Hair Loss

Different types of hair loss

There a number of reasons for hair loss it could be physical or even emotional or even
something else, here is a list of the main causes of hair loss.

Alopecia Androgenetica

Also known as genetic hair loss or alopecia androgenetica) is the most common form of
hair loss in men. It usually develops very gradually, typically involving the appearance of a bald spot on the crown of the scalp accompanied by thinning at the temples. Although this problem can strike any man at any time, many first become aware of it as they approach their thirties.

Telogen effluvium

With this condition, hair is shed very rapidly when the growth cycle is interrupted by a specific event such as illness (e.g. cancer, kidney failure, anaemia), surgery, taking certain prescribed drugs (e.g. Prozac for depression or Inderal for high blood pressure) or even extreme stress. You could notice lots of hairs coming out when you comb or shampoo your head. Often hair is found on the pillow after sleeping. However, it's unusual for more than 50% of the hair to be lost.

Anagen effluvium

Here, the hair follicles are damaged – usually as a result of cancer chemotherapy – and there's a sudden reduction in the growth rate of the hair, accompanied by thinning and breakage of the hair shafts. Typically a patchy kind of hair loss sets in, sometimes leading to the loss of 90% of scalp hair.

Thyroid deficiency

The thyroid gland, located in the neck, controls metabolism in the body and has a profound effect on hair growth. If the thyroid gland is underactive hair becomes brittle, dry and thin. This can be the first sign of thyroid problems.

Iron deficiency

With a good normal diet, most men take in more than enough iron to cover their needs. In vegetarians, or those who avoid red meat and liver, the intake can be insufficient and this can lead to depletion of the body's stores. Iron has a major impact on hair growth, and if body stores are low, hair fall can increase and the hair can become thinner.

Alopecia areata

This results in the sudden loss of hair in oval patches from the scalp. These patches are surrounded by characteristic broken, tapered hairs, known as "exclamation mark" hairs. The causes of this condition are unknown, although there is often a family history of the disease and it may occur alongside Down's syndrome, Addison's disease or vitiligo.

Alopecia totalis

In this rare condition, which is related to alopecia areata, all the hair on the scalp is lost, along with eyebrows and eyelashes. In alopecia universalis, all the body hair is lost as well.

Traumatic alopecia

This is patchy hair loss and twisted broken-off hair which may due to you (or your hairdresser) treating your hair or scalp badly. Even wearing a tight hat or baseball cap can damage the hair in this way.

Fungal infection of the scalp

This can produce itchy bald patches. A bacterial infection may lead to a red, scaly scalp with patchy or diffuse hair loss. The skin disease psoriasis may also be linked to hair loss.

Trichotillomania

This form of baldness is linked to a mental illness in which someone deliberately pulls out his or her hair. It's seen as a form of self-injury.

What causes it ?

There is only a tiny grain of truth in the myth that bald men are more virile because they have more of the male sex hormone testosterone.

This idea probably grew from the observation that eunuchs never became bald and, having
being castrated, they didn't, of course, produce very much testosterone.
Yes, testosterone is involved in male pattern baldness, but its relationship with hair loss is
complicated and not completely understood. Testosterone is naturally converted in the body
to a related sex hormone, dihydrotestosterone (DHT). This stimulates the growth of facial
and body hair, as well as acting on the prostate gland. There is good evidence that male
pattern baldness results from an over-sensitivity of scalp hair follicles to DHT, rather than
raised levels of either sex hormone in the blood.

How can i prevent it ?

You cannot prevent male pattern baldness, although there may be ways of slowing down
the process or disguising the problem.

Should I see a doctor?

To get advice and treatment for hair loss, you should always start with either your GP or a professionally qualified trichologist.
 
Until very recently, male pattern balding was seen as a natural process and you may find your doctor to be neither sympathetic nor helpful if you consult him/her about it. But things may be changing. An increasing number of doctors realise that hair loss can have psychological consequences that significantly diminish quality of life, especially for younger men, and they may be more willing to take the problem seriously.

If you are lucky enough to have an enlightened GP, by all means seek their advice – at the very least, you may get a referral to a reliable trichologist.

