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04 December 2008

Hair loss

Since the arrival of the new baldness drug Propecia® (finasteride), there have been quite a few questions about baldness. There are many reasons for hair loss.

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Since the arrival of the new baldness drug Propecia® (finasteride), there have been quite a few questions about baldness. There are many reasons for hair loss or alopecia, as it is medically known, but only a few of them are common. I will only discuss the common and treatable causes of alopecia for the sake of keeping it simple.

The average person has about 100 000 hairs on his/her head that have an average life span of about three years. A single hair will grow for two to four years, rest for two to four and then fall out. On average a normal person loses about a 70-100 hairs a day that are replaced by new hairs soon after. When something goes wrong with this process, you become bald.

What is Alopecia?
Mainly there are two types of alopecia - localised or patchy and diffuse alopecia. The most common causes for localised alopecia are a fungal infection or alopecia areata. Fungal infections that cause hair loss are, unlike most other fungal skin infections, always treated systemically, i.e. with pills and not creams.

Alopecia areata is patchy areas of hair loss associated with obvious skin disorders or systemic diseases like SLE, syphilis, Addison's disease, vitiligo and cancer. When you're really sick, hair loss is the last thing you're worried about, so this is probably not the reason for anybody you know's hair loss.

Causes of hair loss
There are five fairly common causes of diffuse hair loss. These are: Telogen effluvium, nutritional disorders, drugs, hormone abnormalities and male pattern baldness (androgenetic alopecia).

Telogen effluvium is temporary hair loss of up to a third of a person's hair due an insult to the body. It usually manifests Two to four months after the incident. Common causes are crash diets, exam stress, big operations, pregnancy and divorce/loss of a loved one.

It starts normalising after three to six months and after a year it's almost always back to normal. It is more common in females and needs no treatment.

Nutritional causes of baldness
The most common nutritional problems associated with alopecia are iron and zinc deficiency. In practice, these are probably the only ones causing alopecia.

From this you can see that taking hundreds of vitamins, nutrients, microelements etc. (who knows what some of the concoctions contain), will do no good. Biotin for instance, can make your hair grow strong and thick, but it will not stop you from going bald. If the blood tests for iron and zinc are normal, a nutritional deficiency is not the cause of your alopecia.

Sex hormones don't play a role in hair loss
Drugs most commonly associated with alopecia are oral contraceptives, warfarin, heparin, cimetidine, and propranolol. Chemotherapy is widely associated with hair loss, but this is a reversible hair loss in almost all cases.

Hormone problems may cause hair loss, but not the sex hormones. Neither oestrogen nor testosterone deficiency or excess, plays a role in hair loss. The diseases that are associated with alopecia are diabetes mellitus and thyroid problems. From the above you can work out that when you have blood samples taken to determine the cause of your hair loss, one seldom needs to do more than tests for iron, zinc, thyroid hormone, sugar and a full blood count.

If your dad is bald...
Male pattern baldness is the most common form of alopecia and is of genetic predetermination. If your dad is bald, you will probably become bald too. It is with this form of baldness that the new drug Propecia® (finasteride) has shown promising results.

In male pattern baldness, dihydrotestosterone (DHT) causes a shortening of the growth phase and thinning of the hairs. Finasteride blocks an enzyme called 5a-reductase that changes testosterone into DHT and in this way prevents these changes from taking place.

In 99% of men it will stop hair loss within a year, a third will have a slight increase in hair and a third will show marked improvement. Because it works on the changing of testosterone to DHT, it will not work for women and may be very dangerous in pregnancy.

The downside
Before you think that I'm trying to promote a product, finasteride is not the beginning and the end of treating male pattern baldness. You have to take it as early in the disease as possible and generally it doesn't work for people older than 50 or in cases where the person has gone completely bald.

One thing is for certain, it is a hell of a lot better than anything that has been on the market up to now and definitely something to think about using until something better comes along.

 
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