By Dr. John Frank, M.D. – IAHRS, ABHRS,ISHRS, AHLA, XM Radio: ‘The Bald Truth’, NYC, January 23, 2011
Can You Stop Alopecia? No, but You Can Stop It From Damaging Your Hair
Doctors cannot cure Alopecia, but they can halt its affects, i.e., hair loss, under certain conditions. Our understanding of how Alopecia causes hair loss, especially in men, has led to the development of powerful drugs that can completely arrest hair loss in up to 83% of affected men (according to a landmark FDA study). While many options exist to give the appearance of more hair, unfortunately, once hair has been completely lost, the only way to replace the follicles is surgically. To understand why, read on . . .
What Causes Baldness?
One of the keys to understanding baldness is learning about the natural Hair Cell Cycle. Every hair shaft is programmed to grow several inches over the course of a few years, only to fall out, and to be replaced by a new hair in the exact location. This concept of “shedding” occurs with our skin as well. The important steps of the growth cell cycle are the “Growth Phase” also called Anagen and the “Fall-out” phase, also called Telogen.
Most healthy human scalps have on average, 100, 000 healthy hairs. However, only a fraction of them are in the Telogen phase, typically 10%. Therefore, everyday, it is not uncommon for a healthy scalp to lose a significant amount of healthy hair without ever being noticed. It’s normal and the scalp is continuously replacing those hairs. On the other hand, if something were to happen with the Hair Cell Cycle so that more than 10% of the follicles were in the Telogen phase, then this could create a temporary problem.
As mentioned earlier, the scalp replaces these shedding hairs no matter what. However, if more than 10% are falling out, the scalp has a difficult time catching up so rapidly and at this point the hair loss may become noticeable. It is not a permanent condition and it’s only a matter of time until the hairs are replaced with perfectly healthy hair. This condition is called Telogen Effluvium and can last anywhere from several months to several years, but again is only temporary.
On the other hand, permanent hair loss is not caused by any changes in the Hair Cell Cycle. Permanent hair loss is a condition where some or all of the hair and follicle are weakening, thinning and shortening over a significant period of time. The hair still goes thru the normal phases of growth and fall-out during many hair cell cycles, however, as it’s going thru these phases, it’s shrinking and will eventually be lost permanently. So, unlike shedding or Telogen Effluvium as described above, permanent hair loss is only noticeable over a longer period of time.
“Pattern Baldness” In Men & Women
Pattern Baldness is a permanent type of hair loss that is most commonly caused by the detrimental effects of male hormones in the follicles of the scalp. While it is a genetically based condition, you don’t need to have a DNA based test to determine if “Pattern Baldness” is the cause of your balding. In men, a doctor with specialized hair loss training and experience can often tell if you’re suffering from “Male or Female Pattern” baldness just by briefly examining you. In men and in women, the pattern of hair loss typically occurs in specific areas of the scalp and can be represented by the “Norwood Classification” in men and the “Hamilton” in women.
While Male Pattern Baldness accounts for the majority of types of hair loss men, for women, pattern baldness is less common. Nevertheless, the pattern is still predictable enough that an experienced hair loss specialist can make the diagnosis very easily in a simple evaluation and examinationl
Interestingly, older men (70+) can have a pattern of hair loss that does not occur in specific regions but rather occurs uniformly across the scalp. It is called “senile Alopecia.” Young men can also have this particular type of Alopecia. It is called diffuse unpatterned Alopecia.
How Does Pattern Baldness occur at the follicle level?
Testosterone is responsible for initiating and sustaining Pattern Baldness, in both men and in women (women also secrete small amounts of Testosterone.) Testosterone interacts directly with the hair follicles in the front, top and back of the scalp while leaving the hair and follicles on the sides and back of scalp undamaged. While some individuals may be genetically susceptible to the harmful effects of testosterone and others are immune.
Is Pattern Baldness the Only Cause of Baldness?
While Pattern Baldness is the most common cause of hair loss, it is only one of many different causes of hair loss.
So How Do You Stop the Affects of Alopecia (Hair Loss)?
The only way to stop or reverse the effects of hair loss is to first diagnose and then stop the underlying condition. As mentioned above, it’s not uncommon to suffer from derangements in the hair cell cycle (Telogen Effluvium). Once this condition is diagnosed, it’s imperative to find the cause of the effluvium and attempt to reverse it. For example, many women may have a significant amount of hair loss during pregnancy due the tremendous physiologic stress placed on her body. Once this stress subsides, the hair should also return.
On the other hand, if a young man is diagnosed with Pattern Baldness, then he would need to search for ways to minimize the harmful effects of the testosterone. Several medications and treatments exist which may mitigate the hormonal effects, commonly known ones include Finasteride and Minoxidil.
Unfortunately, these treatments can’t replace hair from areas that have lost all hair. However, for areas that are not completely bald, these hair loss medications can prevent further hair loss. For more information on the physiological mechanisms of action for these treatments, one is directed to the websites for some of the brand names of these medications (ie Rogaine, Propecia).
So What is the Bottom Line?
The most well known of hair loss is Male Pattern and Female Pattern Hair Loss. However, although not discussed in detail in this article, people of all ages may suffer from hair loss from many of other causes. Once the actual condition is accurately diagnosed, then a hair loss treatment plan can be formulated.
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