 |
|
FAQ's
General
| Q: |
What
Is Hair, Really? |
| A: |
"The
adult human body averages five million hairs, of which 100,000 to 150,000 are
on the scalp. Hair is composed of keratin, the same protein that makes up nails
and the outer layer of our skin. The part seen rising out of the skin is called
hair shaft or strand. Each strand consist of three layers. The outermost protective
layer (cuticle) is thin and colorless. The middle layer, or cortex , is the thicknest.
It provides strength, determines your hair color and whether your hair is straight
or curly.
Hair color is determined by melanin from your pigment cells. The more pigment
granules there are, and the more tightly packed, the darker the hair. Two kinds
of melanin contribute to hair color. Eumelanin colors hair brown to black, and
an iron-rich pigment, pheomelanin colors it yellow-blonde to red. Whether hair
is mousy, brown, brunette or black depends on the type and amount of melanin and
how densely it's distributed within the hair. For example, deep-black African
hair contains closely packed melanin in the cortex, a few in the cuticle. Very
dark European hair, quite apart from having more melanin granules than lighter
or blonde hair, has more melanin per granule. When pigment-producing cells cease
to function, the result is the uncolored white or gray hair.
In Caucasians, true blonds typically have more hair (about 140,000 hair) than
brunette (about 105,000) or redhead (about 90,000).
Below your skin is the hair root which is enclosed by a sack-like structure called
the hair follicle. Tiny blood vessels at the base of the follicle provide nourishment.
A nearby gland secretes a mixture of fats (called sebum) which keep the hair shiny
and waterproof to some extent. At the base of the follicle is the papilla, which
is the "hair manufacturing plant." The papilla is fed by the blood-stream which
carries nourishment to produce new hair. Male hormones or androgens regulate hair
growth. Pubic and axillary (armpit) hair are particularly androgen-sensitive and
grow at lower androgen levels than hair on the chest or legs. In boys, most pubic
hair is grown by age 15, followed by the development of armpit hair two to three
years later. In girls, too, an increase in androgens at puberty triggers growth
of pubic and armpit hair. Scalp hair, not directly androgen-responsive, is influenced
by local amounts of a testosterone derivative, dihydrotestosterone.
Hair follicles initially form in utero. No new follicles are created after birth,
and none are lost in adult life. The first hair to be produced by the fetal hair
follicles is Lanugo hair, which is fine, soft, and unpigmented. This is usually
shed in about the eighth month of gestation. The first postnatal hair is vellus
hair, which is fine, soft, usually unpigmented, and seldom more than 2 cm long.
Vellus hair remains on the so-called hairless regions of the body, such as the
forehead and balding scalp. At puberty, the vellus hair in some areas is replaced
by terminal hair, which is longer, coarser, and pigmented. Growth starts in the
pubic region; then the eyelashes and eyebrows become thicker. Axillary hair and
male facial hair appear about two years after growth of pubic hair begins. Body
hair continues to develop long after puberty, stimulated by male hormones that
paradoxically, also cause terminal hair to be replaced by vellus hair when balding
begins.
Scalp hair fibers grow from 100,000 to 350,000 follicles which are reported to
occupy the human scalp; however, not all the follicles are productive. In each
producing follicle, the duration of the hair's life cycle is influenced by age,
pathology and a wide variety of physiological factors.[1,2] The life cycle is
divided into the anagen (active), catagen (transitional) and telogen (resting)
phases.
The anagen phase is the period of active hair growth where protein synthesis and
keratinization are continuously occurring. In normal subjects, this phase lasts
for up to five years, although longer durations have been documented. The cessation
of the anagen phase is characterized by a transitory phase known as catagen. This
phase lasts for two to three weeks. Following the catagen phase, the hair enters
the telogen or "resting" phase. In normal subjects, telogen hair is retained within
the scalp for up to 12 weeks before the emerging new hair dislodges it from its
follicle.
