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By far the most common form of hair loss is determined by our genes and hormones: Also known as androgen-dependent, androgenic, or genetic hair loss. It is the largest single type of recognizable alopecia to affect both men and women. It is estimated that around 30% of Caucasian females are affected before menopause. Other commonly used names for genetic hair loss include common baldness, diffuse hair loss, male or female pattern baldness.

1. Male Pattern Baldness (MPB)

Signs and Symptoms

?Receding hairline

?Moderate to extensive loss of hair, especially on the crown

2. Female pattern Baldness (FPB)

Signs and Symptoms

?General thinning of hair all over the head

?Moderate loss of hair on the crown or at hairline

MPB is the hair loss most frequently encountered. It usually starts with the hair at the temples, which gradually recedes to form an "M" shape. You also may find your hair is finer and does not grow as long as it once did. The hair on the crown of your head begins to thin out and eventually at the top points of the "M" meet the thinned spot on your crown. Over time, you are left with a horse-shoe pattern of hair around the sides of your head. Any remaining hair in the balding areas usually manifests some miniaturization - it is thinner and grows at a below-normal rate, changing from long, thick, coarse, pigmented hair into fine, unpigmented sprouts.

Female pattern baldness usually begins about age 30, becomes noticeable around age 40, and may be even more noticeable after menopause. Female hair loss is usually an overall thinning -- two hairs where five used to be--rather than a bald area on top of the head, though women may have a receding hairline, too. It's thought that about 20 million American women have such hair loss. As in males, hair follicles simply shut down, with hormones playing some role in the process.

A receding hairline reflects age, but not necessarily great age, since some men start balding quite young. With the spurt in androgen secretion at puberty, the hairline moves back a little in 96 per cent of boys and 80 per cent of girls. Most boys continue to shed hair as they mature and, if baldness runs in the family, lose increasing amounts. By age 35 to 40, two thirds of Caucasian men are noticeably bald. The loss may begin at age 20, then stop, only to start up again a few years later. Since this type of baldness is largely hereditary, a man can usually, although not always, predict the extent of his future baldness by examining family portraits. About 50 per cent of children with a balding parent of either sex will inherit the dominant baldness gene.

The mechanism of balding

The rate of hair shedding in androgenic alopecia is speeded up by three forces: advancing age, an inherited tendency to bald early, and an over-abundance of the male hormone dihydrotestosterone (DHT) within the hair follicle. DHT is a highly active form of testosterone, which influences many aspects of manly behavior, from sex drive to aggression.

The conversion from testosterone to DHT is driven by an enzyme called 5-alpha reductase, which is produced in the prostate, various adrenal glands, and the scalp. Over time, the action of DHT causes the hair follicle to degrade and shortens the anagen phase. Thought the follicle is technically still alive and connected to a good blood supply--it can successfully nurture a transplanted follicle which is immune to the effects of DHT--it will grow smaller and smaller (figure 3). Some follicles will gradually die, but most will simply shrink to the size they were when you were born which produce weaker hairs. With a steadily shorter anagen growing cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, unpigmented vellus sprouts.

However, the sebaceous gland attached to it remains the same size. As the hair shafts become smaller, the gland continues to pump out about the same amount of oil. So as your hair thins, you will notice that your hair becomes flatter and oilier.

But the hormonal link in balding is complex. Eunuchs, who produce no testosterone, never go bald -- even if carrying a baldness gene. However, if castrated men with a family history of baldness are given testosterone, they lose hair in the classic horseshoe-shaped pattern.

Studies show that while balding men don't have higher than average circulating testosterone levels, they do possess above-average amounts of a powerful testosterone derivative, dihydrotestosterone in the scalp follicles. In male balding, genetically primed follicles convert circulating testosterone to dihydrotestosterone, which successively diminishes or miniaturizes follicle size, producing ever weaker hairs. With a steadily shorter anagen growing cycle, more hairs are shed, the hairs becoming thinner and thinner until they are too fine to survive daily wear and tear. Balding hair gradually changes from long, thick, coarse, pigmented hair into fine, depigmented vellus sprouts.

Other physiological factors might cause hair loss. Recently, a group of Japanese researcher reported a correlation between excessive sebum in the scalp and hair loss. Excessive sebum often accompanying thinning hair is attributed to an enlargement of the sebaceous gland. They believed excessive sebum causes an high level of 5-alpha reductase and pore clogging, thus malnutrition of the hair root.

