The average human head has about 120,000 hairs, at least 100 of which fall out every day as new growth pushes through. Extreme stress may temporarily increase hair loss, and illness, surgery, chemotherapy, diabetes, and large doses of vitamin A can all result in significant thinning. But, as most men can attest, the most common type of serious hair loss is androgenetic alopecia, or male pattern hair loss, which affects about 70% of men by the time they reach 50.

Balding in men tends to occur in a horseshoe shape on top of the skull. This is because the hair follicles in this area are genetically programmed to respond to dihydrotestosterone (DHT) a hormone derived from testosterone that shortens the growth phase of hair, resulting in thinning and balding. Strangely, hair follicles at the base of the skull do not have receptors for DHT, which is why the hair at the back of the head is not affected.

‘Hair loss is a condition that is usually inherited and gets worse with age,’ says Dr Kevin Alexander, medical director of The Hair Loss Clinic in Johannesburg. ‘For centuries, people have grudgingly accepted this, believing that there was nothing that could be done, but this is no longer so. The latest medical treatments have made it possible to halt and even reverse the problem in young and old alike.’

This is good news to people whose self-esteem shrinks along with their receding hairlines. Since Hipprocrates stirred up a remedy based on bird droppings and opium in 400 BC, there’s been a steady stream of ‘miracle’ potions and lotions that claim to restore hair. Massage and headstands have had their day, and some who’ve been desperate enough to stick their baldpates through farm fences swear by the stimulating effects of a cow’s tongue!

Fortunately, it’s no longer necessary to go gallivanting over the countryside in search of obliging farm animals. Science has now come up with a much more palatable solution: a drug that inhibits the conversion of testosterone into DHT, effectively pressing a ‘pause button’ on hair loss. As is the case with treatment for other genetically inherited conditions, the drug, Propecia, must be taken continuously.
 
‘Propecia will halt the balding process in 83% of men while in 66% the hair will actually grow back thicker and stronger,’ explains Dr Alexander. ‘Known side effects of this gender-specific drug are minimal, other than temporary reduced libido in 1.8 percent of men.’

‘It’s the best thing that ever happened to me,’ says JB, a Johannesburg stockbroker who has been on medication for three years. ‘I was terribly dejected, but as my hair has grown back, I’ve had a change of personality.’

To allow sufficient time for a medical reversal of the hair loss condition, medical treatment should be continued for at least a year before even considering the option of a hair transplant – a procedure that involves removing a strip of scalp from the back of the head where the hair is plentiful. The site is stitched up, and the individual follicles, which usually contain more than one hair, are carefully inserted, one to two millimetres apart, into the bald area. 
To transplant 1000 hairs costs between R10,000 and R15,000. It’s impossible to recreate the density of hair that grows naturally, so transplant surgery should ideally be used to patch a receding hairline or plug small areas of thinning hair. Often, medical treatment combined with surgery gives the best results.

Androgenetic alopecia does not only affect men. Equal numbers of men and women inherit the trait from either side of the family, going back as far as six generations. But because men have 400 times more testosterone, it is more severe in their case. However, 40% of women suffer androgenetic hair loss, which tends to occur all over the head, especially after menopause when there is less oestrogen available to counteract testosterone. Because widespread thinning means that there is no satisfactory site from which to take hair for transplant, medication tends to be the only option for women.

‘There is a gender-specific drug for women and a prescription topical lotion that is highly effective,’ says Dr Alexander. ‘In women, we are able to achieve a 90% success rate through medication alone.’
 
While a balanced diet and lifestyle are essential to overall health, few cases of hair loss are caused by diet alone. ‘Iron is important for hair growth, but only extreme deficiency would result in visible hair loss,’ he says. ‘Treating the condition with hair vitamin supplementation or other natural remedies is unlikely to be successful; however, we are seeing results with these new prescription tablets and lotions that a few years ago were thought impossible to achieve.’

Johannesburg couple Marlene and John Thompson have both been on Dr Alexander’s medication program for a year. Although 20 years older than his wife, John’s results are equally as good, and the bonus for him is that his hair is growing back stronger and darker.
‘We are both very happy,’ says Marlene. ‘I noticed a change in two months, and there’s been a thousand percent improvement since then. I now have a full head of shiny, healthy hair, which has done wonders for my self-confidence.  But, like dieting, you have to be diligent and stick to the treatment or you won’t see results. The important thing is that you don’t have to accept hair loss. Something can be done.’
 
Dr Kevin Alexander can be contacted at: (011) 450 4400
For more information about hair loss, see www.hairloss.co.za