Bald truth: Dr Phil Kieran on ways to tackle a receding hairline

If losing your hair is getting you down talk to your doctor about the various treatment options which range from lotion to drug and transplantation, writes Dr Phil Kieran.

I CAN clearly remember at the age of 15 looking into the mirror trying to convince myself that I was growing enough stubble to start shaving. Now I shave every morning and I would happily go back to my college days when I got away with shaving once a week.

I’m sure not everyone puts as much store in these male hair growth patterns as I did but I find it hard to think I was on my own in feeling this way.

Changing hormones affect the way our hair grows by increasing it in some areas and thinning it out in others.

As we age, three things are guaranteed to happen: Our noses will get bigger; our eyebrows and nose hair will attempt to grow to bizarre lengths; the hair on our heads will start thinning. Sometimes the third development starts to happen at a younger age and it can cause a lot of distress and anxiety.

What are we talking about?

Male-pattern baldness refers to the common type of baldness, which affects the hair on the top of the head, the forehead and around the temples. Its medical name is androgenic alopecia which refers to the fact that one of the causes of baldness is the effect testosterone (an androgen) has on the hair follicle. Early androgenic alopecia is thought to be due to a combination of genetic predisposition and individual levels of a hormone called dihydrotestosterone (DHT), this condition will affect up to 25% of men making it a fairly common issue.

Does it really matter?

Baldness is not a medically damaging condition and is almost always limited to the scalp. If the hair loss doesn’t bother you there is absolutely no reason to seek treatment or advice. However, for a proportion of men, there is significant psychological distress caused.

These men usually come to me wanting to know what options are open to them. Can they reverse the hair loss or, at the very least, slow the rate at which it is progressing? First off, let’s dispel a few myths about baldness. Baldness is not a sign of high or low virility, it’s not even really an indication of testosterone level. Nor is there any link to diet, exercise or sexual activity.

Male-pattern baldness is caused by individual hair follicles shrinking and producing thinner and thinner hairs, which eventually don’t manage to protrude beyond the skin of the scalp. This is heavily influenced by the hormone DHT, which is made from testosterone in many cells around the body. It is thought that people with early baldness have higher levels of DHT in the scalp than other people and this is likely genetically determined before birth.

What can I do about it?

If you do want to try and intervene with this process there are two main options, a lotion or tablet. The first line of treatment I would always advise my patients to consider would be a topical treatment. Minoxidil, which is the active ingredient in products like Regaine, works by increasing blood flow in the scalp. This is thought to reduce levels of DHT in the hair follicles allowing the follicle to regenerate and hopefully to re-grow normal hair.

The tablet option is a drug called finasteride. This drug works by stopping the conversion of testosterone to DHT and can be quite effective at slowing or reversing hair loss within about three months of use.

Finasteride is also licensed for the treatment of enlarged prostate (which responds to DHT). The dose used for hair loss is much lower than that used for prostate enlargement and so is less likely to cause side effects. However, if you are considering this treatment it is important to have a full discussion with your doctor and to discuss the potential pros and cons.

The main side effects tend to be increased oiliness of the skin, some acne type spots, decreased libido and low mood.

This collectively can be a condition called post-finasteride syndrome, which occurs in approximately 1% of people treated and can be quite severe. In most cases the hormone levels recover quickly (within three to six months) after stopping the medication and symptoms resolve in about the same time period.

One of the biggest problems with either of these treatments is that the effect on the hair tends to stop when the treatment is stopped. This may mean that you start losing your hair slowly again but it can also mean that there is an abrupt loss of hair back to the levels of baldness that you would have reached had you not been treated at all.

…and if that doesn’t work?

There is a third option to try and improve this condition, which is hair transplantation. This is a procedure where hair-bearing skin is removed from one part of the body by an aesthetic surgeon. The individual follicles are separated out and placed in small incisions on the scalp. This hopefully allows new hair to grow which should be less sensitive to the effect of DHT as it comes from a different part of the body.

At the end of the day, if you are going bald and it doesn’t bother you, forget about it and carry on.

If, however, it is causing you significant upset there are options so don’t be embarrassed to go and talk to your doctor.

Head-line stats

- Male-pattern baldness is hair loss affecting the forehead, top of the head and the temples.

- It is a very common condition, which affects up to 25% of men.

- It is not a medically damaging condition or a sign of other health concerns.

- For some men, it can cause severe distress and have a detrimental effect on their mood and sense of self-esteem.

- Topical lotion based treatments can be effective while they are being used.

- Tablet treatment can also be an option but can have more severe side effects.

- Surgical transplantation of hair follicles for some people can be a very effective treatment.