A trichologist,  the way, is a hair specialist whose training covers both the cosmetic and the medical aspects of the subject. Some trichologists are also trained hairdressers, but they are not usually medically qualified. The Institute of Trichologists keeps a register of properly qualified people: look for the letters AIT (Associate), MIT (Member) or FIT (Fellow) after their name.

Other types of hair loss, such as alopecia areata, are taken seriously as medical conditions and you should seek your GP's advice as you would for any other medical problem.

What are the other main treatments ?

There is no direct cure for male pattern baldness, but there are both drug and surgical treatments
available which may lead to some improvements.

Minoxidil (sold as Regaine)

This is the only topical treatment (one that you rub into the skin) which is actually licensed for the treatment of male pattern baldness in the UK. It was originally developed (in tablet form) as a drug for high blood pressure. Doctors noticed that people on minoxidil sometimes grew new hair, so the drug was reformulated for this purpose.

Regaine comes as 2% or 5% lotions which you rub, daily, into your scalp. It is best to start with the 2% lotion and after three months, if  you have not seen significant growth of hair, upgrade to the 5% lotion. It is a Pharmacy Only medicine, which means you can obtain it from a pharmacy without a prescription, but only when a pharmacist is on the premises. The pharmacist should check that Regaine is appropriate for you before selling it (for instance, you shouldn't use it without medical supervision if you have high blood pressure).

Regaine cannot work miracles. About one-third of men using it get good hair growth on the bald patches, one-third get a fine, downy regrowth, while the rest will get little or no response. The majority of men using it find that at least they don't lose much more hair – but as soon as you stop using it, hair loss resumes its course.

Expect to wait up to four months before you get any response from Regaine (be patient), but if nothing happens after, say, a year, you may as well give it up. Incidentally, never pay large sums of money to a private trichologist or over the Internet for Regaine – the usual price is around ?30 for a month's supply.

Finesteride (marketed as Propecia)

This is a treatment for male pattern baldness which is licenced in the UK but only on private prescription, not on the NHS. It is one of a class of drugs called 5-alpha-reductase inhibitors. Since 5-alpha-reductase is the enzyme which causes the conversion of testosterone into DHT, inhibiting this with finesteride should, in theory, stop hair loss. In fact, finesteride was originally developed for the treatment of benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged through the action of DHT.

Although there have been no clinical studies directly comparing low dose finesteride and Regaine, the data suggests that the two products may be similarly effective as a treatment for hair loss. Finesteride has been known in some users to have side effects such as impotence, reduced sex drive and reduced semen volume. (These side-effects are reversible when the treatment stops.)

Propecia can be obtained from your GP or dermatologist on private prescription.

Anti-androgen therapy

Another way of tackling male pattern baldness is to directly block the action of DHT using a variety of hormonal drugs. Some of these are similar to oral contraceptives and female hormone replacement therapy. They should only be applied under the supervision of an endocrinologist (hormone specialist) or a dermatologist with expertise in hormone therapy.

Hair transplant surgery

Surgery offers the possibility of a longer-term solution to your hair loss problem. But it doesn't come cheap and it can be hard to find a skilled and reputable surgeon. Put simply, hair surgery involves rearranging your scalp skin so as to minimise the bald areas and maximise those where hair is still growing.

In the UK most hair surgeons use grafts, which involves transferring skin from the hair-bearing area at the back of the head to the bald parts at the front. Hair grafts work because the section of skin transferred retains its own characteristics (i.e. hair grows) rather than acquiring those of the place it is transferred to (where hair does not grow).

The most natural results come from transferring plugs of skin bearing 3–6 hairs (minigrafts) or just one hair (micrografts). The surgeon makes tiny slits or pinholes in the recipient area into which the plugs are inserted. A new hairline can be built up by using rows of micrografts at the front and minigrafts a few rows further back.

When considering surgery, you must remember that your hair loss could well continue around the reconstructed areas. This may look unsightly unless you're prepared to invest in further surgery in a few years time.

Hair surgery usually involves considerable financial investment and you are also involving yourself in a medical procedure. So choose your surgeon carefully, preferably via personal recommendation or through the Institute of Trichologists. He or she should carry one or more of the following qualifications:

 FRCS (Fellow of the Royal College of Surgeons)

 BAAPS (British Association of Aesthetic Plastic Surgeons)

 BACS (British Association of Cosmetic Surgeons)