Baldness

Baldness 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 male humans and other species. The amount and patterns of baldness can vary greatly; it ranges from male and female pattern alopecia (androgenic alopecia, also called androgenetic 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.

Hair Loss Treatment

Hair loss treatment is not necessary if you are comfortable with your appearance. Hair weaving, hairpieces, or change of hairstyle may disguise the hair loss. This is usually the least expensive and safest approach for male baldness.
There are two main drugs used to treat male pattern baldness:
Minoxidil (Rogaine) - a solution that you apply directly to the scalp to stimulate the hair follicles. It slows hair loss for many men, and some men grow new hair. The previous degree of hair loss returns when you stop applying the solution.
Finasteride (Propecia, Proscar) -- a prescription pill that inhibits the production of the male hormone dihydrotestosterone. Like minoxidil, you are more likely to have slower hair loss than actual new hair growth. In general, it is somewhat more effective than minoxidil. The previous degree of hair loss returns when you stop taking the drug.
Hair transplants consist of removing tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring in the donor areas and carries a modest risk for skin infection. The procedure usually requires multiple transplantation sessions and may be expensive. Results, however, are often excellent and permanent.
Suturing hair pieces to the scalp is not recommended. It can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.
Treatment for hair loss varies depending on the case and the preference of an individual. There are some who people who are not affected by baldness as they don't really think that they need medications for loosing hair while there are some individuals who will use all available methods just to hide their foreheads.
Remember that not all treatments can be successful and that some treatments can carry some side effects.
Technically, the success of treatment really depends on the cause of the hair loss as in the case of stress, if the stress is the reason for hair loss, the only solution that will give positive results is to eliminate too much stress or learn to manage the stress in your life.
But if the reason for your hair loss is a because of an underlying illness like thyroid problems then you really have to consult a doctor to treat your thyroid.
If your hair loss is cause by genetic reasons or if one or both of your parents have hair loss then some common medications for these are Minoxidil or Finasteride.
Minoxidil (brand name: Rogaine) - this is a topical application which can be applied twice a day. This can be bought over the counter even without any prescription.
Finasteride (brand name: Propecia) - this can be taken in pill form and can be taken once a day. However, this medication is not approved for women's use by U.S Food and Drug Administration.
Finasteride is not advisable for women because this can cause birth defects.Other treatment options available:For those who don't want to use medications for their hair loss, other options are available. The other two options are to wear hair pieces or hair transplantation surgery.
Hair pieces - hair pieces or hair weaving is a process to which a mesh is attached to your existing hair. Similar type, color and texture of hair are woven to your scalp to match your existing hair. The result can look like your original hair but the prices of hair weaving vary from one type of hair to another.
Hair transplantation surgery - this is surgery where the health professional will move small grafts from your scalp which have full hairs and transfer it to areas where there are thinning or baldness.

Background, cause and incidence

The average human head has about 100,000 hair follicles. Each follicle will grow an average of about 20 individual hairs in a person's lifetime.[1] Average hair loss is about 100 strands a day.
Incidence of pattern baldness varies from population to population based on genetic background. Environmental factors do not seem to affect this type of baldness greatly. 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. According to Medem Medical Library's website, male pattern baldness affects roughly 40 million men in the United States. Approximately 25 percent of men begin balding by age 30; two-thirds begin balding by age 60.
Male pattern is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline". Receding hairlines are usually seen in males above the ages of 25 but can be seen as early as mid-teens.
An additional bald patch may develop on top (vertex). The trigger for this type of baldness (called androgenetic alopecia ) is DHT, a powerful sex hormone, body, and facial hair growth promoter that can adversely affect the hair on the head as well as the prostate.[2]
The mechanism by which DHT accomplishes this is not yet understood. In genetically-prone scalps, DHT initiates a process of follicular miniaturization. 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-VII.
It was previously believed that baldness was inherited from the maternal grandfather. 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.
Trichotillomania is the loss of hair caused by compulsive pulling and bending of the hairs. It tends to occur more in children than in adults. In this condition the hairs are not absent from the scalp but are broken. Where they break near the scalp they cause typical, short, "exclamation mark" hairs.
Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium.[3]
Worrisome hair loss often follows childbirth without causing actual baldness. In this situation, the hair is actually thicker during pregnancy due to increased circulating oestrogens. After the baby is born, the oestrogen levels fall back to normal pre-pregnancy levels and the additional hair foliage drops out. A similar situation occurs in women taking the fertility-stimulating drug clomiphene.
Iron deficiency is a common cause of thinning of the hair, though frank baldness is not usually seen.
Radiation to the scalp, as happens when radiotherapy is applied to the head for the treatment of certain cancers there, can cause baldness of the irradiated areas.
Some mycotic infections can cause massive hair loss.[4]
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.). Tumours and skin outgrowths also induce localized baldness (sebaceous nevus, basal cell carcinoma, squamous cell carcinoma).
Hypothyroidism can cause hair loss, typically frontal, and is particularly associated with thinning of the outer third of the eyebrows (syphilis also can cause loss of the outer third of the eyebrows)
Hyperthyroidism can also cause hair loss, which is parietal rather than frontal.
Temporary loss of hair can occur in areas where sebaceous cysts are present for considerable duration; normally one to several weeks in length.

