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    What Happened to My Hair?!

    Prescription Drugs and Hair Loss

    Buyer Beware!

    Study Links Baldness, Heart Problems

    The Social Dimensions of Hair Loss

    Our Crowning Glory

    What Causes Hair Loss

    What About Drugs and Ointments for Hair Loss?

    The Psychology of Hair Loss

    What About Genes?

    My Experience with Grafting

What Happened to My Hair?!
by
Claudia Kavanagh

 Imagine your teeth suddenly falling out.  You would understandably be distressed and would seek the attention of a qualified  dentist to prevent further decay and correct the loss.  No one would question your motivation to correct this cosmetic defect and return your appearance to its original condition.  Hair loss to women is quite similar, and many suffer tremendous anxiety because of it.

 Hair plays a significant part in our lives.  Another person’s hair is one of the first characteristics we notice upon meeting.  Our own hair is one of the first and last things we attend to before a meeting or social engagement.  Society has placed a great deal of social and cultural importance on hair and hairstyles.  Hair is like a frame for the face.  As an attractive frame and matting compliment a picture, hair compliments the features on a face, and like that picture, if the frame is taken away, the picture appears plainer and less attractive. 

A hair disorder, especially when severe, often profoundly affects the lives of those afflicted.  Men and women both may resort to so-called “magic potions,” megavitamins, scalp massage, and electric treatments to encourage new hair growth.  Severe hair loss evokes not only cosmetic concerns, but may also stir up feelings of vulnerability, loss of self esteem, and alterations in self image

Perhaps you do not know that the possibility is great you know a woman who is bald.  Surprised?  After reading this article, you will probably begin to closely scrutinize the hair of women you know, or do not know for that matter.  It is more than likely that you will not be able to pick out the “bald lady.”  These days, hair replacement for women offers more options and better prices – and best of all, greater “non-detectability!” 

Men deal with their “pattern baldness” in different ways.  They either relax and forget about it (“accept me as I am”), or panic and buy all the tonics and solutions on the market with the hope of curbing their hair loss.  Perhaps vigorous massage is the answer.  In Eastern Europe, there is even a tradition of abating hair loss by rinsing one’s hair in kerosene!  Any number of treatments and products are used and much money is spent on bogus “cures” before these panicky males realize that the shedding is not going to stop.  Deep inside and despite being exposed to relentless advertising, they begin to realize there is really no product that will restore the head of hair they had in their twenties.  At some point, they have to make the decision whether to wear a hair replacement system, toupee, or wig, or just accept their fate. 

We all hear these stories.  Most of us have a male acquaintance or friend who is balding – you can probably tell if there is anguish or acceptance.  But what about a woman in this same situation?  Societal conventions dictate that there can be no “accept me as I am” for a woman.  A full head of hair is a woman’s “crowning glory,” unless she is an entertainer or someone who uses baldness to make a statement or to be remembered.  More than likely, this particular woman has a good amount of hair and shaves it off on purpose. 

But what about the homemaker or businesswoman who does not want to make a statement?  Wearing a wig has traditionally been the only practical solution – but wigs can be hot and uncomfortable, and a lot of times very detectable!  Many women have felt shame and frustration with their situation, and unhappy with the available options - but what other solutions are there?

 A woman can lose her hair for a number of reasons – genetic predisposition – exposure to harsh chemicals – accidents – chemotherapy – alopecia.  Read on to learn more.

 Suzanne’s Story

Suzanne was brought up in a middle class family – good nutrition, regular doctor’s visits, loving parents and siblings – but at a very young age, she began to lose her hair.  In high school, the style was long and straight, but she could never get her hair to grow to an acceptable length.  It had been rather thin since childhood and it was getting worse every year.  As a teenager, Suzanne permed her hair, bleached it, teased it, and tried every thickening treatment she could find, including treatment “from within” with vitamins, but the problem was not going away.  At one family gathering, she was humiliated when her mother mentioned that Suzanne had always had thin hair and it was difficult finding a style that would suit a young girl with this problem.  Of course, at that point, everyone looked closely at Suzanne’s hair and realized that mom was right - Suzanne definitely had a problem.  Poor Suzanne.

Reaching her late twenties, Suzanne knew she had to do something – she already looked 10 years older than her actual age because of her thinning hair.  She happened to be watching TV late one night when an infomercial came on declaring that hair loss was not a problem for women any more!  Perhaps, she thought, there was viable option to her problem!  The “option” required the purchase of hair strands attached to a number of clips that she would attach to her own hair.  There was even a long hair extension woven onto a thin fiber (something like thin fishing line) that she could put on under the clips to give her a long, luscious head of hair.  Finally, she thought, her problem was solved!  She had to pay a few hundred dollars for these hair attachments (borrowing from her parents)  – but when you are desperate, you just do it. 

It was great for a while, but then she noticed that the hair attachments were getting thinner.  She had not realized that with combing, brushing, washing, etc., the hair would begin to fall out of the clips.  Ok fine, so she ordered another set of attachments – a number of times.  This could have gone on forever.  As long as she had the money, she could solve her problem and no one would know the difference, right?  She had not thought about the fact that after a few months, she would not have enough natural hair left to clip the attachments onto.  She soon realized the problem.  Now what?  Was it time for one of those uncomfortable, too-thick-looking wigs? 

Another late night - another infomercial.  This time for a “hair club.”  Wonderful, she thought, this was finally the solution!  She did not have to have her own natural hair to attach anything to.  As a matter of fact – she would just shave the top of her scalp, which was so thin already, and a “hair replacement system” would be attached there with either a strong adhesive tape or a medical grade adhesive.  Actually, it was similar to a man’s toupee – she could blend it into her natural “perimeter” hair.  She could sleep in it, swim in it, make love, backpack, or stand in a strong breeze and not worry about how her hair looked.  This was absolutely the best solution!  Her problem was finally solved! 

