Yul Brenner pulled it off in The King and I. Chris Daughtry of American Idol fame and Vin Diesel of the Fast and Furious series make it look downright sexy. But for most of us, especially women, sporting a bald – or even thinning – pate is a source of intense distress.
The American Academy of Dermatology estimates that about 30 million women and 50 million men in this country suffer from hereditary hair loss. Many more lose hair as a result of health problems or medications. But “the vast majority of permanent hair loss is male or female pattern baldness,” says Jody Levine, MD, Director of Dermatology at Plastic Surgery and Dermatology of New York City.
Causes of Hair Loss
Male or female pattern hair loss, or androgenetic alopecia, explains Dr. Levine, is a hereditary disorder that makes the hair follicles more sensitive to testosterone (women have the male hormone testosterone, too, although in less quantity than men). In these people, an enzyme produced by the hair follicles, called 5-alpha-reductase, converts testosterone into its more active form, dihydrotestosterone (DHT). DHT attacks the hair follicles, eventually causing the hair to fall out.
Although the mechanism for hereditary hair loss is the same, male and female hair loss takes on different patterns. Men tend to have a receding hairline at the forehead or crown, with a fringe of hair left in the back and at the temples. They may become totally bald. Most women have diffuse thinning, but especially at the top of the head, and seldom experience total baldness.
Not all hair loss is hereditary, or permanent, for that matter. In fact, some hair loss is entirely normal. Every day, you lose about 100 of the 100,000 to 150,000 hairs on your head as part of the normal hair follicle life cycle. Hair loss in excess of this can be caused by immune disorders like lupus, conditions such as thyroid disease, scalp infections or anemia, and hormonal changes during and after pregnancy and at menopause. Emotional stress and significant weight loss or crash dieting can accelerate hair loss, too, as can certain medications and physical tension due to pulling the hair back tightly, cornrowing or weaving it. Many of these types of hair loss correct themselves after the underlying problem is corrected.
If you’re experiencing more hair loss than expected, the first step is a trip to the dermatologist. A good doctor will do a thorough history and examination along with possible lab testing to find out whether there’s a physical cause – and a treatment – for the problem. The good news is that even if it’s permanent hair loss, there are more options today than the hot, itchy hairpieces of yesterday.
“Medications aren’t a permanent solution because as soon as you stop taking them, the positive effects reverse,” says Dr. Levine. “But they can be helpful in early stage hair loss.” Some of the medications being used today are:
Minoxidil (Rogaine) is a topical medication that’s sold over the counter. Used by both men and women, it works by increasing the amount of time your hair follicle is in the anagen (growth) phase. Most Rogaine users notice a slowed rate of hair loss in addition to some regrowth, although the new hair may be thinner and shorter than before. Rogaine is applied to the scalp twice a day and takes about three months for optimal results.
Finasteride (Propecia) is a pre-scription medication that is taken by mouth. It is not approved for use by women of childbearing years as it can cause birth defects. Propecia works by blocking the enzyme that converts testosterone to DHT, slowing hair loss and promoting some new growth of hair. It can take several months to see the full effect of Propecia.
Corticosteroids can be injected into the scalp to treat certain types of hair loss such as alopecia areata, thought to be an autoimmune problem. It takes about a month for hair to begin growing as a result of cortisone treatment.
“Off-label” medications, or those medications FDA-approved for another condition but which have inadvertently been found to help with hair loss, may be used to treat difficult cases. Dutasteride (Avodart) is one such medication. Currently being used to treat benign prostrate enlargement, it decreases the amount of testosterone being converted to DHT. Research suggests that Avodart decreases as much as 90 percent of DHT in the blood, an improvement over the 65-70 percent reduction of DHT with Propecia.
Other off-label medications used for female pattern baldness include androgen receptor inhibitors, such as Spironolactone (Aldactone). Aldactone is a diuretic (water pill) that works for hair loss by preventing the cells of the body from interacting with androgens (testosterone), reducing the amount of follicle damaging DHT.
