Hair loss in a 33-year-old man.
Baldness, with some variance in definition, typically refers to the lack of hair on parts of or the whole scalp. It is generally considered a broader term than alopecia, which is loss of hair, since baldness can include context in which the loss is intentional.
The severity and nature of baldness can vary greatly as it ranges from male- and female-pattern alopecia (also called androgenetic alopecia or alopecia androgenetica); alopecia areata, which involves the loss of some of the hair from the head; alopecia totalis, which involves the loss of all head hair; and to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body. Many cases of premature balding (in pre-middle aged individuals) are a result of "chronic stress-effect storage in the hypothalamus," a condition which causes scalp muscle bracing that can destroy the hair follicles.
Many scientists have contemplated whether or not balding is in all cases a preventable disease, or if it is commonly a natural occurrence, at least in males. Those who believe it to be natural phenomena—a belief determined mainly by its strong prevalence in men—have even speculated as to whether it serves a purpose. There are diverse treatments offered for the various forms of alopecia, with some showing limited success, but those who suffer baldness as a result of stress are able to regrow hair upon eliminating the stress effect before the hair follicles die.
The term alopecia is formed from the Greek αλώπηξ (alopex), meaning fox. The origin of this usage is because this animal sheds its coat twice a year.
The term bald likely derives from the English word balde, which means "white, pale," or Celtic ball, which means "white patch or blaze," such as on a horse's head.
Some sources define balding as the loss of hair where it normally grows, including the head. However there are only two places where hair "normally" grows in both genders: the pubic area, and the area of the scalp. The lack of hair anywhere else on the body would not necessarily be considered abnormal and therefore is not usually categorized as baldness.
The average human head has about 100,000 hair follicles. Each follicle can grow about 20 individual hairs in a person's lifetime. Average hair loss is about 100 strands a day.
Incidence of pattern baldness varies from population to population based on genetic background. Environmental factors do not seem to affect this type of baldness greatly. One large scale study in Maryborough, in central Victoria (Australia), showed that the prevalence of mid-frontal hair loss increases with age and affects 57 percent of women and 73.5 percent of men aged 80 and over.
Male-pattern baldness, androgenic alopecia, is characterized by hair receding from the lateral sides of the forehead, known as a "receding hairline." Receding hairlines are usually seen in males above the ages of 25. An additional bald patch may develop on the top (vertex). The trigger for this type of baldness is DHT, a powerful sex hormone, body and facial hair growth promoter that can adversely affect the hair on the head and prostate.
The mechanism by which DHT accomplishes this is not yet fully understood. In genetically-prone scalps, DHT initiates a process of follicular miniaturization. Through the process of follicular miniaturization, hair shaft width is progressively decreased until scalp hair resembles fragile vellus hair or "peach fuzz" or else becomes non-existent. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined. Male pattern baldness is classified on the Hamilton-Norwood scale I-VIII.
It was previously believed that baldness was inherited. While there is some basis for this belief, both parents contribute to their offspring's likelihood of hair loss. Most likely, inheritance is technically "autosomal dominant with mixed penetrance." (See 'baldness folklore' below.)
There are several other kinds of baldness:
There is no consensus regarding the origin of male pattern baldness. Most evolutionary theories regard it as resulting from sexual selection. A number of other primate species also experience hair loss following puberty, and some primate species clearly use an enlarged forehead, created both anatomically and through strategies such as frontal balding, to convey a superior status and maturity. The assertion that MPB is intended to convey a social message is supported by the fact that the distribution of androgen receptors in the scalp differs between men and women, and older women or women with high androgen levels often exhibit diffuse thinning of hair as opposed to male pattern baldness.
One theory, advanced by Muscarella and Cunningham, suggests baldness evolved in males through sexual selection as an enhanced signal of aging and social maturity, whereby aggression and risk-taking decrease and nurturing behaviors increase. It is speculated that may have conveyed a male with enhanced social status but reduced physical threat, which could enhance ability to secure reproductive partners and raise offspring to adulthood.
