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Hair Loss in Men
Meet Tony Maleedy our hair specialist with 25 years experience in clinical practice and hair research. Tony will be regularly contributing to his column on UKHairdressers and helping you care for your hair.
Tony Maleedy, tells us why hair loss happens in men

There are dozens of reasons why we lose hair. Some are common to both sexes like those caused by illness or, indeed, the drugs used to treat an illness. Others are exclusive to women such as hair loss following childbirth. Stress is a common cause of hair loss, as is dieting, or a poor diet, both of which can cause the hair to become thin. But the most common form of hair loss is experienced by men and sometimes older women, commonly referred to as ‘male pattern hair loss’.

How common is hair loss in men?
Hair loss in men is very common. In fact, every man in the UK will experience some hair thinning in his life. The only difference is the degree to which it affects them, and this can vary enormously. Some young men start to lose hair in their teens and may be bald before they are twenty-five, yet others have an almost full head of hair when in their seventies.

Male hair loss or Androgenic Alopecia to give it its proper name (andro: male, genic: genetic/hereditary, alopecia: hair loss) is caused by the effect of the male hormones, called androgens, on genetically predisposed hair follicles. Or, in other words, the tendency to develop this type of baldness runs in families and can be passed down by either parent to a child, male or female.

Within these genetically programmed hair follicles, testosterone, the main male hormone, is converted by an enzyme called 5-alpha reductase into a much more potent hormone, dihydrotestosterone (DHT). It is the effect of this hormone which inhibits the growth of new hair cells, resulting in a finer hair being produced.

In male hair loss successive hairs become progressively finer and their growing periods become shorter, resulting in only short fine hairs being produced. These fine hairs may, in time, stop growing completely.

The growing phase of the hair cycle (anagen) will be of a shorter duration than for unaffected hairs and may last for a period of only months rather than the average of 3-5 years. When these hairs fall out they are replaced by finer hairs with an even shorter growing period. This process can continue until the hair follicles degenerate and are unable to produce any further hair.


What are the first signs of hair thinning?
Usually a slight recession of the hair at the front of the scalp along the hairline is noticed at first. Later, thinning over the crown can develop, these areas may ‘join up’ causing the entire front and top of the scalp to be bald.

Most scalps, however, which appear totally bald actually contain hair follicles which are either still producing very fine hair, or are capable of producing it. These are fine vellus hairs, however, with a diameter below 40 microns which means, in effect, that they are no longer clearly visible to the naked eye. So from a distance, a man may appear bald, but in fact he may still have a large number of fine hairs growing on the ‘bald’ area of his scalp. These hairs are, therefore, no longer ‘cosmetically useful’ as they are too fine to add to the persons appearance.

Are there any effective treatments?
In most cases, yes, but not all. It really depends on how strong the genetic factors are. If a man has inherited a strong genetic predisposition to this type of hair loss where, for example, hair thinning starts in his teens and baldness is obvious in his twenties, then nothing will prevent the loss of most of his hair. If’ however, the genetic factors are much less strong there is the possibility of reducing, stopping or even reversing the hair loss.

Minoxidil
This treatment, sold in the UK as the product Regaine, has proven to be a quite effective at stopping hair loss and in many men. When applied to the thinning region of the scalp twice a day it can have an improvement on the quantity and quality of a man’s hair although its abilities to re-grow hair are limited. It tends to have a better effect in the early stages of hair loss and on younger men. Good results can be obtained in older men, but it may take somewhat longer to see new any hair growth. Regaine is available from chemists without prescription at a 2% or 5% strength. I would only recommend the 5% because it is far more effective.
Some people experience some flaking of the scalp, and possibly some inflammation and tenderness of the scalp tissues. If this happens they should use the 2% solution and the Juniper Mint Scalp Therapy Shampoo (see below) to ensure that the scalp quickly returns back to a healthy condition.
Cost of Minoxidil: £300 - £500 per year.

