If a woman says she is loosing hair, she needs help. This statement might’ve taken a considerate amount of time to be sounded. If some men feel older and less attractive when they start shedding hairs, for a woman hair loss is devastating.
Everyone loses hair daily. This is normally noticed during morning shower or when brushing the hair. This hair loss is insignificant and usually consists of 80-100 single hairs on average. Lost hairs are gradually replaced by new baby ones according to the hair growth cycle theory. People usually notice that something is wrong when they have lost 50% of their hair density. Hair loss in men and women is a common condition at the age of 50 or over but can strike at a much earlier age.
The average rate of hair growth is about half an inch per month. Normally, each hair would grow for two – six years then rest and eventually fall out clearing a space for a new hair follicle. Something similar to milk teeth being replaced with adult teeth when we were 5-6 years old. Only with hairs, it is an ongoing, ever lasting process. About 85% of hairs are in the growing stage and 15% are resting at any one time.
Male Pattern Baldness also known as genetic hair loss or Androgenetic Alopecia, is the most common form of hair loss in men but affects women too. It usually develops very gradually, typically involving the appearance of a bald spot or thinning on the crown, temples, mid scalp or hair line.
Men never lose the hair on the back of the scalp that spreads form ear to ear. These follicles are genetically programmed to stay forever. If the hairs from this zone were surgically rearranged to the bold area they would never fall out. The main three reasons for hair loss in men are heredity, hormones and rate of hair loss.
The gene programmed with hair loss can come from one or both parents. If there are any men in your family who have lost or are loosing hair, the chances are that you will too. The strongest influence, however, is on the mother’s side.
Male pattern baldness requires linkage of the hormone dihydrotestosterone (DHT) to susceptible hair follicles. In the body, DHT is created when the enzyme 5-alpha reductase converts testosterone. This conversion takes place in the bloodstream surrounding hair follicles. DHT acts on genetically susceptible hair follicles causing them to enter resting stage quicker which in turn leads to thinner hairs within each new growth cycle, eventually resulting in the death of the follicles.
This problem can strike any man at any time, but never before puberty. Many will notice some difference in their hair appearance as they approach thirties but majority of men lose hair as their age advances.
Female hair loss can be complicated.
For women hair thinning usually starts a little later than men but can be noticeable around the age of twenty-five for a variety of reasons. These include the result of hormonal dysfunctions such as Polycystic Ovarian Syndrome (PCOS), prolonged illness, during or after pregnancy, and as a consequence of the menopause where 50% of women between fifty-five to sixty will suffer from hair loss as a result.
Hair loss has a massive psychological impact on women especially if they’re balding and thinning in a similar way to the men and it can affect their self-esteem, confidence, quality of life and relationships. Stress can exacerbate genetic hair loss since the adrenal glands secrete male hormones into the body.
Excessive hair styling such as use of extensions can also contribute to the exaggeration of hair loss. Abusive diets and generally luck of Zinc, Iron and vitamins B,C and E may contribute to shedding of hair.
There are 3 main types of Hair Loss in women:
Telogen effluvium – general shedding from all over the head. The shedding accelerates due to weight loss, low iron levels, poor diet and stress, pregnancy, cancer treatment or imbalance of endocrine system. This dysfunction is not permanent and the hair grows back automatically within six months once an imbalance is addressed.
Androgenetic alopecia in women, exhibit central diffuse hair thinning which can affect the sides at the later stage. This hair loss is male hormone-related and affects women exactly as it explained above when Testosterone converted to DHT. However, women have only half of 5-alpha reductase enzyme comparing to men and local formation of oestrogen. Therefore, hair follicle gradually transform to smaller, finer hair follicles lacking in pigmentation but it is extremely rare for a woman to become bald.
Alopecia areata – an autoimmune disease that affects up to 2% of the population. It causes round patches of hair loss and can lead to total baldness. In many cases, the hair regrows.
Can I prevent it?
You cannot prevent Andogenetic Alopecia or Alopecia Aerate. There are ways to slow the process down or disguise the problem. The gradual, all over hair thinning falling under Telogen effluvium type of hair loss can be reversed.
What options are available for me?
This depends on the condition and the stage of hair loss you are in. Balancing your diet right including organic meats, dark green and red vegetables can help. Massaging the scalp can be useful for improving the condition of hair, especially with essential oils like lavender and tea tree. Hair loss can be camouflaged, medically treated or corrected by Hair Transplant procedure.
Do I need to see a GP?
That is your right and you can be lucky enough to have an enlightened GP. Unfortunately, with all our respect, we can not guarantee that you will get a satisfactory consultation. Ideally, you need to be referred to a Trichologist. We can recommend a medical practitioner who will assess you for surgery if you chose that way.
What are the main treatments?
There is no cure for male pattern baldness, but there are both medications and surgical treatments available for men and women such as Minoxidil, Finasteride, PRP (Platelets Reach Plasma) and Hair Transplantation.
Finasteride ( Propecia, Proscar )
Finasteride is suitable for men only. It was developed for the treatment of the enlarged prostate gland which occurred as a result of cancer or a benign tumour of the gland. It was noted that men who were taking the drug long term stopped losing their hair and some even had an improvement in their hair appearance.
To understand the theory of this side effect, it is necessary to know about the physiological processes of hair loss.
In the body, DHT is created when the enzyme 5-alpha reductase converts testosterone. This conversion takes place in the bloodstream and locally in the scalp and other body tissues. DHT acts on genetically susceptible hair follicles to cause miniaturization of the hair, which eventually leads to follicle death.
