Baldness

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Actor Patrick Stewart's bald head is considered part of his distinctive attractiveness.

Male pattern baldness in 40 year old man.

Baldness, includes a set of disorders which involve the state of lacking hair where it would normally grow, especially on the head. The most common form of baldness is a progressive hair thinning condition called androgenic alopecia or 'male pattern baldness' that occurs in adult human males and some primate species. The severity and nature of baldness can vary greatly; it ranges from male and female pattern alopecia (androgenetic alopecia, also called androgenic alopecia or alopecia androgenetica), alopecia areata, which involves the loss of some of the hair from the head, and alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body. Treatment for alopecia has limited success. The more hair lost, the less successful the treatment will be.

Male pattern baldness is thought to occur in varying forms in about 66% of adult males at some point in their lives.[link] It is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline" or "receding brow." An additional bald patch may develop on top (vertex). The trigger for this type of baldness (called androgenic alopecia because it is caused by male hormones or androgens) is DHT, a powerful sex hormone.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15097964&query_hl=2&itool=pubmed_docsum The mechanism by which DHT accomplishes this is not yet 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. Female pattern baldness, in which the midline parting of the hair appears broadened, is less common. It is believed to result from a decrease in estrogen, a hormone that normally counteracts the balding effect of testosterone, which normally occurs in women's blood. Female pattern baldness is classified on the Ludwig scale I-III.

It was previously believed that baldness was inherited from a person's maternal grandfather. While there is some basis for this belief, both parents contribute to their offspring's likelihood of hair loss. (see 'baldness folklore' below)

There are several other kinds of baldness. Traction alopecia is most commonly found in people with ponytails or cornrows who pull on their hair with excessive force. Wearing a hat shouldn't generally cause this, though it is a good idea to let your scalp breathe for 7 hours a day. Traumas such as chemotherapy, childbirth, major surgery, poisoning, and severe stress may cause a hair loss condition known as telogen effluvium.[link] Some mycotic infections can cause massive hair loss.[link] Alopecia areata is an autoimmune disorder also known as "spot baldness" that can result in hair loss ranging from just one location (Alopecia areata monolocularis) to every hair on the entire body (Alopecia areata universalis).

Contents

1 Etymology
2 Evolutionary theories of male pattern baldness
3 Approaches to baldness

3.1 Psychological implications
3.2 Preventing and reversing hair loss

4 Concealing hair loss
5 Embracing baldness
6 Baldness folklore
7 Trivia
8 References
9 See also
10 External links

10.1 Hair loss specialist directories
10.2 Male Pattern Baldness News
10.3 The relationship between androgenic baldness, metabolism, diabetes and heart disease

Etymology

The term Alopecia (al-oh-PEE-she-uh) 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" derives from the English word balde, which means "white."

Evolutionary theories of male pattern baldness

Gorillas evolved anatomically enlarged foreheads to convey increased status and maturity.

There is no consensus regarding the details of the evolution of male pattern baldness. Most 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 increased 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 behaviours increase.(1) This 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 moustache 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.

Approaches to baldness

Psychological implications

The psychological implications for individuals experiencing hair loss vary widely. The most significant effect is a loss of self-confidence. This is enhanced by an insecure or ambivalent attachment pattern.

Retired NASA Astronaut Story Musgrave.

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 (what is called alexithymia) and may be more prone to avoiding family conflicts. Family therapy can help families to cope with these psychological problems if they arise. [link]

Psychological problems due to baldness, if present, are typically most severe at the onset of symptoms. [link]

Some balding men may feel proud of their baldness, feeling a kindred relationship with famous charismatic bald film actors such as Yul Brynner, Vin Diesel, Michael Chiklis, Telly Savalas, Ben Kingsley, Patrick Stewart, Danny DeVito, Bruce Willis, and politicians such as Abe Beame, who have been considered masculine and handsome in part because of their most obvious distinguishing feature. This is not yet true for women, as there are few female celebrities who are bald by choice, chemotherapy or genetics/environment.

Preventing and reversing hair loss

For more information, see the main article on Baldness treatments

It is easier to prevent the aging and falling out of healthy hairs than to regrow hair in follicles that are already dormant. Finasteride (marketed in the U.S. as Propecia) and minoxidil (marketed in the U.S. as Rogaine, and some places as Regaine) have shown some success in partially reversing loss. In a one one-year study of finesteride, evaluation after one year showed five of 21 subjects (23.8%) had two-grade improvement in MNHS grade on a modified Norwood/Hamilton scale and 12 of 21 subjects (57.1%) had one-grade improvement; the others remained at the same grade.[link] However such treatments are generally ineffective at treating extreme cases of hair loss. [link]

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, expected by some scientists to be available to the public in 2009-2015. 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.*

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.