During the anagen phase, protein synthesis is the main distinction of the hair
bulb. In the telogen phase, the dermal papilla undergoes renewal. It is at this
time that structural characteristics can be modified. The new hair should be identical
to its predecessor, but with advancing age, and in some pathological states, a
strict copy is not maintained. In these circumstances, the hair may become finer
and shorter, modifying the esthetic profile. Since these effects occur over several
hair cycles, years may elapse before the affected individual recognizes the difference.
Like skin cells, hair grows and is shed regularly. Shedding anywhere from 50 to
100 hairs per day is considered normal. The average rate of growth is about 1/2
inch a month. It is now known that hair grows fastest in the summer, slowest in
the winter, speeds up under heat and friction, but slows down when exposed to
cold. Hair grows the best between the ages of 15 to 30. But, hair growth begins
to wind down sometime between the ages of 40 and 50. Progressive hair loss begins
naturally in both sex about age 50, accelerating in the 70s. About 40 percent
of Caucasian men lose hair to some extent by age 35."*
*Source: Health Review Magazine, January 1996. All rights reserved.
**Source: Hair Loss FAQ, Peter H. Proctor, PhD, MD. |
return
to top
| Q: |
What are
the different types of hair loss? |
| A: |
•
Alopecia Areata is when recurring bald spots or patches occur in the hair, not
necessarily on the top of the head. It frequently leads to Alopecia Totalis or
Alopecia Universalis.
• Alopecia Totalis is when all or almost all hair on the top of the head
is lost.
• Alopecia Universalis is when all or almost all hair on the body is lost
(hair on head, eyebrows, eylashes, etc.)
"By far the most common form of hair loss is determined by our genes and hormones:
Also known as androgen-dependent, androgenic, or genetic hair loss. It is the
largest single type of recognizable alopecia to affect both men and women. It
is estimated that around 30% of Caucasian females are affected before menopause.
Other commonly used names for genetic hair loss include common baldness, diffuse
hair loss, male or female pattern baldness."*
*Source: Health Review Magazine, January 1996. All rights reserved.
**Source: Hair Loss FAQ, Peter H. Proctor, PhD, MD. |
return
to top
| Q: |
How can
I tell if my hair loss is normal? |
| A: |
Most
of us lose 50-100 hairs a day. Hair loss is a natural process of aging. Overbrushing,
excessive blow-drying and harsh shampoos can aggravate the problem. If you're
concerned about a few too many hairs on your pillow, see your family doctor or
a dermatologist. |
return
to top
| Q: |
What causes
hair loss? |
| A: |
There
is much debate on this topic. While the link between certain forms of hair loss
and the immune system is well-accepted, there is also evidence for a connection
between the immune system and pattern loss (androgenic or androgenetic Alopecia).
In line with this, it appears that male hormones--especially DHT--trigger an autoimmune
response in pattern loss, initiating an attack on the hair follicle that can be
observed microscopically. This results in destructive inflammation that gradually
destroys the follicle's ability to produce terminal hair. The reason for this
could be that androgens somehow alter the follicle, causing it to be labeled as
a foreign body. A possibly related factor is that elevated androgens also trigger
increased sebum (oil) production, which can favor an excessive microbial and parasitic
population, also leading to inflammation. In any case, hair progressively miniaturizes
under the withering autoimmune attack, so that with each successive growth cycle
it gets shorter and thinner until it finally turns into tiny unpigmented vellus
hair (peach fuzz).
In men, balding typically follows the classic horseshoe pattern known as male
pattern baldness or MPB, though diffuse thinning can also occur. It has been noted
that both the number of androgen receptors and the level of 5-alpha reductase,
which converts testosterone to DHT, are higher in susceptible areas than in the
rest of the scalp. Women's hair loss tends to be diffuse but is also primarily
hormonally driven.
The story of balding is, however, not the story of androgens alone. Rather pattern
loss appears to have multiple contributing factors once the process is underway.