There were, of course, downsides – the high cost of the hair system, membership in the “club,” and having to go to the club’s location for attachment and styling.  She always felt self-conscious in the waiting room – afraid that a man would walk in and they would both be embarrassed about knowing the other’s secret.  She was terrified that someone she knew personally would come in, but she really had no choice, right?  She gritted her teeth, drained her bank account, ignored her ego, and dealt with it.

 Jeannie’s Story

Jeannie had never had any problems with thinning hair – hers had been thick and lustrous all of her life.  Reaching her teen years, Jeannie began doing the normal risky and rebellious things – all teenagers do them, right?  One Friday night, she and a few friends were on their way to a late night party.  They had had a bit to drink, but the driver, Judy, swore she was all right to drive.  Unfortunately, Judy had misjudged her sobriety – not unusual for a teenager on a fun night out with her friends.  On a tight turn, she lost control and the car flipped twice as it careened off the road into a ditch.  They had all been wearing their seat belts, but unfortunately for Jeannie, that did not help.  As the car crashed, a large piece of metal hit Jeannie in the head.  The paramedics later said that she had been scalped.

It turned out that she was not really scalped, but a 4 by 4 inch area of skin over her forehead had been sliced open into a “flap.”  The trauma team was able to stop the bleeding and reattach the damaged skin flap, but they knew that normal hair growth would never be possible in that area again.  

Jeannie realized that she was lucky to be alive, but she also realized that her appearance had been permanently altered.  With her thick hair, a large bald spot right in the front was virtually impossible to cover up without detection. 

After experiencing many of the twists and turns that Suzanne had, Jeannie believed the “hair club” option was the best.  Her parents helped with the cost, but they all began to realize that this was beginning to be substantial drain on their resources, and there was no end in sight.  Some other solution had to be available.

 Cleo’s Story 

Cleo was a bright child.  She had been born an only child into a family that was supportive of her endeavors and aspirations.  Although her family was not wealthy, she got the best healthcare her dad’s HMO coverage could provide.  Her mother watched out for her nutrition with the healthiest meals they could afford.  Mom and dad both encouraged Cleo in her athletic and intellectual endeavors.  A great childhood – great parents. 

 After Cleo completed her studies, she relocated to a large city.  Her hope was to use a large part of the money she earned as a graphic designer to pay back her parents for the money they spent to send her to college.  They were getting older and they would need her help as she had needed theirs’ as she grew up.  Cleo’s hopes were not to be realized.

 At the age of 27, Cleo was diagnosed with breast cancer.  This had been a complete surprise.  There was no history of breast cancer in her family – actually, no substantial incidence of cancer of any type.  But the fact was, it was there and she was in for some substantial, life altering treatment –biopsies, radiology, chemotherapy, and perhaps more. 

Most cancer chemotherapy treatment focuses on fast-growing cells – it is the nature of these cells that create tumors.  Hair follicle cells are fast growing as well, and this is why body hair falls out during many sorts of chemotherapy treatment.  Eventually, a cancer patient loses all body hair, becoming completely bald during their course of treatment. 

 Hospitals are becoming more aware of the psychological effects of hair loss on cancer patients  – especially females.  It can be devastating to find out one has cancer, but then to find out that the treatment will substantially change one’s appearance is an added blow that can psychologically affect a positive outcome. 

Cleo was not vain, but in her line of work, she had to look her best – at least “normal.”  She consulted with her doctor and others about her appearance and was soon directed toward the “hair club” solution. 

Eventually, Cleo’s cancer went into remission, but she had amassed a huge “hair club” debt.  Her hair grew back and she no longer needed hair replacement, but the charges she had placed on her credit card for the hair club became overwhelming.  She had yet to pay back her parents for her college expenses and now she had the additional credit card “hair debt” for the time she’d had needed these services.  Cleo was in remission, but her overall health was being overwhelmingly influenced by the psychological stresses of her financial concerns.

Prescription Drugs and Hair Loss

In addition to cancer chemotherapy medications causing baldness, a large number of popular medications can cause hair loss as well.  Neither the pharmaceutical industry nor your doctor (most likely this information will not be known to the doctor) tell you about this side effect.

The next time your physician prescribes a drug for you, ask if it will cause hair loss.  Your doctor may not realize this side effect.  Ask that he or she look it up in the Physicians' Desk Reference, which lists the side effects of all prescription medications.  If the drug is linked to reversible alopecia, ask if another can be substituted.  In addition, just to make sure your physician has given you accurate information, when you get the prescription filled, ask your pharmacist as well.

Below is a list of drugs that are known to cause hair loss in some patients:

Cholesterol-lowering drugs: clofibrate (Atromis-S) and gemfibrozil (Lopid)

Parkinson medications: levodopa (Dopar, Larodopa)

Ulcer drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid)

Anticoagulents: Coumarin and Heparin

Agents for gout: Allopurinol (Loporin, Zyloprim)

Antiarthritics: penicillamine, auranofin (Ridaura), indomethacin (Indocin), naproxen (Naprosyn), sulindac (Clinoril), and methotrexate (Folex)

Drugs derived from vitamin A: isotretinoin (Accutane) and etretinate (Tegison)

Anticonvulsants for epilepsy: trimethadione (Tridione)

Antidepressants: tricyclics, amphetamines

Beta-blocker drugs for high blood pressure: atenolol (Tenormin), metoprolol  (Lopressor), 
nadolol (Corgard), propranolol (Inderal) and timolol (Blocadren)

Antithyroid agents: carbimazole, Iodine, thiocyanate, thiouracil

Others: Blood thinners, male hormones (anabolic steroids)

Alopecia areata 

According to the American Hair Loss Council, alopecia areata affects millions of men, women, and children and is usually temporary.  It is generally thought to be an autoimmune disease in which cells from an individual’s own immune system mistakenly prevent hair follicles from producing hair fiber.  The scalp is the most commonly affected area, but any hair-bearing site can be affected.  The disorder causes patchy hair loss, often appearing as small, smooth patches on different areas of the scalp or other parts of the body.  These patches can appear suddenly, sometimes with 24 hours, and some people report feeling tingling and/or pain at the site.

