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How To Identify How Fast You’re Losing Hair & Why This Matters

When selecting hair loss treatments, it’s critical to understand how fast your hair loss is progressing, and why the speed your hair loss should influence your treatment choices – particularly for those with rapidly-progressing androgenic alopecia.

In this article, we’ll uncover:

  • The average speed of hair loss progression (per year)
  • How to estimate your own speed of hair loss (at home)
  • Why people with faster hair loss face bigger stakes for treatment failures
  • How to minimize these failures by understanding evidence quality

If we have androgenic alopecia, how quickly will we lose hair?

Clinical studies suggest that men with androgenic alopecia will lose 5% hair volume per year. At this rate, it typically takes 15-25 years for a man to go fully bald.[1]Rushton DH, Ramsay ID, Norris MJ, Gilkes JJ. Natural progression of male pattern baldness in young men. Clin Exp Dermatol. 1991 May;16(3):188-92. doi: 10.1111/j.1365-2230.1991.tb00343.x. PMID: … Continue reading[2]Sinclair R. Male pattern androgenetic alopecia. BMJ. 1998 Sep 26;317(7162):865-9. doi: 10.1136/bmj.317.7162.865. PMID: 9748188; PMCID: PMC1113949.

However, it’s important to remember that 5% is just the average rate of hair loss.

In other words, 5% is just the mid-point on a bellcurve. Some people will lose hair at a much slower rate than 5% yearly; others will lose hair much faster.

Hair Loss Speeds

Why should we care about how fast (or slow) we’re losing hair?

Because men & women with faster hair loss face a bigger opportunity cost for failed treatments. For these individuals, the cost of failure is much, much higher. Consider the following hypothetical:

Person A is losing hair slowly. They try a nutraceutical product, which is supported by low-quality evidence. It doesn’t work. After 12 months, they quit. They now have 1% less hair compared to a year ago. Their hair basically looks the same.

Person B is losing hair rapidly. They try the same nutraceutical product. It doesn’t work. After 12 months, they quit. They now have 25% less hair compared to a year ago. Their hair loss has significantly advanced.

Clinical studies overwhelmingly suggest it’s easier to stop hair loss than it is to regrow significant amounts of lost hair.[3]Sinclair R, Torkamani N, Jones L. Androgenetic alopecia: new insights into the pathogenesis and mechanism of hair loss. F1000Res. 2015 Aug 19;4(F1000 Faculty Rev):585. doi: … Continue reading

Therefore, when choosing treatments, time is of the essence. This is especially true for people with rapid-onset hair loss. So if we want to make fully-informed treatment choices, we should know how quickly our hair loss is advancing.

How can we estimate how fast we’re losing hair?

Ask yourself the following question:

In the last 6 months, have you experienced a visual loss in hair density? In other words, during this time, do you feel your hair loss has gotten cosmetically worse?

If no, you’re probably losing hair more slowly. If yes, you’re probably losing hair faster than 5% yearly.

After all, researchers have calibrated mens’ hair density changes with self-perception data, and they concluded: (3)

“…a deterioration in hair density > 15% was required before subjective awareness became evident.”

Long-story short: if you’re weighing your treatment options, do a quick assessment of how fast you’re losing hair.

The slower your hair loss, the more wiggle room you have to experiment. Why? Because the cost of failure might only equate to a 5% loss in hair density.

The faster your hair loss, the more imperative it is to seek treatments with the highest levels of clinical support. Why? Because these treatments tend to maximize your chances of success, and your magnitude of hair regrowth.

We rank some of these treatment options in this video. Moreover, we dive into what constitutes a good study in this article. It’s a deep-dive into how hair loss companies cheat their clinical trials.

Evidence quality example: saw palmetto vs. finasteride

Compare two potential hair loss interventions: saw palmetto and finasteride. One is natural; the other is a drug. Both substances have clinical support for hair growth, particularly for androgenic alopecia. Both substances also work similarly: they help lower the hormone dihydrotestosterone (DHT) in balding regions.

Similar substances. Similar mechanisms. Both clinically supported. But are these truly equal interventions for hair growth? A deeper dive into the evidence on both interventions paints a more nuanced (and dramatically different) picture than what is suggested at face-value.

Saw Palmetto for Hair Loss: 2022 Meta-Analysis

Over nine studies totaling 381 people have shown that saw palmetto might help improve androgenic alopecia.[4]Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disord. 2020 Nov;6(6):329-337. doi: … Continue reading At face value, this sounds great. But looking closer, many of these studies are what we would call lower quality: most of them lacked a placebo group, some were funded by companies selling saw palmetto, and all had small sample sizes.

This means that, for each study, there’s a higher risk of false-positive results: results due to statistical noise that would’ve washed out with a larger sample size.

This phenomenon happens all the time: early studies on an intervention showing promise, followed by larger, more robust studies showing no effect for that same intervention.

In fact, this happened once before for this same supplement – saw palmetto – but for the indication of prostate enlargement.

In the 1990s, several small studies suggested that saw palmetto extract might help reduce symptoms of an enlarged prostate.[5]Descotes, J., Rambeaud, J., Deschaseaux, P. et al. Placebo-Controlled Evaluation of the Efficacy and Tolerability of Permixon® in Benign Prostatic Hyperplasia after Exclusion of Placebo … Continue reading These studies inspired better-controlled clinical trials with hundreds of participants over extended periods, in which saw palmetto showed little-to-no effect.[6]Suzuki M, Ito Y, Fujino T, Abe M, Umegaki K, Onoue S, Noguchi H, Yamada S. Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmacol Sin. 2009 Mar;30(3):227-81. doi: … Continue reading

Again, study quality, results replication, and sample sizes all inform evidence quality. The lower the evidence quality, the more variance researchers will find between “study results” and “real-world results”. The higher the evidence quality, the less variance between “study” and “real-world” results. In the case of saw palmetto’s effects on prostate enlargement, low-quality data suggested benefit… until higher-quality data came long that brought into question that benefit.

