Paging Dr. Frischer - Baldness and thinning hair

Today’s issue is not life threatening, but is quite significant if it happens to you! Baldness and thinning hair is extremely common; by age 35 over two-thirds of American men will have it to some degree, and by 50, the figure increases to about 85%. By one survey, more than half of them would prefer more hair over money, and one-third report that they would give up sex if it meant they would get their hair back! Regardless of whether this survey was conducted scientifically, it is clear that baldness and hair loss can be devastating and certainly can affect self-esteem and confidence. Balding or hair loss has three main causes:

Hereditary hair loss, called androgenic alopecia, affects both men and women. Men with this type of hair loss experience male pattern baldness, a type of baldness that targets the top of the head and hairline. Women’s hair may thin, but they do not tend to become bald.

Diseases that can cause hair loss include diabetes, lupus, fungal infections, hair follicle scarring, thyroid disease, stress, and severe chronic illness.

Drugs that can cause hair loss as a side effect include chemotherapy, retinoids, NSAIDS (which include aspirin, naproxen, and ibuprofen), beta-blockers, birth control pills, and antidepressants.

In addition, environmental exposures, harsh hair treatments, hormonal changes and childbirth, vitamin deficiencies, low iron levels, and smoking can aggravate hair loss. Note that hair loss can occur if the hair is constantly pulled or twisted. Science never passes up a chance to name a condition, and this is known as trichotillomania.  It can affect children as well as adults, and may develop as a habit and/or from a psychological problem. Even wearing tight ponytails, buns or other tight hairstyles over time can cause hair loss.

Naturally, a common but unwanted affliction like hair loss has its share of myths and factoids. The desire for simple solutions is understandable! For example, Hippocrates, father of modern medicine, recommended a mixture containing horseradish and pigeon droppings. Common but incorrect beliefs include:

· Genes for hair loss come only from the mother’s side of the family. While the maternal side does play a greater role in hair growth, common baldness can be inherited from either side of the gene pool.

· Bald men have high levels of testosterone. Hair loss is caused by a greater genetic sensitivity of hair follicles to the hormone DHT (dihydrotestosterone), which is a byproduct of testosterone, and far stronger. There is actually no link between hair loss and a man’s fertility or virility. On the other hand, estrogen helps women avoid complete baldness. Still, over 40% of women suffer from significant thinning throughout their lifetime.

·The natural course of balding results in clumps of hair falling out. This is untrue; instead, hairs with normal thickness are gradually replaced by finer, thinner hairs, and each hair follicle has a shorter lifespan. This process is known as “miniaturization.”

·Decreased blood flow causes hair loss. The truth is actually the opposite! When hair is growing, it requires a significant amount of blood flow. Once hair is lost, less circulation is needed, and blood flow to the scalp decreases. A decreased flow of blood to the scalp is not a cause of hair loss, but a result.

·Wearing a hat causes baldness, due to the hat preventing the scalp from breathing. Nope - hair follicles get their oxygen from the blood stream and not from the air.

·Shampooing causes hair loss. Think about this. When we shampoo, we notice hair in the tub or shower. Concerned about hair loss, some people might wash their hair less often, and the hair that would be coming out regularly now builds up on the scalp. With the next shampoo, even more ends up in the tub, seemingly confirming the belief that shampooing causes hair loss! Again, normal hereditary baldness is not due to hair falling out, but rather by “normal” hairs gradually being replaced by finer, thinner hairs.

·If you are balding, shaving your head will help your hair grow back thicker. Untrue! What is important are the hair follicles, not the hairs.

Finally, remember that once hair loss begins, it tends to progress over a lifetime and never really stops. It is fair to say that the younger you are when hair loss begins, the more likely you are to become bald.

Treatments vary for men and women. Because hair loss in women is usually due to vitamin or hormone issues, supplements can be useful. There are a few very popular FDA-approved medications used to help treat hereditary baldness in men. Rogaine and Propecia work reasonably well in slowing down hair loss and even may generate some hair re-growth. Hair replacement techniques include micro grafting, slit grafting, punch grafting and scalp reduction. Since there can be a considerable cost and some side effects, it’s important to weigh all options. Remember that baldness and hair loss won’t actually harm you.

Everyone’s hair is different, so hair loss and treatments will vary. Remember, a balanced diet and a healthy lifestyle can’t hurt!


Dr. Alan Frischer is former chief of staff and former 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.



Published: Sept. 25, 2014 - Volume 13 - Issue 24