Unless you are one of the 20 million women or 40 million men in Europe who are currently experiencing hair loss, it is difficult to comprehend the emotions these individuals experience. Since most individuals many people view their hair as an important part of their identity, even modest amounts of hair loss can represent a source of anxiety and depression. Studies indicate that losing one's hair can take a heavy psychological toll.
Normally, you will lose on average between 40-100 hairs per day of the 100,000 hairs present on the scalp. During any given time, 85-90 percent of an individuals hair is in the growing phase advancing in length by 1/2 -1 inch per month. Hair can continue to grow from 2-6 years, when the growth phase ends the hair follicle starts a 2-6 month phase of resting and then shedding. Usually, only 10-15 percent of an individual's hair is in the resting or shedding phase at any given time. Randomly, new hair follicles begin to replace the shedding follicles producing a healthy cycle. However, in cases of androgenetic allopecia this natural cycle is disrupted.
Ninety-five percent of hair loss is attributable to androgenetic alopecia, more commonly known as hereditary hair loss or in men male pattern baldness. In men, the condition frequently progresses to the horseshoe fringe of hair. While in women it manifests itself as a generalized thinning of the hair over the entire scalp. Several hypothesis for this condition exist, however, most research of late has focused on a genetic predisposition and the presence of dihydrotestosterone (DHT). Every hair has a genetic predisposition, the gene that determines whether an individual will be susceptible to androgenetic alopecia is located on non-sex chromosomes that determine the genetic makeup of all cells. Contrary to the popular myths concerning these genes they can be inherited from either parent's relatives. Researchers believe that DNA is somehow responsible for the increased sensitivity of hair follicles to the hormone DHT. This hormone results from the breakdown of testosterone by an enzyme called alpha-5 reductase.
Fortunately, there is a hair loss treatment medication, Propecia, that inhibits 5-alpha-reductase, thus blocking the formation of DHT. This interrupts the key element in the development of male pattern hair loss. So Propecia effectively stops hair loss while promoting the growth of new hair.
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DHT causes the hair follicle to atrophy, reducing in size until only vellus hair is produced. Vellus hairs are short fine non-pigmented hairs which are difficult to see. As the diameter of the hair shaft continues to decrease in size the sebaceous glands continue to secrete the same volume of sebum (fats and oils which lubricate the hair). This results in an oily scalp and subsequently flatter hair. The process continues until the vellus hair is no longer produced and individuals develop the characteristic hair loss pattern.
Although the majority of hair loss is secondary to androgenetic alopecia there are other significant causes of hair loss that should be addressed including the following:
With at least forty treatments for thinning hair patented last year and 200 million dollars budgeted for clinical trials in the near future, there is no mystery why there is so much confusion regarding the treatment of hair loss. However, of all the hundreds of shampoos, ointments, herbal supplements, gimmicks, etc. there are only two medications that meet the strict standards set forth by the FDA. Only Propecia (finasteride) and Rogaine (minoxidil) may state in their advertising and/or labeling that their product promotes hair growth or prevents the loss of hair. All the rest of the products many of whose effectiveness are exposed to minimal, if any, clinical trials should be purchased judicially.
Propecia is an effective hair loss treatment. Researchers have recently discovered that men who suffer from male pattern hair loss have increased levels of dihydrotestosterone (DHT). DHT is produced from testosterone through the activity of 5-alpha-reductase enzyme. Propecia inhibits 5-alpha-reductase, thus blocking the formation of DHT. This appears to interrupt a key element in the development of male pattern hair loss.
Clinical studies were conducted in men aged 18 to 41 with mild to moderate degrees of androgenic alopecia. All individuals treated with Propecia received a tar-based shampoo (Neutrogena T/Gel shampoo) and were instructed to wash their hair at least once per day. Clinical improvements were seen as early as three months into the treatment with Propecia. In men with vertex hair loss, global photographs revealed hair re-growth in 66 percent of the men. Furthermore, hair counts with these men indicated that 83 percent of the recipients had no further hair loss over the two-year clinical period.
Similar to all prescription medications, Propecia may cause some side effects. In clinical studies, side effects associated with Propecia were uncommon and did not affect most men. In fact, more individuals discontinued the placebo as compared to Propecia secondary to adverse experiences. A very small number of men, less than two percent, experienced certain sexual side effects including a decrease in libido and erectile dysfunction. Resolution occurred in all men who discontinued therapy with Propecia due to these side effects. The side effects also disappeared in most men, 58 percent, who continued taking Propecia.
Propecia is for the treatment of male pattern hair loss in men only. Women who are or may potentially be pregnant must not use Propecia and should not handle crushed or broken tablets. Propecia may cause potential risk to the development of the male sex organs in the developing fetus of a pregnant women. Propecia tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablet has not been broken or crushed.
