1. Improper hair cosmetic use or improper hair care - Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it is best to stop until the hair has grown out.
   
   
2. Diseases like diabetes, lupus and thyroid disorders can cause hair loss. Both an over-active thyroid and an under-active thyroid can cause hair loss. Your doctor can diagnosis thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.
   
   
3. Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition. Inadequate protein in diet - Some people who go on crash diets that are low in protein, or have abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hair into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out from the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.
   
   
4. Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
   
   
5. Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.
   
   
6. Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase (telogen effluvium), meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.
   
   
7. Infancy. Newborns often lose hair during the first several months of life. This baby hair (vellus) is eventually replaced by more permanent hair. It's also common for babies to lose a patch of hair on the back of their heads from rubbing against mattresses, playpens and car seats. Hair will grow back once a baby begins to spend more time sitting up.
   
   
8. Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. Constant pull causes some hair loss, especially along the sides of the scalp.
   
   
9. Shampooing, combing and brushing too often can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Do not follow the old rule of 100 brush strokes a day that damages hair. Instead, use wide toothed combs and brushes with smooth tips.
   
   
10. Hereditary thinning or balding - Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family. Women with this trait develop thin hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties or thirties.
    
    
11. Alopecia areata - In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age. The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.
    
    
12. Childbirth - When a woman is pregnant, more of her hair will be growing. However, after a woman delivers her baby, many hair enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.
    
    
13. Cancer treatments - Some cancer treatments will cause hair cells to stop dividing. Hair become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.
    
    
14. Birth control pills - Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynaecologist about switching to another birth control pill. When a women stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.
    
    
15. Low serum iron - Iron deficiency occasionally produces hair loss. Some people do not have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.
    
    
16. Major surgery/chronic illness - Anyone who has a major operation may notice increased hair shedding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.
    
    
17. Fungus infection (Ringworm) of the scalp – This is caused by a fungus infection. Ringworm (which has nothing to do with worms) begins as small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.
    
    
18. Hair pulling (Trichotillomania) - Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

Hair changes, including thinning, color loss, dryness, changes in texture, and hair loss, are common features of autoimmune disease. Of these, hair loss can be the most devastating. Overall, hair loss can have many medical causes including hormonal imbalances, medication effects, and autoimmune diseases. Among the autoimmune diseases that cause hair loss or baldness, aleopcia areata is the most common. Alopecia areata may affect small localized scalp patches (alopecia areata molocularis) or it may affect the entire body (alopecia areata universalis). Treatment is available for alopecia areata although, in general, the more hair lost, the less successful the treatment will be.

Other autoimmune conditions in which localized or diffuse hair loss (cicatricial alopecia) can occur include: systemic lupus erythematosus (SLE), Hashimoto's thyroiditis, Graves' disease, central centrifugal cicatricial alopecia, and postmenopausal frontal fibrosing alopesia. In systemic lupus malar rash can cause scarring of the scalp that leads to permanent hair loss. Hashimoto's thyroiditis causes hair to coarsen and become dry, contributing to hair loss, which is seen in more than 50 percent of patients. In Graves' disease, hair tends to become fine and brittle with a reluctance to hold curl and a tendency towards hair loss. Hair loss is reported in 20-40 percent of patients with Graves' disease.

Besides the abovementioned conditions, hair loss can occur in nearly every autoimmune disease, especially conditions in which oral corticosteroids are the mainstay of treatment. Hair loss is one of the undesirable side effects associated with the use of prednisone. Chemotherapeutic agents, such as methotrexate, used in many of the systemic rheumatic conditions, can also cause hair loss. Hair loss is also caused by the following drugs: cimetidine (Tagamet), ranitidine (Zantac), coumadin, heparin, allopurinol for gout, penicillamine, indomethacin, naproxen, isotretinoin, trimethadione, tricyclic antidepressants, atenolol, metoprolol, naldolol, propranolol, timolol, levodopa, and clofibrate.

In vitiligo, autoantibodies that destroy melanin cause pigment loss in both the skin and hair. Conditions affecting hair usually affect the skin in a similar fashion. For instance, the skin in hypothyroidism tends to become thick and dry, and in hyperthyroidism it becomes thin and moist. In patients with relapsing polychronditis, antibodies to cartilage proteins may contribute to hair loss and well as joint damage.

Cartilage hair hypoplasia is a rare autosomal recessive disorder causing short-limbed dwarfism and fine fragile hair, with a tendency toward hair loss. Cartilage hair hypoplasia has been reported in conditions of idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia.

TREATMENT

In endocrine disorders, correcting the hormone imbalance helps restore hair growth and improve its texture. Hair growth also responds to dietary changes. In particular, adding high quality protein to the diet can help restore hair growth. When hair loss suddenly increases it can reflect inadequate dietary protein or malabsorption, a condition of poor nutrient absorption from dietary sources. Malabsorption is common in thyroid disorders, Crohn's disease, pernicious anemia, and celiac disease.

A nutrient-rich diet with adequate protein and dietary supplements, particularly vitamin B complex, can help promote hair growth. Biotin promotes hair and scalp health and can help prevent hair loss. Excellent sources of biotin include nuts, brown rice, brewer's yeast and oats. Iron deficiency (confirmed by blood tests) can also cause hair loss and restoring iron levels can reverse hair loss. Foods rich in iron include green leafy vegetables, leeks, cashews, berries, dried fruits and figs. Vitamin C is necessary for iron absorption. Eating citrus foods after an iron-rich meal helps absorption. Vitamin E, zinc, methylsulfonylmethane (MSM), and essential fatty acids, such as flaxseed and fish oils, are also important for hair growth. A greens formula containing chlorella, spirulina, barley and wheatgrass also promotes hair growth.

The drugs minoxidil (Rogaine) and finasteride (Proscar) promote hair growth in some patients. Proscar is also reported to stop hair loss. Rogaine is applied topically and finasteride is taken orally, using 1 mg daily. Other topical hair stimulators include the oxygen radical scavenger, superoxide dismustase (SOD) Surgical procedures include hair transplantation and scalp reduction. Dr. Peter Proctor's Hair Regrowth Shampoo is reported in Life Extension to be superior to Rogaine and the only FDA-approved hair-treatment product on the market. A world-renowned expert on balding, Dr. Proctor has developed several preparations for restoring hair growth. Rosemary essential oil used as a scalp massage ingredient or added to shampoo can help hair growth by improving the scalp circulation.

Antibiotics such as co-trimoxazole and sulfasalazine help restore autoimmune hair loss in alopecia by inhibiting nuclear factor beta signaling activation, which contributes to anti-inflammatory and immunosuppressive effects.

In his book on Natural Healing, Gary Null reports experiencing regrowth of hair following the use of colonics. He attributes this to increased absorption of nutrients including chlorophyll in green juices. Other recommendations for hair growth include aromatherapy, Bach flower remedies, homeopathic preparations, particularly Natrum muriaticum and silicea, and stress reduction techniques.

Hidden beneath Elline Surianello's beautiful hair is a woman few ever see.

Since she was 14, Surianello has suffered from a condition called alopecia, commonly known as hair loss. She wears a wig to hide the bald spots.

"To be like this all the time and think that this is how you have to be all the time, every day a little part of you dies," she said.

Surianello is among 30 million American women, about 1 in 5, living with female hair loss.

"Very few men are shocked that they are losing their hair," said Dr. Mark Kaufmann, a dermatologist. "With women, there's a complete shock and disbelief."

Surianello agreed to walk outside without her hairpiece with "Good Morning America" cameras following her.

"How do I function in the world knowing that everyone's paying attention to this," Surianello said, pointing to her hair. "Now they're not going to say anything to me because this is not a conversation, but they're going to ignore me. I become a nonentity. I become not a person that makes a statement. And I don't want to live my life that way."

About 70 percent of female hair loss is genetic. Other causes include stress, illness, medication and diet. Crash diets, tight ponytails/braids/weaves/extension, thyroid disorders, pregnancy, going off birth control and general anesthesia can all result in hair loss.

Dermatologist Susan Taylor had the following advice for preventing female hair loss.

• Don't ignore the problem. Get help soon.

• Hair care should be gentle, not painful. If it hurts, it's going to harm your hair.

• Avoid tight pony tails.

• Use gentle shampoos, nothing that itches.

• Don't skip conditioner.

• Don't over brush.

For those who have already lost a significant amount of hair, Taylor said Rogaine and cortisone injections or creams may help stabilize growth and in some cases regrow it. Rogaine costs about $25 per month. Cortisone requires a doctor's prescription and may be covered by insurance. Without insurance, the treatments cost approximately $50 to $150, Taylor said.

Hair transplants are the most expensive and time consuming treatment for female hair loss, at about $5,000 to $10,000 for a series of transplants over several months.

"There's a lot of research being done on stem cells," Taylor said. "The cells that grow hair have been identified, and hopefully we'll be able to use them one day to regrow hair in people who have lost it."

While studying the role of stem cells in skin regeneration, researchers at the University of Pennsylvania medical center say they've been able to regenerate new hair follicles in adult mice. They weren't trying to cure baldness, but they say that they may have, by combining stem cells with a secret compound. This is different from hair loss drugs like Propecia and Rogaine, which help people maintain their hair but don't grow new hair. As Dr. Nancy Snyderman said, this treatment could be on the market for humans within three years.

You brush your hair and the brush becomes full of strands that should be on your head. The drain in your shower gets clogged and suddenly you see your scalp no matter how you part or style you hair. Is this a sign of a serious illness? Will it stop? Are you going bald? Dr. Judith Reichman, "Today" health contributor, was invited to appear on the show to share some insight on female hair loss. Here's even more:

Let’s start with 101 in hair physiology. How does hair grow and should it recycle?
A single hair follicle grows its hair strand over a period of four to six years (the anagen phase). It then rests for two to four months (the telogen phase), after which it loses the “old” hair as a new hair shaft grows and pushes out its predecessor. When the new hair grows in, it does so at a rate of approximately half an inch per month. At any time, 10 percent of your hair is in the telogen phase and 90 percent is in the anagen phase.

What causes a change in this hair loss/ hair growth process?
If lots of hair begins to fall out throughout the scalp, it’s obviously due to a change in the normal hair cycle: either a short anagen phase or an increase in the number of  follicles that enter the telogen phase. When the majority of hair follicles “go telogen” it’s called telogen effluvium or stress alopecia. A shock to the body’s system, which stresses the hair follicles, is often to blame for this change in cyclical hair events. Two to three months after the stressor hits, up to 70 percent of hairs can enter the telogen phase and commence a massive “fall out”. There are a number of shocks that are known to cause this. They include:

• A sudden hormone change (usually a drop in hormone levels)
• After the birth of a baby ( delivery of the placenta causes the levels of pregnancy hormones to plummet)
• Discontinuing birth control pills or hormone replacement therapy
• High fever
• Acute trauma (surgery, physical injury or psychological trauma)
• Severe dieting ( inadequate protein and iron intake)
• Underactive or overactive thyroid
• Diseases such as diabetes and lupus
• Chemotherapy
• Medications: These include retinoids, blood pressure medication, anti-depressants, certain birth control pills and even NSAID’s (including Ibuprofen)
• Burns or radiation therapy

Note with stress alopecia, the loss over the scalp is general, not patchy and hair loss on other parts of the body can also occur. You and your doctor may be able to ascertain if your hair loss falls in the category of stress alopecia by simply running your fingers through your hair and seeing if the many hairs that are shed have clubbed shafts.

Are there other tests that should be done to diagnose telogen effluvium?
Your doctor may want to check your iron and thyroid levels, but in most cases, your history is the most important factor for diagnosis.

What is the therapy for this type of hair loss?
Mostly reassurance. If the loss is due to a birth, illness, or a self-limited problem, it will stop and will not progress to baldness. New hair shafts will come in and in a few months the hair loss will diminish. Eventually the hair will grow back and become normal. Obviously if the loss was due to a medication, the drug should be stopped. (Note: If it was due to chemotherapy the course should be completed and hair growth will subsequently return.)

If iron levels are low, iron should be supplemented (after making sure that the cause was not abnormal bleeding, which could be a sign of a serious disorder), and if the thyroid level is “off,” this should be treated.

Can dyes, hair treatment, or certain hairstyles cause hair loss?
Pulling the hair tightly in a ponytail and the repeated traction used for hair extensions and tight braiding can cause some hair loss, especially in the temple area. This is called traction alopecia. If not corrected, the hair follicle may be permanently damaged. Chemicals that dye, bleach, straighten or perm the hair can also cause the shaft to break off, but once the chemical insult has stopped, the root portion should grow back.

What if patches of hair are coming out?
This may be due to a condition called alopecia areata. This is thought to be an autoimmune disease in which antibodies attack the hair follicles and hair falls out in small, round patches. In some individuals, this can progress to total loss of hair on the head (alopecia areata totalis), or even complete loss of hair on the head, face (eyebrows, eyelashes) and body (pubic and underarm hair). The latter rare condition is called alopecia areata universalis.

What causes alopecia areata?
White blood cells attack cells in the hair follicles that make the hair, the follicle becomes small and hair production is diminished. However, the stem cells that continually supply the follicle with new cells don’t seem to be targeted, so the follicle does have a potential to regrow hair. Although it’s not clear why this occurs, there is some thought that it has a genetic basis, making individuals from the same family predisposed to developing this disease. There also may be some sort of trigger that initially causes the onset of hair loss, perhaps a virus or an environment contaminant.

There are currently about four million Americans of both sexes and all ages and ethnic backgrounds who suffer from alopecia areata. One in five individuals with this disease has a family member who has had it as well.

Alopecia areata also seems to occur in family members who have had other autoimmune diseases such as diabetes, rheumatoid arthritis, thyroid disease, systemic lupus, pernicious anemia or Addison’s disease. Those who develop alopecia areata have been found to have a higher occurrence of thyroid disease, eczema, nasal allergies and asthma.

If I develop this type of hair loss, will it grow back?
In general, there is a very good chance that the hair will grow back, but it can also fall out again. There’s no way of predicting the ultimate course. Some individuals lose just a few patches of hair, it grows back and the condition doesn’t recur. Others continue to lose and regrow hair for years and still others lose all the hair on their head, face and body; rarely this is permanent.

How is this treated?
There are a number of therapies that are currently being used (when there are multiple therapies, it generally means that no one is going to be absolutely effective). They include:

• Corticoid steroids: These are cortisone types of anti-inflammatory drugs that help to suppress the immune system; they can be given as a pill, topical ointment or as a local injection, directly into the hairless patches on the scalp.
• Minoxidil 5%: (known under the brand name of Rogaine) This promotes hair growth in several conditions in which the hair follicles are small and not growing to their full potential. It needs to be used on a daily basis. New hair growth can appear in about 12 weeks, however if use of the drug stops, the new hair may fall out.
• Anthralin (Psoriatic): This is a tar like substance that is used to treat psoriasis; it changes the immune function in the affected skin. If it does work, new hair growth is seen in eight to twelve weeks. It is often used in combination with other medications.
• Sulfasalazin: This sulfa drug is used to treat autoimmune disorders.
• Topical sensitizers: These, when applied to the scalp, cause an allergic reaction that leads to itching and scaling, but also stimulate the hair follicles and can cause hair growth. Again, results are only seen after long-term use, usually three to twelve months.
• Photo chemotherapy: This too is used for psoriasis. It has helped about half those treated, but requires special equipment and treatment two to three times a week. There are concerns that it could increase risk of skin cancer. 

Are there other causes for “patchy hair loss”?
Yes, it can be caused by fungal infections such as ringworm and even syphilis.

What about genetic or inherited hair loss?
We all know that men can become bald as they get older. As a matter of fact, inherited or male pattern baldness occurs in 25 percent of men by 30 and two-thirds are bald or balding by the time they reach 60. This male pattern baldness usually occurs in the hairline and around the crown. It continues until there is just a ring of hair along the side. The male pattern of balding occurs from the effects of testosterone, after it is converted to the more potent DHT (which is the only form that will attach to receptors on the hair follicle). Men who tend to male pattern balding don’t have more testosterone; they simply have an increased conversion of testosterone to DHT in the scalp.(Note: The drug that helps prevent this conversion is called Finasteride, and is used to treat this form of baldness. It is for men only and has not been shown to be effective in women. As a matter of fact, there is concern about a woman being exposed to Finasteride, especially during her reproductive years, since it could cause fetal malformations.)

Women, however, do develop thinner hair as they get older and often this is accompanied by gradual hair loss. It occurs over the top and sides of the head, not in the crown. Once more, it is felt that genetics play a role and it is far more likely to occur if relatives on either side of their family has experienced balding as they age.

What therapies target this hair thinning and loss?
The drug Minoxidil, which was first developed to treat high blood pressure, was found to have a side effect of thickening hair growth in some of those treated. It’s now available over the counter as a lotion applied to the scalp. No one quite knows how it works, but it seems to be effective in about 20 percent of women who develop diffused hair loss or thinning, especially if they are younger when they begin to lose their hair. The disadvantage is that if daily use is stopped, the new hair will fall out.

There are also surgical techniques for restoring hair. The two main options are:

• Hair transplantation: Minute punch holes of skin containing a few follicles of hair are taken from elsewhere in the body or the back of the head where there is more hair, and implanted into the thinning areas. Because women are more likely to have overall loss of hair on their scalp, this technique may be less successful for them than it has been for men.
• Scalp reduction: Devices are inserted in the skin to stretch the area of scalp that still has hair and the bald areas are removed. Flaps of scalp with hair can also be moved around the head.

What about all those so-called wonder products that are advertised on the Internet?
Beware if they say they are going to quickly and easily cure female pattern hair loss. They probably won’t. You are providing money for the individuals who are using the Internet to promote their product, and there’s a good chance the product will not promote your hair growth.

Dr. Reichman's Bottom line: In most cases your hair loss is due to trauma to the hair follicle and after several months your hair will grow back. Make sure that you talk to your doctor before you try any products on your own. Reassurance and patience may be all you need.

“Why me?” can be a question that men may ask themselves when they first notice that they have male pattern hair loss--a condition that affects two out of three men.

Despite the fact that male pattern baldness is very common, many men who are faced with hair loss feel embarrassment and have low self-esteem. According to Phillip Ginsberg, D.O., J.D., an osteopathic physician who practices in Philadelphia, Pa. when a male is experiencing hair loss it is important to know what is causing the hair loss and become educated about the available treatment options.

“First of all, I think that it is vital to break through the myths about male pattern hair loss,” says Dr. Ginsberg. Common myths associated with hair loss in men are that baldness is inherited from the mother’s side of the family; and wearing a hat or using a blow-dryer can cause hair loss.

“There are no facts to support any of these myths,”states Dr. Ginsberg. “Male pattern hair loss is caused when the hair follicle gradually becomes smaller, which results in shorter and finer hair and eventually no hair.”

While genetics does play a role in male pattern hair loss, Dr. Ginsberg notes that the gene can come from either parent, not just the mother. In addition, males who experience hair loss usually have a high presence of endocrine hormones.

Symptoms of male pattern baldness may begin appearing in men as young as 20 years old and can consist of thinning hair; a receding hairline, usually from the front toward the back over time; loss of hair around the crown of the head; or progression of hair loss in a typical “M”-shaped pattern.

“Unfortunately, there is no cure for male pattern hair loss,” says Dr. Gingsberg. “But, there are treatments available that may help to slow down the process or even make new hair grow.”

According to Dr. Ginsberg, two of the most popular treatments are the prescription drugs, minoxidil and finasteride. Minoxidil is usually used on the scalp and has been known to help hair grow in approximately 20-25% of the population. The majority of users experience slowed hair loss. Loss of hair will resume with the discontinuation of minoxidil.

The other common medication used to treat male pattern baldness is finasteride, which is the only oral medication approved by the FDA to help treat male pattern baldness. Finasteride inhibits the production of the hormone that contributes to male pattern baldness. Approximately 50 percent of men who take finasteride have increased their hair growth in one year.

“Minoxidil and finasteride are two of the most common forms of treatment for male pattern baldness, however, they are not the only options available,” states Dr. Ginsberg. “Hair transplants, which consist of removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in the areas that are balding, are also a popular form of treatment.”

