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-{{Use mdy dates|date=September 2012}}
-The '''management of hair loss''', also known as [[alopecia]] or [[baldness]], may include medications and surgery.
-==Medication==
-Treatments for the various forms of hair loss have only moderate success.<ref name=Levy2013/> Three medications have evidence to support their use in male pattern hair loss: [[finasteride]], [[dutasteride]] and [[minoxidil]].<ref name=Ban2013/> They typically work better to prevent further hair loss than to regrow lost hair.<ref name=Ban2013/>
-They may be used together when hair loss is progressive or further regrowth is desired after 12 months.<ref name="webmd_treatments">{{cite web |url=http://www.webmd.com/skin-beauty/guide/hair-loss-treatments |title=Propecia & Rogaine for Treating Male Pattern Baldness |publisher=Webmd.com |accessdate=May 19, 2010}}</ref> Other medications include [[ketoconazole]], and in female androgenic alopecia [[spironolactone]] and [[flutamide]].<ref name="pmid22735503">{{Cite journal| last1 = McElwee | first1 = K. J.| last2 = Shapiro | first2 = J. S.| title = Promising therapies for treating and/or preventing androgenic alopecia| journal = Skin therapy letter| volume = 17| issue = 6| pages = 1–4| year = 2012| pmid = 22735503}}</ref> Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use.<ref>{{Cite journal| last1 = Khandpur | first1 = S.| last2 = Suman | first2 = M.| last3 = Reddy | first3 = B. S.| title = Comparative efficacy of various treatment regimens for androgenetic alopecia in men| journal = The Journal of dermatology| volume = 29| issue = 8| pages = 489–498| year = 2002| pmid = 12227482 | doi=10.1111/j.1346-8138.2002.tb00314.x}}</ref>
-===Minoxidil===
-[[Minoxidil]], applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with [[androgenic alopecia]].<ref name=Var2014/><ref>{{Cite journal|last=van Zuuren|first=Esther J.|last2=Fedorowicz|first2=Zbys|last3=Schoones|first3=Jan|date=2016-05-26|title=Interventions for female pattern hair loss|journal=The Cochrane Database of Systematic Reviews|issue=5|pages=CD007628|doi=10.1002/14651858.CD007628.pub4|issn=1469-493X|pmid=27225981}}</ref> About 40% of men experience hair regrowth after 3–6 months.<ref>{{cite journal | pmid = 25112173 | doi=10.1111/dth.12164 | volume=28 | issue=1 | title=Clinical utility and validity of minoxidil response testing in androgenetic alopecia. | journal=Dermatol Ther | pages=13–6}}</ref> It is the only topical product that is FDA approved in America for androgenic hair loss.<ref name=Var2014>{{cite journal|last1=Varothai|first1=S|last2=Bergfeld|first2=WF|title=Androgenetic alopecia: an evidence-based treatment update.|journal=American journal of clinical dermatology|date=July 2014|volume=15|issue=3|pages=217–30|pmid=24848508|doi=10.1007/s40257-014-0077-5}}</ref> However, increased hair loss has been reported.<ref>http://www.drugs.com/sfx/rogaine-side-effects.html</ref><ref name="Drugs.com">{{cite web | url = http://www.drugs.com/pro/minoxidil.html | title = Minoxidil Official FDA information, side effects and uses | publisher = Drugs.com}}</ref>
-===Antiandrogens===
-<!-- Finasteride -->
-[[Finasteride]] is used to treat [[male pattern hair loss]].<ref name=PropeciaLabel>{{cite web |url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020788s024lbl.pdf |title=Propecia label}}</ref> Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken.<ref name=2014AArev>{{cite journal|last1=Varothai|first1=S|last2=Bergfeld|first2=WF|title=Androgenetic alopecia: an evidence-based treatment update.|journal=American journal of clinical dermatology|date=Jul 2014|volume=15|issue=3|pages=217–30|doi=10.1007/s40257-014-0077-5|pmid=24848508}}</ref> There is no good evidence for its use in women.<ref name=Levy2013/> It may cause [[gynecomastia]], [[erectile dysfunction]] and [[Depression (mood)|depression]].<ref>{{Cite journal| last1 = Andersson | first1 = S.| title = Steroidogenic enzymes in skin| journal = European journal of dermatology : EJD| volume = 11| issue = 4| pages = 293–295| year = 2001| pmid = 11399532}}</ref>
-<!-- Dutasteride -->
-[[Dutasteride]] is used off label for male pattern hair loss.<ref>[http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=11618 Avodart 0.5 mg soft capsules | SPC from the eMC]</ref>
-<!-- Spironolactone -->