In a study by Muscarella and Cunnhingham, males and females viewed 6 male models with different levels of facial hair (beard and mustache or clean) and cranial hair (full head of hair, receding and bald). Participants rated each combination on 32 adjectives related to social perceptions. Males with facial hair and those with bald or receding hair were rated as being older than those who were clean-shaven or had a full head of hair. Beards and a full head of hair were seen as being more aggressive and less socially mature, and baldness was associated with more social maturity.
The psychological effects for individuals experiencing hair loss vary widely. Some people adapt to the change comfortably, while others have severe problems relating to anxiety, depression, social phobia, and in some cases, identity change.
Alopecia induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. Body image does not return to the previous state after regrowth of hair for a majority of patients. In such cases, patients have difficulties expressing their feelings (alexithymia) and may be more prone to avoiding family conflicts. Therapy can help families to cope with these psychological problems if they arise. Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms.
Some men who experience balding may feel proud of their baldness, feeling a kindred relationship with famous or historically significant bald men. Baldness has, in recent years, in any case become less of a (supposed) liability due to an increasing fashionable prevalence of very short, or even completely shaven, hair among men, at least in western countries. This is even true for women, as shown by the case of some women singers who have a shaven head.
Treatments for the various forms of alopecia have limited success, but those who suffer baldness as a result of stress are able to regrow hair upon eliminating the stress effect before the hair follicles die. Clinics specializing in the prevention of hair loss claim that the problem is now a very preventable, and even reversible, condition. Some hair loss sufferers make use of "clinically proven treatments" such as finasteride and topically applied minoxidil in an attempt to prevent further loss and regrow hair. As a general rule, it is easier to maintain remaining hair than it is to regrow; however, the treatments mentioned will supposedly help some of the users suffering from androgenetic alopecia, and there are new technologies in cosmetic transplant surgery and hair replacement systems that can be completely undetectable.
The treatments for baldness approved by the United States Food and Drug Administration are finasteride (marketed for hair loss as Propecia) and minoxidil.
A pharmaceutical company reportedly sought to find the smallest effective quantity of finasteride and test its long-term effects on 1,553 men between ages 18 and 41 with mild to moderate thinning hair. Based on their research, 1 mg daily was selected, and after 2 years of daily treatment, over 83 percent of the 1,553 men experiencing male hair loss had actually maintained or increased their hair count from baseline.
Minoxidil was first used in tablet form as a medicine to treat high blood pressure, but it was noticed that some patients being treated with Minoxidil experienced excessive hair growth (hypertrichosis) as a side-effect. Further research showed that by applying topical Minoxidil solution directly to the scalp, it could prove to be beneficial to those experiencing hair loss.
FDA clinical trials showed that 65 percent of men with androgenetic alopecia maintained or increased their hair count from the use of minoxidil 5 percent in liquid form. 54 percent of these men experienced moderate to dense regrowth and 46 percent experienced hair loss stabilization and mild regrowth.
In controlled clinical studies of women aged 18-45, 2 out of 3 women with moderate degrees of hereditary hair loss reported re-growth after using 2 percent minoxidil. Initial results occur at 4 months with maximum results occurring at 8 months.
A low level laser is shone directly on the scalp to stimulate hair growth through "Photo-Biostimulation" of the hair follicles. One product of these low level laser therapies is the "Hairmax Lasercomb." There is no peer-reviewed evidence to support this claim. The lasercomb was cleared by the FDA as being Substantially Equivalent (SE) to predicate devices legally marketed before May 28, 1978. This clearance is not the same as approval because it only applies to the lasercomb and not to any other similar laser based hair devices. The devices that the lasercomb proved itself equivalent to were a variety of FDA approved laser based/non hair growth devices intended for hair removal and pain relief, and 2 non FDA approved non laser based/hair growth devices such as the Raydo & Wonder Brush and the Vacuum Cap. These last two devices were sold in the early 1900's and are well established as medical quackery, but they were legal to market at the time which does satisfy the FDA's 510k SE criteria.
