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What You can do about Hair Loss


You have about 100,000 hair follicles in your scalp. Hair grows for two to six years, pauses for two or three months and then falls out. Normally, we lose about 50 to 100 hairs each day. As you lose each hair, a new one from the same follicle grows in its place. Hair grows about a half inch every month. The number remains the same all your life, but the follicles typically become less active and productive as you age. Which simply means that it’s completely normal to lose hair as you get older.

Women lose hair as time goes by, but it’s usually not as noticeable as the hair loss of men. Men generally begin losing their hair sometime between ages 17 and 40. About half of all men experience what’s called male pattern baldness by the time they’re 50. This happens when the hair above the temples recedes and the hair at the top of the scalp becomes thin.

A substance called DHT causes the hair loss. An enzyme called 5-alpha reductase converts testosterone to DHT. People who have a higher level of 5-alpha reductase have more DHT binding to hair follicle receptors, and that causes the hair loss. You can inherit baldness from your mother or father. It’s just the luck of genetics.

How can hair loss be treated?
Hair loss has a lot of psychological implications for many men, but it’s not a disease. It doesn’t require treatment, but the 33 million Americans who spend about $1.5 billion each year on hair loss products may not agree. Many men choose to take medication for hair loss or to have cosmetic procedures that minimize the appearance of hair loss. Here are the most common approaches:

There are two drugs approved for male pattern baldness: minoxidil, marketed as Rogaine, and finasteride, marketed as Propecia. How do they work?

Minoxidil is sold in tablet form as a prescription drug for high blood pressure. But as Rogaine, it’s sold as a non-prescription lotion or spray. There’s regular-strength Rogaine, which contains 2 percent minoxidil, and Extra Strength Rogaine, which contains 5 percent minoxidil. Rogaine works only on hair follicles that are still active, so it works best in younger men who have a short history of hair loss. As soon as you stop using Rogaine, it stops working. The manufacturer recommends applying it twice a day.

Most men find that Rogaine works best for male pattern baldness, not for receding hairlines. Even then, not everybody thinks it’s worth the trouble. One study showed that 36 percent of men who had used Rogaine for several years thought it was worth the effort.

Rogaine can cause some side effects:

  • Scalp irritation
  • Dizziness and low blood pressure (not very common)

Finasteride is a prescription medication in pill form. As a 5 milligram tablet, it’s prescribed for benign prostatic hyperplasia. In its 1 milligram form, it’s prescribed for male baldness and is called Propecia. Finasteride blocks testosterone from converting to DHT. You have to take it every day, and it’s more expensive than Rogaine yet brings about the same results.

Women of childbearing age should never take Propecia because it can cause genital abnormalities in a developing fetus.

Hair replacement surgery
The most common type of hair replacement surgery is hair replacement grafting. The surgeon harvests long strips of scalp from the sides and back of the head, where hair is typically most plentiful. The grafts are divided into smaller grafts of a few hairs each, and then inserted into holes and slits that the surgeon makes in the bald area. It can take several months for the grafts to begin to grow hair, but they will be as permanent as the hairs originally from the harvested area.

For men with a greater degree of hair loss, there’s a procedure called scalp reduction. The surgeon removes skin from the bald areas, and then stretches the remaining skin over the scalp with extenders and expanders. There’s also a procedure called the flap technique, in which the surgeon removes a flap of hair-containing scalp skin from the sides and back to the top of the head. This type of surgery transfers the greatest amount of hair in the shortest amount of time, but it’s more complicated than the other procedures.

Some men are extremely happy with the results of hair replacement surgery, and others are less so. It causes temporary scalp pain and tightness, and there is scarring that’s visible until the hair grows over it. So you have to be willing to put up with some initial discomfort and inconvenience.

If you’re considering having surgery yourself, the most important thing is to talk to a surgeon who can assess exactly which procedure will give you the best results. It’s also important to have a skilled surgeon perform the procedures, so before you choose your doctor, be sure to ask about qualifications and experience.

Baldness isn’t a disease
Baldness doesn’t affect your physical health, although male pattern baldness seems to be a marker for coronary artery disease. This means that baldness tends to occur more frequently in men who have heart disease, but baldness itself doesn’t cause the problem. 

Baldness can have psychological implications for men who simply hate the fact that they’re losing or have lost their hair. If you are one of those people, go ahead and talk with your doctor about your options for treatment.

American Hair Loss Council; American Medical Association’s Complete Guide to Men’s Health, John Wiley and Sons, Inc., 2001; National Institutes of Health; H. Simon, The Harvard Medical School Guide to Men’s Health, The Free Press, 2002.
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