While male pattern hair loss might be unwanted, Dr. Ginsberg says men experiencing this condition should not be embarrassed to talk to their physician about any health-related concerns that they might have.

“It is especially important to discuss this issue with your doctor if hair loss occurs in a pattern other than that of typical male pattern baldness or is accompanied by itching, skin irritation and other symptoms,” says Dr Ginsberg.

On average, there are 100,000 to 150,000 hairs on the human scalp. The hairs grow from hair roots, or follicles (saclike structures under the skin). Blood vessels at the base of each follicle provide the nourishment necessary for hair growth. Hair growth in each root occurs in a cycle independent of the other roots. At any time about 90 percent of the hairs on the scalp are in the growth phase, while the other 10 percent are in the resting phase. The growth phase lasts an average of four to five years, after which the follicle enters the resting phase, which lasts about two months to four months. At the end of the resting phase, the hair falls out naturally and is replaced by a new hair. Consequently, some hair loss is a normal part of the hair growth cycle. In fact, on a typical day, about 50 to 150 scalp hairs are lost. Baldness (or alopecia) results when hair loss occurs at an abnormally high rate; when hair replacement occurs at an abnormally slow rate; or when normal hairs are replaced by thinner, shorter ones.

What is male pattern baldness?

About 95 percent of all cases of hair loss are the result of androgenetic alopecia (also known as male pattern baldness in men). Androgenetic alopecia occurs much more frequently in men than in women. It affects roughly 40 million men in the United States. Approximately 25 percent of men begin balding by age 30; two-thirds begin balding by age 60.

While some types of hair loss are easily reversible, male pattern baldness is more permanent. It occurs in a characteristic pattern on the scalp: hair loss usually begins at the temples and at the top of the head toward the back, causing a receding hairline and a bald spot. Hair loss may continue until the two sections become joined, leaving a horseshoe-shaped area of hair on the sides and back of the head. Balding may begin at any age after puberty, even in the middle teens, and can range from partial loss to complete baldness. Male pattern baldness progresses slowly and is not associated with redness, itching, or pain. Currently, there is no way to prevent male pattern baldness from occurring.

What causes male pattern baldness?

The causes of male pattern baldness are thought to be complex and are not completely understood. However, as suggested by its medical name (androgenetic alopecia), male pattern baldness seems to involve both hormonal (androgen) and genetic factors. Many different types of hormones play roles in the regulation of scalp hair, but the hormones with the largest effect are the androgens. Testosterone and its more potent derivative dihydrotestosterone (DHT) are responsible for increasing the size of hair follicles in areas such as the beard and underarm during puberty, but can also cause hair follicles in the scalp to decrease in size later in life. These contrasting responses to DHT might be explained by genetic differences in the individual hair follicles. Similarly, in men who are balding, genetically determined characteristics of hair follicles in the scalp may cause the follicles to be more likely to degrade in the presence of androgens. Hair follicles become miniaturized, and the hair consequently becomes thinner and shorter. The growing phase of the growth cycle becomes progressively shorter, which means more hairs are shed. Although the follicles still have an adequate blood supply, they continue to shrink, and some eventually die.

Whatever the exact causes of male pattern baldness may be, it is a hereditary trait. There are multiple genetic factors that influence male pattern baldness. A tendency toward baldness in the men on either the mother's or father's side of a man's family indicates a genetic predisposition to baldness. The speed, pattern, time of onset and degree of balding are all influenced by heredity. Generally, the earlier the onset of balding, the more extensive the degree of hair loss will eventually be.

Contrary to popular myth, balding is not caused by wearing hats. Massaging or brushing the scalp will not help regrow hair, and excessive cleaning of the scalp will not "unclog" follicles and allow hair growth. While extreme psychological stress may contribute to a form of hair loss known as alopecia areata, normal everyday stress does not contribute to balding and is not a cause of androgenetic alopecia.

What are some other types of hair loss?

Aside from male pattern baldness, some of the most common types of hair loss include:

• Alopecia areata, which leads to patchy hair loss on the scalp. While the causes of alopecia areata are not completely understood, the hair loss is thought to be the result of the body's immune system attacking the hair follicle. Alopecia areata often resolves without treatment.
• Traction alopecia, which results from long-term pulling on the hair. This type of hair loss can be caused by certain hairstyles, such as tight braids. The hair loss is usually reversible once the cause of this pulling is eliminated.

Certain diseases, such as diabetes, systemic lupus erythematosus and disorders of the thyroid gland can also cause baldness. Sudden hair loss may be an early warning sign for some diseases and should be reported to a doctor.

Hair loss has many other causes, including illness, poor nutrition, skin damage, some medications, and certain medical treatments such as anticancer chemotherapy and radiation therapy. Ringworm, a fungal infection, may sometimes be the cause of balding in children, but is generally not a problem in adults.

How is the cause of hair loss diagnosed?

Because there are many potential causes of excessive hair loss, consult a dermatologist if you are concerned. Your doctor will ask questions about your family's history of baldness. He or she may also want to examine a few hairs under a microscope or check the scalp for signs of skin damage. You may be asked questions about your diet, hair-care procedures, medications (including vitamins and herbal supplements) that you take, and recent illnesses. In some cases, your doctor may order blood tests or a skin biopsy (taking a small sample of tissue for examination) to help make a diagnosis. He or she may also ask you to monitor the number of hairs lost during a day, by collecting and counting as many as possible.

What are the treatment options for male pattern baldness?

Male pattern baldness is not a medical disorder. Whether treatment is desirable is a personal decision. Many men decide to let the process run its course. However, baldness can be a source of anxiety for others and can have a negative effect on self-image. If you decide that you are not comfortable with your hair loss, you may want to consider the treatment options described below.

Prescription medications

• Minoxidil (Rogaine®)
  Originally used to treat high blood pressure, minoxidil is now widely used as a topical solution applied twice daily to treat male pattern baldness. Studies have indicated that it may help grow hair in 10 percent to 20 percent of those who use it, and it may slow the rate of loss for 90 percent. It is not clear exactly how minoxidil works, but when it is effective, it seems to somehow prolong the growing stage of the hair growth cycle, enlarge the follicles, and cause follicles at rest to grow. Minoxidil is generally more effective for young men and those whose onset of hair loss is recent.

  Minoxidil may take four months or longer to show results. The treatment is relatively expensive and must be applied indefinitely; when application is stopped, regrown hair falls out. Newly grown hair may also not be as long and thick as normal hair. As with most medications, side effects are possible, including irritation of the scalp. The solution was originally available only in a 2 percent solution, but the Food and Drug Administration has recently approved a 5 percent solution, which has shown better results in some cases.

• Finasteride (Propecia®)
  Originally used for the treatment of enlargement of the prostate gland, finasteride was recently approved by the FDA to treat male pattern baldness. It is taken daily in pill form. Finasteride works by inhibiting the conversion of testosterone to DHT, decreasing the levels of DHT in the blood and scalp. In this way, finasteride helps to block androgen-dependent degradation of hair follicles. In a recent study, nearly half of the men who took finasteride grew hair on the scalp, and the drug was even more effective at halting hair loss. A significant percentage did, however, continue to report hair loss.

  Side effects associated with finasteride are mainly related to sexual function, such as loss of sex drive, reversible impotence and a decrease in the quantity of semen. These side effects were experienced by approximately 2 percent to 5 percent of patients in clinical trials. Finasteride is not approved for use by women, because it may cause birth defects. Broken or crushed tablets should not be handled by women who are or may be pregnant.

  Currently, minoxidil and finasteride are the only medications approved by the FDA for use in the treatment of male pattern baldness. Nonprescription preparations are not effective and were banned by the FDA in 1989.

Surgical treatments

• Hair transplantation
  In hair transplantation, productive hair follicles are removed from a donor area on the scalp and transplanted to a balding area. The follicles are commonly taken in plugs of one hair to two hairs (called micrografts) from the sides or back of the head and moved to the front and/or top, with the hairline being slowly reconstructed. Larger plugs of up to 10 hairs are also sometimes used. Donor sites with full hair make transplants more successful. In the flap technique of transplantation, areas of hair are removed from the sides and back of the scalp and transplanted to the top.

  Some scarring in the donor site may result. Transplanted follicles may be permanent, or they may last only for a few years. The implantation of synthetic hair fibers has a high rate of infection and has been banned by the FDA.

• Scalp reduction
  Balding areas of the scalp may be surgically removed to decrease the appearance of baldness. Scalp reduction is usually used in conjunction with grafts or flaps. Devices may be used to stretch the scalp, expanding areas where hair grows. The effectiveness of scalp reduction depends on the degree of hair loss and the elasticity of the scalp.

As with any surgical procedure, hair transplantation and scalp reduction present certain risks, including scarring and infection. If you are considering one of these treatments, discuss the risks with your doctor.

Cosmetic treatments

• Synthetic hair
  A hairpiece (or toupee) can be custom made to cover a balding area. Hairpieces may fade and loosen over time. Certain organizations specialize in cleaning, coloring and tightening hairpieces. It is important not to neglect the scalp under the hairpiece, which should continue to be washed regularly. Another option is a weave, in which synthetic hair is sewn into existing hair.
• Hair products
  Be wary of hair-care products that claim to thicken and strengthen hair. This is accomplished simply by waxes or oils that build up on hair, creating the illusion of thickening.

While male pattern baldness presents no physical risks, your emotional well-being is an important part of your complete health. If hair loss causes you anxiety and negatively affects your self-image, treatment can be beneficial. Consider the treatment options and discuss them with your doctor.

'First of all there's panic, then it's denial because you refuse to accept that the way you've looked for so many years has now changed irreparably. That's when you move on to treatment and, if that doesn't work, you reach rock bottom. A part of you dies and you realise there's nowhere left to go, and that's where acceptance comes into it,' he says.

At 23, Ian is a long way from making the same bold decision as Russell. He is three months into a one year programme of laser treatment aimed at giving him back the amount of hair he had at 18.

The fuzz on the top of his head looks promising, but it may owe more to the hair restoring lotion, Regaine, that he is also using. There isn't any independent scientific evidence that pointing a laser at empty hair follicles makes them work again. But there is good data to show that 60% of men who use Regaine (also called minoxidil) do get some regrowth, especially if they start when their bald patch is small.

Originally developed for treating high blood pressure, no one knows how Regaine works. It's on sale at pharmacies and from trichologists. If Regaine is going to work, you should see some sign of a reduction in hair loss within four to six weeks and, if it does work, you'll need to keep taking it.

The same is true of Propecia (also called finasteride) which men can get on private prescription from their doctor. Designed to treat enlarged prostates, Propecia blocks the production of the male sex hormone, testosterone, which makes the prostate gland grow. Although male baldness is usually caused by over-sensitivity of the hair follicles to testosterone, rather than too much of it, reducing the amount that a man produces does seem to help about two thirds of balding men who try it. The only downside is that a few men get a reduction in their libido.

male pattern baldness

Both Russell and Ian have male pattern baldness (alopecia androgenetica). It is the most common form of hair loss in men, but it can affect women too. The hairline begins to recede into an 'M' shape and there is some hair loss on the crown of the head. Eventually the receding hairline and the bald patch meet, leaving a horseshoe-shaped fringe of hair around the back and sides of the head.

Male pattern baldness runs in families; the hair follicles are genetically programmed to shrink in response to the male sex hormone, testosterone, levels of which increase in both men and women after puberty. As the follicles get smaller, the hairs get thinner and shorter and less deeply rooted. Eventually, they stop growing altogether.

hard graft

Thirty-five-year-old Lee (who was treated at the Farjo clinic) sees the thousands of pounds he has spent on hair surgery as an investment in his future. He has had two operations to remove healthy hair follicles from the back of his head and insert them in the balding skin on the top of his head. Each small strip from the back is divided into hundreds of plugs of only one to three hairs and planted into tiny holes in Lees's scalp. It's all done under local anaesthetic and doesn't hurt.

The new hairs in the grafted follicles will grow in a normal whirl from the crown of Lee's head. The downside is that there's only so many healthy hair follicles that men like Lee have at the back of their head and three operations is usually the maximum.

'I did have to ask myself a lot of very hard questions,' says Lee. 'I did have to be 110% sure I was doing the right thing. I'm not going to go bald now because the transplanted hair is not going to fall out. You could say it's a long term investment.'

A variation of this procedure is to implant synthetic tufts of hair. Since this is 'foreign' material, there is a greater likelihood that the scalp will reject it and the tufts will fall out, with an accompanying risk of infection.

The other surgical option for extensive baldness is scalp reduction. This means removing the central area of baldness and stitching the remaining pieces of scalp together so that the hairless part becomes smaller.

If you do decide to consider surgery, be sure to choose an experienced surgeon, who is prepared to explain exactly what he or she plans to do, show you photographs of previous operations, and ensure that you know what you are letting yourself in for – physically, emotionally and financially.

'not a wig'

Carl Howell, managing director of Advanced Hair Studio, is horrified if anyone suggests that sticking a small piece of human hair over a bald patch is like having a wig. It's a hair replacement procedure, he explains, not a wig.

'It's like calling a computer an adding machine or a computer chip an optical illusion. It's so sophisticated that it's really insulting to call it that.'

James, a hairdresser who cannot contemplate life without hair, spent £3,000 five years ago on a hair replacement procedure and hands over £50 every six weeks to have it tidied up. Hidden within his gelled and spiky hair, lies his tiny hairpiece – human hair embedded in a small piece of skin-like material.

'A guy's got to have hair. A guy's got to look cool. A guy's got to be attractive. People desire lustrous hair. It's just a fact of modern living,' he says. 'This is the new me and this is the me that's staying. I would never, ever go back to being bald.'

coming clean

An estimated 100,000 men in Britain wear a wig, but very few are prepared to come clean and admit they have one. Trichologist Mandy Baldwin believes they get a raw deal:

'If I were to put on a wig, people would say it's really nice. But if a man puts one on, people think there's something funny about it, and they laugh,' she says.

Today's wigs are very different from the 'dead animal' scrunch of synthetic hair beloved of 1970s comedians. For £500 or £600, you can buy a hairpiece made of human hair imbedded in synthetic 'scalp' so life-like that, as Mandy points out, you're tempted to look for dandruff.

If you are going to buy a wig or hairpiece, go to a specialist centre where there are hundreds of styles and dozens of colours to choose from. People whose hair is thinning or who have patches of hair loss do not usually require a wig and only need a hairpiece.

You can have a permanent hairpiece, which is attached to your own hair with a medical adhesive and is worn all the time, or a removable hairpiece, which is attached by a double-sided adhesive and can be taken off at night. A permanent hairpiece will withstand the pressures of showers, swimming, and sporting activities but does require grooming and re-attachment to adjust for growth of the natural hair to which it is attached.

However, men like Russell who have come to terms with their loss, urge other men to bite the bullet and wear their baldness with pride.

'If someone was losing their hair today, I'd say I know what's ahead of you and it's not going to be very nice. But a day will come when you'll step outside and you'll not care. There's nothing I can say that will make the transition any easier, other than "Hang on in there, you'll feel better one day."'

Despite the fact that the hair loss industry generates worldwide revenues of several billion US dollars, there seem to be only a few options proven to deliver measurable results. One such option is hair surgery. Hair surgery alone is estimated to make revenues of three billion dollars from the nearly 300,000 hair transplants that are expected to be performed around the world this year. In addition to that, there are billions of dollars to be made annually from the sales of diverse hair loss products. But how many of them really work? One would not be exaggerating to say that 90% of all non-surgical, hair loss treatments are a scam. Having said that, billions of dollars are spent every year wastefully on useless rubbish. One thing is wasting money and the other no less important thing is losing the battle against time while the hair loss continues, most likely becoming irreversible. But how can you tell which treatment is a waste of time and money without trying it out?

Once you have pinpointed the product you are considering trying, check the independent consumer reviews to get a basic understanding of its effectiveness. Do not use testimonials at the manufacturer’s website. It is best-advised to use references from large independent websites such as Folica, Amazon or RateItAll and crosscheck with reviews at various hair loss forums. Since it is difficult to recognise right away who is telling the truth and who is cheating you, you might need to come back and check again here once you have done your research and gained a better understanding of the product and its individual components.

As a second step, you should look at the composition of the remedy you are considering buying. If you cannot find the list of individual, active substances, ask the manufacturer to provide it. If they fail to provide you the required breakdown, consider it a scam. You need to check the stories behind active substances and if you want to get a really good insight into their science, you must verify references to clinical trials and peer studies. This is probably the most difficult and the most time-consuming part of this job.

The third thing you might need to do is to examine the manufacturer’s claims. Check the product’s website and try to read between the lines. If the claims sound unsubstantiated and too good to be true or the before and after pictures look unrealistic, be careful.

Though these tips may not be exhaustive, they should help you in assessing the potential of the hair loss product you are considering buying and might save you frustration with wasting time and money on useless rubbish. If you have tried certain products already and want to share you experience, there are several places where you can have your word spread and heard by other hair loss suffers, such as the aforementioned Amazon, Folica and RateItAll, to name just a few.

This article was written by Dody Gasparik and readers are encouraged to use his blog http://www.greyhairloss.com/blog/home.html to share their experiences in order to warn each other about hair scams and recommend products that they have found effective.

• Androgenetic hair loss in men – this is the most common type of baldness that can be helped by hair transplantation
• Hair loss due to accidents and operations.

• Infection – this can occur because the skin is broken to perform the procedure. It can be treated with antibiotics.
• Bleeding – this is usually controlled through careful postoperative care.
• Scarring – approximately 11 per cent of the population have a tendency to scar.
• Temporary, operation-induced hair loss – known as telogen effluvium, this can occur with hair transplantation as well as some other operations. It occurs in approximately five per cent of patients.
• Unacceptable cosmetic results – scarring and unacceptable cosmetic results are more common when hair transplants are carried out by inexperienced practitioners.

Alternatives and solutions for hair loss in women:

Hair loss affect about 70% of women who are approaching menopause. Hair loss usually lasts for the whole menopause transition (until the mid 50's), but some women may experience them for the rest of their life. Menopause is not an illness, but a natural process in a woman's body. The symptoms of menopause are just indicators of changes between the hormones estrogen, testosterone and progesterone. These changes result in a hormonal imbalance in a woman's body and cause the common hair loss in women.

Though the pharmaceutical companies would have you believe that for the treatment of hormonal imbalance, drugs are the best solution, that isn't the case. Before you make the choice of taking synthetic hormones, you might want to consider less risky approaches, like alternative medicine or lifestyle changes. The medical establishment is becoming increasingly interested in alternative medicine since breast and ovarian cancer as well as heart diseases, blood clots and other side effects are associated with conventional HRT treatment.

Three solutions for treating hair loss in women:

Three levels of solutions can be considered for treating hair loss in women. These are categorized as: (1) Lifestyle Changes, (2) Alternative Medicine and (3) Drugs and Surgery. You should always start with the least risky approach (lifestyle changes) and go on to riskier approaches (surgery/drugs) only if necessary.

1: Lifestyle changes

The first level involves no risk but may be the hardest way to go. You'll have to restrict yourself from many things. So if you are considering this approach, you will need a strong mind and a positive thinking for managing these changes. Surprisingly, there has been less research on how lifestyle changes can affect hormonal imbalance. Nonetheless, techniques for stress reduction (e.g. yoga), a diet rich in estrogenic food (soy, apples, alfalfa, cherries, potatoes, rice, wheat and yams) or even becoming more fit by doing regular exercises, will have positive effects on the treatment of hair loss in women.

It's not easy to follow up this approach, that's why you might want to consider the next level of treatment. Alternative medicine has proven to be excellent alternative for treating hair loss in women in a natural and safe way.

2: Alternative medicine

Alternative solutions involve little or no risk and can be considered as the best and safest way for treating hair loss in women. In this level of approach, Herbal remedies and Acupuncture established themselves as the best treatments. Acupuncture is a Chinese medical treatment involving the insertion of very fine sterile needles into the body at specific points according to a mapping of "energy pathways". It's an excellent alternative, but complicated to follow. A successful acupuncture treatment involves time, money and finding the right practitioner. Therefore, most women are looking for less complicated ways of alternative treatment and think herbal remedies are a safe and effective solution.

