Hair Loss: What You Can and Can't Control

According to the American Hair Loss Association (AHLA), about one in four men with male-pattern baldness (MPB) start to lose their hair before the age of 21 and two in three men will experience some hair thinning by age 35. Self-confidence recedes along with the hairline leaving depressed men in its wake.

Though less common, hair loss can also be caused by stress, disease, or medicines/medical treatments. But unlike with MPB, in these cases hair falls out in clumps and usually returns when the trigger stops.

The Science Behind Hair Loss

Hormones play a part in MPB. In genetically-susceptible men, there is an over production of dihydrotesterone (DHT)-a product of the male hormone testosterone. Over time these high levels of DHT shrink the hair follicles weakening the hair and eventually causing it to stop growing.

Today with proper treatment, the process can be slowed-or even stopped-if caught early enough. Generally, the younger you are when you start losing your hair, the more advanced your hair loss will be. Again, early intervention is key to achieve the best results.

What You Can Do

No costly hair analysis or scalp biopsy is necessary to properly diagnose hair loss, according to the AHLC. Before considering any treatment options, have your scalp examined by an experienced medical hair loss expert. A device called a densitometer should be used to assess the hair follicles and make the diagnosis of MPB.

The AHLC also cautions consumers to exercise extreme caution when considering the large variety of shampoos, hair-care cosmetics, scalp massagers, and other devices since many of these make questionable hair growth promises.

To date, only two medications have received approval from the US Food and Drug Administration (FDA): minoxidil (available over the counter as Rogaine) and finasteride (by prescription only as Propecia). But clinical research trials for other promising medications-including dutasteride-are ongoing.

Applied twice daily to the areas of the scalp undergoing hair loss, minoxidil (Rogaine) was accidentally discovered to be a hair loss remedy when it was in use for hypertension. Minoxidil slows the progression of hair loss and causes fine hair regrowth.

More effective than minoxidil, finasteride (Propecia) works by blocking DHT. Finasteride is taken orally once a day and is effective in approximately two thirds of men.

Dutasteride has been shown to decrease levels of DHT by 90 percent after only two weeks, making it a more powerful and faster-acting weapon against hair loss than finasteride.

Surgery and Other Options

Hair additions such as hair weaves, extensions, hair pieces, and toupees are made up of human hair, synthetic fiber, or a combination of both. These techniques rely on using existing hair or the skin as anchor sites. There are pros and cons to each technique.

A new treatment option being carefully considered by the FDA is low-level laser light therapy (LLLLT). LLLLT uses a laser-emitting device to stimulate hair growth. One downside is that it requires several weekly applications to work.

Hair graft transplantation is a very common surgical procedure. The results of hair transplantation can be dramatic on those with an advanced degree of hair loss. Hair transplant costs are usually determined by the number of follicular unit hair grafts necessary to achieve the desired result starting at around $5,000.

Regardless of the treatment option you decide to pursue, some would argue that it's a great time to be hairless. Baldness is no longer associated with men like Mr. Clean or scary-looking TV characters such as Uncle Fester. Today, baldness can be sexy. The careers of rock star Chris Doughtry or actor Bruce Willis certainly haven't been derailed by hair loss.


National Institutes of Health/National Institutes of Arthritis and Musculoskeletal and Skin Diseases

The University of Pennsylvania School of Medicine

The American Hair Loss Council

The Hair Loss Learning Center