 Dianne’s Story

 Dianne’s was another case of a normal childhood with caring parents, adequate healthcare, and good nutrition.  “Normal” lasted well into her 40’s.  Suddenly, her hair began to come out in clumpy handfuls!  What was going on?  She had not suddenly changed her lifestyle, and a thorough physical exam excluded cancer or other life-threatening disease.  After lengthy consultation and testing with a general practitioner and dermatologist, it was determined that she was suffering from alopecia universalis.  She had never even heard of alopecia universalis, but being personally afflicted, she soon became well informed about the condition.  Areata universalis is a form of alopecia areata that causes hair loss  over the entire body.

Coming to grips with the severity of her condition and realizing that hair regrowth might be unlikely, or take months to reappear, Dianne began to investigate her options.  She was not wealthy and her quest was not substantially different from the other women mentioned above.  As they did, she eventually decided that a hair replacement system was the best solution.  She didn’t want to get sucked in to the “hair club” financial quagmire, so using her Internet savvy, she researched “hair replacement” on the World Wide Web and discovered some interesting alternatives – one that stood out was CK Hair Solutions (ckhairsolutions.com).  She found that by taking on some responsibility for her situation, she could save hundreds of dollars by purchasing hair replacement systems over the Internet and attaching them herself.  After some investigation, she found  a hairdresser who would style the system after she had attached it.

As illustrated, many things can cause abnormal hair loss.  But perhaps you have never heard about the following causes: 

Childbirth

 When a woman is pregnant, she does not lose as much hair as usual.  However, after delivering her baby, many strands of hair enter the resting phase of the hair growth cycle.  Within two to three months after delivery, some women may see large amounts of hair coming out in their brushes and combs.  This may last between one to six months, but in most cases the condition reverses completely.

High fever, severe infection, severe flu

 From four weeks to three months after a person has a high fever, severe infection, or flu he or she many be shocked to see a lot of hair falling out.  This condition usually corrects itself, but may require treatment.

 Thyroid disease

 Both an overactive thyroid and an under active thyroid can cause hair loss.  A physician can diagnose thyroid disease with laboratory tests.  The hair loss associated with thyroid disease can be reversed with proper treatment.

 Inadequate protein in the diet

 Some vegetarians, people who go on crash diets that exclude protein, and those with severely abnormal eating habits may develop protein malnutrition.  When this happens, a person’s body will help to save protein by shifting growing hairs into the resting phase.  Massive hair shedding can occur two to three months later.  The hair can be pulled out by the roots fairly easily.  This condition can be reversed and prevented by eating the proper amount of protein and when dieting, maintaining adequate protein intake.

 Birth control pills

 Women who lose hair while taking birth control pills may have an inherited tendency toward thinning hair.  They can consult their gynecologists about switching to another pill.  When a woman stops using or contraceptives, she may notice that her hair begins shedding two or three months later.  This may continue for six months, then it usually stops.  This is similar to hair loss after the birth of a child.

 Low serum iron

 Iron deficiency occasionally produces hair loss.  Some people do not have enough iron in their diets and some may not fully absorb the iron in their diets.  Women who have menstrual periods my develop an iron deficiency.  Low iron can be detected by laboratory test and can be corrected by taking iron supplements. 

Solutions?

 When a person starts to lose his or her hair, there are really only four options to consider, (1. topical treatments and drug therapy; (2.  non-surgical hair replacement; (3.  surgical hair restoration; (4.  learn to live with it.  There is a great old saying: “If it sounds too good to be true, it probably is.”  Keep that in mind when an ad promises to restore your hair.  Is there really a product out there that will grow hair on your head, even if you suffer from a condition like alopecia?

 Unscrupulous providers may give you bad information and promise to get your hair back – but there is usually something that does not sound quite right.  Here is an example:  A clinic  in New York offered a permanent lifetime answer to baldness through their surgical procedure.  The surgeons would thicken a patient’s scalp hair by adding filaments of hair to the scalp, giving a full, lustrous head of hair to the wearer.  They said that no maintenance was required after the surgery was completed and offered a lifetime warranty!

 It turned out that the miracle surgery was nothing more than a plan old hairpiece sewn onto the patient’s scalp – and it was certainly not painless.  One of the worst side effects of this process was the infection and scarring caused by the sutures.  In addition, the sutures needed to be replaced from time to time just to keep the hairpiece in place.  Not exactly maintenance free!

This is an extreme case, but it shows just how far con artists are willing to go to get someone to put up big bucks to fund their schemes.  Like every other industry, the hair loss business is plagued by fraud.  The key thing for a consumer to do is to make sure that the procedure or treatment you contemplate using is safe, effective, and accepted by standard medical practices.  