-There is tentative support for [[spironolactone]] in women.<ref name=Levy2013/> Due to its feminising side effects and risk of infertility it is not often used by men.<ref>{{Cite journal| last1 = Buchanan | first1 = J. F.| last2 = Davis | first2 = L. J.| title = Drug-induced infertility| journal = Drug intelligence & clinical pharmacy| volume = 18| issue = 2| pages = 122–132| year = 1984| pmid = 6141923}}</ref><ref>{{Cite journal| last1 = Sinclair | first1 = R.| last2 = Patel | first2 = M.| last3 = Dawson | first3 = T. L.| last4 = Yazdabadi | first4 = A.| last5 = Yip | first5 = L.| last6 = Perez | first6 = A.| last7 = Rufaut | first7 = N. W.| title = Hair loss in women: Medical and cosmetic approaches to increase scalp hair fullness| doi = 10.1111/j.1365-2133.2011.10630.x| journal = British Journal of Dermatology| volume = 165| pages = 12–18| year = 2011| pmid = 22171680| pmc = }}</ref> It can also cause [[hypotension|low blood pressure]], [[hyperkalemia|high blood potassium]], and [[cardiac dysrhythmia|abnormal heart rhythms]]. Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a [[teratogen]], and can cause ambiguous genitalia in newborn children.<ref name="Spirono">{{Cite journal| last1 = Rathnayake | first1 = D.| last2 = Sinclair | first2 = R.| title = Use of spironolactone in dermatology| journal = Skinmed| volume = 8| issue = 6| pages = 328–332; quiz 332| year = 2010| pmid = 21413648}}</ref>
-<!-- Flutamide -->
-There is tentative evidence for [[flutamide]] in women; however, it is associated with relatively high rates of liver problems.<ref name=Levy2013/> Like spironolactone, it is typically only used by women.<ref>{{Cite journal| last1 = Yazdabadi | first1 = A.| last2 = Sinclair | first2 = R.| doi = 10.1111/j.1440-0960.2010.00735.x| title = Treatment of female pattern hair loss with the androgen receptor antagonist flutamide| journal = Australasian Journal of Dermatology| volume = 52| issue = 2| pages = 132–134| year = 2011| pmid = 21605098| pmc = }}</ref>
-===Ketoconazole===
-[[Ketoconazole]] may help in women.<ref name=Levy2013/>
-==Surgical treatments==
-===Hair transplantation===
-{{main article|Hair transplantation}}
-{{double image|right|Man before receiving hair transplant.jpg|150|Man after receiving hair transplant.jpg |130|A man before and after a hair transplant.}}
-Hair transplantation is a [[surgery|surgical]] technique that moves individual [[hair follicle]]s from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore [[eyelash]]es, [[eyebrow]]s, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from [[skin graft]]ing in that grafts contain almost all of the [[Epidermis (skin)|epidermis]] and [[dermis]] surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
-Since hair naturally grows in follicles in groups of 1 to 4 hairs, [[Organ transplant|transplant]]ation takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through [[Follicular unit transplantation]] (FUT).
-Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called [[Hair follicle|follicular units]], can be moved to balding areas of the [[hair restoration]]. These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as "strip harvesting", or [[Follicular Unit Extraction]] (FUE), in which follicles are transplanted individually.
-In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp.<ref>{{Cite journal| last1 = Rashid | first1 = R. M.| last2 = Morgan Bicknell | first2 = L. T.| title = Follicular unit extraction hair transplant automation: Options in overcoming challenges of the latest technology in hair restoration with the goal of avoiding the line scar| journal = Dermatology online journal| volume = 18| issue = 9| pages = 12| year = 2012| pmid = 23031379}}</ref> After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar.<ref name="pmid22808618"/>
-===Scalp reduction===
-{{main article|Scalp reduction}}
-Scalp reduction is a surgical procedure in which the hairless region of the scalp of a [[Pattern hair loss|bald man]] is reduced. This procedure can reduce the area of the scalp without hair.<ref>{{cite journal |last=Bell |first=M. L. |last2= |first2= |date=February 1982 |title=Role of scalp reduction in the treatment of male pattern baldness |journal=[[Plastic and Reconstructive Surgery]] |volume=69 |issue=2 |pages=272–7 |doi= 10.1097/00006534-198202000-00016|pmid=7054796}}</ref><ref>{{cite book |last1=Unger |first1=Martin G. |author-link1= |last2=Toscani |first2=Marco |author-link2= |last3= |first3= |author-link3= |last4= |first4= |author-link4= |last5= |first5= |author-link5= |display-authors= |author-mask= |last-author-amp= |date= |year=2016 |orig-year= |chapter=Scalp reduction |script-chapter= |trans-chapter= |chapter-url= |chapter-format= |editor1-last=Scuderi |editor1-first=Nicolò |editor1-link= |editor2-last=Toth |editor2-first=Bryant A. |editor2-link= |editor3-last= |editor3-first= |editor3-link= |editor4-last= |editor4-first= |editor4-link= |editor5-last= |editor5-first= |editor5-link= |display-editors= |title=International Textbook of Aesthetic Surgery |script-title= |trans-title= |url=https://www.springer.com/gp/book/9783662465981 |dead-url= |format= |type= |series= |language= |volume= |issue= |others= |edition= |location= |publisher=[[Springer Nature|Springer]] |publication-date= |page= |pages=555–556 |at= |nopp= |arxiv= |asin= |bibcode= |doi=10.1007/978-3-662-46599-8 |doi-broken-date= |isbn=978-3-662-46598-1 |issn= |jfm= |jstor= |lccn= |mr= |oclc= |ol= |osti= |pmc= |pmid= |rfc= |ssrn= |zbl= |id= |archive-url= |archive-date= |access-date=7 December 2016 |via= |registration= |subscription= |lay-summary= |lay-source= |lay-date= |quote= |name-list-format= |mode= |postscript= |ref= }}</ref>
