You've likely seen magazine ads, radio commercials and TV promoting miracle treatments for hair loss. Unfortunately, that is what's needed for those treatments to work - a miracle.

The most common cause of hair loss in both men and women is genetic, and it's called androgenetic alopecia, also known as male pattern balding and female pattern hair loss. In fact, heredity accounts for 95% of all the cases of baldness (alopecia) in the United States. In androgenetic alopecia, hormones related to testosterone (also called androgens) cause hair follicles to have a shorter than minimal growth phase, resulting in hair shafts that are abnormally short and thin.


Medical considerations

Physicians and nurse practitioners can usually diagnose androgenetic alopecia by examining the scalp. In some cases, blood work will be needed to investigate other causes, like changes in hormone levels, low iron levels or thyroid problems. Such evaluations usually are covered under most plans because the diagnostic workup is looking for medical etiology.

The common treatment for hair loss is medication. Two drugs, minoxidil (Rogaine) and finasteride (Propecia or Proscar) are available to treat male pattern balding. Women can be treated with minoxidil or spironolactone. Finasteride is not safe for use in women who could become pregnant.

Minoxidil, which can be purchased without a prescription, is a liquid or foam scalp treatment that promotes hair growth by lengthening the growth phase of hair follicles and causing more follicles to produce hair. The hairs that are produced tend to be larger and thicker. Since it can be purchased over the counter, suggest to employees that the cost of this drug may be eligible for reimbursement through the comany-offered medical spending account (although they may still need to get a prescription.)

Finasteride (Proscar or Propecia) is a pill that decreases the production of one of the hormones associated with androgenetic alopecia, resulting in an increased amount of hair covering more of the scalp. Because finasteride is also used to treat some prostate conditions, it typically is covered under most prescription plans. Just to be safe, you may want to check your prescription plan to make sure that there are no exclusions.

Beyond drug treatment, there also are surgical and nonsurgical solutions (like hair transplants or hair additions) to treat hair loss. Although you can check to see if your plan covers these treatment options, they generally are not covered by insurance because they are considered strictly cosmetic.


Quality-of-life issues

Beyond the medical issues, though, it's also important to consider quality-of-life issues related to hair loss. For many people, losing their hair is a frustrating and often difficult emotional experience - especially for women, since there is little understanding of the condition. Patients often describe issues of low self-esteem or feeling unattractive as a result of their hair loss. It can be helpful to sufferers if they have mental health benefits through their employer to guide them through their emotional response to their hair loss.

Contributing Editor Betty Long is a registered nurse and founder of Guardian Nurses Healthcare Advocates, a health care advocacy firm that has helped thousands of patients navigate the health care system and saved millions of dollars in health care costs.

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