There are basically two types of herbs for hair loss in women: phytoestrogen and non-estrogenic herbs. The phytoestrogen herbs (e.g. Black Cohosh, Dong Quai) contain estrogenic components produced by plants. Though, these herbs are good for treating low hormone levels, because they replace some of the missing estrogen hormones, they aren't the best solution for treating hormonal imbalance. As a result of adding hormones from outside, your body will become less responsive to produce estrogen on its own. This causes a further decrease of body-own hormone levels.

Unlike phytoestrogen herbs, non-estrogenic herbs, as its name suggests, don't contain any estrogen. These herbs nourish your hormonal glands into producing more efficiently your own natural hormones. This ultimately ends up in balancing not only estrogen, but also progesterone and testosterone. In other words, non-estrogenic herbs stimulate your own hormone production, by inducing the optimal functioning of the pituitary and endocrine glands. Due to this, non-estrogenic herbs, like Macafem, can be considered as the safest way to treat hair loss in women naturally.

Nature & Health magazine. Dr. Chacon says:
"Macafem nutrients help restore natural hormones in women. Unlike hormone drugs, which are basically resumed in taking synthetic hormones, Macafem acts totally different in your body. It nourishes and stimulates your own natural hormone production, by inducing the optimal functioning of the pituitary and endocrine glands".

A combination of approaches is a good route to take. Lifestyle changes combined with alternative medicine will probably take care of the hormonal imbalance in a more efficiently way. Nonetheless, there will always be some women who need or want to go through the third level of approach. Side effects are inevitable, but sometimes these are worth if considered the relief this approach provides.

3: Drugs and surgery

Interventions at level 3 involve the highest risk and often the highest costs. The most common drug therapy for treating 34 menopause symptoms in the US is hormone replacement therapy (HRT). There's no doubt that this is the quickest and strongest way to combat hormonal imbalance; but, unfortunately, it entails serious side effects and increases the risk of different cancer types among women, as the following study has proven.

In 1991 the National Institute of Health (NIH) launched the Women's Health Initiative (WHI), the largest clinical trial ever undertaken in the United States . The WHI was designed to provide answers concerning possible benefits and risks associated with use of hormone replacement therapy (HRT). This study was canceled in July 2002, after it was proven that synthetic hormones increase risks of ovarian and breast cancer as well as heart disease, blood clots and strokes. The findings were published in JAMA, the Journal of the American Medical Association.

If you still want to consider this solution, take a visit to your physician, and be more informed about what this treatment option involves.

These three levels of solutions are not mutually exclusive. You can use different approaches at different times or combine several at the same time. Nowadays more and more women think dealing with hair loss in women is best accomplished via a combination of healthy lifestyle and alternative treatments.

A safe way for treating hair loss in women:
Non-estrogenic herbs for treating hair loss in women, as seen in the second approach, are considered to be the most effective solution. Low costs and the non existence of side effects are only some of the reasons why to prefer this treatment option.

Macafem, for example, is an excellent non-estrogenic herb. Its simple, rather than putting hormones from outside into your body artificially, Macafem stimulates your hormone glands to produce the necessary hormones naturally. This is what makes Macafem so unique.

Look around a crowd, and you'll see that lots of middle-aged men are losing their hair. As Baby Boomers, they have every right to demand, What is science doing about this? Quite a bit, it turns out.

A British company, for example, says five guys are walking around with hundreds more hairs than they had before, thanks to an early test of what's been called hair cloning. An American outfit hopes to start testing a similar approach next year.

Other scientists are tracking down genes that make some men susceptible to hair loss, and struggling to understand the mysterious biology behind it. For example, how can men lose hair on the top of their heads while their beards and even eyelashes keep going strong?

Black men are far less susceptible, but about a third of 30-year-old white men have signs of what doctors call male-pattern baldness. By the time they're 50, about half of them do. The condition creeps across the head like three tiny armies bent on deforestation: one starting at the back, and two making inroads from the front.

Sure, some men say bald is beautiful. And others can smear on minoxidil (Rogaine) or take Propecia pills, or get hair transplants.

In fact, right now is "the best time in history to be going bald, because there's an awful lot of things that can be done,'' says Dr. Ken Washenik of the Aderans Research Institute in Philadelphia, which is investigating the "hair cloning'' approach.

But the drugs don't help everybody, and not everyone is interested in a transplant. So there's room for new approaches.

To understand the search for new treatments, it helps to know a little about hair and male pattern baldness. (Women can also get hormone-induced baldness like this, but it's not clear if it's really the same condition).

Everybody starts out with a lifetime supply of about 100,000 follicles on the scalp, each primed to produce a single hair shaft. Normally, any given follicle pumps out that shaft for two years to six years, then takes a break for a few weeks. Then it sheds that hair, and starts the cycle over again.

Each day, we lose about 100 hairs this way. No big deal; about an equal number of follicles enter the growth phase on the same day, and at any one time about 90 percent to 95 percent of the follicles are busy growing new hair.

But in some men, in selected places on the scalp, this orderly process goes awry.

The hair-growing phase gets progressively shorter and the resting phase gets longer. So the resulting hairs get shorter and shorter with each trip through the cycle. Eventually, they don't even poke out through the scalp.

What's more, affected follicles take longer to start growing hair again after they've shed the last one. And they shrink, so the hair they produce is finer. On your head, it's like replacing mighty trees with saplings. And the total number of remaining hairs slips by about 5 percent a year.

What causes this? The full picture isn't known, but it clearly involves a combination of genetic susceptibility and hormones, including testosterone.

Researchers are eager to identify the biochemical actors within follicles that could be manipulated to fight baldness. As for genetics, some studies have implicated a particular gene that may be necessary to get the condition but not sufficient to produce baldness on its own, said Stephen Harrap of the University of Melbourne in Australia.

In all, it might take inheriting certain versions of about five genes to get the condition, like getting a bad poker hand, suggested Rodney Sinclair of the university.

In England, meanwhile, a company called Intercytex has just begun human studies of an approach sometimes called hair cloning. It focuses on a particular kind of cell, found at the base of the follicle, that can team up with skin cells to produce new follicles.

Here's the idea: Extract some cells from the areas of a man's head that resist balding, put them in a lab dish and expand their numbers by thousands of times. Then inject these new cells back into the scalp, where they'll work with skin cells to form new follicles. So, unlike transplants, the guy actually ends up with more hairs than he started with.

The company has recently tested this on seven men with thinning hair due to male pattern baldness, and five of them gained hair, says Intercytex chief scientific officer Paul Kemp. This was just an initial study to look for side effects like inflammation, Kemp says, and no such problems appeared.

Not that this restored a full head of hair. The treated areas were just the size of a quarter, and covered places that already had hair, rather than bald spots.

"We didn't want to create these weird and wonderful patterns on their head,'' Kemp said. "It's such a small area in the hairy area anyway, I would be surprised if they really knew any difference.''

Eventually, if further studies go well, the technique could allow hair transplant surgeons to cover more of a bald head, Kemp said. The next round of human research is expected to start next summer.

Someday, men might avoid transplants altogether, just getting periodic shots of their own cells to counterbalance their hair loss. "You would be going thin, and you'd be maintained,'' Kemp said.

"Sometime in the future, I think baldness will be a choice rather than something you have to suffer,'' said Kemp. "Any bald people will have chosen to be bald.''

Within five years, Kemp says, his company may have a commercial product.

Washenik, of the Philadelphia-based Aderans institute, said his group's efforts in hair cloning have shown promise so far in mice. He hopes studies in people can begin next year.

He said follicles that grow from the transplanted cells should resist balding, because they come from a part of the head that balding doesn't touch. Ordinary hair transplants show that follicles from these resistant regions stay resistant even when planted in bald regions, he said. But even if the transplanted cells do eventually succumb, "you've got years of hair on your scalp that's of benefit to you,'' said Washenik, who also works for a hair transplantation business called Bosley.

Ultimately, he said, scientists would love to accomplish the same goal with a cream that can be smeared on the scalp and deliver just the right chemical signals to stimulate new follicles to grow.

In any case, he said, it's not just about hair.

Hair follicles, after all, are organs. So what's learned from follicle research may help other scientists who are working to regenerate bigger organs like the liver and kidneys, Washenik said.

The same notion was expressed by Sinclair, who's testing a skin cream in mice that may alter follicle behavior by fiddling with genes. (He says he can't discuss the results because they are a commercial secret.)

Sinclair said follicle research allows scientists to approach not just organ regeneration, but also questions about stem cells, cell growth and gene therapy that may pay off someday in new treatments for diseases like cancer and Alzheimer's.

"The idea of growing hair on a bald scalp is only of moderate interest,'' Sinclair said in a telephone interview. "If we find the cure for baldness we're not going to stop studying hair.''

That's just great, Doc.

But if you do find the cure for baldness, lots of men would like to know.

ThymuSkin® hair products preserve hair follicles and/or stimulate dormant but live follicles into regrowth. Basically, one can start the program with two or three of the most important products, ThymuSkin® Shampoo, ThymuSkin® Treatment and ThymuSkin® Gel.

The fundamental principle for the shampoo is for cleansing the scalp with tiny penetrating thymus peptides. Since these peptides are broken down into the smallest of sizes - only 300 angstroms in length - they do diffuse themselves into the hair follicles better than any other mode of cleanser. They clean out each follicle of accumulated oil, dirt, debris, and other waste and prepare the scalp for receiving the treatment lotion.

The usual experience of users is that large amounts of hair fallout around the sink or in the shower. The user notices a decrease of hair fall within the first week of only using the shampoo. If you, as the user, have observed balding or thinning of head hair for less than five years, you are likely to notice new hair growth as early as two to three months. If your hair loss has been occurring far longer than five years, than it could take anywhere from twelve to eighteen months for you to see new hair growth. Usually after eighteen months, if the ThymuSkin® combination of ingredients hasn't helped, you are proving that the hair follicles on remaining bald areas are dead and nothing applied will help to restore them to life.

The ThymuSkin® Hair Treatment Gel is a higher concentration of thymus peptides, vitamins, minerals, enzymes, and amino acids. It was developed to be used in conjunction with the shampoo arid treatment lotion. The gel is a kind of "miracle grow" that tends to produce follicular stimulation more quickly. Because it's so very concentrated, only place the gel onto the balding or thinning areas for intervals of twelve hours. And use it separately from the shampoo and lotion. That is, you might apply the gel in the evening and go to sleep with it spread over the scalp; then in the morning shampoo it away and put on the lotion for the balance of your working day.

Perms, dyeing. and highlighting for hair have no adverse effect on the success of treating with ThymuSkin®. However, it's recommended that you should use high-quality branded products for these purposes.

Baldness is connected to an auto-immune disease. The German physicians discovered that baldness is not just the result of excessive testosterone and hormonal problems in the body. Baldness is actually a disease that results from the body attacking itself.

The body regards the hair follicles as something growing too fast, so it sends out white blood cells, leukocytes, to attack the hair follicles, which it considers to be foreign invaders. The hair follicles are so damaged by the attack of the leukocytes that they let go of the hair strands, and hair falls out. Eventually, the result is baldness.

Baldness is connected to an auto-immune disease. The physicians in Germany discovered that baldness is not just a result of excessive testosterone and hormonal problems in the body. Baldness is actually a disease that results from the body attacking itself.

The body actually regards the hair follicles as something growing too fast, and sees this as excessive growth, as something pathological. So it sends its white blood cells, leukocytes, to attack the hair follicles which it considers a foreign invader, and that is why the hair follicles die. The hair follicles are so damaged by the attack of the leukocytes, that the hair follicle will let go of its strand and hair falls out. Normally we lose 50-100 hairs per day, gradually more fall out than grow up, so eventually you become bald.

Other temporary patchy losses of hair

Ringworm can show small round or oval patches of alopecia and be very similar to AA to look at. Traumatic hair loss, breakage and scaling can be brought on by itching of the scalp and/or hairdressing mishaps, both painful and distressing. Trichotillomania is a condition, not widely known, because those suffering would not wish the loss of hair and the sparse regrowth to be seen. It is a habitual pulling of hairs from the scalp that can be very distressing for the person themselves and the family around them.

Androgenetic Alopecia

or Male Pattern baldness (MPB)

Progressive thinning, giving the appearance of loss of follicles, to temples and crown areas but does not extend to the back and sides of the scalp. If hair is being readily lost then the differences between diffuse loss/patchy loss and MPB must first be identified. Apparently, the absence of 5-alpha reductase keeps the man from developing MPB, and Men with higher levels of 5-alpha reductase and dihydrotestosterone are the men losing their hair.

Treatment: Finasteride can be taken orally available by prescription only. A 5% minoxidil solution can be applied to the scalp, twice daily and hair restoration surgery can be considered that is proving to be very worthwhile for the 40+ patient.

Androgenetic Dependant Alopecia (ADA)

or Female Pattern Loss

Progressive thinning with loss of density showing in a triangular shape behind a well defined hair line, forehead to crown. It must be emphasised that most ladies do not lose follicles in the same manner as men the effect is more diffuse loss than balding. Treatment can be sought through an Endocrinologist as ADA can be alleviated by oral anti-androgens and, if indicated, a 2% preparation of minoxidil could be applied. A diffuse loss in addition to ADA must be differentiated and tested accordingly.

Diffuse Loss of Hair

Increased shedding that is noticeable by seeing more hairs in the basin after shampooing and in the brush or comb. Hair can be shed in this way for many reasons and the most well known is after having a baby. It does not happen to all and it does not happen to the same person after each pregnancy. Hairs throughout the pregnancy are held in the anagen phase of the hair growth cycle and the hairs that would have been shed throughout, plus those due to be shed naturally, all fall together within the first few months after the baby has been born. The situation takes time to get back to normal and if there is more excess shedding after six to nine months then it is wise to see the General Practitioner and have both thyroid and ferritin levels checked.

Telogen effluvium

The term used to describe large numbers of hairs going into the telogen phase and shedding two to four months later in a diffuse manner. TE is referred to as a reflective loss of hair and can be caused by thyroid disorder, low iron, diabetes, medications, and protein deficiency. This is not a definitive list as there are other causes, not least the effects of the sympathetic nervous system described generally as ‘stress’, to do with emotional upset.

Permanent Patchy Loss of Scalp Hair

Hair loss will happen in very small patches that grow very slowly, are hardly noticeable at their onset, but go through periods of time when they progress a little more, and in some cases stop altogether to leave small bald areas that grow no further than the size of a thumb nail. The causes are of unknown origin, although bacterial infection and auto-immune factors have been looked at during research into such cases. The follicles are replaced by scar tissue and different to all of the above conditions. In some cases hair can be transplanted and great success is achieved by scalp reduction for areas of scar tissue.

It was Dec. 31, 1986. Kobren was 22. He knew his life had changed irrevocably. "It was devastating, man," he says, his tone mournful and anguished. "I felt like I was losing a limb. Once you cross that line, there's no going back."

His hair, lush and dense as a tropical forest, was starting to disappear. So began an odyssey to restore what time and genetics were slowly robbing. Kobren tried lotions made of keratin and potions infused with amino acids. He tried hanging upside down. He consulted psychics. He tried zapping his noggin with electrical charges, wrapping it with hot towels, rubbing it with cayenne pepper, shooting it up with hormones. He spent years and thousands of dollars on a fruitless, hairless quest.

Along the way, Kobren's obsession fused into Kobren's profession: self-proclaimed advocate for the bald and balding. First came a book, "The Bald Truth," a self-help/exposé of the hair restoration industry -- a wild-and-woolly netherworld of plugs, drugs and rugs. The book, in turn, led to Kobren's current platform, his pulpit of the airwaves.

Every Sunday night, on a string of stations across the country (including WJFK-FM at 11 p.m.), Kobren spends two hours coaching, consoling and cajoling the follicularly challenged. He rages against "snake oil remedies," mocks "wig" merchants, and blasts various hair transplant surgeons whom Kobren deems "butchers."

All along, he feels the bald community's pain.

To some baldness is just a mundane genetic condition common to tens of millions. Not to Spencer Kobren. In his worldview, it's an ego-shattering, soul-shredding personal cataclysm. A death sentence.

You just don't know, man.

He calls baldness "silent suffering" and describes his program as "a support group" for those losing their hair.

Hair loss, he says often, is "cancer of the spirit."

Kobren typically opens his program by bantering sympathetically with second banana David Solazzo, aka "Intern Dave," about Solazzo's hair loss insecurities. Solazzo, 30, often worries about what "the chicks" will think about his incipient baldness, about what his pals will think, about what the audience at his music gigs will think. Dave apparently thinks about his hair a lot.

Then it's time for callers to share. A few weeks ago, a regular caller named Joe from Staten Island confided his sense of humiliation about his depleted hair. His male friends, Joe said, didn't understand "why something as inconsequential as hair loss is a problem."

Kobren certainly knew. "I wouldn't be on the radio if there weren't so many people suffering out there," Kobren replied firmly. "I know it's a big problem."

That seemed to buck up Joe. "God bless America," he concluded, "and God bless you, Spencer, for protecting the rights of hair loss sufferers."

On another show, Alfred, a 19-year-old from Miami, said he'd noticed that his hair had been thinning since he was 15 or 16.

"Oh, my God!" responded Solazzo. But Kobren remained in control, calmly talking Alfred down. "You're a lucky guy," he said. "You're 19 and you're dealing with it now with products that work. Within five years, you'll get all your hair back."

There's no question that Kobren, 38, can talk the bald talk. Though he has no formal medical training, he has a seemingly encyclopedic knowledge about androgenetic alopecia, or baldness. Kobren can discourse at length about dihydrotestosterone, the hormone that causes hair loss; about the relative merits of Rogaine, Propecia and Proscar; and about the nuances of follicular unit transplantation, a surgical hair replacement technique that costs between $4,000 and $6,000.

He also relates to listeners his own adventures in hair. Kobren's own 'do is startlingly full, as luxuriant as the hair of a 1970s game-show host. He often credits Proscar -- a powerful drug originally prescribed for benign prostate enlargement -- as the silver bullet that finally turned back his advancing scalp.

Kobren attends to his fantastic foliage with obsessive devotion. When the first plane slammed into the World Trade Center on Sept. 11, 2001, Kobren was awakened in his apartment, a block and a half away. Unsure of what was happening, but aware he'd have to leave in a hurry, Kobren did what came naturally: He made sure his hair looked good.

After a quick shower, he went through his usual regimen of blow-drying and brushing, followed by applications of hairspray and Toppik, a scalp-covering makeup.

The concussion from the second plane's impact threw him across his apartment, injuring his back. As he and his girlfriend crawled from their building into a nightmare of debris and devastation, a thought wedged into his carefully coiffed head: "I was hoping there wouldn't be any strong winds."

Shortly thereafter, he moved to Los Angeles.

Kobren is so particular about his hair that he refused to let anyone cut it for 12 years. He did it himself. "It wasn't easy," he says in an interview from his home, "and looking back on the pictures, it wasn't that great. I know it sounds bizarre but I was so ashamed of being outed for my hair loss at a young age. You go into one of those [salons] and there are a lot of young chicks around. When someone is standing over my head staring at your baldness, it's just not a comfortable feeling." With coaxing from friends, Kobren eventually found a sympathetic barber, whom he's been visiting for the past four years.

As a result of his radio soapbox, Kobren is a big man in a rather small pond, the $3.5 billion-a-year hair restoration business. He is alternately beloved and hated, cheered and feared, depending on the perspective.

"Spencer Kobren is not a doctor, has never worked for a doctor, and has never had a procedure himself," says Randall Sword, a physician who runs a Los Angeles clinic that Kobren has blasted on the air. "He calls himself unbiased and a patient advocate. I question that."

"This is a bipolar industry, and Spencer is one of the poles," notes Chris Webb, the editor of National Hair Journal, a hair replacement industry publication. "You will get extreme reactions to him in the market. I'll be cautious in what I say. Let's just say he has a distinctive character and that works well for him."