 Will genetic engineering be the answer?  Recently, researchers were engaged in developing new diagnostic and therapeutic methods for the treatment of cancer.  As part of this research, they attempted to grow normal human skin in the laboratory.  To their surprise, not only did the cells grow, they produced hair!  A cure for baldness?  Not yet.  They tried topical application of the substance responsible for the hair production, but there was no hair growth.  Gene and growth therapies may ultimately offer hope to the 80 million men and women that suffer from hair loss.  Time and much more research will tell.

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Prescription Drugs and Hair Loss

Many people take prescription drugs that may have an adverse effect on hair.  The following information may be useful:

While male- and female-pattern baldness result in permanent hair loss, other factors can cause temporary loss of hair.  For instance, the drop in the level of estrogen at the end of pregnancy can cause a woman's hair to shed more readily.  Two or three months after a woman stops taking birth control pills, she may experience the same effect, since birth control pills produce hormone changes that mimic pregnancy.

It is well known that many cancer chemotherapy medications cause baldness.  Most people are willing to put up with hair loss when accepting treatments for life-threatening diseases.  However, a large number of popular medications can cause hair loss, while neither the pharmaceutical industry nor your doctor (most likely this information will not be known to the doctor) will tell you about this side effect.

Here is a list of drugs that are known to cause hair loss in some patients:

Cholesterol-lowering Drugs:  clofibrate (Atromis-S) and gemfibrozil (Lopid)

Parkinson Medications: levodopa (Dopar, Larodopa)

Ulcer Drugs: cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid)

Anticoagulants:  Coumarin and Heparin

Agents for Gout: Allopurinol (Loporin, Zyloprim)

Antiarthritics:  penicillamine, auranofin (Ridaura), indomethacin (Indocin), naproxen (Naprosyn), sulindac (Clinoril), and methotrexate (Folex)

Drugs Derived from Vitamin A:  isotretinoin (Accutane) and etretinate (Tegison)

Anticonvulsants for Epilepsy:  trimethadione (Tridione)

Antidepressants: tricyclics

Beta-blocker Drugs for High Blood Pressure:  atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), propranolol (Inderal) and timolol (Blocadren)

Antithyroid Agents:  carbimazole, Iodine, thiocyanate, thiouracil

Others:  Blood thinners, male hormones (anabolic steroids)

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The Social Dimension of Hair Loss

Hair plays a significant role in our lives. Another person's hair is one of the first characteristics we notice upon meeting. Our own hair is one of the first and last things we attend to before a meeting or a social engagement. Hair disorder, especially when severe, often profoundly affects the lives of those afflicted. Severe hair loss evokes not only cosmetic concerns but may also evoke feelings of vulnerability, loss of self-esteem, alterations in self-image, and, perhaps, even self-identity.

In 1992, researchers at Old Dominion University in Norfolk, Virginia, surveyed 145 men, and found that 84 percent of the balding men were preoccupied with their loss. They described themselves as filled with self-consciousness, helplessness, and envy of men with full heads of hair. Single men and woman who had begun losing hair in their early twenties were more likely to suffer from extremely low self-esteem.

While stressful, balding isn't the end of the world. Although the men reported glancing in the mirror constantly and wearing hats even in warm weather, they manage to make it through their daily lives without much problem. For some it even sparked self-improvement tactics like fiddling with hair styles, working out more, and dressing better. Survey result is shown in the following chart:

How deep does a bald man's anxiety runs?

Stereotypes associated with baldness are not flattering. A research study back in 1971 had been conducted to investigate how one person was perceived by others can be influenced by quantity of scalp hair (regular, balding, and bald) as well as color, length, and quality of scalp hair. Pictures of the same person were presented to 60 judges. Differences in appearances of this person (i.e., experimental conditions of regular, balding, and bald) were  manipulated through modifications made by a commercial artist. The results revealed that the person with a regular quantity of hair was rated as most handsome, virile, strong, active, and sharp. The person with a balding head of hair was rated as least potent, weak, dull, and inactive, and the person with a bald head of hair was rated as most unkind, bad, and ugly. Many other studies also show employment discrimination based on a person's appearance.

Motivation to avoid baldness is not confined to this century. In 1150 BC Egyptian men smear their pates with fats from ibex, lions, crocodiles, serpents, geese, and hippopotamuses. In modern society, this aversion is readily evident from the many available remedies such as creams, hormones, vitamins, hairpieces, wigs, scalp reduction and hair transplants. A government report in 1983 reveals that over the past 9 years the FDA has overseen the investigation of ingredients in about 300,000 products claimed to help hair re-growth, none of them has any medical benefit, of course.

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Our Crowning Glory

Society has placed a great deal of social and cultural importance on hair and hair styles. If hairlines start to recede or hair thins, both men and women may become very concerned about the loss. Without understanding why their hair is falling out, they may resort to so called "magic potions," megavitamins, scalp massage and electric treatments to encourage new hair grow.  Hair loss is common in nearly two out of every three men develop some form of balding.  An even higher percentage of men and women have some form of hair loss during their lives.  With correct diagnosis, many people suffering from hair loss can be helped.

Normal Hair Growth

About 90 percent of a person's scalp hair is continually growing, a phase that lasts between two and six years.  Ten percent of the scalp hair is in a resting phase that lasts between two and three months.  At the end of its resting stage, the hair is shed.  Shedding 50 to 100 hairs a day is considered normal.  When a hair is shed, it is replaced by a new hair from the same follicle located just below the skin surface.

Scalp hair grows about one-half inch a month.  Natural blondes typically have more hair (140,000 hairs) than brunettes (105,000hairs)or redheads (90,000 hairs).  As people age, their rate of growth slows down.

Hair is mostly made up of a form of protein, (keratin) the same material found in fingernails and toenails. Everyone, regardless of age, should eat an adequate amount of protein to maintain normal hair production.  Protein is found in meat, chicken, fish, eggs, some cheese, dried beans, tofu, grains and nuts.

