Your Solution to Hair Loss

In a society where a full head of healthy-looking hair is seen as desirable and as an indicator of youth, hair loss can be a painful process. Most men, and certainly the great majority of women, who lose their hair find that they lose some of their self-confidence and self-esteem. Hair loss can also affect interpersonal relationships and professional lives of those that suffer from it.

Common male pattern baldness (MPB) or Androgenic alopecia, as opposed to medical causes such as illness, is responsible for more than 95% of hair loss in men. By the age of thirty-five more than 95% of American men will experience some degree of visible hair loss and by the age of fifty about 85% will have significant thinning.  About 25% of these men begin their hair loss process before the age of 21. 

According to the American Academy of Dermatology, forty percent of women have visible hair loss, or female pattern baldness (FPB), by the age of 40. If anything, the emotional toll on women is even more severe, as most people accept hair loss in men as “normal” but not in women.

Medical science has a good, but incomplete understanding of both male and female pattern hair loss. There is a genetic predisposition to both MPB and FPB, although the exact mechanism of inheritance is not clear. For example, the old notion of “if your mother’s father was bald, you will be too” is too simple to be true.

The role of the sex hormone, testosterone, which is present in higher levels in males than females, is critical. When testosterone is converted into dihydrotestosterone (DHT) by an enzyme in the body, it is DHT which causes the hair follicles of the scalp to undergo the process we see as balding. There are some medical differences between MPB and FPB, but both require the presence of DHT in a person with the genetic tendency towards balding. This relationship between hormones and balding can be present in normal, healthy men and women with a genetic predisposition or in a minority of people who have medical illnesses that affect their hormone levels. The balance between testosterone and estrogen is different in women and men and adds complexity to the process. Many illnesses, including but not limited to thyroid disorders, autoimmune diseases, pregnancy, menopause, stress and the side effects of some medicines or drugs can cause hair loss as well and need to be differentiated from MPB or FPB.  

Other than wigs, toupees and shaving one may ask, “what can we do about this process?” Start with a medical evaluation. Not all Cosmetic Surgeons or Dermatologists have an interest in this subject, so ask before you make an appointment.

Minoxidil or RogaineⓇ, is a foam or liquid that is available without a prescription. We don’t know why it slows down hair loss, but is effective with both men and women. However, it does not regrow a lot of hair. It is best started early in the process of hair loss and needs to be used daily. Both men and women can use the 5% product. Read the package inserts, always!! Good scalp care products may help as well.

Finasteride or ProscarⓇ is a prescription medicine for men only. It blocks the conversion of testosterone to DHT.  It has been shown to slow the progression of hair loss and may increase hair counts in users. It should not be handled by women of childbearing age, as it has been linked with birth defects when given during pregnancy. Finasteride is not however transferred during intercourse. It slows the progression of hair loss and may increase hair counts in users. Sexual side effects, such as ED, can occur and are more common in the older population that uses this medicine.

The use of special lasers and Platelet Rich Plasma have been promising and are available. The future probably lies in the use of stem cells from the patient’s’ body to regenerate lost hair follicles.

It is of clinical interest that the hair follicles of the front and top of the scalp are DHT sensitive and not the follicles in the back of the head, roughly between the ears. That is why we see a “horseshoe” of remaining hair in the very back. It is also true that taking hair from this area and relocating or “transplanting” it to the balding scalp gives a permanent growth of hair in most hair transplant patients.

Old style “plugs” or unnatural looking results are a thing of the past as is the strip-method that leaves the tell-tale scar in the back of the scalp.

Modern hair transplants take the permanent hairs (follicular units) from the back of the scalp and transfer them to the areas of current and anticipated loss (MPB/FPB is an ongoing process). The best results use technology, such as the NeograftⓇ system, to take individual hairs or groups of hairs by the follicular unit extraction (FUE) method and places them into tiny slits in the scalp in an artistic manner to regrow hair. Unlike other procedures, the NeograftⓇ procedure is a one day, in-office procedure with minimal downtime for both men and women.

In short, there are good options in 2019 for men and women who are losing their hair. We hope that you find this information useful and begin that journey!!

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