For instance, damage to blood vessel linings can inhibit a growth factor they
ordinarily produce: endothelium-derived relaxing factor (EDRF) or nitric oxide
(NO). Minoxidil probably works in part by mimicking this growth factor. Similarly
it has been noted that severe baldness is strongly correlated with heart disease
and even diabetes, so there appears to be some common etiology outside of the
strictly androgen paradigm for pattern loss. There are likely other factors as
well. |
return
to top
| Q: |
Is balding
hereditary? |
| A: |
Genes
are believed to be a factor, especially in male pattern baldness. Other medical
and environmental conditions, however, may contribute to hair loss. |
return
to top
| Q: |
What is
male pattern baldness? |
| A: |
A
horseshoe fringe of hair characterizes male pattern baldness, which affects more
than 30 million men in the United States alone. |
return
to top
| Q: |
What is
Alopecia? |
| A: |
Alopecia
is baldness or hair loss believed to be the result of an autoimmune disorder;
however, any number of other causes including genes, illness or medications can
play a role. About one percent of the U.S. population experiences a form of Alopecia
at some point in their lives. Alopecia Areata is a condition where circular patches
of baldness suddenly appear. Alopecia Totalis is when all the hair on the scalp
falls out. Alopecia Universalis is where every hair on the body falls out. Hair
re-growth can occur even after many years. |
return
to top
| Q: |
What non-surgical hair
loss treatments are available?
|
| A: |
There are no hair loss cures
but there are treatments. Today, Rogaine (Minoxidil), a topical hair loss solution,
and Propecia, a pill used to treat male pattern baldness, are the only two FDA-approved
treatments. For those suffering from Alopecia, steroids can be effective in helping
to suppress the immune system.
Natural hair pieces are
another option for hair loss sufferers. The best hair systems are secure, lightweight
and comfortable
|
return
to top
| Q: |
What surgical hair loss
treatments are available?
|
| A: |
Hair transplantation is
a system of taking hair follicles from an active hair growth area and relocating
them to the scalp. Grafting is sometimes performed in conjunction with scalp reduction
surgery in which a slice of the bald area is actually removed.
|
return
to top
| Q: |
Is stress a factor in
hair loss?
|
| A: |
Sometimes stress can play
a role in diffuse loss. Stress-induced loss ordinarily regrows within a year of
eliminating the cause.
|
return
to top
| Q: |
What's the best hair
loss treatment?
|
| A: |
There is no simple answer
to this. No one treatment is spectacular for the average individual. However,
there are a few treatments that yield decent results for a majority of people.
(Decent is defined here as cessation of further hair thinning and perhaps some
regrowth, ranging from a little to moderate.) Some people do respond unusually
well--but then some don't respond at all. Most fall somewhere in between.
Since there are multiple factors in pattern loss, it is wisest to approach the
problem from several angles to maximize results, as some treatments are complementary
and address different underlying causes. A common fundamental approach is to use
an "antiandrogen" of some kind, whether systemic (such as finasteride) or topical
(such as Spironolactone or azelaic acid), and a growth stimulant such as minoxidil.
To this basic program many add a topical SOD. Other options include therapeutic
shampoos, such as the antimicrobial and growth stimulant shampoos. Still other
approaches that may help include dietary and nutritional considerations and even
lifestyle modifications. There are many adherents to such a "kitchen sink" approach.
You can also start with a single treatment, though due to the long lag time before
you can actually verify efficacy, this can be very hit and miss and may bring
less than optimal results by only addressing one aspect of a larger problem.
|
return
to top
| Q: |
How long does it take
to see results from any treatment program?
|
| A: |
At least 2 months, though
usually significantly longer. Many do not notice any apparent improvements until
well after a year. Best results are often seen after the two-year mark. This is
because hair follicles undergo a relatively long dormancy period in between growth
cycles (usually about 3 months). In addition, hair only grows about 1/2 inch per
month in non-thinning areas and usually considerably slower in thinning areas.
