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Baldness
What Is Baldness?
Baldness is lack of or loss of hair from areas of the body where hair is normally found. The most common cause of hair loss in both men and women is the result of genetic factors passed down to you by your parents, not only through your mother's side of the family, but also through your father's side of the family - a combination of generations. Called androgenic (referring to the male hormone androgen) alopecia, it is known as male-pattern baldness in men and female-pattern hair loss in women. Alopecia is the scientific term for baldness for partial or complete loss of hair. According to the American Hair Loss Council, genetics accounts for 95 percent of all cases of hair loss in this country.
Baldness results from a combination of genetic factors and levels of testosterone. Testosterone is a hormone produced by the adrenal gland in both sexes and also by the testes in men.
If hormone levels are right, then the hair follicles will express their genetic destiny by growing for shorter periods and producing finer hairs.
In men, who have higher levels of testosterone than women, this eventually results in a bald scalp at the crown of the head and a horseshoe-shaped fringe of hair remaining on the sides.
In women, the hair thins all over the scalp, the hairline does not recede. This type of hair loss doesn't usually show up in women until menopause, until then, estrogen tends to counteract the effects of testosterone.
In the United States, some 40 million men are losing or have lost their hair from male-pattern baldness, according to the American Hair Loss Council. Approximately 20 million women have experienced a similar loss of hair (from female-pattern hair loss), and an estimated 2.5 million Americans have lost their hair due to other causes.
It is normal to lose some hair each day due to the replacement of human hair during the hair growth cycle. The hair growth cycle has 3 phases:
- 1) Anagen - this is the growth phase, when a hair grows. The growth phase lasts about 2 to 7 years. At any given time, about 90 percent of scalp hair is in the growth stage.
- 2) Catagen - this is the transition period between the anagen (growing) and telogen (resting) phases, which is when hair growth begins to shut down and stop activity. About 2 percent of our hair is in this phase at any given time. The catagen phase lasts about 3 weeks while a club hair is formed. This process cuts the hair off from its blood supply and from the cells that produce new hair. A new hair is formed and pushes the club hair up the follicle and eventually out.
- 3) Telogen - this is when a hair is resting and is ready to be naturally shed. This lasts from 3 weeks to 3 months. About 10 to 18 percent of hairs are in the resting phase at any given time.
Once the resting phase is over, the hair strand falls out and a new one begins to grow, which is when the hair growth process starts over again.
Many things such as genetic factors, diet, stress, and medications, can change this process. Genetic baldness is caused by the body's failure to produce new hairs.
Both men and women tend to lose hair thickness and amount as they age. Inherited or "pattern baldness" affects many more men than women. About 25 percent of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60.
Typical male pattern baldness involves a receding hairline and thinning around the crown with eventual bald spots. Ultimately, you may have only a horseshoe ring of hair around the sides. In addition to genes, male-pattern baldness seems to require the presence of the male hormone testosterone. Men who do not produce testosterone (because of genetic abnormalities or castration) do not develop this pattern of baldness.
Some women also develop a particular pattern of hair loss due to genetics, age, and male hormones that tend to increase in women after menopause. The pattern is different from that of men. Female pattern baldness involves a thinning throughout the scalp while the frontal hairline generally remains intact.
Causes of Baldness
Baldness is not usually caused by a disease, but is related to aging, heredity, and testosterone. In addition to the common male and female patterns from a combination of these factors, other possible causes of hair loss, especially if in an unusual pattern, include:
- Alopecia Areata - bald patches that develop on the scalp, beard, and, possibly, eyebrows. Eyelashes may fall out as well. Treatment may require topical or injectable steroids or ultraviolet light.
- Autoimmune conditions such as Lupus.
- Burns.
- Certain infectious diseases such as syphilis.
- Chemotherapy - the use of anticancer drugs to kill cancer cells. Pronounced KEE-moh-THAYR-uh-pee
- Emotional or physical stress.
- Excessive shampooing and blow-drying.
- Fever.
- Hormonal changes -- for example, thyroid disease, childbirth, or use of birth control pills.
- Nervous habits such as continual hair pulling or scalp rubbing. Compulsive Hair Pulling
- Radiation therapy - treatment using radiation to destroy cancer cells.
- Tinea capitis - ringworm of the scalp. Ringworm on the scalp may require the use of an oral drug, such as griseofulvin, because creams and lotions applied to the affected area may not get into the hair follicles to kill the fungus.
- Tumor of the ovary or adrenal glands.
- Abnormal kidney and liver function.
- Hypothyroidism - underactive thyroid.
- Hyperthyroidism - overactive thyroid.
Home Care
- Hair loss from menopause or childbirth often returns to normal 6 months to 2 years later.
- For hair loss caused by illness (such as fever), radiation therapy, or medication use, no treatment is necessary. The hair will usually grow back when the illness has ended or the therapy is finished. A wig, hat, or other covering may be desired until the hair grows back.
- For hair loss due to heredity, age, and hormones, the topical medication Rogaine (minoxidil) can be helpful for both male and female pattern baldness. Expect to wait 6 months before you see results. The oral medication Finasteride (propecia) is effective in some men. This medicine can decrease sex drive. When either medication is stopped, the former baldness pattern returns.
- Hair transplants performed by a physician is a surgical approach to transferring growing hair from one part of the head to another. It is somewhat painful and expensive, but usually permanent.
- Hair weaves, hair pieces, or changes of hair style may disguise hair loss. This is generally the least expensive and safest approach to hair loss. Hair pieces should not be sutured to the scalp because of the risk of scars and infection.
When to Contact a Medical Professional
- You are losing hair in an unusual pattern.
- You are losing hair rapidly or at an early age, for example, teens or twenties.
- You have any pain or itching associated with the hair loss.
- The skin on your scalp under the involved area is red, scaly, or otherwise abnormal.
- You have acne, facial hair, or menstrual irregularities.
- You are a woman and have male pattern baldness.
- You have bald spots on your beard or eyebrows.
- You have been gaining weight or have muscle weakness, intolerance to cold temperatures, or fatigue.
What to Expect at Your Office Visit
- A careful medical history and examination of the hair and scalp are usually enough to diagnose the nature of your hair loss. Your doctor will ask detailed questions such as:
- Are you losing hair only from your scalp or from other parts of your body as well?
- Is there a pattern to the hair loss like a receding hairline, thinning or bald areas on the crown, or is the hair loss throughout your head?
- Have you had a recent illness or high fever?
- Do you dye your hair?
- Do you blow dry your hair? How often?
- How often do you shampoo your hair?
- What kind of shampoo, hair spray, gel, or other product do you put on your hair?
- Have you been under unusual stress lately?
- Do you have nervous habits that include hair pulling or scalp rubbing?
- Do you have any other symptoms like itching, flaking, or redness of your scalp?
- What medications do you take, including over the counter drugs?
Tests that may be performed (but are rarely needed) include:
- Microscopic examination of a plucked hair.
- Skin biopsy (if skin changes are present).
References:
1) Medlineplus - July 2007 - www.nlm.nih.gov/medlineplus
2) U. S. Food and Drug Administration - FDA Consumer - December 1991 - www.cfsan.fda.gov
This summary is a general overview about the topic discussed and does not include all the facts, or include everything there is to know about any medicine and/or products mentioned. Do not use any medicine and/or products without first talking to your doctor. Possible side effects of medications, other than those listed, may occur. Full Disclaimer & General Safety Advisory