Interestingly, placebo treatments in studies often have reasonable success rates, though 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.[link]

Regular aerobic exercise can help keep androgen levels naturally lower while maintaining overall health and lowering stress, though weight training may have a detrimental effect on hair by increasing testosterone levels.

Stress reduction can be helpful in slowing hair loss.

Immunosuppresants applied to the scalp have been shown to temporarily reverse hair loss, though the possibly lethal side effects of this treatment make it untenable.

Saw Palmetto (Serenoa repens) is an herbal DHT inhibitor often claimed to be cheaper and have fewer side effects than finesteride and dutasteride. Unlike other 5alpha-reductase inhibitors, Serenoa repens induces its effects without interfering with the cellular capacity to secrete PSA. [link] Saw palmetto extract has been demonstrated to inhibit both isoforms of 5-alpha-reductase unlike finesteride which only inhibits the (predominant) type 2 isoenzyme of 5-alpha-reductase. [link] [link] [link]

Polygonum Multiflorum is a traditional Chinese cure for hair loss. Whether the plant itself is useful, the general safety and quality control of herbs imported from China can be questionable.

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.

Resveratrol, from grape skins, is a lipase inhibitor. By decreasing the body's ability to absorb fat through the intestine walls, it reduces the total fat and calorie content of a person's diet.

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 March 2006, Curis announced that it had received the first preclinical milestone, a $1,000,000 cash payment, in its hair growth program with Procter & Gamble Pharmaceuticals, a division of The Procter & Gamble Company. The program is focused on the potential development of a topical Hedgehog agonist for hair growth disorders, such as male pattern baldness and female hair loss. http://biz.yahoo.com/bw/060509/20060509005684.html?.v=1

Concealing hair loss

John D. Rockefeller, who had alopecia universalis, with toupee

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.

Another method is to wear a hairpiece - a 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. The best wigs - those that look like real hair - cost up to tens of thousands of dollars. Organizations such as [Wigs for Kids] collect individuals' donations of their own natural hair to be made into wigs for young cancer patients who have lost their hair due to chemotherapy or other cancer treatment.

Embracing baldness

Of course, instead of concealing hair loss, one may embrace it. A shaved head will grow stubble in the same manner and at the same rate as a shaved face. Many celebrities and athletes shave their heads. They spread the message of baldness by shaving the heads of adults to raise money for curing childhood cancer, which often causes children to lose their hair. Websites such as Curtis Bickham's www.Head-Liner.com proclaim, "Let the Skin Proceed When the Hair Recedes", as a way of dealing with hairloss. See Head shaving. Female baldness is less socially accepted. [Sharon Blynn], [Bald Is Beautiful] founder and an ovarian cancer survivor whose motto is "Always smile from the inside out!" encourages women to define beauty for themselves on their own terms.

Baldness folklore

There are many myths regarding the possible causes of baldness and its relationship with one's virility, intelligence, ethnicity, job, social class, wealth etc. While skepticism is warranted due to lack of scientific validation, some of these myths may have a degree of underlying truth.

"You inherit baldness from your mother's father."
: Previously, early baldness of the androgenic type was thought to be sex linked dominant in males and to be sex linked recessive in females.
: Research suggests that the gene for the androgen receptor, which is significant in determining probability for hair loss, is located on the X chromosome and so is always inherited from the mother's side. There is a 50% chance that a person shares the same X chromosome as their maternal grandfather. Because women have two X chromosomes, they will have two copies of the androgen receptor gene while men only have one.
: However research has also shown that a person with a balding father also has a significantly greater chance of experiencing hair loss.

