MEN'S HAIR LOSS

James Nesbitt, 44, began losing his hair in his early twenties and has always been vocal about his hatred of going bald. In 2001 he admitted taking vitamin tablets in an attempt to slow his hair and four years ago he said he was using a lotion to try to stimulate his follicles. Although he said the sensation made his scalp feel like it was 'going to explode', he added: 'It opens the pores of the scalp to encourage new growth. It's ridiculous, but it's horrible going bald. Anyone who says it isn't, is lying."  Nesbitt hasn't revealed yet which vitamin tablets he has been taking.

HRH Prince William however, seems content with his head of hair and seeing as he is only 26 years old, he is confident enough to carry it off.

In the past, baldness was often seen as something unfortunate or undesirable. However, this attitude has changed over the years and nowadays a clean-shaven head is usually considered both fashionable and attractive.

The human head has on average 100,000 hairs. Hair is made in hair follicles, the roots of the hair. Each hair grows for about three years, then it drops out and a new one grows, losing 40-120 hairs a day.

Hair may start to disappear from the temples and the crown of the head at any time. For a few men this process starts as early as the later teenage years, but for most it happens in their late 20s and early 30s and follows a typical pattern. Male pattern baldness (also known as genetic hair loss or alopecia androgenetica) is the most common form of hair loss in men. Male-pattern baldness is so called because it tends to follow a set pattern: First, a receding hairline develops and gradually the hair on top of the head also begins to thin. Eventually, the two balding areas meet to form a typical U-shape around the back and sides of the head. A little thinning of the hair may be noticeable first, followed by wider hair loss allowing more of the scalp to become visible.  The hair that remains is often finer and does not grow as quickly as it used to. It can progress to complete baldness, but this is rare.

Some men have areas on the scalp that are very sensitive to the male sex hormones that circulate in men's blood. The hormones make the hair follicles - from which hair grows - shrink. Eventually, they become so small that they cannot replace lost hairs. The follicles are still alive, but are no longer able to perform their task. This happens because of an excess of a chemical called dihydrotestosterone, or DHT, which causes the hair follicles to make thinner and thinner hair until they eventually pack up completely.

Alopecia is loss of hair and sometimes baldness. The commonest form is male-pattern baldness (androgenic alopecia), which can also affect women. Both women and men can lose their hair.

Alopecia areata is another type of hair loss, involving patches of baldness that may come and go. It affects about one in 100 people - mostly teenagers and young adults and runs in the family in one in five cases.

Alopecia areata is thought to result from a problem with the immune system. There is no proven effective treatment, but in most cases the hair grows back after about a year.  One in five people with alopecia areata may go on to develop a more severe form of hair loss – alopecia totalis (no scalp hair) or alopecia universalis (no hair on the scalp and body).

In some cases, hair loss is a side effect of having cancer treatment drugs, but in many cases the hair grows back.

Hair loss can lead to problems with confidence and self-esteem. Some men aren't troubled by this process at all. Some suffer great emotional distress associated with a lack of self-confidenceand sometimes depression.

Male-pattern and female-pattern baldness is caused by over-sensitive hair follicles. This is linked to the hormone dihydrotestosterone (DHT), which is made from the male hormone testosterone. If there is too much DHT, the follicles react to it and the hair becomes thinner and grows for less time than normal. The balding process is gradual because different follicles are affected at different times.

Two-thirds of all men will eventually be affected by male pattern baldness – in the UK, this means that 7.4 million men are losing their hair at any one time. There are racial differences, however, in the incidence of male pattern baldness. The highest rates are found among Caucasians, followed by Afro-Caribbeans. Chinese and Japanese men have the lowest rates. For some unknown reason, this form of hair loss is does not occur among Native Americans.  Male pattern baldness runs in the family. If your grandfather, father or brothers went bald early, the chances are that you will too. The strongest influence is on the mother's side: if your maternal grandfather went bald, that's probably a better indicator that you will too than if your father's father lost his hair.

There is only a tiny grain of truth in the myth that bald men are more virile because they have more of the male sex hormone testosterone. This idea probably grew from the observation that eunuchs never became bald and, having being castrated, they didn't, of course, produce very much testosterone.

Yes, testosterone is involved in male pattern baldness, but its relationship with hair loss is complicated and not completely understood. Testosterone is naturally converted in the body to a related sex hormone, dihydrotestosterone (DHT). This stimulates the growth of facial and body hair, as well as acting on the prostate gland. There is good evidence that male pattern baldness results from an over-sensitivity of scalp hair follicles to DHT, rather than raised levels of either sex hormone in the blood.

Other causes of hair loss include:

•        iron-deficiency anaemia
•        under active thyroid
•        fungal scalp infection
•        some prescribed medicines
•        stress

These are usually reversible.