Since it generally takes several cycles of growth/fallout/regrowth, with the hair
getting thicker and longer each time, it can take a great deal of time to see
noticeable improvement. Note that best regrowth results are seen with hair that
was lost within the last five years and in areas of the scalp in which there is
still some fine hair.
|
return
to top
| Q: |
Does poor blood ciculations
cause hair loss?
|
| A: |
Poor blood circulation has
been listed as a cause of hair loss, especially since Minoxidil came out, which
is a increases blood circulation. Unfortunately, Minoxidil does not grow hair
by increasing blood circulation (at least that is not the main way it does). There
are literally dozens of drugs that increase drug circulation, none of which grow
hair. If bad blood circulation caused hair loss, these would work too, but they
don't. Also, bad blood circulation would not be restricted to the top of the head.
Since the sides of the head show no loss, this also indicates the problem is not
circulation. Any "cure" that tries to address blood circulation is no
cure. Bad blood circulation definitely will cause hair loss. It is just not the
cause of MPB. There are some indications that blood vessel lining to the hair
follicle may become damaged through the process of MPB. Repairing these structures
may provide more blood flow to the hair follicle and increase hair growth. However
this is not the complete cause of MPB. Vasodialators that increase blood flow
probably don't help this problem, since the actual vessels are damaged.
|
return
to top
Rogaine
/ Minoxidil / Topical Questions
| Q: |
Are there topical antiandrogens
I can use instead of taking something internally such as Finasteride?
|
| A: |
Yes. Some things have been
used topically to either bind up receptors (Spironolactone or estrogens) or reduce
androgens or diminish hormonal impact (azelaic acid, pyridoxal B6, zinc, free
fatty acids). There is much debate about the efficacy of these agents. The problem
is a lack of study data regarding their use in pattern loss, though there are
studies suggesting why these agents may help.
|
return
to top
| Q: |
What's the difference
between Rogaine and Minoxidil and are these actually helpful for thinning hair?
|
| A: |
Rogaine is just a brand
name for minoxidil. Minoxidil can be purchased from numerous sources and in varying
strengths from 2% to 5% liquid and even in a 12.5% micronized lotion. It also
comes combined with Retin-A, which improves results by increasing the absorption
of minoxidil. (Retin-A also apparently exerts some antiandrogenic effects over
time.) MiNOxidil's name betrays its relationship to nitric oxide, an important
hair growth messenger that appears to be diminished in balding scalp. Minoxidil
can be helpful in pattern loss, but it is not a panacea. It is best used as part
of an overall program that attacks the problem from different angles.
|
return
to top
| Q: |
How effective is Rogaine?
|
| A: |
59% of men reported growth
after 4 months use of Rogaine. 26% reported moderate to dense regrowth (what most
of us would consider acceptable), while 33% experienced minimal regrowth (a few
hairs here and there, but not worth the effort). It should be noted that 42% of
men using the placebo (containing no minoxidil) reported some growth. 11% reported
moderate to dense regrowth (probably due to the propylene glycol, extra massaging,
or just overoptimism), while 31% reported minimal regrowth (if you rub just about
anything into your head twice a day, you're bound to see one or two hairs here
and there).
5% Minoxidil is a non FDA approved version of Minoxidil containg a larger concentration
of minoxidil. It is much more effective than the standard 2%. Many who do not
respond to 2% will respond to 5%. Unfortunately, since it is not yet FDA approved,
it has to be custom made by a pharmacy through a doctors prescription. Due to
this, many doctors will not prescribe it. Also, many pharmacies can't or won't
make it and most that do sell it at a high price. Many people swear by 5% minoxidil
though.
|
return
to top
| Q: |
Who is the ideal Rogaine
candidate?
|
| A: |
The ideal Rogaine candidate
is a young male (20s) with little (thinning) hair loss on the crown/vertex, or
a small bald spot 1-2" in diameter. The less you match this description the less
likely Rogaine is to work for you.
|
return
to top
| Q: |
Is it OK to apply Minoxidil
after showering?
|
| A: |
Yes. In fact, you will have
enhanced absorption after shampooing, as a well-hydrated scalp is more permeable
and will better absorb topical agents. Just be sure to towel dry the hair first
to remove standing water. The only precaution is to be attentive to signs of excessive
absorption, such as a racing heart.
|
return
to top
| Q: |
Is oral Minoxidil safe
and is it effective in MPB?
|
| A: |
Some people have used oral
minoxidil (Loniten), but this is a much more risky treatment than topical application.
