Managing Expectations and Tailoring Therapies in Modern Hair Loss Management

In a continuing conversation, Alexandra Richmond, MD, founder and owner of Dermhaus in Charleston, South Carolina, stressed the importance of setting realistic expectations when initiating treatment for hair loss. Because hair growth is a slow process, patients should understand that meaningful improvement generally takes months rather than days or weeks. Richmond typically schedules an early follow-up to assess medication tolerability rather than expecting visible hair regrowth at that stage. Establishing this timeline can help patients remain adherent rather than prematurely abandoning treatment when early results are limited.

Managing expectations is particularly important for patients with scarring alopecia. Richmond explained that treatment cannot restore hair in areas where follicles have been permanently destroyed by scarring. Instead, the goal is to preserve existing hair, support its growth, and prevent further progression.

Richmond often uses multiple treatment approaches to target hair growth through different mechanisms. Depending on the diagnosis and patient-specific considerations, systemic options may include minoxidil, finasteride, dutasteride, or spironolactone. Treatment is individualized based on potential adverse effects and other factors, with medications sometimes introduced sequentially and additional therapies added as needed. Topical treatments, including topical minoxidil or corticosteroids, may also be incorporated depending on the type of hair loss.

Other treatment modalities can include low-level light therapy and platelet-rich plasma (PRP), particularly for patients interested in approaches that complement or reduce reliance on medications. Richmond noted that some patients are increasingly interested in more “natural” treatment strategies and therefore appreciates having multiple options to discuss. She also describes her use of Xtressé supplements, which contain lower levels of multiple nutrients intended to support hair growth. The formulation, as she notes, is designed to minimize potential interactions with other medications and is available as a gummy, which may improve convenience and tolerability for patients.

Looking ahead, Richmond is particularly interested in next-generation oral minoxidil formulations. She notes that currently used oral minoxidil was originally developed as a cardiovascular medication and can produce a relatively rapid increase followed by a decline in drug levels, prompting consideration of cardiovascular and pulmonary risks. An extended-release formulation in late-stage development is designed to provide a more gradual increase in exposure. Richmond anticipates that this approach could offer improved tolerability while maintaining efficacy, potentially expanding treatment options for patients with hair loss.

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