-==Radiation-induced hair loss==
-Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression.<ref>{{Cite journal| last1 = Nanashima | first1 = N.| last2 = Ito | first2 = K.| last3 = Ishikawa | first3 = T.| last4 = Nakano | first4 = M.| last5 = Nakamura | first5 = T.| doi = 10.3892/ijmm.2012.1018| title = Damage of hair follicle stem cells and alteration of keratin expression in external radiation-induced acute alopecia| journal = International Journal of Molecular Medicine| volume = 30| issue = 3| pages = 579–584| year = 2012| pmid = 22692500| pmc = }}</ref><ref>{{Cite journal| last1 = Kamiya | first1 = K.| last2 = Sasatani | first2 = M.| title = Effects of radiation exposure on human body| journal = Nihon rinsho. Japanese journal of clinical medicine| volume = 70| issue = 3| pages = 367–374| year = 2012| pmid = 22514910}}</ref> Radiation therapy has been associated with increased [[mucin]] production in hair follicles.<ref>{{Cite journal| last1 = Takeda | first1 = H.| last2 = Nakajima | first2 = K.| last3 = Kaneko | first3 = T.| last4 = Harada | first4 = K.| last5 = Matsuzaki | first5 = Y.| last6 = Sawamura | first6 = D.| doi = 10.1111/j.1346-8138.2010.01187.x| title = Follicular mucinosis associated with radiation therapy| journal = The Journal of Dermatology| volume = 38| issue = 11| pages = 1116–1118| year = 2011| pmid = 22034994| pmc = }}</ref>
-Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia.<ref>{{Cite journal| last1 = Kalia | first1 = S.| last2 = Lui | first2 = H.| doi = 10.1016/j.det.2012.08.018| title = Utilizing Electromagnetic Radiation for Hair Growth| journal = Dermatologic Clinics| volume = 31| issue = 1| pages = 193–200| year = 2012| pmid = 23159188| pmc = }}</ref>
-==Cosmeses==
-[[File:Wigs on display.jpg|thumb|There have been advances in the [[fashion industry]] in [[wig]] design.]] Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle.<ref>{{Cite journal| last1 = Davis | first1 = M. G.| last2 = Thomas | first2 = J. H.| last3 = Van De Velde | first3 = S.| last4 = Boissy | first4 = Y.| last5 = Dawson Jr | first5 = T. L.| last6 = Iveson | first6 = R.| last7 = Sutton | first7 = K.| title = A novel cosmetic approach to treat thinning hair| doi = 10.1111/j.1365-2133.2011.10633.x| journal = British Journal of Dermatology| volume = 165| pages = 24–30| year = 2011| pmid = 22171682| pmc = }}</ref> There have also been developments in the fashion industry with [[wig]] design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a "constant companion".<ref>{{Cite journal| last1 = Zannini | first1 = L.| last2 = Verderame | first2 = F.| last3 = Cucchiara | first3 = G.| last4 = Zinna | first4 = B.| last5 = Alba | first5 = A.| last6 = Ferrara | first6 = M.| doi = 10.1111/j.1365-2354.2012.01337.x| title = 'My wig has been my journey's companion': Perceived effects of an aesthetic care programme for Italian women suffering from chemotherapy-induced alopecia| journal = European Journal of Cancer Care| volume = 21| issue = 5| pages = 650–660| year = 2012| pmid = 22339814| pmc = }}</ref> Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use.<ref>{{Cite journal| last1 = Inui | first1 = S.| last2 = Inoue | first2 = T.| last3 = Itami | first3 = S.| title = Psychosocial impact of wigs or hairpieces on perceived quality of life level in female patients with alopecia areata| doi = 10.1111/1346-8138.12040| journal = The Journal of Dermatology| pages = 225–6| year = 2012| pmid = 23252418| pmc =| volume=40| issue=3}}</ref>
-Specialized scalp tattoos can mimic the appearance of a short buzzed haircut.<ref>{{cite news |title=Considering a hair tattoo? Pros and cons to consider before you commit |author=Elisabeth Leamy |url=http://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/|newspaper=ABC News |date=May 31, 2012|accessdate=December 16, 2012}}</ref><ref>{{cite news |title=Wish you were hair|author=Bella Battle |url=http://www.thesun.co.uk/sol/homepage/features/4121987/News-Bald-men-can-try-out-new-hair-scalp-tattoo.html|newspaper=The Sun |date=February 11, 2012 |accessdate=December 16, 2012 |location=London}}</ref>
