Hair Loss and Baldness

Hair Loss and Baldness

Hair is made up of a protein called Keratin and is produced in hair follicles which are found all over our bodies, except the palms of our hands and the soles of our feet.  The hair we can see is actually a string of dead keratin cells.

An adult head has between 100,000 to 150,000 hairs and loses up to 100 strands of hair every day, which most people do not notice as it normally grows back. Hair grows at approximately 6 inches a year but as we get older the rate of hair growth slows down.

By the time they are 50, approximately 85% of men will experience noticeable hair thinning with most cases (about 95%) the result of hereditary pattern baldness. By the age of 65 around 50% of women will experience female-pattern baldness. Hair loss can also be triggered by a variety of other conditions and circumstances, in both men and women.

What is hair loss?

Hair loss is also known as alopecia and can be categorised as follows:-

• Involutional alopecia – naturally occurs with age. Hair appears thinner due to fewer and shorter hairs.
• Androgenic alopecia – genetic condition affecting both men and women. Also know as pattern baldness.
• Alopecia areata – often starts suddenly, causing patchy hair loss in children and young adults and can lead to complete baldness. In the majority of cases hair usually returns within a few years.
• Alopecia barbae – localised to the beard area. It can be a single bald patch or hair loss across the whole beard area.
• Alopecia universalis – causes all body hair to fall out including eyebrows and eyelashes.
• Trichotillomania – psychological condition in which person pulls out their own hair.
• Telogen effluvium – temporary hair thinning over the scalp when large number of hair folics stop growing and shed. Can be caused by a sudden or stressful event.
• Traction alopecia – usually due to excessive pulling or tension on the hair shafts usually caused by keeping hairstyles like tight ponytails, cornrows or braids.
• Anagen effluvium – usually caused by chemicals such as those used to treat cancer.
• Scarring alopecias – permanent hair loss caused by skin conditions resulting in scars that destroy the hair follicles.

What causes hair loss?

Each hair follicle has its own life cycle which can be influenced by age, genes, hormones, disease and injury.

The most common type of permanent hair loss is male and female pattern baldness.  This is usually genetic with the predisposition towards baldness being passed on from both parents. Men can begin to suffer with hair loss as early as late teens, usually beginning with a receding hairline progressing to hair thinning around the crown and frontal scalp, before losing the hair completely from these areas.  The extent of the hair loss can depend on how early a person starts to lose their hair.

Women are unlikely to suffer with pattern baldness before their 40’s and will experience general thinning, more noticeably at the crown.

If hair falls out suddenly it is likely to have one of a number of causes:

• Thyroid problem
• Diabetes
• Lupus
• Anaemia
• Some treatments for cancer (Radiotherapy or chemotherapy)
• Some medications to treat Gout, depression, blood pressure and epilepsy
• High doses of vitamin A
• Iron deficiency
• Taking male hormones such as testosterone and anabolic steroids
• Female hormones in the form of the contraceptive pill and hormone replacement therapy
• Scalp infections
• Stress
• Cosmetic procedures such as perms, bleaching, hot curlers and Keeping hairstyles like tight ponytails, cornrows or braids for many years
• Weight loss

Sudden hair loss is more likely to be temporary and will grow back once the cause is treated or taken away.

What are the risk factors?

Male pattern baldness isn’t generally a sign of a serious medical problem, although it has been linked to coronary heart disease, enlarged prostate or prostate cancer, diabetes, obesity and high blood pressure.

When should I see my GP about hair loss?

With regards to your health, hair loss isn’t usually anything to worry about but if you experience any of the following, contact your GP: –

• Sudden hair loss
• Develop bald patches
• Are losing clumps of hair
• Your head itches and burns, or
• You are worried about your hair loss

Make a note of any pattern of loss, how much you are losing and make an appointment to see your GP.  Your GP will also want to see you if your hair loss is affecting your wellbeing and/or causing distress.  They can advise you on treatments and places where support is available.

Diagnosis

In 95% of cases where a man is experiencing hair loss the cause is male pattern baldness which is hereditary.  For women hair loss can be triggered by many different conditions and circumstances this can be difficult to diagnose as the pattern of hair loss is not as noticeable as it is in men. It is estimated that 50% of women over 65 experience female pattern baldness.

If you make an appointment with your GP you will be asked about your medical history and the pattern of hair loss you have been experiencing ie if it has been gradual, sudden and the shape of the hair loss.  The doctor will examine your scalp and check for any sign of a fungal condition. You may also be asked about your hair styling habits such any chemical treatments (bleaching, colouring, straightening).  Expect to be also asked about your general well-being and any stresses that may be triggering the hair loss as well as any medication or supplements you are taking.

