Unlike the receding hair line creeping over a man's scalp, hair loss sneaks up on a woman.

Maybe she sees a few more hairs in her favorite brush. Her ponytail feels skinnier. Her part widens. Eventually she notices she can see her scalp peeking through in a photograph.

Whatever the telling sign, female pattern hair loss can be traumatic. But women today are less likely to suffer in silence than a decade ago; doctors report that women increasingly are coming forward to seek remedies.

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In some cases, pinpointing the cause is the first step to a cure, though the source of hair loss in women is not always as clear as it is in men.

The hormone fluctuations of puberty, pregnancy and menopause can cause hair to shed. So can the stress of general anesthesia, illness, anemia, crash diets and thyroid abnormalities. Some women -- and a few men, too -- suffer a compulsion to tug at the hair, damaging the follicles.

Stress on the hair itself, whether from chemical treatments, extensions or tight hairstyles that tug at the scalp, can also break the hair or scar the follicle. Black women are particularly vulnerable due to the hair relaxing treatments and braiding often begun at a young age.

"Half of our hair loss visits are African-American women," said Dr. Marianne O'Donoghue, a dermatologist in Oak Brook and associate professor at Rush University Medical Center. "They have a terrible time keeping their hair in."

The most common cause of female hair loss is androgenetic allopecia, or female pattern baldness. Thought to be influenced by levels of sex hormones, this type of hair loss usually begins after menopause, but it can start as early as puberty. Instead of a woman losing 100 to 125 hairs a day, which is normal, she'll lose so many that her scalp will show through.

Help is available. The topical medicines, laser treatments and hair transplants designed for men can help women, too.

Stopping the loss

One of the oldest treatments for hair loss in men and women is Rogaine, the brand name of the drug minoxidil. Spread over the scalp twice a day, Rogaine works by increasing the growth phase of the hair follicles. It also helps hair grow thicker, stronger and with more pigmentation.

Women's Rogaine is less potent than men's -- a 2 percent strength rather than 5 percent -- though some doctors recommend the 5 percent strength for women, too.

"If you're going to fill your tank up with gas, you may as well fill it up," said Dr. Alan Bauman, a hair loss specialist in Florida.

A new foam version of Rogaine is less irritating to the scalp, Bauman said.

The mistake many women make with Rogaine is quitting too early, Bauman said. Many women quit after six weeks. But it will take six to 12 months to see the results in the mirror, Bauman said. As soon as you quit you'll start losing hair again.

"About 70 percent of women are going to get a response from it, but it's a long-term commitment," he said.

Since it has not been studied in pregnant women, women who are nursing or pregnant are usually advised against using Rogaine.

Propecia is an oral medication that stops hair loss in 90 percent of men, but it's not FDA-approved for use in women and poses risks to a developing male fetus. But some doctors prescribe Propecia to women who are not of childbearing age. While the evidence is not conclusive, a few studies show it works in women whose hormones are controlled with birth control pills or hormone therapy, Bauman said.

Other medications are available for specific types of hair loss. Women with alopecia areata, an autoimmune disorder signaled by circular bald patches, may get cortisone shots in the scalp or a topical cream. Low iron levels or thyroid disorders can be treated and the patient usually will regrow her hair, O'Donoghue said.

Laser therapy

A newer -- and less proven -- treatment involves beaming low-level lasers over the scalp, usually in a series of treatments lasting several months. The FDA recently approved a laser comb as a cosmetic device that can be used at home, though doctors said the laser hoods available in offices are more effective.

The lasers increase blood flow to the scalp and boost cell metabolism, said Dr. Stephen Dayan, a Chicago plastic surgeon who is testing a laser hair restoration device in his office.

"By increasing cell metabolism, you're creating more energy for the hair follicles, and the hair follicles are creating thicker hairs," he said.

The laser treatments work best on men and women with thinning -- not absent -- hair. They have to have functioning follicles.

"If they've been bald for a long time, it's probably not going to do a lot for them," Dayan said.

Jessica Hinkle of Streamwood is completing a series of laser treatments for thinning hair she first noticed five years ago. She didn't have a receding hair line, just more scalp where her bangs should be.

"My husband shaves his head on purpose," Hinkle said. "But a woman being bald is not OK."

Because she's planning to have more children, the 31-year-old didn't want to use Rogaine or other medications that pose any risk to a developing baby. So she entered a contest sponsored by a radio station and won a series of free laser treatments at Deerfield-based Natural Hair Growth Institute.