"Intellectual activity or psychological problems can cause baldness."
: This myth probably was inspired by the fact that the human brain is located inside the skull, very close and just below where hair grows, and so it was thought that the use and abuse as well as mental diseases could have negative effect on hair growth and number.#redirect It may also be due to the fact that cholesterol is involved in the process of neurogenesis and also the base material from which the body ultimately manufactures DHT. While the notion that bald men are more intelligent may lack credibility in the modern world, in the ancient world if a person were bald it was likely that he had an adequate amount of fat in his diet. Thus, his mental development was probably not stunted by malnutrition during his crucial formative years, he was more likely to be wealthy, and also have had access to a formal education. However a sedentary lifestyle is less likely to correlate with intelligence in the modern world, and dietary fat content is less strongly linked to economic class in developed countries.
: This is sometimes used as a stereotype in films, where the more intellectual or rather frustrated characters are most usually portrayed as bald and generally unattractive, as opposed to the main characters which are usually portrayed as attractive, fit, mentally stable and generally with no apparent hair problems.
: This same myth normally extends to considering people having intellectual jobs more prone to baldness problems compared to manual laborers, sometimes further extending the myth to male college or university students when compared to workers of the same age.#redirect The myth is suspect because counterexamples can be found in any case.
: There is evidence, confirmed by cross cultural studies, for an association between androgen levels and intellectual ability. These findings are controversial due to their implications regarding psychology and gender.
: Total testosterone exhibits a positive relation to tactual-spatial abilities and to the degree of lateralization. Total testosterone is negatively correlated with verbal fluency. Testosterone in the saliva is also significantly positively correlated to tactual-spatial test scores and, in addition, to field independence. DHT and the ratio DHT/total testosterone are positively related to verbal fluency and negatively to the degree of lateralization of tactual-spatial performance.[link]
"Baldness can be caused by emotional stress, sexual frustration etc."
: Emotional stress has been shown to accelerate baldness [link] in genetically susceptible individuals.
: Stress due to sleep deprivation in millitary recruits lowered testosterone levels, but is not noted to have effected SHBG.[link]
: Thus, stress due to sleep deprivation in fit males is unlikely to elevate DHT. Whether it can cause hair loss by some other mechanism is not clear.
"Bald men are more "virile" or sexually active than others."
: Levels of free testosterone are strongly linked to libido and also DHT levels, but unless free testosterone is virtually non-existent levels have not been shown to affect virility. Men with androgenic alopecia are more likely to have a higher baseline of free androgens. However sexual activity is multifactoral, and androgenic profile is also not the only determining factor in baldness. Additionally, because hair loss is progressive and free testosterone declines with age, a person's hairline may be more indicative of their past than present disposition.
"Shaving hair makes it grow back stronger"
: Proposed as a popular remedy against baldness, it's very probably just an illusion similar to the one perceived after shaving one's beard or mustache. Shaving one's head doesn't increase the number of healthy hair present on the scalp, and, when the remaining hair has grown a few millimeters, no enhancement in thickness or overall quality can be observed.
"Frequent ejaculation causes baldness"
: There are many misconceptions about what can help prevent hairloss, one of these being that frequent ejaculation may have an influence on MPB. While ejaculation significantly lowers levels of relaxin (a 5-alpha reductase inhibitor) in a male's body and causes testosterone levels to temporarily elevate, the claim that frequent ejaculations can cause baldness is often viewed with skepticism. Higher free testosterone levels may correlate with both hairloss and increased sex drive in predisposed individuals.
"Standing on one's head alleviates baldness"
: The "blood-flow" theory, which led men to stand on their heads in the 1980's, can be found in the advertising for many of the fake hair-loss treatments for sale on the internet. While Minoxidil is a vasodilator and is speculated to work, in part, by increasing blood flow to hair follicles, there is no evidence that standing on one's head can alleviate baldness.
"Tight hats cause baldness."
: This one probably started in the military where young men entering the service were required to wear hats and soon showed signs of going bald, or at least of hair thinning. This is due to coincidental timing. The age that young men enter the military is also the same age that male pattern hair loss begins. This is due to dihydrotestosterone, not hats. Hats do cause hair breakage and, to a lesser degree, split ends. Since hats are not washed as frequently as other clothing, they can also lead to scalp uncleanliness and possible P. ovale contamination in men with naturally oily scalps.

Trivia

John D. Rockefeller had an extreme case of alopecia that caused him to lose all of the hair on his face, including his eyebrows and eyelashes. Another famous person who suffers from similarly severe alopecia is Italian football referee Pierluigi Collina. Actor Patrick Stewart lost most of his hair to alopecia by age 19.
Eunuchs do not go bald, due to reduced hormone levels.[link]
Baldness is not only a human trait. Some other primates, such as Chimpanzees, stump-tailed macaques, and South American nakari show progressive thinning of the hair on the scalp after adolescence. [link]
The different predecessors of Old World and New World vultures convergently evolved a bald head, preventing feathers from retaining material from the vulture's diet of rotting meat, as well as helping in heat regulation.[link] [link]
The American Bald Eagle is not really bald. The feathers on the head of this bird are white, in contrast to the brown feathers of the body. The term "bald" derives from the English word balde, which means "white."

