Platelet Rich Plasma (PRP) for Hair Loss

You may be wondering why Platelet Rich Plasma, or PRP, as a treatment for hair growth belongs in a blog about natural remedies for hair loss.

Because it is the perfect natural treatment. No drugs. No chemicals. Merely, an awakening in the scalp of nature’s fearfully and wonderfully made natural processes for healing and growth.

What is Platelet Rich Plasma?

One succinct definition of platelet rich plasma describes it as an “autologous concentration of platelets in concentrated plasma”.[1] Autologous means that the source of platelets comes from the patient. In this case, the source is the patient’s own blood. A doctor draws the blood into test tubes from the patient’s arm, then spins the blood with a tool called a centrifuge. Blood is composed of white blood cells, red blood cells, platelets, and plasma and numerous other components. The centrifuge separates these components, enriching the plasma several times over with the platelets. Once the centrifuge spin is completed, the doctor is able to draw out just the plasma from the test tubes. At this point, the PRP is essentially ready for the patient.

How does Platelet Rich Plasma Induce Hair Growth?

Injecting PRP stimulates hair growth via the action of several powerful protein growth factors contained in the platelets of the concentrated plasma. Once these growth factors are introduced to the hair follicles of the scalp, at several times hair’s normal exposure via the circulatory system, they trigger the follicle’s stem cells to begin hair production. Dormant hairs activate. Hair grows thicker and longer.[2]

Each growth factor specializes in promoting the growth of various components and subcomponents of the hair, skin and blood vessels. These number six:

  • platelet-derived growth factor (PDGF)
  • transforming growth factor (TGF)
  • vascular endothelial growth factor (VEGF)
  • insulin-like growth factor (IGF)
  • epidermal growth factor (EGF)
  • interleukin (IL)-1

Doctors can use PRP in tandem with a hair transplant procedure or as a stand alone treatment. During a hair transplant, the doctor removes hair follicles from the donor area and puts them in a holding solution to protect them and give them nutrients until they are placed into the target area of the scalp. This is a stressful event for the follicle and sometimes it does not survive the circuit. Research shows that adding PRP to the holding solution can improve follicle survival. The PRP-bathed hair follicle also benefits by the boost in nutrition once in the scalp and exhibits better tissue healing and growth.[2]

The evidence for PRP as a stand alone treatment for hair loss, apart from hair transplant, comes from more than one study. The procedure involves mildly injuring the scalp as the PRP is delivered. This action seems to induce the platelets to release their growth factors at the site of injury, resulting in better hair growth over a span of about four months. [1,2,3,4]

History of Platelet Rich Plasma In Medicine

The medical community has been long familiar with the benefits of platelet rich plasma treatment. Nearly forty ago, for example, hospitals began to see improved healing in patients who received enriched plasma to surgical wounds. But regularly creating potent plasma was challenging given the technology available then, so its use was not well studied or widely applied beyond the hospital surgical suite. Gradually, as technology advanced and techniques improved for distilling plasma from blood, doctors and their patients began to realize the benefits of PRP across more surgical specialties. More recently, urology, thoracic surgery, cardiac surgery, dental surgery, maxillofacial, neurosurgery and cosmetic surgery – almost all surgical sub-specialties have demonstrated the enhanced healing effects of platelet rich plasma across a diverse set of tissues (skin, hair, bone, cartilage, muscle, etc).[1,3]

But, while PRP enjoys a fair degree of popularity, what does the science really say?

Platelet Rich Plasma is Not Approved by the FDA

As I mentioned at the beginning of this post, platelet rich plasma is considered “autologous.” But there are several kinds of autologous procedures in medicine. For example, the common blood transfusion is an example of an autologous therapy. So are skin grafts where the skin from one area of a patient’s body is harvested to repair another area on the same patient, as is often done for severe burn victims or cancer patients. In all of these cases, the same patient is the donor and recipient of the tissue. As a result, these kinds of procedures are “immunologically neutral” to the body, meaning that there is no risk of a reaction or a response by the immune system. This also means therefore that autologous therapies do not fall under the FDA’s regulating authority.

When a therapy or procedure does not require FDA approval, the obvious benefit is that it does not have to wait for long and expensive clinical studies to conclude before allowing health care providers to deliver these interventions to the market. Doctors are free to apply autologous procedures to their patients as indicated by their training and the empirical evidence they acquire from their practices.

On the other hand, this also means there is no incentive to conduct the kinds of large-scale, rigorous studies which result in objective data to prove the degree of effectiveness, safety, indications for, and risks of autologous procedures like platelet rich plasma. For which tissues is PRP the most effective and to what degree? In which settings? How much PRP and at what concentrations and ratios of growth factors? When is PRP NOT effective? Without the data to answer these questions, we do not really know in what situations PRP is most effective. The risk becomes that providers will over prescribe the procedure, using it to treat all manner of diseases, even those in which it is not effective.

And that is the problem of a lack of FDA approval: Physicians are not supposed to make any claims regarding the effectiveness of platelet rich plasma for hair growth. None. The reality is that many often do since FDA enforcement in this area is lax.

While several studies report on the relative effectiveness and safety of PRP in the treatment of hair loss, none of these meet the requirements for FDA approval. The FDA requires large, controlled clinical trials involving approved devices and employing objective means for collecting data that clearly describe and demonstrate PRP safety and effectiveness.

How can PRP Help Grow Hair if DHT Is Still in the Blood?

