Hair Loss

Like many of you, I am also a victim of hair loss…..

More and more Singaporean men are losing their ‘crowns of glory’ and this trend may be getting earlier and earlier.On the streets in these recent years, we may spot a relatively number of young men who are bald or balding. Compare this phenomenon to say ten years ago when this phenomenon is not commonly seen.

This balding trend among Singaporean men is sparking an increasing proliferation of hair treatment centres. Hair treatment centres have practically sprung up all over the island with the likes of Beijing 101, Yunnan, Svenson, Bossin, etc. Causes of hair loss can be hereditary, or caused by stress, drug medications, poor diets, oily scalp etc and these causes manifest into the many forms or types of hair loss such as male pattern baldness, telogen effluvium, alopecia areata, etc. A normal human loses about 50 to 100 hairs per day and this loss is not alarming.

However if more than this number is lost per day, one should seek a doctor before it is too late.Hair grows from follicles, and if one balds and takes no actions, the follicles will eventually die and there will be no more growth. It will be too late for any action. Note that when I say bald, normally a human will not go totally bald, the follicles at the sides of the human scalp, the parts above the years are programmed for life, and hair grows for life at these particular areas. Balding follows a pattern known as the Norwood chart. There are three stages of hair growth: anagen (the growing phase), catagen (the intermediate phase) and telogen (the shedding phase). Hair loss occurs when the hair grows and sheds fast.

The average life cycle of a hair is 2 to 3 years and each hair growth to fall can last 25 cycles, balding occurs when these cycles are accelerated and completed so fast that the cycles end, the follicles dies off and the hair can never grow back again. I understand in this post, there are many jargons and technical terms that are used. The internet offers a rich array of resources for which one can research in depth and understand more about hair loss. In this post, I will just roughly summarize what I understand and experience about hair loss from my studies and very own personal experiences.In the past, I have very thick volumes of hair so much so that I complained about having to go to the barber often as my hair grows so fast. Showering, there would be no hair lost as my hair is so strong. Following a medical treatment some two years ago from a supposedly reputable clinic and consuming the drug nimigen, I notice hair loss, my hair shed in the dozens on the bed and at the bathtub sinks daily so much so that I stopped taking this drug nimigen and stop the laser treatments.

During the consumption of nimigen, my complexion becomes too dry as it is supposed to prevent facial oiliness but it overdoes. Till today, I still do not know the real reason for my hair loss though I believe it has to do significantly with the laser treatment and the consumption of nimigen. On hindsight, I shall not have carried out with the treatment and the consumption of the medicine and this doctor still asked his nurses to force me back to continue with the remaining treatments and at the same time, refuting all my allegations squarely. I spent close to $3K only to lose even more. Anyway that is the past already and nothing can be done to turn back the clock. What I want to share with readers here are my experiences and what I have gone through to combat hair loss and hopefully it can provide some useful glimpses or lessons to those who are currently suffering from hair loss.Okay for the start, I first stopped all the causes that I believe have contributed to my hair loss and that is to discontinue with the medical treatments and the nimigen consumption. But even with that, two months down the road, the hair loss does not subside, so it was time to take some real actions.

From the internet, I came to learnt of two drugs called Propecia, an oral medication, costing about $95 dollars at that time for 28 pills, to be taken one pill a day; and a topical hair spray called minoxidil (called Regaine, Rogaine, Growell, etc in the market) also at a $95 for one bottle that can last a month.I went to a doctor and was prescribed Propecia, taking one pill a day for three months, after which I stopped.

Why do I stop? Firstly, there was no improvement and secondly, I began to experience what was mentioned as the side effects of this drug, i.e. I begin to feel less manly, though it was a minor side effect that the drug claimed and that it affect only a small percentage of users. With these two factors, I stopped using this drug and the less- than- manly feeling, which was temporary finally subsided. I did not use Minoxidil, as I also learnt of its side effects too. I want to list down the possible side effects of these two drugs here:Propecia: Lack of ‘manliness’Minoxidil: Increase scalp sensitivity, itchiness, dandruff, increase sensitivity to the sun. And the most important drawback of these two scientific proven drugs is that once you stop using these two drugs, whatever new hair that you have grow will fall again! Thus these two drugs are to be used for life! Imagine the cost involved to maintain these newly formed hair: $100 (for each of these treatments per month), this amount translates to $1200 and more per year, and so on……

So after ending the use of the Propecia, I began to explore natural ways of cure. One method that I thought of was using mild shampoo like Johnson Baby Shampoo, however its mild concentration was not strong enough to clear the oilness of my scalp. My hair loss may be due to oiliness and dandruff as I did notice these symptoms like dandruff on my pillow.