Though Kobren states at the start of his program that his show isn't an infomercial (a program-length commercial) and that he isn't selling anything, neither statement is entirely accurate.

Kobren pays stations in New York, Los Angeles, San Francisco and Washington to air his show, rather than the other way around (his two hours on WJFK cost $825 a week). He then resells some of this airtime to sponsors. This makes it a "time-brokered program" -- that is, a variant of an infomercial -- under Federal Communications Commission rules.

What's more, "The Bald Truth" features plenty of plugs, and not just the hair transplant kind.

The show carries ads that sound like ads (for, among others, a hair transplant chain called the New Hair Institute) as well as on-air recommendations by Kobren himself. The other night, for instance, Kobren wove in endorsements of physicians Robert Bernstein of New York and John Cole, who has an office in Wheaton.

Both Bernstein (who heads the New Hair Institute) and Cole are members of something called the International Alliance of Hair Restoration Surgeons (IAHRS). The 38 members of the alliance pay $10,000 per year to join. Membership entitles doctors to display the IAHRS logo and to get referrals off the organization's Web site.

The IAHRS was founded by Spencer Kobren, who serves as its "director of consumer/patient affairs." He's also the chief arbiter of who can join.

In other words, Kobren is plugging the same people who advertise on his program, or have paid to become members of his organization.

"It's like paying to be declared one of America's Top 10 steakhouses," says dermatologist Matt Leavitt, the founder of a Florida-based practice, Medical Hair Restoration, and not an IAHRS member. "I don't think it has a whole lot of credibility. They should acknowledge that it's nothing more than a marketing tool."

Sword is more blunt: "Spencer has a good thing going. This [the radio program and organization] is a way of making money. Period."

The International Alliance is not to be confused with an older and larger group, the International Society of Hair Restoration Surgery, an educational and promotional organization. There's also the American Board of Hair Restoration Surgery, which certifies doctors through oral and written exams, although hair transplant doctors aren't required to be certified to perform surgery.

In his defense, Kobren says he uses rigorous criteria to screen applicants, including patient interviews and clinic visits. As a result, he says far more doctors are rejected -- 361 by his count -- than accepted into membership. Besides, he adds, he discloses the membership fees on the air.

"I felt that if I was promoting them and they were making a fortune from me, it was reasonable for them to support my Web sites and myself in some way," Kobren says.

Members aren't complaining. Among other things, "We're able to market our philosophy better," says Paul McAndrews, a Beverly Hills surgeon who serves as the IAHRS medical adviser. "We don't have the marketing budgets of the bigger clinics. . . . Spencer has brought together doctors with a similar philosophy, which is to make patients aware of the range of treatments available to them."

Kobren won't talk specifically about his income, acknowledging only that "it's significant." But he also says: "I could make a much better living promoting bad medicine. Even if I took twice the number of [IAHRS] applicants it would still be selective. I'm just trying to separate the good doctors from all the others."

But if membership has its privileges, one of them may be to insulate the alliance's members from Kobren's frequent on-air slams. Kobren often labels those he considers substandard "butchers." None of those on his hit list are members of the alliance. His on-air criticisms have elicited plenty of complaints and one defamation lawsuit. In that instance, Kobren represented himself and settled without monetary damages (he agreed to restrict his comments about the plaintiff to no more than half his broadcasts). "My defense," he says confidently, "is truth."

Among Kobren's targets are the nation's two largest hair replacement practices, Beverly Hills-based Bosley Medical Group, and Medical Hair Restoration, which is headquartered outside Orlando. He has tarred both with the "B" word before, though he has tempered his criticisms in the past year or so.

Bosley, he says in an interview, "has come a long way, but they're not there yet. I don't say they're butchers, but there was a time when I did."

He offers equally backhanded support of MHR: "I don't think they're butchering people the way they used to." Neither company advertises on "The Bald Truth" or is an IAHRS member.

Asked for comment, Bosley's vice president of marketing, George Fettig, said: "We have worked out our differences with Spencer. He's not the negative influence that he once was."

MHR's Leavitt responded: "He said some very threatening things about us. Well, he's not a doctor, so it's not clear to me how he could make some of the judgments he did. We've had face-to-face discussions with him. He's backed off an awful lot."

Kobren says he'll continue to fight. "I won't back down," he says. "I'm the only guy on the radio who's not a whore, and there are plenty of them out there."

A bald statement, certainly, but the bald truth?

You just don't know, man.

A number of conditions can affect the hair follicle and cause hair loss, also known as alopecia. The most common type of hair loss, affecting 30 to 40 percent of men and women, is an inherited condition called androgenetic alopecia, also known as male pattern baldness.

For many people, losing their hair is a frustrating experience. Fortunately, research is helping to explain the causes of male pattern balding and has yielded treatments that can be effective in some cases.

A separate topic review is available that discusses another type of hair loss, known as alopecia areata. (See "Patient information: Alopecia areata").

CAUSES — The hair follicle is a structure that encases the lower part of the hair shaft. Each follicle contains blood vessels that nurture new hair growth. All hair follicles are present at birth; throughout the lifetime each follicle grows and sheds single hairs in a repetitive cycle. The growth phase for a single new hair lasts two to three years. At the end of this time, growth ceases and the follicle enters a resting phase. After three to four months in the resting phase, the hair is shed and the next growth cycle begins. On a normal scalp, approximately 80 to 90 percent of follicles are growing at any time. Each day, about 75 follicles shed their hair while the same number enter a new growth phase.

Men and women experience androgenetic alopecia with equal frequency, although it may be camouflaged better in women. People who experience this type of hair loss have some hair follicles with a shorter than normal growth phase and produce hair shafts that are abnormally short and thin. These follicles are said to be "miniaturized". They develop because of a hormonal changes that occur in the hair follicle itself, although men with male pattern balding also may have higher levels of dihydrotestosterone (a byproduct of testosterone) in the blood.

SIGNS AND SYMPTOMS — In men, androgenetic alopecia is characterized by gradual hair thinning that most often affects the crown and frontal areas of the scalp. In many men, the hairline around the temples regresses. As it moves back to the midscalp, an M-shaped hair pattern develops. The hair in areas affected by hair loss may be of various lengths and thickness, and the presence of uneven lengths and texture is a classic sign of male pattern balding.

Women may have similar patterns of hair loss, although typically the hair loss is a little more diffuse than in men; women rarely experience loss of all their hair.

DIAGNOSIS — Androgenetic alopecia can usually be diagnosed in men based on visual inspection of the scalp. A family history of similar hair loss is suggestive of androgenetic alopecia.

The diagnosis of androgenetic alopecia in women is also based on the history and visual inspection of the scalp. The scalp should be inspected carefully, however, for signs of hair disease such as scarring or follicular plugging. In addition, other causes of hair loss should be considered, including certain illnesses (such as hyperthyroidism, hypothyroidism, or iron deficiency) or medication side effects (such as anticoagulants, anticonvulsants, beta blockers, and antidepressants).

Women may rarely experience hair loss due to an excess of male hormones (androgens). Typically these women have other signs of androgen excess, such as menstrual irregularities, acne, and excess hair growth in other areas. However, given the frequency with which androgenetic alopecia occurs in women, no extensive testing is necessary unless one of these other signs of androgen excess is present.

PSYCHOSOCIAL IMPACT — The psychosocial impact of hair loss can be severe for some patients, especially women, since there is little understanding or acceptance of the condition. Women may have difficulty with issues of low self-esteem or feeling unattractive.

Patients who are having difficulty with the psychosocial impact of losing their hair should speak to a healthcare provider about their feelings. Providers can offer support and may recommend that a patient work with a therapist, clinical psychologist, or support group; individual and group therapy can help patients adjust and cope with hair loss, and may also provide tips on cosmetic coverings.

TREATMENT — Two medications, minoxidil and finasteride, are available to treat male pattern balding in men; only minoxidil is used in women. A medication called spironolactone is also sometimes used in women. Surgical options may also be considered in some cases.

Minoxidil (Rogaine®) — Minoxidil promotes hair growth by lengthening the growth phase of hair follicles and causing more follicles to produce hair. The hairs that are produced tend to be larger and thicker. Minoxidil is a liquid preparation that is applied directly to the scalp. It is available in both 2 and 5 percent solutions; the 5 percent solution is more effective in men and is probably more effective in women. It can be purchased over-the-counter without a prescription.

Administration — Minoxidil is a scalp treatment, not a hair treatment. One milliliter of the solution should be applied twice a day to the affected areas of the scalp using a dropper or pump spray device. The solution should be lightly spread over the affected area with a finger, and does not need to be massaged into the scalp. People using minoxidil must have a normal, healthy scalp since cuts or openings can allow the solution to be absorbed into the bloodstream.

Results — Minoxidil must be used twice a day for at least four months before the initial response to treatment can be gauged. When it is effective, people usually begin to shed less hair within two months after the start of treatment, and by four to eight months hair begins to grow. The effects of minoxidil usually stabilize after 12 to 18 months of use.

Treatment must be continued indefinitely. If minoxidil is discontinued, any hair that has been maintained or regrown as a result of the medication will be lost.

Not all people benefit from minoxidilWH&drug=true">minoxidil. The best results are seen when baldness has been present for less than 5 years, when it affects the crown (vertex) of the head, and when the area of hair loss is less than 10 centimeters in diameter. Studies have shown that 30 to 40 percent of men and women with vertex hair loss experience cosmetically significant results with minoxidil.

Side effects — minoxidil causes few side effects. Occasionally, the skin may become irritated. Bodywide side effects are possible if minoxidil is absorbed through cracks or cuts in the scalp. Patients with a history of heart disease, in particular, should watch for systemic side effects such as an increased heart rate, edema or swelling (for example in the hands or feet), or weight gain. Four percent of women treated with 5 percent minoxidil develop increased facial hair.

Finasteride (Propecia®) — Finasteride decreases the level of a hormone, dihydrotestosterone, in the blood, resulting in an increased amount of hair covering more of the scalp. It should not be used (or even touched) by women who could become pregnant due to the risk of abnormal genitalia development in male fetuses. One study that evaluated the use of finasteride in postmenopausal women with androgenetic alopecia found that finasteride did not improve hair loss.

Finasteride has been also been used in younger women who took an oral contraceptive. However, further study is needed before safety and efficacy are confirmed. Thus, finasteride is not currently recommended for women at any age.

Finasteride is taken orally by men at a dose of 1 milligram (mg) per day. Higher doses of finasteride (such as those used to treat some prostate conditions) can cause side effects including erectile dysfunction and decreased sex drive. However, such side effects are rarely seen with the 1 mg dose used to treat hair loss.

A small study suggested that finasteride worked better than 2 percent minoxidil and there may also have been a benefit with combination therapy. Studies directly comparing finasteride and 5 percent minoxidil have not been performed. However, finasteride is easier to use than minoxidil (one pill once daily versus spraying the scalp twice daily) and may be more likely to be taken consistently, thus yielding better outcomes.

Spironolactone blocks the action of the hormone aldosterone. Women with androgenetic alopecia who do not respond to minoxidil may benefit from the addition of spironolactone. A typical dose is 100 to 200 mg per day.

Surgery — For some patients, surgery may be a preferred form of treatment. Surgical options include hair transplantation, in which healthy follicles from other parts of the scalp are transplanted to areas affected by baldness. Scalp reduction is another procedure sometimes performed. In scalp reduction, bald patches of the scalp are removed and the remaining skin is sutured together.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two patients are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Robin Parks, MS

Everyone loses some hair every day. Losing up to 100 hairs a day is normal.

But if hair loss runs in your family, you could lose a lot more hair. Over time, you may end up with bald spots or hair that slowly gets thinner. About half of all people have this type of hair loss by around age 50.^{1, 2}

Other factors, such as diseases and medicines, also can cause you to lose more hair than normal.

Although hair loss is fairly common, it can be a tough thing to live with, especially when it changes how you look. But there are ways you can treat your hair loss.

What causes hair loss?

Common causes of hair loss include:

• Heredity. In most cases, hair loss is inherited, which means it’s passed down from one or both of your parents. This is called male-pattern or female-pattern hair loss.
• Stress, including physical stress from surgery, illness, or high fever.
• Chemotherapy, which is powerful medicine that destroys cancer cells.
• Damage to your hair from pulling it back too tightly, wearing tight braids or ponytails, or using curling irons or dyes.
• Age, since you grow less hair as you get older. Hair also gets thinner and tends to break more easily as you age.
• Poor diet, especially not getting enough protein or iron.
• Thyroid diseases, like hypothyroidism and hyperthyroidism.
• Ringworm of the scalp, which is common in children.

What are the symptoms?

Your symptoms will depend on what kind of hair loss you have.

If your hair is thinning, it happens slowly over time, so you may not notice the hairs falling out. If your hair is shedding, then clumps of hair fall out. You may lose hair all over your scalp, which is called general hair loss. Or you may lose hair only in one area, which is called focal hair loss.

With inherited hair loss, men usually get bald spots around the forehead or on the top of the head, while women have thinning all over the scalp.

See a picture of typical inherited hair loss.

Since your hair has a lot to do with your appearance, losing it may cause you to have lower self-esteem if you don't like how you look. This is especially true in women and teens.

How is hair loss diagnosed?

Your doctor will ask you some questions, like how much hair you're losing, when it started, and whether your parents have hair loss. He or she will look closely at your scalp and hair-loss pattern and may gently pull out a few hairs for tests.

If it’s not clear what’s causing you to lose your hair, your doctor may do a blood test or look at a sample of your hair or scalp with a microscope.

How is it treated?

How you choose to treat your hair loss depends on the cause. It also depends on your feelings. You may decide that you need treatment, or you may not be worried about thinning hair or baldness. The choice is up to you.

Hair loss that runs in the family can be treated with medicines or with surgery, such as a hair transplant. Some people choose to wear hairpieces, like wigs or toupees (say "too-PAYZ"). Finding different ways of styling your hair, like dyeing or combing, also can help. If hair loss is caused by something you can control, like stress or medicines, you can treat it by getting rid of the cause.

When you are deciding about treatment, think about these questions:

• Which treatment is most likely to work?
• How long will it take?
• Will it last?
• What are the side effects and other risks?
• How much will it cost, and will insurance cover it?

Will your hair grow back?

When your hair loss is inherited, your hair won't grow back naturally. Treatment can help some hair grow back and prevent more from falling out, but you probably won't get all your hair back. And treatment doesn't work for everyone.

When medicines, stress, or hair damage cause you to lose your hair, it often will grow back after you take away the cause. If this doesn't help, you may need other treatment.

If you're unhappy with how hair loss makes you look, treatment may boost your self-esteem. It’s natural to want to like the way you look.

But keep in mind that treatment, especially medicines and surgery, can have some side effects and risks. Be sure to discuss your

By Rebecca Campen, M.D., J.D.

Question:

Is hair loss common with HIV?

Answer:

Hair loss can occur from many causes, including aging, illness, infections, scalp conditions, stress, hormone changes, and medications. Hair loss can also occur with HIV.

There are additional reasons that hair loss may occur with HIV besides the virus itself. Many medications used to treat HIV can cause hair loss.

People with HIV are susceptible to a wide variety of viral, bacterial and fungal infections. Such infections can involve the scalp, causing hair loss. The infections can also involve other organs, stressing the body. Premature aging can occur with HIV, resulting in accelerated graying of hair and hair shedding.

In some cases, hair may thin over the temples as with aging. This type of hair loss is called "androgenic alopecia." In males, this is often referred to as "male pattern baldness." In other cases there may be circles of hair loss, similar to the condition called "alopecia areata," which also occurs in people who do not have HIV. In other cases there may be diffuse thinning over the entire scalp.

If you have HIV and hair loss, it is important to discuss with your doctor your best option for treatment. Underlying scalp conditions caused by fungal or bacterial infection can be treated. For male pattern baldness, Minoxidil (Rogaine) applied to the scalp, or finasteride (Propecia), taken by mouth, may be helpful.

Unlike the receding hair line creeping over a man's scalp, hair loss sneaks up on a woman.

Maybe she sees a few more hairs in her favorite brush. Her ponytail feels skinnier. Her part widens. Eventually she notices she can see her scalp peeking through in a photograph.

Whatever the telling sign, female pattern hair loss can be traumatic. But women today are less likely to suffer in silence than a decade ago; doctors report that women increasingly are coming forward to seek remedies.

Locks we love

In some cases, pinpointing the cause is the first step to a cure, though the source of hair loss in women is not always as clear as it is in men.

The hormone fluctuations of puberty, pregnancy and menopause can cause hair to shed. So can the stress of general anesthesia, illness, anemia, crash diets and thyroid abnormalities. Some women -- and a few men, too -- suffer a compulsion to tug at the hair, damaging the follicles.

Stress on the hair itself, whether from chemical treatments, extensions or tight hairstyles that tug at the scalp, can also break the hair or scar the follicle. Black women are particularly vulnerable due to the hair relaxing treatments and braiding often begun at a young age.

"Half of our hair loss visits are African-American women," said Dr. Marianne O'Donoghue, a dermatologist in Oak Brook and associate professor at Rush University Medical Center. "They have a terrible time keeping their hair in."

The most common cause of female hair loss is androgenetic allopecia, or female pattern baldness. Thought to be influenced by levels of sex hormones, this type of hair loss usually begins after menopause, but it can start as early as puberty. Instead of a woman losing 100 to 125 hairs a day, which is normal, she'll lose so many that her scalp will show through.

Help is available. The topical medicines, laser treatments and hair transplants designed for men can help women, too.

Stopping the loss

One of the oldest treatments for hair loss in men and women is Rogaine, the brand name of the drug minoxidil. Spread over the scalp twice a day, Rogaine works by increasing the growth phase of the hair follicles. It also helps hair grow thicker, stronger and with more pigmentation.

Women's Rogaine is less potent than men's -- a 2 percent strength rather than 5 percent -- though some doctors recommend the 5 percent strength for women, too.

"If you're going to fill your tank up with gas, you may as well fill it up," said Dr. Alan Bauman, a hair loss specialist in Florida.

A new foam version of Rogaine is less irritating to the scalp, Bauman said.

The mistake many women make with Rogaine is quitting too early, Bauman said. Many women quit after six weeks. But it will take six to 12 months to see the results in the mirror, Bauman said. As soon as you quit you'll start losing hair again.

"About 70 percent of women are going to get a response from it, but it's a long-term commitment," he said.

Since it has not been studied in pregnant women, women who are nursing or pregnant are usually advised against using Rogaine.

Propecia is an oral medication that stops hair loss in 90 percent of men, but it's not FDA-approved for use in women and poses risks to a developing male fetus. But some doctors prescribe Propecia to women who are not of childbearing age. While the evidence is not conclusive, a few studies show it works in women whose hormones are controlled with birth control pills or hormone therapy, Bauman said.

Other medications are available for specific types of hair loss. Women with alopecia areata, an autoimmune disorder signaled by circular bald patches, may get cortisone shots in the scalp or a topical cream. Low iron levels or thyroid disorders can be treated and the patient usually will regrow her hair, O'Donoghue said.

Laser therapy

A newer -- and less proven -- treatment involves beaming low-level lasers over the scalp, usually in a series of treatments lasting several months. The FDA recently approved a laser comb as a cosmetic device that can be used at home, though doctors said the laser hoods available in offices are more effective.

The lasers increase blood flow to the scalp and boost cell metabolism, said Dr. Stephen Dayan, a Chicago plastic surgeon who is testing a laser hair restoration device in his office.

"By increasing cell metabolism, you're creating more energy for the hair follicles, and the hair follicles are creating thicker hairs," he said.

The laser treatments work best on men and women with thinning -- not absent -- hair. They have to have functioning follicles.

"If they've been bald for a long time, it's probably not going to do a lot for them," Dayan said.

Jessica Hinkle of Streamwood is completing a series of laser treatments for thinning hair she first noticed five years ago. She didn't have a receding hair line, just more scalp where her bangs should be.

"My husband shaves his head on purpose," Hinkle said. "But a woman being bald is not OK."