References

Muscarella, F., & Cunningham, M.R. (1996). The evolutionary significance and social perception of male pattern baldness and facial hair. "Ethology and Sociobiology" journal (volume 17: 99-117 (1996).
Rossi S (Ed.) (2004). Australian Medicines Handbook 2004. Adelaide: Australian Medicines Handbook. ISBN 0-9578521-4-2
This article incorporates content from the 1728 Cyclopaedia, a publication in the public domain.
Starka L, Cermakova I, Duskova M, Hill M, Dolezal M, Polacek V. (2004) Hormonal profile of men with premature balding. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology (and) German Diabetes Association (volume 112: 24-28 (2004))

External links

["Medical Treatments for Balding in Men,"] April 1999, American Family Physician (medical journal)
[North American Hair Research Society] Frequently asked questions
[The relationship between androgens and verbal memory]

Hair loss specialist directories

[Directory of Specialists by Region] from the American Hair Loss Council

Male Pattern Baldness News

[Health Alternatives:] zinc, silica, methylsulphonylmethane (MSM) and cod-liver oil, to slow down the process.
[What may be the markers of the male equivalent of polycystic ovary syndrome?] Discusses androgenic alopecia and insulin resistance.
[The Pityrosporon yeasts. Their role as pathogens.] Pubmed article on pathogenic yeasts which feed on sebum
[Topical application of ketoconazole stimulates hair growth in C3H/HeN mice.] Pubmed article: Topical application of ketoconazole grows hair in C3H/HeN mice indicating that ketoconazole may be effective as a hair growth stimulant in people with seborrheic dermatitis.
[Vitamin D3 analogs stimulate hair growth in nude mice.] Pubmed article: Vitamin D3 analogs dramatically stimulated the hair growth of nude mice indicating the role of vitamin D3 in hair growth
[Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men.]
[reductase inhibitors available, current 2006]

The relationship between androgenic baldness, metabolism, diabetes and heart disease

[Androgenic effects of oral contraceptives: implications for patient compliance.] Pubmed article on androgenic alopecia, contraceptives and women
[Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals.] Pubmed article: Male Pattern Baldness in Female to Male transsexuals receiving testosterone esters or testosterone undecanoate was not an indicator of increased risk for coronary heart disease.
[Male pattern baldness is not associated with established cardiovascular risk factors in the general population.] Pubmed article: While male pattern baldness is associated with coronary heart disease, it is not correlated with abnormal height, weight, blood pressure, pulse rate, total and high-density lipoprotein cholesterol, or plasma fibrinogen indicating that male pattern baldness is linked to heart disease through some other mechanism.
[Early onset of androgenetic alopecia associated with early severe coronary heart disease: a population-based, case-control study.] Pubmed article: Study indicates that early onset of androgenic alopecia is an indicator for coronary heart disease later in life.
[The risk of coronary heart disease in men with androgenetic alopecia.] Pubmed article: 36 person study finds serum lipoprotein (a) and triglyceride levels, both risk factors for coronary heart disease, to be higher in men with male pattern baldness.
[Nitric oxide in the human hair follicle: constitutive and dihydrotestosterone-induced nitric oxide synthase expression and NO production in dermal papilla cells.] DHT stimulates production of the free radical Nitrogen Monoxide (NO) which in turn stimulates hair growth.
[Lipid peroxidation and antioxidants in hyperlipidemia and hypertension.] Pubmed article: Lower blood plasma levels of vitamins C and E correlate with higher cholesterol levels.
[Sex Hormone-Binding Globulin and Serum Testosterone are Inversely Associated with C-Reactive Protein Levels in Postmenopausal Women at High Risk for Cardiovascular Disease.] Levels of Sex Hormone Binding Globulin and total testosterone were inversely associated with C reactive protein levels (believed to be a marker of chronic inflammation) among people not using hormone replacement therapy.
[Low Sex Hormone Binding Globulin is a potential marker for metabolic syndrome.]
[Hormonal profile of men with premature balding.] Pubmed article: A hormonal profile of men with premature balding. Balding men were found to have subnormal values of several hormones including; Sex hormone binding globulin (SHBG), testosterone and epitestosterone. Balding men were NOT found to have a lower free androgen index (i.e. they didn't have a lower level of bioavailable androgens in their blood.) A borderline significant trend was recorded with respect to increased levels in 17OH-P and prolactin.
[The relationship between serum levels of insulin and sex hormone-binding globulin in men: the effect of weight loss.] Pubmed article: Sex hormone binding globulin levels are reduced by high levels of insulin.

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