Saw Palmetto Versus Finasteride: Clinical Evidence

When comparing the hair regrowth data on saw palmetto to that of finasteride, the totality of evidence and quality of evidence differ significantly. For instance, finasteride has been studied for 30+ years, in over 30,000 patients, across hundreds of research groups, with dozens of randomized clinical trials – nearly all of which showed significant hair density and hair count increases.

In fact, if you just looked at the treatment arm of one of the randomized, blinded, placebo-controlled studies on oral finasteride, you’d see that the number of participants in a portion of this single study outnumber all participants across all hair growth studies evaluating saw palmetto by a factor of four.[7]Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ. Finasteride in the treatment of men with … Continue reading[8]Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disord. 2020 Nov;6(6):329-337. doi: … Continue reading

When it comes to evidence quality and totality, combining all participants across all saw palmetto studies cannot even add up to a single treatment arm of one placebo-controlled finasteride study.[9]Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ. Finasteride in the treatment of men with … Continue reading[10]Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disord. 2020 Nov;6(6):329-337. doi: … Continue reading

With this visual, we can really see the relative differences in evidence quality across saw palmetto and finasteride. And this is just one of the dozens of finasteride studies available.

Hierarchy of Evidence & Totality of Evidence

These comparisons illustrate two concepts: the hierarchy of evidence – which evaluates how well studies are designed – and the totality of evidence – which evaluates how much research has been done on any one intervention. The higher the hierarchy of evidence and totality of the evidence, the more likely it is that those study results reflect the real-world experience of people trying it.

We capture these concepts inside our Treatment Metrics: a standardized tool we use to help hair loss sufferers evaluate the science supporting (or not supporting) any hair loss intervention at-a-glance.

Again, for a deep-dive into these concepts, see this article.

This is important because people can use the hierarchy and totality of evidence to rank how hair loss interventions might compare to one another. At the top of the list, there are pharmaceutical options. Toward the bottom of the list, there are natural interventions – which absolutely work for some people. But again, the hierarchy and totality of evidence supporting them are more limited, which means that in real life, there will be higher variability in clinical results versus real-world results.

An example hierarchy of evidence for FDA-approved and experimental hair loss interventions.

Here’s how not understanding this can become a problem.

If you’re fighting hair loss, and you’re hit with an advertisement for a product that claims, “clinically proven to regrow hair”, it’s possible this claim is true. But if that claim is also based on a single, small-scale study funded by the company selling you that product, then it’s also true that the evidence supporting that product is not very robust and subject to bias, and that it has a lower likelihood of getting you the hair gains you desire.

In other words, that product probably ranks lower on the hierarchy of evidence and totality of the evidence. So if someone tries it, there are higher odds that the results from that single clinical study won’t reflect their real-world experience.

How Does This All Relate to Hair Loss Speeds?

If you have faster-onsetting hair loss, your opportunity costs for failed treatments are high. In a single year of failed experimentation, you might not lose 5% hair volume; you might lose 20% of your hair or more. There’s a good chance this will be cosmetically significant, which means that people with quickly-progressing hair loss don’t have the same time-freedom as people with slowly-progressing hair loss to play around with interventions that are poorly supported.

So, when considering treatments, one must remember how fast they’re losing hair.

The slower it’s progressing, the better a candidate you are for more experimental, lesser-supported interventions. The faster your hair loss, the more you should consider FDA-approved treatments that rank strongly on the hierarchy and totality of evidence.

Long story short: when fighting hair loss, time is of the essence. The speed of hair loss should always inform candidacy for novel therapies. The slower the hair loss, the better position someone is in to experiment. The faster the hair loss, the more aggressively hair loss should be treated.

References

References
1 Rushton DH, Ramsay ID, Norris MJ, Gilkes JJ. Natural progression of male pattern baldness in young men. Clin Exp Dermatol. 1991 May;16(3):188-92. doi: 10.1111/j.1365-2230.1991.tb00343.x. PMID: 1934570.
2 Sinclair R. Male pattern androgenetic alopecia. BMJ. 1998 Sep 26;317(7162):865-9. doi: 10.1136/bmj.317.7162.865. PMID: 9748188; PMCID: PMC1113949.
3 Sinclair R, Torkamani N, Jones L. Androgenetic alopecia: new insights into the pathogenesis and mechanism of hair loss. F1000Res. 2015 Aug 19;4(F1000 Faculty Rev):585. doi: 10.12688/f1000research.6401.1. PMID: 26339482; PMCID: PMC4544386.
4, 8, 10 Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disord. 2020 Nov;6(6):329-337. doi: 10.1159/000509905. Epub 2020 Aug 23. PMID: 33313047; PMCID: PMC7706486.
5 Descotes, J., Rambeaud, J., Deschaseaux, P. et al. Placebo-Controlled Evaluation of the Efficacy and Tolerability of Permixon® in Benign Prostatic Hyperplasia after Exclusion of Placebo Responders. Clinical Drug Investigation 9, 291–297 (1995). https://doi.org/10.2165/00044011-199509050-00007
6 Suzuki M, Ito Y, Fujino T, Abe M, Umegaki K, Onoue S, Noguchi H, Yamada S. Pharmacological effects of saw palmetto extract in the lower urinary tract. Acta Pharmacol Sin. 2009 Mar;30(3):227-81. doi: 10.1038/aps.2009.1. PMID: 19262550; PMCID: PMC4002402.
7, 9 Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89. doi: 10.1016/s0190-9622(98)70007-6. PMID: 9777765.

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