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By Waldo Acebo, MD

Today, more people are experiencing hair loss; some 70 million of adults in the United States are suffering from it. There is an important difference between male and female balding, based on the pattern in which the hair loss occurs. Male and female hormone distribution occurs in different areas of the scalp, causing the different gender-related patterns of hair loss. Regardless of sex, hair loss is a severe blow to a person's self steam.

How do you figure out if you are losing too much hair?

Scalp hair grows about one-half inch per month. Throughout a normal growth cycle, 50 to a 100 hairs are shed daily, and this should not be a cause for alarm. The hair pull test is a simple diagnostic test in which you, or your physician, lightly pulls a small amount of hair (approx. 100 simultaneously) in order to determine if there is excessive loss. Normal range is zero to three hairs per pull.

What causes men to lose hair?

Male-pattern baldness, the most common type in men, usually starts at the temples and gradually recedes to form an "M" shape. Some males have only a bald spot at the crown. Males losing hair during the mid-teen years are likely to become completely bald on top of their heads.

Men go through a similar decline in hormones as women; andropause is to men what menopause is to women. Fluctuating levels of testosterone resulting from andropause, stress and poor diet can impact the body's ability to regenerate hair follicles. The relationship between testosterone and hair loss is due to dihydrotestosterone (DHT), a derivative of testosterone. DHT causes hair follicles to regress and die. Hereditary factors involving your genes can make certain hair follicles (usually in the front and crown of the head) especially sensitive to this hormone. DHT is also partly responsible for adolescent and adult acne in men and for prostate enlargement in older men.

What causes women to lose hair?

Female-pattern baldness is a diffused thinning across all areas of the scalp. It usually begins about age 30, becomes more noticeable by age 40, and can be quite evident following menopause. Although, the hair loss in women could be permanent, it rarely progresses to near or total baldness.

A variety of factors tied to the actions of hormones, including Polycystic Ovarian Syndrome (PCOS), contraceptive use, synthetic hormone therapy, excessive thyroid hormone replacement, childbirth, and menopause can lead to hair loss in women. This is due to a drop in estrogen levels, which is responsible of thicker and longer hair in women.

Hormone contraceptives are a leading cause of distressing hair loss and other symptoms in women. Since the birth-control pill first began being used in 1960, many young women are given contraceptive hormones even when they are not sexually active, as a treatment for irregular menses or acne. This is an error, since contraceptive drugs use synthetic hormones that suppress ovulation, and do not address the underlying cause. It rather severely shifts hormonal balance and lead to health problems, including significant hair loss, either during or several weeks or months after stopping the drug.

What are other common causes of hair loss you should know about?

Stress forces the body to produce excess amount of cortisol –the stress hormone-, as well as excess testosterone and adrenaline. High or low levels of cortisol can lead to hair loss. More testosterone means more DHT, which in turn can also lead to hair loss. Malnutrition, changes in your diet, severe infections, major surgery, or extreme or prolonged stress, can suddenly shift as much as 90 percent of hairs that are in the growing, or resting phase, to the shedding phase. This shift can be appreciated from six weeks to three months after the stressful event. Known as telogen effluvium, this type of hair loss is reversible, once the cause is found and corrected.

Other causes of hair loss worth mentioning are mineral or vitamin deficiency: zinc, manganese, iron, vitamin B6, and biotin; essential fatty acid deficiency from a low calorie diet or eating disorders, protein deficiency (vegan diets); anemia from a low iron diet, poor digestion or excess blood loss; eating disorders, like anorexia, bulimia, 'yo-yo' dieting; excessive physical exercise, drug toxicity such as anesthesia during surgery or chemotherapy for cancer; prescription medications including bromocriptine, beta blockers, ACE inhibitors, amphetamines, and anti-cholesterol agents; severe infections, either viral or bacterial; severe stress, hypothalamic or pituitary disorders; thyroid gland disease, steroid imbalance such as low progesterone, estrogen dominance, excess testosterone or insulin; perms, hair color, bleach, improper brushing/combing, pulling on the hair such as pony tails and brading; and autoimmune disease such as Lupus or Multiple Sclerosis.

What laboratory tests are helpful to understand your hair loss problem?

It is important to determine the cause of a major symptom like persistent excessive hair loss. Diagnostic testing that can help identify the source of your metabolic imbalance are: hormone levels (dehydroepiandrosterone, testosterone, androstenedione, cortisol, prolactin, sex hormone binding globulin, Follicular Stimulating Hormone, and Luteinizing Hormone), a complete blood count plus serum iron and ferritin, a thyroid function panel, fasting blood sugar and HbA1C, cholesterol and triglyceride levels, ANA to screen for auto-immune disease, VDRL to screen for syphilis. Further, a scalp biopsy could be helpful, and in some cases it is advisable.

What is the key for a successful treatment?

First, it is crucial to determine the cause of the individual's hair loss. It could be as simple as having a gene that makes you susceptible to female or male pattern baldness, or it could be a sign of something else being wrong (hormone imbalance, nutritional deficiencies, disease, medications, or some other condition). Once the cause is dealt with, hairs go back to their random pattern of growth and shedding, and balding stops.

Diet and exercise are keys to maintain optimal hormone balance. In fact, for women with PCOS, research is clear: there is no drug therapy more effective than proper diet and regular exercise. Natural bio-identical hormone replacement therapy paired with a customized nutrition, fitness and supplement program can bring the levels back to optimal balance and can be an effective men's hair loss treatment.

Rogaine® (minoxidil) is widely used as a topical solution applied once to twice daily. It may improve hair growth in 10 to 20%, and slow hair loss in 90% of users. Minoxidil may take 4 months or longer to produce results. Treatment is relatively expensive and must be continued indefinitely. When minoxidil is stopped, re-grown hair falls out.

Propecia® (finasteride) is FDA-approved for hair loss treatment. It is available, by prescription, in 1-mg tablets for men. Propecia® is not appropriate for women. Finasteride®, in daily doses as low as 0.2 mg, decreases scalp, skin, and serum Dihydrotestosterone levels.

Bio-identical Hormone replacement therapy (BHRT) is an effective form of treatment for androgenic alopecia and hormonal imbalance in patients that demonstrate this problem with the use of proper diagnostic testing. These therapies are natural, individualized to your signs and symptoms, highly effective to stop hair loss, and to restore your overall health and wellbeing.

A healthy diet, low in fat and high in fiber, fresh fruit, and vegetables, can have a major role in inhibiting hair loss associated with aging and genetics. In Asian countries, where vegetables are prevalent in standard dietary practices, pattern-type hair loss is rarely observed. Botanically-based nutrients may prevent hair follicles from entering a permanent dormant state. Nutritional supplements can provide some benefit.
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