-==Alternative medicine==
-Many people use unproven treatments,<ref name=Ban2013>{{cite journal|last=Banka|first=N|author2=Bunagan, MJ |author3=Shapiro, J |title=Pattern hair loss in men: diagnosis and medical treatment|journal=Dermatologic clinics|date=January 2013|volume=31|issue=1|pages=129–40|pmid=23159182|doi=10.1016/j.det.2012.08.003}}</ref> but there is little evidence of the effectiveness of [[vitamin]]s, minerals, or other dietary supplements regrowing hair or retaining hair.<ref name=Levy2013/>
-===Laser therapy===
-and 2012 reviews found little evidence to support the use of special lights or lasers to treat hair loss.<ref name=Levy2013>{{cite journal|last1=Levy|first1=Lauren L.|last2=Emer|first2=Jason J.|title=Female pattern alopecia: current perspectives |journal= [[International Journal of Women's Health]] | url = https://dx.doi.org/10.2147/IJWH.S49337 | doi = 10.2147/IJWH.S49337 |date=29 August 2013 | volume=5 | pages=541–56| pmid = 24039457 | pmc=3769411}}</ref><ref name=Roger2008/><ref name=Soph2012/> Additionally none are approved by the [[Food and Drug Administration|FDA]] in America for this use.<ref name=Soph2012>{{Cite journal|title = Alopecia: a review of laser and light therapies|journal = Dermatology Online Journal|date = Feb 2012|issn = 1087-2108|pmid = 22398224|pages = 3|volume = 18|issue = 2|first = Sophia|last = Rangwala|first2 = Rashid M.|last2 = Rashid|quote=Since then, a number of studies have suggested the use of lasers as an effective way to treat alopecia, particularly androgenetic alopecia and alopecia areata, but there is still a paucity of independent, peer-reviewed blinded clinical trials.}}</ref> Both laser and lights appear to be safe.<ref name=Roger2008>{{cite journal|last1=Rogers|first1=NE|last2=Avram|first2=MR|title=Medical treatments for male and female pattern hair loss.|journal=Journal of the American Academy of Dermatology|date=October 2008|volume=59|issue=4|pages=547–66; quiz 567–8|pmid=18793935|doi=10.1016/j.jaad.2008.07.001}}</ref>
-A 2014 and 2016 review found tentative evidence of benefit for lasers.<ref>{{Cite journal|title = Low-Level Laser (Light) Therapy (LLLT) for Treatment of Hair Loss|journal = Lasers in surgery and medicine|date = 2014 |issn = 0196-8092|pmc = 3944668|pmid = 23970445|pages = 144–151|volume = 46|issue = 2|doi = 10.1002/lsm.22170|first = Pinar|last = Avci|first2 = Gaurav K.|last2 = Gupta|first3 = Jason|last3 = Clark|first4 = Norbert|last4 = Wikonkal|first5 = Michael R.|last5 = Hamblin}}</ref><ref>{{cite journal|last1=Zarei|first1=M|last2=Wikramanayake|first2=TC|last3=Falto-Aizpurua|first3=L|last4=Schachner|first4=LA|last5=Jimenez|first5=JJ|title=Low level laser therapy and hair regrowth: an evidence-based review.|journal=Lasers in medical science|date=February 2016|volume=31|issue=2|pages=363–71|pmid=26690359|doi=10.1007/s10103-015-1818-2}}</ref> While another 2014 review concluded that the results are mixed, have a high risk of bias, and that its effectiveness is unclear.<ref>{{cite journal|last1=Gupta|first1=AK|last2=Daigle|first2=D|title=The use of low-level light therapy in the treatment of androgenetic alopecia and female pattern hair loss.|journal=The Journal of dermatological treatment|date=April 2014|volume=25|issue=2|pages=162–3|pmid=23924031|doi=10.3109/09546634.2013.832134}}</ref>
-===Dietary supplements===
-Dietary supplements are not typically recommended.<ref name=Roger2008/> There is only one small trial of [[saw palmetto]] which shows tentative benefit in those with  mild to moderate androgenetic alopecia.<ref name=Roger2008/> There is no evidence for [[biotin]].<ref name=Roger2008/> Evidence for most other produces is also insufficient. There was no good evidence for [[gingko]], [[aloe vera]], [[ginseng]], [[bergamot essential oil|bergamot]], or [[hibiscus]] as of 2011.<ref name=Blu2011>{{cite journal|last1=Blumeyer|first1=A|last2=Tosti|first2=A|last3=Messenger|first3=A|last4=Reygagne|first4=P|last5=Del Marmol|first5=V|last6=Spuls|first6=PI|last7=Trakatelli|first7=M|last8=Finner|first8=A|last9=Kiesewetter|first9=F|last10=Trüeb|first10=R|last11=Rzany|first11=B|last12=Blume-Peytavi|first12=U|last13=European Dermatology Forum|first13=(EDF)|title=Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men.|journal=Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG|date=October 2011|volume=9 Suppl 6|pages=S1-57|pmid=21980982|doi=10.1111/j.1610-0379.2011.07802.x}}</ref> While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin.
-==Mechanism==
-[[File:Skin.png|thumb|[[Hair follicle]] with mesenchymal [[dermal papilla]], labelled at top, location of hair follicle [[stem cell]]s and thought to be site of action of [[Dihydrotestosterone|DHT]].]]