                                                Causes of Abnormal Hair Loss

Abnormal hair loss can be due to many different causes.  People who notice their hair shedding in large amounts after combing or hair brushing, or whose hair becomes thinner or falls out, should consult a dermatologist.  It's important to find the cause and whether or not the problem will respond to medical treatment.

Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications taken within the last six months, family history of hair loss, any recent illness, and hair care habits.  The dermatologist may ask a female patient about her menstrual cycles, pregnancies and menopause.  After examining a patient's scalp and hair, he may check a few hairs under the microscope.  Laboratory tests may be required which sometimes include examining a small sample of scalp under a microscope.

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What Causes Hair Loss?

If you grew up hearing that baldness is caused by vitamin deficiencies, poor circulation to the scalp, or too much hat-wearing, you might be surprised to know that all these theories have been disproved. Also untrue:

Many people with this disorder also use minoxidil, the only FDA approved medication for safe and effective treatment of both male and female pattern hair loss. Generally, minoxidil, available in both oral (by prescription) and topical (over-the-counter) forms is generally more effective at retarding hair loss than at stimulating growth -- many people say they experience both.

Alopecia Areata

According to the American Hair Loss Council, alopecia areata also affects (to some degree) millions of men, women and children. It is estimated that approximately two percent of the population will be affected at some point in their lives, or over 4.5 million.  This non-scarring, inflammatory condition is usually temporary -- it is experienced in episodes by almost 90 percent of those who have it.  

Alopecia areata is generally thought to be an autoimmune disease in which cells from an individual's own immune system mistakenly prevent hair follicles from producing hair fiber.  The affected hair follicles become very small, drastically slow down production, and grow no hair visible a over the surface for month or years.  It usually starts with one or more small, round, smooth patches.  The scalp is the most commonly affected area, but any hair-bearing site can be affected alone or together with the scalp.  In many cases, the body will use its own management system to reverse the problem in time. However, those affected even temporarily by the disease can experience low self-esteem and depression and may need help from their families and friends.

The National Alopecia Areata Foundation says that approximately 20 percent of alopecia areata cases are related to heredity, as opposed to androgenic alopecia, in which heredity plays a more prominent role.

There is no diagnostic test for alopecia areata, but an experienced dermatologist can usually identify it. (For a more definitive diagnosis, doctors sometimes need to take a small skin biopsy for microscopic examination). The disorder causes patchy hair loss, often appearing as small, smooth patches on different areas of the scalp (or occasionally, on other parts of the body). These patches can appear suddenly, sometimes within 24 hours, and some people report feeling tingling and/or pain at the site. Other types of alopecia areata include:

Patients whose conditions don't respond to medical treatment might want to explore the use of wigs (some insurance companies pay for these, contact the American Hair Loss Council for a list of companies that do) or hair coverings such as turbans or scarves. Because of the unpredictability of alopecia areata, experts suggest that you avoid covering a patchy area with small hair additions. This is because the hair piece might be useless to you within a few weeks due to further advancement of the alopecia. No matter how widespread the hair loss, the hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal.   The dermatologist can best tell you when your condition has stabilized -- at that time, more options might be available to you.

Experts suggest that parents support their child's choice when it comes to purchasing a wig or prosthesis.  Putting pressure on the child to wear a wig can send the wrong message and make the child feel self-conscious about the way he or she looks. There are support groups across the country for people of all ages. Contact the National Alopecia Areata Foundation to find a group in your area.

Chemotherapy Related Hair Loss

As mentioned earlier, chemotherapy is the administration of drugs that are poisonous to rapidly reproducing cancer cells. Cancer cells are some of the most rapidly reproducing cells in the body. Other cells, such as those that contribute to the formation of hair shafts and nails also reproduce quickly.  However, while chemotherapy drugs preferentially destroy cancer cells, some of the drugs also can destroy cells responsible for normal growth of hair and nails. That is why cancer patients sometimes shed their hair eyelashes, eyebrows, and nails during treatment. 

Hair loss usually start 2 to 3 weeks after beginning the drug treatment.  Sometimes it starts within a few days.  It is usually a gradual loss - you will not wake up one morning with no hair.

If you are worried about hair loss during chemotherapy, below are some of the things other chemotherapy patients suggest you might do:

No hair growth stimulates, shampoos, conditioners or other cosmetic treatments can prevent or retard the hair loss. The good news is that once chemotherapy is completed, the hair usually grows back within six months to a year.  The new hair might be softer, a different color, or curlier.

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What About Drugs and Ointments for Hair Loss?

Pharmaceutical hair restoration treatments use manufactured chemical substances to affect the structure or function of the hair follicles in an effort to stop hair loss and promote hair growth. Some hair loss medications work by causing hair follicles that have shrunk or shut down to enlarge and grow hair again. Hair restoration medications are used to treat both sudden temporary hair loss and chronic hair loss that starts slowly and becomes progressively more extreme over time.

These medications may be applied to the skin, taken by mouth, or injected, and they include both prescription and non-prescription drugs. Prescription drugs are typically powerful and have the potential for some serious undesirable side effects if not used as directed and for their intended purpose.

Over-the-counter medications, like prescription drugs, contain active ingredients which affect the body's structure or function in order to treat a medical condition. These medications are intended for conditions that do not generally require skilled medical diagnosis. They are usually less powerful than prescription drugs and less likely to cause harmful side effects.

Minoxidil

Minoxidil (the generic name) is in a class of drugs called hair growth stimulants. Oral minoxidil, a prescription drug originally used to treat high blood pressure, was found to increase body hair growth in the majority of patients taking it daily.