Once a week, Hinkle sits under a device shaped like a salon hair dryer while lasers glow on her scalp. Since she began treatments in May, Hinkle said her hair is thicker and her scalp less visible.

"I was skeptical, but it's noticeably different," she said. "A lot of people have noticed my hair has changed."

Not everyone can win a contest, and such treatments don't come cheap. Steve Bennis, a former engineer who launched Natural Hair Growth Institute after lasers helped with his own hair loss, says clients spend between $6,800 and $12,800 for a six-month series of treatments.

Bennis is not a doctor, so he requires clients visit one first to rule out medical conditions that could cause hair loss. He says clients start to see new hair growth within four weeks.

"When I started my business, I thought it was only for men," Bennis said. "Now I have 70 percent women. They like it because it's non-invasive, and it solves the problem."

You can also buy a variety of laser combs or brushes that range from $399 to $2,499. Newer versions cover wider areas in less time, Bauman said.

"The lasers are not a miracle cure, but I have noticed in my patients that laser therapy can certainly enhance hair quality and produce thicker, fuller, healthier, shinier hair," Bauman said. "It's not going to give you a teenager's head of hair, but you can see improvements over time."

Transplants

The growing awareness among the public about what cosmetic surgery offers has spread to include hair transplants, even for women, said Dr. Arthur Kaplan of Medical Hair Restoration in Oak Brook.

"Women are the fastest growing percentage of patients," he said.

Part of that is due to more refined technique. A surgeon can implant follicles taken from the back of the head one, two or three at a time, rather than plugs.

"For women, plugs were unacceptable from day one, whereas with men there was a time that was acceptable," Kaplan said. "The aesthetics women required were much higher. As the field has evolved, that has opened up the opportunity."

Micrografts are essential for women, who often have diffuse thinning in a part of the scalp. A surgeon must take care to preserve existing follicles, Bauman said.

"You can't put large grafts into diffuse areas or you're going to cause trauma," he said. "You can't go into a tomato garden with a backhoe. You have to use a small instrument to plant those seeds."

The cost depends on the number of follicles transplanted. Women are usually less expensive than men because a smaller area is involved. Most women spend between $4,500 and $6,000 for transplants at Medical Hair Restoration in Oak Brook.

The procedure takes two to four hours. Women start to notice new hair growth in three to five months, with full results taking a year to appear.

"Biophysicists said that unless there is cell heating or chemical triggering, the energy contained in the electromagnetic field had no effect on the body," explains Arthur Pilla. An Adjunct Professor of Orthopaedics at Mount Sinai's School of Medicine in New York City, Pilla is the former Director of the school's Bioelectrochemistry Laboratory. And while he is a chemist by training, his doctorate is in electrochemistry, not medicine. His research changed the way the medical community views the curative powers of weak electromagnetic fields. Today, if you are one of the tens of millions of Americans with thinning hair, his research could have an immediate impact upon your life. Pilla's technology is the basis of a machine that could prevent you from going bald.

The Missing Link
It was around 1984 that Pilla and his colleagues made electromagnetic therapies respectable by discovering how they worked. They found that the presence of a small amount of energy imparted by an electromagnetic field instructed cells to release more growth hormones. The first critical test of the theory came when Pilla and Dr. Andrew Bassett, a New York surgeon, used their approach to heal a patient's broken leg. Electro-magnetic stimulation is now used around the world to treat fractures that are slow to heal, or not healing at all.

Pilla and Bassett were convinced the healing bone was only the beginning. "All we would have to do is understand what signal to use, what biochemical pathway to activate," he tells POPULAR MECHANICS. "Obviously that was the dream, but we are still moving forward."

Since the case of the broken leg, the application of low-strength electromagnetic fields has been used to improve blood flow in diabetics and to reduce the amount of chemotherapy needed in cancer treatments. More recently, the technology was adapted to help women who are dealing with what is for many a devastating impact of breast cancer--the hair loss that accompanies chemo. "It was a surprise [researchers] didn't expect," Pilla says.

The hair experiment was conducted several years ago at St. Mark's Breast Center in Auckland, New Zealand, by Dr. Timothy Meakin. He followed the progress of 13 women under-going chemotherapy. During their 24-week treatment, they sat for brief periods of time beneath a device resembling a hair dryer. Coils inside the hood created a localized electromagnetic field around their scalps. All but one of the women kept their hair. And some experienced hair growth.

Pilla theorizes that at the level of the hair follicle, the electromagnetic field is strong enough to affect the production of the protein calmodulin. In the body, calmodulin relays signals to various enzymes, ion channels and other proteins. Among these are growth hormones that stimulate sufficient hair growth to compensate for losses caused by chemotherapy drugs.