-Several lines of evidence support the [[dermal papilla]] of the [[hair follicle]] as the androgenic target for hair loss prevention and reversal.<ref name="structure">{{Cite journal| last1 = Soni | first1 = V. K.| title = Androgenic alopecia: A counterproductive outcome of the anabolic effect of androgens| doi = 10.1016/j.mehy.2009.03.032| journal = [[Medical Hypotheses]]| volume = 73| issue = 3| pages = 420–426| year = 2009| pmid = 19477078| pmc = }}</ref>{{ums|date=November 2017}} [[5-alpha reductase|Type 1 and 2 5α reductase enzymes]] are present at [[Sebaceous gland|pilosebaceous units]] in papillae of individual [[hair follicle]]s. They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate [[Insulin-like growth factor 1|IGF-1]] at facial hair, causing hair regrowth, but stimulate [[TGF beta 1|TGF β1]], [[TGF beta 2|TGF β2]], [[DKK1|dickkopf1]] and [[Interleukin 6|IL-6]] at the scalp, causing hair follicle miniaturisation.<ref name=Inui2013>{{cite journal|last1=Inui|first1=Shigeki|last2=Itami|first2=Satoshi|title=Androgen actions on the human hair follicle: perspectives|journal=Experimental Dermatology|volume=22|issue=3|year=2013|pages=168–171|doi=10.1111/exd.12024|pmid=23016593}}</ref>
-Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to [[Alopecia totalis|total hair loss]].<ref name="Female pattern baldness"/> [[Finasteride]] and [[minoxidil]] are usually first line therapy for its treatment. Other options include topical or systemic [[spironolactone]] or [[flutamide]], although they have a high incidence of [[Feminisation (biology)|feminising]] [[side effects]] and are better tolerated in female androgenic hair loss.
-More advanced cases may be resistant or unresponsive to medical therapy, however, and require [[hair transplantation]]. Naturally-occurring units of one to four hairs, called [[Hair follicle|follicular units]], are excized and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either [[Follicular unit transplantation|Follicular Unit Transplantation]] (FUT)&nbsp;–&nbsp;colloquially referred to as "strip harvesting"&nbsp;– or [[Follicular Unit Extraction]] (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites.<ref name="pmid22808618">{{Cite journal| last1 = Caroli | first1 = S.| last2 = Pathomvanich | first2 = D.| last3 = Amonpattana | first3 = K.| last4 = Kumar | first4 = A.| title = Current status of hair restoration surgery| journal = International surgery| volume = 96| issue = 4| pages = 345–351| year = 2011| pmid = 22808618 | doi=10.9738/cc31.1}}</ref><ref name="pmid 21792780">{{Cite journal| last1 = Rose | first1 = P.| title = The Latest Innovations in Hair Transplantation| doi = 10.1055/s-0031-1283055| journal = Facial Plastic Surgery| volume = 27| issue = 4| pages = 366–377| year = 2011| pmid = 21792780| pmc = }}</ref> Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut.<ref>{{cite news |title=Considering a hair tattoo? Pros and cons to consider before you commit |author=[[Elisabeth Leamy]] |url=http://abcnews.go.com/blogs/health/2012/05/31/considering-a-hair-tattoo-pros-and-cons-to-consider-before-you-commit/ |newspaper=ABC News |date=May 31, 2012 |accessdate=December 16, 2012}}</ref><ref>{{cite news |title=Wish you were hair |author=Bella Battle |url=http://www.thesun.co.uk/sol/homepage/features/4121987/News-Bald-men-can-try-out-new-hair-scalp-tattoo.html |newspaper=The Sun |date=February 11, 2012 |accessdate=December 16, 2012 |location=London}}</ref> Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to [[Alopecia totalis|total hair loss]]. Treatment options are similar to those for men, although topical or systemic estrogen is used more often.<ref name="Female pattern baldness">{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/001173.htm |title=Female pattern baldness |accessdate=December 15, 2012 |date=December 15, 2012 |publisher=MedlinePlus}}</ref><ref>{{Cite journal| last1 = Kovalevsky | first1 = G.| last2 = Ballagh | first2 = S. A.| last3 = Stanczyk | first3 = F. Z.| last4 = Lee | first4 = J.| last5 = Cooper | first5 = J.| last6 = Archer | first6 = D. F.| doi = 10.1016/j.fertnstert.2008.12.095| title = Levonorgestrel effects on serum androgens, sex hormone–binding globulin levels, hair shaft diameter, and sexual function| journal = Fertility and Sterility| volume = 93| issue = 6| pages = 1997–2003| year = 2010| pmid = 19394598| pmc = }}</ref>
-==Research==