Although this condition could be hereditary, they believe diet is a more prominent cause. The researchers note that Japanese hair was thick and healthy, with a small gland and little scalp oil, until the occidental habit of consuming animal fat crept into their diet after World War II. This change has led to a significant height increase in the Japanese population, but it has also resulted in more Japanese men losing hair. To some extent, their observation makes sense since problems with greasy hair have often been noted as much as six months to a year prior to when thinning hair becomes noticeable, but this might be just one of the symptoms, not underlying cause, more research is needed. Most doctors agree that if you have a oily scalp with thinning hair, frequent shampooing is advised. shampooing can reduce surface sebum, which contains high levels of testosterone and DHT that may reenter the skin and affect the hair follicle.

Treatments for Baldness/Hair Loss

Balding men and women seem to go to almost any lengths to regrow thinning hair. Until now, inherited balding in either sex has not responded well to any anti-balding stimulants, applications, injections, or other treatments. Specific foods or vitamins don't regrow hair -- although good nutrition is essential for healthy hair.

Antiandrogen Therapy

In the United Kingdom, the most commonly used anti-androgen for women is CPA (cyproterone acetate) in combination with ethinyl-estradiol. In the United States, where CPA is not available, the aldosterone antagonist spironolactone has been given in dosages from 75 to 100 mg per day with some benefit. However, higher doses (150 to 200 mg per day) appear necessary to produce a significant increase in cosmetically useful hair, as occurs with CPA therapy.

Anti-androgen treatment must be continued for at least 12 months. Often two years is required before a subjective improvement is observed. Complete reversal of the hair loss can never be achieved unless treatment is instigated within two years of its onset. This is probably due to the atrophy of the miniaturized hair follicles with time. The degree of benefit observed is dependent upon the subject's age and the duration of alopecia; however, most patients are satisfied with the thought that no further hair loss will occur. Some improvement in hair quality should be expected in all cases, although withdrawal of therapy results in further progression of the alopecia.

Nonhormonal aspects are critical to ensure an optimal therapeutic response is achieved. And, the need to maintain vitamin and serum ferritin levels above values previously thought adequate has recently been demonstrated.

The side effects of oral CPA therapy in combination with ethinyl-estradiol are well documented and are similar to those associated with other oral contraceptive regimens. Spironolactone disrupts the menstrual cycle and increases menstrual bleeding in some patients; but, in general, it is well tolerated.

To understand how these hormonal remedies work, you need to know a little science. DHT is one of several male hormones, called androgens, that compete for a berth on the hair follicle's receptor sites. In principle, if you could keep the receptor busy metabolizing other hormones, like progesterone, DHT would never have a chance to move in and start shrinking the follicle. The researched based on this concept have made little progress over the past decade. The biggest hurdle: to limit the effects of the androgen blocker to the scalp only.

If DHT is blocked at other sites around the body, a male will lose his sex drive and develop a vocal delivery that resembles a teenage girl's. Blocking the activities of DHT in female who have hair loss is, of course, less problematic. Spironolactone or Aldactone does just that, and very effectively.


By far the most publicized medical treatment available for male pattern baldness is minoxidil (Rogaine). The idea of using minoxidil topically to grow hair was serendipitous. This drug was originally developed to treat high blood pressure and had the unanticipated side effect of stimulating hair growth, sometimes in unwanted areas. This observation led to the testing of topical minoxidil on balding areas of the scalp. Since its introduction in 1988, Upjohn, the manufacturer, sells about $150 million worth of the drug each year, even though its ability to grow back hair is, at best, modest.

A large-scale clinical trial involved over 2,300 participants with male pattern baldness was carried out by having 1,547 patients apply 1 ml of 2% or 3% minoxidil and 779 patients apply 1 ml of placebo ( no active ingredients, only alcohol and propylene glycol) twice a day to the balding area. Actual counts of vellus hairs, indeterminate hairs, and terminal hairs in an one-inch patch were made before and after treatment. At 4 months, 5% to 8% of patients had moderate to marked hair growth on the balding vertex of the scalp. This figure is statistically no different from the number of men who regrow hair in response to a plcaebo. another 15% to 20% of patients had some growth of vellus hair on the balding area. At 12 months, 39% of patients had moderate to marked hair growth, while 11% of those using placebo reported an increase in hair growth. This result shows that you to used minoxidil for more than 4 months in order to decide whether this treatment works for you.