Use at your own risk. Side effects of excessive minoxidil intake (either orally
or topically) include racing heart and salt and water retention. Pay attention
to symptoms such as swelling in the feet. Oral minoxidil in any significant quantity
ordinarily has to be taken with a loop diuretic and is best done under a physician's
care.
|
return
to top
| Q: |
Will I lose the hair
I grew if I quit Rogaine?
|
| A: |
Yes. Rogaine requires continual
treatment to maintain the new growth. If you stop using Rogaine your hair will
revert back to what it would have been had you never used Rogaine in about 2-3
months.
|
return
to top
| Q: |
What's SOD?
|
| A: |
Superoxide dismutase. This
is an enzyme produced by the body to neutralize the superoxide radical. Superoxide
is a messenger of inflammation and is involved in the body's autoimmune response.
It exists in a yin-yang relationship with nitric oxide. Nitric oxide is a vasodilator
that appears to be important for hair growth, while superoxide is a vasoconstrictor
that may be part of the signaling mechanism that tells hair to stop growing. Superoxide
can also interact with nitric oxide to form a highly destructive free radical
called peroxynitrite, which causes protein and lipid oxidation.
A few hair products contain copper peptides, which are SOD mimetics; i.e., mimic
the effects of the body's SOD enzyme. SOD-containing products have been noted
a number of times by researchers to stimulate hair growth and block hair loss
in mice. Recent study data on Tricomin, a copper peptide SOD, indicates increased
hair growth in MPB. Among other beneficial things, SODs appear to help spare growth-stimulating
nitric oxide, reduce damaging inflammation, and help reverse fibrosis (follicular
scarring that impedes the follicle's ability to grow hair). There are a few patents
for SODs as hair growth stimulators and even one for an SOD inhibitor that blocks
hair growth by increasing superoxide.
|
return
to top
| Q: |
Are higher strength Minoxidil
formula's better than lower strength ones?
|
| A: |
To a degree, minoxidil response
is dosage dependent. For example, 5% minoxidil generally grows more hair than
2%. But you can also apply 2% more liberally, or more frequently, and deliver
a comparable daily dosage of minoxidil. While more minoxidil sometimes helps,
beyond a certain threshold, additional minoxidil makes little if any difference.
|
return
to top
| Q: |
What can I do about the
flaking I've noticed since I started using Minoxidil?
|
| A: |
Occasionally people will
notice flaking with minoxidil. This can be due to the minoxidil itself flaking
off, or it can be contact dermatitis if it seems like bad dandruff or the scalp
feels irritated. If your minoxidil also contains Retin-A, the flaking may be due
to increased skin cell turnover induced by that agent. Nizoral shampoo often helps
with flaking. If it's contact dermatitis, though, you may need to discontinue
or lessen the frequency of minoxidil applications, or you can also use a minoxidil
formula that uses glycerol instead of propylene glycol, which is usually the problem
ingredient. Check with a compounding pharmacy or with www.minoxidil.com. If irritation
persists when using minoxidil or any topical, it is probably best to discontinue
usage.
|
return
to top
Propecia
/ Proscar / Finasteride Questions
| Q: |
What's the difference
between Propecia and Proscar?
|
| A: |
Both medications contain
finasteride and are made by the same company. They differ only in strength. Propecia
has 1 mg of finasteride, while Proscar has 5 mg. Proscar has been around for awhile
for the treatment of prostate enlargement, which, like pattern loss, has been
linked to DHT. Because of the price disparity between the two medications, some
people procure Proscar and divide the tablets into smaller dosages instead of
buying Propecia.
|
return
to top
| Q: |
How do people divide
Proscar tablets?
|
| A: |
Some people section them
with a pill splitter (available at any pharmacy), some crush and dissolve them
in alcohol (such as Everclear, whiskey or others), and some crush and encapsulate
them along with a filler such as corn starch to remove the air from the capsule.
|
return
to top
| Q: |
What if I split Proscar
but don't section it perfectly. Will this slightly varied daily dosage cause a
problem?
|
| A: |
No. Subtle daily variations
will not diminish finasteride's effectiveness. Some people even have good results
by taking a larger dosage only once every few days.
|
return
to top
| Q: |
Where do you get Proscar?
