Androgenetic Alopecia in Men & Women
October 22, 2009
James L. Breeling and Debbie Baratz
Low level laser light, when applied to the scalp, is one of the newest therapies to treat hair loss. Laser therapies for hair restoration are available through hand-held laser devices and may be used at home, or in a medical setting under a physician's supervision.
What are the facts about laser therapy for hair loss? Let's take a look through evidence-based facts and unsubstantiated claims to learn about this treatment option.
Definitions: Understanding the Terminology
Lasers are widely used in medicine, in industry, in the military, and of course, as weapons in science-fiction. The laser's energy used to stimulate hair growth is visible in the red light spectrum. Their use in treating hair loss and other medical conditions is defined as low-level laser therapy (LLLT). LLLT is sometimes included under a broader definition of phototherapy called "low-level light therapy" where the light-emitting device may be a laser or a light-emitting diode (LED). Only laser energy has been proven effective in the treatment of hereditary hair loss whereas phototherapy using lasers and LEDs have numerous uses in medicine.
How LLLT Works
Light from a laser has an effect on your body when the specific wavelength of light is absorbed by molecules of the target tissue. When light energy is absorbed by target tissue molecules, the energy level of the molecules is increased and the molecules respond by "working off" the excess energy with adaptive changes. These changes may be chemical or physical and they may have biological effects on the target tissue or surrounding tissues.
Because the changes in the molecules are brought about by phototherapy, chemical changes are said to be due to "photochemistry" and physical changes to "photophysics." As a result, the biological effects on tissue are called photobiomodulation.
Photobiomodulation in the Treatment of Male and Female Pattern Hair Loss
Many hypotheses have been offered to explain how LLLT photobiomodulation may stimulate new hair growth. While LLLT's chemical and physical effects have occurred with new hair growth attributed to LLLT, none of these effects has been shown as the primary effect in stimulating new hair growth. It is however, hypothesized that LLLT mediates new hair growth through either a direct or an indirect increase in proliferative activity within the hair follicle epithelial matrix.
Evidence also points out that laser energy reverses follicular apoptosis (programmed cell death) and from observations of wavelength stimulation of optimal hair growth and from an ex-vivo study, it has been shown precisely what wavelengths, power, intensity are necessary for optimal effect in stimulating new hair growth.
It is important to note that heat is not associated with the photochemical and photo therapeutic effects of LLLT. While there are visible red wavelengths and low wattage associated with LLLT, it is a "cold light" laser produces no sensation on the skin of persons undergoing treatment.
LLLT's Accidental Origin in Stimulating Hair Growth
The 1967 discovery that visible red laser light may stimulate hair growth was an accidental observation by a Hungarian scientist studying the use of lasers in treating skin cancers in mice. The backs of the mice were shaved in the area to receive treatment. One group of mice received laser treatment, one group did not. The scientist noted that hair grew back more quickly in the mice treated with laser.
LLLT Today: Delivery Systems
Hand-held devices are sold for home use in treating hair loss. While there are many products in this category, the market leaders in hand-held laser devices are the X5 Laser® by Spencer Forrest and the Hair Max LaserComb®. These two devices have significant differences in their coverage area, total power, number of laser diodes, output, and cost, but share the same laser wavelength and laser class. Both devices are available for purchase from reputable online sites, directly from the manufacturer or, in the case of the Laser Comb, through a physician's office.
There are many differences in hand-held laser devices, but the two market leaders make the following claims.
The X5 bypasses intervening hair by making direct contact with the scalp using diodes. The LaserComb instead provides lasers which are located in a vertical line along the center of the LaserComb device. As the LaserComb moves across the head, the hair-parting teeth push aside hair to create a direct path between the laser beams and the scalp.
The X5 Laser is marketed as a cosmetic device and needs no further clearances to be sold for this purpose, but the company continues to conduct ongoing clinical studies and research for FDA clearance.
The LaserComb device was cleared by the FDA in 2007 for treating male pattern hair loss. It received FDA 510(k) Clearance for Marketing. The key component of the clearance was a clinical study proving efficacy and safety of the device. LLLT in a medical setting may be delivered by a device that looks somewhat like a "hood" used in a beauty parlor. Panels in the "hood" deliver a measured LLLT dose to a specific area of the scalp for a precise period of time. The devices are classified under FDA standards for the patient's safety, but these devices do not have FDA Clearance for Marketing.
