Are You Lonely at the Top?

There are approximately 430 million bald or balding men in the world. Losing your hair is probably on everyone’s list of worst-case scenarios. More than 66 percent of men will experience some hair loss (alopecia) during their lifetime. Those who become bald usually have significant hair loss by the age of 35. 1 of every 4 women will also experience hair loss. The human head has about 100,000 hairs and the average person loses approximately 100 to 200 hairs a day with more men than women losing their hair. Under normal circumstances, about 90 percent of hairs are in a growing stage all of the time, so no hair loss is usually evident. Hair loss can have many causes including chemotherapy and radiation, self-induced hair loss from pulling or tugging at the hair, from sudden stress, and from scarring related to infections and lupus. One type, alopecia areata, is believed to be an autoimmune disorder. The most common cause of hair loss is androgenetic alopecia, most commonly known as male pattern baldness or female pattern baldness. 95 percent of hair loss can be attributed to this type. It starts when an enzyme called 5-alpha reductase in a hair follicle combines with testosterone. The enzyme changes testosterone into a hormone called dilhydrotestosterone, or DHT. It is believed that DHT causes the hair follicle to shrink until the hair grows thinner and smaller, eventually disappearing altogether. Men in their early twenties can begin losing their hair.
The younger you are when hair loss begins, the more likely you are to become bald. If your mother’s father or her male relatives were bald, you are likely to go bald, too, because hereditary male-pattern baldness usually passes through the mother’s genes. Although Finasteride (Propecia) and Minoxidil (Rogaine) are the only currently approved non-surgical treatments for hair loss, other treatments are on the horizon. Studies continue on various medications, gene therapy, and even cloning. One such prospect is known as RU 58841, a non-steroid antiandrogen. When applied to the skin, it has shown to affect androgen production at the follicle site, but not to affect other organs. An oral drug known as GI198745 may be available for men in the years to come. It is similar to Finasteride (Propecia), but may be more effective. Women in their childbearing years may not use, handle, or touch Propecia under any circumstance as there is a risk of systemic absorption of the drug and potential damage to a fetus. Post-menopausal women and women who have undergone hysterectomies or tubal ligations may use Propecia with success. Many shampoos, gels and styling products are currently on the market with varying degrees of success.
Many experts believe that the future will bring better, more specific agents to treat alopecia with fewer side effects and better results. Options such as hairpieces and sprays that combine with your own hair to make it look fuller are also available as cosmetic options. Some drugs, whose primary use has been to treat another medical condition, may also grow hair in some cases. They include oral contraceptives for women, a diuretic called spironolactone, a systemic antiandrogen called flutamide, the hormone progesterone, cyproterone acetate and cimetidine (Tagamet). In advanced baldness, a procedure is available called scalp reduction, which removes areas of bald scalp if the skin is very loose. This procedure may be used in conjunction with hair transplantation, so that the person’s available hair can provide more coverage. New hair can not be created, but the existing hair may be relocated to help cover bald areas. Hair transplantation has become a common procedure in the past three decades and many improvements to the technique have been developed. The use of micrografts and minigrafts now gives a natural permanent change in appearance. You can engage in activities such as swimming, working out, and riding against a strong wind, without fear of dislodging a hair piece or a comb-over hairstyle. Hair restoration is considered minor surgery, much like a dental procedure. General anesthesia is rarely necessary, except during the most aggressive form of hair restoration called the flap technique, which is not commonly performed. Many surgeons feel that surgical procedures are more appropriate for patients 30 years old and up, because the pattern of future hair loss will be more predictable by then. Surgical procedures will be more likely to yield satisfactory results if the surgeon can anticipate the patient’s future pattern of baldness. It is also wise to wait because there are new techniques being introduced all the time. The longer you can wait, the more likely you will benefit from the latest techniques in surgical hair transplanting. Dr. Gho in the Netherlands is experimenting with a technique that can split a single follicle into several follicles, multiplying the total number of grafts that can be transplanted. However, it will probably be years before this technique becomes available to the public.