Ever stared down at the plughole in the shower and wondered how much hair gets collected there? The thought of losing hair can be a dreadful thought for some and it is a well-founded concern. In some societies, hair loss is generally accepted as a sign of ageing which eventually becomes the subject matter of jokes about ageing.
However, it may not be a laughing matter after all. Hair loss usually manifests itself differently depending on gender, age and the person’s physical and mental health. For men especially, hair loss is not restricted to scalp hair but also other body hairs such as beard hair and eyebrow hair. Loss of scalp hair tends to be of greater importance for most men as it has some bearing on a man’s image and the way he presents himself. Ultimately, the one main concern for men is just how devastating can hair loss really be? Hopefully this article can help shed some much needed light on this age old problem and also debunk some myths about hair loss.
Hair loss, or alopecia, as it is known among the medical fraternity, is the umbrella term for the many types of hair loss which presents itself with different causes and symptoms. Male pattern baldness or androgenetic alopecia is undoubtedly the most common type of hair loss which affects about 1 in 2 men as they reach the age of 50. It generally presents itself as a pattern of balding with loss of scalp hair leading to a receding hairline. The end result is a distinctive horseshoe shape around the back and sides of a men’s head.
Loss of scalp hair is caused by thinning of hair around the temple and crown regions of the head. Androgenetic alopecia is the result of a gene which leads to increased sensitivity of hair follicles (the cavity where each strand of hair resides) to androgens. Androgens, namely testosterone and dihydrotestosterone are a class of hormones responsible for the growth of male reproductive organs and the development of male secondary sexual characteristics such as growth of pubic hair. Dermal cells in the skin are capable of converting testosterone to dihydrotestosterone which can lead to shrinking of hair follicles. Expression of that particular gene basically leads to more shrinking of hair follicles which causes thinning of hair and the receding hairline.
Male pattern baldness tends to become more prominent as a man ages; although, most males suffering from it do not end up with a bald head. Ethnic factors do play a part in male pattern baldness. Male Caucasians are more likely to experience it compared to Asian men and Afro-Caribbean men.
Can hair loss affect younger people?
Men can experience initial signs of male pattern baldness even before they reach their forties. It may not be so obvious at this stage but there will be some degree of hair loss which will appear as small patches of exposed scalp. It is possible to confuse this with alopecia areata (AA) which is another common form of alopecia. Alopecia areata usually manifests itself as small hairless patches on the scalp. Someone suffering from AA may not necessarily lose all his hair but it is possible for this disease to progress to a more advanced form known as alopecia totalis (AT) where the scalp becomes totally devoid of hair.
An even more severe form of alopecia involves complete hair loss from the entire body. AA can affect anyone regardless of age. This type of alopecia is the result of an over reactive immune system. Basically, the white blood cells of the immune system meant to defend our body against invaders goes into overdrive and starts attacking the hair follicles. Hair becomes progressively shorter and thinner and eventually falls out.
Fortunately, hair can grow back again even without treatment as the stem cells that give rise to hair follicles are not destroyed. AA may be hereditary as statistics have shown that 1 in 5 patients with AA have at least one family member with the condition. A GP will check your medical history of any autoimmune conditions as many AA patients may also suffer from autoimmune conditions and medicinal treatment with drugs like Finasteride (Propecia) is not suitable for patients with this type of alopecia. Absence of any autoimmune diseases will more likely point towards male pattern baldness or androgenetic alopecia which can be treated with drugs.
Is it normal to lose hair on a daily basis?
As mentioned earlier, is it perfectly normal to lose on average about 100 strands of hair every day. However, some people tend to lose more hair than that which results in telogen effluvium. Telogen phase of the hair follicle growth cycle is the natural phase of scalp hair shedding. If hair follicles remain in telogen phase for a longer period of time than usual, it is likely that the person will start shedding hair leaving the scalp exposed. Such a change can be brought about by triggers such as trauma, childbirth, bereavement and even hormonal changes. The mechanism which causes this to happen is still not fully understood. As with all types of hair loss, it is possible to re-grow the hair provided the triggers are removed.
What’s the big issue with going bald?
At first glance, it may seem like hair loss is more of a cosmetic problem rather than a health condition. In fact, hair loss is not life-threatening at all in anyway. The effects of hair loss tends to be more psychological in nature rather than physical. Losing hair and having bald patches before a man reaches his early forties can deal a huge blow to a man’s self-esteem. A person’s outward appearance could not be more important in this day and age where society is obsessed with looks and aesthetics.