Finesteride blocks 5-reductase (type II) enzyme and therefore stops conversion of testosterone to DHT.
It is the only licensed oral medicine for Male Pattern Alopecia (hair loss), which stimulates hair growth and slows down the baldness process. You cannot buy it over the counter unlike other remedies. This means that the doctor who prescribes it for you takes full responsibility. The medication is listed in British National Formulae (BNF), the main guide of licensed and prescribed medication in UK for doctors and nurses. It is available from all major pharmacies with prescription.
The medication is reported to be safe by numerous reputable researchers around the world. A recent report involving a large group of men in different age groups, from 16 countries and taken over 5 years, stated that around 80% of men showed improvement in the appearance of their hair in two years from the start date. Improvement can be noticed between three to six months of taking the medication. The peak of hair loss stabilisation usually falls on and around the end of the second year and then remains at that level.
Unfortunately the medication is useless on completely bald areas. It does not re-grow hair but if there are some miniaturised hairs still remaining, Finesteride can stimulate their growth.
The only side effect recorded, so far, is a reduction of sexual libido, which affects less then 5% of men and disappears in a few weeks after the medication is stopped. Some men however continued to take Finasteride and later reported that things came back to normal.
Finasteride is not recommended to be handled by pregnant women or those planning to be a mother. As the drug substances can be absorbed through the skin and lead to malformation of the genitalia of the male foetus.
The dose is set to 1mg daily so usually you will buy a 5mg tablets and break them into parts with a pill cutter.
Finasteride can shadow the true level of Prostate Specific Antigen (PCA) in your blood and give a wrong reading of the PCA test. Such a test can be requested by your GP in case if he/she has a reason to suspect that you are having problems with the prostate gland. Usually if the gland is enlarged the PCA level has risen in your blood. That is why it is advisable for men aged 45 and over, to have the PCA level checked before starting Finasteride. Always tell your doctor that you are taking this medication.
The last point you have to consider before getting the prescription is that you will be bound to this pill on a long term basis. As soon as you stop taking the medication, your hair will start falling out again and slowly you will come back to the stage where you were before you committed yourself to this treatment.
At the end I would like to add that I have seen a lot of happy men for whom this treatment really helped. But please remember that they are from those lucky 80%, you can be one of the remaining 20% who do not benefit from this treatment.
It does not mean that “this is it”. There are other available options you can look into which can help to resolve your situation.
Minoxidil ( Regaine)
This medication is suitable for men and women. It was developed to control high blood pressure. People who were taking Minoxidil noticed a change in the appearance of their hair, such as an increase in volume and quantity. It was licensed in USA in 1998 as a topical application to the scalp for stimulation of hair growth.
This is a topical medication which is legally available in the UK and listed in the British National Formulary (BNF). It is available without prescription over the counter.
The mechanism of how the drug affects the hair follicle is unknown. But it is believed that it probably prolongs Anagen (growing phase) of hair growth cycle by stimulation of blood vessels around the hair thus delivering more nutrients to it.
Unfortunately the medication is useless on completely bald areas. It does not re-grow hair but if there are some miniaturised hairs still remaining, Minoxidil can stimulate their growth.
Regaine has to be applied on the scalp at least twice daily. You will notice any changes in four to six months. The peak of hair loss stabilisation usually falls around the end of second year and then remains at the same level.
Regaine works better in patients that are younger and have a small area of baldness which has just started to develop. It should be applied to the dry scalp (not hair) and not rinsed off.
If you have a sensitive scalp , dermatitis can develop after long term use of the medication. Absorbed into the blood stream Minoxidil can cause a fall in blood pressure, and an increase in heart rate and weight gain (fluid retention).
Patients with heart failure or significant coronary heart disease should avoid Regaine because of these side effects. Regaine’s alcohol base can irritate the eyes. The medication should not be used with other topical medications because they may increase its absorption and side effects. Regaine should be used with caution in those with high blood pressure. Regaine should not be used in pregnancy and by nursing women.
A few side-effects can develop after a long term use such as: skin and eye irritation, itch, contact dermatitis, hives, swelling and sensitivity. Studies show that only about 20 per cent of women between age 18 and 45 have moderate regrowth using Regain, while another 40 per cent experience minimal regrowth.
PRP (Platelets Reach Plasma) for hair loss
PRP therapy is not new and has been used in medical world to enhance wound healing and tissue growth stimulation since 1980. It’s been widely used in cardio surgery, dental implantation, sport medicine and orthopedics. It’s been used along side of Hair Transplantation where it shows significant improvement in hair density and stimulation of hair growth. PRP therapy is suitable for men and women.
The high content of growth factor which is a key in regenerative steps, such as development of new blood vessels, provides the main therapeutic effect of PRP. There is evidence that PRP reversed symptoms of different types of alopecia.
The procedure itself is relatively painless although may be slightly uncomfortable. It is 100% safe because plasma is extracted from the patient’s own blood. Meaning, it cannot be rejected by the body, cause any side effects, allergic reaction or infection. Only a small amount of blood is taken at the time causing no noticeable discomfort.
First signs of improvement may be detected in 4-6 weeks but it normally takes 3-6 month to visually see the difference. One treatment won’t be enough. A course of 3 monthly sessions depending on extent of hair loss will be recommended. This treatment proved to be very successful but the result depends on many factors as everybody’s genetics and physiology are different.
What improvement you can expect after PRP therapy?
- reduction of hair shedding
- thicker existing hairs
- all over volume of hair
- growth of new baby hairs
In the next post, Part 2, we will talk about Hair Transplant.
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