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Paging Dr. Frischer - Hair Loss
WRITTEN BY :   Dr. Alan Frischer

Have you or has someone close to you experienced hair loss? What causes it? Can anything be done to prevent it, or to reverse this non-life threatening yet nevertheless distressing condition? Every hair on our head follows a cycle of approximately one year: it grows, rests, and then falls out. About 90% is growing at any one time, with the balance resting for a period of two to three months. After resting, the hair goes through a shedding phase. It is normal to shed 50 to 100 hairs per day. Once a hair is shed, a new one starts growing from the same hair follicle, and grows about 1/2 inch per month. Hair is made of protein, the same material that is found in fingernails and toenails. Note, therefore, that eating adequate amounts of protein can aid in hair growth. Among other food items, protein is found in red meat, chicken, fish, eggs, cheese, beans, soy products, grains, and nuts. For many men, hair loss is inevitable. It is hereditary and progresses with age. These genes may be passed from either the maternal or paternal side of the family. Male pattern baldness, or common baldness, is by far the most typical cause of hair loss, and in our country alone approximately 40 to 65 million men suffer from it (depending on the criteria used). Often in the late twenties, the hairline begins to recede and the hair on the top of the head becomes thinner. There are other conditions that can lead to hair loss: •Three to four months after a major stress (emotional or physical) such as an accident, surgery, or illness, people of either gender may experience significant hair loss. This hair loss is temporary. •Hormonal problems may cause hair loss. Disorders of the thyroid gland, whether over or under active, can cause hair to fall out. Hair loss can also occur when male or female hormones (androgens and estrogens) are out of balance. Correcting these hormonal imbalances may stop the loss. •Pregnancy can be a factor. Many women notice hair loss three months post partum (after the baby’s birth). This is again a hormonal problem, and is temporary. High levels of female hormones cause hair to stay in longer than normal, and when levels fall back to normal, hair goes back to its old cycle. •A number of common prescription medicines have side effects that cause hair loss. The most common culprits are blood thinners, gout medicines, chemotherapy agents used for treating cancer, birth control pills, antidepressants, and even too much (nonprescription) vitamin A. The problem will reverse itself if the medication is stopped. •Infections also may cause hair loss. For example, fungal infections of the scalp are treated with an antifungal medication to reverse the problem. Of course, any significant infection that causes major physical or emotional stress (see above) can also cause a reversible hair loss. •Certain diseases such as lupus or diabetes can cause hair loss. Hair loss can serve as a valuable early warning sign, so it is important to diagnose the cause as early as possible. •Hair loss may even be the result of wearing pigtails or cornrows! Pulling tightly on the hair causes a type of hair loss called traction alopecia. This type of damage must be halted early on or it will become permanent. In addition, the hot oils used in “permanents” may cause hair loss due to the inflammation and swelling of hair follicles. In order to determine the cause of your hair loss, your doctor will ask you about your diet, if it is balanced, and whether it contains adequate nutrition – especially protein. You will want to list your medications in order to determine whether one might have resulted in hair loss as a side effect. The doctor will take a health history, in order to reveal whether you have undergone unusual stress or illness in the past three to four months. If you are a woman, you will discuss your menstrual cycles, pregnancies and menopause. A physical exam should be done, including looking specifically for scalp infections. Lab tests may be taken to determine whether there are any hormone imbalances, diabetes, thyroid disease or rheumatologic diseases. Treatment for common inherited male pattern baldness is complex. There is no cure at present, but finesteride (Propecia) is a prescription hair loss medication (for men only) and has been analyzed in a five-year study. An impressive 77% showed scalp hair growth verses only 15% of test subjects taking a placebo. Side effects of Propecia appear to be minimal: They include decreased libido in 1.8% of subjects, and decreased volume of ejaculate, impotence, or breast tenderness in less than 1%. Minoxidil (Rogaine) is an over-the-counter medication rubbed directly into the scalp and may work for both men and women. In a study published in 2005, one-year follow-up data showed that areas of the scalp with hair loss became smaller in 62% of the patients, unchanged in 35% and larger in 3%. Finally, hair transplantation is a surgical approach that has made great advances in recent years. Healthy hairs with follicles intact are harvested from an area of the scalp with normal hair growth and the individual hairs are re-implanted into areas of the scalp with hair loss. The results can look very natural. Costs run roughly five to six dollars per hair, or $3,000 to $9,000 for the procedure. Allow me to “part” with some suggestions: •Eat a balanced and nutritious diet for hair health. •Treat your hair carefully. Be careful with foreign chemicals, heat and tight hairstyles (ponytails, buns, etc.). •Avoid compulsively pulling, twisting, or rubbing your hair. Rogaine and Propecia have proven efficacy for growing new hair and preventing further hair loss. Other over-the-counter products have not yet been proven. •Many find success with a natural looking wig or hairpiece…or by developing a fondness for the bald look. See your doctor to ensure that there are no infections or other underlying problems responsible. Where feasible, work together to eliminate or alter medication that may be causing the hair loss. It is crucial that you get a proper diagnosis, and treatment when possible. There may be a reversible cause to your hair loss. I wish you good health! Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.
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Published: March 13, 2009 – Volume 7 – Issue 47



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