Because she's planning to have more children, the 31-year-old didn't want to use Rogaine or other medications that pose any risk to a developing baby. So she entered a contest sponsored by a radio station and won a series of free laser treatments at Deerfield-based Natural Hair Growth Institute.

Once a week, Hinkle sits under a device shaped like a salon hair dryer while lasers glow on her scalp. Since she began treatments in May, Hinkle said her hair is thicker and her scalp less visible.

"I was skeptical, but it's noticeably different," she said. "A lot of people have noticed my hair has changed."

Not everyone can win a contest, and such treatments don't come cheap. Steve Bennis, a former engineer who launched Natural Hair Growth Institute after lasers helped with his own hair loss, says clients spend between $6,800 and $12,800 for a six-month series of treatments.

Bennis is not a doctor, so he requires clients visit one first to rule out medical conditions that could cause hair loss. He says clients start to see new hair growth within four weeks.

"When I started my business, I thought it was only for men," Bennis said. "Now I have 70 percent women. They like it because it's non-invasive, and it solves the problem."

You can also buy a variety of laser combs or brushes that range from $399 to $2,499. Newer versions cover wider areas in less time, Bauman said.

"The lasers are not a miracle cure, but I have noticed in my patients that laser therapy can certainly enhance hair quality and produce thicker, fuller, healthier, shinier hair," Bauman said. "It's not going to give you a teenager's head of hair, but you can see improvements over time."

Transplants

The growing awareness among the public about what cosmetic surgery offers has spread to include hair transplants, even for women, said Dr. Arthur Kaplan of Medical Hair Restoration in Oak Brook.

"Women are the fastest growing percentage of patients," he said.

Part of that is due to more refined technique. A surgeon can implant follicles taken from the back of the head one, two or three at a time, rather than plugs.

"For women, plugs were unacceptable from day one, whereas with men there was a time that was acceptable," Kaplan said. "The aesthetics women required were much higher. As the field has evolved, that has opened up the opportunity."

Micrografts are essential for women, who often have diffuse thinning in a part of the scalp. A surgeon must take care to preserve existing follicles, Bauman said.

"You can't put large grafts into diffuse areas or you're going to cause trauma," he said. "You can't go into a tomato garden with a backhoe. You have to use a small instrument to plant those seeds."

The cost depends on the number of follicles transplanted. Women are usually less expensive than men because a smaller area is involved. Most women spend between $4,500 and $6,000 for transplants at Medical Hair Restoration in Oak Brook.

The procedure takes two to four hours. Women start to notice new hair growth in three to five months, with full results taking a year to appear.

Female-pattern baldness

Women lose hair on an inherited (genetic) basis too, but the female pattern is more diffuse, with less likelihood of the frontal hairline being lost. Although some women may notice hair thinning as early as their 20s, the pace of hair loss tends to be gradual, often taking years to become obvious to others. (It's common to hear women with what appear to have a full head of hair exclaim, "This is nothing--you should have seen how thick it used to be!")

Notions about baldness being inherited through the mother's family, just like stories about hats choking off follicles or long hair pulling on the roots, are just folklore.

Hair loss "myths" of special concern to women:

• Longer hair does not put a strain on roots.
  
  
• Shampooing does not accelerate hair loss; it just removes those that were ready to fall out anyway.
  
  
• Coloring, perming, and conditioning the hair do not usually cause hair loss. Styles that pull tight may cause some loss, but hair coloring and "chemicals" don't.

What treatments are there for hair loss in women?

• Ask your doctor about minoxidil (the generic name for Rogaine). This is over-the-counter and available in 2% and 5% concentrations. It's something of a nuisance to apply, but it helps conserve hair and may even grow some.
  
  
• Propecia is a drug that helps men retain their hair. It is unsafe for women of childbearing to take this drug, or even handle tablets. (It is, however, safe for their husbands to take it while they are trying to become pregnant.) Propecia is safe for older women but not very effective; newer studies suggest that it might be somewhat helpful and may be worth considering.
  
  
• Surgical procedures like hair transplants can be useful for some women as well as men to "fill in" thinned-out areas.

Facts about normal hair growth:

About 90 percent of hair on the scalp grows continually. The other 10 percent of scalp hair is in a resting phase that lasts two to three months. At the end of the resting stage, this hair is shed.

Shedding 50 to 100 hairs a day is normal. When a hair is shed, it is replaced by a new hair from the same follicle and the growing cycle starts again. Scalp hair grows about one-half inch a month.

As people age, the rate of hair growth slows.

What causes excessive hair loss?

Most hair shedding is due to the normal growth-rest cycle, and losing 50 to 100 hairs a day is no cause for alarm. When concerned about excessive loss of hair or dramatic thinning, consult a dermatologist. Excess loss of hair may be due to many different causes, including:

• a high fever, severe infection
• thyroid disease
• inadequate protein in diet
• certain medications
• cancer treatments
• low serum iron
• major surgery/chronic illness
• alopecia areata
• hereditary thinning or balding
• a fungus infection (i.e., ringworm) of the scalp
• improper hair cosmetic use/improper hair care

Can hair loss be prevented?

Hair loss from some causes will regrow naturally. Other causes may be treated successfully by a dermatologist. There are several causes of hair loss for which there is no successful treatment at present.

Non-surgical hair replacement with medication:

• Finasteride (Propecia)
  
  Finasteride, produced by Merck and Company under the name Propecia, was approved by the FDA in December 1997, as a treatment for male pattern baldness. It is the first drug available in pill form for the treatment of baldness.
  
  In men with mild to moderate hair loss, clinical trials showed that 83 percent of the male patients had kept their hair or grown more after one year of treatment. Propecia (finasteride) works by blocking an enzyme called 5-alpha reductase, which is responsible for the formation of dihydro-testosterone in a man's body. The enzyme converts testosterone to DHT (dihydrotestosterone). It is believed that DHT is a key factor in male pattern hair loss, and finasteride decreases the concentration of DHT in a man's scalp by about two-thirds.

Finasteride is available by prescription only.

• minoxidil (Rogaine)
  
  Minoxidil, a drug produced by Upjohn under the name of Rogaine, has been available since 1988 for the treatment of hair loss. It is currently available as an over-the-counter drug.

  Minoxidil is topical solution that must be applied by applicator or fingers to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness within 3 to 6 weeks. It can take 4 to 12 months to see results.

  According to the Food and Drug Administration (FDA), clinical studies show that 26 percent of men between 18 and 49 reported moderate to dense hair regrowth after four months of Rogaine treatment. An additional 33 percent had minimal hair regrowth. Almost 20 percent of women between 18 and 45 had moderate regrowth, while an additional 40 percent showed minimal regrowth.

Surgical hair replacement:

When experiencing thinning hair or baldness, men (and some women) consider hair transplantation, a permanent form of hair replacement. Anyone who has permanent hair loss may be a candidate for hair transplantation, including:

• men with male pattern baldness
• some women with thinning hair
• persons who have lost hair as a result of burns or other scarring injuries to the scalp, eyebrows, or eyelashes

Types of hair replacement surgery:

There are a number of techniques used in hair replacement surgery. Sometimes two or more techniques are used to achieve the best results.

• punch grafts - usually contain about 10-15 hairs
• mini-grafts - contain about 2 to 4 hairs
• micro-grafts - contain 1 to 2 hairs
• slit grafts - contain about 4 to10 hairs each
• strip grafts - contain 30-40 hairs

Complications of hair replacement surgery:

Individuals vary greatly in their physical reactions and healing abilities, and outcome is never completely predictable. Complications may include:

• infection
• excessive bleeding
• wide scars, called stretch-back scars
• some of the grafts may not take
• bumps that form at the transplant sites
• unnatural, patchy look may result
• additional surgery may be required

Surgical hair replacement procedures:

Treatment may be performed in a surgeon's office, an outpatient surgery center, or, rarely, a hospital as an outpatient or an inpatient.

Hair replacement surgery is usually performed using a local anesthesia along with sedation to make the patient relaxed, although general anesthesia may be used for more complex cases involving tissue expansion or flaps.

• hair transplantation
  Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to two years before seeing the final result with a full transplant series.

The number of large plugs transplanted in the first session may vary, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session.

• tissue expansion
  A balloon-like device, called a tissue expander, is inserted beneath the hair-bearing scalp next to a bald area. The device is gradually inflated with saline over a period of weeks, causing the skin to expand and grow new skin cells. When the skin beneath the hair has stretched enough -- usually after about two months -- another procedure is performed to move the expanded skin over to cover the bald area.

• flap surgery
  A section of bald scalp is removed. A flap of hair-bearing skin, still attached at one end, is lifted off the surface and moved into its new position where the bald scalp was removed. It is sewn into place, but remains tethered to its original blood supply.

• scalp-reduction
  This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or advanced to fill in a bald crown. Scalp reduction is designed for coverage of bald areas at the top and back of the head. It is not beneficial for coverage of the frontal hairline.

Resuming normal routines depends on the length, complexity, and type of surgery.

Follow-up procedures for surgical hair replacement:

A surgical touch-up procedure may be needed to create more natural-looking results after the incisions have healed. This may involve blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts.

If a small bump, called a dog ear, remains visible on the scalp, it can be surgically removed after complete healing has occurred.

1. Scalp exam for any scars, erythema, scaling, or inflammation Density and distribution of hair Hair shaft exam for caliber, length, shape, and fragility Thyroid palpation to determine thyroid size, nodularity, or vascularity

If a patient demonstrates positive hair-pull tests all over the scalp, he/she may be warned he/she will most likely lose all of their hair. Next, provide anticipatory guidance during the period of extensive hair loss as the cycle reestablishes and regrowth begins.

Finally, determine if eyebrow, eyelash, axillary, or body hair is affected. Examine hair density in other areas such as the face and extremities. A female patient who presents with thinning scalp hair and demonstrates increased facial, thigh, chin, or chest hair may have an androgen excess.

Laboratory Studies

Once other causes such as malnutrition, androgenetic, hereditary conditions (by history, progression, and presentation), trauma (trichotillomania, traction alopecia), and drugs (telogen effluvium) have been ruled out, consider labs for secondary conditions:

• For female alopecia with symptoms of hyperandrogenism (such as menstrual irregularities, infertility, cystic acne, virilization, or galactorrhea), check total testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S), or prolactin levels. For male and female alopecia without symptoms of hyperandrogenism, consider measurement of serum thyroid stimulating hormone concentration to rule out thyroid disease; venereal disease research laboratory (VDRL) technique to rule out syphilis; serum ferritin to rule out anemia; antinuclear antibody test (ANA), RF (rheumatoid factor) to rule out autoimmune disease; potassium hydroxide (KOH) examination to rule out tinea capitis; swab a wound culture to rule out infections; and scalp biopsy as needed to rule out neoplasm.

Disorders Causing Hair Loss in Adults

• Androgenetic alopecia
  • Male: Hereditary. Dihydrotestosterone compels follicles into perpetual telogen phase. The earlier oral or topical treatment is started, the better results one may expect. Female: Female androgenetic pattern incidence increases with age. Incidence is approximately 6% in women under 50, but increases to 38% in women over 70. Female pattern hair loss typically demonstrates a lower density of hair but maintains a relatively even distribution, known as "Ludwig" distribution. Even thinning across the crown is typical, while the frontal line maintains position.
  Telogen effluvium
  • Telogen effluvium is the most common form of diffuse alopecia. It is often diagnosed from a history of an initiating event 3 months before the onset of shedding. Causes include childbirth, sustained high fever, surgery, systemic disease exacerbation, crash low protein diets, severe emotional stress, and drug reactions. Pull tests are positive all over the scalp. Bitemporal recession is a useful diagnostic sign in women. The acute form normally subsides in 3 to 6 months. In true telogen effluvium, the hair invariably regrows within a short time.
  Postpartum telogen effluvium
  • This condition is associated with postpartum hormone-related changes that temporarily prolong hair resting phase. It is most commonly seen 2 to 4 months postpartum.
  Anagen effluvium
  • Anagen effluvium is drug or toxin-induced and may mimic diffuse alopecia areata. Chemotherapy is the most common cause.
  Trichotillomania
  • Trichotillomania is the manifestation of a psychogenic behavioral pattern of frequent hair-pulling by the patient. It is frequently related to obsessive-compulsive disorder and can be seen in males and females of all ages, but most commonly in preadolescent and early adolescent girls. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The bald area manifests as a distinct, unnatural geometric shape. Hair may be pulled from a secondary site, such as the eyelashes, eyebrows, underarms, body, or pubis. Assess for other psychosocial factors and disorders and refer for counseling as indicated. Diagnostic and Statistical Manual-IV (DSM-IV) Criteria for Trichotillomania:
    • Recurrent pulling out of one's hair, resulting in untreatable hair loss Increasing sense of tension immediately before pulling out the hair or when attempting to resist behavior Pleasure, gratification, or relief when pulling out the hair The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatologic condition).
  Alopecia areata
  • Alopecia areata is an inherited autoimmune condition of varying severity. In some patients, hair loss is confined to one or more small oval patches; in others, the scalp is essentially denuded except for a few tufts of hair. It may involve the entire scalp (alopecia totalis) or the surface of the whole body (alopecia universalis). The condition is marked by exacerbation and recovery with high variability among individuals.
  Tinea capitis
  • Tinea capitis is a contagious fungal infection of the scalp mostly seen in ages 4 to 14 years. There are fine, scaly, circumscribed areas that are frequently itchy and inflamed. Hair is dull and brittle, breaking off at scalp. In more extensive cases, there may be fever and cervical lymphadenopathy. In the United States, over 90% of cases are from the nonfluorescent Trichophyton fungus. Potassium hydroxide (KOH) examination shows hyphae. Antifungals such as terbinafine, fluconazole, itraconazole, or griseofulvin are used for treatment.
  Systemic lupus erythematosus (SLE)
  • SLE is a chronic autoimmune inflammatory disease affecting collagen. It involves multiple systems of the body including hair loss.
  Secondary syphilis
  • Secondary syphilis usually begins 2 to 8 weeks after chancre type lesions appear. It can present with patchy hair loss, mostly on the scalp and often elsewhere on the body. This hair loss is often described as having a moth-eaten appearance. High-risk clients should also be questioned regarding past rashes, especially on the palms, soles, and any chancroid lesions or condyloma. Diagnosis is serologic (VDRL or rapid plasma regain [RPR]), and hair regrowth occurs after penicillin therapy. Penicillin remains the first choice, but if an allergy exists, intramuscular Rocephin (x 10 days), tetracycline, or doxycycline may be tried for 2 weeks.
  Side effects of medications
  • Medications such as cytotoxic agents, colchicine, heparin, oral anticoagulants, hydroxyurea therapy, vitamin A, captopril, protease inhibitors such as indinavir and nelfinavir, amphetamines, anticancer agents, gout medication, isotretinoin (Accutane), lithium, male hormones, propranolol hydrochloride (Inderal), and valproic acid (Depacon, Depakene, Depakote), can all induce nonscarring hair loss.
  Birth control pills
  • Women who lose hair while taking birth control pills may have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a woman stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.
  Caustic chemicals
  • Anyone who curls, straightens, colors, or dyes their hair may cause hair loss. Repeated exposure to these substances can injury hair follicles, weaken hair, or even damage the scalp. It is most often seen in African women, and inflammation is not always obvious.
  High fever or severe infection
  • Acute and some chronic illnesses may cause hairs to enter a prolonged resting telogen phase (also known as telogen effluvium). It is not uncommon to experience a higher incidence of hair loss up to three months after high fever, severe illness, or infection. This resting phase typically resolves after several months and normal hair growth rebounds when the growth cycle returns.
  Other causes of hair loss
  • Other causes of hair loss include anemia, hypoalbuminemia, malnutrition, Lichen planus, Staphylococcal folliculitis, scleroderma, psoriasis, seborrhoeic dermatitis, menopause, hypothyroidism, herpes zoster, and others.

Treatment Recommendations

The choice of therapeutic intervention for alopecia depends on several factors:

• The underlying cause The goals of therapy The long-term risks, benefits, costs

The evaluation and treatment of alopecia should begin as early as possible after the onset of symptoms. Many conditions causing alopecia or reduced hair density may be reversed or minimized with prompt intervention.

Pharmacologic – Treatment of the Underlying Illness

• Hypothyroidism
  • Thyroid replacement or adjustment as indicated
  Fungal infection
  • Ketoconazole, oral antifungal agents such as griseofulvin (Grifulvin), itraconazole (Sporanox), terbinafine (Lamisil), and fluconazole (Diflucan) may be used. Oral steroids may be necessary to decrease inflammation and scarring.
  Hormone imbalance
  • If female androgen excess is suspected (hirsutism, acne) or menses is irregular, check DHEA-S and free testosterone levels first to rule out adrenal or ovarian cancer. Once ruled out, consider spironolactone, flutamide, or finasteride. Spironolactone competes with testosterone and dihydrotestosterone at the androgen receptor level. Spironolactone 100 mg per day can be given in divided doses; this dose may be increased to 200 mg. Flutamide (Eulexin), an antiandrogen that blocks androgen uptake and nuclear binding, is a very effective drug in treating hyperandrogenism. Give 250 mg daily and monitor hepatotoxicity. Finasteride (Propecia) blocks the conversion of testosterone to dihydrotestosterone. The plasma levels of testosterone may increase during treatment, whereas the dihydrotestosterone level decreases. Of utmost importance, the patient should be aware that she must avoid pregnancy during treatment with finasteride because of the potential for causing ambiguous genitalia in a male fetus.
  Drug-induced hair loss (effluvium)
  • Drugs that induce hair loss include antihypertensive agents, anti-gout medications, etc. Consider tapering or discontinuing the medication if untoward risks are low.
  Chemotherapy
  • Recommend nonpharmacologic therapy (wig, hairpiece).
  Psychological causes of hair loss (Trichotillomania)
  • Consider behavioral therapy, antianxiety or antidepressant medication, or any combination of the two.
  Physical stress from surgery/acute illness
  • Reassure patient hair regrowth once stress removed.
  Lupus and diabetes
  • Treat underlying diseases.
  Traction alopecia
  • Hair loss that is secondary to grooming such as tight braids, "cornrows," pony tail: Change hair styling technique.
  Drug therapy for alopecia (alopecia with no underlying disease)
  • Minoxidil (Rogaine 2% for women, Rogaine 5% for men): Apply 1 mL twice a day (BID) regardless of the extent of the affected area; one year of use may be needed before obvious efficacy. Minoxidil is mainly for hair loss at vertex, not for frontal baldness. Propecia (finasteride 1 mg): Food and Drug Administration (FDA) approved; for MEN ONLY Monotherapy or synergistic use:
    • For women - May add estrogen to any therapy For men/women - May add tretinoin (Retin-A) topical as an adjunct/synergistically with minoxidil

Nonpharmacologic Treatment

• Cosmetic measures (hairstyle adjustments, wigs, extensions, hair pieces, hats, scarves) Cessation of wearing tight braids, buns, pins In chemical/allergic causes, avoidance of the identified sources

Monitoring Treatment/Discontinuation of Treatment

Patients with Hypothyroidism

Initiate thyroid hormone replacement therapy to obtain thyroid-stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) in the normal range. Treatment will be long term, even as hair regrowth occurs. Monitor hair regrowth in each follow up with hypothyroidism.

Patients Considered for Treatment Related to Fungal Infection

If long-term antifungal treatment is required, monitor liver function and gastrointestinal (GI) symptoms. Obtain baseline alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin before treatment. Reevaluate in 4 to 8 weeks. Discontinue if there are any GI symptoms or signs of liver dysfunction such as fatigue, nausea, anorexia, vomiting, dark urine, or pale stools. Monitor drug interactions when patients have comorbidities and are using other medications. Check safety of different antifungals on women in childbearing ages.

Patients with Androgenetic Imbalance

Monitor hepatotoxicity if the patient is treated with flutamide. Monitor irregular menses, reduced libido, mood swings, and electrolytes if treated with spironolactone.

