If you're a man who is seeing more of your scalp
than you'd like, you're not alone. According to the American Academy
of Dermatology, two out of three men in this country develop some form
of balding. While some cutting-edge treatments in the world of hair
renewal are still things of the somewhat distant future, treatments
such as medications and hair transplantation surgery are available
now. You probably won't become Andre Agassi's hair twin, but you can
start filling in your gaps.
Follicles of the Future
Most men who lose their hair have a hereditary condition called
androgenic alopecia, says Neil Sadick, M.D., Clinical Associate
Professor in the Department of Dermatology at Cornell University
Medical College. These men have increased levels of a hormone known as
5(alpha)-reductase, which changes testosterone to dihydrotestosterone
(DHT). The DHT in turn causes follicles to sprout shorter and finer
hairs before eventually dying out. It also causes the growth phases of
hair follicles to become shorter, and the rest phases to be longer.
But researchers are discovering that this rest phase can be
shortened. The October 1999 Journal of Clinical Investigation
reported that scientists at the Weil Medical College of Cornell
University succeeded in nudging hair follicles out of their rest
phases -- at least in mice. They used an altered form of cold virus to
deliver what they have named the "Sonic hedgehog" gene
(after a video-game character), which plays a central role in hair
follicle development. This therapy spurred the mice to sprout new
hairs, presumably by causing those in the rest phase to enter the
growth phase. Researchers say further study is needed before it is
known if this therapy could potentially help those with male pattern
baldness.
Lend Me Your Hair
Another potential treatment for balding was described in the
November 1999 issue of Nature. Researchers found it was
possible to grow hair follicles and hair from donated follicle cells.
Hair follicles are one of the few immunoprivileged parts of the
body -- that is, they are protected from the immune system so the body
doesn't treat them as foreign and attack them. Researchers thus
wondered if they might be transplanted from one person to another
without triggering an immune response and therefore rejection. Hair
follicle cells, donated from the arm of a male scientist, were
implanted into the arm of a female scientist. A few weeks later, she
grew large, thick, dark hairs -- unlike her own -- in the area of the
transplant.
In what is currently a standard hair transplant, follicles are
transplanted from one part of the patient's scalp where hair is
present, to another where hair is sparse. In other words, more hair is
not being created, but just spread around. The amount of coverage that
can be obtained depends on how many active hair follicles still
remain.
If the cell-transplant approach were to develop into a viable
technique, it would actually create new hair follicles and have
distinct advantages over current methods. "There's no limitation
to the number of new hair follicles," says Peter B. Cserhalmi-Friedman,
M.D., one of the study's authors and an associate research scientist
in the department of dermatology at the College of Physicians and
Surgeons at New York City's Columbia University. "Because you
don't have to remove a follicle from someplace else, it can probably
be used not only on people with good hair on one part of their scalp
but also on people without any hair."
But don't start looking for an ideal donor yet. Any new techniques
in this area would probably not be available for at least another
decade, says Sadick.
Hair Today
Fortunately for those who still have hair on their heads, there's
something you can do in the here and now. But time is of the essence,
says Sadick, since the two FDA-approved drugs for hair growth work
better when the hair follicles are not yet dead, when they still have
some activity and can be saved.
Finasteride, sold under the brand name Propecia, is taken as a
daily pill. A September 1999 New England Journal of Medicine
article that reviewed the literature on hair loss found that after two
years of treatment, two-thirds of the men taking this medication had
improved scalp coverage, with higher hair counts and longer, thicker
hair. A very small number of men experienced a decreased libido with
the drug, but these side effects usually disappeared during prolonged
treatment.
For those who don't want to take a pill, minoxidil (sold under the
brand name Rogaine) is a treatment that must be applied twice daily to
the scalp indefinitely. However, it works for fewer men than
finasteride does, says Sadick. The main side effect is skin
irritation.
Since few insurance plans cover either drug -- or the surgery, for
that matter -- and you need to take them without interruption to get
the benefits and maintain them, hair-transplant surgery is probably
more cost-effective, says Sadick.
