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At a loss

HAIR loss can be distressing but is a fairly common condition, particularly among men.

When it comes to hair loss, most of us will lose over 100 strands each day without noticing. That’s partly because the average scalp has about 100,000 hairs as well as the fact that for the most part, new hair growth matches hair loss.

When hair loss significantly exceeds hair growth, or when new hair shafts are significantly finer than those being replaced, you will eventually start to notice thinning or balding.

The commonest form of hair loss is known as androgenetic alopecia or “male pattern balding”. It affects all men to some degree, some earlier and some later. Women may also be affected although it tends to be milder and much less common. With men, hair is usually lost at the temples and the hairline recedes followed by thinning at the crown. It can start as early as the teens and by age 30 about a quarter of men are affected to some degree. By age 60 around two thirds of men are either bald or have a balding pattern.

In women, the frontal hairline tends to be maintained with thinning mainly affecting the top of the head and crown. A woman may notice her part becoming wider or her ponytail becoming thinner or simply that she can now see more of her scalp than before.

More than 55 per cent of women will notice mild degrees of hair loss as they age but only around 20 per cent of women suffer moderate or severe loss.

What causes hair loss?

Androgenetic alopecia is largely determined by genes and hormones, in particular, testosterone levels. Other causes of hair loss or balding include “traction” alopecia, where pulling the hair tightly back in ponytails and so on results in hair breakage and loss. Vigorous brushing, and overuse of harsh chemicals, dyes, curlers, hot irons and hairdryers can damage hair, making it brittle but unless the hair root is damaged, normal growth should continue.

The psychological condition “trichotillomania”, where people pull on or chew their hair when stressed, is another fairly uncommon cause of hair loss.

High fevers, severe viral infections, surgery and extreme emotional or physical stress are also associated with temporary hair loss.

Ringworm (a fungal infection) can cause hair loss if the scalp is affected. Chemotherapy, radiotherapy, burns and certain autoimmune conditions may also cause hair loss.

Hair thinning may result from eating disorders and poor nutrition. In addition, certain medications may also cause hair loss in some people

During pregnancy, women tend to shed less hair and the process of hair loss is delayed until several months after delivery.

Alopecia areata is a condition of unknown cause in which patchy, often recurrent hairloss occurs, usually followed by partial or full regrowth. Affected people are thought to be genetically predisposed.

What can be done?

Depending on the cause (if any) and degree of hair loss you have suffered, your doctor can advise you on treatment options. There are prescribed medications that can be applied to the scalp or taken orally. There is the option of hair transplantation, scalp reduction (removing part or all of the bald area of skin), wigs and “spray-on” hair. Some choose to wear hats or scarves while others prefer to shave it all off and live by the mantra that “bald is sexy”. One look at Yul Brynner is enough to convince me.

Question: Will my hair re-grow after chemotherapy or radiotherapy?

Answer: It usually takes from four to six weeks after finishing chemotherapy for the first fine hairs to reappear. By three to six months a reasonable thatch will have grown which may be slightly different in colour and texture to your original hair. Hair may take from six to 12 months to regrow after radiotherapy. Depending on the dose and duration of radiation treatment the quality, quantity and speed of hair regrowth may vary. If the dose of radiation has been very high, hair may not regrow or growth may be patchy.

Do you have Hair Loss Problems, read our Hair Loss Help

Hair Club Shows Some Skin.

It’s official: Hair Club for Men, best known for its “replacement systems for hair loss,” and Playboy are now bedfellows.

The pair offers an online game, PhotoHunt, where players are shown before and after photos and are prompted to identify what’s changed before moving up to the next level.

Participants get to “play” with either Jinger or Amanda.

Do you have Hair Loss Problems, read our Hair Loss Help

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Hair Raising Question

Question: I’ve been losing some hair, which is no surprise for an old lady, but I was wondering if there’s anything I can do to hold on to what I have?

Alopecia is the medical term for hair loss. Androgenetic Alopecia, or pattern baldness, is the most common type of alopecia; it affects about one-third of us. I’m in that third with you.

