baldness - Etymology, Approaches to baldness, Concealing hair loss, Embracing baldness, Baldness folklore

Commonly described as permanent loss of hair from the front and/or top of the head, usually in men, because of the degeneration and reduction in the size of hair follicles. Genetic factors, ageing, and androgens (eunuchs are seldom bald) may be causative agents. There is no effective cure. An improper diet, certain endocrine and skin disorders, as well as some chemical or physical agents may damage the hair follicles leading to either permanent or temporary baldness in either sex at any age. Some other primates also develop baldness, such as the oukari monkey of South America.

Alopecia
Classifications and external resources

Actor Patrick Stewart
ICD-10	L63-L64
ICD-9	704.0

Baldness is a trait which involves the state of lacking hair where it often grows, especially on the head. The most common form of baldness is a progressive hair thinning condition called androgenic alopecia or 'male pattern baldness' that occurs in adult human males and some primate species. it ranges from male and female pattern alopecia (androgenetic alopecia, also called androgenic alopecia or alopecia androgenetica), alopecia areata, which involves the loss of some of the hair from the head, and alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body. The more hair lost, the less successful the treatment will be. One large scale study in Maryborough, in central Victoria (Australia) showed the prevalence of mid-frontal hair loss increases with age and affects 57% of women and 73.5% of men aged 80 and over.

Male pattern baldness is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline" or "receding brow." The trigger for this type of baldness (called androgenic alopecia because it is caused by male hormones or androgens) is DHT, a powerful sex hormone.
The mechanism by which DHT accomplishes this is not yet understood. Through the process of follicular miniaturization, hair shaft width is progressively decreased until scalp hair resembles fragile vellus hair or "peach fuzz" or else becomes non-existent. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined. Male pattern baldness is classified on the Hamilton-Norwood scale I-VIII. While there is some basis for this belief, both parents contribute to their offspring's likelihood of hair loss. Most likely, inheritance is technically "autosomal dominant with mixed penetrance" (see 'baldness folklore' below)

There are several other kinds of baldness:

Traction alopecia is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force. Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium. Some mycotic infections can cause massive hair loss. Alopecia areata is an autoimmune disorder also known as "spot baldness" that can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis). Localized or diffuse hair loss may also occur in cicatricial alopecia (lupus erythematosus, lichen plano pilaris, folliculitis decalvans, central centrifugal cicatricial alopecia, postmenopausal frontal fibrosing alopecia, etc.). Hypothyroidism can cause hair loss, especially thinning of the outer third of the eyebrows

Etymology

The term Alopecia (al-oh-PEE-she-uh) is formed from the Greek αλώπηξ (alopex), meaning fox.

Approaches to baldness

Psychological implications

The psychological implications for individuals experiencing hair loss vary widely.

Alopecia induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. Body image does not return to the previous state after regrowth of hair for a majority of patients.

Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms.

Some balding men may feel proud of their baldness, feeling a kindred relationship with famous charismatic bald film actors such as Yul Brynner, Vin Diesel, Michael Chiklis, Telly Savalas, Ben Kingsley, Patrick Stewart or Bruce Willis;

Many companies have built a successful business selling products that reverse baldness, by allegedly regrowing hair, transplanting hair or selling hairpieces.

Preventing and reversing hair loss

It is easier to prevent the falling out of healthy hairs than to regrow hair in follicles that are already dormant. However such treatments are generally ineffective at treating extreme cases of hair loss.

Surgery is another method of reversing hair loss and baldness, although it may be considered an extreme measure. The surgical methods used include hair transplantation, where patches of skin with hair are moved from one part of the head to another.

Looking forward, the prospective treatment of hair multiplication/hair cloning, which extracts self-replenishing follicle stem cells, multiplies them many times over in the lab, and microinjects them into the scalp, has been shown to work in mice, and is currently under development, expected by some scientists to be available to the public in 2009-2015. Subsequent versions of the treatment are expected by some scientists to be able to cause these follicle stem cells to simply signal the surrounding hair follicles to rejuvenate.*

Topical application of ketoconazole, which is both an anti-fungal and a potent 5-alpha reductase inhibitor, is often used as a supplement to other approaches.

Regular aerobic exercise can help keep androgen levels naturally lower while maintaining overall health and lowering stress, though weight training may have a detrimental effect on hair by increasing testosterone levels.

Stress reduction can be helpful in slowing hair loss.

Immunosuppresants applied to the scalp have been shown to temporarily reverse hair loss, though the possibly lethal side effects of this treatment make it untenable.

Polygonum Multiflorum is a traditional Chinese cure for hair loss. Consuming large amounts of oil to get at small quantities of beta sitosterol is likely to exacerbate male pattern baldness.

In March 2006, Curis announced that it had received the first preclinical milestone, a $1,000,000 cash payment, in its hair growth program with Procter & The program is focused on the potential development of a topical Hedgehog agonist for hair growth disorders, such as male pattern baldness and female hair loss.

In October 2006, UK biotechnology firm Intercytex announced they have successfully tested a method of removing hair follicles from the back of the neck, multiplying them and then reimplanting the cells into the scalp (Hair multiplication). The initial testing resulted in 70% of male patients regrowing hair.

Concealing hair loss

Head

One method of hiding hair loss is the "comb over", which involves restyling the remaining hair to cover the balding area. It is usually a temporary solution, useful only while the area of hair loss is small. As the hair loss increases, a comb over becomes less effective. The wig is a layer of artificial or natural hair made to resemble a typical hair style. In most cases the hair is artificial. In the United States, the best wigs - those that look like real hair - cost up to tens of thousands of dollars. Organizations such as Wigs for Kids and Locks of Love collect individuals' donations of their own natural hair to be made into wigs for young cancer patients who have lost their hair due to chemotherapy or other cancer treatment in addition to any type of hair loss.