-===Bimatoprost and latanoprost===
-[[Latanoprost]] and [[bimatoprost]] are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes,<ref>{{Cite journal| last1 = Law | first1 = S. K.| title = Bimatoprost in the treatment of eyelash hypotrichosis| journal = Clinical ophthalmology (Auckland, N.Z.)| volume = 4| pages = 349–358| year = 2010| pmid = 20463804| pmc = 2861943 | doi=10.2147/opth.s6480}}</ref><ref>{{Cite journal| last1 = Tosti | first1 = A.| last2 = Pazzaglia | first2 = M.| last3 = Voudouris | first3 = S.| last4 = Tosti | first4 = G.| title = Hypertrichosis of the eyelashes caused by bimatoprost| doi = 10.1016/j.jaad.2004.05.002| journal = Journal of the American Academy of Dermatology| volume = 51| issue = 5| pages = S149–S150| year = 2004| pmid = 15577756| pmc = }}</ref> darken hair pigmentation<ref>{{Cite journal| last1 = Wand | first1 = M.| title = Latanoprost and hyperpigmentation of eyelashes| journal = Archives of ophthalmology| volume = 115| issue = 9| pages = 1206–1208| year = 1997| pmid = 9298071 | doi=10.1001/archopht.1997.01100160376025}}</ref> and elongate hair.<ref name="pmid22735503"/> Bimatoprost is available as treatment for eyelash growth.<ref>{{Cite journal| last1 = Banaszek | first1 = A.| title = Company profits from side effects of glaucoma treatment| doi = 10.1503/cmaj.109-3919| journal = Canadian Medical Association Journal| volume = 183| issue = 14| pages = E1058–E10F1| year = 2011| pmid = 21876012| pmc =3185096}}</ref> Latanoprost has shown ability to promote scalp hair density and pigmentation,<ref>{{Cite journal| last1 = Blume-Peytavi | first1 = U.| last2 = Lönnfors | first2 = S.| last3 = Hillmann | first3 = K.| last4 = Garcia Bartels | first4 = N.| title = A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia| doi = 10.1016/j.jaad.2011.05.026| journal = Journal of the American Academy of Dermatology| volume = 66| issue = 5| pages = 794–800| year = 2012| pmid = 21875758| pmc = }}</ref> and is theorized to function at the [[dermal papilla]].<ref>{{Cite journal| last1 = Johnstone | first1 = M. A.| last2 = Albert | first2 = D. M.| title = Prostaglandin-induced hair growth| journal = Survey of ophthalmology| volume = 47 Suppl 1| pages = S185–S202| year = 2002| pmid = 12204716 | doi=10.1016/s0039-6257(02)00307-7}}</ref> A study found latanoprost ineffective on eyelashes in a patient with [[alopecia areata]].<ref>{{Cite journal| last1 = Roseborough | first1 = I.| last2 = Lee | first2 = H.| last3 = Chwalek | first3 = J.| last4 = Stamper | first4 = R. L.| last5 = Price | first5 = V. H.| title = Lack of efficacy of topical latanoprost and bimatoprost ophthalmic solutions in promoting eyelash growth in patients with alopecia areata| doi = 10.1016/j.jaad.2008.08.029| journal = Journal of the American Academy of Dermatology| volume = 60| issue = 4| pages = 705–706| year = 2009| pmid = 19293023| pmc = }}</ref> It has also been found ineffective in treatment of eyebrow hair loss.<ref>{{Cite journal| last1 = Ross | first1 = E. K.| last2 = Bolduc | first2 = C.| last3 = Lui | first3 = H.| last4 = Shapiro | first4 = J.| title = Lack of efficacy of topical latanoprost in the treatment of eyebrow alopecia areata| doi = 10.1016/j.jaad.2005.06.031| journal = Journal of the American Academy of Dermatology| volume = 53| issue = 6| pages = 1095–1096| year = 2005| pmid = 16310083| pmc = }}</ref>
-===Hormones===
-Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with [[oral contraceptives]]. Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in [[Europe]].<ref name=Blu2011 /> Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in [[North America]].<ref name="pmid22735503"/>
-There is tentative evidence for [[cyproterone acetate]] in women.<ref name=Levy2013/>
-===IGF-1===