This led to the development of topical minoxidil, sold over-the-counter and marketed in its 2 percent form under the brand name, HealthGuard (Bausch & Lomb Pharmaceuticals), and in its 5 percent form under the brand name, Rogaine (Pharmacia & Upjohn). These formulas have been shown to stimulate hair growth in men with pattern baldness. In women, these ointments can help increase growth in the forehead area, according to manufacturers.

Pregnant or nursing women should avoid minoxidil in either form and be cautioned that the use of extra-strength formulas are not designed for women and can cause facial hair growth and other problems.

Minoxidil is what pharmacists call dose-dependent. This means that treatment must be continued in order to maintain or increase hair growth benefits. Regular-strength Rogaine must applied on a dry scalp at least twice daily (and left in place for at least four hours) and for at least four months to see results (Extra strength formulas work much more quickly (about 45 days), manufacturers say).

Oral minoxidil can cause a fall in blood pressure, an increase in the heart rate, and weight gain (fluid retention). An increase in the absorption of topical minoxidil from the scalp can occur in users with inflamed or abnormal scalps and can lead to the same side effects as those of the oral minoxidil. This means that people with heart failure or major coronary heart disease should avoid the drug in either form, and those with high blood pressure should consult their doctors. In addition, topical minoxidil should not be used with other ointments or topical creams. Skin side effects might include irritation, itching, hives, swelling and sensitivity.

Finasteride

Finasteride, a prescription drug marketed in a 1-mg. tablet as Propecia (Merck Pharmaceutical), was approved by the FDA in 1998 for the treatment of androgenetic alopecia. (Finasteride -- in a 5-mg. tablet -- was manufactured and marketed earlier as Proscar, which is still used to treat prostrate abnormalities.)

Propecia  works by decreasing the concentration of the male hormone DHT (see earlier explanation!) by about 60 percent in people taking one tablet per day. Since finasteride inhibits this hormone that is a key factor in the miniaturization of scalp hair follicles, this allows for a reversal of the balding process. Results are usually seen in about three months, and this drug is also dose-dependent. (Generally, finasteride is not beneficial in the treatment of female pattern baldness.)

Some researchers say a combination of minoxidil and finasteride provides hair growth that is superior to that resulting from the use of either single drug. Talk to your doctor about this.  Side effects that have been attributed to finasteride include decreased libido and groin aches.

Other Medications

Other less familiar options include using Retin-A (Ortho Pharmaceutical) alone and in combination with minoxidil to treat male pattern baldness. It is thought that the combination works because the increased absorption caused by Retin-A increases the amount of minoxidil reaching the hair follicle cells. (Since Retin-A is degraded by strong light, you should only use it at night. If you're using a combination formula, wear a hat or stay in the shade.)

Xandrox solutions, which are alternatives to Rogaine, come in formulas with varying amounts of minoxidil, Retin-A, and azelaic acids. Ask your doctor or pharmacist to help you choose the right formula.

Other Over-the-Counter Products

If the shampoo bottles marked "for thicker hair" grab your attention in the store, you might want to think again before tossing one into your cart. According to the FDA, none of the shampoos or hair products that claim to give you thicker, fuller hair can actually do that. What these products do, instead, is to create the appearance of greater fullness by plumping up hair follicles.

There's another interesting product on the market -- make-up that colors your scalp the same color as your hair. It's cheap, it's fast, and it's safe. (Manufacturers say it won't run when wet but easily washes off with normal shampooing.) You can't create a frontal hair line with this product, but if you can't afford surgery or a new wig, why not check it out?

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Buyer Beware!

When you first begin to lose your hair, you really only have four options to consider: 

There’s a great old saying: “If it sounds too good to be true, it probably is.” 

Think of that the next time you see an ad that promises to restore your hair.  Does it sound too good to be true?  Does the treatment described even seem plausible?  Is there really a product out there that will grow hair on your head, even if you suffer from a condition like alopecia?  The person you should ask this of is the salesperson making the offer.  Listen carefully to his or her response.  Does the provider offer to send you medical data supporting his or her claim?  If so, does that data check out? 

You see, there are plenty of legitimate methods available to you that will help you get you your hair back.  Nevertheless, this does not stop the unscrupulous providers from giving you bad information...or worse.  They promise to get you your hair back.  They describe what appear to be logical solutions – but there is something about the whole process that just does not seem quite right.  Here is a classic example:

The now defunct New Jersey based International Cosmetics Lab (ICL) offered "a permanent lifetime answer to baldness" through their surgical procedure.  ICL surgeons offered to thicken their patients' scalps by adding filaments of hair to the scalp, giving a full lustrous head of hair to the wearer.  ICL promised that no maintenance was required after the surgery was completed and offered a lifetime warranty.  Finally ICL offered to reverse the procedure for a fee of between $1200-$4500. 

It turned out that the miracle surgery ICL was offering was nothing more than a plain old hairpiece sewn into the patient's scalp.  And make no mistake about it, the procedure HURT!  In fact, one of the worst side effects of this process was the infection and scarring caused by the sutures.  In addition, the sutures needed to be replaced from time to time, just to keep the hairpiece in place.  Not exactly maintenance free! 

Thanks to the Attorney General’s office, ICL is now out of business. 

Now, this is an extreme case–but it does show how far con artists are willing to go to get you to put up big bucks to fund their schemes.  It is cynical.  Yes, they provided hair to their clients, but it certainly was not the “permanent lifetime answer to baldness” they said it was going to be.  Like every other industry, the hair loss business is plagued by fraud.  The key thing for a consumer to do is to make sure that the procedure you contemplate using is safe, effective, and accepted by standard medical practices. 

