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January 2008

Medicines offer hope for regrowth of hair

Jan 2008

First the forehead gets higher, then a spot at the back of the head clears -- hair loss is for many men the worst thing they could possibly suffer as they get older.

While balding men used to place their hopes in all kinds of remedies or attempt to conceal the areas with hair pieces, effective hair growth medications have been available for years. But they can't guarantee the return of a full head of hair.

There are good reasons for the anxiety men feel when their hair starts to fall out.

"Studies show that to other people, bald men appear to be an average of three to four years older than they actually are," said Ronald Henss of Saarbruecken.

"They also are perceived as less stylish than men with a full head of hair. In the eyes of many beholders, a bald head means the loss of attractiveness. One small comfort: "Most people think of bald-headed men as family men and faithful husbands," said Henss.

The likelihood of hair loss increases with age. By their 80th birthday about 80 percent of men are affected, said dermatologist Natalie Garcia Bartels of a center's of excellence for hair at Berlin's Charity Hospital. Up to 100 individual hairs fall out per day from a normal head. Anything over that is considered hair loss.

"Mostly it is congenital hair loss -- the so-called androgenic alopecia or male-pattern baldness, which can begin in men from age 20," said Garcia Bartels.

It appears gradually as a receding hairline from the lateral sides of the forehead or hair loss as a bald patch at the top of the head that works its way gradually toward the front. "Many men are left with only a ring of hair around the lower part of their head."

Hair loss is set off by a hormone in the scalp. An enzyme causes testosterone to be transformed into dihydrotestosterone (DHT), which is believed to be the primary contributing factor in most cases of male pattern baldness.

The hair follicle develops a deep sensitivity to DHT, which initiates a process of follicular miniaturization. This progressively decreases the width of the hair shaft until the scalp hair resembles peach fuzz or goes away completely.

"The result is more hair than normal is lost. Why this happens to some men and not others has not yet been researched," said endocrinologist Gerd Hofmann of Munich.

There are other types of hair loss, but they occur less frequently. When circular patches of hair fall out, for example, the cause typically is an autoimmune disease that sets in rapidly, said Garcia Bartels. Sometimes hair loss is attributed to an internal disease of the thyroid or a low level of iron in the blood.

There are remedies available to stop hair loss caused by male pattern baldness and possibly even to reactivate the still existing hair follicles.

The effectiveness of the remedies in fact has been documented in studies. Remedies with the effective ingredient finasterid, used in high doses to treat the prostate gland. It blocks the enzyme that converts testosterone into the hair follicle-damaging DHT.

Finasterid can be obtained through a prescription and it is in the form of a tablet taken daily.

"If the treatment is stopped, the hair loss as a rule will start again," said Garcia Bartels. The price of the drug -- about 150 euros (US$220) for a three-month supply -- is high. Somewhat more economical is Minoxidil, which is a lotion that must be applied to the scalp twice a day.

Originally developed as a blood pressure medication, Minoxidil was found to have the side effect of hair growth.

Minoxidil's success rate is however lower: while hair loss is stopped in 80 percent of the people who use finasterid, the rate is 70 percent among people who apply Minoxidil.

Additionally, 70 to 80 percent of finasterid users experience hair regrowth. This is true for 50 to 60 percent of Minoxidil users.