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Say 'Aaah' | The Healthy Man

Losing Hair, Not Yourself

April 26, 1999|Kristl I. Buluran

If you're inspecting the grungy shower drain for clumps of hair or combing skimpy strands of hair in directions they were really never meant to go, join the club: Two out of three men will have to face male pattern baldness.

Male pattern baldness is largely a hereditary problem. Other influences, however, include age and an overabundance within the hair follicle of the male hormone dihydrotestosterone, or DHT, which is a highly active form of testosterone. Testosterone is converted to DHT by an enzyme called 5-alpha reductase. Over time, DHT causes the hair follicle to degrade, resulting in death of the follicle or weak hairs that shed easily.

A man's hair loss typically begins at the temples and is always symmetrical, meaning that it occurs on both sides of the head. Most men begin to notice a receding hairline and thinning in their early 30s, although it may occur sooner for some men; the reasons for this are not yet known.

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While male pattern baldness is considered more of a cosmetic than a medical problem, hair loss obviously has a psychological dimension, too. Research on men suffering from hair loss has shown that those who experience the greatest loss of hair have lower levels of self-esteem and satisfaction with their appearance. Also, younger men experiencing hair loss suffered more from these negative effects. So it's no surprise, then, that the business of hair treatment loss is a booming one.

There are currently two drug treatments for male pattern baldness approved by the Federal Drug Administration. One of them is called minoxidil, which is better known as Rogaine. It is a clear topical solution that is applied to the scalp daily. Although minoxidil has been studied extensively, researchers still do not fully understood why it makes hair grow. The product, on the market since 1988, has a good safety record, where the most common side effect is itching of the scalp, according to the FDA. It is also sold over-the-counter as a generic product.

The other drug treatment is called finasteride, marketed under the name Propecia. Approved for sale by the FDA in 1997, Propecia comes in the form of a pill to be taken daily. This medication works by blocking the conversion of testosterone to DHT by inhibiting the 5-alpha reductase enzyme.

Clinical studies have shown that finasteride promotes scalp hair growth and prevents further hair loss in a significant proportion of men with male pattern hair loss. This medication is currently available only through prescription. Some reported side effects include loss of libido and sexual function; however, clinical studies have shown these to be rare and of mild to moderate severity.

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The highest concern lies with the danger Propecia has for women. The drug has been shown to pose a significant danger to women of childbearing age, as it may cause serious birth defects in male fetuses. Pregnant women are advised to not even handle crushed or broken finasteride tablets. However, no side effects have been observed in women as a consequence of their partners' use of finasteride.

Because side effects vary with each individual, you should discuss with your doctor which treatment is best for you. Also, the effects of combined usage of minoxidil and finasteride are currently under study, so it is best not to combine the medications until further results are known.

Other known treatments for male pattern baldness involve surgery and hair transplantation. If you are interested in exploring these alternatives, it's a good idea to discuss them with your family physician, who may be able to make a referral.

Finally, there is that age-old question: to shave your head or not? If you are so preoccupied with your hair loss that you are forgetting your good points, such as your charming personality, nice smile and so on, perhaps you should just shave your head. Many men feel that in losing their hair, they are losing their youth, vitality and sex appeal. But I'll let you in on a secret: Some women find men with bald heads rather attractive. Michael Jordan comes to mind.

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Kristl I. Buluran holds a master's degree in public health and is a clinical researcher in Los Angeles. She can be reached via e-mail at buluran@ibm.net.

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