• Hair Loss: Can Skin Ever Be "In"?

    IMAGEHair loss in men can be devastating to self-esteem, confidence, and body image. Consequently, hair replacement is a huge industry. However, hair loss can also be a sign of a medical problem.
    Significant baldness strikes about 50% of men aged 50 years. By age 70, about 80% of men have the characteristic monk hairline—bald on top with hair only around the temples and back of head.
    "Men fear baldness so much because it's a sign of the aging process—that he's getting older and becoming more vulnerable," says William Boss, MD, associate chief of plastic surgery at Hackensack Medical Center. "It's natural for males to think they are invincible, but baldness is a very visible chink in the armor."
    Oddly, a completely shaven head—like that of Mr. Clean, Yul Brynner as the King of Siam, and Sean Connery—can be the picture of manly virility. For most men, the dreaded loss of hair starts with a receding hairline and, with time, results in hair that covers only the back of the neck and just over the ears. If balding starts in the teen years, it is usually extensive. Some balding men only call attention to their condition by growing the hair above their ears very long and then combing the scant strands across their glistening domes. Others just wear hairpieces.

    Predicting Baldness Patterns

    So, what causes hair loss? Doctors think a male hormone, androgen, interrupts the natural growth cycle of hair in the front and crown regions of the scalp, but it does not happen without genetic predisposition. "Look to your father and grandfather to get an idea of what your own hair line may do as you age," says Mark Stevens, PhD, professor of psychology at the University of Southern California. "Actually, the most dominant part of your DNA inheritance comes from your mother. So look closely at her brothers and her father for clues about your hairline."
    Thomas F. Downham II, MD, in the department of dermatology at Henry Ford Medical Center in Detroit, Michigan, points out, "Don't just jump to the conclusion you have male pattern baldness because you are losing some hair. That hair loss could also be a sign of low serum iron, an early indication of a blood condition. Or it could be caused by the medications you are taking, or it could be a sign hypothyroidism. Of the medical specialists, dermatologists are best suited to evaluate hair loss." Moreover, hair loss can be a side effect from taking certain medicines, like drugs to treat high blood pressure, beta-blockers, and anticancer preparations.
    You can also lose a lot of hair during times of intense stress. Being shipped off to a war, losing a job, being hospitalized, or the rigors of divorce court can cause a type of balding.

    Pros and Cons of Hair Transplants

    For reasons doctors do not fully understand, the hair at the back of the head is genetically hardier. And that observation led to a major industry—hair transplanting. Doctors remove a patch of hair-bearing skin from the back of the head and sew the scalp shut. Using either a scalpel or a laser, practitioners make holes for the grafts in the scalp and then plunk in micrografts, containing one or two hairs, or minigrafts—plugs of skin with three or four hairs.
    "Transplanted hair is very soft and downy and not like the hair you had before," cautions Downham. "I would say that about 50%-60% of my patients have had a good response from transplanting. However, if you have a lot of bare skin on your head, you won't get any significant amount of transplanted hair to grow over the long run. You may require additional transplants later on in life."
    Depending on the procedure, it can take six months to a year for a natural appearance to show. Cost? Better bring all your credit cards. Hair transplants can range from $4,000 to $20,000 depending on the number of procedures involved. One session can require about five hours.

    Hair Growth Treatments: Do They Work?

    What if you do not want to undergo surgery? Another option is to use minoxidil (eg, Rogaine), a topical solution that is rubbed into the scalp. While it is not clear exactly how minoxidil works, the medicine may be able to extend the hair's growth cycle. It is recommended that you continue to use it to maintain hair growth. If you stop using minoxidal, your hair will eventually return to the condition it was in before.
    Another medicine used as a treatment for baldness is finasteride (Propecia, Proscar), taken as a one milligram tablet. The drug works by reducing the hormone which interferes with hair growth. It can take about three months to see the full effect.
    Of course, if a bald head makes no difference at all to your self-esteem, you can always join the ranks of men, like actor Sean Connery and basketball player Michael Jordan, who show that baldness can be an attractive trait.

    RESOURCES

    American Academy of Dermatology http://www.aad.org/

    Family Doctor.org http://familydoctor.org/

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Adhizer G, Krop T. Doctor's Book on Hair Loss. Harper and Row; 1983.

    FAQs. Rogaine website. Available at: http://www.rogaine.com/men/faq#question-440076e5552e35f549ed72554fbc3273 Accessed May 23, 2011.

    Finasteride (oral route). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR600655/DSECTION=before-using. Updated November 1, 2010. Accessed May 23, 2011.

    Hair transplant cost. Hair Transplant Site.org website. Available at: http://www.hairtransplantsite.org/hairtransplantcost.cfm. Accessed May 23, 2011.

    Hair transplant FAQs. Hair Loss Learning Center website. Available at: http://www.hairlosslearningcenter.org/content/treatments/hair-transplant-faqs.asp. Accessed May 23, 2011.

    Lexi-PALS. Finasteride. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary/. Updated November 30, 2011. Accessed May 23, 2011.

    Rogaine products—how to use it and what to expect. Rogaine website. Available at: http://www.rogaine.com/men/rogaine-products Accessed May 23, 2011.

    Ross EK, Shapiro J. Management of hair loss. Dermatol Clin. 2005;23:227-243.

    Stough D, Stenn K, Haber R, Parsley WM, Vogel JE, Whiting DA, Washenik K. Psychological effect, pathophysiology, and management of androgenetic alopecia in men [review]. Mayo Clin Proc. 2005;80:1316-1322.

    Wells PA, Wilmoth T, Russell RJ. Does fortune favour the bald? Psychological correlates of hair loss in males. British Journal of Psychology. 1995;86(Pt 3):337-344.

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