Eyebrows

Though not as common as the loss of hair on the head, chemotherapy, hormone imbalance, forms of alopecia, and other factors can also cause loss of hair in the eyebrows.

Embracing baldness

Of course, instead of concealing hair loss, one may embrace it. They spread the message of baldness by shaving the heads of adults to raise money for curing childhood cancer, which often causes children to lose their hair (see Head shaving).

Baldness folklore

There are many myths regarding the possible causes of baldness and its relationship with one's virility, intelligence, ethnicity, job, social class, wealth etc. Previously, early baldness of the androgenic type was thought to be sex linked dominant in males and to be sex linked recessive in females. Research suggests that the gene for the androgen receptor, which is significant in determining probability for hair loss, is located on the X chromosome and so is always inherited from the mother's side.There is a 50% chance that a person shares the same X chromosome as their maternal grandfather. However research has also shown that a person with a balding father also has a significantly greater chance of experiencing hair loss. "Intellectual activity or psychological problems can cause baldness." This myth probably was inspired by the fact that the human brain is located inside the skull, very close and just below where hair grows, and so it was thought that the use and abuse as well as mental diseases could have negative effect on hair growth and number. This is sometimes used as a stereotype in films, where the more intellectual or rather frustrated characters are most usually portrayed as bald and generally unattractive, as opposed to the main characters which are usually portrayed as attractive, fit, mentally stable and generally with no apparent hair problems. This same myth normally extends to considering people having intellectual jobs more prone to baldness problems compared to manual laborers, sometimes further extending the myth to male college or university students when compared to workers of the same age. Whether it can cause hair loss by some other mechanism is not clear. Levels of free testosterone are strongly linked to libido and also DHT levels, but unless free testosterone is virtually non-existent levels have not been shown to affect virility. Additionally, because hair loss is progressive and free testosterone declines with age, a person's hairline may be more indicative of their past than present disposition. "Shaving hair makes it grow back stronger" Proposed as a popular remedy against baldness, it's very probably just an illusion similar to the one perceived after shaving one's beard or mustache. Shaving one's head doesn't increase the number of healthy hair present on the scalp, and, after the remaining hair has grown a few millimeters, no enhancement in thickness or overall quality can be observed. "Frequent ejaculation causes baldness" There are many misconceptions about what can help prevent hairloss, one of these being that frequent ejaculation may have an influence on MPB. While ejaculation significantly lowers levels of relaxin (a 5-alpha reductase inhibitor) in a male's body and causes testosterone levels to temporarily elevate, the claim that frequent ejaculations can cause baldness is often viewed with skepticism. "Standing on one's head alleviates baldness" The "blood-flow" theory, which led men to stand on their heads in the 1980's, can be found in the advertising for many of the fake hair-loss treatments for sale on the internet. While Minoxidil is a vasodilator and is speculated to work, in part, by increasing blood flow to hair follicles, there is no evidence that standing on one's head can alleviate baldness. This one probably started in the military where young men entering the service were required to wear hats and soon showed signs of going bald, or at least of hair thinning. The age that young men enter the military is also the same age that male pattern hair loss begins. Hats do cause hair breakage and, to a lesser degree, split ends. Rockefeller had an extreme case of alopecia that caused him to lose all of the hair on his face, including his eyebrows and eyelashes. Actor Patrick Stewart lost most of his hair to male-pattern baldness by age 19 (His natural "horse-shoe" of remaining hair can be seen in the film L.A. Some other primates, such as Chimpanzees, stump-tailed macaques, and South American nakari show progressive thinning of the hair on the scalp after adolescence.

Male Pattern Baldness News

New gene found to control hairloss What may be the markers of the male equivalent of polycystic ovary syndrome? Pubmed article on pathogenic yeasts which feed on sebum Topical application of ketoconazole stimulates hair growth in C3H/HeN mice. Pubmed article: Topical application of ketoconazole grows hair in C3H/HeN mice indicating that ketoconazole may be effective as a hair growth stimulant in people with seborrheic dermatitis. Vitamin D3 analogs stimulate hair growth in nude mice. Pubmed article: Vitamin D3 analogs dramatically stimulated the hair growth of nude mice indicating the role of vitamin D3 in hair growth Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men. reductase inhibitors available, current 2006

The relationship between androgenic baldness, metabolism, diabetes and heart disease

Androgenic effects of oral contraceptives: implications for patient compliance. Pubmed article on androgenic alopecia, contraceptives and women Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals. Pubmed article: Male Pattern Baldness in Female to Male transsexuals receiving testosterone esters or testosterone undecanoate was not an indicator of increased risk for coronary heart disease. Male pattern baldness is not associated with established cardiovascular risk factors in the general population. Pubmed article: While male pattern baldness is associated with coronary heart disease, it is not correlated with abnormal height, weight, blood pressure, pulse rate, total and high-density lipoprotein cholesterol, or plasma fibrinogen indicating that male pattern baldness is linked to heart disease through some other mechanism. Pubmed article: 36 person study finds serum lipoprotein (a) and triglyceride levels, both risk factors for coronary heart disease, to be higher in men with male pattern baldness. "Endothelium-Derived Relaxing Factor and Minoxidil: Active Mechanisms in Hair Growth" Nitric oxide is the "natural minoxidil". Nitric oxide in the human hair follicle: constitutive and dihydrotestosterone-induced nitric oxide synthase expression and NO production in dermal papilla cells. DHT stimulates production of the free radical Nitrogen Monoxide (NO) which in turn stimulates hair growth. Nitric oxide stimulates hair growth, keeps follicles in the growth phase, etc. The relationship between serum levels of insulin and sex hormone-binding globulin in men: the effect of weight loss.