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Baldness, often a subject of jokes and also popularly considered by some women as a symbol of virility, appears to have a more serious implication, as far as health risks are concerned.

In a study on more than 22, 000 men ages 40 to 84, published in the Archives of Internal Medicine, the findings suggest that “men with male pattern baldness may be at increased risk for heart disease.”

“Compared to men with no hair loss, those with severe vertex baldness (balding at the crown of the head) had a 36% increased risk of heart disease; men with moderate crown balding had a 32% increased risk, while mild balding on the crown carried a 23% increased risk…. Men with frontal baldness had a 9% increased risk.”

The correlation was especially evident in men with vertex baldness whose cholesterol level or blood pressure was high. Baldness is a non-modifiable health risk, unlike smoking or eating high fat diet, so hair loss remedy, like Rogaine or Propecia, might improve the look but won’t reduce the risk to heart disease.

Another health risk related to baldness is the increased risk for cancer of the prostate, according to the US National Cancer Institute of the National Institute of Health Division of Cancer Epidemiology. Their study on 4,421 men with male pattern baldness (ages 25 to 75) without history of cancer of prostate, revealed that the risk for prostatic cancer was significantly elevated among these men, compared to their peers with abundant hair.

Physicians now use male pattern baldness as an early clinical marker or indicator of susceptibility to heart disease and prostatic cancer.

How common is baldness?

Baldness affects approximately 40 million men and 20 million women in the United States. We could not find statistics for the Philippines. Male-pattern baldness is recession of the hairline from the forehead upwards and back, thinning or fallout from the crown of the head, leaving a horseshoe-shaped hair mass around the sides and back of the head. Female-pattern baldness is a diffuse hair loss throughout the scalp. Even Julius Caesar, according to legend, used the ceremonial wreath of laurel leaves as a crown to hide his baldness.

What causes baldness?

About 95 % of hair loss is caused by a hereditary condition called androgenetic alopecia. DHT is dihydrotestosterone comes from a male hormone called androgen, which circulates in the bloodstream. Androgen is converted to DHT by an enzyme called 5-alpha reductase. Those with more reductase activity have more DHT binding to the hair follicle receptors, which adversely affects hair follicles, until the follicles wither away.

How does one know if he/she will have baldness?

All men have to do is to look at their father’s hair, and the women, at their mother’s hair, since baldness or thinning hair is strongly hereditary. Of course, there are some other medical conditions that could affect the future of one’s hair besides genetics.

What is the normal rate of hair loss?

Normally, we lose about 100 hairs a day, and they regenerate, unless a person has a tendency to baldness or has an illness that affects hair growth.

What is alopecia areata?

This is a condition due to autoimmune disease of unknown cause, where inflammatory cells attack the bulbs of the hair follicles under the scalp, resulting in hairless patches or areas of baldness, hence “areata.” While baldness only hurts one’s psyche, some of the causes of hair loss may signal a health problem, like alopecia areata. This is why consulting with one’s physician is essential.

Could hair fall out from the entire head at once?

Yes, in more serious cases, which luckily is not very common, hair may actually fall out of the entire head, eyebrows and beard included, and hair from the rest of the body. In many cases, though, hair spontaneously regrows.

What medical conditions can cause hair loss?

Severe malnutrition, childbirth, thyroid problems, a form of lupus, and, more popularly see (even on TV shows), following chemotherapy for cancer.

Can mental stress lead to hair loss?

Psychological stress has been reported to have caused hair loss but only at times of extreme emotional trauma. The medical community doubts the role of emotional stress as a significant factor in the causation of baldness. Sudden appearance of spots or areas of premature gray hair in some people who were under severe personal stress is not uncommon.

Do herbal potions, other creams or lotions help prevent hair loss?

No, there is no known cream or ointment, lotion or potion, mousses, gel, volumizers, or shampoo that can prevent hair loss or baldness, much less cure them. The US Food and Drug Administration has banned all these over-the-counter salves in 1989. The only two things that will surely grow when you use these costly preparations are your expenses and the bank accounts of the manufacturers and dealers.

What can be done then?

Rogaine (minoxidil-based), Nioxin shampoo and conditioner, and other aids are available in the market. The response is individual, but it provides real hope. Hair (micro or mini-graft) transplantation and the use of hairpieces (toupees and wigs) are the two other options. State-of-the-art hair transplant centers have had great successes with most natural looking hair growths. Synthetic hair transplant has been legally banned by the FDA because of the attendant complications and dangers. In today’s society, baldness is well-accepted and so with the use of hair pieces or hair transplants.

How about the related health risks mentioned above?

The prudent way is to minimize all modifiable health risks, like cigarette smoking, excess alcohol intake, high-cholesterol, high-fat diet, a sedentary lifestyle, and unmanaged stress. This strategy for a healthier lifestyle will also help counter the increased risk for heart disease and prostate cancer among all individuals, including those men with male pattern baldness.

Health@Heart
Philip S. Chua, MD, FACS, FPCS

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