Follicle Folly

You don’t have to abandon hope just because your hair is abandoning ship.

by Claire Sykes

July-August 2013

From singer Seal to tennis player Andre Agassi, the world has seen some attractive bald men. But millions of guys who have lost their hair don’t feel so good about their looks; that describes how Matt Lachmann felt 20 years ago, when his aunt pointed out the empty spot on top of his head.

“I thought, ‘Oh, great,’” says the 46-year-old Portland, Oregon, accountant. “I wasn’t mortified, I didn’t try to hide it, but I wasn’t happy about it, either.”

A couple years later Lachmann started using a topical product with minoxidil, a drug billed as being able to prod hair growth and curb balding. “After two years, it wasn’t working, so I didn’t stick with it.”

Soon the hair on the crown of Lachmann’s head was just a memory, baldness gaining speed when he hit 40. Whatever was left he buzz-cut, shorter and shorter each time.

“For another year I lived with this three-inch triangle patch right above my forehead, a little island of hair, uneven and thicker than the rest. It got so noticeable that I decided to just shave my whole head.”

For most men with male pattern baldness (MPB), hair loss begins with a receding hairline and thinning crown, then takes over the temples and the top of the scalp. Also called androgenic alopecia, MPB accounts for more than 95% of hair loss in men, starting as early as a man’s late teens and early 20s. By the time they reach age 35, two-thirds of American men have less hair, and 85% of them experience significant hair loss by age 50.

Everyone sheds about 100 of their 100,000 scalp hairs every day. Hair goes through a cycle of growth, transition and rest that lasts for several years; the old strands are then pushed out when those follicles regenerate and produce brand-new hairs.

A number of factors can increase the number of hairs lost. Disease, reaction to some medications and even stress may cause hair loss to accelerate. And like men, women can also experience age-related hair loss, which often occurs as a general thinning across the entire scalp. But especially for men with MPB, the cause of hair loss rests in the limbs of their family tree.

Hormonal Transformation

Lachmann’s maternal grandfather and uncle are both bald, and most likely passed down to him their sensitivity to the hormone dihydrotestosterone (DHT), a byproduct of testosterone—the same stuff that causes a man’s first whiskers to sprout. As a man ages, though, the enzyme type II 5-alpha-reductase, found in the hair follicle’s oil glands, can act on testosterone, turning it into DHT. “When testosterone gets converted, its androgen [male hormone component], which is now in the DHT, is far more potent,” says Paradi Mirmirani, MD, of the American Academy of Dermatology. And that’s when things start getting hairy.

Most people with hair loss have elevated levels of DHT. But a blood test can’t tell you how much DHT you actually have, since it isn’t found in the blood. Too bad, because “you could have a sensitivity to DHT for years and not know it until you start going bald.

This sensitivity makes the hair follicles more susceptible to shrink, involute [curl up] and fall out,” says Neil Sadick, MD, of Sadick Dermatology in New York City and clinical professor of dermatology at Weill Cornell Medical College.

Shrinkage, or miniaturization, happens when DHT shortens the hair follicle’s growth phase. With each new cycle, the follicle produces increasingly shorter and finer hairs, until none remain. “Some hair follicles are destined to grow and others to regress, and that’s what causes hair thinning,” explains Sadick. “A genetic sensitivity to DHT is only one part of the male pattern baldness story, though. You could also have elevated DHT and not experience hair loss, because of other factors that play a role. But we don’t know how other causes of hair loss interact with DHT.”

Herbal Assistance

One way to help slow hair loss, especially if undertaken early in the process, is to block type II 5-alpha-reductase from turning testosterone into DHT. The herb saw palmetto is best known for use by men suffering from benign prostate enlargement. It is seen as a promising aid in slowing hair loss, and for the same reason: DHT has also been linked to prostate problems, and saw palmetto interferes with the action of type II 5-alpha-reductase.

Traditional Chinese Medicine (TCM) views all undesirable conditions, including hair loss, as the result of imbalances among the body’s “organs,” which in TCM aren’t physical structures as much as energy distribution points. Stagnation in these organs—in the case of hair loss, the liver and kidney—keeps blood from rising to the scalp, which results in a failure to nourish the hair.

TCM’s herbal hair-loss remedies are designed to enhance blood circulation to the scalp. The herb most often used for this purpose is Polygonum multiflorum, employed by Chinese healers for centuries to slow hair loss and restore gray hair to its original color.

Chinese herbs are almost always used together in multi-herb formulas. In addition to Polygonum multiflorum, other hair-restorative herbs include Eclipta prostrata, the main “hair herb” in India’s Ayurvedic medicine; Poria cocos, a Chinese mushroom with anti-inflammatory properties; and Centella asiatica, also known as gotu kola, used to strengthen hair, skin, nails and connective tissue.

Herbal hair-support remedies work best in the context of good overall nutrition and healthy lifestyle habits. That means “not smoking and getting plenty of protein, which you need to make hair,” says Mirmirani. Avoid consuming excessive sugar and refined starch, which are linked to higher insulin levels; insulin appears to accelerate MPB.

Deficits of certain nutrients make hair loss more likely. Low levels of vitamin C or essential fatty acids leave hair prone to splitting and breaking easily. Iron, copper, vitamins B6 and B12, and the B vitamin folic acid, are all required for the healthy functioning of the red blood cells that carry oxygen to hair follicles. (Copper is also required for the development of hair pigmentation; deficiencies can result in color changes.) Another B vitamin, biotin, improves follicle health, allowing for fuller hair growth.

If MPB has left your scalp uncovered, be sure to take care of it. “After I shave my scalp I put moisturizer on it, and I wear sunscreen and hats to protect my skin,” says Lachmann.
Balding may simply be your genetic inheritance. But there are natural steps you can take to at least slow the process.

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