Who is the best candidate for this drug? research showed that you have to be:

1) young man (20 to 30 years old), who only recently (within 5 years) had begun to bald

2) not completely bald, and

3) not bald at the temples

This drug works best on small areas of vertex baldness (smaller than 1 square inch). There is no evidence that topical minoxidil could regenerate hair on the receding temple area. Topical minoxidil was as effective at a concentration of 2% as at 3%. A 1% formulation was less effective.

Successful treatment, however, does require a lifetime commitment. The topical solution must be applied to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness within 3 to 6 weeks. The cost? Anywhere between $600 to $1,000 a year, depending on the size of the area to be treated.

Why minoxidil works remain a mystery. It is know to be a powerful vasodilator, but other drugs the dilate blood vessels do not promote hair growth. It is postulated that it delays or prevents some follicles' entry into the next anagen phase for long periods of time and stimulate these follicles back into active production. But this theory remains to be vindicated.

The disadvantages of minoxidil are: 1) lifetime commitment; 2) high cost : It is not covered by health insurance schemes as it's considered a cosmetic; 3)Its side effects; including itching and prickling, headaches (in 40 per cent), dizzy spells and, in some, heartbeat irregularities. Although apparently safe when rubbed into the scalp - since little is absorbed into the bloodstream - it is a vasodilator and not recommended for anyone with heart trouble. Its safety in men over age 49 and its long-term safety remain unknown. Some scientists believe that minoxidil is more effective in preventing hair loss than in promoting regrowth, but no controlled trials are available.

At the time of writing this book, the only away you can obtain rogaine is through a doctor's prescription. That could be changed soon. Upjohn is confident it will obtain FDA approval to take the drug over the counter.

New Treatments

Medical researchers in Asia believe that hair loss is caused mainly by insufficient blood  supply to the scalp. The other possibility is excessive sebum in the scalp which causes pore clogging and malnutrition in the hair root( "sebaceous Gland Hypothesis", proposed by Dr. Yoshikata Inaba of The Inaba Aesthetic Surgery in Tokyo). The so-called 101 hair regrowth lotion is formulated to attack the problems. 101 became famous after it had won several international awards, among them, "gold medal" from 14th International Inventors Exposition in New York (June 4, 1991). According to Dr. Zhuang-Guang Zhao, the inventor, 101 promotes blood circulation by removing blood stasis in the scalp and dilating the blood capillaries, it also remove sebum in the scalp. Unlike other treatments, it has no side effects, the active compounds in this lotion are isolated from plants, According to Newsweek and New York Times reports (references at page 48), there is no questioning its popularity with the 3 million bald folks in Japan. Masashi Sada, a popular Japanese singer, said recently on the radio that the product worked wonders on his head. Millions of men and women in Asia reportedly have used 101 and 90 percent are said to have found it effective in hair regrowth and a significant reduction of hair loss.

One anti-androgenic drug now being tried as a baldness remedy is oral finasteride. It inhibits the 5-alpha reductase (enzyme) that transforms testosterone into the dihydrotestosterone (DHT) form responsible for hair loss. Blocking the action of DHT seems to stimulate growth of stronger, thicker and more pigmented hair. In one multicentre study, 200 males aged 18 to 35 with distinct baldness had a one-inch circle of scalp shaved and periodically examined for hair growth. The report states that "men taking 5 mg per day of oral finasteride had significantly increased hair growth. Side effects - such as impotence, loss of libido and reduced sperm counts - were not widespread, and often decreased with time, affecting about three per cent of the sample." Ideal candidates for finasteride treatment are men who have already fathered all the children they wish, as its use for baldness might be lifelong and it could harm any fetus conceived (while taking it). Further studies are needed to assess the drug's efficacy, dosage and long-term safety. Another dihydrotestosterone-inhibitor now being tested is a derivative of hyaluronic acid, the chemical at the tip of sperm that aids penetration of the egg's membrane. Massaged into the scalp, this substance apparently blocks the androgenic action that causes hair loss, but more research is needed.

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