Hair loss: can skin ever be "in?"

Predicting baldness patterns

"Look to your father and grandfather to get an idea of what your own hair line may do as you age," says Mark Stevens, Ph.D., professor of psychology at the University of Southern California. Actually, the most dominant part of your DNA inheritance comes from your mother. So look closely at her brothers and her father for clues about your hairline".

However, hair loss can be more than fading confidence or spotting many bald relatives perched on the branches of your family tree. Says Thomas F. Downham II, M.D. in the department of dermatology at Henry Ford Medical Center in Detroit, Michigan: "Don't just jump to the conclusion you have male pattern baldness because you are losing some hair. That hair loss could also be a sign of low serum iron, an early indication of a blood condition. Or it could be caused by the medications you are taking, or it could be a sign hypothyroidism. Of the medical specialists, dermatologists are best suited to evaluate hair loss." Moreover, hair is very sensitive to anti-hypertensive drugs, beta blockers, and anticancer preparations.

Historically, there have been many theories about the causes of hair loss. Aristotle thought sexual indulgence caused male pattern baldness. Genetics notwithstanding, you could go bald in the 1940s and 50s from wearing a hat every day -- or so people thought. Various other theories implicated scalp tension as the cause of hair loss. Following that was a theory that the scalp muscles lead to a shearing stress in the skin. The most recent explanation for male baldness has held sway for three decades. It's a tongue-twisting condition known as androgenetic alopecia.

Doctors think a male hormone, androgen, interrupts the natural growth cycle of hair in the front and crown regions of the scalp. But it doesn't happen without that genetic predisposition. You can also lose a lot of hair during times of intense stress. Being shipped off to a war, losing a job, or the rigors of divorce court can cause a type of balding known as diffuse hair loss. If the stress continues unabated, hair loss will become patchy and, often, permanent.

Pros and cons of hair transplants

For reasons doctors don't fully understand, the hair at the back of the head is genetically hardier. And that observation lead to a major industry -- hair transplanting. Doctors remove a patch of hair-bearing skin from the back of the head and sew the scalp shut. Using either a scalpel or a laser, practitioners make holes for the grafts in the scalp and then plunk in micrografts, containing one or two hairs, or minigrafts--plugs of skin with three or four hairs.

"Transplanted hair is very soft and downy and not like the hair you had before," cautions Dr. Downham. "I would say that about fifty to sixty percent of my patients have had a good response from transplanting. However, if you have a lot of bare skin on your head, you won't get any significant amount of transplanted hair to to grow over the long run. You may require additional transplants later on in life."

Although 242 articles for medical journals have been written on hair loss since 1992, there are no reliable scientific data yet on the long-term survival of transplanted hair. Depending on the procedure, it can take six months to a year for a natural appearance to show. Cost? Better bring all your credit cards. Hair transplants can range from $3000 to $10,000 depending on the number of procedures involved. One session can require two to five hours.

Hair growth treatments: do they work?

About 30% of men participating in clinical trials have had success with an anti-high blood pressure medication, minoxidil, which was first used for hair growth in 1980. Since then, a 2% preparation has been approved for over-the-counter (O.T.C.) distribution, marketed as Rogaine. Minoxidil is rubbed into the scalp and probably helps by increasing blood circulation there. The F.D.A. is currently considering approving a 5% minoxidil solution for O.T.C. use, as well.

Another medicine being studied as a treatment for baldness is finasteride, taken as a one milligram tablet. In clinical trials at two large medical centers, 1500 men took the drug and found the majority of subjects enjoyed significantly increased hair growth. The drug works by reducing the hormone which interferes with hair growth. The manufacturers of finasteride, Merck Research Labs, have no clue when the F.D.A. will approve the drug.

Of course, if a bald head makes no difference at all to your self-esteem, you can always join forces with th 10,000 proud members of the Bald Headed Men of America. Their mission? To convince you that skin is in.