-In December 2012, topical application of [[Insulin-like_growth_factor_1| IGF-1]] in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans.<ref>{{Cite journal| last1 = Castro | first1 = R. F.| last2 = Azzalis | first2 = L. A.| last3 = Feder | first3 = D.| last4 = Perazzo | first4 = F. F.| last5 = Pereira | first5 = E. C.| last6 = Junqueira | first6 = V. B. C.| last7 = Rocha | first7 = K. C.| last8 = Machado | first8 = C. D. A.| last9 = Paschoal | first9 = F. C.| last10 = Gnann| doi = 10.1111/j.1365-2230.2012.04441.x | first10 = L. A.| last11 = Fonseca | first11 = F. L. A.| title = Safety and efficacy analysis of liposomal insulin-like growth factor-1 in a fluid gel formulation for hair-loss treatment in a hamster model| journal = Clinical and Experimental Dermatology| volume = 37| issue = 8| pages = 909–912| year = 2012| pmid = 22924775| pmc = }}</ref> Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells.<ref name="pmid22164296">{{Cite journal| last1 = Yoon | first1 = S. Y.| last2 = Kim | first2 = K. T.| last3 = Jo | first3 = S. J.| last4 = Cho | first4 = A. R.| last5 = Jeon | first5 = S. I.| last6 = Choi | first6 = H. D.| last7 = Kim | first7 = K. H.| last8 = Park | first8 = G. S.| last9 = Pack | first9 = J. K.| last10 = Kwon | first10 = O. S.| last11 = Park | first11 = W. Y.| editor1-last = Najbauer| editor1-first = Joseph| title = Induction of Hair Growth by Insulin-Like Growth Factor-1 in 1,763 MHz Radiofrequency-Irradiated Hair Follicle Cells| doi = 10.1371/journal.pone.0028474| journal = PLoS ONE| volume = 6| issue = 12| pages = e28474| year = 2011| pmid = 22164296| pmc =3229574}}</ref> Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors [[FGF7]], [[Basic fibroblast growth factor|FGF-2]] and [[Vascular endothelial growth factor|VEGF]]. [[Beta-catenin|β-catenin]] transcription increased, which promotes dermal papillae as well.<ref name="pmid22164296"/> Dietary [[isoflavones]] increase IGF production in scalp [[dermal papillae]] in transgenic mice.<ref>{{Cite journal| last1 = Zhao | first1 = J.| last2 = Harada | first2 = N.| last3 = Kurihara | first3 = H.| last4 = Nakagata | first4 = N.| last5 = Okajima | first5 = K.| title = Dietary isoflavone increases insulin-like growth factor-I production, thereby promoting hair growth in mice| doi = 10.1016/j.jnutbio.2010.01.008| journal = The Journal of Nutritional Biochemistry| volume = 22| issue = 3| pages = 227–233| year = 2011| pmid = 20576422| pmc = }}</ref> Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP.<ref>{{Cite journal| last1 = Okajima | first1 = K.| last2 = Harada | first2 = N.| title = Promotion of insulin-like growth factor-I production by sensory neuron stimulation; molecular mechanism(s) and therapeutic implications| journal = Current medicinal chemistry| volume = 15| issue = 29| pages = 3095–3112| year = 2008| pmid = 19075656 | doi=10.2174/092986708786848604}}</ref> Ascorbic acid has led to increased IGF expression ''in vitro''.<ref>{{Cite journal| last1 = Kwack | first1 = M. H.| last2 = Shin | first2 = S. H.| last3 = Kim | first3 = S. R.| last4 = Im | first4 = S. U.| last5 = Han | first5 = I. S.| last6 = Kim | first6 = M. K.| last7 = Kim | first7 = J. C.| last8 = Sung | first8 = Y. K.| doi = 10.1111/j.1365-2133.2009.09108.x| title = L-Ascorbic acid 2-phosphate promotes elongation of hair shafts via the secretion of insulin-like growth factor-1 from dermal papilla cells through phosphatidylinositol 3-kinase| journal = British Journal of Dermatology| volume = 160| issue = 6| pages = 1157–1162| year = 2009| pmid = 19416266| pmc = }}</ref>
-===Platelet-rich plasma===
-A May 2013 review on the use of [[Platelet-rich plasma|platelet-rich plasma]] (PRP) to regrow hair concluded more evidence is needed to verify the efficacy of PRP.<ref>{{Cite journal|title = New investigational drugs for androgenetic alopecia|journal = Expert Opinion on Investigational Drugs|date = May 2013|issn = 1744-7658|pmid = 23550739|pages = 573–589|volume = 22|issue = 5|doi = 10.1517/13543784.2013.784743|first = Isabel Cristina|last = Valente Duarte de Sousa|first2 = Antonella|last2 = Tosti}}</ref>
-===Stem cell therapy===
-{{Main article|Hair cloning}}
-Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the [[stem cell]]s from which the follicles arose.<ref>{{Cite journal| last1 = Garza | first1 = L. A.| last2 = Yang | first2 = C. C.| last3 = Zhao | first3 = T.| last4 = Blatt | first4 = H. B.| last5 = Lee | first5 = M.| last6 = He | first6 = H.| last7 = Stanton | first7 = D. C.| last8 = Carrasco | first8 = L.| last9 = Spiegel | first9 = J. H.| last10 = Tobias| doi = 10.1172/JCI44478 | first10 = J. W.| last11 = Cotsarelis | first11 = G.| title = Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells| journal = Journal of Clinical Investigation| volume = 121| issue = 2| pages = 613–622| year = 2011| pmid = 21206086| pmc =3026732}}</ref> Research on these follicular stem cells may lead to successes in treating baldness through ''hair multiplication'' (HM), also known as ''[[hair cloning]]''.