Hair For All
The electromagnetic field stimulation penetrates only as deep as the hair follicles. This opens up a related cosmetic application. If the stimulation helps cancer patients keep their hair, it should also help healthy but balding men and women retain their youthful tresses.

Just how well the technology works is something Americans will soon be able to determine for themselves. Current Technology Corp. of Vancouver, British Columbia, has begun marketing a baldness treatment called ElectroTrichoGenesis. It is based on Pilla's work. The company is cautious to point out its therapy isn't a cure. However, for the millions of Americans who see their youth washing away into a hair-clogged sink strainer, the treatment could be just what the doctor ordered.

Background on Laser and Theory of Proposed Benefits

For the Laser to become a medical device for benefiting the person with hair loss from genetic causes, the devices that are being promoted must prove that they are safe for use and that they are effective to meet the claims of those who promote it. It is critical for the consumer to know that what he is buying (either a service or a device) does what he has bargained for and does not expose him/her to any undo risks. There have been a great deal of claims for benefit of these laser hair devices along with proposed mechanisms of action. The purpose of this document is to review the information that is available (substantiated and unsubstantiated) so that you, the reader, can judge whether or not Laser treatment for hair loss is appropriate for your situation.

The Low Laser Therapy (LLT) for hair loss is claimed to work by supplying energy to the body in the form of non-thermal photons of light. The technology is further claimed that in the right application, the body is able to absorb this external energy on a cellular level and transform light energy into chemical energy, which the body then uses to accelerate the normal healing rate of tissue for a wide range of ailments. .

For the body to be able to absorb and transform the energy, certain parameters need to be defined such as treatment time, wavelength of the light energy, dosage, etc.. with the various techniques.

For a Laser, the wavelength of light is extremely important, since the wavelength ultimately decides the penetration depth in the target tissue. Red light from a 670 nm continues-wave is claimed to be less well absorbed in blood, which is also red, so the penetration rate is much greater than from other hair lasers closer to the red spectrum (632,8 nm, 635 nm 650 nm etc.) Since wavelengths from 670 to 690 nm support the redox processes (oxidization processes) it is believed that the 670nm wavelengths show better efficacy in therapeutics than lower wave length lasers such as the He-Ne-lasers (632,8 rim) etc. Low-energy visible light (LEVL) has been shown, in some studies, to stimulate certain cell functions. This is called "photobiostimulation" and has been used over the last three decades for treating a range of conditions, including soft tissue injuries, severe wounds, chronic pain, and more. Although the mechanism of photobiostimulative processes is still being debated, in order to interact with the living cell, light has to be absorbed by intracellular chromophores. In a search for the chromophores responsible for photobiostimulation, endogenous porphyrins, mitochondrial and membranal cytochromes, and flavoproteins were found to be favorable candidates. The above-mentioned chromophores are photosensitizers that generate reactive oxygen species (ROS) following irradiation. As the cellular redox state has a key role in maintaining the viability of the cell, changes in reactive oxygenation may play a significant role in cell activation. There is suggestive evidence demonstrating various ROS and antioxidants are produced following LEVL illumination. There are suggestions that the change in the cellular redox state plays an important role in maintaining cellular activities and leads to photobiostimulative processes

In the field of photochemistry, the light must be absorbed before photochemistry can occur. This is a very simple but powerful concept for this field and as such, is basic to the 'laws' of the science. Of the lasers in the visible region 670nm laser is considered to provide superior absorption (penetration). In 1993 a study on rat schwann cells demonstrated the variations between 670, 780 and 830 nanometer absorption. The highest absorptions were exhibited at 670 nm and the lowest at 830 nm. However there is clinical evidence that in contrast to other wavelengths, the 830 nm laser light produces specific beneficial biological reactions that are not produced by other wavelengths. Because the scalp skin is thin, the deep penetration of the 830 nm wave length may be too deep to get the full benefits to the rather superficial hair follicles and is therefore not needed for hair therapeutics. Today, the wavelengths most commonly used for therapeutic purposes are 632,8 run, 635 nm, 650 nm, 660 nm, 670 nm, 780 nm, 820 nm, 830 nm, 904 nm (GaAs lasers). Except for GaAs, all these lasers usually produce a continuous beam but some may also be pulsed. The infrared lasers, invisible to the eye, are more suitable for muscle therapy (deep penetration) and are not used in hair loss therapy because the penetration depth is not needed. With these lasers, eye protection is needed and these devices are considered Class IIIb devices by the FDA. (Visible light ranges from: 400 nm (violet) - 700 nm (red) Infrared light: Above the 700nm Infrared light, the light is invisible.