So I decided to explore the help of professionals and there was a vast array of choices from the dermatogists and hair treatment centres. I went to one such hair treatment centre for a free consultation and these ‘professionals’ scanned my hair, only to reveal many patches of oil and these ‘professionals’ introduced me a package to clear my scalp greasiness. The package cost a bomb and I did not like the pushiness of these professional in introducing these packages to me. Also I have heard many stories of people having spent more than $10,000 on these supposedly good cures only to lose even more hair or having no improvement seen, besides wasting their hard-earned money! Thus, hair treatment centres scared me off at that point and I decided to consult a top hair dermatologist in Singapore instead. It was not cheap. First consultation alone cost $80. The dermatologist inspected my hair and said there was nothing wrong. She prescribed me with two shampoo, Nizoral ($25) and a Gentle Shampoo ($21) to be rotated interchangeably daily and a sebum regulator to be applied on the scalp at night after washing ($18).
However, there was still no improvement.

In fact, the residue from the sebum regulator produced tiny sticky white residue on my hair once my hair dried to the extent that my colleagues thought my hair had dandruff. Anyway my hair was still very oily and coated with some dandruff too, despite applying the supposedly strong and beneficial shampoos that the top dermatologist prescribed. I confirmed this fact when I popped into one of the hair treatment centre at a shopping centre for curiosity and did a free consultation with the centre. The ‘scanner’ that the centre operators used magnified my scalp glands many times over, revealing the oily spots, it really look disgusting with such a hundred times over magnification of the sebaceous scalp glands. The operators said my scalp glands were choked with oil, and this may cause hair loss; but I did not want to take any chance with this centre and off I left. I went for a second consultation with the dermatologist I saw previously. Again, the dermatologist said there was nothing wrong with my hair or with my scalp and the results from the ‘hair-pull’ test she carried out on me revealed no extraordinary hair loss.

After hearing the story of the medical treatment I did and the drug nimigen I consumed, she suspected that it may be telogen effluvium caused by the medication, a condition which could only go away in times to come; though my oily scalp may be a contributing factor too. She told me that she could not do anything except to help me diagnose the cause of my hair loss via a scalp biopsy ($589) and a blood test ($169); all price stated without GST. Hearing the prices, I hesitated but in an urge to find out the real cause, I decided to take the plunge and carried out the scalp biopsy and the blood test.I did the blood test first and the pain was nothing compared to the scalp biopsy I undergone later on. It was no joke, having a piece of your head scalp being removed surgically and the pain was terrible despite the application of anaesthetics prior to the treatment. After both the tests, the nurse rubbed a Bactroban cream on the part of my scalp which was operated on to kill the bacteria; after sewing this part of the scalp. There was still little pain that subsisted every time I shampoo the sewn part of the scalp. I was told to come back two weeks later to remove the stitch and to obtain the results of the diagnosis. I was given the remaining of the Bactroban cream to apply daily on the affected scalp to ease the pain and kill the bacteria. Two weeks later, I returned to the same clinic to remove the stitch and the dermatologist handed me the result; and the result indicated that it was telogen effluvium.

The dermatologist said it was good news as this condition which may be due to the medication I took would finally subside after some time. I would be waiting for this to come soon.But alas, days pass and then months, it was futile. Seeing tons and tons of hair on the bathroom sink and waking up everyday to witness the hundreds of hair strewn across my bed and on my bedroom floor did nothing to assuage me that my illness would go away. The visits to the dermatologist have also drained me financially and in a desperate move, I decided to try out some off-the-counter hair loss products available at pharmacies. I tried the Himalyan Hair Loss Cream (Herbal) for about one month but it was useless so I went to see the dermatologist again for the fourth and fifth time (that was in April and May last year), but again the dermatologist assessed and said there was nothing wrong with my hair, no male pattern loss or whatever. But indeed, my hair was getting thinner and thinner by the day.

She prescribed me with stronger shampoos and sebum regulator which I used without seeing any improvements. It was at this time that I finally decided not to see the dermatologist again as there was simply no use at all! Hair continued to fall and fall. From then on (Jun 07), I have ‘more or less accepted my fate’ and accepted my hair loss fact. I tried Kaminomoto Hair Growth Accelerator and a good shampoo called Melaleucca Shampoo recommended by my friend but it was really no use at all. The telogen effluvium which I was diagnosed with did not seem to be the hair illness that struck me as it simply did not stop within a short period. It was over one year and my hair still continued to fall like rain. Over the whole of this hair loss ordeal, I carried out numerous researches on hair loss over the internet, which further equipped me with all knowledge concerning hair loss. I tried all I could, from observing what I consumed (less oil), watching my diet, exercising regularly and even cutting down on some coffee and tea. But it did not help in the loss.

