The Root of Hair Loss

Lately there are an increasing number of highly publicized advertisements made by numerous companies claiming their products or treatments to be able to effectively treat hair loss. However, we do not know how effective these drugs or treatment programs really are. But as hair is of such great importance to the self image of a person in this current world of fashion, many people would often gamble on their precious savings just to get their hair back. So before signing up on one of the many anti hair loss programs, let us look at the root of this medical problem, or shall I say cosmetic problem of hair loss.

There are 3 phases of hair growth namely anagen or growing phase, catagen or resting phase and telogen or shedding phase. The anagen or growing phase last for 3 to 7 years and at any one time, 80 to 90 percent of scalp hairs are in this growing phase. The resting phase or catagen phase lasts 3 to 4 weeks and at any one time 10 to 20 percent of scalp hairs are in catagen phase. Finally the shedding or telogen phase accounts for less than 1 percent of hair at any one time and that rounds up to roughly 50 to 100 scalp hairs being shed each day.

There are several causes of hair loss and a thorough history and physical examination by your doctor is needed to diagnose the actual cause of hair loss. This should not be taken lightly as there are a group of causes that can lead to hair loss with scarring such as systemic lupus erythematosus (SLE) and tertiary syphilis. However, androgenetic alopecia or male pattern baldness is by far the most common type of hair loss and it is also the only type that is self treatable. Despite its name, it can occur in both sexes and appears to have an inherited pattern although the exact mode of inheritance is unclear. What we are clear though is the excess of male hormone known as dihydrotestosterone (DHT) does have a role to play in androgenetic alopecia.

Males can be affected starting from the second decade of life while in women the problem usually becomes more prominent after menopause. In male, hair loss usually starts from both edges of the forehead and gradually spreads upwards, resulting in a receding hairline at the forehead. Women may also exhibit this male pattern of hair loss although a diffuse thinning instead of a complete loss of hair is more common, thus preserving the hairline at the forehead.

Now comes the reality and reality usually hurts. There is no absolute cure for androgenetic hair loss but two drugs have been proven by studies to be able to help alleviate the severity of the problem. As already mentioned earlier, you should only consult your pharmacist for these drugs once your doctor has confirmed your hair loss to be androgenetic hair loss. The two drugs are topical minoxidil (such as Regaine) which produces response in a third of cases and finasteride (a 5 alpha reductase inhibitor) which when taken orally as a tablet inhibits the action of the 5 alpha reductase enzyme, hence reducing the levels of DHT.

We do not know exactly how minoxidil works but it is usually applied to the scalp two times a day. Do not expect miracle results immediately as widely claimed. An improvement can be seen after 4 months while for optimal results, expect to wait for up to a year. However, a shorter duration of response can be achieved with the more concentrated solution of minoxidil which is marketed as the 5 percent solution. The other important information is that minoxidil only works as long as you continue to apply it, so once it stopped, any hair which has been regain are likely to be lost again.

If you should find unsatisfactory results with topical minoxidil or for those who wanted to regain hair at the forehead (as minoxidil can only stimulate regrowth of hair at the crown), then the oral medication of finasteride can be considered. This drug is not an over the counter drug and it is not recommended for women as it is not effective (especially in post menopausal women) and is in fact harmful to development of male fetuses in pregnant mothers. The onset of improvement only comes at 3 months and optimal results takes up to 1 year to achieve. The other downside of this drug is that although it stimulates hair growth both in front of the scalp and at the crown, it unfortunately does not do the same at both edges of the forehead. Lastly similar to topical minoxidil, continuation of the drug is necessary to preserve the regrown hairs.