The bald truth is not so bad

Richard Gray

April 26, 2011

Medical science is now offering men ways of keeping their hair for longer – and perhaps even avoid going bald at all.

It is a moment men dread: the barber asks if they want a haircut to help disguise their bald spot. For many men the fact they are thinning on top at all will come as a shock.

They may have been aware of a gently growing expanse of forehead as their hairline recedes, but it is rather difficult to see on top of one’s head. And even if they had an honest spouse to forewarn them, few choose to believe it until confronted by their naked crown in a barber’s mirror.

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It was like that for me. It was not until the age of 26, when I was asked by my barber if I used many styling products, that I realised how visible my scalp was from above. The rate at which my hair vanished after that was alarming, and I now consider myself firmly among the follicularly challenged members of society.

I should have guessed it was going to happen – my grandfather was bald by his mid-twenties, and baldness has a strong hereditary element. Yet medical science is now offering men ways of keeping their hair for longer – and perhaps even avoid going bald at all.

The actor James Nesbitt, 46, recently showed off how effective the procedure can be after two transplants. “I would go as far as to say it has changed my life,” said Nesbitt who, after the surgery, has landed several high-profile roles, including a part in a film of Tolkien’s The Hobbit.

“Several years ago, I began losing my hair and, like a lot of men, it was a major concern to me. In fact, it was practically an obsession. But also I’m an actor and in the public eye a lot and I really felt that my hair loss could affect my career prospects.”

Others admitting to transplants include former England cricketer Graham Gooch and former England rugby scrum half Kyran Bracken. Mel Gibson and Nicolas Cage have also been the subject of speculation, but have never commented.

The results are a far cry from the early attempts by Elton John to replace his hair with transplants, and the Italian Prime Minister, Silvio Berlusconi.

“Hair transplants are very good now,” said Barry Stevens, general secretary of The Trichological Society, the professional body of hair scientists. “When it started we were taking tufts of hair and it produced an effect a bit like a brush or a doll’s head. We can now do transplants where single or double hairs are individually transplanted. There isn’t anything out there that is as good.”

The most common form of baldness is androgenic alopecia, or male-pattern baldness, which is thought to have a strong genetic component. This type of hair loss typically begins above the temples and causes hair to thin on the crown. The human head has on average 1,000 hairs per square inch. People lose around 100 hairs per day due to normal hair cycling, but with alopecia this can be far higher.

Research has shown that a hormone, dihydrotestosterone, is involved in androgenic alopecia, but the exact mechanism is unclear. It is thought that a genetic sensitivity to this hormone causes follicles to shrink, reducing their ability to produce hair normally. Still, the picture is complex as the hormone is also responsible for hair growth in other parts of the body.

A quarter of men begin balding in their twenties and two thirds have started going bald by 60. So with the majority of men suffering baldness before retirement age, why is it such a big issue?

“Hair symbolises youth and health,” explains Lucy Beresford, a psychotherapist who specialises in cosmetic appearance. “If you have a good, healthy head of hair it is a shorthand way of your body saying that you have good genes. So going bald can really impact on people’s sense of self, as it makes them realise they are not the young person they think they are. It reminds them of their own mortality.”

Some men choose to embrace baldness, shaving thinning hair so they appear balder. It can bring good results – the actor Patrick Stewart, who has been bald since he was 19, is frequently named the sexiest man on television. Yet some men will go to any length to disguise their naked scalps with wigs, or comb-overs.

But now with new technology and surgical techniques, balding men have the option of hair transplants. This involves cutting out tiny patches of skin that contain the hair follicles from which the hair shaft grows. These grafts are taken from the back of the head where there is still hair under general anaesthetic, with up to 50 grafts, each containing between one and four hairs, being placed in a square centimetre of bald scalp. In one operation surgeons might make more than 4,000 grafts, which is why a procedure can cost up to pounds 14,000.

Immediately after an operation, patients are urged not to touch the transplant in case they damage the grafts – even pulling a T-shirt over the head is discouraged – and must sleep in an upright position for three nights. Patients often also take hair growth drugs, but if the surgery is successful, the transplanted hair should last for the rest of the patient’s life – although they will continue to lose their other hair as they age.

Transplants, however, do not work for everyone. If there is insufficient hair left at the back of the head, then it is impossible to transplant enough to restore the bald areas. In New York, scientists have been attempting to use beard hair as a source, while other approaches have attempted to use regenerative therapy techniques to “clone” the patient’s hair cells.

One such approach was taken to a phase two clinical trial by Dr Bessam Farjo, from the Farjo Medical Centre in London. By extracting dermal papilla cells from patients’ heads, Dr Farjo was then able to multiply the cells before injecting them back into scalps. This was thought to stimulate the formation of new follicles and rejuvenate those that had stopped producing hair. Two thirds of patients saw hair growth after the treatment. A similar technique is being developed in Italy, with attempts to grow cultures of follicle cells that can then be injected into the scalp.

There are only two drugs licensed to treat genetic hair loss – minoxidil and finasteride. Finastaeride blocks the conversion of testosterone to dihydrotestosterone. Minoxidil was developed to treat high blood pressure but was found to cause increased hair growth. It is not fully understood how it works, but is thought to increase the flow of potassium molecules in follicles.

Until recently these drugs were only available on prescription, but there have also been a recent spate of over-the-counter products. One foam-based one, Regaine, which contains minoxidil, is sold in supermarkets.

Meanwhile, L’Oreal’s luxury Redken brand has launched a spray-on treatment, Intra Force, containing aminexil, which is thought to prevent the build-up of collagen around follicles. “During the hair cycle the follicle has to be rebuilt from stem cells,” explains Dr Bruno Bernard, director of research for life sciences at L’Oreal. “Stem cells in human hair follicles are localised in two different reservoirs – one is in the upper part of the follicle and the other in the lower part.

“The cells in the lower part are required to activate the cells in the upper part and so help to maintain the follicle function. The thickening of collagen in the connective tissue sheath, which sits around the base of the hair follicle, prevents the movement of stem cells from the lower reservoir to the upper reservoir. Bit by bit, the follicle is squeezed and causes the follicles to grow smaller and smaller.” Indeed, research from The Rockefeller University in New York suggests movement between the two groups of stem cells is crucial in normal hair growth.

Another recent study, at the University of Pennsylvania, has shown that bald areas of scalp contain the same number of stem cells as hairy areas. It disproved theories that hair loss in androgenic alopecia was due to a loss of follicle stem cells suggesting that they have just become inactive.

This has raised hopes that it may be possible to regenerate follicles by reactivating these stem cells. “There may be a lack of an activator or the presence of an inhibitor,” says Dr George Cotsarelis, chairman of the department of dermatology at the University of Pennsylvania. “We are looking to tackle this mostly by activating genetic pathways we think are important either through transgenic approaches or pharmacologically. It’s reasonable to believe that a therapy based on manipulating stem cells will eventually be available.”

Inspired by these advances, I decided to reverse my own follicle decline by trying Redken’s 30-day treatment. One week in, I have yet to see less skin shining through my closely cropped hair. However, I do like the way it makes my scalp tingle.

The Sunday Telegraph

Sourced & published by Henry Sapiecha

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