Patients on Medications for Hair Loss

Minoxidil (Rogaine) - Topical use

Since its mechanism of action is to stimulate hair growth by vasodilation, it may exacerbate angina pectoris. Use with caution in patients with pulmonary hypertension, congestive heart failure, coronary artery disease, and significant renal failure. Topical use may also cause pruritus, and Stevens-Johnson syndrome.

Finasteride (Propecia)

Give 1 mg daily (QD) with or without food to MALE patients only. Pregnant women or women who may potentially become pregnant should not touch crushed tablets because of teratogenic effects on male fetus. Monitor hepatic function. Potential side effects include decreased libido and erectile dysfunction.

Steroids (e.g. prednisone)

Side effects of steroids include diabetes, weight gain, hypertension, electrolyte and fluid imbalance, osteoporosis, striae, acne, renal function impairment, avascular necrosis, and immunosuppression. Abrupt discontinuation may cause adrenal crisis.

Individualization of Therapy

• The Women's Androgenetic Alopecia Quality of Life Questionnaire (WAA-QOL) is useful in evaluating health-related quality of life (HRQOL) specific to women. It is self-completed in about 10 minutes and may serve both to indicate the impact on the patient (and potential indication for intervention) and evaluate therapeutic responses to therapy. Decide whether the patients want to use topical treatment or oral treatment. Patients at different ages may have preferences. The hair growth cycle is slow. Affected changes take time to notice. Once therapy is selected, stick with it for 3 to 6 months and then reevaluate. Treatment follow-up (3- to 6-month intervals). Adjust therapy and identify causes if inadequate response.

Important Considerations

Cosmetic management and psychosocial adaption

• Regrowth of new or thicker hair for larger scalp coverage Decreased rate of hair loss (i.e., slow down balding progression) Surgical reconstruction Cost and side effects of drug therapy Tolerability of therapy (patient satisfaction with care, quality of life, and adherence to treatment regimen) Final assessment and evaluation including hair density readings Assessment of patient satisfaction as measured by quality of life index

Screening and diagnosis

Routine laboratory tests help to determine the presence of underlying causes and risk factors that would affect treatment. Optional tests may be used, depending on findings obtained in the history and physical examination and previously known conditions. A greater, more inclusive assessment can be determined by referral to dermatology.

Informed guidance to treatment options

Clinicians should begin by providing the patient with a summary of information on:

• Causes of hair loss and their respective potential to respond to medical therapies Details of what therapeutic options involve, including directions for use, potential side effects, interactions, timeline for responses, follow-up visits, financial expense, and long-term outcomes

Evaluate treatment goals

The primary objective of treatment is to reach therapeutic responses as closely to patient goals within budget and expectation that is both understood and acceptable by the informed patient. To modify drug therapy and maximize response toward patient goals, clinicians should consider cost where therapeutic effect is equal. To facilitate compliance, clinicians should choose medications with simple regimens.

Therapeutic adjustment and further individualization

• Titrate drug or add another agent if there is good tolerance but poor response. Allow for several weeks to two months before drug or dosage changes are made. If the response remains less than anticipated, substitute with a drug of a different class or action. Always consider alternative explanations for poor response to drug therapy to explore secondary causes. In each patient encounter, reassess adherence, quality of life, and patient goals. Assess the long-term response to therapy. Reassess side effects that might complicate therapy or limit efficacy. Monitor the development of target organ damage. Reinforce lifestyle modification.

Evaluate the efficacy of therapy

• To assess adequacy of hair growth, use an objective measurement tool such as a scalp chart, comparison with before-treatment photos, and a subjective self-assessment of quality of life before and after treatment. Patients should be seen within 1 or 2 months after the initiation of therapy to determine therapeutic response, degree of patient adherence, and presence of adverse effects. Earlier follow-up may be necessary for patients with underlying comorbid conditions. Once the patient's response is observed, follow-up at 3- or 6-month intervals (depending on the patient status) is generally appropriate. Consider referral or consultation in unresponsive or complex comorbid cases.

But what if it were possible to move an entire, full and durable scalp from another person, albeit a dead one, all at once?

That prospect set hundreds of hair-restoration specialists atwitter at a late-September scientific conference in Las Vegas, where transplantation expert Maria Siemionow presented research that many believe will make such a thing a reality one day.

Siemionow, who is renowned for her groundbreaking work in the field of facial transplants, said her team at The Cleveland Clinic has developed a treatment in lab animals that reduces the length of time any recipient must be on immunosuppressant drugs to just a week. Today, the recipient of any transplant must stay on fairly toxic and expensive medication for life, which makes it untenable to do transplants for anything less then life-essential organs. It remains untested in humans.

The scientist told her audience at the International Society of Hair Restoration Surgery's convention that her aim is to make full-scalp transplants possible for severe burn and trauma victims. But that didn't keep listeners from imagining the cosmetic applications.

"What she's talking about … has implications for the future in our field in terms of perhaps being able to move hair from one person to another," says Vance Elliott, a hair restoration surgeon from Canada. "We've always considered that impossible because the immune system rejects it."

Some may think such a move — to don the hair of a cadaver — would be extreme, but nobody should underestimate the determination of balding people to reverse the scourge of a receding hairline. Spending on hair-restoration surgeries in 2006 topped $1.2 billion worldwide, a figure that does not include spending on proven drugs such as Propecia and Rogaine or any number of disreputable gadgets and balms sold online or on late-night television.

And, with the exception of trauma or burn victims, virtually none of that spending is covered by health insurance. A full set of hair-replacement surgeries can cost as much as $10,000; Propecia can cost $50 a month, and Rogaine retails for about $20 a month.

"Hair loss can be intensely traumatic and emotionally painful for many people," says Elliott, who has performed more than 2,000 hair-replacement surgeries in his 12-year practice. He also leads workshops for other doctors, such as the one he conducted at the Las Vegas conference where 30 colleagues practiced incision skills on honeydew melons. "A lot of people are very, very deeply bothered by it."

Increasingly, that includes women, too. The society's data show that 13.8% of hair-transplant patients are female, up from 11.4% in 2004, and that's expected to rise as public awareness grows that women also lose hair.

Diagnosing women with pattern balding is more challenging because it usually occurs as an overall thinning rather than in the predictable manner that most men experience, says Sharon Ann Keene, a hair-restoration surgeon from Tucson. Also, women can experience temporary shedding caused by anemia, heavy-metal poisoning and hormone fluctuations, whereas male balding is permanent and almost entirely a function of genetics. Many doctors don't know what to look for in women or are too overwhelmed to be bothered, Keene says.

"I get ladies who go to the dermatologist and are told that they're just stressed out or that it's not a real problem like, say, skin cancer," says Keene, the conference's program chair. "It is a tremendous untapped market."

Aware that popular culture trivializes and mocks hair loss and that hucksters give the business a bad name, Paul Cotterill of Toronto, the organization's president, and others say the society was formed in 1993 to bring credibility to the practice.

One discussion at the conference revolved around eyelash transplants, a relatively new procedure that's on the rise but carries with it the potential for the hair to grow into the eye and cause sight damage. The society released a position paper saying it ought to be used only on trauma or burn victims and not on people who desire more lush or longer eyelashes.

"We want to make sure that (procedures) are being done for the proper reasons," Cotterill says.

Though the conference was dominated by discussion of new concepts — the ability to clone hair follicles is in its preliminary research stages, for instance — it also was a celebration of a business that has progressed from unsightly toupees to obvious hair plugs to today's virtually unnoticeable transplants.

"I still get patients who say, 'I don't want those awful plugs,' " says Ricardo Mejia, a hair-restoration surgeon in Jupiter, Fla. "I have to constantly tell people we don't do that anymore."

What is baldness?

Baldness is loss or lack of hair, usually from the top of the head. It may also occur on other parts of the body where hair normally grows. Baldness is usually part of the aging process. Some diseases and drugs may also cause baldness.

Hair loss may be either temporary or permanent, depending on the cause.

How does it occur?

There are several types of baldness: male and female pattern, local, and general.

Male-pattern baldness runs in families. This hereditary baldness usually happens above the forehead, causing a receding hairline. It also happens at the crown of the head. Over time, the bald spots increase in size until the entire top of the head is bald and there is hair only on the sides of the head.

Sometimes female-pattern baldness occurs in women. Usually it causes the hair to thin in the front, on the crown, or on the sides.

Local hair loss is usually patchy and confined to certain areas. It may result from:

• alopecia areata, a condition in which hair is lost suddenly from a particular area, usually a small area of the scalp (the cause is unknown)
• ringworm, a fungus infection
• radiation therapy for cancer
• a hot comb or hair dryer
• hairstyles that pull on the hair, such as tight pigtails or cornrows
• nervous, repeated hair pulling
• permanent skin damage from burns or serious skin diseases.

General hair loss occurs when all of your hairs enter a resting phase at the same time and then fall out. This may be caused by:

• stressful situations or conditions, such as major surgery, high fever, or severe or chronic illness
• pregnancy.

Other causes of general hair loss are:

• drug treatment for cancer
• some prescription drugs and high doses of vitamin A
• thyroid disease.

Alopecia universalis is a rare and severe form of baldness that results in permanent loss of all body hair, including eyebrows, eyelashes, and hair in the pubic area and armpits. The cause is unknown.

How is it diagnosed?

Your health care provider will ask about your recent medical history and any history or patterns of hair loss in your family. Your provider will examine your scalp and skin. You may have blood tests or a skin scraping to check for fungus.

How is it treated?

Some baldness can be treated with medicine.

Your health care provider may recommend medicine to slow your hair loss and stimulate hair growth. Minoxidil (Rogaine) is a medicine you can put on bald spots daily. Finasteride (Propecia) is a tablet men can take daily. Although other medicines are being studied, these 2 medicines are the only FDA-approved medicines for treating hereditary baldness. They can improve hair growth or preserve hair in most people.

If you use minoxidil daily, some hair should grow back in about 4 months. The hair will remain only if you continue to use the medicine every day.

Only men should take finasteride. Pregnant women should not even touch the tablets because the medicine can be absorbed through the skin. The medicine can cause abnormal growth of the genitals in baby boys before they are born.

If an illness is causing you to lose hair, your health care provider may prescribe medicine to treat the illness. For example, your provider may prescribe an antifungal medicine if a fungus, such as ringworm, is the cause of your hair loss. Hair generally grows back in the affected areas.

If you have alopecia areata, the hair usually grows back naturally in 6 to 12 months. Your health care provider may try to speed up regrowth by injecting your scalp with steroids or by having you put minoxidil solution directly on the bald area. This problem can recur.

Hair transplant surgery involves moving sections of skin with hair from one part of the scalp to another. The results may last a few years or be permanent.

How long will the effects last?

Male-pattern baldness will continue for the rest of your life. Baldness that is the result of skin damage from a disease or burn is also likely to be permanent. Other types of baldness may be temporary and last only a few weeks or months.

How can I take care of myself?

If you have noticeable hair loss or a change in skin condition, consult your health care provider. In the meantime, eat balanced meals, get plenty of rest, and try to reduce stress. This can help you recover faster if an underlying illness is the cause of baldness.

Avoid irritating the area affected by baldness. For example, don't use barrettes, elastic hair bands, blow dryers, hot combs, or hair dyes or other chemicals.

Avoid using nonprescription hair-growth products other than minoxidil. These products are generally not effective and may in fact harm the skin and hair.

What can be done to help prevent baldness?

There is nothing you can do to prevent most types of baldness.

Almost all men and women will notice hair loss or hair thinning as they age. However, up to 40% of men and women will experience a more obvious form of this condition. Hair loss typically begins in the 20s and 30s, although in women the changes are most noticeable after menopause. The condition is also called androgenetic alopecia and, in men, male-pattern baldness.

Researchers have begun to understand more about the cause of this type of hair loss. Under the influence of a form of the male hormone testosterone, the normal cycle of hair growth changes, resulting in shorter, thinner or "miniaturized" hair. Eventually, hair growth in certain parts of the scalp stops entirely, which causes the typical pattern of hair loss. Contrary to the folk wisdom that baldness is inherited from one's mother's family, the condition seems to depend on genes contributed by both parents.

Hereditary-pattern baldness starts with thinning of the hair and progresses to complete hair loss on parts of the scalp. Hairs on the pillow, in the tub or on the comb are unreliable symptoms of hair loss. The average non-balding person loses 100 hairs per day, and more hair may fall out under certain circumstances, such as after childbirth or a serious illness.

In men, hair loss typically begins at the temples and crown and proceeds in an M-shaped pattern. In the most advanced stage, only a rim of hair along the side and back of the scalp remains.

In women, hair loss tends to be more widespread but better hidden. The top of the head down the middle is most commonly affected, often in a "Christmas tree" pattern. In contrast to men, the hairline along the forehead and temples usually remains normal in women. Complete loss of hair in any one place on the scalp is unusual and may suggest that a different problem is the cause, such as alopecia areata (an immune system disorder that causes bald patches), a fungus infection or one of a number of other skin conditions.

Hereditary-pattern baldness usually is diagnosed by both its pattern and a history of a similar type of hair loss affecting family members. In most people, no further tests are required.

Hair loss is permanent.

If you begin to lose hair in a hereditary pattern, you may be able to slow further hair loss by using minoxidil (Rogaine) or finasteride (Propecia). Minoxidil can be used by both men and women, while finasteride usually is used just for men.

Minoxidil is a solution, now available over the counter. It is applied to the scalp twice daily. It can help to slow further hair loss in some people, and within four to eight months there is often some hair regrowth. In men a higher strength (5%) works best. In women there seems to be little difference in effect of the 2% strength and the 5% strength, and there is the risk of development of facial hair with the 5% strength. One caution: If you stop using minoxidil, you probably will lose any hair that may have been retained or restored by the medication.

Finasteride is a prescription-only pill that blocks the formation of the type of testosterone that affects hair growth. Higher strengths of the same medication are used in men to stop non-cancerous (benign) growth of the prostate gland. Studies suggest that finasteride helps to prevent hair loss in up to 99% of men with hereditary-patterned baldness, and that two-thirds experience some new hair growth. As with minoxidil, any benefits from the medication are quickly lost once it is discontinued. In addition, a small number of men develop difficulty with sexual function.

Finasteride does not appear to prevent hair loss in women. It also may cause birth defects, and should not be used by any woman who could possibly get pregnant. However, other types of hormonal treatment, such as certain types of birth control pills, may help the small number of women with hair loss who have elevated levels of male hormones.

In some people, hair loss may be caused by certain hair treatments (straightening, coloring), hairstyles (tight braids) or hair pulling. These do not cause hereditary-pattern baldness, but they may contribute to hair loss and should be discontinued.

A variety of other creams, oils, lotions and herbal remedies for hair loss are regularly advertised. However, only minoxidil and finasteride have been proven useful.

Some over-the-counter scalp treatments can cause irritation or harm and worsen hair loss.

Minoxidil and finasteride may prevent hair loss and promote new hair growth. This effect, however, is quite unpredictable from one person to the next.

Hair weaves, wigs and toupees can be used. In addition, a variety of surgical techniques also can be used, including: Scalp reduction Strips of bald skin are removed surgically to decrease the size of a bald spot. Hair flaps A strip of skin with good hair growth can be moved from a less cosmetically important area to a more important one. Hair transplants Tiny plugs of skin containing from one to 15 hairs are moved from the back or side of the scalp to a bald area. The newer "micrografts," which contain very few hairs, yield the best results, but are more expensive and time consuming than older types of transplants. Up to 700 individual grafts may be necessary to complete a treatment. It may take up to two years to see the full benefit of hair replacement surgery.

When To Call a Professional

Call a health care professional if you have any of the following symptoms; they can suggest a problem other than hereditary-pattern baldness: Hair that falls out suddenly or in clumps Patchy hair loss ("flea bitten" appearance) Redness, flaking or scarring of the scalp in the area of hair loss Hair loss in women under age 30 Signs of abnormally high testosterone levels in women, including abnormal menstrual periods, deepening of the voice, acne, hair loss in a male pattern or hair growth in unusual places (face, chest) Most doctors or dermatologists will prescribe finasteride to men who would like to use it. If you are interested in cosmetic surgery, consult a cosmetic surgeon or dermatologist who specializes in hair restoration.

Prognosis

Unless a preventive treatment is started, hereditary hair loss becomes more pronounced over time. Generally, the earlier hair loss begins, the more severe it will become. Minoxidil or finasteride, if used, must be continued indefinitely to maintain results.

Your hair loss may have started with a few extra hairs in the sink or in your comb. But now you can't look in the mirror without seeing more of your scalp.

Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.

Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat baldness. Before pursuing any of these treatment options, talk with your doctor about the cause of and best possible treatments for your hair loss.

The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Another type of alopecia, alopecia areata, can be temporary. It can involve hair loss on your scalp or other parts of your body.

Androgenetic alopecia
Having androgenetic alopecia may mean you experience hair loss as early as during your teen years. For men, this type of baldness is typically characterized by hair loss that begins at the temples and crown. The end result may be partial or complete baldness. Women with androgenetic alopecia usually have hair loss limited to thinning at the front, sides or crown. Complete baldness rarely occurs in women.

Alopecia areata
With alopecia areata, baldness usually occurs in small, round, smooth patches. You may lose only scalp hair, or you may lose body hair as well.

About 90 percent of the hair on most people's scalps is in a two- to six-year growth (anagen) stage at any given time. The other 10 percent is in a two- to three-month resting (telogen) phase, after which time it is shed. Most people shed 50 to 150 hairs a day. Once a hair is shed, the growth stage begins again as a new hair from the same follicle replaces the shed hair. New hair grows at a rate of approximately one-half inch each month.

Hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.

What causes androgenetic alopecia
Androgenetic alopecia is caused by heredity. Although it's most common among men, it can also affect women. A history of androgenetic alopecia on either side of your family increases your risk of balding. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of your baldness.

What causes alopecia areata
Alopecia areata is classified as an autoimmune disease, but the cause is unknown. People who develop this type of baldness are generally in good health. Some scientists believe that some people are genetically predisposed to develop alopecia areata and that a trigger, such as a virus or something else in the environment, sets off the condition. A family history of alopecia areata makes you more likely to develop it. With alopecia areata, your hair generally grows back, but you may lose and regrow your hair a number of times.

Other causes of temporary hair loss include:

• Disease. Diabetes, lupus and thyroid disorders can cause hair loss.
• Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition.
• Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
• Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.
• Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase (telogen effluvium), meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.
• Infancy. Newborns often lose hair during the first several months of life. This baby hair (vellus) is eventually replaced by more permanent hair. It's also common for babies to lose a patch of hair on the back of their heads from rubbing against mattresses, playpens and car seats. Hair will grow back once a baby begins to spend more time sitting up.
• Childbirth. Some women experience an increase in hair loss several months after delivering a baby. This is because during pregnancy the hair is shifted into an active growth state that then goes back to baseline soon after delivery. This increased hair loss usually corrects itself.
• Hair treatments. Chemicals used for dying, tinting, bleaching, straightening or perming can cause hair to become damaged and break off if they are overused or used incorrectly. Excessive hairstyling or hairstyles that pull your hair too tightly also can cause some hair loss. This is known as traction alopecia.
• Scalp infection. Infections such as ringworm can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally regrows. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.

Baldness, whether permanent or temporary, can't be cured. But treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any treatment.

Medications
The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.

The types of drugs for treatment of alopecia that are approved by the Food and Drug Administration include:

• Minoxidil (Rogaine). This over-the-counter medication is approved for the treatment of androgenetic alopecia and alopecia areata. Minoxidil is a liquid that you rub into your scalp twice daily to regrow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. Minoxidil is available in a 2 percent solution and in a 5 percent solution.

  New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough regrowth for some people to hide their bald spots and have it blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. If you experience minimal results within six months, your doctor may recommend discontinuing use. Side effects can include irritation of the scalp.

• Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many people taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Positive results may take several months. Finasteride works by inhibiting the conversion of testosterone into dihydrotestosterone (DHT), a hormone that shrinks hair follicles and is an important factor in male hair loss. Rare side effects of finasteride include diminished sex drive and sexual function. As with minoxidil, the benefits of finasteride stop if you stop using it.

