Hair! From personal statement to personal problem - baldness

FDA Consumer, Dec, 1991 by Devera Pine

From the shaved heads of medieval monks, to the long-haired hippies of the 60s, to the spiked hairdos of today's punk rockers, hair has always made a personal statement.

"It's one of the leading ways people can establish their individuality and express their style," says Jerome Shupack, M.D., professor of clinical dermatology at New York University Medical Center in New York City. "Hair has had sociological importance throughout the ages."

Because of its importance, anything that happens to our hair that we can't control-falling out or turning gray, for instance-can be the source of much anxiety.

In the United States, some 35 million men are losing or have lost their hair from male-pattern baldness, according to the American Hair Loss Council. Approximately 20 million women have experienced a similar loss of hair (from female-pattern hair loss), and an estimated 2.5 million Americans have lost their hair due to other causes.

The Basics

Hair is produced by hair follicles-indentations of the epidermis (outer skin layer) that contain the hair root, the muscle attached to it, and sebaceous, or oil, glands. Hair is made up of dead cells filled with proteins, most of which are known as keratins. The cells are woven together like a rope to form the hair fiber. The hair fiber, in turn, has three layers: the outer cuticle with its fish-scalelike structure; the cortex, which contains the bulk of the fiber; and the center, or medulla. Hair color is determined by melanocytes, cells that produce pigment. When these cells stop producing pigment, hair turns gray.

Although it seems as if the hair on your head is always growing, hair actually has active and rest phases. The growth phase, known as anagen, lasts for two to six years. At any given time, about 90 percent of scalp hair is in the growth stage. The remainder is in the rest phase, known as telogen; this lasts from two to three months.

Once the rest phase is over, the hair strand falls out and a new one begins to grow. As a result, it's considered normal to lose from 20 to 100 hairs a day, says Diana Bihova, M.D., a dermatologist in private practice in New York City. Only a change in your regular pattern of loss is considered abnormal-but many things, including genetic factors, diet, stress, and medications, can change that pattern.

Baldness: Manifest Destiny?

The most common cause of hair loss in both men and women is rooted in genetic predisposition. Called androgenic alopecia, it is known as male-pattern baldness in men and female-pattern hair loss in women. (Alopecia is the, scientific term for baldness.) According to the American Hair Loss Council, genetics accounts for 95 percent of all cases of hair loss in this country.

Baldness results from a combination of genetic factors and levels of testosterone (a hormone produced by the adrenal gland in both sexes and also by the testes in men). If hormone levels are right, then the hair follicles will express their genetic destiny by growing for shorter periods and producing finer hairs. In men, who have higher levels of testosterone than women, this eventually results in a bald scalp at the crown of the head and a horseshoe-shaped fringe of hair remaining on the sides. In women, the hair thins all over the scalp; the hairline does not recede. This type of hair loss doesn't usually show up in women until menopause; until then, estrogen tends to counteract the effects of testosterone.

One Approved Drug

The only drug approved by the Food and Drug Administration to treat pattern baldness or hair loss is minoxidil topical solution (Rogaine), which is rubbed into the scalp. Originally approved for hereditary male-pattern baldness in 1988, it was also approved for treating female-pattern hair loss in August 1991. However, it should not be used by pregnant or nursing women.

In his dermatological practice, Arthur P. Bertolino, M.D., Ph.D., director of the hair consultation unit at New York University, says that this lotion helps hair grow in 10 to 14 percent of the people who try it. He estimates that approximately 90 percent of the time, Rogaine at least slows down hair loss. (Minoxidil is also available in tablet form to treat severe high blood pressure. Oral minoxidil has a potential for serious side effects and is not approved to treat baldness.)

No one is certain yet just how topical minoxidil works to promote hair growth. "One theory is that it dilates the blood vessels, so it may stimulate nourishment of follicles," says Bihova. Alternatively, Rogaine may convert tiny hair follicles that produce peach fuzz into large hair follicles that produce normal-size hairs. Again, no one knows for sure.

What is certain is that, at least in men, Rogaine works better on patients who fit a certain profile: They've generally been bald for less than 10 years, have bald spots on top of the head that are less than 4 inches in diameter, and they still have fine hairs in their balding areas. "The process begins very early," says Bihova. "I see 19-, 20-year-old males who have it."