SPECIAL FROM Next Avenue

By Laine Bergeson

Hair loss, common for men and many women in midlife, can have profound emotional and psychological effects. So, too, can baldness cures advertised as magical remedies.

“There’s this guy, a regular caller on my radio show, who had his head disfigured by a terrible hair transplant,” says Spencer Kobren, founder and president of the American Hair Loss Association and author of The Bald Truth: The First Complete Guide to Preventing and Treating Hair Loss. “He purposely became a New York City cop so he could wear a hat.” And he refused promotions so he could remain a beat cop and keep wearing the hat.

Forty percent of hair loss sufferers are women, and the phenomenon can be particularly devastating for them. “With men, hair loss in midlife is expected and they can still be seen as attractive,” says Kobren. “But for a woman, it is over.”

This makes women especially vulnerable to all manner of hair loss “cures,” and the possibility of spending lots of money, time and emotional investment on ineffective treatments.

“A lot of men are suicidal,” says David Kingsley, author of The Hair Loss Cure. “And it is very traumatic for women. It affects their social life and their life with their spouse or partner.”

Hair loss treatment is a $3.5 billion industry — as big as the over-the-counter cold and flu market. “But about 99 percent of the treatments don’t work at all,” says Kobren.

So what triggers hair loss in midlife, what really helps and what is nothing but a gimmick?

The Causes of Hair Loss

The most effective treatment for hair loss depends on what is causing hair to fall out in the first place. There are a variety of reasons men and women lose hair, according to Kingsley. They include:

Heredity

Hormones

Stress

Poor diet/missing nutrients

Chemical hair styling services

Certain medications

Surgery or high temperature

Sometimes the cause is a combination of factors. One person may lose hair due to a mix of stress and a recent surgery or medications. Male pattern baldness (MPB), on the other hand, is the result of the intersection of hormones and heredity, occurring in men who have a genetic sensitivity to the hormone dihydrotestosterone (DHT).

Contrary to popular belief, notes Kingsley, genetic hair loss probably isn’t tied to your mother’s father. “The latest research indicates girls follow mother’s father, boys follow father’s father,” says Kingsley. “But most likely, it is an assortment from both.”

The very first step a person should take, says Sophia Emmanuel, a certified trichologist (a professional trained in all aspects of care and treatment for the head and scalp) in New York City, is to find a dermatologist or trichologist to help diagnose the root cause of hair loss.

Diagnosis can include blood work to test for nutrient deficiencies, scalp examination (looking at patterns and shapes of hair loss, possibly a skin biopsy) and gathering medical, lifestyle and family information.

Once you know the cause of hair loss, you can choose targeted treatments that help maintain the hair you do have or regrow new hair.

Hair Loss Treatments

One hair loss myth, note both Emmanuel and Kingsley, is that all hair loss is permanent. “It’s not,” says Kingsley.

When the cause is nutrient deficiency or stress, for example, the hair loss is typically temporary. In such cases, hair growth can be encouraged by addressing the underlying problems: working to build up the body’s stores of zinc, boosting iron levels and better managing stress — though experts note that it may take several months to see progress.

Genetic hair loss, on the other hand, is largely permanent, as is any type of hair loss triggered by scarring on the scalp, says Emmanuel. Scarring can be caused by chemical hair styling services or too-tight pony tails, a problem Emmanuel sees with many African American women who are hair-loss sufferers. She adds that scarring can also be triggered by some autoimmune disorders.

Women with genetic or autoimmune related hair loss “have very few options” for hair regrowth, says Kobren. Minoxidil (brand name Rogaine) has been FDA-approved for women in a 2 percent concentration, but it only helps maintain existing hair and does not promote regrowth.

Kobren encourages women interested in using minoxidil to buy it over-the-counter to save money. Lots of companies will add minoxidil to expensive shampoos and charge top dollar, he says, when straight minoxidil is available for much less money at regular pharmacies.

Men with genetically-driven hair loss have more options for hair regrowth, continues Kobren, thanks to a drug called finasteride, which is marketed as Propecia by the pharmaceutical giant Merck. Finasteride works by blocking the creation of dihydrotestosterone, which fuels male pattern baldness, and double-blind clinical trials have shown that finasteride can noticeably thicken men’s hair.

Many men shy away from taking finasteride, however, because of the possibility of sexual side effects, including loss of libido. And, more recently, studies have shown that those side effects may persist after discontinuation of the medicine.

What About Surgery?

Surgery can be an effective option for men with male pattern baldness, says Kobren. The procedure’s success is predicated on moving DHT resistant hair to areas on the scalp that previously grew DHT-sensitive hair. Because DHT sensitivity is rarely the problem for women, they almost never gain long-term benefit from the procedure.

This is despite aggressive marketing to women, who may feel vulnerable due to hair loss, making them a susceptible target.

Kobren says: “Surgery is often the first place women go, but I strongly advise them against it.”

Men, too, need to use caution because the success of the procedure all depends on the quality and training of the practitioner performing it.

“The whole field of cosmetic surgery is a very dangerous place,” says Kobren, and that is especially true in the booming hair loss market. “I know a gynecologist who promotes himself as a hair transplant specialist.”

In the wrong hands, a transplant can disfigure and further traumatize a hair loss sufferer.

Kobren founded a group, the International Alliance of Hair Restoration Surgeons (IAHRS.org), to help identify qualified practitioners. He said the organization has received over 900 applications, but accepted just 65 people based on the quality of their work.

He advises people interested in transplants to comb through the site for someone in their area. But Kobren cautions that the site is just a starting point — a place to begin to do due diligence. Just because someone is listed there, says Kobren, doesn’t make him or her the right practitioner for a particular client.

The most important thing someone interested in surgery can do, says Kobren, is homework: talk to specialists, meet people they’ve worked on, read reviews online. This piece is critically important for success.

It is also important given the price of the surgery.

“The average surgery is about 2,000 grafts,” says Kobren, “and grafts are between $5 and $11 per graft. You can be talking a minimum investment of $20,000.”

Other “Cures” and Myths

Kobren believes that two other emerging therapies hold promise: platlet-rich plasma therapy and laser therapy, but at this point he doesn’t endorse either.“I haven’t seen enough clinical data yet to show that it works,” he says. Anecdotal evidence, however, has been promising.

The vast majority of other miracle cures — like thickening shampoos or standing on your head — are nothing more than snake oil, says Kobren. And even effective therapies can be ineffective if the treatment and the root cause don’t align.

Kinsley highlights three other myths about hair loss:

Myth: Washing your hair every day causes hair loss. “That’s rubbish,” says Kinsley. “It doesn’t make your hair fall out. Don’t be frightened.”

Myth: Shaving your head makes hair grow faster. “No, it doesn’t,” says Kinsley.

Myth: There is a fast solution. With some medical issues there is a quick fix, says Kinsley. “A person goes on medicine and it’s all under control. With hair loss, it’s different. There is no one thing you can put on the scalp or take to fix the problem.”