Finasteride
The treatment which can produce the best regrowth of hair (excluding hair transplants) is Finasteride, sold in the UK under its trade name, Propecia. Finasteride is a drug which blocks the conversion of testosterone into dihydrotestosterone, this means that there is much less DHT in the cells of the hair follicles to prevent hair growth. The action of Finasteride can be impressive, with the first effect being a reduction in hair loss of up to 90%, this usually happens within a month or two of starting the treatment. Within six months approximately 50% of men will have new hair growing, usually on the periphery of the thinning regions. Within twelve months the re-growth can be considerable over the entire region.

Propecia is only available on private prescription from a doctor. There can be some minor side effects from Finasteride, so consult your doctor about its use.
Many people find that the combined effect of taking Finasteride internally and using a treatment which is applied to the scalp has the best effect.
Cost of Finasteride: £300 - £400 per year.

Hair Transplants
Hair Transplanting is a surgical technique that involves moving individual hair follicles from the donor site at the back of the head to bald area of the scalp (the recipient site). The reason this technique can be very successful is because the hairs which are transplanted from the back of the head are not genetically programmed to respond to elevated levels of DHT and so will not be lost as the original hair were.

Hair transplantation has improved enormously over the last 15 years or so. Originally comparatively large grafts of skin were transplanted from one area to the other and frequently these ‘plugs’ of hair were unsightly. Indeed, in the past I have come across hair transplants so badly done eventually all the plugs had to be removed because they looked embarrassingly ridiculous.

In total contrast this, however, there have always been excellent hair transplant surgeons who’s work was always superb; and things have got even better with the last few years with a technique called micro-grafting. This is where, instead of the large plugs of skin, very small grafts containing 1 to 4 hairs are inserted into the thinning area of the scalp, with often spectacular results. In the right hands this technique results in totally natural looking hair which is virtually undetectable even to an expert eye.
Cost: £4,000 - £10,000+ depending on the number of graphs required.

Juniper Mint Scalp Therapy Shampoo
The Juniper Mint Scalp Therapy Shampoo has been clinically developed and can have dramatic effects on the scalp and hair. It is rich blend of natural, therapeutic oils including juniper, corn mint, thyme, tea tree and rosemary oils, these are combined with coconut derived cleaners to create a unique shampoo that not only ensures that the scalp is healthy and free from scale, but creates the optimum conditions for hair growth. It does this in three ways:

1. By generally improving the health of the scalp. This, in many cases, allows the hair to grow better. Your hair is a product of your scalp. It grows from the scalp and it depends upon it for its nourishment and well being - similar to a rich fertile soil needed for plants to grow and flourish - so when the scalp becomes unhealthy more often than not it shows in the hair, frequently in the form of hair loss, so improving the health of the scalp can greatly reduce the quantity of hair falling out.

2. Research by scientists at the Department of Dermatopathology, University of Liège in Belgium published a paper showing that when certain anti-microbial substances, traditionally used to treat dandruff, are incorporated into a shampoo at elevated levels they have a marked effect in the prevention of male pattern hair loss.
The study states “When one of these substances, Piroctone Olamine, is incorporated into an appropriate shampoo base and used 2-3 times per week there is reduction in hair loss by 16.5% and increase in hair growth of by 8%”.
The juniper mint scalp therapy shampoo contains 1% Piroctone Olamine and stimulates hair growth as reported in the University of Liège study.

3. As previously mentioned, the hair of many people responds well to the use of minoxidil. There is, however, one great drawback in the use of topically applied treatments such as this. Much of the solution applied to the scalp is absorbed by scale on the surface of the scalp, therefore preventing the solution from flowing down the hair follicle to the target site, the dermal papilla (the root of the hair) at the base of the hair follicle.

To overcome this obstacle and allow Minoxidil to be more effective the juniper mint scalp therapy shampoo clears the scalp surface of absorbent scale (this scale is not just dandruff flakes, but an ordinary, daily accumulation of dead skin cells) allowing a higher proportion of topically applied Minoxidil to reach the root of the hair and an stimulate hair growth.

The Juniper Mint Scalp Therapy Shampoo works extremely well when used in conjunction with any of the other treatments described here. In fact, the synergistic effect of combined treatments gives the absolute optimum results for hair loss prevention and hair re-growth.