Hair Loss
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Hair loss or baldness is called alopecia. The most common form of hair loss occurs in men, where the condition is called male pattern baldness or alopecia androgenetica. Most men will experience hair loss to some extent as they grow older. Women can also suffer from hair loss, particularly after the menopause. The condition is also called alopecia androgenetica but because hair is lost from a different part of the head than it is in men, it is called female pattern baldness.

Alopecia areata is another form of hair loss, where hair is lost in patches from the head. It is usually a temporary condition affecting young adults.
Alopecia androgenetica, whether occurring in men or women, is hereditary. If someone's parents or grandparents suffered from hair loss, the chances are that they will too. The trigger that causes this type of baldness is thought to be related to an increased sensitivity to the hormone dihydrotestosterone (DHT). As people get older, DHT is thought to act on the hair follicles that make the hair, causing them to shrink. The result is that the hairs become short and thin so they are barely visible to the naked eye. Eventually, the hair follicles shut down completely and no more hair is produced. Bald areas appear as old hair falls out and is no longer replaced by new hairs.

In women, the most common causes of hair loss are due to hormonal changes. Changes in hormone levels, such as those occurring with the menopause, pregnancy, the stopping or starting of oral contraceptives or hormone replacement therapy, or disorders of the thyroid gland can all cause temporary hair loss in women. For example, after a woman gives birth it may take 3 to 6 months for her hormones to return to their pre-pregnancy state. During this period, women may notice an increase in hair loss. Hair loss is usually temporary and tends to return to normal within twelve months.

Bleaching, styling, colouring and other aggressive hair care techniques involving chemicals are also a common cause of temporary hair loss. As too are stress, poor nutrition, prolonged illness, drug treatment, chemotherapy and radiotherapy.

Alopecia areata is believed to be the result of an autoimmune disease, a fault in the normally protective immune system, where the hair follicles are mistakenly attacked by the body's immune system, destroying them and preventing hair growth.
A man suffering from male pattern baldness will find that his hair will start to recede and feel thinner and lighter on the crown and at the temples. The hairline continues to recede but hair at the sides and back will seem to stay the same, eventually leaving just a 'horseshoe' shape of hair or finally becoming completely bald.

Women suffering from female pattern baldness do not experience the same pattern of hair loss as men, instead of getting bald patches, the hair tends to thin all over the scalp.

Alopecia areata appears as isolated bald patches usually on the scalp, but it can occur on any hairy part of the body.
As a hereditary condition, there is nothing that can be done to prevent male or female pattern baldness from developing.

There are two drugs available that can slow hair loss, finasteride and minoxidil. Finasteride should not be used to treat baldness in women. Minoxidil can be used for men and for women.

Finasteride acts by inhibiting the conversion of the hormone testosterone to DHT, so reducing the effects of DHT on the hair follicles and allowing them to continue to produce normal hair. The product is available as tablets called Propecia that contain 1mg finasteride. The recommended dosage is one 1mg tablet daily. Generally, 3 to 6 months of treatment are required before loss of hair can be stabilised, and use has to be continued to sustain the effect. If treatment is stopped, the beneficial effects begin to reverse by 6 months and return to how things were before treatment started by 9 to 12 months. There is no proof to suggest that an increase in dose will increase the drug's effect, instead it is more likely to increase the drug's side effects. Finasteride should not be used to treat baldness in women. In pre-menopausal women there is a risk of the drug causing malformations of male babies if the woman becomes pregnant. In post-menopausal women there is lack of clinical evidence to show that the drug works.

Minoxidil also restores hair growth and can be used to treat both male pattern baldness and female pattern baldness. Its exact mechanism is not fully understood, but it is possibly related to an increased blood supply to the hair follicles that allows them to produce hairs more efficiently. The product is available as a solution or gel containing 2% minoxidil, and as an extra strength solution containing 5% minoxidil. The solutions or the gel are applied directly to the scalp twice daily. It may take at least 4 months before there are any signs of hair growth, and use has to be continued to sustain the effect. If treatment is stopped, any hair that has regrown is likely to disappear within 3 to 4 months.
When to see your pharmacist
Solutions and gel containing minoxidil for the treatment of male and female pattern baldness are available from your pharmacy without a prescription. Your pharmacist will advise you that the solution has to be applied twice daily for several months to see any noticeable effects, and that treatment must continue or hair loss will resume. Finasteride is not available without a prescription. If your pharmacist thinks that finasteride may help, you will be advised to see your doctor.

Both minoxidil and finasteride are used to treat medical conditions other than hair loss. Minoxidil is used for the treatment of high blood pressure and finasteride is used for the treatment of an enlarged prostate. Tell your pharmacist if you are taking minoxidil, finasteride or any other medicines or health supplements for the treatment of these or other conditions as they should not be used at the same time.
When to see your doctor
You should see your doctor if you are concerned by your hair loss, or the loss has been dramatic. Your doctor will investigate if there are other causes that could be responsible. If you doctor does decide to prescribe minoxidil or finasteride to treat the hair loss, you will have to pay for the items on a private prescription as they are not available at NHS expense.
Living with hair loss
Losing hair affects people in different ways, some people simply accept the fact as a natural process of getting older, while for others it can have a dramatic effect on their self-esteem particularly if they are young and female.

If you are a woman suffering from temporary hair loss, try not to be too worried. Often, small patches of hair loss are not as noticeable to others as you may think. The clever use of hair clips, slides and bands can easily help to disguise any thin patches. Also, try to identify what may be causing the problem. If you have altered what you do to your hair, for example changed its style or colour, stopping doing these things may help. Try to eat a balanced diet, rich in fresh fruit and vegetables, adding a multi-vitamin supplement may also help. Good regular exercise will help you rest and cope with stress better too.

If you have recently had a baby, or have recently changed your oral contraceptive or hormone replacement therapy, let things settle down for a few months. You'll soon find that your hair returns to normal.

If you are a man experiencing male pattern baldness, the easiest and best thing to do may be just to accept it. Short hair and bald heads are common place and can be made to look very fashionable. Allowing hair to grow on other parts of the scalp in an attempt to conceal bald patches can often make things look worse than they are. A good barber or hairdresser will be able to change your hairstyle to one that is right for you. If you are considering the use of drugs to restore hair growth, think about what is involved before starting treatment. Improvement is not guaranteed to work, hair loss is never fully restored and if there is any improvement, treatment has to be continued to sustain the effect. These drugs are not available on the NHS to treat baldness, which means that you will have to pay for them yourself for a long time.

Whether a woman or a man experiencing hair loss, a good hair style can make the hair look much better. Colouring the hair to make it a closer colour to the scalp can make hair loss less noticeable. Other options include wearing hairpieces or having hair woven to the existing hair. There are also a number of surgical procedures available, such as hair transplants. Anyone considering any type of surgery, should always discuss their thoughts with their doctor who will be able to provide advice about the techniques available. If your hair loss is sudden and dramatic, for example because of recent treatment for cancer, advice will be given to you during your treatment about the availability of wigs and hair pieces.
Advice to carers and other family members
It is very common for people with hair loss to be self-conscious about their appearance. If a member of your family or someone you look after experiences hair loss, your being there to offer support and to help advise on hair styles and treatment options can be of great comfort.
Useful Tips
  • Don't blow-dry your hair using a high heat setting
  • Avoid using harsh chemical dyes
  • Use a gentle shampoo and conditioner
  • Allow things to settle down after pregnancy or if starting or stopping oral contraceptive or HRT
  • A very short haircut can detract from a receding hairline
  • A layered haircut can make your hair look thicker