Get hair, do not get fleeced! 

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Study Links Baldness, Heart Problems

Men who are losing the hair on the crowns of their heads have up to a 36% greater risk of experiencing heart problems, including heart attacks and bypass surgery, a study found.  Men with a receding hairline are not at increased risk, but those going bald at the crown should pay special attention to their blood pressure and cholesterol levels, and lead a healthy lifestyle, researchers said.  The study, published in a January edition of the Archives of Internal Medicine, found that the greater the hair loss on the top of a man's head, the greater the risk.  Balding men with high cholesterol levels had almost three times the risk for heart disease when compared with men with a full head of hair who also had high cholesterol.  Past studies have confirmed a link between hair loss and heart problems, but this study is among the largest.  It also is one of the first to include detailed information about different patterns of baldness and to identify the risk pattern in men of all ages.

The study, co-authored by several doctors in Boston, analyzed baldness patterns of 22,000 male doctors who were 40 to 84 years old when enrolled in the Physician's Health Study.  Eleven years into the study, the researchers asked the doctors to describe their patterns of baldness at age 45.  Out of the total pool sampled, about 1,500 men reported a coronary event.  Balding men accounted for 62% of that total.  The authors suggest one possible biological explanation for the increased risk: The bald men had elevated levels of testosterone and a hormone it converts into, dihydrotestosterone.  Previous studies have suggested elevated testosterone levels may contribute to increased risk for hypertension and abnormal cholesterol levels.  Manson said it is a hypothesis that merits further study.  However, Dr. Philip Greenland, a cardiologist at Northwestern University, does not support more studies focusing on baldness as a marker for heart disease.  ''Papers like this actually divert attention from the primary message,'' Greenland said.  ''About 80 to 90% of what we need to prevent heart disease is already known.  The problem is that addressing those behaviors is something many Americans do not want to do, so they are looking for other excuses.  ''Established risk factors for heart disease include hypertension, high blood pressure and cholesterol, and a sedentary lifestyle. 

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The Psychology of Hair Loss

Imagine your teeth suddenly falling out as you reach your twenties and thirties.  You would understandably be distressed and would certainly seek the attention of a qualified dentist to prevent further decay and correct the loss. No one would question your motivation to correct this cosmetic defect and return your appearance to its original condition.

Hair loss to many men and women is quite similar.  An otherwise young healthy person is suddenly faced with a gradual, yet dramatic change in their appearance for the worse.  This change in appearance is progressive and most of the time, permanent.  For men, the dilemma is compounded by the fact that socially and historically, it is unmanly for a male to be concerned about his appearance.

Many people suffer tremendous anxiety about their hair loss.  They are depressed about the appearance and stigma of baldness.  Men often are ashamed to admit that the condition bothers them for fear they would be considered vain.

At the onset of hair loss, denial is often the first response.  A person sees a change in the hair, the temples are receding or the crown seems a bit thin, but he or she denies to himself or herself  that it could be happening. This strategy only works for so long.  Eventually the thinning increases or a "sensitive" friend points out his increasingly visible scalp at a social gathering.  Every time he or she talks to someone, their eyes seem to travel to his vanishing hairline.

After denial there is usually panic.  All the societal implications of baldness start running through the persons head.  To be bald you are older, boring, and lack sex appeal. There are no positive characteristics associated with baldness..

Depression though, often does occur at the onset of hair loss and in some cases never goes away.  The image we see in the mirror can certainly affect our conduct in society.  Often people will not go out and socialize because of their hair loss.  Many times their mother or father will bring a young person to a physician and describe their antisocial behavior and anger at being bald.  They may rail at their parents for causing this condition as if their parents had a choice.  Oftentimes, even posture will change.  They will slump and look sullen so they can avoid eye contact with the outside world.

Hair loss is not something we are born with, it happens later in life after we have gotten use to seeing ourselves a certain way.  Consider the term hair loss.  We lost something we had, and that is the problem! Our hair is the frame of our face.  Just like a attractive frame and matting compliment a picture, our hair compliments the features on our face, and just like that picture, if we take away the frame, the picture appears plainer and less attractive.

This feeling of loss of our appearance is a significant factor why men and women do not accept baldness. Dr. Gary Hitzig, a cosmetic surgeon, has been performing hair restoration surgery for over 21 years. According to Dr. Hitzig, "for every actor, model or politician I have seen for consultation about hair loss, I have seen hundreds of very ordinary people who typically are not very vain or concerned about their appearance in general but can not accept going bald."   

Finally, we come to action.  What is there to do about our hair loss?  Some men go so far as to embrace baldness.  They wear it as a badge of honor, proudly proclaiming “I am Bald and Proud.”  The Bald Headed Men's Club of America, in Moorehead, N.C. has members from around the world who correspond and get together to support hair loss as a mature, sexy, virile appearance that society should look upon with admiration. Most men deal with hair loss as inevitable and natural and move on with their lives and careers.  Appearance is comprised of many aspects, not the least of which is our personality and intelligence.  A good personality and interesting mind have more of an influence on our attractiveness than any physical characteristic.

"Just as hair loss is not the cause for all your problems, it is also not the cure,” states Dr. Hitzig.  For individuals to succeed socially and professionally, it is much more important to have personality, intelligence and strong character.  Hair can improve appearance and self-image, but only strong character and motivation can help succeed in life.  It is important that when looking into the mirror for answers to problems, we should look deeper then the surface for the solutions.

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What About Genes?

It may soon be possible to resuscitate gray hair and recover follicles that have gone dormant, suggest the results of a somewhat bizarre experiment conducted by researchers at a small biotechnology company.