  Finasteride is not approved for use by women. In fact, it poses significant danger to women of childbearing age. If you're a pregnant woman, don't even handle crushed or broken finasteride tablets because absorption of the drug may cause serious birth defects in male fetuses.

• Corticosteroids. Injections of cortisone into the scalp can treat alopecia areata. Treatment is usually repeated monthly. Doctors sometimes prescribe corticosteroid pills for extensive hair loss due to alopecia areata. Ointments and creams can also be used, but they may be less effective than injections.
• Anthralin (Drithocreme). Available as either a cream or an ointment, anthralin is a synthetic, tarry substance that you apply to your scalp and wash off daily. It's typically used to treat psoriasis, but doctors can prescribe it to treat other skin conditions. Anthralin may stimulate new hair growth for cases of alopecia areata.

Surgical procedures
Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed as hereditary hair loss progresses with time.

Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. If you're interested in these procedures, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Consult with this doctor to confirm the cause of your hair loss and review all treatment options, including nonsurgical ones, before proceeding with plans for surgery.

Wigs and hairpieces
If you would like an alternative to medical treatment for your baldness or if you don't respond to treatment, you may want to consider wearing a wig or hairpiece. They can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.

Chances are that the greatest challenge of losing your hair is coping with the change in your appearance. You may be frustrated or upset by other people's reactions or after trying various treatments with little success. If you're having difficulty coping with baldness caused by heredity, a medical condition or medical treatments, you may find some of the following suggestions helpful:

• Learn about the cause of your baldness and treatment options. Be wary of alternative treatments that have no proven track record or may cause dangerous or unpleasant side effects.
• Educate those near to you. Your family and friends can be more sympathetic if they understand the cause of your baldness or your concerns about your looks. You may also learn that they are less concerned about changes in your appearance than you are.
• Consider joining a support group. While support groups aren't for everyone, they can be sources of information and comfort. Talking with people who experience the same challenges or medical conditions and learning how they cope can be reassuring.

People's reaction to hair loss is a very personal issue - different people react differently. Some people become very distressed as they believe it makes them look older and less attractive, affecting their body image and self-esteem. Others are not as concerned. However, treatments are available for many of the different types of hair loss.

Normal Hair Growth
Hair grows, then rests, then falls out. Each hair follicle on your scalp produces a number of hairs throughout your life. Hair grows from the follicle at the rate of about 1cm a month for about three years. After that time that hair will die and no longer grow and simply sit dormant in the follicle for a further three months. After that three month interval the next hair starts to grow out of the follicle and, as it grows, it pushes the original one out. This is a cycle that continues throughout life.

Diffuse Hair Thinning
Hair growth is random so that rather than losing all our hairs at once every 3 years we tend to lose a few every day. It is normal to lose between 50 and 100 hairs a day. As long as the hairs that are lost are replaced by hairs of the same size and same characteristics, then the hair density on your scalp is maintained.

Types of Hair Loss and Their Causes
Hair loss can 'just happen' or it can be linked to some medical conditions and medicines. It can be patchy or widespread, and can range from mild to severe cases.

Androgenetic Alopecia
Androgenetic AlopeciaAndrogenetic alopecia, or male pattern hair loss, refers to scalp hair loss that occurs in a distinct pattern. It is called androgenetic alopecia because this type of hair loss is actually determined by male sex hormones called androgens, and by genetics (or having inherited the condition from your family).

Male pattern hair loss is a common condition in men, but can also occur in women to a lesser degree. Approximately 60% of men will have significant hair loss by the age of 50, and 50% of women will also have some hair loss by the age of 60. In men, the hair loss usually begins with a receding front hairline, then a bald patch develops on the crown or vertex of the head.

Eventually, complete loss of hair on top of the head can occur. In women the frontal hairline usually remains, with hair loss or thinning occurring over the crown extending to frontal hairline.

If you have androgenetic alopecia the normal hair growth cycle is disrupted. The new emerging hair is not as thick and does not grow for as long as the one before it. This results in old hair being replaced by finer and shorter hair and you losing more hairs each day. Alopecia areata is a condition where hair loss usually occurs suddenly in round patches. In contrast to male pattern baldness, the areas of hair loss are random and can occur on other parts of the body as well as
the scalp. In a small number of people, all the scalp and body hair may be lost. Alopecia areata can affect men, women and children. Why it develops is not known, but many cases resolve spontaneously and most of the remainder can be effectively treated. It is caused by an overactive immune system.

Tinea Capitis
Tinea Capitus, Scalp Ringworm
Tinea capitis, or scalp ringworm, is a fungal infection that may cause irregular areas of hair loss where the fungus occupies the hair shaft and the hair breaks off. It occurs more commonly in children than adults and is treated with antifungal medicines.

Tinea Capitus, Scalp Ringworm

Scarring Alopecia
Scarring alopecia with pus
Scarring alopecia is a rare condition that results in permanent destruction of the hair follicles. Unlike alopecia areata, there is no chance of renewed hair growth, but early diagnosis may prevent progression.

Traction Alopecia
Traction alopecia is a condition that may occur if hair curlers and hair grips are applied too tightly or if chemical treatments are used excessively or incorrectly. The hair becomes brittle causing it to break.

Trichotillomania
Trichotillomania is a form of hair loss caused by deliberate plucking and twisting of the hair. Hair shafts are broken off at irregular lengths, but the underlying scalp in normal and hair will grow back if pulling is not prolonged. Children may twist and pull their hair as a matter of habit similar to nail biting. When this condition occurs in older children or adults, it is usually part of a compulsive disorder. Psychiatric help is sometimes needed to treat this condition.

Other Causes of Hair Loss
Medical ConditionsMedical conditions, such as anaemia and thyroid diseases, can cause rapid hair loss. These can be reversed with treatment from your doctor.Certain medicinesCertain medicines, such as those used in the treatment of high blood pressure, high cholesterol, other heart problems, cancer, acne and birth control pills can cause hair loss.

Women on the pill who suffer hair thinning often have an hereditary tendency to hair loss. Hair may also start to fall out 2 to 3 months after stopping the pill, and this can last for up to 6 months.

Chemotherapy used to treat cancer can cause a rapid loss of nearly all scalp hair. When the treatment is completed the hair often regrows.Pregnancy and Child Birth Pregnancy and child birth can affect hair growth. During pregnancy women do not lose as much hair as usual. However, within 2 to 3 months after delivery, some women may see large amounts of hair coming out in their brushes and combs. This can last 1 to 6 months. In most cases the condition reverses completely. Longterm illness, major surgery and high fever Anyone who has had a high fever, major illness or operation, or a tremendous shock to the system (for example, death in the family) may notice increased hair loss within 1 to 3 months afterwards. The condition, called telogen effluvium, reverses itself within a few months but people who have a severe longterm illness may notice increased hair loss for the duration of the illness.

Crash diets, with rapid weight loss can also cause this type of hair loss.

Help from your Doctor
If you are concerned about your hair thinning or hair loss, talk to your doctor. Your doctor will review your history of hair loss and any events which may have played a role in it, as well as examine your scalp. Blood tests to check for anaemia, thyroid disease or hormonal changes may be needed.

Your doctor may refer you to a skin and hair specialist, called a dermatologist, who may conduct further tests to determine the cause of your hair loss. Further tests may include:

• Hair pluck - a group of hair roots are removed for examination and assessment.
Testing of the hair shafts for the presence of fungal infection. Scalp biopsy - examination of the scalp to determine the number of remaining hairs, their state of health, whether there is ongoing inflammation and whether the follicles are being destroyed.

After determining the cause of your hair loss, your doctor or dermatologist may be able to recommend an appropriate treatment.

Hair loss can be distressing. You can talk to your doctor about how you are feeling, or a support group such as the Alopecia Areata Foundation to learn about strategies that other people have used to cope with hair loss.

Treatment of Hair Loss
The treatment of hair loss depends on what is causing the problem. In some cases the hair loss may be temporary and full regrowth will occur without treatment. The identification and treatment of reversible conditions such as anaemia or thyroid disease can often result in complete recovery. In other cases hormone replacement therapy or measures to block hormone effects on the follicles may be used.

If your have alopecia area, cortisone injections into the scalp or a mixture of topical creams and lotions may be used.
Antifungals or antibiotics may be required for certain infections causing hair loss, for example for tinea capitis.

Male pattern hair loss (androgenetic alopecia) may be treated with topical lotions, such as minoxidil, or tablets, such as finasteride.

Apart from medical measures there are surgical options such as hair transplantation, scalp reductions and artificial hair fibre techniques which may be used in certain types of hair loss. Where appropriate, a wig or hairpiece can cover the area of hair loss.

Many people recommend various non-scientific treatments for hair loss, including vitamins, zinc, tyrosine, amino acids, hair lotions, tonics, etc. None of these has been shown to promote hair growth or prevent hair loss. Each year new treatments are recommended by non-medical practitioners. A recent example is the use of lasers and again there is not scientific evidence to support its use. If in doubt, check with your doctor before committing to any of these treatments.

Despite advances in the understanding of hair loss and the increased ability to diagnose individual conditions, there are limits to current treatment. In particular, age-related hair loss and inherited forms of hair loss are difficult to reverse, although there are treatments that may prevent further loss. there are also limits to controlling alopecia areata. In many conditions hair loss or thinning will stabilise and may not progress to baldness.

Talk to your doctor or dermatologist about the best form of treatment for you.

This information is based on a publication of the Australasian College of Dermatologists.

When used with oral contraceptives, the male hair-loss medication finasteride (brand-named Propecia) may also help improve hair loss in women, Italian researchers report.

"This treatment was well accepted by the patients, who judged the results to be even better than the investigators," a team from the University of Bologna reported in the March issue of the journal Archives of Dermatology.

The study included 37 women, ages 19 to 50, who took 2.5 milligrams of finasteride by mouth daily, along with an oral contraceptive. The contraceptive was necessary because finasteride is known to cause birth defects. The contraceptive used in the study was a type that also reduces levels of male hormones (which also circulate at small amounts in women). The researchers believed that might also help reduce hair loss in the women.

62% showed an improvement
The women's heads were photographed and their hair density was assessed at the start of the study and again a year later. At the follow-up, 23 (62 percent) of the women were rated as improved, according to comparisons of the photographs. Thirteen patients were judged not to have improved and one woman's condition was rated as worse.

Twelve women had improved hair-density scores.

"Further studies are needed to establish optimal dosage and mode of administration of finasteride in premenopausal women and to definitively assess the efficacy of this drug compared with oral antiandrogens," the researchers added in a prepared statement.

As many as half of women experience female pattern hair loss during their lifetimes. Current therapy usually involves minoxidil, which is applied to the scalp in order to encourage hair regrowth. This medication is effective but not always well accepted by patients, the authors said. – (HealthDayNews)

What is it?
Chances are, you've seen the commercials for Propecia, the newest treatment for male-pattern baldness. Along with all the glowing testimony from men who say it has changed their lives comes a warning that it is for men only and that women should not even touch the tablets. Sounds pretty scary, doesn't it? You may have nightmares about waking up one morning with two heads if your husband even brings the stuff into the house. Well, worry no longer. The truth about Propecia is here.

Propecia, chemical name finasteride, is produced by Merck and was cleared by the FDA in late 1997 for sale in the U.S. It is available only by prescription to male patients.

How does it work?
Propecia works by blocking the conversion of testosterone to an alternative form of testosterone called dihydro-testosterone (DHT), a chemical found in the hair follicles that may block hair growth. A study conducted by Merck found that hair follicles on bald skin contained more DHT than hair follicles on hairy skin. This is the basis for using Propecia. If testosterone can be blocked from being converted into DHT, this may help hair follicles to produce hair.

Should women be concerned?
When tested on rats, Propecia caused birth defects in male fetuses when a very large amount of Propecia was administered to the rats (about 5 to 5,000 times the dose recommended for humans). Propecia caused abnormalities in the genitalia of male fetuses when the pregnant mother underwent exposure. In male fetuses the conversion of testosterone to DHT is needed to form their male organs. The defect is called hypospadis. That is when the urethra opens onto the undersurface of the penis, instead of the end. This is the basis for all the warnings to women about staying far away from Propecia. The concern is that just slight exposure may harm a male fetus.

As a result of these studies, women are warned not to use this drug to treat baldness, whether or not they are pregnant. Women are warned against touching broken or crushed tablets of Propecia, as there is the remote possibility that they may absorb some of the active ingredient into their system. To guard against such problems, the tablets have a coating on them, so as long as the tablet is whole, it is unlikely that a woman will be putting her unborn child in danger.

The main concern about women being exposed to this drug is that they may be pregnant, even if they do not think they are. Contact with this drug will not harm future fetuses. It is as yet unknown if Finasteride (the active ingredient in Propecia) can be passed to a baby via the mother's milk, so it is a good idea to steer clear of it not just during pregnancy, but also while breast feeding.

The Bottom Line
In short, you do not need to be overly concerned that something awful will happen to you if you are within a mile of Propecia tablets. However, keep in mind that caution is a good policy.

What causes hair loss?
Hair loss is a natural part of the body's process of renewal. As some hair falls out, new growth replaces it. However, this process may be accelerated by a number of conditions. Hormonal changes may contribute to rapid hair loss, such as during pregnancy or childbirth, or even when coming off the Pill. As these fluctuations in hormone levels drop off, the hair loss should clear up, so the condition is only temporary. In a recent study, hormone levels were studied in both male and female patients experiencing severe hair loss. The research points towards a complex interaction between sex and thyroid hormones that may lead to the condition.

Stress is another factor linked to hair loss. While it has not been proved definitively, emotional trauma has been loosely associated with hair loss, but milder strains and worries probably do the same thing. Stresses placed on the body may also cause a woman's hair to jump ship. For example, crash dieting, in which a woman loses a large amount of weight rapidly, may also cause her to lose her tresses, too. Since stress is often transient, if its cause clears up, the resultant hair loss should disappear as well.

Female-Pattern Hair Loss
As women age, their hair tends to thin out, although the results are not as dramatic as they are for many men - think of your grandmother's hair compared to your grandfather's (if he has any). Women's pattern of hair loss is analogous to men's, but has several important differences. The ages we begin having hair loss are the same. A few of both sexes will begin having hair loss very early--in their twenties, but most do not note changes until the mid-thirties to forties. Women's hair loss tends to be an even overall thinning; as opposed to men's hair loss in which the hairline recedes and/or there is balding at the crown of the head. Women tend to lose hair on the crown and at the hairline, which is referred to as female-pattern hair loss.

When to Worry
Of course, although hair loss may often be temporary, a condition called alopecia areata (al-o-pee-see-uh are-ee-ah-tuh) is more serious. This disease is characterized by patchy loss of hair, and if a woman is experiencing this, she should consult her dermatologist. Corticosteroids are often prescribed to slow or even halt hair loss.

Hair loss is often hereditary and effects about 50% of women. So long as it is not abrupt, severe, or patchy, nor caused by emotional or physical stresses, it can be considered a normal part of maturing.

Treatment
However natural or normal this may be, many women want to reverse or halt this trend. If a woman wishes to take action medically, she will get better results if she acts sooner rather than later. Rogaine (minoxidil) is one of the most popular remedies. Still, only about 20% of people have normal hair re-growth, another 40% have a lighter, shorter re-growth that is like "peach fuzz." The growth only lasts for as long as the woman uses it. It costs about $30 a month and must be applied twice a day.

A new drug, Propecia, is now being tested by Merck on post-menopausal women. Propecia works by blocking the conversions of testosterone into a related hormone, dihydrotestosterone that shrinks hair follicles. It has about the same success rate as Rogaine in the men and likewise the hair re-growth stops once the drug is discontinued. It is not know whether it will work as well with women's hormone profile. In addition, this drug cannot be taken while pregnant because it can cause birth defects in the urinary and genital organs of male fetuses. There are concerns about taking a drug that affects hormones long-term in men (sound familiar, ladies?).

The earlier hair transplant techniques took large chunks of scalp and hair from dense areas and moved them to bald spots, something that did not address the typical situation for women. The newer, micrograft hair transplant techniques make this a viable option for a woman's overall thinning pattern.

Many women can forego the medical route for this problem. Hair loss can be managed through a variety of hair products, from mousses and gels to coloring to wigs and extensions. These often give better cosmetic results at lower costs and with less trouble.

Alopecia is the medical term for baldness or hair loss. It can affect the entire scalp or smaller localised areas and may be temporary or permanent. Other parts of the body where hair normally grows can also be affected.

Alopecia may have an underlying cause or may simply be part of the natural ageing process.

The commonest form of alopecia is male-pattern baldness (also known as androgenic alopecia or common baldness). Male pattern baldness tends to run in families. It usually starts in the late 20s or early 30s. Initially there may be just some thinning of the hair and a receding hairline. Gradual hair loss occurs at the temples and crown of the head. Eventually, the bald spots increase in size until the entire top of the head is bald and hair remains on the back and sides of the head only. In some men, total baldness can occur. Men who start losing their hair at an early age tend to develop more extensive baldness.

Female pattern baldness occurs in some women as they get older and becomes more noticeable after the menopause. The hair begins to thin at the front and crown of the head. This also tends to run in families.

Small areas of patchy hair loss are caused by a condition called alopecia areata. The patches of baldness are about the size of a large coin and may come and go. Alopecia areata affects about 1 in 100 people, mostly teenagers and young adults. Other areas besides the scalp may be affected.

Alopecia universalis is a severe form of alopecia areata that results in permanent loss of all body hair, including eyebrows, eyelashes, and hair in the pubic area and armpits.

Hair grows from specialised cells called hair follicles. In some people, androgens (male sex hormones) cause the hair follicles to shrink and cease to produce hair as normal. This sensitivity of the hair follicles to androgens is genetic and the main cause of male pattern baldness.

The cause of alopecia areata is unknown but it may be an auto-immune disorder. The hair follicles are usually not permanently damaged and in many cases the hair grows back in a few months. One in 5 cases are genetic. A person with alopecia areata is more likely to have or to develop other autoimmune conditions such as thyroid disease, diabetes and vitiligo (a condition that produces white patches on the skin). Occasionally all body hair may be lost (alopecia universalis). The chance of hair regrowth is poorer for people with alopecia universalis and extensive alopecia areata.

Other causes of localised hair loss include:

• Fungal infection of the scalp such as ringworm
• Overuse of hot comb or hair dryer
• Hairstyles that pull on the hair
• Deliberately pulling out of the hair (trichotillomania)
• Permanent skin damage from burns or serious skin diseases
• Radiation therapy

Generalised hair loss result from:

• Chemotherapy
• Stress (including bereavement or stress of major surgery)
• Severe illness
• Thyroid disorders
• Pregnancy
• Post-partum (after having a baby)
• Some prescription drugs and high doses of Vitamin A
  
  

If you are concerned that you may be developing alopecia, visit your doctor. Your scalp and skin will be examined. A skin scraping may be taken to check for a fungal infection.

Can baldness be treated?

That depends on what is causing your hair to fall out. In some cases, such as completion of chemotherapy, or treatment of a fungal scalp infection, your hair will start to grow again.

Medical treatments

There are only two medical treatments that actually help slow or prevent male-pattern or common baldness. These treatments are minoxidil and finasteride. As yet, only minoxidil is available in Ireland.

• Minoxidil is a liquid that is applied to the scalp twice daily and is used to prevent or slow down male pattern baldness. It can also be used to treat female baldness and alopecia areata. How it works is unclear but it is believed that it may act by direct stimulation of the hair follicle epithelium (covering). Effectiveness varies from person to person.

  When used continuously for long periods of time, minoxidil produces satisfactory results in about 25% of people with androgenic alopecia. It may take a few months before an improvement is noticed. This new hair is usually thinner and lighter in colour and is sometimes like baby hair. New hair stops growing soon after minoxidil is discontinued. For hair to remain, treatment with minoxidil must be continued daily.
  Minoxidil should not be used for hair loss due to illness or childbirth. Side effects include dryness and irritation of the scalp.

