Hair Today, Gone Tomorrow
For: The Long and Short of It: Hair Myths
and Facts, August 2002
Many people lose their hair, but few regain it. The most
common form of hair loss, known as androgenic alopecia, is determined
by genes, hormones, and aging. Though the term sounds like a serious illness,
it refers simply to male—and female—pattern baldness. Millions
of people of European origin experience this kind of hair loss: the receding
hairline that eventually turns into a bald pate or, at most, thin fine
hair on top. Asians, Native Americans, and Africans and African-Americans
have this problem far less often. The process can begin in early adulthood,
though hair loss occurs more commonly in the fifties. Gradually your own
hormones cause your hair follicles to shrink and to stop producing hair.
No one quite understands this process, but—alas—it's quite normal,
and there's no way to prevent it.
But for many men and women alike, baldness is a source of
embarrassment and distress. It's no wonder that a billion-dollar hair-replacement
industry flourishes. Indeed, the effort to grow hair probably began when
the first human head went bald. Hair is precious—a comfort in winter,
an emblem of youth and attractiveness, and the first thing we groom in
the morning, provided we have any to groom.
Not all hair loss is normal. For instance, the second most
common kind of hair loss is alopecia areata ("area baldness"),
characterized by hair loss in patches, sometimes leading to complete hair
loss. Thought to be an autoimmune disorder, it can sometimes be treated
successfully; sometimes the hair just grows back. If
you have sudden hair loss, you should see a physician.
Other possible causes of hair loss include the hormonal
changes of pregnancy and its aftermath, severe emotional stress, mal-nutrition,
thyroid disorders, anemia, large doses of vitamin A, certain medications
(including chemotherapy for cancer), pulling hair too tight in braids
or pony tails, and constantly wearing very tight wigs or hats. Usually
hair grows back once the underlying problem is corrected.
Though scientists and entrepreneurs tirelessly search for a baldness cure,
only two drugs have been found effective so far, and it may be stretching
to call one of them safe.
Minoxidil (brand name: Rogaine)
This drug dilates blood vessels and was originally developed
as an oral medication to treat high blood pressure. One startling side
effect was that it stimulated hair growth, sometimes where no hair was
wanted. Then it was shown to promote new hair growth when applied to the
skin: that way, you could better control where the hair actually appeared!
It is now available without a prescription in 2% and 5% formulations.
The 2% version will promote hair growth in about 25% of men and 20% of
women—and is the only formulation approved for women. There's disagreement
about whether the 5% formulation is more effective. It may also increase
the risk of side effects.
Minoxidil's drawbacks:
• You have to use it indefinitely. If you stop, your new hair will fall out. It costs about $1 a day.
• It doesn't work for everyone, and its effects seem to fade with time.
• New hair is usually thinner and lighter, like baby hair. Also, the hair grows only on the top of the head, not at the hairline.
• Side effects may include unwanted hair growth on the face, especially in women. Skin irritation is the most commonly reported side effect. Dizziness and increased heart rate have also been reported, but rarely. It does not appear to affect blood pressure or produce other serious side effects, which is why the FDA allows it to be sold over the counter.
Finasteride (brand name: Propecia)
This is the same prescription drug used in higher doses
(and called Proscar) to treat an enlarged prostate. Unlike minoxidil,
it must be taken orally. It blocks the hormone that shrinks hair follicles.
Propecia is not effective in men over 60 or in the completely bald, but
it does promote hair growth and slow hair loss in younger men who are
just beginning to lose hair. In one study 60% of men showed new hair growth
and more than 80% showed slowing of hair loss with 6 to 12 months of treatment.
Propecia's drawbacks:
• It may lower PSA levels, so that it becomes more difficult to detect prostate cancer or other disorders of the prostate. If you are using Propecia and are about to have a PSA test, be sure to tell your physician.
• It takes at least six months for any improvement to occur.
• It is not recommended for men with liver problems.
• Among the reported side effects is reduced sexual drive and function in 2 to 3% of men.
• It is not recommended for women: it causes severe birth defects in male fetuses, so pregnant or potentially pregnant women should not even touch the tablets. When tested in postmenopausal women, Propecia did not make hair grow.
• It costs about $50 a month. That's a permanent addition to your budget. If you stop taking it, any new hair will fall out.
• When the FDA approved this drug for treatment of hair loss three years ago, no studies had been published. Some have since appeared, showing that Propecia works in some men. But no one has any idea what the long-term side effects may be. This is particularly disquieting, because young men are the prime candidates, and the drug has to be taken for a lifetime.
We advise you to stay away from Propecia.
If you do decide to take it, you should know that the standard dose is
one milligram, but studies show that one-fifth that amount works just
as well. If you cut the pill into fifths or quarters, you can save a considerable
amount of money.
Herbs and other hair-raising measures
Drugs like spironolactone, which blocks hormone production
and is used to treat certain kinds of heart failure and cirrhosis of the
liver, are sometimes prescribed "off-label" for hair loss. That
is, they are not approved for this use, but some doctors think they will
help. Progesterone, the female hormone, is also used. We know of no evidence
that these drugs will promote hair growth, and they can have dangerous
side effects. We don't recommend them.
Chief among the herbs promoted for hair growth is saw palmetto. Since it appears to have some of the same effects in the body as Proscar, this is not farfetched. The difficulties are twofold: nobody knows if this herb promotes hair growth, and it is impossible, in today's market, to know what's in the capsules you are buying. You will find a plethora of other herbals on the shelves and on the Internet—containing nearly every medicinal plant, plus vitamins and minerals. Maidenhair fern and horsetail plant, imaginatively enough, are sold as hair-raising agents. Hope (if not hair) springs eternal, but we have found no study to support any herbal product for hair growth.
Other "hair-growing" products that don't work, but at least pose no immediate dangers:
• Wheat germ oil or lanolin.
• Electrical stimulators, special combs, and scalp massage.
• Vitamins or minerals taken internally or applied to the head.
• Special foods or diets.
• Shampoos, salves, creams, and "revitalizers," often sold as "systems"—that is, you must buy three or four products.
If you decide to try any of the hundreds of remedies offered
on the Internet and in drugstores and health-food stores, we suggest you
retain your skepticism. You probably should retain your money, too.
UC Berkeley Wellness Letter, March 2001
Warning: Failed opening '../sc_footer.php' for inclusion (include_path='.:/usr/share/pear') in /home/httpd/wellnessletter/subCorner/RA2001/RA2002/scRA0802_03.php on line 218