Minoxidil was first approved in 1979 has hypertensive medication. However, some individuals began to develop hair everywhere. So Upjohn went back to the lab and developed a topical version of the medication. Ten years later minoxidil was re-introduced has Rogaine. The mechanism of action of Rogaine is basically unknown. The medication is known to be vasodilator, however, other medications that dilate the blood vessels do not stimulate hair growth. Rogaine is believed to work in part by partially enlarging miniaturized follicles and reversing the miniaturization process. This supposedly prolongs the growth phase of the hair cycle, allowing the hair to become thicker and longer.
Clinical trials have shown with the 2% solution that 16 percent of men ages 18-49 reported moderate to dense hair re-growth following four months of treatment. An additional 33 percent had minimal hair re-growth. Approximately 20 percent of women between the ages of 18-45 had moderate re-growth, while an additional 40 percent minimal re-growth. The new extra strength 5% Rogaine solution has demonstrated slightly improved results as compared to the 2% solution in men. Currently, the extra strength 5% solution is not recommended for women.
Side effects associated with Rogaine are minimal. The most common side effects reported during clinical trials were itching of the scalp and other skin irritations in the treated areas. These side effects are not serious and will cease upon discontinuation of the medication. Well-controlled clinical studies have not been conducted in pregnant or nursing women, therefore, the medication should not be used during these conditions.
There are some other topical treatment options that warrant some discussion at this time. Please keep in mind before you rush out to purchase any of the following products that there has been limited clinical testing concerning hair loss on these treatments.
For individuals who have not benefited from the pharmaceutical approach there are hairpieces. Interestingly, over a million men in the Europe sport a hairpiece, spending some 350 million annually on the purchases and maintenance of these products. "You would think with all his money he would have a decent hair piece," is the quite frequently stated remark concerning men with ill-fitting hairpieces. However, cost has less to do with a good-looking hairpiece than does the selection of the manufacturer combined with the grooming and care given it by the wearer. An attractive hairpiece requires careful color matching, fitting, as well as subsequent styling and replacement. Unfortunately, many individuals fail to properly care for their hairpieces as time progresses. Hairpieces can be made from synthetic materials such as nylon or actual real human hair. Prices can vary considerably, small filler pieces may cost from $250.00 up, full wig $1000.00 up. The average hairpiece of good quality, synthetic or real will usually cost between $1000.00-$3,500.00.
The debate goes on, human hair verses synthetic hair. Human hair tends to react more to the sun and other elements such as chlorine. The most significant problem is the color of the hair fades with time. Human hair also requires more maintenance including monthly visits to the hair stylist for styling and cleaning, at a cost of $40-$60; periodic dyeing can cost another $75-$100. Additionally, hairpieces made from human hair rarely look appropriate longer one year. Manufacturers of synthetic hair claim their products look more natural, are water resistant, hold their shape better and last longer than human hair. However, individuals must still bring their hairpiece in for maintenance every four to six weeks, at a cost of $35-$50. Synthetic hair generally looks natural for up to two years. The decision human verses synthetic is primarily one of preference. Reputable hairpiece companies will encourage individuals to research both types of hair prior to purchasing.
For many men hairpieces for one reason or another is just not an option. Many of these individuals turn to hair transplants. According to the American Academy of Cosmetic Surgery, some 244,500 hair transplants were performed in Europe last year. The popularity of hair transplants combined with frustration of managed care has pushed all types of physicians into the field, which has historically consisted of dermatologist and plastic surgeons. The influx of new hair-transplant physicians has subsequently brought transplant prices down significantly from as high as $30.00 to as low as $4.00 per graft. This reduction in price is not necessarily favorable news for all patients. Some of the more reputable hair transplant centers have suggested that a third or more of their clientele result from patients looking for someone to repair the inadequacies of previous transplants.
During recent years, physicians have developed and refined new transplant techniques that represent the way hair grows naturally. Physicians now transplant hair using the mini/micro-graft procedure. Rather than creating rows or clumps of conspicuous hair the mini-graft transplant consist of much smaller grafts containing 3-6 hairs, approximately the size of a pinhead. Micro-grafts contain only 1-2 hairs and are used on the periphery to create a soft and natural hairline.
Donor sites are usually obtained from the posterior aspect of an individual's head. Usually a 1⁄2 to 1 x 3 to 5 inch donor strip of hair is surgically removed. The scalp is very elastic so the incision is simply pulled together and closed with sutures. The small suture line remains concealed by the existing hair.
The surgery team then delicately divides the donor graft into mini/micro grafts for transplant. The grafts are then implanted into the appropriate donor sites. The correct selection, placement and angle of the grafts remain the critical element in obtaining a positive result. Physicians must posses a unique artistic flare combined with surgical skill to create a natural appearance of the hair. Hair transplants have evolved to the point where they are done on an outpatient basis. Most surgeries last 3-4 hours and patients may return home a couple of hours following the procedure. A bandage is usually applied to keep the area clean and free from infection, patients are usually asked to return the next day for a follow-up appointment. Many patients return to work within 24 hours although strenuous activity is discouraged.
