It has no vital function in humans, but with the evolution of social consciousness and changes in social behavioral patterns, presence of hair appropriate to body sites, its amount, color and even texture have been markers of beauty; and human society places much importance to this trend.[break]
No wonder, excessive hair at the ‘wrong’ places, or loss of hair from the ‘right’ places is considered a deviation from the culturally accepted norm, and is a cause for serious concern and distress.
Common baldness or patterned baldness, also known as male- or female-pattern baldness or androgenetic alopecia, is the commonest cause of hair loss. Other causes being normal cyclical hair fall, fungal infections of the scalp, iron deficiency anemia, decreased thyroid hormone levels, immunity-related diseases, medications and stress. There is adequate scientific evidence to suggest that the androgen hormone is responsible for balding. Testosterone is the major androgen in the body, but balding is driven by its metabolite dihydro-testosterone, which binds with greater affinity to androgen receptors present in hair follicles.
The effect of this on hair follicles is the gradual reduction in the size of hairs while it passes through repeated fall and growth cycles, a process known as miniaturization, which eventually leads to baldness. The condition also affects women, but less commonly and less visibly. It is known that balding runs in families, but fathers of affected individuals may not always have the condition.
The gene responsible for balding is located on the X chromosome and may be inherited from either parent. The degree and rapidity of balding also varies. Even treatment responses are not uniform amongst patients. All these suggest that there are multiple factors responsible for balding and modern science is yet to solve all its mysteries. It would suffice to understand for now that balding occurs in genetically susceptible individuals in whom all these factors come into play.
There is much speculation regarding the association of balding with internal diseases. Recent scientific studies have shown that there is an increased tendency for balding men to develop ischemic heart disease (condition that leads to heart attacks), and also enlarged prostate glands. However, the evidence is not strong enough to raise alarm bells, and there are more important lifestyle-related risk factors for these diseases, such as smoking, alcohol consumption, fatty diet, lack of physical activity, obesity, etc. Therefore, balding remains primarily a cosmetic problem, with only temporary solutions, and no permanent cures.
People losing hair are a worried lot and look for good advice. Unfortunately, most of the information available to the general public is from companies trying to sell quick-fix solutions. Treatment options available today range from locally applicable lotions, oral medications to hair transplantation. The effects of medications last only as long as they are used, and individuals may experience varying results, depending on the degree and stage of balding. Medications such as minoxidil lotions and finasteride tablets are proven to have a good success record with relatively few side effects, and have thus been approved for treatment of baldness by international drug regulatory authorities. Individuals in the early stages and with a less severe degree of balding have the best response. For those with advanced balding, wearing wigs remains the only option.
Hair transplantation is an option for those who do not respond satisfactorily to medications used for at least a year. It is usually performed for those over 25 years of age and with hair loss over 50% or more of the scalp area. It is also essential to have an adequate amount of hair present over the backside of the scalp (donor site) because this process involves harvesting one’s own hairs from the donor site and transplanting them over the bald areas. Due to the tedious nature of the surgery and also significant amount of skills required in performing it, it remains an expensive option. Not everyone is a suitable candidate for transplantation, and it is important to clearly understand the limitations and risks of this surgery in order to have realistic expectations. However, in well selected candidates, this surgery has very satisfying results, and is a popular method of permanent hair restoration worldwide.
Society has played a major role in defining the patterns of human perception and standards of social acceptance. Though it has created enough room for debate on various issues, baldness is one such condition where social perceptions have largely influenced the level of its acceptance among affected individuals. It is always a good practice to think positive and look at the brighter side of life, especially when the cause of worry doesn’t merit the amount of attention it receives. Men who have accepted their baldness also learn to comfortably accept other unavoidable fates of life and are surely happier. It is said when it comes to style, hair is not only the main thing on your head but also the main thing on your mind. Changing social perceptions have initiated a gradually increasing fashionable trend towards the bald and beautiful.
The writer is a consultant dermatologist and medical director at DI Skin Hospital and Research Center Pvt Ltd, Maharajgunj, Kathmandu.
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