Surgery is another method of reversing hair loss and baldness, although it may be considered an extreme measure. The surgical methods used include hair transplantation, whereby hair-producing follicles are taken from the sides of the head where hair is full and injected into bald or thinning areas.
Looking forward, the prospective treatment of hair multiplication/hair cloning—which extracts self-replenishing follicle stem cells, multiplies them many times over in the lab, and microinjects them into the scalp—has been shown to work in mice and is currently under development. Subsequent versions of the treatment are expected by some scientists to be able to cause these follicle stem cells to simply signal the surrounding hair follicles to rejuvenate.
In October 2006, UK biotechnology firm Intercytex announced they have successfully tested a method of removing hair follicles from the back of the neck, multiplying them and then re-implanting the cells into the scalp ([[Baldness treatments#Hair multiplication (Hair multiplication). The initial testing resulted in 70% of male patients regrowing hair.
Topical application of ketoconazole, which is both an anti-fungal and a potent 5-alpha reductase inhibitor, is often used as a supplement to other approaches.
Particular unsaturated fatty acids such as gamma linolenic acid are 5 alpha reductase inhibitors if taken internally.
Interestingly, placebo treatments in studies often have reasonable success rates (although not as high as the products being tested), and even similar side-effects as the products. For example, in Finasteride (Propecia) studies, the percent of patients with any drug-related sexual adverse experience was 3.8% compared with 2.0% in the placebo group.
One study suggests that both heavy exercise and increased fat intake, in combination, are required for increased free testosterone in strength trainers. Increased total or free testosterone would help them build and repair muscle, but may cause susceptible individuals to lose hair.
However, there is at least one study that indicates a decline in free testosterone combined with an increase in strength due to an (unspecified) strength training regime.
Immunosuppressants applied to the scalp have been shown to temporarily reverse alopecia areata, though the side effects of some of these drugs make such therapy questionable.
Saw palmetto (Serenoa repens) is an herbal DHT inhibitor often claimed to be cheaper and have fewer side effects than finasteride and dutasteride. Unlike other 5alpha-reductase inhibitors, Serenoa repens induces its effects without interfering with the cellular capacity to secrete PSA. Saw palmetto extract has been demonstrated to inhibit both isoforms of 5-alpha-reductase unlike finasteride which only inhibits the (predominant) type 2 isoenzyme of 5-alpha-reductase.
Beta sitosterol, which is a constituent in many seed oils, can help to treat BHP by lowering cholesterol. If used for this purpose, an extract is best. Consuming large amounts of oil to get at small quantities of beta sitosterol is likely to exacerbate male pattern baldness.
While drastic, broad spectrum anti-androgens such as flutamide are sometimes used topically. Flutamide is potent enough to have a feminizing effect in men, including growth of the breasts.
In May 2007, US company Follica Inc, announced they have licensed technology from the University of Pennsylvania which can regenerate hair follicles by reawakening genes which were once active only in the embryo stage of human development.
One method of hiding hair loss is the "comb over," which involves restyling the remaining hair to cover the balding area. It is usually a temporary solution, useful only while the area of hair loss is small. As the hair loss increases, a comb over becomes less effective. When this reaches a stage of extreme effort with little effect it can make the person the object of teasing or scorn.
Another method is to wear a hat or a hairpiece (wig or toupee). The wig is a layer of artificial or natural hair made to resemble a typical hair style. In most cases the hair is artificial. Wigs vary widely in quality and cost. In the United States, the best wigs—those that look like real hair— cost up to tens of thousands of dollars.
There are many myths regarding the possible causes of baldness and its relationship with one's virility, intelligence, ethnicity, job, social class, wealth, and so forth. While skepticism is warranted due to lack of scientific validation, some of these myths may have a degree of underlying truth.
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