Fortunately the scalp is very vascular, so the healing process is relatively short. However, as with any surgery there is always risk of infection. Individuals may also experience some swelling of the forehead in the week following the surgery, some areas may also scab over. Patients should also realize that transplanted hair shaft often go into a resting phase shedding the existing hair. Usually within 3-6 months the transplanted hair follicles will begin to produce noticeable hair. There is a new FDA approved product developed by ProCyte called GraftCyte that helps prevent transplanted follicles from going into the resting phase so the transplanted hair does not shed as often.
The number of procedures required is dependent on the surface area that needs to be covered and the expectations of the patient. The human scalp averages one follicular unit per 1mm and each unit represents approximately 2.2 hairs. So a section of healthy scalp measuring 1cm by 10 cm would represent some 1000 follicular units or around 2,200 hairs. Normally two or three sessions are sufficient to get a natural appearance. Natural appearance does not necessarily dictate natural density. Hair loss remains a dynamic process and donor sites are limited, therefore, individuals are encouraged to be realistic about the density of their transplants.
For those individuals who desire more expedient or dramatic results there are several other surgical procedures:
Tissue expanders - are procedures involving two surgical sessions spaced approximately 8-12 weeks apart. Expanders are balloon-like devices, which are surgically inserted under the scalp during the first surgery. The expanders are then gradually filled with saline solution over a period of weeks. As the balloons expand, the skin supporting the healthy follicles is stretched. During the second surgery the expanders are removed, all or a portion of the bald area is excised and then the adjacent sections of healthy scalp are sutured together. The major disadvantage to this procedure is that individuals have to tolerate the strange appearance of balloons underneath their scalp for several weeks. Though men can find ways to camouflage this, most find it embarrassing. Average cost between $4,000-$6,000.
Free flaps - represent an extensive surgery, first all or a portion of the bald area is excised. A section of micro vascular surgery, the blood vessels that supply nourishment to the donor flap are connected to the vessels in the new area. Sutures are then used to close both donor and recipient areas and transplanted micro-grafts are inserted to promote a natural look. There are some disadvantages to the flap procedures. Sometimes the resulting frontal hair does not appear natural and a scar along the hairline can be detected. Additionally, the hair of the flap may grow in a direction different from the natural hairs, giving an artificial look. Free flaps also cost between $3,000-$9,000 depending on the extent of the surgery.
The above mentioned procedures may be performed using local or general anesthesia depending upon the extent of the surgery. Surgical risk is similar to the mini/micro transplant procedures, there is always a risk of infection. In the US any licensed physician may perform hair surgery, many individuals end up with unsatisfactory results i.e. excessive scarring, patches of thin transplanted hair partially covering areas that continue to lose hair, loss of hair leaves the scars from previous surgeries visible, etc. Carefully and cautiously select a surgeon, beware of seductive marketing brochures showing after photos of men thick, full heads of hair. Ask for referrals, actually talk with individuals who the surgeon has treated. Check the credentials of the surgeon, individuals may contact The American Hair Loss Council phone 1-312-321-5128).
Hair Loss Myths
There are reputable products on the market that do not promote hair growth but they can help give the illusion that an individual has more hair. Regular shampooing is an important concept for individuals experiencing hair loss. The sebaceous glands continue to produce the same quantity of sebum even has hair follicles shrink. Therefore, the thinning hair shaft is subjected to more oil, which results in flat and/or dull looking hair. DHT is also found in high concentration sebum and is secreted with the oil onto the scalp. Regular shampooing prevents the scalp from reabsorbing the DHT so it cannot be recycled into the follicle, thus, preventing further damage. As a physician, patients commonly ask for a recommendation when it comes to shampoo. There are literally hundreds of shampoos currently on the market with a new product being introduced every day. The problem is each one of these products has a different marketing ploy that can be very confusing to consumers.
The most inexpensive shampoo at neighborhood department store is probably the best, however, none of us would actually use that shampoo! The next choice would be the Neutrogena T/Gel shampoo. Neutrogena is a name that has become synonymous with quality products in the hospital. Merk Pharmaceuticals must also have some confidence in the Neutrogena products because that is the brand of shampoo they used in their clinical trials while testing the effectiveness of Propecia.
American men spend an estimated 60 million dollars per year on coloring their hair. Melanocytes, the cells containing the pigment, become dormant as individuals grow older. Usually Caucasian men begin to show signs of graying around age thirty-five, black individuals follow around ten years later. By age fifty, approximately 50 percent of all hairs on men are white.
Another product, that appears almost comical, is actually quite beneficial for those individuals who are experiencing subtle hair loss primarily on the vertex of their head. Remember the late night infomercials where the host pulls out this can of stuff, resembling spray paint, and the next thing you notice is the whole set has a haze finally surrounding it. Then when the haze finally settles, the host directs his attention to some poor follicle challenged individual whose head as been assaulted with a paint like substance. Today, this type of product has improved immensely, by matching a small area of the scalp with the hair color the illusion of more hair can be realized. For example, thinning hair in individuals with red hair is far less noticeable than in the general public. Dermatologist attribute this to how the course red hair matches or agrees the ruddy skin in these individuals.
Hair Loss Treatment Conclusions
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