Male-Pattern Baldness

Why am I losing my hair?

If your hair is gradually deserting your temples or crown while standing fast at the back and sides of your head, you're probably experiencing male-pattern hair loss (androgenetic alopecia). Normally, individual hairs grow for two to four years, "rest" for about three months, and then fall out to make room for new hairs to grow in. But in some men, the hair follicles near the top of the head are more sensitive to the male hormones that kick in after puberty. After years of exposure to the hormones, these follicles start to shrink and can produce only fine, short, light-colored hairs, or none at all.

The best way to predict what's going to happen on your own head is to look at your male relatives on both sides of the family (not just your mother's father, as conventional wisdom has it). If they're balding, ask them when it started. Hairlines can start to recede as early as adolescence; about 40 percent of men will have noticeable hair loss by age 40.

Thinning hair and balding are not necessarily unhealthy or unattractive, of course: think Yul Brynner, Andrei Agassi, Sean Connery. There's no need at all to treat hair loss or investigate drugs that promote hair growth if you're comfortable with your appearance.

I may want to look into drugs for baldness: How well do they work?

Until recently, your only recourse for thinning hair was Rogaine, a lotion you rub into your scalp twice a day. It contains a small amount of minoxidil, a drug that sometimes stops follicles from shrinking. Minoxidil slows hair loss in about three-quarters of the men who use it, and about one in three actually regains some hair, though it may be finer and lighter than normal. (You have to keep using the product consistently or you'll quickly shed all the hair you've saved or regrown.)

The drug is now available over the counter in several brands. Side effects are generally pretty mild; about one in 20 men experiences itching or a rash on his scalp. If you have no such reaction to the drug, you might even try the new extra-strength version.

You've probably also seen ads for Propecia, the prescription alternative to minoxidil. It's a pill containing finasteride, a drug that lowers your production of the hormone dihydrotestosterone, one of the main culprits in male pattern baldness. (Finasteride is also used at a higher dose to treat the symptoms of an enlarged prostate.) Eight out of 10 men who take Propecia stop losing their hair within two years, and about two-thirds regain some of what they've lost albeit in a finer, lighter form.

The side effects are a little troubling, but not common; about one in 200 men have trouble getting an erection, feel less desire for sex, or ejaculate a smaller amount of semen. As with minoxidil, you have to keep using the drug or lose whatever hair it has preserved. Many men who've used minoxidil for years have now started taking finasteride as well. Since the two drugs work in different ways, experts say the combination may offer the best results. Caution: Recent stray reports have noted a possible association between finasteride and male breast cancer, so talk with your doctor about possible side effects.

Are there any alternative treatments?

Many other chemicals with hair-growing properties are under study, and some herbs may help. Saw palmetto is one promising botanical candidate; it appears to ease prostate symptoms in much the same way finasteride does, but its effects on hair growth haven't yet been tested. Don't be taken in by products called hair-farming solutions, vasodilators, or thinning-hair supplements. These preparations often contain polysorbate, a common ingredient in shampoos. They may temporarily make your hair look a little thicker, but they won't "unlock trapped hairs" or stimulate new growth.

What about hair-transplant surgery?

If you're looking for a more permanent solution, a surgeon can transplant hair from the back of your head to the balding spots. Transplanted hairs usually look natural in their new position and should heal quickly with no stitches required, but it will take three to seven sessions to move a significant amount of hair at a cost of $2,000 to $4,000 a session. Ask your doctor or your hairstylist for a referral to a reputable surgeon.

For a list of questions to ask the surgeon, visit the American Hair Loss Council's Web site at http://www.ahlc.org. Insist on meeting a few former patients, and ask to see their "before" photos. The doctor should take your medical history, ask about medications you're using, and order a blood test to check your hormone levels and rule out other causes for your hair loss.

What else could be triggering my hair loss?

Certain medical conditions and treatments can make your hair fall out, including fungal infections, prolonged fever, thyroid disease, malnutrition, and chemotherapy. But you'll notice the thinning all over your head, not just on top. See a doctor if you lose a significant amount of hair within a couple of months. In most cases, it will grow back when you recover.

-- A former senior editor at WebMD, Laird Harrison is a freelance writer and editor in Oakland, California. His stories on health issues have appeared in Time, Health, The New Physician, and many other magazines, newspapers, and web sites. He has also won awards from the Columbia Scholastic Press Association, and has taught journalism at San Francisco State University.

References

Shenly, N.k. and Prabhakar S.M. Finasteride and Male Breast Cancer: Does the MHRA Report Show a Link? J. cutan aestheth surg, 2010 May;3 (2):102-5.

Mella JM et al..Efficacy and safety of finasteride therapy for androgenetic alopecia: a systematic review. Arch Dermatol 2010 Oct;146(10):1141-50.

Male-Pattern Baldness. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/article/001177.htm

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