Hair Loss - Information and Cures

Worried about your receding hairline? Try this: Combine boar's grease, ashes of burnt bees, ashes of southernwood, juice of white lily root, oil of sweet almonds and musk into an ointment and rub it into the scalp every day.

Actually, don't bother. This old English recipe for baldness will be time consuming (how do you burn bees?) and almost certainly won't work.

But it does suggest that men were just as desperate to cure baldness in the Middle Ages, when this recipe was concocted, as they are today.

For many men, a receding hairline is a body blow. A quarter of balding men feel less confident, a fifth feel less attractive and three quarters think they look older than men with a full head of hair, according to one recent Australian survey.

But they needn't be so despondent. There are treatments that work, and in any case, some women think balding men are sexy. You don't hear Andre Agassi complaining.

A bit about hair

Hairs are tiny shafts of a protein called keratin, anchored in a group of specialised cells in the scalp that produce and support each hair called a follicle. The follicle supplies oxygen and nutrients to the bulb, and lubricates the hair shaft with an oily substance called sebum.

The human body is completely covered with these hair follicles (except the palms of the hands, soles of the feet, genitals and lips).

But mostly, follicles are tiny and the hairs they produce don't grow long enough to protrude from the pore. They do protrude to be visible above the skin in some areas – those areas are the armpits, face, around the genitals, the front of the chest and the back – but most profusely on the scalp of the head.

A man's scalp typically contains about 150,000 hairs. The colour, curl, length, thickness and amount of hair are determined by the genes.

Hairs grow and then are shed. Hair grows at different rates so not all the hairs are shed at once. At any one time, about 90 per cent are in a growth phase, which in men averages two to three years, with the others in a resting phase – when there's no growth – lasting about three months. After the resting phase the hair falls out. The scalp loses between 50 and 200 hairs a day.

Male Pattern Baldness

In some males the growth process slows right down. The growth phase of each hair gradually becomes shorter, whereas the resting phase becomes longer. Eventually the hairs that are growing become so short that they barely emerge from their hair follicle.

There is also an increasing lag time between the end of the resting phase and the next growth phase, also resulting in fewer hairs emerging. The process begins at the sides of the head and at an area at the top of the head, and spreads.

This is so called 'male pattern' baldness, known technically as androgenetic alopecia. It's the most common type of baldness, affecting about half of all men by the age of 50 and over 80 per cent by the age of 70.

Why does it happen? It's thought that testosterone, the male sex hormone, somehow acts on the hair follicles to stop them making hairs. Whether or not this happens in a particular man, at what age it starts, as well as how extensive it will be is determined by the man's genes. It's thought to be autosomal dominant – the gene is inherited from usually one or other parent, but the gene is not always expressed; for reasons we don't understand, the faulty gene doesn't actually cause baldness. So if parents or grandparents have male pattern baldness then it's more likely in a man, but not certain.

Hair Loss Treatment

Men who are going bald have several options – drug treatments, hairpieces, hair transplants. Alternatively, they can ignore it, or go the whole hog and shave the remainder of their hair off.

Drugs

There are two drugs that have been shown to halt, and sometimes reverse, male pattern baldness; finasteride (Propecia or Proscar) and minoxodil (Rogaine). They're most effective in the early stages of hair loss.

Finasteride works by blocking the enzyme that changes testosterone to dihydrotestosterone, the form of this male hormone that is thought to be responsible for male pattern baldness. It was originally developed to treat benign prostatic hyperplasia (enlarged prostate). Available only on prescription from a doctor, it's taken as a tablet once a day.

It will slow hair loss in about 80 per cent of men and in some, cause hair to regrow. Usually it takes about three months before there's either visible re-growth or reduction of further hair loss. However, it may take two or more years before there's a noticeable effect. The effect isn't permanent – if the drug is stopped, any hair regrown will be lost, probably within 12 months.

A small percentage of men – less than two per cent – experience decreased sex drive and problems getting erections; these side effects reverse very quickly after stopping treatment, and often disappear gradually during treatment.

Minoxidil comes as a lotion, to be massaged into the dry scalp twice a day. It's thought to increase blood flow to the hair follicle cells and stimulate them. It's available over-the-counter in pharmacies.

About 80 per cent of users experience a reduction in the rate of further hair loss using it, and about one-third can expect minimal to moderate regrowth and almost one in 10 dense regrowth. However, it can take between six and 12 months to see any effect and, as with finasteride, it has to be used continuously or any new hair will be lost in three or four months. About two per cent of users experience scalp dryness, itching or dermatitis.

Transplant

This involves a cosmetic surgeon taking strips or plugs of hair from the back or sides, and surgically placing them in areas where there is no hair, or between hairs in thinning areas.

The standard operation used to be to take large round plugs of hair bearing skin with more than 12 hairs per graft. This tended to leave patchy scarring at the donor site and an unnatural tufted look where the plugs were inserted. So the trend now is to use smaller plugs – very small grafts containing one to four hairs known as micrografts or follicular units.

Up to a couple of thousand plugs can be transferred in a single session. It's usually done as a day-only procedure under local anaesthesia. The transplanted hairs fall out in a few weeks but then begin to grow again after about 10 weeks and continue to grow. In the donor area too, the hair is lost at first but begins to regrow in a few months. In some people there is scarring at the donor site but it's usually concealed by hair regrowth.

Hairpieces

Hairpieces made from treated human hair, can give reasonably satisfying results. The hairpiece is usually attached to the scalp by bonding glue, adhesive tape, hair clips, or meshing with existing hair. It can be removed for sleeping or washing of the scalp. It needs to be well maintained and replaced every 12 months or so.

Natural DHT Blockers

Some natural hair loss remedies are designed to block DHT (dihydrotestostrone) from getting to your body, which is one of the major causes of hair loss. These natural hair loss products are designed to block DHT and supply the proper nutrients to your body specifically tailored to prevent hair loss and to help you regrow hair naturally. Strong, healthy hair begins with the proper nutritional building blocks. You don't have to wait until there's a problem to prevent it. Supplement your body's natural supply of these nutrients and lets the tiny follicles beneath your scalp receive exactly what they need to create beautiful, full-bodied hair

Androgenetic alopecia in women

Women get androgenetic alopecia too, but it's less common than in men, because women's testosterone levels are much lower. The pattern of hair loss is different from men; hair loss in women tends to produce thinning over the top of the scalp rather than a patch of baldness. Over 50 per cent of women have some mild hair loss as they age, and about 20 per cent of women develop moderate or severe hair loss. It's more common in women who have hormonal imbalances or are using the contraceptive pill or corticosteroids. As in men, it often responds to Minoxidil.

Other causes of hair loss

Alopecia areata

This is an autoimmune disease in which the person's own immune system attacks the hair bulb and destroys it, for reasons not understood. It affects both men and women equally. It often appears as just one patch, typically a few centimetres in diameter, or several patches. In severe cases it can affect the whole body – the person loses even their eyebrows. The treatment is corticosteroids – cortisone creams or injections in mild cases, tablets in severe cases. In some people, the hair grows back within a few weeks or months, but other people are left with persistent bald spots.

Emotional impact

Whilst most men learn to accept baldness, a small proportion – particularly men who get it early in life – suffer severe depression or become obsessional about their hair loss. Women can also find hair loss distressing. If you are upset by hair loss, it's a good idea to seek help from a mental health professional for appropriate support and treatment.

Illness

Hair loss can also occur after a severe illness, major surgery, chemotherapy to treat cancer, sudden shock such as bereavement, and as a side effect of some medications. Burns can permanently destroy hair follicles through scarring. Fungal infections (for example, ringworm) can also cause bald patches.









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