I have also shared my findings with others on an internet discussion forum posting and the thread saw some 55,000 odd readers before it was finally removed by the administrator. With my knowledge learnt from the internet and my ordeal, I shared with some of these forumers; some of them even emailed me to ask questions. For hair loss, there is really no one fixed miracle panacea: what works for one may not work for others. The hair loss did affect my life a bit: waking up in the morning and after shampooing, I counted the number of strands of hair that I lost and any fewer in count would make me slightly happier. I used to enjoy the wind but now I avoid being ‘confronted’ with a gust of wind for fear that the wind would blow off some of my hair. It does not help that Singapore can get breezy at times! And definitely, my self-esteem would suffer a bit of loss and it did not help that I am still without a girlfriend at my age! Hair loss would certainly dealt me a serious disadvantage in this ‘image-conscious’ society; though it may not be always true: I still do my fair share of admirers as some girls are not particular over looks.Entering the MRT daily, I always observed young man at different stages of balding; sometimes I saw friends who I have not seen for some years completely bald!

Normal Hair Growth and Common Hair Loss

Normal Hair Growth Cycles

Undisturbed, each terminal scalp hair usually grows continuously for about approximately three to five years. Then, the hair transitions into a resting state where the visible portion above the skin is shed. No hair grows from the follicle for 90 days. Once this time has passed, a new hair begins growing through the skin and continues for another three to five years at a rate of approximately 1/2 inch per month.

It is thought that as many as 100 genes are involved in regulating the creation, construction and cycling of scalp hair. To date, very few of these genes have been identified.

Common Pattern Hair Loss

Hamilton-Norwood Hair Loss Scale

For those concerned about hair loss, many myths and half-truths abound, but useful information can be difficult to obtain. Therefore, an objective overview of pattern hair loss is presented herein.

In healthy well-nourished individuals of both genders, the most common form of hair loss is androgenetic alopecia (AGA), also known as pattern hair loss. The disorder affects approximately 40 million American men. Perhaps surprisingly, the same disorder affects about 20 million American women. The difference between men and women is that a woman suffering hair loss usually retains her feminine hairline and experiences thinning behind this leading edge. In men, a distinct “pattern” of loss manifests where the frontal edge recedes at the same time that a thinning zone expands from the posterior crown. In more pronounced cases, these zones meet and the person is said to be clinically bald.

Three Triggers

Importantly, three things need to occur in order for one to be affected by AGA. First, one must inherit the genetic predisposition. This means that the problem comes from one or both sides of the family. Second, one needs to attain a certain age. Nine year old children do not experience pattern hair loss. And third, one needs to have the circulating hormones that precipitate onset and progression of the disorder.

Typically, the earliest onset of AGA occurs in late puberty or one’s early 20′s. As a general rule, the earlier hair loss begins, the more pronounced it is likely to become.

Hormones, Enzymes & Other Factors

Crystallography of DHT molecule
From a susceptibility standpoint, the principle hormonal trigger linked to pattern hair loss is 5-alpha dihydrotestosterone, commonly referred to as DHT. Intriguingly, it has been shown that in persons genetically insensitive to DHT, pattern hair loss does not occur. DHT is synthesized from the androgen hormone testosterone and is useful early in life and during puberty.

In adults, DHT is thought to cause significant harm, but very little good. Disorders as disparate as benign prostatic hyperplasia and pattern hair loss are both triggered by DHT. The synthesis of DHT occurs via two closely related forms of the enzyme 5-alpha reductase. Hair loss treatment options that efficiently interfere with the interaction between 5-alpha reductase and androgen hormones like testosterone have been shown to offer clinical benefit in treating pattern hair loss.

Because hair growth is regulated by multiple genes and attendant biochemical pathways, the underlying factors are extremely complex. Another challenge to understanding hair loss has been the fact that humans, alone among mammals, suffer from androgenetic alopecia. Thus, no efficient animal model exists that would otherwise tend to shed light upon the key factors at work.

Hair Loss Variations Other Than AGA

In either gender, the differential diagnosis is typically made based on the patient’s history and clinical presentation. The common differentials for AGA include alopecia areata (AA), Trichotillomania, and telogen effluvium. Less often, the cause of hair loss may be associated with disorders such as lupus erythematosis, scabies or other skin manifesting disease processes. Scalp biopsy and lab assay may be useful in ascertaining a definitive diagnosis, but, in such cases, should generally only follow an initial clinical evaluation by a qualified treating physician.