If the reason for your hair loss is not clear, your doctor is likely to run tests including hair analysis, where a sample of your hair will be taken and examined, and blood tests for any thyroid problem, anaemia or vitamin deficiencies.

What treatment is there for hair loss?

Treatments are not normally available on the NHS as they are regarded as cosmetic, although if you are due to receive chemotherapy or radiotherapy, you may be entitled to help in purchasing a wig.

There is no 100% cure for male and female pattern baldness and most products claiming to prevent or treat hair loss do not work. You are best advised to only use hair loss treatments which have been approved by the MHRA (Medicines and Healthcare products Regulatory Agency) in the UK or the FDA (U.S Food and Drug Administration). Finasteride (proscar, Propecia) and Minoxidil (Rogaine) are two drugs which have been clinically proven to treat hair loss in men with varying degrees of success.  Other options you may wish to consider, which disguise hair loss rather than cure are hair transplants or a hairpiece (wig).

Women should not take Finasteride, particularly if pregnant as it is known to cause birth defects in baby boys.  Minoxidil is the best proven treatment for female pattern baldness. Most women will notice their hair loss slowing or stopping altogether with up to 25% seeing regrowth while using it.

Finasteride (proscar, Propecia) can be obtained on prescription but is not prescribed on the NHS. It works by slowing the body’s ability to produce the hormone DHT. DHT causes the hair follicles to shrink, this shrinking causes the hair to become thinner and eventually get so small that hair is unable to grow. Clinical trials have shown that taking Finasteride stops the progress of hair loss in 86% of men and substantial regrowth of hair in 65% of trial participants. Finasteride only works for as long as you are using it.  Once you stop using it, hair loss will return.

In rare cases Finasteride can cause side effects such as a skin rash, erectile dysfunction, lowered sex drive or tender nipples. These side effects should pass once your body gets use to finasteride but if you are at all concerned, stop taking it and speak to your doctor

Minoxidil (Rogaine) is an over the counter treatment.  It is a topical cream that can be applied directly to the head and has been clinically proven to slow the progression of hair loss and some experience regrowth.  Men may find it is not as effective as Finasteride and that it is only usually recommended if Finasteride doesn’t work.

Wigs are available on the NHS but you will have to pay unless you qualify for financial help. Synthetic wigs are cheaper and easier to look after than real hair wigs but only last up to 9 months as opposed to 3-4 years with real hair. Real hair wigs are likely to be more comfortable and look more natural. There is a wide range of quality and cost so take time to do your research to find the right one for you.

A hair transplant involves moving hair from an area unaffected by hair loss to an area of thinning or baldness.  It is only suitable for treating permanent hair loss such as pattern baldness and can cost between £1,000 and £30,000.  Surgery is carried out under local anaesthetic and sedation with the option of two different methods, Follicular unit transplantation (FUT/Strip method) or Follicular unit extension FUE).

Follicular unit transplantation involves a strip of hair bearing skin being removed from the back and sides of the head then divided into individual hair grafts consisting of 2 hairs each.  The grafts are then placed into tiny incisions made into the scalp of the target area. The areas where the graft has been taken from are then closed with stitches. Follicular unit extension involves the entire head being shaved then a special punch device is used to remove individual grafts of hair, one by one. The grafts are then placed into tiny incisions made in the scalp. If a large area is being treated you may need a few sessions, several months apart.

If you are considering surgery do your research.  Check the Care Quality Commission (CQC) website for registered treatment centres and view your surgeon’s fitness to practice history with the General Medical Council (GMC). As with all surgery there is a small risk of excessive bleeding, infection and allergic reaction to the anaesthetic.  There is also a small chance the transplant won’t take, and the hair falls out.

Before starting or finishing any treatments for hair loss, consult your GP.

How can I prevent hair loss?

Male and female pattern baldness is a genetic trait so, unfortunately, there is no way to prevent it although it can be treated with Finasteride and/or Minoxidil in many cases with varying degrees of success.

If your GP diagnoses another cause, follow their advice and any course of treatment prescribed.

If your hair loss is affecting your confidence and emotionally you are having difficulty coming to terms with it, there is help, advice and support out there. As well as speaking to your GP there are societies and support groups that you can speak to and who can provide additional advice. Please follow the links below.

www.alopeciaonline.org.uk/

www.alopecia-awareness.org.uk/

https://www.macmillan.org.uk/information-and-support/coping/side-effects-and-symptoms/hair-loss

https://www.nhs.uk/Livewell/cancer/Pages/Cancerandhairloss.aspx