This story is a part of The Truth About Hair Loss, an exploration into why we lose our hair, the emotional and monetary costs that come along with the experience, and what the future of treatment (and acceptance) could look like.
Even before the pandemic hit, the hair restoration industry was booming (it's projected to reach over $12 billion in 2026). Add in the stress-included hair loss that we’ve seen during the COVID-19 pandemic, and suddenly all eyes are on the scalp.
It may be surprising that, in a market set to see significant growth in the next few years, we're arguably lacking in great solutions to the problem — particularly for women, who aren't always candidates for all the treatments currently available to men. In fact, of the two FDA-approved drugs on the hair rejuvenation market, minoxidil and finasteride (aka Rogaine and Propecia, respectively), only Rogaine is also approved for women. But with advances in technology and other innovations on the horizon, that all may change in the next few years.
Why is treating hair loss so hard?
First, hair loss is notoriously persistent. Beyond that, it comes down in large part to the fact that it may happen for a variety of reasons (among them: thyroid and metabolism troubles and possibly air pollution) that may require different solutions. Temporary hair loss, caused by events like chemotherapy, stress, or post-pregnancy, may clear up on its own once circumstances change. But other types require intervention to see improvement: For example, the autoimmune disorder alopecia areata may be treated with immunotherapy or with injected and topical corticosteroids. For your average case of male or female pattern baldness (androgenic alopecia), there are a few options that have varying degrees of results and costs associated with them, and with some come the chance of unsexy side effects (see: finasteride's erectile dysfunction). And while researchers continue to study the underlying causes of hair loss, there hasn’t been a drug approved to combat it since 1997.
For people assigned female at birth, finding the right solution — or solutions — can be especially hard. "In general, male hair loss is mainly caused by the hormone DHT (dihydrotestosterone) which causes hair to progressively thin (miniaturize) over each successive growth cycle," says Christine M. Shaver, a board-certified dermatologist at Bernstein Medical Center for Hair Restoration in New York. "Thus, the main treatment for male hair loss is through simply blocking the formation of DHT." While DHT is also a factor for women, Shaver says that in this group overall "hair loss is more complex [so it] can prove quite difficult to treat." Simply blocking the hormone often isn't enough — plus, the main way of doing it, finasteride, hasn't been approved for women. Not that it doesn't work — studies show it can — but there are enough potential safety concerns for women who are pregnant (or may become pregnant), breast-feeding, or have a family history of breast cancer that the FDA considers it a no-go.
Then there's the fact that women aren't often great candidates for scalp hair transplants. Shaver explains that the way that hair loss typically occurs in women is to blame, as it's commonly diffused all over the scalp rather than concentrated in one bald patch. "This poses an issue with hair transplant because the donor hair in hair transplant at the back and sides of the scalp must be stable and not thinning," she says. If it isn’t, it will continue to thin once implanted.
The Current Hair Loss Treatment Landscape
Before we get into what's on the horizon, here's a quick rundown of the major options available now: First, there is surgical hair transplant, which may or may not be done with robotic assistance, and, again, isn't always an option for women. Another in-office offering is platelet-rich plasma (PRP) scalp injections, in which platelets are separated out from a patient's own blood, and then injected back into the scalp, which offers moderate results in some people.
Looking beyond minoxidil (which has been proven to be somewhat beneficial for both men and women), topically you have serums and the like, which mostly get not-so-great reviews from the experts we spoke with, though there are some exceptions. For instance, Samuel M. Lam, MD, facial plastic and hair restoration surgeon in Plano, TX, and the administrative chair of the multimedia committee for the American Academy of Facial Plastic and Reconstructive Surgery — reported success with redensyl, a topical he's found so effective, he formulated his own serum for brows and lashes with it called Folliflo.
In addition to finasteride in the oral category, you have supplements, some of which, like Nutrafol, get namechecked by from experts as beneficial for some. However, Shaver points out, "There is little scientific support behind the ability of vitamins and supplements to promote hair growth unless the patient has a nutritional deficiency that needs to be corrected."
Another option is low-level laser (aka cold laser) therapy devices, caps, or wands, which "aim to stimulate the hair follicle and cause hair growth," says Shaver. In theory, they may provide some help, but "practically speaking, they often do not provide much improvement when patients try these devices." Furthermore, many of the devices on the market don't have the correct wavelength or strength to get results, adds Lam.