• Finasteride is a new oral prescription-only medication (not licensed here yet). In clinical studies, 80% of men experienced slowing of hair loss, and 66% had visible regrowth. It usually takes about six months to start working and may take up to a year to see results. If treatment is stopped, the effects will be entirely gone in 12 months. Finasteride should never be taken by women because it can cause serious birth defects.

Surgical treatment

• Hair transplantation. Tiny plugs of skin containing one or multiple hair follicles are taken from an area of the scalp where the hair is still present (usually the back and sides of the scalp). These plugs are implanted into bald sections of the scalp. Hair growth from the transplant takes 4 to 6 months. Results may last a few years or be permanent.
• Scalp reduction. This procedure decreases the area of bald skin on the head. The hairless skin is stretched and surgically removed and the space is closed with hair-covered scalp.
  
  Scalp reduction and hair transplants can be used in combination with each other. They are quite expensive and time consuming.

There is no real effective treatment for alopecia areata; the hair usually grows back naturally in 6 to 12 months. Your doctor may try to speed up regrowth by injecting your scalp with steroids or by advising minoxidil solution directly on the bald area. Alopecia areata can recur. Treatment is less likely to be effective in people with extensive alopecia areata (more than 50% scalp hair loss) or alopecia universalis.

If you have inherited the genes responsible for male-pattern or female-pattern baldness there is not a lot you can do to prevent it happening. Treatment such as minoxidil, however, may slow down the hair loss.

Avoid non-prescription hair-growth products other than minoxidil. These products are generally not effective and could be harmful.

Author
Dr Bridget Maher, MB, BCh, BAO NUI.

Researchers at Brigham and Women's Hospital (BWH) have found that the prostate specific antigen (PSA) cancer screening test is falsely lowered by a factor of two in middle-aged men who have taken Propecia (finasteride), a hair-loss drug used by more than 4 million men worldwide, for one year. These findings were published on Dec. 5, in Lancet Oncology online

"For these men, the PSA level needs to be corrected, or the detection of prostate cancer may not occur until it is more aggressive," said Anthony D'Amico, Harvard Medical School professor of radiation oncology, chief of genitourinary radiation oncology at BWH, and lead author of the study. "It is also important to note that because PSA becomes a more accurate indicator for cancer presence when taking finasteride-containing drugs like Propecia, changes in PSA as low as 0.3 ng/ml in one year have been used to recommend a prostate biopsy."

PSA is a protein produced by the prostate gland and is often elevated in the presence of prostate cancer and other prostate disorders. A blood test to measure PSA is the most effective test available for the early detection of prostate cancer, and levels are reported as nanograms of PSA per milliliter of blood (ng/ml). Controversy exists as to what is considered a normal PSA level, but a high PSA level and the rise in PSA levels over time may indicate that cancer is present and a biopsy is necessary. 

In this study, researchers aimed to determine whether Propecia, which is a 1 mg. formulation of finasteride, has a similar effect on PSA levels as Proscar, a 5 mg. formulation of the drug used in the treatment of enlarged prostate. Previous studies have shown Proscar to significantly decrease PSA levels. The researchers studied 355 men aged 40 to 60 years old for 48 weeks in a placebo-controlled, randomized, double-blind study. Participants' PSA levels were obtained at the start of the study and once every 12 weeks for the duration of the study. Researchers found that for men who received 1mg/day of finasteride in an analogous fashion to Proscar, PSA levels dropped by a factor of two in one year. As a result of this decrease, researchers recommend that men between 40 and 60 years of age who take Propecia for hair loss have their PSA levels adjusted by a factor of 2 just as they would if they were taking Proscar.

Whether it's a matter of wanting to look young, feel confident or simply have a woman run her fingers through it, many men will go to great lengths to avoid losing their hair.

In a survey of 2,338 men by the International Society of Hair Restoration Surgery, more than 1,300 said they'd be willing to give up a personal possession in exchange for more hair. Of that group, 26% said they'd be willing to give up a stereo system, 21% a cellphone, 17% a laptop and 13% a plasma TV.

It's estimated that the U.S. market for hair restoration procedures in 2004 was about $811 million, the vast majority of which was for male patients, according to the ISHRS.

Dr. Jeffrey Epstein, of the Foundation for Hair Restoration, says men unhappy with their receding hair lines basically have two options. They can shave their heads, a la Bruce Willis—a style that makes a statement but takes guts. Or they can seek treatment.

"People that lose their hair are viewed as less powerful and more suspicious," says Epstein, who has surgical and consultation offices in South Florida and New York. "It's also seen as a measure of virility."

The First Step

While androgenetic alopecia, a genetically determined condition that spurs balding, affects roughly 50% of men internationally, it's not the only cause. Before you start trolling the Internet for quick fixes, head to the dermatologist's office to rule out underlying medical problems, suggests Dr. Gene Rubinstein, a clinical instructor at UCLA, who is in private practice at the Dermatology and Laser Centre of Studio City, Calif.

A dermatologist can help you figure out if medications, such as menoxidil, aka Rogaine, or prescription-only propecia, are smart choices. The only two drugs approved by the U.S. Food and Drug Administration for treating hair loss, both have been shown as effective in preventing hair loss for as long as they're used and can be taken simultaneously for potentially better results. They can also promote regrowth of hair, albeit typically thin hair, Rubinstein says.

Earlier this year, the FDA also gave clearance to a handheld home medical device called the HairMax LaserComb, which uses a laser's energy to promote hair regrowth. It sells for $395 to $545.

But since men may not want to take a pill every day for the rest of their lives or regularly use a comb, many turn to hair transplantation, says London and New York-based plastic surgeon Dr. Laurence Kirwan.

Top Techniques

Follicular unit grafting is considered the gold standard in hair transplantation techniques, according to Epstein. While a decade ago doctors took large grafts of hair—known as plugs—from the back of a patient's head and transplanted them to the crown, follicular unit grafting takes hairs in groups of one to four. Procedures may take several hours and cost upwards of $10,000. But patients end up with smaller donor site scars and, more important, doctors can recreate a permanent, natural-looking hair line.

Turowski has had two of the grafting procedures, giving him a look he says makes him feel "more approachable."

As for upcoming advances, one technique doctors have high hopes for in the future is hair cloning. Currently being researched by a handful of companies, the process is many years from hitting the market. Bosley is looking to make it work by extracting cells from the areas of a man's head that resist balding, putting them in a lab dish and multiplying them by the thousands. The hope is that once the new cells are injected back into the scalp, they'll work with skin cells to form new follicles, says Dr. Ken Washenik, medical director of Bosley. Unlike with transplants, the patient could end up with more hairs overall.

Don't Buy The Snake Oil

If you're confused about what to do and looking for unbiased information, consider the Hair Foundation. A new independent, nonprofit group, it presents facts about hair care, hair loss and hair replacement techniques.

"There are so many plain old false claims," says Dr. Tony Mangubat, the foundation's current president and founder of Seattle's Southcenter Cosmetic Surgery and Hair Restoration. "The history of this is life-long. We wanted to set up a method to cut through myths and get to the truth."

While men have options when it comes to treatments, they don't always work for everyone and some, Rubinstein says, have been touted a little too highly.

"If there were truly a cure, there would be no bald dermatologists," he says

Your hair loss may have started with a few extra hairs in the sink or in your comb. But now you can't look in the mirror without seeing more of your scalp.

Baldness typically refers to excessive hair loss from your scalp and can be the result of heredity, certain medications or an underlying medical condition. Anyone — men, women and children — can experience hair loss.

Some people prefer to let their baldness run its course untreated and unhidden. Others may cover it up with hairstyles, makeup, hats or scarves. And still others choose one of the medications and surgical procedures that are available to treat baldness. Before pursuing any of these treatment options, talk with your doctor about the cause of and best possible treatments for your hair loss.

The medical term for hair loss is alopecia. Pattern baldness (androgenetic alopecia), the most common type of alopecia, affects roughly one-third of men and women. It's typically permanent. Another type of alopecia, alopecia areata, can be temporary. It can involve hair loss on your scalp or other parts of your body.

Androgenetic alopecia
Having androgenetic alopecia may mean you experience hair loss as early as during your teen years. For men, this type of baldness is typically characterized by hair loss that begins at the temples and crown. The end result may be partial or complete baldness. Women with androgenetic alopecia usually have hair loss limited to thinning at the front, sides or crown. Complete baldness rarely occurs in women.

Alopecia areata
With alopecia areata, baldness usually occurs in small, round, smooth patches. You may lose only scalp hair, or you may lose body hair as well.

About 90 percent of the hair on most people's scalps is in a two- to six-year growth (anagen) stage at any given time. The other 10 percent is in a two- to three-month resting (telogen) phase, after which time it is shed. Most people shed 50 to 150 hairs a day. Once a hair is shed, the growth stage begins again as a new hair from the same follicle replaces the shed hair. New hair grows at a rate of approximately one-half inch each month.

Hair loss may lead to baldness when the rate of shedding exceeds the rate of regrowth, when new hair is thinner than the hair shed or when hair comes out in patches.

What causes androgenetic alopecia
Androgenetic alopecia is caused by heredity. Although it's most common among men, it can also affect women. A history of androgenetic alopecia on either side of your family increases your risk of balding. Heredity also affects the age at which you begin to lose hair and the developmental speed, pattern and extent of your baldness.

What causes alopecia areata
Alopecia areata is classified as an autoimmune disease, but the cause is unknown. People who develop this type of baldness are generally in good health. Some scientists believe that some people are genetically predisposed to develop alopecia areata and that a trigger, such as a virus or something else in the environment, sets off the condition. A family history of alopecia areata makes you more likely to develop it. With alopecia areata, your hair generally grows back, but you may lose and regrow your hair a number of times.

Other causes of temporary hair loss include:

• Disease. Diabetes, lupus and thyroid disorders can cause hair loss.
• Poor nutrition. Having inadequate protein or iron in your diet or poor nourishment in other ways can cause you to experience hair loss. Fad diets, crash diets and certain illnesses, such as eating disorders, can cause poor nutrition.
• Medications. Certain drugs used to treat gout, arthritis, depression, heart problems and high blood pressure may cause hair loss in some people. Taking birth control pills also may result in hair loss for some women.
• Medical treatments. Undergoing chemotherapy or radiation therapy may cause you to develop alopecia. After your treatment ends, your hair typically begins to regrow.
• Recent high fever, severe flu or surgery. You may notice you have less hair three to four months after events such as an illness or surgery. These conditions cause hair to shift rapidly into a resting phase (telogen effluvium), meaning you'll see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.
• Infancy. Newborns often lose hair during the first several months of life. This baby hair (vellus) is eventually replaced by more permanent hair. It's also common for babies to lose a patch of hair on the back of their heads from rubbing against mattresses, playpens and car seats. Hair will grow back once a baby begins to spend more time sitting up.
• Childbirth. Some women experience an increase in hair loss several months after delivering a baby. This is because during pregnancy the hair is shifted into an active growth state that then goes back to baseline soon after delivery. This increased hair loss usually corrects itself.
• Hair treatments. Chemicals used for dying, tinting, bleaching, straightening or perming can cause hair to become damaged and break off if they are overused or used incorrectly. Excessive hairstyling or hairstyles that pull your hair too tightly also can cause some hair loss. This is known as traction alopecia.
• Scalp infection. Infections such as ringworm can invade the hair and skin of your scalp, leading to hair loss. Once infections are treated, hair generally regrows. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication.

Baldness, whether permanent or temporary, can't be cured. But treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any treatment.

Medications
The effectiveness of medications used to treat alopecia depends on the cause of hair loss, extent of the loss and individual response. Generally, treatment is less effective for more extensive cases of hair loss.

The types of drugs for treatment of alopecia that are approved by the Food and Drug Administration include:

• Minoxidil (Rogaine). This over-the-counter medication is approved for the treatment of androgenetic alopecia and alopecia areata. Minoxidil is a liquid that you rub into your scalp twice daily to regrow hair and to prevent further loss. Some people experience some hair regrowth or a slower rate of hair loss or both. Minoxidil is available in a 2 percent solution and in a 5 percent solution.

  New hair resulting from minoxidil use may be thinner and shorter than previous hair. But there can be enough regrowth for some people to hide their bald spots and have it blend with existing hair. New hair stops growing soon after you discontinue the use of minoxidil. If you experience minimal results within six months, your doctor may recommend discontinuing use. Side effects can include irritation of the scalp.

• Finasteride (Propecia). This prescription medication to treat male-pattern baldness is taken daily in pill form. Many people taking finasteride experience a slowing of hair loss, and some may show some new hair growth. Positive results may take several months. Finasteride works by inhibiting the conversion of testosterone into dihydrotestosterone (DHT), a hormone that shrinks hair follicles and is an important factor in male hair loss. Rare side effects of finasteride include diminished sex drive and sexual function. As with minoxidil, the benefits of finasteride stop if you stop using it.

  Finasteride is not approved for use by women. In fact, it poses significant danger to women of childbearing age. If you're a pregnant woman, don't even handle crushed or broken finasteride tablets because absorption of the drug may cause serious birth defects in male fetuses.

• Corticosteroids. Injections of cortisone into the scalp can treat alopecia areata. Treatment is usually repeated monthly. Doctors sometimes prescribe corticosteroid pills for extensive hair loss due to alopecia areata. Ointments and creams can also be used, but they may be less effective than injections.
• Anthralin (Drithocreme). Available as either a cream or an ointment, anthralin is a synthetic, tarry substance that you apply to your scalp and wash off daily. It's typically used to treat psoriasis, but doctors can prescribe it to treat other skin conditions. Anthralin may stimulate new hair growth for cases of alopecia areata.

Surgical procedures
Hair transplants and scalp reduction surgery are available to treat androgenetic alopecia when more conservative measures have failed. During transplantation a dermatologist or cosmetic surgeon takes tiny plugs of skin, each containing one to several hairs, from the back or side of your scalp. The plugs are then implanted into the bald sections. Several transplant sessions may be needed as hereditary hair loss progresses with time.

Scalp reduction, as the name implies, means decreasing the area of bald skin on your head. Your scalp and the top part of your head may seem to have a snug fit. But the skin can become flexible and stretched enough for some of it to be surgically removed. After hairless scalp is removed, the space is closed with hair-covered scalp. Doctors can also fold hair-bearing skin over an area of bald skin in a scalp reduction technique called a flap. Scalp reduction can be combined with hair transplantation to fashion a natural-looking hairline in those with more extensive hair loss.

Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. If you're interested in these procedures, consider only board-certified dermatologists, plastic surgeons or cosmetic surgeons, and check local and state medical boards for a record of patient complaints before choosing a doctor. Consult with this doctor to confirm the cause of your hair loss and review all treatment options, including nonsurgical ones, before proceeding with plans for surgery.

Wigs and hairpieces
If you would like an alternative to medical treatment for your baldness or if you don't respond to treatment, you may want to consider wearing a wig or hairpiece. They can be used to cover either permanent or temporary hair loss. Quality, natural-looking wigs and hairpieces are available.

Chances are that the greatest challenge of losing your hair is coping with the change in your appearance. You may be frustrated or upset by other people's reactions or after trying various treatments with little success. If you're having difficulty coping with baldness caused by heredity, a medical condition or medical treatments, you may find some of the following suggestions helpful:

• Learn about the cause of your baldness and treatment options. Be wary of alternative treatments that have no proven track record or may cause dangerous or unpleasant side effects.
• Educate those near to you. Your family and friends can be more sympathetic if they understand the cause of your baldness or your concerns about your looks. You may also learn that they are less concerned about changes in your appearance than you are.
• Consider joining a support group. While support groups aren't for everyone, they can be sources of information and comfort. Talking with people who experience the same challenges or medical conditions and learning how they cope can be reassuring.

Treatment with medication


• Minoxidil lotion (Regaine regular strength or Regaine extra strength) is applied twice daily to the scalp. Minoxidil was originally invented as a treatment for high blood pressure; the hair growth is a side effect that, in this case, has proved useful. It is not available on NHS prescription, but can be purchased over-the-counter. About 60 per cent of patients benefit from it to varying degrees and its effects start to wear off as soon as it is stopped.
  
  
• Finasteride (Propecia) is a medicine taken in tablet form that partially blocks the effects of the male hormones (an 'anti-androgen'). It is used in a higher dose to reduce the size of the prostate gland in men with benign prostatic hypertrophy. Propecia has been shown to halt further hair loss and promote re-growth of scalp hair in approximately 80 per cent of patients after three to six months. Treatment must be continued to sustain the improvement in hair growth. It is only available on private prescription and a months supply costs around £30.
  
  

Plastic surgery

Plastic surgery may be the only reliable way to replace lost hair, and techniques for restoring hair growth are constantly improving. These include:


• a transplant , where the surgeon moves non-sensitive hairs from the back of the head to the top. This is best for men whose hair loss is limited to the front of the scalp. Factors that determine whether a person is a suitable candidate include age, hair colour, the nature of hair loss, and whether the hair type is straight or curly.
  
  
• scalp reduction , a technique that is most suitable for men with a small, well-defined bald spot on the top of the head.
  
  
• flap-surgery , which involves making the part of the scalp that still contains hair larger. This is a possibility in cases of hair loss over a small area.

A popular hair-growth drug may alter the accuracy of prostate cancer screening, say researchers.

Propecia, a drug commonly used to regrow thinning hair, appears to alter levels of a hormone that alerts doctors to an increased risk of prostate cancer in middle-aged men, possibly hiding the presence of the disease.

Prostate-specific antigen (PSA) is a hormone always present in men, but it tends to become elevated if prostate disorders including cancer develop. Therefore, PSA testing has become a routine cancer screening, recommended to begin around age 40, when the risk of prostate cancer begins to grow.

However, a recent study has shown that Propecia may interfere with the results of this screening, as it seems to lower the amount of PSA present in a man’s body.

“For these men, the PSA needs to be corrected, of the detection of prostate cancer may not occur until it is more aggressive,” said Dr. Anthony D’Amico, lead study author from the Dana-Farber/Brigham and Women’s Cancer Center in Boston, Massachusetts.

For the study, D’Amico and colleagues looked as 355 men between the ages of 40 and 60, 247 of whom were given a low dose of Propecia for 48 weeks. The men’s PSA levels were measured before the start of the study and once every 12 weeks.

Hidden beneath Elline Surianello's beautiful hair is a woman few ever see.

Since she was 14, Surianello has suffered from a condition called alopecia, commonly known as hair loss. She wears a wig to hide the bald spots.

"To be like this all the time and think that this is how you have to be all the time, every day a little part of you dies," she said.

Surianello is among 30 million American women, about 1 in 5, living with female hair loss.

"Very few men are shocked that they are losing their hair," said Dr. Mark Kaufmann, a dermatologist. "With women, there's a complete shock and disbelief."

Surianello agreed to walk outside without her hairpiece with "Good Morning America" cameras following her.

"How do I function in the world knowing that everyone's paying attention to this," Surianello said, pointing to her hair. "Now they're not going to say anything to me because this is not a conversation, but they're going to ignore me. I become a nonentity. I become not a person that makes a statement. And I don't want to live my life that way."

About 70 percent of female hair loss is genetic. Other causes include stress, illness, medication and diet. Crash diets, tight ponytails/braids/weaves/extension, thyroid disorders, pregnancy, going off birth control and general anesthesia can all result in hair loss.

Dermatologist Susan Taylor had the following advice for preventing female hair loss.

• Don't ignore the problem. Get help soon.

• Hair care should be gentle, not painful. If it hurts, it's going to harm your hair.

• Avoid tight pony tails.

• Use gentle shampoos, nothing that itches.

• Don't skip conditioner.

• Don't over brush.

For those who have already lost a significant amount of hair, Taylor said Rogaine and cortisone injections or creams may help stabilize growth and in some cases regrow it. Rogaine costs about $25 per month. Cortisone requires a doctor's prescription and may be covered by insurance. Without insurance, the treatments cost approximately $50 to $150, Taylor said.

Hair transplants are the most expensive and time consuming treatment for female hair loss, at about $5,000 to $10,000 for a series of transplants over several months.

"There's a lot of research being done on stem cells," Taylor said. "The cells that grow hair have been identified, and hopefully we'll be able to use them one day to regrow hair in people who have lost it."