For hair applications, the first and most significant condition in choosing laser wavelength is depth penetration, which should be sufficient to target hair bulbs typically resting at a 5-6 mm depth.

Visible red light, at a wavelength of 660 nanometers (run -1 nanometer is equal to one billionth of a meter), penetrates tissue to a depth of about 8-10 mm so the entire hair organ will be covered to a depth just beyond the hair bulb. Visible red light also can theoritically be effective in the entire scalp and might include; wounds, cuts, scars, folliculitis, etc... Higher Infrared light in the non-visible area will penetrate to a depth of about 30-40 mm and therefore might make it effective in the treatment of joints, deep muscle, etc… (areas of application which are used today).

Lasers can operate in two modes: (1) either continuous-wave (cw) or (2) pulsed operation modes. The biological responses of the same cells to pulsed and continuous-wave (CW) light of the same wavelength, average intensity, and dose can vary.

Supporters for pulsed LLLT produce the following arguments for why pulsed might be better:

• It is believed that pulsed LLLT can stimulate tissue repair and regeneration
• It is believed that pulses stimulate cell, activity. Theory suggests that rapid pulsing of LLT starts to simulate a continuous beam.
• It is believed that pulsed LLLT can regulate biological rhythms or cycles
• It is believed that pulsed light produces deeper penetration compared to continuous wave. More science is needed to define and prove such claims.
• It is believed that pulsed LLLT has an anti-imflamatory effect.
• It is believed that when both pulsed light is used in combination with the visible infrared red light spectrum, it might have value for various hair treatments which are becoming the focus of marketing and research activities today.

There are two ways to create the pulsations:

1. By turning the lasers on / off mechanically
2. By transfer the light in specific patterns through internally moving parts to the administration device. The laser diodes can be fixed within a hood and by moving band shaped fields of light repeatedly over the area a pulsating stimulation of the hair follicles of the skin can be simulated. One of the commercial systems available today, Laser Hair Care, uses this proprietary approach and this company believes that this increases the stimulatory effect of LLLT on the scalp and hair.

When dosing LLLT (often referred to as "fluence"), the energy is measured in J (joules), the area in cm2, and, consequently, the dose in J/cm2. To induce an optimal effect, the exposure dose has a lower and upper limit. The optimum theoretical dose probably lies somewhere in the middle. It is believed that repeated doses, given at intervals, induce stronger effects than the same total dose given in one treatment and as such, the treatment effect is cumulative. This would mean that repeated doses with a suitable, relatively short interval might give an added response. Fluences between 0.24 - 1.0 J/cm2 on one hand and 3 - 4 J/cm2 on the other hand, may be more favorable for different conditions.

I have obtained access to the Laser Hair Care device which produces 108 Joule in 15 minutes spread over a density between 0.12 - 1.09 J/cm2/15 minutes (10.8 J/cm2/15 minutes). In a scalp blood microcirculation study done with the Laser Hair Care device in 1996, Pontinen demonstrated that the Laser Hair Care (60 mW) fluencies increased blood flow while He-Ne laser 0.01 J/cm2 had no effect. The same study demonstrated that light emitting diodes (LED) with fluences between 0.68 - 1.36 J/cm2 (112.5 mW) produced Vasoconstriction* (reduced blood flow). Some believe that an increase in blood supply will parallel an increase in the demand for blood supply and as hair is amongst the highest metabolic organs in the body, the presumption that the demand for blood and oxygen from the hair organ is driving the higher blood supply reported in this and other similar studies. Speculation for interested third parties need science to back this assumption up with better studies that show the relationship between the size and mass of the sum of the hair organs when compared with pre-treatment metrics.

The power, watt or milliwatt, of a laser determines how much energy is initially delivered to the tissue surface and along with the wavelength, the power at any given depth of penetration. Energy density (Joules / entimeter2) is equal to the power of the laser in watts multiplied by the treatment time in seconds, divided by the surface area irradiated in square centimeters. Laser light has the unique properties of monochromaticity, (a single wavelength), coherence (travels in a straight line), and defined location (concentrated beam). Amongst the questions needed to be better understood is the effects of LLLT on the cells, namely: Do cells exposed to LLLT convert the energy into chemical energy and can they use that energy for repair, regeneration, or growth stimulation?