Bald truth

If los­ing your hair is get­ting you down talk to your doc­tor about the var­i­ous treat­ment op­tions which range from lo­tion to drug and trans­plan­ta­tion

Irish Examiner - Feelgood - - Family - DR PHIL KIERAN

ICAN clearly re­mem­ber at the age of 15 look­ing into the mir­ror try­ing to con­vince my­self that I was grow­ing enough stub­ble to start shav­ing. Now I shave ev­ery morn­ing and I would hap­pily go back to my col­lege days when I got away with shav­ing once a week.

I’m sure not ev­ery­one puts as much store in these male hair growth pat­terns as I did but I find it hard to think I was on my own in feel­ing this way.

Chang­ing hor­mones af­fect the way our hair grows by in­creas­ing it in some ar­eas and thin­ning it out in oth­ers.

As we age, three things are guar­an­teed to hap­pen: Our noses will get big­ger; our eye­brows and nose hair will at­tempt to grow to bizarre lengths; the hair on our heads will start thin­ning. Some­times the third de­vel­op­ment starts to hap­pen at a younger age and it can cause a lot of dis­tress and anx­i­ety.

What are we talk­ing about?

Male-pat­tern bald­ness refers to the com­mon type of bald­ness, which af­fects the hair on the top of the head, the fore­head and around the tem­ples. Its med­i­cal name is an­dro­genic alope­cia which refers to the fact that one of the causes of bald­ness is the ef­fect testos­terone (an an­dro­gen) has on the hair fol­li­cle. Early an­dro­genic alope­cia is thought to be due to a com­bi­na­tion of ge­netic pre­dis­po­si­tion and in­di­vid­ual lev­els of a hor­mone called di­hy­drotestos­terone (DHT), this con­di­tion will af­fect up to 25% of men mak­ing it a fairly com­mon is­sue.

Does it re­ally mat­ter?

Bald­ness is not a med­i­cally dam­ag­ing con­di­tion and is al­most al­ways lim­ited to the scalp. If the hair loss doesn’t bother you there is ab­so­lutely no rea­son to seek treat­ment or ad­vice. How­ever, for a pro­por­tion of men, there is sig­nif­i­cant psy­cho­log­i­cal dis­tress caused.

These men usu­ally come to me want­ing to know what op­tions are open to them. Can they re­verse the hair loss or, at the very least, slow the rate at which it is pro­gress­ing? First off, let’s dis­pel a few myths about bald­ness. Bald­ness is not a sign of high or low viril­ity, it’s not even re­ally an in­di­ca­tion of testos­terone level. Nor is there any link to diet, ex­er­cise or sex­ual ac­tiv­ity.

Male-pat­tern bald­ness is caused by in­di­vid­ual hair fol­li­cles shrink­ing and pro­duc­ing thin­ner and thin­ner hairs, which even­tu­ally don’t man­age to pro­trude be­yond the skin of the scalp. This is heav­ily in­flu­enced by the hor­mone DHT, which is made from testos­terone in many cells around the body. It is thought that peo­ple with early bald­ness have higher lev­els of DHT in the scalp than other peo­ple and this is likely ge­net­i­cally de­ter­mined be­fore birth.

What can I do about it?

If you do want to try and in­ter­vene with this process there are two main op­tions, a lo­tion or tablet. The first line of treat­ment I would al­ways ad­vise my pa­tients to con­sider would be a top­i­cal treat­ment. Mi­nox­i­dil, which is the ac­tive in­gre­di­ent in prod­ucts like Re­gaine, works by in­creas­ing blood flow

in the scalp. This is thought to re­duce lev­els of DHT in the hair fol­li­cles al­low­ing the fol­li­cle to re­gen­er­ate and hope­fully to re-grow nor­mal hair.

The tablet op­tion is a drug called fi­nas­teride. This drug works by stop­ping the con­ver­sion of testos­terone to DHT and can be quite ef­fec­tive at slow­ing or re­vers­ing hair loss within about three months of use.

Fi­nas­teride is also li­censed for the treat­ment of en­larged prostate (which re­sponds to DHT). The dose used for hair loss is much lower than that used for prostate en­large­ment and so is less likely to cause side ef­fects. How­ever, if you are con­sid­er­ing this treat­ment it is im­por­tant to have a full dis­cus­sion with your doc­tor and to dis­cuss the po­ten­tial pros and cons.

The main side ef­fects tend to be in- creased oili­ness of the skin, some acne type spots, de­creased li­bido and low mood.

This col­lec­tively can be a con­di­tion called post-fi­nas­teride syn­drome, which oc­curs in ap­prox­i­mately 1% of peo­ple treated and can be quite se­vere. In most cases the hor­mone lev­els re­cover quickly (within three to six months) af­ter stop­ping the med­i­ca­tion and symp­toms re­solve in about the same time pe­riod.

One of the big­gest prob­lems with ei­ther of these treat­ments is that the ef­fect on the hair tends to stop when the treat­ment is stopped. This may mean that you start los­ing your hair slowly again but it can also mean that there is an abrupt loss of hair back to the lev­els of bald­ness that you would have reached had you not been treated at all.

…and if that doesn’t work?

There is a third op­tion to try and im­prove this con­di­tion, which is hair trans­plan­ta­tion. This is a pro­ce­dure where hair-bear­ing skin is re­moved from one part of the body by an aes­thetic sur­geon. The in­di­vid­ual fol­li­cles are sep­a­rated out and placed in small in­ci­sions on the scalp. This hope­fully al­lows new hair to grow which should be less sen­si­tive to the ef­fect of DHT as it comes from a dif­fer­ent part of the body.

At the end of the day, if you are go­ing bald and it doesn’t bother you, for­get about it and carry on.

If, how­ever, it is caus­ing you sig­nif­i­cant up­set there are op­tions so don’t be em­bar­rassed to go and talk to your doc­tor.

HAIR SCARE: Male-pat­tern bald­ness, though not a re­flec­tion of viril­ity or linked to diet, can cause psy­cho­log­i­cal dis­tress in those af­fected.

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