If there's a reversible cause, it's normally possible to stop hair loss. For instance, if it's caused by anaemia you can stop hair loss by replenishing the body's iron stores.

A huge number of treatments have been tried to slow down and even reverse the process of male pattern hair loss - some are successful, others aren't. But many men find their hair loss slows down or stops for no apparent reason at a certain age anyway.

It's a good idea to ensure an illness isn't responsible, particularly if the hair loss is patchy rather than being in the typical male pattern distribution. Moreover, if the hair loss is accompanied by other symptoms (such as tiredness) then blood tests may be necessary.

•      Wigs and hair transplants are, obviously, the most direct form of treatment. Different hairstyles can create the appearance of a fuller head of hair.
•      Herbal preparations that contain zinc, magnesium, iron, vitamin E and other substances in various combinations can help.
•      Minoxidil is a lotion available from the pharmacist that you rub on to the scalp. It slows down the process of hair loss and can cause new hair growth but you have to keep on using it or it will stop being effective.
•      Finasteride (Propecia) is the latest drug treatment. It comes in tablet form and works by slowing down hair loss; it's also reported to cause new hair growth. In the UK it's only available on private prescription from your GP.

Bizarre treatments have included rubbing curry into the scalp or having a cow lick the scalp.

•     You cannot prevent male pattern baldness, although there may be ways of slowing down the process or disguising the problem.
•     To get advice and treatment for hair loss, you should always start with either your GP or a professionally qualified trichologist.
•      Until very recently, male pattern balding was seen as a natural process and you may find your doctor to be neither sympathetic nor helpful if you consult him/her about it. But things may be changing. An increasing number of doctors realise that hair loss can have psychological consequences that significantly diminish quality of life, especially for younger men, and they may be more willing to take the problem seriously.

If you are lucky enough to have an enlightened GP, by all means seek their advice – at the very least, you'll get a referral to a reliable trichologist (although you'll probably have to pay for any treatment you receive).

A trichologist, by the way, is a hair specialist whose training covers both the cosmetic and the medical aspects of the subject. Some trichologists are also trained hairdressers, but they are not usually medically qualified. The Institute of Trichologists keeps a register of properly qualified people: look for the letters AIT (Associate), MIT (Member) or FIT (Fellow) after their name.

Other types of hair loss, such as alopecia areata, are taken seriously as medical conditions and you should seek your GP's advice as you would for any other medical problem.

There is no cure for male pattern baldness, but there are both drug and surgical treatments available which may lead to some improvements.

Minoxidil (sold as Regaine)

•     This is the only topical treatment (one that you rub into the skin) which is actually licensed for the treatment of male pattern baldness in the UK. It was originally developed (in tablet form) as a drug for high blood pressure. Doctors noticed that people on minoxidil sometimes grew new hair, so the drug was reformulated for this purpose.
•      Regaine comes as 2% or 5% lotions which you rub, daily, into your scalp. It is best to start with the 2% lotion and after three months, if you have not seen significant growth of hair, upgrade to the 5% lotion. In the UK, Regaine is a Pharmacy Only Medicine (POM), which means you can obtain it from a pharmacy without a prescription, but only when a pharmacist is on the premises. The pharmacist should check that Regaine is appropriate for you before selling it (for instance, you shouldn't use it without medical supervision if you have high blood pressure).
•      Regaine cannot work miracles. About one-third of men using it get good hair growth on the bald patches, one-third get a fine, downy regrowth, while the rest will get little or no response. The majority of men using it find that at least they don't lose much more hair – but as soon as you stop using it, hair loss resumes its course.
•      Regaine is not a quick-fix. Expect to wait up to four months before you get any response from Regaine, but if nothing happens after, say, a year, you may as well give it up. Incidentally, never pay large sums of money to a private trichologist or over the internet for Regaine – the usual price is around £30 for a month's supply
•      It is not recommended for those under the age of 16

Finesteride (marketed as Propecia)

•     This is a treatment for male pattern baldness which is licenced in the UK but only on private prescription, not on the NHS. It is one of a class of drugs called 5-alpha-reductase inhibitors. Since 5-alpha-reductase is the enzyme which causes the conversion of testosterone into DHT, inhibiting this with finesteride should, in theory, stop hair loss. In fact, finesteride was originally developed for the treatment of benign prostatic hyperplasia (BPH), a condition in which the prostate gland becomes enlarged through the action of DHT.
•      Although there have been no clinical studies directly comparing low dose Finesteride and Regaine, the data suggests that the two products may be similarly effective as a treatment for hair loss. Finesteride can lead to side effects in up to 2% of users such as impotence, reduced sex drive and reduced semen volume. (These side-effects are reversible when the treatment stops.)
•      Propecia can be obtained from your GP or dermatologist on private prescription.