And a note about hair pieces: There have been many advances in toupees and lace-front hairpieces and wigs that make hiding hair loss easier — and pretty much undetectable. But none of the hairstylists we spoke with offered them up as a long-term solution for someone dealing with permanent hair loss. When it comes to hair, people really want it to be home-grown.
The Rise of the Clones (and Robots)
Looking to the future, bioengineered hair — or hair cloning, as it's more commonly referred to — was by far the top innovation named by the experts we spoke with as the one to watch. And it's been a long-time coming. Says Yael Halaas, a board-certified facial plastic surgeon, "Every 10 years I tell my patients we are closer to cloning and growing hair in a laboratory. And every 10 years we are getting closer." Sara Wasserbauer, a board-certified hair restoration surgeon of California Hair Surgeons with locations in San Jose, San Francisco, Walnut Creek, and Napa, explains the cloning can happen two ways, either by replicating hairs in a lab or by cloning the cells that make the hair. Cloning is the hair rejuvenation industry's big hope because, Lam explains, "Once we have unlimited donor supply, we can easily rebuild a [patient's hair]." And that includes anyone with overall hair thinning, rather than a single bald patch.
As of now, "we have studies that show hair regeneration from stem cells in mice, but so far no clinical studies to support efficacy in humans," says board-certified plastic and hair surgeon Gary Linkov of City Facial Plastics in New York City. But a team of scientists in Japan, led by Takashi Tsuji, is currently awaiting the start of a clinical trial to test cultured hair follicles in humans, so all eyes will be on the results.
Linkov, who currently prefers to do hair implantation by hand or via motorized equipment, predicts that when we have cloning, we'll also have better robots to help with the transplants. He says, "I envision a time when the surgeon can harvest a few hairs from a person, send it to a company for expansion into thousands of grafts and then plug those grafts into a machine that would perform the transplant."
Exosome Hair Therapy
The second-most name-checked therapy on the horizon is the use of exosomes, which use the same mRNA technology seen in the Pfizer and Moderna COVID-19 vaccines. Explains Wasserbauer, "Exosomes contain mRNA, which is the same type of 'messenger RNA' that COVID-19 vaccines are using to tell cells what to do to recognize the virus. Messenger RNA can tell a cell to do many different things like grow, shrink, or produce a certain protein." Halaas (who co-authored a paper reviewing its therapeutic potential) calls it "by far the most exciting treatment in recent years."
Exosomes are administered via injection, so it's a low-pain option, and patients will likely require maintenance injections once or twice a year. But many are hopeful it could be a good solution. Wasserbauer says, "Everyone in the hair medicine community is anxious to see results of the scientific trials."
New (and Potentially Better) Topicals
There are two innovations getting buzz on the cusp of finishing clinical trials overseas. First, there's a drug called FOL-005 that's being developed for men by the biotech company Follicum. It features osteopontin, a protein in hair which may stimulate or inhibit hair growth, depending on the derivative (Follicum claims to have isolated a stimulating one). It has been studied in injections and is now being looked at in topical form. Linkov calls it "promising for now, but time will tell its safety and effectiveness in humans as their clinical trials proceed."
Another topical with growing buzz, thanks to its ability in trials to antagonize DHT without serious adverse effects, is Breezula, an anti-androgen made by the pharmaceutical company Cassiopea. Explains Halaas, "Because it works on DHT locally, we are hoping we will see good results without the side effects of Propecia." So far its trials have been done on men but the company is currently studying its use for women.
Better Low-Level Light Therapy
While this therapy is currently not considered a go-to treatment — in fact, Shaver predicted a slow turn away from laser therapy, calling it "underwhelming" for most patients — some of the experts we spoke with see the potential for big advances in this area.
The thinking here is that as devices (used both at-home and in-offices) get better and deliver the type of light that provides results, the before/afters will become more dramatic. Wasserbauer’s take: "Low-level light therapy has been dosed improperly for decades." The idea that the optimal number of photons of the right wavelength, direction, strength, as well as the correct time on the head will be found — and can be delivered at home — is exciting because "it's drug-free and boosts the efficacy of other hair loss treatments, even exosomes presumably," she says.
The Bottom Line
Cloning, robots, mRNA technology, and suped-up laser caps — they all show promise. In reality, whatever technologies may come, patients will likely mix and match them to find their perfect regime. That means hair rejuvenation may end up looking like something out of a sci-fi movie. Can't say we didn't see that coming.