Pattern Hair Loss Treatment Options

It has wryly been observed that the choices for dealing with hair loss are “rugs, plugs, or drugs”. This quip articulates three treatment options that are more kindly referred to as non-surgical hair systems, surgical hair restoration, and pharmacotherapy. A fourth option has recently evolved, which will also be touched on herein. This is non-drug based therapy.

Non-surgical Restoration

Typical Hair Piece

Hair replacement systems have been in regular use at least since the time of ancient Egypt. These products also go by the term hair integration systems, wigs, weaves, hair pieces, toupees and many other names. All have one thing in common—they are not growing out of one’s scalp. Thus, they must somehow be attached either with the bald skin or the fringe of hair remaining above the ears and in the back of the scalp.

Such attachment to the living scalp is almost never permanent, and for good reason. Aside from the fact that the unit itself wears out, basic hygiene dictates that the wearer regularly remove the unit to clean the underlying hair and scalp. There are almost always three basic elements to a hair replacement system. The first is the hair itself which may be synthetic, natural, or a combination thereof. The second element is the base of the unit. Typically, the hair is woven in to a fabric-like base which is then attached in some fashion to the scalp. This brings up the third element; which is the means of attachment. Methods include sewing the base to the fringe hair, gluing the base to the fringe hair, or gluing the base to the bald scalp.

Potential advantages to hair systems include the immediacy of achieving a full hair “look” that can appear, to the casual observer, to approximate a full head of hair. The potential disadvantages of hair systems are many and varied.

In persons who are actively losing hair, vs. those who are essentially bald, the hair system itself may rapidly accelerate the process of going bald. Another disadvantage is the hard leading edge that can give away the fact that a person is wearing a hair system. In the past, this problem has been addressed by using delicate lace front artificial hairlines that look quite natural but tend to be extremely fragile.

Because they are nonliving, hair systems must be serviced and eventually replaced themselves. The costs of servicing and maintaining a hair replacement system are not insubstantial–and such costs can dramatically exceed the initial price of acquisition.

Surgical Hair Restoration

Surgical hair restoration, commonly known as hair transplantation, exploits a phenomenon first described in the 1950′s. This phenomenon, donor dependence refers to the observation that hair bearing tissue, when relocated to a previously balding area of the same person’s scalp, continues to produce viable, vigorously hair that persists in its new location as it otherwise would, had it not been “relocated”. In appropriately selected patients, surgical hair restoration can constitute a positive solution to pattern hair loss

There are important caveats to hair transplantation. The first concerns supply and demand. At the present time, one may not transplant hair from one person to another without causing a florid and destructive foreign body response in the recipient. Thus, both operator and patient are relegated to whatever permanent hair bearing tissue is in place. Accordingly, it is highly important to conserve and strategically place this precious resource appropriately.

The second major caveat to hair transplantation concerns achieving clinically beneficial endpoint results. A hair line that is spotty or too abrupt may look worse than it did before it was restored. By the same token, hair behind the leading edge that is not restored in a fashion that yields meaningful density (e.g. 1 hair per mm/sq) often fails to approximate a full head of hair. Therefore, in selecting a transplant surgeon, artistic excellence is at least equal in importance to basic surgical skill.

The third caveat to hair transplantation refers to a problem known as chasing a receding hair line. Because hair loss is progressive and relentless, it is possible that donor hair restored integrated into an apparently intact area of scalp hair may end up as an island of hair because the hair behind it continues to erode. In this situation, patients are compelled to augment hair behind the restoration zone in order to retain a full appearance. This works reasonably well until either the hair stops thinning or one eventually runs out of donor hair.

Ideally, for persons undergoing transplant surgery, it would be helpful to incorporate a treatment option that safely and effectively arrested the progression of hair loss, allowing the treating surgeon to fill in the thin areas without the concern of chasing a receding hair line.

Drug-based Hair Loss Treatment Options

From a treatment perspective, the two most widely used therapeutic interventions against pattern hair loss have been topical minoxidil and oral finasteride.

Minoxidil

Minoxidil, first sold under the trade-name Rogaine(TM) was initially developed as the oral antihypertensive drug, Loniten(TM). In some patients who used minoxidil to treat blood pressure problems, it was observed that unusual hair growth occurred on the face and scalp. This was somewhat colloquially referred to as the werewolf affect. >From this observation, topical compositions containing minoxidil were successfully tested on balding scalps. Rogaine(TM) (2% minoxidil) was the first hair loss treatment drug approved by the FDA for use in men. Eventually, Rogaine(TM) (2% minoxidil) was approved for use in women. Extra Strength Rogaine(TM) (5% minoxidil) was approved by the FDA for use solely in men.