Do you need a prescription?
|
| A: |
Proscar is a prescription
medication in the US. Some doctors will write a prescription for Proscar for hair
loss patients wishing to avoid the greater expense of Propecia; others won't.
You can order Proscar from overseas from numerous sources without prescription.
FDA regulations allow the importation of a 3-month supply of medication for personal
use. The company selling the medication typically requires that you sign a form
indicating that you are using the medication under the guidance of a physician.
|
return
to top
| Q: |
How come some people
take less than the standard 1 mg dosage of Finasteride?
|
| A: |
Early dose ranging studies
showed that much smaller dosages, such as 0.5 mg and even less, inhibited DHT
on average almost as well as much higher dosages, such as 5 mg. One 6-month study
comparing a placebo group, which lost hair, to users taking differing dosages
of finasteride found that 0.2 mg of finasteride increased hair counts about 81%
as much as 1 mg when compared to the placebo. Similarly, 1 mg increased hair counts
82% as much as a full 5 mg compared to placebo. The tiny 0.2 mg dosage did about
66% as well at regrowth and retention as 5 mg. Accordingly, the 1 mg dosage was
probably a compromise designed to be high enough to pick up those who may not
respond as well to the lower dosages, but low enough to minimize side effects.
Many of those who take less than 1 mg opt for either 0.5 mg or 0.625 mg (1/8th
of a Proscar tablet). Some people also skip days periodically based on the fact
that finasteride suppresses DHT for up to several days and also on the old pharmacological
rationale that it may help preclude any possible tendencies toward tolerance,
which sometimes happens with continuous long-term use of medications.
|
return
to top
| Q: |
Is there a problem if
my wife gets pregnant while I'm taking Finasteride?
|
| A: |
No. Originally Merck decided
to err on the side of caution and warned against the possible problem of finasteride
transfer in semen. This warning has since been removed. At issue is the theoretical
danger that there could be genital birth defects in the male fetus. However, women
who are or could get pregnant should avoid finasteride ingestion and the handling
of broken finasteride tablets.
|
return
to top
| Q: |
How effective is Finasteride?
|
| A: |
Finasteride is not a miracle
treatment, but it works reasonably well for many people. Results tend to be slow,
and it appears to be much better at retaining than regrowing hair. But as treatments
go, it's fairly effective. Recent longer term results indicate that it continues
to work well for responders (i.e., the majority of users) a few years into treatment.
Like all treatments discussed here, it is typically best used as part of a multifaceted
program.
|
return
to top
| Q: |
What kind of side effects
can you get with Finasteride or other systemic DHT inhibitors?
|
| A: |
Finasteride is the best
documented of the DHT inhibitors and most people notice no side effects from it.
Some people do, however, experience a reduction in libido or notice more watery
semen. Some get some noticeable hyperandrogenicity, as evidenced by increased
facial oil, pimples or unusually high libido. Testicular ache is occasionally
noted, probably due to increased testosterone output, and the body takes time
to adjust to this. (Increased T levels--15% on average in finasteride users--are
likely in large part a compensatory response to reduced DHT.) Most often any side
effects dissipate within 2 or 3 months. If they do not, things should return to
normal after discontinuing finasteride, although this may take a couple of weeks,
as finasteride has a relatively long biological effect, although a short serum
half-life.
|
return
to top
| Q: |
What kind of side effects
can you get with Finasteride or other systemic DHT inhibitors?
|
| A: |
Finasteride is the best
documented of the DHT inhibitors and most people notice no side effects from it.