Manufacturers of hand-held and "hood" devices offer recommendations for safe and effective use. Physician hair restoration specialists who offer LLLT as a hair restoration option also follow safety/effectiveness protocols they have found to be optimal.
LLLT Today: Who Will Benefit from Its Use?
Hair loss can be due to inherited, metabolic, autoimmune or infectious causes. Medical experts who specialize in treating hair loss agree that treatment should be based on the correct diagnosis of its cause. Inherited androgenetic alopecia is a common cause; however, hair loss due to a condition such as hypothyroidism will be corrected only by adequate treatment of the metabolic disorder.
Medical experts also agree that LLLT should be considered as an option only for the treatment of androgenetic alopecia-inherited male and female pattern hair loss. There have been no studies showing that LLLT is effective in treatment of hair loss due to other causes. FDA clearance of the LaserComb device is only a treatment for Norwood Hamilton classes of IIa-V androgenetic alopecia.
Physicians who use LLLT in treating androgenetic alopecia have usually found that LLLT is most effective in persons with minimal to moderate hair loss but is less effective with major hair loss. Keep in mind, responses to LLLT is somewhat unpredictable and results vary from person to person.
People considering LLLT for the treatment of hair loss, at home, or in a medical setting, should not undergo treatment until a correct diagnosis of the cause of hair loss has been made by a physician specializing in hair loss treatment.
LLLT Today: Is It Effective in Hair Restoration?
Medical experts reviewing currently available data1 agree that LLLT can be effective in treating male and female pattern hair loss when either used alone or in conjunction with other medical therapies. Physicians have observed that the overall condition and health of existing hair may be improved in a LLLT treated area, even if no new hair growth is stimulated.
LLLT has been observed to improve outcomes of hair transplantation by improving patency of grafts and speeding healing time. Data from the first randomized, double-blind, multi-center study was published in 20092. This was a double blind, multicenter study of treatment of male pattern hair loss comparing use of the LaserComb, with an inert "sham" device.
LLLT Today: How Do LLLT Results Compare with Other Treatments for Androgenetic Alopecia?
In the United States, finasteride (Propecia®) and minoxidil (Rogaine®) are the only medications approved by the FDA for treatment of androgenetic alopecia. The effectiveness of these medications has been investigated in many well-designed studies over many years.
By comparison, data regarding effectiveness of LLLT is available only from small studies and one double-blind study published in 2009. Comparison of results on the basis of peer-reviewed evidence is difficult; however, physicians and hair restoration specialists have favorably assessed the efficacy of LLLT in everyday treatment of androgenetic alopecia based on global assessment of the patient's hair loss and medical status.
LLLT Today: How Long Does Treatment Take to Be Effective?
Hand-held devices come with recommended protocols for home use. LLLT in a medical setting may require regular therapy sessions over a period of months. As with the medical treatment of androgenetic alopecia, hair restoration using LLLT is not a one-time "fix" for hair loss. It must be repeated at intervals to maintain results; medical treatment also must be maintained to retain results.
The only permanent "fix" for androgenetic alopecia is hair transplantation or other surgical hair restoration procedure.
LLLT Today: How Much Does It Cost?
The LaserComb costs less than $500 and the X5 Laser costs less than $199. The cost of LLLT administered in a medical setting is set by the physician's practice and can cost from several hundred to several thousand dollars depending on factors included in the treatment and other fees.
1 [Leavitt M, Charles G, Heyman E, Michaels D. Clinical Drug Investigation. 2009; 29:283-2922 and Avram MR, Leonard RT Jr, Epstein ES, Williams JL, Bauman AJ. Journal of Cosmetic and Laser Therapy. 2007; 9:27-28]
2 (Leavitt M, Charles G, Heyman E, Michaels D. Clinical Drug Investigation. 2009; 29:283-292).
The Hair Foundation does not endorse any one hand-held laser device. Please see our disclaimer for more information.