The advantages of Rogaine(TM) include the ability to arrest, and possibly reverse, pattern hair loss. Based on Pfizer’s own marketing materials, Rogaine(TM) has primarily been shown to be effective in treating hair loss in the vertex and posterior scalp, but not the anterior hairline. Minoxidil is a potent drug with potential side effects that include hypotension and skin irritation.

Finasteride

Finasteride, a selective type II 5-alpha reductase inhibitor was originally developed, in 5 mg oral dosage, under the trade name Proscar(TM) to treat benign prostatic hyperplasia (BPH). Because BPH is linked biochemically to the same metabolic pathways that trigger pattern hair loss, it was hypothesized that finasteride could be clinically useful in both pathologies. From this work, Propecia(TM) (1 mg finasteride) was developed. In placebo-controlled studies on men with mild to moderate hair loss, Propecia(TM) was shown to produce clinically relevant benefit in arresting, and in some cases, reversing the progression of the disorder. Propecia(TM) is not indicated for use in women. Noted side effects include reduced libido, as well as reduced ejaculate volume. Gynecomastia (male breast enlargement) is another potential side effect. Finasteride can also artificially lower the levels of a key protein (PSA) used to screen for prostate cancer. Finasteride is considered a teratogen (may cause feminizing birth defects) and should not be handled by pregnant women or even those persons who may come into contact with pregnant women.

Dutasteride

Like finasteride, dutasteride was originally developed to treat BPH. Unlike finasteride however, dutasteride inhibits both isoforms of 5-alpha reductase, while finasteride inhibits only type II 5-alpha reductase. Interestingly, a clinical study undertaken by GlaxoSmithKline, the EPICS trial, did not find dutasteride to be more effective than finasteride in treating BPH.

At the present time, dutasteride is approved to treat BPH. Clinical trials for dutasteride as a hair loss drug were undertaken, but halted in late 2002. Potential side effects noted with the use of dutasteride include gynecomastia, changes to PSA levels, teratogenic effects and others that closely parallel the negative side effect profile described by the makers of finasteride.

In December 2006, GlaxoSmithKline embarked on a new Phase III, six month study in Korea to test the safety, tolerability and effectiveness of a once-daily dose of dutasteride (0.5mg) for the treatment of AGA in the vertex region of the scalp (types IIIv, IV and V on the Hamilton-Norwood scale). The future impact that this study will have on the FDA’s approval or disapproval of Avodart for the treatment of male pattern baldness in the United States is yet to be determined.

Other Drugs

On occasion, but specifically in female patients drugs including spironalactone & flutamide have, on occasion been used off-label to treat various forms of hair loss. Each drug comes with a host of potential side effects, and none has been approved by the FDA for the treatment of pattern hair loss.

Non-drug based Hair Loss Treatment Options

Recently, botanically derived substances have come under serious investigation as potentially useful tools against AGA. This effort has been largely pioneered by the makers of HairGenesis(TM). After the creation of HairGenesis(TM) a number of other products came on the market. Some incorporated drugs like minoxidil. Others, used variations on the theme of non-drug based formulations. However, aside from HairGenesis(TM), none has been supported with a third party, IRB monitored, placebo-controlled, double blind study–published in the peer-reviewed medical literature. This makes HairGenesis(TM) unique in the category. For those wishing to see how HairGenesis(TM) is thought to compare to other hair loss treatment options, a review of the HairGenesis(TM) Comparison Page is encouraged.

Inasmuch as the bulk of this website focuses on the benefits associated with HairGenesis(TM), the numerous points in favor of HairGenesis(TM) treatment will not be reiterated herein. Two points are relevant to the present discussion, however, and will be concisely articulated.

First, the complex of naturally derived active substances used in HairGenesis(TM) have been shown to operate through pathways and mechanisms that are unique from one another, as well as separate and apart from those within which drug-based treatments work. Suffice to say that this observation has presented a unique opportunity to develop HairGenesis into a “cocktail” treatment wherein formulation synergy would most likely occur.

In plain English, this means that HairGenesis(TM) has been designed to be greater than the sum of its parts.

The second key point is that research is actively underway by the makers of HairGenesis(TM) to develop new, more advanced and more potent, versions. Such improvements will be reported as appropriate.