Some people do, however, experience a reduction in libido or notice more watery
semen. Some get some noticeable hyperandrogenicity, as evidenced by increased
facial oil, pimples or unusually high libido. Testicular ache is occasionally
noted, probably due to increased testosterone output, and the body takes time
to adjust to this. (Increased T levels--15% on average in finasteride users--are
likely in large part a compensatory response to reduced DHT.) Most often any side
effects dissipate within 2 or 3 months. If they do not, things should return to
normal after discontinuing finasteride, although this may take a couple of weeks,
as finasteride has a relatively long biological effect, although a short serum
half-life.
|
return
to top
Specific
Treatment Questions
| Q: |
Six weeks ago I started
using X and now my hair is shedding like crazy. What's going on?
|
| A: |
Sometimes treatments will
cause follicles to "wake up" a few weeks early in initiating hair growth. This
causes the old dormant hair that's still present to suddenly be ejected prematurely.
Thus you may see a temporary wave of increased loss. It's only an apparent increase
in actual loss, however, as this falling hair had stopped its growth cycle many
weeks earlier and was just waiting to drop out. Increased fallout of this sort
should normalize within a few weeks. If it continues over a prolonged period of
time (a few months) it may be that the treatment is contraindicated. Note that
the majority of people do not notice any increased shedding with various treatments.
Increased shedding is most often a positive sign, but its absence is not a negative
sign.
Note also that hair fallout is not perfectly uniform throughout the year, so sometimes
increased or decreased shedding is simply coincidental with normal hair cycles.
Also bear in mind that it is perfectly normal to lose hair every day. The problem
with pattern loss is primarily one of having insufficient regrowth.
|
return
to top
| Q: |
A few days ago I began
using X and now I'm losing a lot of hair. How come?
|
| A: |
Unless you're experiencing
incredible irritation and redness, acute inflammation, or are undergoing an extremely
toxic medical treatment, this week's loss has nothing to do with what you've been
doing the last few days. The hair fallout you see this week is actually of hair
that ended its growth cycle many weeks ago. Thus today's loss is a picture of
the state of your scalp from at least 2 - 4 weeks (and probably more like 6 -12
weeks) ago. This hair was already in the loss phase, in other words, before you
even started your recent treatment. Thus, short of mechanically pulling hair out
prematurely or undergoing a course of chemotherapy or radiation, this week's falling
hair is completely uninfluenced by what you're doing this week. Any loss you're
seeing now is coincidental to other events. Similarly, what you're doing treatment-wise
today won't be reflected in your hair fallout until several weeks from now.
|
return
to top
| Q: |
I heard that treatment
X helps grow hair. Is this true?
|
| A: |
Many agents grow some hair
in certain people. The question is whether or not a given treatment will grow
a significant amount of hair in a significant percentage of people. Personal experimentation
will provide the only sure answer for any given individual. On the other hand,
there clearly are "snake oil" treatments that only make the seller's bank account
grow, so be wary.
|
return
to top
| Q: |
Can shampoo make a difference
in MPB?
|
| A: |
Sometimes it can, as a percentage
of the active ingredients gets absorbed into the scalp and left behind after rinsing.
For instance, seborrheic dermatitis ("seb derm," a bad case of dandruff) is now
thought to play a minor role in pattern loss. In the Propecia trials, researchers
had test subjects use T/Gel shampoo (one of the many treatments for seb derm)
as a means of leveling the field and cutting out this factor as a variable in
determining results. Also, 2% prescription strength Nizoral shampoo used 2 - 4
times weekly was shown in one study to produce hair growth results comparable
to 2% minoxidil used once daily in a small group of group of test subjects. It
was also shown in a larger group to increase the number of hairs in the anagen
(growth) phase and to increase average hair shaft diameter. There are almost certainly
other shampoos that can positively influence hair growth, as medication can reach
the hair follicle fairly easily when the scalp is in a well-hydrated state. Water
is a superb penetration enhancer that is, in fact, added liberally to many medicated
penetrating creams.