Anti-androgen therapy

Another way of tackling male pattern baldness is to directly block the action of DHT using a variety of hormonal drugs. Some of these are similar to oral contraceptives and female hormone replacement therapy. They should only be applied under the supervision of an endocrinologist (hormone specialist) or a dermatologist with expertise in hormone therapy.

Hair transplant surgery

Plastic surgery may be the only reliable way to replace lost hair, and techniques for restoring hair growth are constantly improving.

A good hair surgeon probably has enough 'word of mouth' business to not advertise their services  Talk to people that you know have undegone any treatments.  When you choose a surgeon, ask them for testimonials from other clients.

•     Surgery offers the possibility of a longer-term solution to your hair loss problem. But it doesn't come cheap and it can be hard to find a skilled and reputable surgeon. Put simply, hair surgery involves rearranging your scalp skin so as to minimise the bald areas and maximise those where hair is still growing.
•     a transplant, where the surgeon moves non-sensitive hairs from the back of the head to the top. This is best for men whose hair loss is limited to the front of the scalp. Factors that determine whether a person is a suitable candidate include age, hair colour, the nature of hair loss, and whether the hair type is straight or curly.
•     scalp reduction is a technique that is most suitable for men with a small, well-defined bald spot on the top of the head.
•     flap-surgery which involves making the part of the scalp that still contains hair larger. This is a possibility in cases of hair loss over a small area.
•      In the UK most hair surgeons use grafts, which involves transferring skin from the hair-bearing area at the back of the head to the bald parts at the front. Hair grafts work because the section of skin transferred retains its own characteristics (i.e. hair grows) rather than acquiring those of the place it is transferred to (where hair does not grow).
•      The most natural results come from transferring plugs of skin bearing 3–6 hairs (minigrafts) or just one hair (micrografts). The surgeon makes tiny slits or pinholes in the recipient area into which the plugs are inserted. A new hairline can be built up by using rows of micrografts at the front and minigrafts a few rows further back.
•      When considering surgery, you must remember that your hair loss could well continue around the reconstructed areas. This may look unsightly unless you're prepared to invest in further surgery in a few years time.
•      Hair surgery usually involves considerable financial investment and you are also involving yourself in a medical procedure. So choose your surgeon carefully, preferably via personal recommendation or through the Institute of Trichologists. The surgeon should also have one or more of the following qualifications:
•         FRCS (Fellow of the Royal College of Surgeons)
•         BAAPS (British Association of Aesthetic Plastic Surgeons)
•         BACS (British Association of Cosmetic Surgeons)

Other treatments

As far as other treatments are concerned, be very wary. There are many bogus operators out there who are only too keen to exploit people with hair loss and part them with their hard earned money.

•      Treat your remaining hair with a bit more respect. Most people are too rough with their hair. It's better to use a comb, not a brush, and to avoid tightly fitting caps or hats. Hair is more fragile when it's wet, so handle it with care.
•      Some shampoos and other hair cosmetics can make your hair look thicker and fuller. Ask your hairdresser for advice.
•      Short hair minimises the contrast between balding and non-balding areas. Long hair has the reverse effect and is very ageing. It shouldn't need saying, but combing hair over a bald spot is not a good idea.
•      Include sufficient protein in your diet, especially if you are vegan or vegetarian (hair loss sometimes starts when people give up meat). Ensure that you do not become anaemic by eating plenty of iron-rich foods like liver, eggs and green vegetables.

There's no cure for male pattern baldness, although other forms of male hair loss are often reversible. Baldness is generally regarded as natural and not a disease. So if a person decides they wish to try to get their hair back, they will probably have to pay for the lengthy, expensive procedure themselves

Alopecia areata

There is no really effective treatment for alopecia areata.However, in about eight out of 10 cases, the hair grows back after about a year without any treatment, so sometimes ‘watchful waiting’ is best – especially if you just have a few small patches.

Steroid injections

These appear to be the most effective treatment for small patches of alopecia. A steroid solution is injected several times into the bald areas of skin. This stops the immune system from attacking the hair follicles and can stimulate hair to regrow in those patches after about four weeks. Injections are repeated every few months. Alopecia may return when injections are stopped.

Topical steroids and steroid tablets

Topical steroids (creams and ointments) are widely prescribed for alopecia areata, but their long-term benefits are not known. There is some evidence that they cause hair to regrow.

Steroids can also be taken as tablets, but alopecia often returns when the tablets are stopped, and after a while of taking them they can produce serious side effects such as diabetes and stomach ulcers. Other possible side effects are itching or hair growth in other areas.

There are several places you can go to for further information:

Hairline International: The Alopecia Patients Society