Evolutionary theories of male pattern baldness

There is no consensus regarding the details of the evolution of male pattern baldness. A number of other primate species also experience hair loss following puberty, and some primate species clearly use an enlarged forehead, created both anatomically and through strategies such as frontal balding, to convey increased status and maturity. The assertion that MPB is intended to convey a social message is supported by the fact that the distribution of androgen receptors in the scalp differs between men and women, and older women or women with high androgen levels often exhibit diffuse thinning of hair as opposed to male pattern baldness.
One theory, advanced by Muscarella and Cunningham[5], suggests baldness evolved in males through sexual selection as an enhanced signal of aging and social maturity, whereby aggression and risk-taking decrease and nurturing behaviours increase. This may have conveyed a male with enhanced social status but reduced physical threat, which could enhance ability to secure reproductive partners and raise offspring to adulthood.
In a study by hector by Muscarella and Cunnhingham [5], males and females viewed 6 male models with different levels of facial hair (beard and mustache or clean) and cranial hair (full head of hair, receding and bald). Participants rated each combination on 32 adjectives related to social perceptions. Males with facial hair and those with bald or receding hair were rated as being older than those who were clean-shaven or had a full head of hair. Beards and a full head of hair were seen as being more aggressive and less socially mature, and baldness was associated with more social maturity. A review of social perceptions of male pattern baldness has been provided by Henss (2001) [6] .
Other evolutionary hypotheses include genetic linkage to beneficial traits unrelated to hair loss and genetic drift.

[edit] Non-human baldness
Baldness is not only a human trait. Some other primates, such as chimpanzees, stump-tailed macaques, and South American nakari show progressive thinning of the hair on the scalp after adolescence. Adult stump-tailed macaques, in fact, are commonly used in laboratories for the testing of hair-regrowth treatments.
The different predecessors of Old World and New World vultures convergently evolved a bald head, preventing feathers from retaining material from the vulture's diet of rotting meat, as well as helping in heat regulation.[7]

Male Pattern Baldness and genetics

Much research went into the genetic component of Male Pattern baldness. Research indicates that susceptibility to premature male pattern baldness is largely X-linked. Other genes, that aren’t sex linked, are also involved.
Large studies in 2005 and 2007 stress the importance of the Maternal line in the inheritance of Male Pattern Baldness (AGA). German researchers name the Androgen Receptor gene as the cardinal prerequisite for balding[8]. They conclude that a certain variant of the androgen receptor is needed for AGA to develop. In the same year the results of this study were confirmed by other researchers [9]. This gene is recessive and a female would need 2 X chromosomes with the defect to show typical Male Pattern Alopecia. Seeing that Androgens and their interaction with the androgen receptor are the cause of AGA it seems logical that the Androgen Receptor gene plays an important part in its development.
Other research in 2007 suggests another gene on the X chromosome, that lies close to the androgen receptor gene, is an important gene in Male Pattern Baldness. They found the region Xq11-q12 on the X-chromosome to be strongly associated with AGA in males. They point at the EDA2R gene as the gene that is mostly associated with AGA.
Other genes involved with hair loss have been found. One of them being a gene on chromosome 3. The gene is located at 3q26[10]. This gene is also involved in a type of baldness associated with mental retardation. This gene is recessive .
Another gene that might be involved in hair loss is the P2RY5. This gene is linked to hair structure. Certain variants can lead to baldness at birth while another variant cause “wooly hair”.

