The Bald Truth About Hair Loss
More potent drugs are under development, including a treatment that blocks two of the enzymes that convert testosterone into DHT. (Propecia inhibits a single enzyme.) In one trial, this experimental formulation reportedly suppressed DHT by 82 percent, compared with a 38 percent rate achieved by Propecia.
For those who don't want to wait for improved drugs, hair transplantation is an option. Experts agree that techniques have improved from the days when unsightly plugs of hair blossomed like oases on otherwise barren patches of scalp. But they differ on whether transplants -- which move hair follicles from one part of the scalp to another -- produce a look that's natural enough to be worth the expense, which can run into the tens of thousands of dollars.
None of the treatments mentioned so far will work for alopecia areata, a type of hair loss that stems from an autoimmune disease. With this condition, hair likely will reappear spontaneously in six months to two years. Scarring alopecia may look like hereditary baldness, but early treatment with medications can cure this condition.
Women, especially after menopause, are not immune to hair loss. By age 70, roughly 50 percent of women experience some hereditary hair thinning, compared with 80 percent of men. Dermatologist Laurence Miller of Chevy Chase says the toughest part of his practice is not being able to help women in their forties "who are losing their hair and we can't find out why."
Alternatives Are Minimal
There's nothing outside Western medicine that unquestionably works for the major forms of hair loss -- and certainly there's a dearth of U.S. studies to back up the efficacy of alternatives. Acupuncture is perhaps the most promising technique, based on medical literature and practice from China and on acupuncturists' reports. But even they concede that the ancient healing art likely wouldn't work for hereditary baldness -- if they were to offer it for this purpose.
Michael Arnold, a physician and acupuncturist in Pacific Grove, Calif., says hair loss usually is incidental to a reduction in the body's core vitality, described in Chinese medicine as a "kidney deficiency." If a patient says he is tired and losing hair faster than his father did, Arnold says he would treat the hair loss with acupuncture, herbs and lifestyle counseling. But in general he wouldn't treat hereditary balding, which he says is "just a trait, part of the genes."
Yet Xiaoming Tian, a licensed acupuncturist in Bethesda who is a clinical consultant to the National Institutes of Health and a member of the White House Commission on Complementary and Alternative Medicine Policy, says acupuncture can "do a very good job" for hair loss that is related to stress.
Tian says he often uses a small hammer-like device called a "plum blossom," whose seven tiny needles lightly stimulate bald areas on the scalp to improve blood flow. He also uses needles and acupressure on acupuncture points along the body's meridians, or energy channels, and he draws from an arsenal of Chinese herbs, including black sesame.
Bryan L. Frank, president of the American Academy of Medical Acupuncture, a group of medical doctors and osteopaths, has heard reports about benefits of acupuncture for hair loss. "But in my opinion," he says, "it's always been a little suspicious."
• American Academy of Family Physicians: www.familydoctor.org/handouts/081.html
• National Alopecia Areata Foundation: www.alopeciaareata.com
• For a free information package, "Alopecia Areata and Related Hair Disorders," write to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 1 AMS Circle, Bethesda, MD 20892-4675. Or call toll-free 877-22-NIAMS.
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