MALE Hair Loss
by Dr Chester Lan, DTAP Clinic (Dr. Tan & Partners)
Look around you in a busy place. Do you see a middle aged or older gentleman who is balding? Chances are you probably will. Hair loss is something that affects a significant proportion of men as they age.
Statistics vary from country to country, but the American Hair Loss Association states that, by the age of 35, two-thirds of men will experience some degree of appreciable hair loss, and by the age of 50 approximately 85% of men have significantly thinning hair. But hair loss does not just affect males. It can affect females as well.
Each person on average has about 100,000 hair follicles on their heads.
If everything is intact, you will have a nice crop of hair. Hair follicles go through 3 main phases of growth – anagen, catagen and telogen. The first is the anagen phase, where the root of the hair is dividing rapidly, adding to the hair length. Hair grows at about 1cm every month during this phase, and this phase can last anywhere from 2-7 years. The next phase is the catagen phase, where at the hair itself is cut off from its blood supply and from the cells that produce new hair.
This lasts for about 2-3 weeks. Lastly, the telogen phase where the hair follicle rests, and the hair that was grown is released and falls out.
Not all the hair follicles are in the same phase at the same time, and about 100 hairs are shed daily from a normal scalp. If everything is normal for you, the telogen phase would not last too long, and re-enter the anagen phase after about 3 months.
So why do people lose head hair? There are a variety of reasons why this may be so. Sometimes, the hair follicles are forced to cut short their anagen phase and enter the telogen phase prematurely. This can happen during times of extreme stress or if you have fallen ill. In some people, the hair follicle may be killed off by the body’s own defence systems. The hair follicle may also be affected by fungal or bacterial skin infections.
The majority of head hair loss that affects men is due to the hormone dihydrotestosterone (DHT). In men, the 5-alpha-reductase (5-AR) enzyme converts testosterone into DHT in the testes and the prostate. Up to 10 percent of testosterone is normally converted into DHT. DHT is more powerful than testosterone as a male hormone. It attaches to the same receptors as testosterone, but more easily and for longer periods of time. The hair follicles on the head contain these receptor and when DHT binds to them, the follicles slowly become miniaturized, the anagen phase is reduced, and the telogen phase becomes longer. Over time, the anagen phase becomes so short that the new hairs do not even grow past the surface of the skin. Telogen hair is less well-anchored to the scalp, making it easier to fall out. As the follicles become smaller, the shaft of the hair becomes thinner with each cycle of growth.
Eventually, hairs are reduced to soft thin hairs, and can eventually stop growing. For reasons that are not well understood, DHT is essential for most other bodily hair growth, but it is detrimental to head hair growth. That is why you can see a bald man with a full beard. How your hair follicle responds to DHT and how long your anagen phase is are usually genetically predetermined.
So knowing the above, what can we do about your falling crop of hair? We know that stress can affect your hair. Late nights, poor diets and stress can disrupt hormonal balances and reduce your blood circulation to your scalp, leading to hair loss. So a healthy lifestyle is the solution to that – reduce your stress, exercise regularly, eat healthily, and sleep adequately. Washing your hair too much can strip your scalp of natural oils needed for a healthy scalp. If you do not wash enough and it may cause a build-up of oils in follicles and prevent hair growth. So find the balance with an appropriate shampoo and frequency of wash. Active people may need to wash their hair more often, and less active people may only need to wash their hair every other day.
If you use hair products, ensure they do not contain too harsh chemicals as that might irritate your hair follicle causing your hair to drop.
Make sure these products are washed off completely at the end of the day as well. Chemical treatments like hair dyes and heat therapies may also affect your hair follicle, so space these treatments apart. Brushing your scalp (gently) can stimulate blood circulation to the scalp which is essential for hair growth.
Should all of these lifestyle changes not work, one thing you have to understand is that prevention is better than cure. Once your hair follicle is dead, there is very little we can do about it. At this point in time, medical care can play a part. Treatment can start even as early as the 20s to prevent or slow down the process of follicle miniaturisation before it’s too late. There are a variety of things doctors can do. Topical medications can be applied to the scalp to stimulate hair growth. There are non-invasive methods like hair serums, light therapy and laser therapy. There is another treatment known as Regenera Activa. This is a hair growth technology from Europe that has gone through clinical trials and has achieved approval as a medical device. Visible results can be seen in a few months and effects can last for at least a year. There are also medications that we can prescribe to block the formation of DHT. If all else fails, then the last resort is usually a hair transplant.
I hope this short introduction to hair loss, its prevention and some of the treatments has given you some information that is useful. When in doubt, consult your doctor, and don’t be shy about it. We too, want a full crop of hair for you!