Dr Nina replies: Male pattern baldness affects 30pc of 30-year-olds, and 50pc of men over 50. In the majority of cases the cause is a hereditary condition called androgenic alopecia. While there are no known physical problems associated with hair loss, the negative psychological impact leads many men to seek possible remedies.
The exact pattern of inheritance isn't certain. It can pass through either side of the family. If you have a first-degree relative who is bald, your chances are increased by 50pc. Using hair products or wearing hats does not encourage hair loss. Those who have male pattern baldness do not have higher circulating testosterone and are not more virile than men with full heads of hair.
Male pattern baldness occurs in a very typical manner. Firstly, the hairline at the front recedes; next, a bald patch develops at the top of the head (vertex). Slowly these areas enlarge and eventually merge. Normal hair growth occurs in small pockets called hair follicles. Healthy hair grows for three to six years then sheds and a new hair grows.
In male pattern baldness, the follicles get smaller, leading to thinner, weaker hair. The growth cycle becomes shorter until eventually only a small stub of hair, that doesn't make it to the skin surface, remains. Male hormones play an important role in this. Testosterone is converted to dihydrotestosterone (DHT) in the hair follicles. Those with male pattern baldness have increased sensitivity to this, causing the follicle to shrink, and thus a destructive cycle ensues. It is not clear why only some hairs are affected at a time or why this process doesn't affect hair on other parts of the body.
There are a number of treatments available. Some literature recommends a diet low in processed or high fat foods. Others recommend lean protein and ensuring silica, iron and zinc in the diet. These are largely based on the fact that hair is composed of protein and evidence is largely lacking to support any major dietary benefit.
There are two medical compounds, which do show some benefit. Minoxidil (Rogaine and Regaine) is a solution applied topically twice daily. It comes in 2pc and 5pc strengths. The 5pc compound has shown more benefit, although is more unpleasant to apply. About 15 in 100 users report good results. It must be applied every day and takes four months for full benefit.
Finasteride (Propecia) is a prescription medicine initially designed to help with prostate problems. It is a tablet taken once daily at a dose of 1mg. It works by blocking the conversion of testosterone to DHT, thus allowing the hair to remain thicker. Research showed that two-thirds of men reported regrowth. In studies it only works on hair loss on the top of the head.
Both remedies are considered safe, although some side effects have been reported. With Minoxidil most are localised and include irritation and rash. Finasteride can cause reduced libido in approximately 2pc of users and has also been associated with breast enlargement or tenderness. Finasteride can also change the result of the PSA test. These can be expensive and need to be continued indefinitely.
Q. Is there any such thing as a safe level of sunbed use?
The World Health Organisation has classified UV rays from the sun and artificial devices as carcinogenic. The UV radiation in sunbeds damages skin and is a major risk for skin cancer. Radiation from sunbeds can in fact be more than 10 times stronger than that of a midday hot Mediterranean sun. If you have ever used a sunbed, your risk of melanoma is increased by 20pc. Those who first use a sunbed under the age of 35 have a nearly 60pc increased risk of skin cancer. Regular use under the age of 30 increases it by over 75pc.
The increased use of sunbeds in younger women means that melanoma has surpassed cervical cancer as the most common cancer occurring in this age group. A large review of the medical literature published in the Journal of Dermatology surmised that melanoma due to tanning is more common than lung cancer due to smoking.
Skin cancer can occur on all types of skin, but there are a number of notable risk factors. These include fair skin, a personal or family history of skin cancer, excessive UV exposure whether from sunlight or tanning beds, a history of blistering sunburn, especially in childhood, the presence of lots of atypical moles on the body, weakened immunity, and previous exposure to chemicals such as tar, petrol products, arsenic and soot.
Despite what some who manage to tan think, the majority of native Irish people are classified as having fair skin, which immediately puts us at a higher risk of skin cancer. It takes 20 to 30 years for skin cancer to develop, but damage is often done in childhood. Tanned skin is damaged skin. Sunbeds are not a healthy way to boost your vitamin D and a tan acquired from these does not protect your skin from damage if acquired prior to travelling abroad. The answer is simple: Do not use tanning beds, ever.
Source: Dear Dr Nina: I'm 21 and going bald. Is medication safe to take?
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