THE BALD AND THE BEAUTIFUL
MANILA, September 24, 2004 (STAR) AN APPLE A DAY By Tyrone M. Reyes, M.D. - It lacks the pain of a heart attack, the threat of prostate cancer, and the complications of hypertension. Still, despite the best efforts of Michael Jordan, millions of people are distressed by hair loss. Thatís because in many cultures, a full head of hair symbolizes youth and vitality. So itís not surprising that you may cringe at the first sight of thinning hair.
While thinning hair is common for both men and women, itís more treatable than ever before. With an array of choices and an onslaught of marketing, how do you know which treatment is best for you? Talking with your doctor or dermatologist may be a good first step. Heredity And Hormones Common baldness, sometimes called male or female pattern baldness, accounts for 99 percent of hair loss. Its exact causes arenít known, but researchers believe that heredity, hormones and, of course, age play roles.
Unlike hair loss resulting from disease or other nonhereditary factors, hair loss due to common baldness is permanent. Hair growth slows over a period of years as the hair bulbs (follicles) yield increasingly finer, lighter and shorter hairs. Eventually, the follicles may stop sprouting hair altogether. However, if treatment is sought before growth stops, itís possible to slow hair loss and, in some cases, regrow hair.
Male baldness usually begins with thinning at your hairline (receding hairline), followed by the appearance of a thinner or bald spot on the crown of the head. It may progress to near total or even total baldness (see diagram). Women with common baldness rarely develop a receding hairline. They experience thinning hair over the crown of the scalp. This thinning is often most pronounced at the top-central part of the head.
Men typically experience more hair loss than women, and it starts becoming noticeable at a younger age. By age 50, over half of men are affected. Almost all men experience some slowdown in hair growth and some loss of hair during their lifetime. In old age, itís not uncommon for men to be completely bald.
While women may start to lose hair as young as 25, the most substantial hair loss tends to occur after menopause. One recent study found that over two-thirds of women experience at least some hair loss after menopause. Although their hair may become thinner and lighter in color, women rarely lose all their hair. Not all hair loss is pattern baldness. In some people, especially pre-menopausal women, hair loss may be from factors such as a hormonal imbalance or a vitamin deficiency.
For both men and women, pattern baldness tends to have a significant genetic link. If one of your parents had hair loss, itís more likely that you will, too. Restoring Oneís Crowning Glory Male pattern baldness is not a disease. Its only consequences are cosmetic, and its only implications are psychological. That is why, doctors may not think that it is a problem Ė but many men will, Iím sure, disagree. Thatís why in the United States alone, 33 million Americans spend about $1.5 billion a year to replace or restore lost hair.
Treatment takes many forms, ranging from wigs and toupees to scalp surgery and hair transplants. Many men and women prefer wigs to surgery. Some are worn on top of existing hair; others are interwoven with their own hair. Interwoven wigs have to be adjusted every few weeks as the natural hair grows, adding to the expense and inconvenience.
For generations, a bewildering array of concoctions, claiming to restore lost hair, has been sold to gullible men. In 1989, the US Food and Drug Administration issued guidelines that cleared the shelves of many expensive but worthless products. At present, only two drugs are approved to treat pattern baldness.
When sold in tablet form, minoxidil is a prescription drug for hypertension. But for more than 12 years now, it has been available as Rogaine, a nonprescription lotion for hair loss. Regular Rogaine solution or spray contains 2 percent minoxidil, while extra strength Rogaine has 5 percent. The drug increases the duration of the hair folliclesí growth phase, but it works only on follicles that are still active, and its benefits last only as long as it is used regularly. Rogaine is more effective for bald spots than receding hairlines, but itís only partially effective at that; in one study only 36 percent of men who had used the product for several years felt it was worth the time and money.
According to the manufacturer, Rogaine should be rubbed into your scalp twice daily. Scalp irritation can occur; dizziness and low blood pressure are less common side effects. The drug is expensive.
Finasteride is an oral preparation medication that inhibits 5-alpha reductase, thereby blocking the conversion of testosterone to dihydrotestosterone (DHT). DHT stimulates the growth of hair follicles in the beard and body, but it has the opposite effect on scalp hair. In a 5-mg tablet, finasteride is sold as Proscar, for benign prostatic hyperplasia; in a 2-mg tablet, itís marketed as Propecia, for male baldness. Thus, itís approved only for men and is available only by prescription.
To date, I know only four studies on Propecia, all funded by the manufacturers. Two of the trials involved a total of 1,553 men with mild to moderate male pattern baldness that was most prominent at the top of the scalp. Half of the men were given Propecia, the other half a placebo. After three months, the men who took Propecia were more satisfied with the appearance of their hair. After a year, they had an average of 876 hairs in a 1-inch circle on the scalp, while those treated with the placebo had 769 hairs.
The third trial evaluated 326 men with mild to moderate frontal hair loss; after a year, 50 percent of the men taking Propecia and 30 percent of the men taking placebo thought their appearance had improved. Finally, a small 2002 study (66 men) reported that finasteride increases hair thickness as well as hair counts, thus enhancing itís cosmetic benefit.
The 1,879 men in the three large trials were between the ages of 18 and 41, and none was completely bald. Since Propecia will not revive hair follicles that are inactive, it cannot be expected to regrow hair in older men who are bald. As a result, it warrants consideration only by younger men with partial hair loss.
Because Propecia must be taken daily, years of therapy are required to maintain even modest improvements. Propecia is even more expensive than Rogaine. It is well tolerated, but 1-2 percent of men experience diminished libido and potency with Propecia. Surgical Strategies If drug treatment is ineffective or your baldness has advanced to a late stage, you may consider surgery. Surgery is rarely required for women. Two procedures are available:
ē Hair transplants. Tiny plugs of skin, each containing several healthy hairs, are removed from the back or side of the scalp. These are implanted into bald areas. Recently, surgeons have started using micro- or mini-grafting to transplant grafts containing only one or two hairs, resulting in a more natural-looking hairline.
ē Scalp reduction. This procedure involves removing hairless sections of the scalp, then closing the space with hair-covered scalp. Doctors can also shift or rotate hair-covered skin to replace an area that has been removed. Scalp reduction can also be combined with hair transplantation. Not Perfect But Improved Although many new treatments exist to help stop hair loss and regrow hair, none is totally effective at mimicking your natural hair-growing process. Talk with your doctor or dermatologist about what might work best for you.
Or take a look at the mirror and think it over. And before you decide, try to imagine how Michael Jordan would look with a bit of hair!
Reported by: Sol Jose Vanzi
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