Imagine losing confidence while attending a job interview, all because you are worried about the interviewer judging you based on your appearance. Lack of self-esteem can be debilitating for a man trying to socialise or even get intimate with other people. The crux of the matter is that some men may be embarrassed about going bald or having bald patches on their head. In extreme cases, depression, social phobia and anxiety issues could be likely outcomes which will greatly impact a person’s quality of life. Studies conducted by researchers prove that men suffering from hair loss tend to suffer from higher levels of anxiety compared to men without hair loss.
Losing hair progressively over a period of time can stir up concerns over body image. Men may not feel so confident about stepping out in the open as they become overly concerned about how other people perceive them. The social phobia or anxiety can be due to feelings of regret over something they lost, which in this case happens to be their hair, despite knowing full well that it was not their fault at all. Such feelings of loss can be so bad that some patients suffering from hair loss described the sensation to be akin to mourning someone’s death.
Are there any solutions?
Treatment may not always be necessary for male pattern baldness. But let’s face it, not everyone with a bald head can stand tall and proud. Psychosocial impact of hair loss on people has been well-acknowledged and helping the affected person cope with the emotional impact could be more important than seeking aesthetic treatments or wigs.
Boosting a person’s self-confidence about his image can be empowering to help someone realise that he can continue with his daily routine despite without losing sleep over what he looks like. Additionally, purchasing wigs may not be economical for certain men. Wigs cost around £68.90 even for stock modacrylic wigs. A full bespoke human hair wig can cost nearly four times as much as a modacrylic wig. Wigs are available on a NHS prescription but not everyone qualifies for free wigs even if they are exempt from NHS prescription charges. The other thing that patients should bear in mind is that acrylic wigs may not be suitable if the patient is allergic to acrylic hair.
Alternatively, patients may prefer to try medical drug treatment options like finasteride. Finasteride is available as a tablet which generally works by inhibiting the conversion of androgen hormone testosterone to dihydrotestosterone which causes shrinking of hair follicles. Finasteride is convenient to take as patients only need it to take once a day. There are currently two versions of finasteride available in our pharmacy, the branded Propecia® and the generic finasteride version. Both contain the same active ingredient at the same strength; the only difference is the price of the two products.
Branded versions tend to work out to be more expensive than the generic version as the company that originally held the patent for the drug needs to recover the cost of research and development (R&D) of the drug, whereas the company that developed the generic version does not need to conduct extensive R&D in the process of manufacturing the product. Generally, most men can take finasteride safely provided they are above the age of 18 as it is not licensed for use in those below the age of 18.
Sexual side effects such as reduced desire to have sex have been previously reported but it is important to remember that not everyone has them. Only about 1 in 100 men will experience these effects. These unwanted effects may even subside later as the treatment progresses. Beneficial effects are only seen if a patient adheres to the treatment for at least 6 months or even longer.
Minoxidil on the other hand is available as a lotion for direct application to the scalp. The exact mechanism of how it works is not fully understood but evidence suggests that it encourages the hair follicles to enter the anagen phase or rapid growth phase.
It is very important to note that hair loss may resume if both treatments are discontinued abruptly. At the moment, both treatments are currently only available via a private prescription. There are other treatments such as corticosteroid creams and lotions that are prescribed by skin specialists. Beyond drug treatments, most other treatments such as ultraviolet light treatment and hair loss surgery demonstrate variable outcomes which does not outweigh the high-cost of treatment.
What are the misconceptions about hair loss?
Over the years, oral tradition has contributed too many misconceptions about hair loss. People have somehow reached the conclusion that use of hair care products cause hair loss. The truth is, people are free to use gel, mousse or hair sprays as often as they choose as it does not cause hair loss. It may make sense to believe that increasing blood flow to the scalp area helps reverse hair loss. Engaging in habits such as washing hair with cold water does encourage blood flow to the scalp but increasing blood circulation does not influence hair growth or loss of hair. It is true, however, that any activity that adds too much tension on hair can cause hair loss. This includes wearing tight hats and adopting certain hairstyles; although, this is applies more to women than men.
To sum it up, hair loss is very much manageable according to the choice of treatment that a patient prefers. Fortunately, there are now drug treatments which have been proven to work. If you are uncertain about hair loss, please do contact us for more advice. Our pharmacy team will be more than happy to confidentially discuss any queries or concerns you may have about hair loss. You can also consult with Dr McHugh, our London-based GP for further advice. Hopefully, hair loss will be less of a hairy issue for men given the wide range of management options available.