A Full Head Of Hair Restores
Pride And Glory To Man’s Crown

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

I casually queried men regarding their specific health concerns and was surprised to learn that hair loss is a major concern and that many men worry more about their thinning hair than heart disease or prostate cancer.

Baldness is a reality for nearly forty percent of men. Since Michael Jordan popularized the shaved head, I don’t really know who among my male friends or family members was balding before he decided to “be like Mike.”

But that isn’t the point. Thinning hair, for some men, causes the same feelings of aging, unattractiveness, anxiety and insecurity that the post childbearing abdominal “pooch” or sagging breasts cause in some women. Hair loss symbolizes lost youth and “becoming like one’s dad.” Bald men often feel less sexually attractive to women. It’s ironic that androgenic alopecia (a pattern of baldness in which a man’s hair recedes from the temples and thins from the crown) is actually the result of increased levels of testosterone.

Male pattern baldness is usually genetic. Circulating testosterone is converted to the active compound Dihydrotestosterone (DHT). DHT forms a waxy substance that collects around the bulbs of hair follicles causing constriction of the blood vessels in genetically susceptible areas of the scalp. The hair produced becomes thinner and more easily broken resulting in the baldhead.

Anything that compromises the blood supply to the scalp compromises hair growth. Some other causes are autoimmune disorders, medications, chemical exposures, prolonged illness, hormonal imbalances, stress and poor nutrition. When blood supply is completely inhibited hair growth ceases and baldness (alopecia) results.

Blood supplies the oxygen and nutrients necessary for follicles to synthesize hair. Hair synthesis has three phases:

Anagen: The active growth phase which lasts six to ten years. Immature cells develop deep within the hair follicle at the bulb and are nourished by the circulating blood. As the cells mature, they differentiate and then combine to produce hair. Ninety percent of hair is in this active growth cycle. As hair begins to grow, it moves up and out of the follicle away from the nutrient rich bulb.

Catagen: The transition phase lasting one to three weeks. The hair begins to move up the follicle through the scalp. As the hair loses contact with the rich blood supply of the scalp, growth slows to a halt.

Telogen: The resting phase lasting thirty to ninety days. There is no activity in the follicle. Visible hair is dead and is easily removed with regular brushing and shampooing. Hair not removed with grooming is pushed out when the follicle begins growth of a new hair. At any given time, approximately ten percent of our hair is in telogen.

Non-surgical treatments for male pattern baldness attempt to lower levels of circulating testosterone and halt the conversion of testosterone to DHT. A first step treatment for hair loss is to follow a diet that is low in fat and sugar. Testosterone is synthesized from cholesterol. A low fat diet provides less cholesterol available for testosterone production resulting in lower levels of circulating testosterone. A diet high in sugar causes excess insulin production for sugar metabolism. High levels of insulin cause high levels of arachidonic acid, an essential fatty acid that aids in the conversion of testosterone to DHT.

Next are anti-androgenic agents. They inhibit the activity of the enzyme that converts testosterone to DHT, increase blood flow to hair follicles and stimulate healthy hair growth. Finasteride, (US brand name Propecia) is the only FDA approved anti-androgenic preparation available in the United States. Propecia stimulates hair growth but has potential unpleasant side effects including breast enlargement and tenderness, skin rash, swelling of lips, decreased libido, erectile dysfunction and others.

Minoxidil (brand name Rogaine) was originally an oral medication for high blood pressure. During treatment, patients noted increased hair growth and physicians and researchers developed a topical solution specifically to stimulate hair growth. Minoxidil solution dilates blood vessels and increases blood flow to hair follicles where it is applied. The solution must be applied at least twice daily and it takes at least 4 months and possibly up to a year to see any growth. When Minoxidil application ceases, hair growth stops and the hair loss pattern returns. Individuals with high blood pressure and heart disease should not use Minoxidil. Minoxidil may make your skin sensitive to sunlight and may have other unwanted side effects.

Many men opt for permanent hair replacement. These surgical procedures involve taking active follicles from areas of the scalp where there is healthy hair growth, not susceptible to DHT, and transplanting it to areas where there is little or no growth. The procedures vary from micro-grafts where only one or two follicles are transplanted at a time to mega-grafts where larger sections are transplanted. The procedures are generally safe and performed in an outpatient setting. Adverse effects include infection and scarring. Men considering hair transplantation should consult with a trichologist (hair loss specialist), and look for surgeons with specialized training in dermatology, cosmetic plastic and reconstructive surgery and hair restorative surgery. Surgeons should be board certified by the American Board of Hair Restoration Surgery.