Every few months, a headline appears suggesting that baldness has finally been solved. Most deserve a healthy degree of scepticism.

This one caught my attention because the results are genuinely impressive.

A medication already used for arthritis and other inflammatory conditions has helped a significant number of people with severe alopecia areata regrow most—and in some cases all—of their scalp hair.

Naturally, the headlines have focused on the idea that an arthritis drug can reverse baldness. That is technically true, but it also risks giving men the wrong impression. The medication was not tested on the receding hairlines and thinning crowns most men experience. It was studied in people with a severe autoimmune form of hair loss.

It’s a really important distinction.

 

What did the study actually show?

The medication is upadacitinib, known by the brand name Rinvoq. It belongs to a group of medicines called JAK inhibitors, which work by interrupting certain inflammatory signals within the immune system.

Two major phase 3 trials studied the medication in almost 1,400 adults and adolescents with severe alopecia areata. Everyone taking part had lost at least half of their scalp hair, and the average participant had lost more than 80%.

After 24 weeks, around 45% of people taking the lower dose and 55% taking the higher dose had regained enough hair to achieve at least 80% scalp coverage. Between 13% and 23% achieved complete scalp hair regrowth.

As a doctor, I think these are important results. Alopecia areata can be extremely difficult to treat, particularly when it is extensive, and its effect reaches well beyond appearance. Hair is tied closely to identity, confidence and how people feel when they walk into a room. Losing it suddenly can be devastating.

So this is not a cosmetic breakthrough being dressed up as medicine. For the right group of patients, it could become a meaningful new treatment option.

However, it is not a cure for ordinary male pattern hair loss.

 

Not all hair loss is the same

“Alopecia” simply means hair loss. It does not tell us why the hair is being lost.

Alopecia areata is an autoimmune condition in which the immune system mistakenly attacks healthy hair follicles. It often causes sudden, clearly defined bald patches, although more severe forms can affect most of the scalp, beard, eyebrows, eyelashes or body hair.

Male pattern hair loss develops through a different process. It usually appears gradually as a receding hairline, thinning around the temples or reduced density through the crown. It is predominantly driven by genetics and by the sensitivity of certain hair follicles to dihydrotestosterone, or DHT.

Both conditions result in less hair, but that is largely where the similarity ends. One involves the immune system attacking the follicle; the other involves the gradual miniaturisation of genetically susceptible follicles.

This is why I am always cautious when a single treatment is presented as a cure for “hair loss.” Before we talk about treatment, we need to understand which type of hair loss we are treating.

 

Could this medication be used in New Zealand?

Upadacitinib is available in New Zealand and is currently used for conditions including rheumatoid arthritis, severe eczema and inflammatory bowel disease. It is not, however, approved or funded here for alopecia areata.

Using it for hair loss would therefore be off-label, most likely under specialist supervision. It would also be expensive when prescribed privately, with the listed cost exceeding $1,000 for 28 tablets at the lowest dose studied.

More importantly, this is not a harmless hair-growth tablet. Because it modifies the immune response, it carries risks that need to be properly assessed and monitored.

Before considering treatment, a clinician would need to look at infection risk, tuberculosis exposure, vaccination history, other medical conditions and possible interactions with existing medication. Blood tests and ongoing monitoring would also be required.

In the trials, common side effects included acne and respiratory infections. Serious adverse events occurred in 1.6% of people taking the lower dose and 2.3% taking the higher dose, compared with 0.4% receiving placebo. The initial 24-week results did not identify any new safety concerns, but we still need longer-term evidence to understand how well the benefits are maintained and what happens after treatment is stopped.

The science is exciting. That does not mean we should get ahead of it.

 

What should men experiencing hair loss do now?

My advice is fairly straightforward: do not begin with the product. Begin with the cause.

Male pattern hair loss is common, but it is not the only reason men lose hair. Sudden shedding or thinning can also be associated with thyroid disease, illness, medication, nutritional deficiencies, hormonal changes, autoimmune conditions or periods of significant physical and psychological stress. Sometimes more than one factor is involved.

For male pattern hair loss, we already have established options including topical minoxidil and prescription finasteride. Finasteride 1 mg is approved in New Zealand specifically for male pattern hair loss. Other treatments may sometimes be considered off-label, depending on the individual, the diagnosis and the balance between likely benefit and possible risk.

Alopecia areata requires a different approach. Depending on its severity, treatment might include topical or injected corticosteroids, topical immunotherapy or systemic treatment managed with specialist input.

There is no single treatment plan that makes sense for every man because there is no single cause of hair loss.

 

Promising, but let’s keep the headline in perspective

I am genuinely encouraged by this research. For people living with severe alopecia areata, the degree of regrowth seen in these trials could represent a major step forward.

For the average man noticing that his hairline is gradually retreating, however, it is unlikely to change what we do tomorrow.

The good news is that men do not need to wait for the next breakthrough before seeking help. We already have evidence-based treatments, and we are usually in a better position to protect hair when the problem is assessed early.

At Mr, our role is to work out what is happening beneath the surface, explain the available options honestly and build a treatment plan that makes sense for the individual. If the pattern suggests an autoimmune condition or something requiring specialist care, we can arrange the appropriate investigations and referral.

Hair loss may be common, but that does not mean every man should receive the same answer.

 

Dr Afraz Adam
Chief Medical Officer, Mr Healthcare

This article provides general health information and does not replace an individual medical assessment. All medications have potential benefits and risks and should be considered with an appropriately qualified healthcare professional.