Men start to get pattern baldness at the hairline and crown. This can lead to complete baldness. Women’s hair loss is usually limited to thinning; they rarely go totally bald.

There are a few steps you can take to preserve your hair:

1. Avoid tight hairstyles that pull on the hair. So, forget braids, ponytails, cornrows, and tight hair rollers. The pulling causes some hair loss, especially along the sides of the scalp. This type of hair loss is called traction alopecia. If the pulling scars the scalp, it can cause permanent hair loss.

2. Brushing or combing too much can break hair, so keep them to a minimum. Use combs with wide teeth and brushes with smooth tips. Wet hair is more fragile than dry hair, so show care when you do your hair after a shower.

3. Shampooing too often is bad for your hair. Use a cream rinse or conditioner after shampooing to make it easier to comb. And don’t dry your hair by rubbing it with a towel.

4. Don’t use hot-oil hair treatments or chemicals in permanents. These may cause inflammation of the hair follicles, which can lead to hair loss.

There are about 100,000 hairs in the average scalp. About 100 hairs are lost from your head every day. Each individual hair survives for an average of four half years and grows about a half inch a month. In its fifth year, the hair usually falls out and is replaced within six months by a new one.

We lose hair as we age. Pattern baldness affects many more men than women. About 25 percent of men begin to bald by the time they are 30 years old, and about two-thirds have at least a balding pattern by age 60.

Androgenetic alopecia is caused by heredity; a history of it on either side of your family increases your risk of balding.

Medicines may help slow or prevent the development of common baldness. Rogaine is available without a prescription. It is applied to the scalp. Both men and women can use it. Propecia is available with a prescription. It comes in pills and is only for men. It may take up to six months before you can tell if one of these medicines is working.

Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Scalp reduction, as the name implies, means decreasing the area of bald skin on your head.

If you are lucky enough to have an enlightened GP, by all means seek their advice – at the very least, you will get a referral to a reliable trichologist (although you’ll probably have to pay for any treatment you receive).

A trichologist, by the way, is a hair specialist whose training covers both the cosmetic and the medical aspects of the subject.

Do you have Hair Loss Problems, read our Hair Loss Help

Is there any way to prevent hair loss? By Dr Fred Kavalier.

Bald-spot fears.

In recent months I have noticed a slightly bald spot on my head. Like most men, I am not keen to lose my hair. I know there isn’t much that can be done once your hair is gone, but in the last few years I’ve heard that there are very effective products one can take to prevent the loss of hair in the first place. Also, can anyone assess whether I will lose more hair or not? Can a GP or a professional hairdresser tell you? It would be good to know if my concerns are justified, and therefore whether there are measures for prevention, or if I am just paranoid.

Typical male baldness, which is caused by genes and hormones, makes the hairline recede at the front of the head and thin and disappear from the crown. Eventually the two areas meet up, leaving a horseshoe-shaped area of hair around the sides and back. As this happens, the hair generally gets thinner. If your bald spot seems to fit into this pattern, then you will probably gradually lose your hair and become bald, to a greater or lesser extent. But if your “slightly bald spot” does not fit into this pattern, it could be caused by something different. A GP or a professional hairdresser will probably be able to give you an idea of whether or not your bald spot is the first sign of baldness. If it is something else, you will need an expert diagnosis from your GP or a dermatologist. There are two drugs that can help with baldness, but they only work if you use them continuously. As soon as you stop, the hair disappears again. Minoxidil is a lotion that you rub into the scalp. Finasteride is a tablet that affects male hormones. You might get a clue about the cause of your hair loss if you look at other male members of your family. It is a myth that baldness is inherited from the maternal side of the family.

Do you have Hair Loss Problems, read our Hair Loss Help

Medicines offer hope for hair regrowth.

First the forehead gets higher, then a spot at the back of the head clears – hair loss is for many men the worst thing they could possibly suffer as they get older. While balding men used to place their hopes in all kinds of remedies or attempt to conceal the areas with hair pieces, effective hair growth medications have been available for years. But they can’t guarantee the return of a full head of hair.

