Hair apparent? For some, a new solution to baldness

FDA Consumer, Dec-Jan, 1988 by Judy Folkenberg

Hair Apparent? For Some, a New Solution to Baldness

Samson's hair made him the strongest man alive, according to the Bible. He killed a lionwith his barehands, wreaked havoc on his enemy's cornfields, vineyards and orchards, and slaughtered a thousand Philistines with the jawbone of an ass.

Eager to capture Samson, the Philistines sent the beautiful seductress Delilah, who asked Samson to prove his love to her by revealing the source of his strength. Eager to please the woman, Samson told her his secret, his hair was cut while he slept, and he was captured by the Philistines.

Samson's story notwithstanding, hair serves no vital human function. Its psychological impact, however, is immeasurable. In an age where narcissism reigns supreme, Americans spent $24 billion in 1987 to cut, curl, color, tint, perm, style, wash, condition, mousse, gel, and blow-dry their hair. A musical has been written about it, people have been fired over how they styled it, kids have been expelled from school over its length, and millions of men agonize over its loss.

But at last this agony has now been tempered. A new hair product has arrived on the scene. Called Rogaine (also known as minoxidil, the generic name of its active ingredient) it is manufactured by The Upjohn Company of Kalamazoo, Mich. For an estimated 50 million to 55 million balding Americans this product holds the promise of restoring lost locks.

But that promise won't be fulfilled for everyone. While minoxidil helps grow hair for some men, for many it won't work. Nonetheless, it is a worthy beginning to solving the problem of hair loss.

The battle against baldness goes back at least to Julius Caesar. When he was pursuing Cleopatra up and down the Nile, he carefully combed his thinning hair across the bald spot on the top of his head.

In the 1800s, hair strengtheners, baldness cures, and hair restorers were a major staple of the traveling medicine show. If the balding man missed the show, he could purchase a nostrum at his pharmacy, through a catalog, or from a traveling salesman. These hucksters sold men elixiers whose ingredients included cantharides (more commonly known as Spanish fly) that could blister the skin, olive oil, borax, sulfur, bone marrow, and lead acetate.

Even today, the willingness of balding men to fork over hundreds of dollars for remedies that don't work is testimony to mankind's vanity. FDA estimates that approximately $100 million is spent annually on fraudulent balding remedies, whose ads grace the pages of even reputable magazines.

But now comes minoxidil, the first product to be medically proven to remedy hair loss in some patients. And in August of this year it becme the first--and only--FDA-approved treatment for hair loss.

Minoxidil's hair-growing properties were discovered accidentally. It was originally marketed as a high blood pressure medicine known ad Loniten. Doctors noticed that many who took Loniten (about 80 percent) grew hair, not only on their heads but often on their foreheads and upper cheeks. Understandably, patients weren't crazy about these results, but it didn't take long to figure that a topical solution of minoxidil--rubbed on the scalp--might help balding men.

Just how minoxidil works remains a mystery, although, according to an Upjohn spokesperson, "minoxidil somehow reverses the genetic instructions which tell the hair follicle to stop growing hair."

In 1982 and 1983, Upjohn tested minoxidil in clinical trials at 27 medical centers across the country. The 2,300 participants (mostly males, although a few women were included) were young (18-49) and healthy with typical male pattern baldness (androgentic alopecia)--a pattern of baldness in which hair thins out at the crown while the frontal hairline recedes.

Participants in the study were split into two groups: One group applied minoxidil twice a day, while the control group applied a placebo (inactive) solution. At the end of four months, some in the minoxidil group began showing some hair growth. Since it was obvious the drug had an effect, the placebo participants were switched over to the minoxidil group. At the end of a year, 39 percent of the men had experienced moderate or dense hair growth on their balding spots, while the remaining 61 percent experienced little or no hair growth.

Closer examination of Rogaine and the design of the study, however, shows that this 39 percent figure needs qualification.

There was no definition of "dense" or "moderate" hair growth. Beauty, or, in this case, hair growth, was in the eyes of the researchers; no objective criteria guided their judgment.

A more accurate figure for the percentage of men who had moderate or dense hair growth is 10 percent to 20 percent, say a number of dermatologists. An article in the May 2, 1987, British medical journal Lancet concurs. Drs. Anton C. De Groot, Johan P. Nater, and Andrew Herxheimer of the Willem-Alexander Hospital in the Netherlands and Westminster Medical School in London, state that after reviewing a number of studies (including Upjohn's) "less than 10 percent of men treated obtain a result that a neutral observer would find cosmetically acceptable." (Minoxidil is already marketed in some 40 other countries.)