Approaches to baldness

[edit] Psychological effects

Retired bald NASA astronaut Story Musgrave.
The psychological effects for individuals experiencing hair loss vary widely. Some people adapt to the change comfortably, while others have severe problems relating to anxiety, depression, social phobia, and in some cases, identity change.
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. In such cases, patients have difficulties expressing their feelings (alexithymia) and may be more prone to avoiding family conflicts. Family therapy can help families to cope with these psychological problems if they arise.[11]
Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms.[12]
Some balding men may feel proud of their baldness, feeling a kindred relationship with famous charismatic bald men, much of whose perceived masculinity and handsomeness derives from their most obvious distinguishing feature. Baldness has, in recent years, in any case become less of a (supposed) liability due to an increasing fashionable prevalence of very short, or even completely shaven, hair among men, at least in western countries.
Many companies have built a successful business selling products that reverse baldness, by allegedly regrowing hair, transplanting hair or selling hairpieces. While some of these products show improvements in a moderate amount of users, people should always be cautious about claims for hair regrowth, and research these products and alternatives before investing in expensive treatments.

Preventing and reversing hair loss

It has been suggested that this section be split into a new article entitled Baldness treatments. (Discuss)
Main article: Baldness treatments
Treatments for the various forms of alopecia have limited success. Some hair loss sufferers make use of clinically proven treatments such as finasteride and topically applied minoxidil (in solution) in an attempt to prevent further loss and regrow hair. As a general rule, it is easier to maintain remaining hair than it is to regrow; however, the treatments mentioned will help some of the users suffering from Androgenetic alopecia, and there are new technologies in cosmetic transplant surgery and hair replacement systems that can be completely undetectable.
In the USA, there are only two drug-based treatments that have been approved by the FDA (Food and Drug Administration) and one product that has been cleared by the FDA for the treatment of androgenetic alopecia, otherwise known as male or female pattern hair loss. The two FDA approved treatments are finasteride (marketed for hair loss as Propecia) and minoxidil.

Finasteride
Main article: Baldness treatments#Finasteride

Low-level laser therapy
Main article: Baldness treatments#Low-level laser therapy

Surgery
Main article: Baldness treatments#Hair Transplantation

[edit] Hair multiplication
Main article: Baldness treatments#Hair multiplication (under development)

[edit] Ketoconazole
Main article: Baldness treatments#Ketoconazole

[edit] Unsaturated fatty acids
Main article: Baldness treatments#Unsaturated fatty acids

[edit] Exercise

It has been suggested that this section be split into a new article entitled Baldness treatments#Diet and lifestyle. (Discuss)
Regular aerobic exercise can help keep androgen levels (particularly free testosterone levels) naturally lower while maintaining overall health, lowering stress and increasing SHBG. [1] [2]
Weight training without aerobic exercise may increase testosterone. [3]; [4] [5] [6] One study suggests that both heavy exercise and increased fat intake, in combination, are required for increased free testosterone in strength trainers. Increased total or free testosterone would help them build and repair muscle, but may cause susceptible individuals to lose hair. [7]
However, there is at least one study that indicates a decline in free testosterone combined with an increase in strength due to an (unspecified) strength training regimen.[13]

[edit] Stress reduction
Stress reduction can be helpful in slowing hair loss. (see Baldness Folklore)

[edit] Immunosuppressants
Immunosuppressants applied to the scalp have been shown to temporarily reverse alopecia areata, though the side effects of some of these drugs make such therapy questionable. [8][9]

[edit] Saw palmetto
Main article: Baldness treatments#Saw palmetto
Saw palmetto extract has been demonstrated to inhibit both isoforms of alpha-5-reductase and does not interfere with the cellular capacity to secrete PSA

[edit] Polygonum multiflorum
Polygonum multiflorum is a traditional Chinese cure for hair loss. P. multiflorum contains stilbene glycosides similar to resveratrol. [10]

[edit] Hedgehog agonists
Main article: Baldness treatments#Hedgehog agonists

[edit] WNT gene related
Main article: Baldness treatments#Hair multiplication (under development)

[edit] Coffee Beans
Main article: Baldness treatments#Caffeine