There are good reasons for the anxiety men feel when their hair starts to fall out.

“Studies show that to other people, bald men appear to be an average of three to four years older than they actually are,” said Ronald Henss of Saarbruecken.

“They also are perceived as less stylish than men with a full head of hair. In the eyes of many beholders, a bald head means the loss of attractiveness. One small comfort: “Most people think of bald-headed men as family men and faithful husbands,” said Henss.

The likelihood of hair loss increases with age. By their 80th birthday about 80 per cent of men are affected, said dermatologist Natalie Garcia Bartels of a centre of excellence for hair at Berlin’s Charite Hospital. Up to 100 individual hairs fall out per day from a normal head. Anything over that is considered hair loss.

“Mostly it is congenital hair loss – the so-called androgenic alopecia or male-pattern baldness, which can begin in men from age 20,” said Garcia Bartels. It appears gradually as a receding hairline from the lateral sides of the forehead or hair loss as a bald patch at the top of the head that works its way gradually toward the front. “Many men are left with only a ring of hair around the lower part of their head.”

Hair loss is set off by a hormone in the scalp. An enzyme causes testosterone to be transformed into dihydrotestosterone (DHT), which is believed to be the primary contributing factor in most cases of male pattern baldness. The hair follicle develops a deep sensitivity to DHT, which initiates a process of follicular miniaturization. This progressively decreases the width of the hair shaft until the scalp hair resembles peach fuzz or goes away completely.

“The result is more hair than normal is lost. Why this happens to some men and not others has not yet been researched,” said endocrinologist Gerd Hofmann of Munich.

There are other types of hair loss, but they occur less frequently. When circular patches of hair fall out, for example, the cause typically is an autoimmune disease that sets in rapidly, said Garcia Bartels. Sometimes hair loss is attributed to an internal disease of the thyroid or a low level of iron in the blood.

There are remedies available to stop hair loss caused by male pattern baldness and possibly even to reactivate the still existing hair follicles. The effectiveness of the remedies in fact has been documented in studies. Remedies with the effective ingredient finasterid, used in high doses to treat the prostate gland. It blocks the enzyme that converts testosterone into the hair follicle-damaging DHT.

Finasterid can be obtained through a prescription and it is in the form of a tablet taken daily.

“If the treatment is stopped, the hair loss as a rule will start again,” said Garcia Bartels. The price of the drug – about 150 euros (220 dollars) for a three-month supply – is high. Somewhat more economical is Minoxidil, which is a lotion that must be applied to the scalp twice a day. Originally developed as a blood pressure medication, Minoxidil was found to have the side effect of hair growth.

Minoxidil’s success rate is however lower: while hair loss is stopped in 80 per cent of the people who use finasterid, the rate is 70 per cent among people who apply Minoxidil. Additionally, 70 to 80 per cent of finasterid users experience hair regrowth. This is true for 50 to 60 per cent of Minoxidil users.

Apart from these medicines and the toupee, there is another way of achieving a full head of hair again: hair transplantation. This involves removing pieces of skin with hair follicles from another part of the body, typically the back of the neck, and transplanting them to the bald spots.

“Such measures come into play only if the hair loss has ended,” said Garcia Bartels. Otherwise, the remaining original hair will continue to fall out around the newly transplanted hair.

Hair transplantation is a very costly solution to baldness. The cost of refilling in a small spot with hair can run over 1,000 euros.

“The results that I have seen thus far are not especially satisfying,” said Hofmann. Apparently, it is better when a man accepts his baldness.

“The problems that men have with hair loss decline anyway as they get older,” said Henss. “Perhaps time does not grant a full head of hair, but it does heal all wounds.”

On the internet there are numerous advertisements offering lotions and similar remedies for hair loss. Hofmann said these are best avoided.

“Remedies that cost a lot of money and do nothing only cause aggravation and frustration,” said Hofmann. The money would be better spent on a head massage or a hair tonic containing rubbing alcohol.

“Such measures help increase blood circulation to the scalp, thus supplying it with oxygen.”

Do you have Hair Loss Problems, read our Hair Loss Help