Researchers are primarily engaged in developing new diagnostic and therapeutic modalities for the treatment of cancer.  As part of this work, they grow various types of cancer cells on artificial sponge-gel matrices.  One day, they tried growing normal human skin on the gel matrices.  To their surprise, not only did the cells grow, they produced hair.

Having developed a method to cultivate hair-growing skin cells, the next obvious step was to screen for molecules that might modify hair growth.  Working along these lines, the researchers found liposomes (synthetic microscopic phospholipid spheres) could be used to selectively and efficiently target molecules to the follicle cells.  They have now reported the successful delivery of plasmid DNA coding for the lacZ gene to mouse skin cells.  The lacZ gene was chosen as a reporter gene because it produces galactosidase, an enzyme that is easy to detect by staining.

In the study, they were able to selectively target the lacZ reporter gene to the hair follicles of mice after topical application of the gene entrapped in liposomes.  These results demonstrate that highly selective, safe gene therapy for the hair process is feasible 

Topical application of the gene not encapsulated in liposomes did not result in gene transfer.  Moreover, no sign of the LacZ gene was observed in the follicles of animals not treated with the liposome-gene combination.  These findings could lay the groundwork for the treatment of baldness or for methods of artificial darkening of hair that has turned gray with age, using a very safe and relatively straightforward procedure. 

The hair follicle is a complex structure composed of epidermal and dermal cell layers, specialized keratinocytes, and hair matrix cells.  The matrix cells give rise to the hair shaft. These results demonstrate that genes can be targeted selectively to the most important cells of the hair follicle by liposomes representing the most important cells of the hair follicle, by liposomes representing the most selective targeting of a gene observed thus far in vivo.

There is an enemy, hair follicle disease, and now there might be a gun with which to fight that enemy.  It has been demonstrated that the gun works by firing blanks at the hair follicles.  What remains for scientists to do is to develop the ammunition that will make the gun useful in the fight against hair loss.

This new highly selective method of targeting genes could lead to targeting hair matrix cells and possibly follicle stem cells to restore hair color.  The tyrosinase gene could be a suitable candidate for this application.  Preliminary research suggests this enzyme could reactivate pigment production in the follicles of people with gray hair.

Researchers are also investigating the idea of using liposomes-containing drugs to prevent hair loss caused by cancer chemotherapy.  This approach may be the first to bear fruit (hair?) with some experimental data suggesting that pre-treated chemotherapy patients may be able to keep up to 80% of their hair.

Scientists have already developed a method for delivering melanin, the chemical that gives hair its color, to hair follicles.  This would allow coloration of hair without the telltale off-color roots.  It is possible a cosmetic product could make it to market within a couple of years.

Liposome-based gene and drug therapies could ultimately offer hope to people with hereditary alopecia, the most common type of baldness that affects 80 million men and women in the U.S. alone.  Success in this area will depend on the identification of genes involved in both the growth and loss of hair.

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My Experience With Grafting

I am a 34-year-old male who has been losing my hair for about 5 years.  I have the type of balding pattern that to most eyes is undetectable.  I have gone from a very full head of hair to what I call "every other hair" fallout.  I still the height and volume, but the entire top is thinning so evenly that what is left is sort of a "shell" of hair that appears to be the same, but is seriously thinning underneath.  Because my hair is long (high), it covers a lot.

Discovering the “Un-named Medical Clinic” in a travel magazine on a flight from California to New York, I believed it a legitimate company, so I looked into it.  I received a videotape was very impressed!  This tape was first-rate.  The production value was superior to any other tape I had seen – and I have seen many!  Certainly, anyone who has seen the “Un-named Medical Clinics” tape would agree. 

Eventually I arrived at the “Un-named Medical Clinic” in New York and met with an "associate.” This term bothered me because when you discuss one of the most important issues in your life, you would expect to talk to an actual physician.  He asked if I really wanted to do the procedure at all.  Now some might say that this was an honest question (not to sell if it is not needed), but I thought, clearly, he was able to see my thinning, especially since I explained how much hair I had actually lost up to that point. Keep in mind, I did have a lot of hair left then, but I thought who better to recognize what was happening than a hair specialist?  Eventually, the associate diagnosed my head and balding pattern and told me that I would require 400 grafts, which would be done in four 100-graft sessions.  Agreeing, I said that I wanted  to get started. Feeling that this was the best facility there was (i.e. my only choice), I scheduled an appointment.

When I arrived for the grafting appointment at the “Un-named Medical Clinic, I finally met the doctor.  He looked me over and explained what was about to happen.  The procedure was painless and well done, with the exception of the very beginning when a receptionist came in and asked for payment.  I was doling out $100 bills while in the chair!

Months later, after the four sessions, the hair started coming in, but there were so few of them, I thought this is only 1/4 of the estimate of what I needed.  I was disappointed. The work was good, but, I thought, not only was this estimate unrealistic, I could never afford more grafts!  Then I received a letter from clinic stating that for "a limited time" it would be providing lower prices due to a new revolutionary method of grafting (slit grafts).  They even said that their facilities were undergoing changes to provide this new service.  The price of the “revolutionary method of grafting” was reduced depending on how many grafts I wanted.  Still, thinking this was the best facility – remember, the previous grafts were good – I scheduled another appointment.  I don't think I have to explain the desperation one goes through when balding occurs.  This time the procedure included 300 slit grafts at $20 per graft.  I later realized after my procedure that all this meant was less hair per graft for less money.  So much for this new revolutionary process.

The procedure was the same.  The exception, however, was the process that occurs after the surgeon makes the slits.  The assistants – all very kind and helpful – began to remove “excess” from the scalp so that the actual grafts could be placed.