That’s a good question. We know that DHT is a metabolite of the androgenic hormone Testosterone, the metabolite most commonly responsible for thinning hair and baldness, especially in men. From what I’ve been able to tell from doctor’s responses online, PRP neither increases or decreases the quantity of DHT in the scalp. It also does not enhance or oppose DHT directly. PRP’s effect is simply as described above – growth factors act on the hair follicles to stimulate growth, waking dormant hairs, and increasing hair diameter and length. In that respect, it seems like the effects of the growth factors simply add up to more than the effect of DHT.

My Experience Undergoing PRP

In February, 2016 I decided to quit my Avodart prescription for hair loss, which I’d been taking for one year. Before that, I had been on Finasteride for about a decade. The trigger for my decision followed a visit to a doctor experienced with male hormone replacement. I made the appointment because I was experiencing loss of libido, anxiety, enlarged breasts, and fat deposits behind my knees, back and around my midsection. He examined me and remarked that my body seemed “gynecogenic”.

According to Merriam Webster’s medical dictionary, gynecogenic means “tending to induce female characteristics”.

Translation: My body was womanly. This is the awful truth of taking DHT blocking medications. I had become a living example.

He told me to stop the Avodart immediately. Six months later, I could no longer deny it. I felt and looked a lot better, but my hair was noticeably thinner.

I had read several reports and testimonials about the favorable results of PRP online and wondered if it could help my situation. The closest place to me offering the procedure was Chambers Hair Institute in Troy, Michigan, about a 2-½  hour drive from my house. They are the most established and recognized hair transplant center in the Michigan. I liked them immediately because a technician or doctor personally answered my and took my phone calls.

The procedure was expensive at a price of $1,500 for a package of two. This came in at least twice the average price I had seen discussed on the Internet, but Chambers seemed to be the only reputable hair center around offering PRP, so I bought it. A technician named Sal explained to me that they sold two treatments in a package when a person is new to the procedure. Each treatment is given a few months apart. After that, I should require only one treatment annually for maintenance.

Sal ushered me into an exam room to start the procedure. I sat back in an exam chair as he prepared the numbing medication. He rolled up paper towels into the shape of a headband and put it around my head as a barrier to bleeding. He injected the numbing medication in several places in my scalp and then left me for a few minutes to allow the medication to work.

Next, Dr. Cavaliere entered the room. He drew blood from my right arm, filling what had to be five or six tubes. He took the blood filled tubes to another room to spin my blood in a centrifuge for a few minutes. It wasn’t longer before he returned with a syringe containing my amber-colored, translucent plasma in a syringe and needle. After a few deft jabs under my scalp, he injected the plasma and the procedure was over.

The pain was minimal thanks to the numbing medication. I compare the procedure’s discomfort to that of a root canal, if not less. Bleeding was minimal too; afterward my courtesy paper towel headband was hardly stained. Sal and Dr. Cavaliere made me feel comfortable the whole time by engaging me in conversation and working professionally and quickly. I was able to make the 2-½ hour trek back home without any problems. It wasn’t until later in the evening, around bedtime, that my scalp started to smart mildly. I took a couple of ibuprofen and needed nothing more after that. Overall, the anxiety about the whole thing was worse than any pain or discomfort.

I’m two months out as of this writing and there isn’t any doubt that my hair is thicker and fuller. It seems like, so far, the hair growth has been proportional based on the hair already present in any area. In other words, growth occurred everywhere, but thicker areas seem to grow better than thinner areas. The picture to the right is a close up of my crown two months after the procedure (I wish I’d taken a photo just before the procedure, but didn’t realize at the time I would be blogging about this). I’ll take another picture at month three and four and update this post with them for comparison. My crown is my greatest area of concern.

But, a caveat: I also take supplements, nutrients, hair oils, shampoos and red light therapy for hair growth. So, any potential improvement attributable to PRP will be difficult to quantify. I can tell, however, that it was only after the PRP that my hair seemed to come in thicker in a relatively short amount of time. 

I’m pleased so far with the results and looking forward to seeing what happens over the next couple of months. Everyone is different. Age, race, gender, health history, nutrition, genetics and other variables will factor into your final result. For me, the response has been so far positive, positive enough that I plan on making this a regular part of my hair maintenance regimen.

References

  1. Gkini MA, Kouskoukis AE, Rigopoulos D,1 and Kouskoukis K. Platelet-rich Plasma as a Potential Treatment for Noncicatricial Alopecias. International Journal of Trichology. 2015 Apr-Jun; 7(2): 54–63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4502475/#ref3
  1. International Society of Hair Restoration Surgery. Platelet-Rich Plasma in Hair Transplantation. http://www.ishrs.org/article/platelet-rich-plasma-hair-transplantation#eight
  1. Li ZJ, Choi HI, Choi DK, Sohn KC, Im M, Seo YJ, et al. Autologous platelet-rich plasma: A potential therapeutic tool for promoting hair growth. Dermatol Surg. 2012;38:1040–6. https://www.ncbi.nlm.nih.gov/pubmed/22455565
  1. Swapna SK, Yuvraj EM, Neeta RG, Dipali CC, Nitin B. Platelet-rich plasma in androgenic alopecia: Myth or an effective tool. 2014; 7(2): 107-110. http://jcasonline.com/article.asp?issn=0974-2077;year=2014;volume=7;issue=2;spage=107;epage=110;aulast=Khatu#ref12
  1. Betsi EE, Germain E, Kalbermatten, DF, Tremp, M, Emmenegger, V. Platelet-rich plasma injection is effective and safe for the treatment of alopecia. 2013; 36(7): 407-412. PDF at  https://www.researchgate.net/profile/Evelyn-Evanthia_Betsi/publication/257380465_Platelet-rich_plasma_injection_is_effective_and_safe_for_the_treatment_of_alopecia/links/54df75570cf2953c22b307a8.pdf

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