the growth phase of the hair growth cycle starts all over again.
  • Exogen – The shedding phase. This phase is (basically) the final part of the telogen phase. Hair strands are released from the hair follicles while new hairs are growing in the follicles. It’s to be expected that as many as 100 hairs may fall out each day, which is normal daily hair loss.

How do medicines affect hair health?

Some medications can lead to hair loss as a side effect. This occurs mostly when a drug interferes with the normal cycle of scalp hair growth. The different types of influence depend on the mechanisms of the drug. The main effects are:
  • Slowing down the growth phase (anagen)
  • Causing more hairs than usual to enter the resting (telogen) and falling out (exogen) phases
  • Directly damaging the hair follicles.
Medications can cause hair loss through two primary mechanisms:
  • Anagen effluvium occurs during the hair’s growth phase, often due to medications that affect cell reproduction, such as chemotherapy agents, resulting in significant hair loss.
  • Telogen effluvium, sometimes referred to as hair shedding, is the most common type of medication-induced hair loss. It involves premature shifting of hair from the growth phase to the resting phase, leading to shedding.

Which medications are known to cause hair loss through anagen effluvium?

Chemotherapeutic drugs are a major cause of hair loss. According to the article dealing with Anagen Effluvium on the National Library of Medicine website, the condition is often referred to as chemotherapy-induced alopecia, as it can be triggered by the types of drugs administered as chemotherapeutic therapy, specifically antimetabolites, mitotic inhibitors, and alkylating agents. Some specific examples are
  • Nexavar – Prescribed to treat patients with advanced kidney, liver, or thyroid cancers
  • Femara – Treats estrogen receptor-positive cancers in postmenopausal women
  • Nolvadex-D – Treats advanced breast cancer in men and women and early breast cancer in women.
Beta-blockers, mostly used to treat high blood pressure, have been linked to hair loss. The most common ones are Lopressor Inderal and Tenormin, The older forms of blood thinners (anticoagulants), mainly Heparin and Warfarin, have been associated with hair loss. Newer anticoagulants like direct oral anticoagulants (DOACs) are not currently believed to be implicated in alopecia. Anticonvulsants known to induce hair loss are Depakote/Depalept (based on sodium valproate) and Tegretol or Carbatrol (based on carbamazepine). Most of the common types of antidepressants have hair loss listed as a side effect. These include Wellbutrin, SSR (selective serotonin reuptake) inhibitors such as Luvox, and SNR (serotonin and norepinephrine reuptake) inhibitors like Cymbalta, Prozac, and Effexor. Hormonal therapies such as birth control pills and contraceptives usually are based on testosterone, which can trigger changes in hair growth in women. Hormone Replacement Therapy (HRT) for menopausal women has been reported to cause androgenetic alopecia, which presents as a gradual thinning of the hair, especially on the crown and along the part line.

Is medication-induced hair loss permanent?

In many cases, hair loss from medication is not permanent. Hair can usually grow back once the medication causing the problem is stopped or changed. While preventing hair loss caused by medication might not be entirely possible, steps can be taken to minimize the impact (assuming that the treating physician does not recommend switching to a different medication).

Steps to minimize medication-induced hair loss:

  • Try to maintain a balanced diet that is rich in the vitamins and minerals that support hair health.
  • Avoid aggravating the effect of any medications by avoiding hair styling practices that can stress the hair follicles, such as heat styling, and harsh chemicals, such as formaldehyde, used in keratin hair-smoothing treatments. Limit styling that pulls on the hair roots with tight braids, cornrows, dreadlocks, hair extensions, or weaves.
  • If undergoing chemotherapy, there are cooling caps that can be worn during chemotherapy sessions to reduce the risk of hair loss.

Can supplements or treatments help regrow hair after medication-induced hair loss?

It is necessary to tread carefully when addressing a question like this. Everyone is unique, and the exact causes of medication-induced hair loss can be a combination of the person’s specific medications, the condition being treated, and their own body’s way of metabolizing any drugs. Adding another drug into the medication cocktail may not only fail to produce a beneficial effect but may make things worse. However, based on many years of answering this question, there are two products that we have been able to recommend and for which customers have come back with favorable reviews and re-orders. What’s important to remember is that hair growth is a slow process, so there’s no way to get full regrowth quickly. Nevertheless, the following reputable products can help the lost hair to grow again in a reasonable length of time. Loniten (minoxidil) is not specifically FDA-approved for medication-induced hair loss, but it can be prescribed off-label for this purpose by a healthcare professional. Minoxidil is usually prescribed to treat androgenetic alopecia, also known as pattern baldness. This condition is the main cause of male baldness, which presents as a receding hairline and crown thinning. It has also been shown to stimulate hair growth and improve hair density in other types of alopecia by prolonging the growth phase of the hair cycle. Its effectiveness for medication-induced hair loss derives from its ability to promote blood flow to the hair follicles, which can counteract the effects of medications that disrupt hair growth cycles. Phyllotex is an over-the-counter oral medication designed to boost hair regeneration by supplying all the necessary vitamins and minerals for hair health. It has been proven to both slow down hair loss and promote recovery after medication-induced hair loss. Tests showed that after three months, the hair count of many patients had doubled, and it doubled again after six months if they persisted with treatment. Phyllotex is a proprietary product containing tabebuia avellanedae (Pau D’arco), green coffee beans, acai, and olive leaf. It also has added vitamins and minerals such as vitamin D, vitamin B5 (pantothenic acid), magnesium, and zinc. These work together to protect and stimulate hair follicles and reverse hair loss. Phyllotex can reduce excess hair shedding and promote faster growth of thicker and longer hair. It is completely natural, vegetarian, without side effects, and intended for both women and men.  
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