|
return
to top
| Q: |
Do any treatments work
in the frontal area or are they only effective in the crown?
|
| A: |
All treatments that work
on the crown also work to some degree in the front--just not as well. Treatments
are generally more effective the further back you go. Confusion arises because
of the way some studies were conducted. With minoxidil, for instance, studies
only measured vertex balding; i.e., the traditional bald spot. Accordingly, the
only hair growth results that the manufacturer--Upjohn--is allowed to claim pertain
to the vertex.
|
return
to top
| Q: |
I've been using a finasteride/minoxidil
combination for awhile with some success. Is it possible I can maintain my hair
gains by just using the finasteride alone now?
|
| A: |
Unfortunately some of this
hair regrowth is likely a direct consequence of minoxidil stimulation. Any such
"minoxidil-dependent hair" will return to baseline if you drop the minoxidil.
You might be able to lessen the frequency of minoxidil applications and still
maintain the hair, but don't count on finasteride alone being able to protect
and retain all the new hair grown from the combination protocol.
|
return
to top
| Q: |
What's this I keep hearing
about a dual 5AR inhibitor?
|
| A: |
DHT is produced from testosterone
by two 5-alpha reductase isoenzymes, called Type I and Type II. Type I 5AR is
much more prominent in the scalp than Type II. However, immunostaining techniques
reveal that Type I is abundant in sebaceous glands, while significant Type II
is present in the dermal papilla itself. Glaxo Wellcome is currently testing a
medication (Dutasteride) that inhibits both isoenzymes. It is noteworthy that
Dutasteride also appears to inhibit more Type II 5AR than finasteride does. What
remains to be seen is whether the incidence of side effects will increase with
the dual inhibitor above the level seen with finasteride and whether results will
be greater or not.
|
return
to top
| Q: |
What is DHT?
|
| A: |
DHT stands for dihydrotestosterone,
which is produced from testosterone by the enzyme 5-alpha reductase. DHT is the
androgen thought to be most responsible for male pattern baldness. DHT has a very
high affinity for the androgen receptor and is estimated to be five to ten times
more potent than testosterone. Other androgens that may be significant in pattern
loss include androstenedione, androstanedione and DHEA (especially in women).
All of these fall into hormonal pathways that can potentially result in elevation
of DHT downstream via various enzymes. It is possible that certain DHT metabolites
may play a role in pattern loss as well.
|
return
to top
| Q: |
Is it true that the herb
saw palmetto is better than Finasteride (Proscar/Propecia) and has no side effects?
|
| A: |
Saw palmetto has been used
successfully in prostate enlargement. Accordingly it may have utility in pattern
loss, though it has not been formally tested for this. Saw palmetto and finasteride
are not really equivalent, since saw palmetto has a much broader range of anti-hormonal
activity than finasteride. As for side effects, these are certainly possible with
saw palmetto, though everyone will respond uniquely. It must be borne in mind
that saw palmetto is as much a chemical concoction as finasteride; it was merely
produced in Nature's laboratory instead of a conventional one. Like anything,
if it's potent enough to cause a biochemical change in the body--especially involving
hormones--it's potent enough to cause side effects in some people. Saw palmetto
may be useful topically.
|
return
to top
| Q: |
What's reflex hyperandrogenicity?
|
| A: |
When the effects of androgens
in the body are lessened, e.g. through lowering DHT or by systemic hormone receptor
blockade, the body seeks equilibrium through a process called upregulation. This
can take the form of increased hormone production and/or increased tissue sensitivity
to the remaining hormones. The reason side effects usually gradually disappear
with finasteride is probably due to such upregulation. In a small percentage of
individuals, it may be that this process overshoots the mark, resulting in significant
hyperandrogenicity. This is marked by such signs as greatly increased facial oil,
increased pimples, and greatly elevated libido. It's possible that in certain
cases such hyperandrogenicity overcomes the hair-protective effect of, say, finasteride,
though this does not appear to be the case for the vast majority of people.
|
return
to top
|
|