Low Level Laser Therapy (LLLT) has been used for years in medical settings for temporary pain relief and for wound healing, and is also offered in some dermatology settings for hair loss. This treatment consists of sitting under a hood device that contains panels of lasers that shine on the scalp, delivering specific wavelengths of light for a prescribed period of time to the area. While it’s not known exactly how LLLT helps with hair loss, David Michaels, inventor of an FDA-approved handheld laser product called HairMax LaserComb, says that the mechanism of action is “transferring light energy to cellular energy” in the hair follicles.
Research has shown that some people indeed do benefit from laser treatment for hair loss, whether through cellular stimulation or through increased blood flow to the treated area. It may take as long as six months to see good results with laser treatment, and like medication treatment, LLLT must be used continuously to maintain hair growth. “It’s most effective in the early stages of hair loss,” says Michaels. “It’s not for someone who’s totally bald.”
Hair Restoration Surgery is the only permanent fix for hair loss, says Nicholas Nikolov, MD, FACS, a Beverly Hills plastic surgeon. Early hair restoration surgery involved round sections (grafts) of 12-20 hairs each being taken from the head and transplanted onto the balding area, explains Dr. Nikolov. But it was hard to maintain blood flow to the graft, and often hair in the middle of the round graft would die, causing a “donut” appearance. These days, a follicular unit transplant is the method of choice for good hair restoration results.
A follicular unit transplant is exactly what it sounds like, says Dr. Nikolov. “It’s taking follicles from one area of the head where there’s an abundance, and putting it in an area where you’re a little short. Just like replanting a tree.”
Many hair restoration surgeons do follicular unit transplants by removing a strip of hair follicles (along with skin) from the back of the head, where the hair is genetically programmed to stay put the longest. Then, the strip of hair is put under high-powered microscopes, where trained technicians divide the follicles into individual grafts, consisting of 1-3 hairs. The grafts are then transplanted into small incisions in the balding areas, and the “donor” area is stitched together.
Dr. Nikolov uses another technique for harvesting grafts, called automated follicular unit extraction (FUE). This method, unlike the strip method, removes follicles separately from the donor area using a tiny automated punch and forceps. Then the grafts are microscopically divided and implanted in much the same way as the strip method. The advantage of FUE, says Dr. Nikolov, is that there is no incision and suturing of the donor site, which means easier recovery and less scarring. The disadvantage – it takes about one and a half times longer for the procedure.
No matter which method of follicular unit transplantation, it is a lengthy (5-8 hours) and expensive process. There are post-surgical instructions to follow, and you have to wait about six months to see the full results (during which time the newly transplanted hair falls out prior to regrowth of hair). Additionally, few women are good candidates for follicular unit transplantation, because unlike men, they seldom have healthy hair follicles in the back of the head for donor grafting.
Whatever treatment you choose for hair loss, it’s important that you find a physician who will spend time discussing your expectations and goals with you and matching the treatment options to your needs – and finances. And if you’re interested in a surgical procedure, check the doctor’s credentials thoroughly. Choose a board-certified dermatologist, plastic surgeon or cosmetic surgeon and check state medical boards for possible patient complaints before selecting a doctor.
Could It Be Drug-Induced Hair Loss?
Many drugs are thought to cause hair loss. Some of them are:
- Acne medications containing vitamin A
- Birth control pills
- Cholesterol lowering medications
- Certain high blood pressure pills, like beta-blockers, ACE inhibitors and diuretics
- Hormone replacement therapies
- Thyroid medications
- Chemotherapy drugs
For More Information
To learn more about hair loss and treatment options: American Hair Loss Association (www.americanhairloss.org)
To find a doctor for hair restoration surgery: International Alliance of Hair Restoration Surgeons (www.iahrs.org)
By Linda Hepler, BSN, RN