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No easy cure for baldness

June 2017

balding man's head

It has long been accepted that baldness, especially in men, is a natural part of ageing. For some, it starts very early but for most as the years roll past hair thickness starts to decline and many suffer from severe hair loss.

Today the condition is medically recognised with an official name, alopecia, and research is taking place all over the world to try and slow or even prevent baldness and distressing levels of hair loss.

The most common type of hair loss in men is hereditary and is inherited down the genes. It has been linked to having too much of a specific male hormone. It seems some hair follicles are especially sensitive to dihydrotestosterone (DHT), a hormone converted from testosterone. In these cases, the DHT sticks itself to the receptors within the hair follicles and gradually shrinks them. This first makes the hair thinner and then the follicle finally no longer has a capacity to produce any hair at all.

The cause of women’s hair thinning and baldness is not so well understood, but it appears to occur with more frequency in women after the menopause and there is some thought that this is because of decreasing female hormones.

In addition there are specific medical causes of hair loss such as chemotherapy or some conditions such as discoid lupus, and here treating the medical condition can help the hair problem.

Otherwise, for men there are now two medications that are thought to be effective in treating baldness in men, finasteride and minoxidil.

Finasteride can be obtained on private prescription from your doctor, and works by inhibiting type II 5 alpha reductase. This is the enzyme responsible for converting testosterone into DHT, without this the hair follicle can keep or even regain its normal size. It takes a long time to work, possibly three to six months, and if you stop taking it, then the hair problem will occur again.

Minoxidil is a lotion that you can buy at a chemist. Its use for baldness was discovered by accident when doctors were monitoring the effect of the drug for high blood pressure. One of the unexpected side effects was hair growth.  Exactly how it works is still being investigated, but it could be simply that it increases blood flow to the hair follicles, energizing them. Again it offers so permanent treatment and would only be effective during usage.

For women, obviously finasteride is no good because it targets a male hormone, but reports have indicated that minoxidil can work better for women than men.

There has been some interest in a drug called dustasteride which is used to treat prostatic enlargement.  In America this is not approved by the FDA but it has been prescribed by some physicians to help combat male pattern baldness and it could be more effective that finasteride because it also inhibits type 1 of the 5 alpha reductase enzyme.

But none of these offer an easy or indeed a full solution to the problem of hair loss and baldness.
Some facilities offer low level laser light therapy to treat baldness, and it is thought that this is based on increasing blood flow to the scalp, or possibly stimulating the epidermal stem cells in the follicle to shift it back into the growth phase of its natural cycle. However, more evidence is needed before this becomes a full medically recommended treatment.

One treatment that has been growing in popularity over the years is hair transplants. This is where the surgeon removes miniscule pieces of skin from areas of the scalp where hair growth is active and implanting these into the balder areas. This doesn’t actually increase the number of healthy hair follicles in the head but spreads them around more evenly for good overall growth.

This treatment has improved significantly in recent years, and it has been rumoured that some high profile names includes Wayne Rooney have undergone hair transplants.

It is a long laborious process though, and also hugely expensive. There can also be some side-effects such as swelling, infection or numbness of the scalp plus it takes some months before the new hair sets in properly.

There is lots of hope for the future though as research continues. A team at the Southwestern Medical Centre in Dallas, Texas, have found that a protein called KROX20 can switch on cells in the skin and tell them to become hair producing cells. Other ideas including the use of stem cells are all now being looked at.

Tattoos, hair fibres that you shake on your head to thicken what is there, and other products are also available today.

But as yet, there is no easy cure to prevent hair loss and baldness and it remains a natural, albeit often unwelcome, part of the natural cycle of life.


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