-Per a May 2015 review, no successful strategy to generate human&nbsp;hair&nbsp;follicles, for hair regrowth,  from adult&nbsp;stem cells&nbsp;has yet been reported.<ref>{{Cite journal|title = Epidermal stem cells and skin tissue engineering in hair follicle regeneration|journal = World Journal of Stem Cells|date = May 26, 2015|issn = 1948-0210|pmc = 4444612|pmid = 26029343|pages = 711–727|volume = 7|issue = 4|doi = 10.4252/wjsc.v7.i4.711|first = María Eugenia|last = Balañá|first2 = Hernán Eduardo|last2 = Charreau|first3 = Gustavo José|last3 = Leirós}}</ref>  However, in April 2016, scientists from Japan published results of their work in which they created human skin from [[induced pluripotent stem cell]]s; implanted into laboratory mice, the cells generated skin with hair and glands.<ref>{{cite journal|date=1 Apr 2016|title=Bioengineering a 3D integumentary organ system from iPS cells using an in vivo transplantation model|url=http://advances.sciencemag.org/content/2/4/e1500887|journal=Science Advances|volume=2|issue=4|doi=10.1126/sciadv.1500887|accessdate=2 May 2016|pages=e1500887}}</ref>
-===Genetics===
-From 2005 to 2007 Curis and [[Procter & Gamble]] collaborated on developing a topical [[Hedgehog signaling pathway|hedgehog]] [[agonist]] for hair loss; the agent did not meet safety standards, and the program was terminated.<ref>{{cite news|last1=Weintraub|first1=Arlene|title=Curis and Genentech Unleash the Hedgehog to Fight a Deadly Skin Cancer|url=http://www.xconomy.com/boston/2011/06/28/curis-and-genentech-unleash-the-hedgehog-to-fight-a-deadly-skin-cancer/?single_page=true|work=Xconomy|date=28 June 2011}}</ref><ref>{{cite web|title=Curis Form 8-K: Termination of a Material Definitive Agreement.|url=https://www.sec.gov/Archives/edgar/data/1108205/000119312507109693/d8k.htm|publisher=SEC EDGAR|date=May 10, 2007}}</ref> In 2008 researchers at the [[University of Bonn]] announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene [[P2RY5]] causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first [[Receptor (biochemistry)|receptor]] in humans known to play a role in hair growth.<ref>{{Cite journal| last1 = Pasternack | first1 = S. M.| last2 = Von Kügelgen | first2 = I.| last3 = Al Aboud | first3 = K. A.| last4 = Lee | first4 = Y. A.| last5 = Rüschendorf | first5 = F.| last6 = Voss | first6 = K.| last7 = Hillmer | first7 = A. M.| last8 = Molderings | first8 = G. J.| last9 = Franz | first9 = T.| doi = 10.1038/ng.84| last10 = Ramirez | first10 = A.| last11 = Nürnberg | first11 = P.| last12 = Nöthen | first12 = M. M.| last13 = Betz | first13 = R. C.| title = G protein–coupled receptor P2Y5 and its ligand LPA are involved in maintenance of human hair growth| journal = Nature Genetics| volume = 40| issue = 3| pages = 329–334| year = 2008| pmid = 18297070| pmc = }}</ref><ref>{{Cite journal| last1 = Shimomura | first1 = Y.| last2 = Wajid | first2 = M.| last3 = Ishii | first3 = Y.| last4 = Shapiro | first4 = L.| last5 = Petukhova | first5 = L.| last6 = Gordon | first6 = D.| last7 = Christiano | first7 = A. M.| doi = 10.1038/ng.100| title = Disruption of P2RY5, an orphan G protein–coupled receptor, underlies autosomal recessive woolly hair| journal = Nature Genetics| volume = 40| issue = 3| pages = 335–339| year = 2008| pmid = 18297072| pmc = }}</ref><ref>{{Cite journal| last1 = Sprecher | first1 = E.| title = Disentangling the roots of inherited hair disorders| doi = 10.1038/ng0308-265| journal = Nature Genetics| volume = 40| issue = 3| pages = 265–266| year = 2008| pmid = 18305473| pmc = }}</ref> Researchers found that disruption of the [[gene]] [[SOX21]] in mice caused cyclical hair loss.  Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models.<ref>{{Cite journal| last1 = Kiso | first1 = M.| last2 = Tanaka | first2 = S.| last3 = Saba | first3 = R.| last4 = Matsuda | first4 = S.| last5 = Shimizu | first5 = A.| last6 = Ohyama | first6 = M.| last7 = Okano | first7 = H. J.| last8 = Shiroishi | first8 = T.| last9 = Okano | first9 = H.| doi = 10.1073/pnas.0808324106| last10 = Saga | first10 = Y.| title = The disruption of Sox21-mediated hair shaft cuticle differentiation causes cyclic alopecia in mice| journal = Proceedings of the National Academy of Sciences| volume = 106| issue = 23| pages = 9292–9297| year = 2009| pmid = 19470461| pmc =2695080}}</ref> Deletion of SOX21 dramatically affects hair lipids.<ref>{{Cite journal| last1 = Kawaminami | first1 = S.| last2 = Breakspear | first2 = S.| last3 = Saga | first3 = Y.| last4 = Noecker | first4 = B.| last5 = Masukawa | first5 = Y.| last6 = Tsuchiya | first6 = M.| last7 = Oguri | first7 = M.| last8 = Inoue | first8 = Y.| last9 = Ishikawa | first9 = K.| doi = 10.1111/exd.12050| last10 = Okamoto | first10 = M.| title = Deletion of theSox21gene drastically affects hair lipids| journal = Experimental Dermatology| volume = 21| issue = 12| pages = 974–976| year = 2012| pmid = 23171466| pmc = }}</ref>
-==References==
-{{Reflist|30em}}
-==External links==
-* [http://www.aafp.org/afp/990415ap/2189.html "Medical Treatments for Balding in Men"], April 1999, ''American Family Physician'' (medical journal)
-{{Human hair}}
-{{Other dermatological preparations}}
-<!--?: {{DEFAULTSORT:Baldness Treatments}}-->
-[[Category:Dermatologic procedures]]
-[[Category:Plastic surgical procedures]]