Hair Loss: Chapter 1
I am the only male doctor in my city with long hair. In all honesty, I can say that this fact has brought me more recognition than my bedside manner or diagnostic skills. Indeed, our hair seems to reflect or even define our personalities. Just imagine the possibilities: Clean-cut, radical, en vogue, natural, or colorful. As such, it's important to most of us. Therefore, when something goes wrong with the hair on our head, it's a big problem - especially hair loss.
Chapter 1: Pattern hair loss
Pattern baldness is mostly about hormones and genes. In other words, it's programmed from within. As the name implies, the hair loss follows a pattern of recession on the scalp. These patterns are different among males and females.
Male Pattern Baldness
Male pattern baldness, or androgenic alopecia, is quite common - with estimates as high as 70% to some degree over a man's lifetime. Signs can develop any time after puberty, but the hair loss becomes more prevalent with age. Though it can occur in women, it is, for the most part, a characteristic of men.
The pattern of baldness involves the frontal hair line with recession in an "M" pattern along with thinning at the crown in a circular fashion. The hair loss can progress to total loss at the top of the head but always spares a rim above the ears and around the back of the head. In other words, total baldness is not the norm with male pattern baldness.
The genetic-hormone relationship in male pattern baldness is complex and variable. The primary player in the process is testosterone and its relative hormones. It is an interesting paradox that as testosterone "turns on" in puberty, facial hair sprouts, but the hair at the temples recedes. Testosterone and a complex array of sex hormones and non-sex hormones can negatively impact growth at the hair follicle in the specific areas of the male pattern. This causes thinning and eventual loss, turning off the hair follicle.
Understanding the genetics of male pattern baldness involves a brief primer on chromosomes. Chromosomes contain our genetic material in the nucleus of our body's cells. Within a person, they are identical from cell to cell. Chromosomes come in pairs, either XX or XY. The Y chromosome is known as the male chromosome. Women are XX and men are XY. At conception the egg (always containing an X chromosome) comes together with the sperm, which contains either the X or the Y from the father. This pairing determines the baby's sex and sets forth a lifetime of male or female characteristics.
When it comes to male pattern hair loss, most of the genes associated are "X-linked recessive." In other words, if there is a non-problematic other X chromosome, the problem is not expressed. That other X chromosome is present in women, but males' X chromosome is always paired with a Y chromosome. For this reason, fathers can pass the problem to their sons and maternal grandfathers can silently pass the problem to their grandsons, unexpressed in the mother. If a woman gets the gene on both of her X chromosomes, the possibility exists that pattern baldness can be expressed.
Female Pattern Baldness
Female pattern baldness is less common than its male counterpart. This pattern involves the diffuse thinning of hair across the scalp. Complete hair loss is rare, but the thinning can be significant. While there do exist genetic and hormonal factors, the condition is often associated with chronic health issues such as diabetes or high blood pressure. Having multiple children has also been shown to correlate, though it is unknown whether the root of this is hormonal or the associated physical and emotional stress.
Treatment and Prevention
As with any emotionally charged condition, there are a lot of misconceptions and false promises for treatment. Cutting the hair short does not cause baldness, and growing the hair longer does not prevent it. Really, no lifestyle modifications have been shown to prevent pattern baldness - other than preventing the chronic disease factors associated in females. While exercise (aerobic and anaerobic) have been shown to modestly boost various hormone levels, there has been no benefit shown in preventing baldness among a few studies.
The mainstays of pharmaceutical therapy for baldness have been minoxidil (Rogaine) and finasteride (Propecia). Rogaine is usually given as a topical (lotion or foam) and can be purchased without a prescription. Propecia, originally developed to treat prostate problems, is available as a topical or pill, with the pill form being more popular. It is not well understood how these medications work to treat hair loss. Rogaine is thought to promote blood flow to the hair follicle, enhancing nourishment. Propecia, on the other hand, is an inhibitor of an enzyme in the conversion of testosterone, which is a major player in pattern hair loss.
These medications have been well studied and found to be effective in stalling our hair loss and causing modest regrowth. Interestingly, however, the medications only seem to work on crown balding and not at the frontal hair line. Both medications may be used in men or women. The big issue, however, with these medications is that any progress caused by the medications is lost when the the medication is discontinued.
Hair replacement therapy involves removing hair from a more abundant part of the scalp or body and transplanting it onto the scalp. This redistribution method can have amazing results, but is usually quite expensive.
Saw palmetto, a natural therapy derived from the saw palmetto (or sea grass) plant has shown some benefit in small-scale studies. Therapy can be found in the form of capsules taken orally or a lotion applied to the scalp. This remedy likely has some effects on androgen hormones such as testosterone, as it has been shown to help in men suffering from chronic inflammation of the prostate.
Therapy with low-level laser pulses is coming on the scene as a therapy for hair loss. The theory is that this burst of intense light re-awakens the hair follicles. Higher intensity lasers are used successfully for deactivating hair follicles for hair removal. At this point, scientific study on the success of this method is quite limited.
A glance at the potential to better tackle this problem leaves quite a bit of hope. Study of hair follicles involved in pattern baldness shows them to be dormant rather than dead. And based on the potential market of a successful therapy, research and development in this field is huge.
Pattern hair loss is a common phenomena that is fueled both genetically and hormonally. Though no definitively successful therapy has emerged to regenerate and maintain thick, youthful hair, research is being aggressively pursued toward finding a solution.