BALDING
OVERVIEW
Hair shedding is part of a normal hair-growth cycle.
At any given time, 90% of scalp hair is in a 2- to
6-year growth phase; 10% is in a 2- to 6-month dormant
phase. When the dormant phase ends, hair is shed. New
hair subsequently emerges from these follicles.
Throughout a normal growth cycle, many hairs are shed.
Loss of 50 to even 100 hairs daily is not cause for
alarm. Noticeable thinning indicates significant hair
loss or balding. Hair loss and balding are not
life-threatening, but can cause emotional distress.
Hair loss results from aging, genetic
pre-disposition, thyroid imbalance, eating disorders,
illness, hormonal effects of birth control pills,
pregnancy, or menopause, and certain medications. The
most common cause of hair loss is a hereditary condition
known as androgenetic alopecia (AGA). Balding runs in
families.1
Hair loss caused by AGA in men and women is
characterized by a gradual shrinking of hair follicles
which shortens the life cycle of hair. As the growth
cycle phase progressively shortens, newly grown hair is
shorter and thinner until new hair growth eventually
ceases entirely. Hair-thinning conditions can be
treated. Consult a physician or dermatologist for an
evaluation to determine the cause of thinning hair.2
EPIDEMIOLOGY AND GENETICS
Genetic or hereditary hair loss does not discriminate
between sexes or races. Approximately 40 million men or
2 out of 3 men in the United States have significant
hair loss. About 25% have some form of balding by age
30, and 65% begin to bald by age 60. In women, the
number affected by pattern-type hair loss is slightly
less: about 30 million or 1 in 4. Thinning hair can
occur anytime between ages 25 to 45, but most commonly
hair loss presents after age 40. Hair loss occurs in
about 25% of pre-menopausal women and in 38% of
post-menopausal women.
Types of Hair Loss
Male-Pattern Baldness
Male-pattern balding, the most common type in men,
usually starts at the temples and gradually recedes to
form an "M" shape. Hair on the top of the head thins.
Over time, hair takes on a horseshoe-shaped pattern.
Some males have only a receding hairline or bald spots
at the crown. Hair remaining in balding areas is long,
thick, and pigmented and then changes into fine,
non-pigmented hair that grows at a slow rate. Males
losing hair during the mid-teen years are likely to
become completely bald on top of their heads.3
Androgenetic alopecia (AGA) is a major factor in
male-pattern baldness. AGA is attributed to androgens,
hormones that are responsible for male characteristics.
AGA has three causal factors: advanced age, an inherited
tendency to early baldness, and overabundance of DHT (dihydrotestosterone,
the most potent androgen in the hair follicle which is
derived from testosterone). Testosterone is metabolized
into DHT by 5-alpha-reductase, an enzyme produced in the
prostate, adrenal glands, and scalp. DHT (and perhaps
other androgens) causes hair follicles to shrink and
enter a permanent dormant state. DHT triggers synthesis
of transforming growth factor-beta2 (TGF-beta2) which
suppresses epithelial cell proliferation and eventually
leads to apoptotic cell death.4
TGF-beta2 is directly responsible for significant hair
loss on a cellular level. Combating the effects of
TGF-beta2, using combination therapy with current DHT
and androgen inhibitors, may have a significant role in
treating hair loss.5
Female-Pattern Baldness
Female-pattern baldness (or diffused thinning) is
caused by aging, genetic susceptibility, and androgen.5
Female-pattern baldness usually begins about age 30. It
becomes more noticeable by age 40 and can be quite
evident following menopause. Female-pattern baldness
usually causes hair to thin all over the head. It rarely
progresses to near or total baldness. Female-pattern
baldness causes permanent hair loss.
Telogen Effluvium
Telogen effluvium is an abnormal loss of hair caused
by alteration of a normal hair cycle. In telogen
effluvium, a large proportion of hair enters the dormant
phase and hair shedding is greater than normal.6
Telogen effluvium can follow a case of flu or emotional
stress7 or can
occur after a pregnancy. Hormonal changes in pregnancy
can cause increased numbers of hair follicles to remain
in a growth phase. After pregnancy, an increased
proportion of these hairs enter a dormant phase, a
temporary self-correction that increases hair shedding.8
This condition is seen when birth control pills are
stopped.9
Chemotherapeutic Hair Loss
Cancer chemotherapy cause hair cells to stop
dividing, a usually transient condition.10
Hair can fall out for 3 to 4 months before growing back.
When a drug is prescribed, ask your physician if a side
effect is hair loss. Side effects of all prescription
drugs are listed in the Physicians' Desk Reference.
Pharmacists also have this information.
Alopecia Areata
Alopecia areata is a highly unpredictable, autoimmune
skin condition that causes loss of scalp hair, facial
hair, and hair elsewhere on the body It affects
approximately 1.7% of individuals (over 4.7 million
people) in the United States.11
In alopecia areata, affected hair follicles are
mistakenly attacked by an individual’s immune system
(white blood cells) and the hair growth stage is
arrested. Alopecia areata typically begins with one or
more small, round, smooth bald patches on the scalp. It
can progress to total scalp hair loss (alopecia totalis)
or total body hair loss (alopecia universalis).12
Alopecia areata affects males and females of all ages
and races. Onset often begins in childhood when it can
be emotionally devastating. Alopecia areata is not
life-threatening, but is most certainly life-altering.
Its sudden onset, recurrent episodes, and unpredictable
course have profound psychological impact.
Trichotillomania
Trichotillomania is a psychological disorder (an
impulse control disorder). Impulse control disorders are
characterized by an uncontrollable urge (or impulse) to
do something that harms one’s self or others.
Trichotillomania patients repetitively pull their hair
out at the root from the scalp, eyebrows, or eyelashes
or chronically scratch or brush their hair.
Trichotillomania affects 1 to 2% of the population,
primarily children. Girls are more likely to be affected
than boys.
Scarring Alopecia
Scarring alopecia describes skin scarred by burns,
X-ray therapy, skin cancer, or severe injury which
results in hair loss.
Other Causes of Hair Loss
Hair loss can occur from damage caused by hair
styling processes and products and from twisting and
pulling hair. Certain skin conditions cause hair loss
and baldness. Hair loss can be caused by oral
medications, including cholesterol-lowering drugs,
Parkinson's medications,13
ulcer drugs,14
anticoagulants,15
anti-arthritics,16,17
drugs derived from vitamin A,18
epilepsy anticonvulsants,19
antidepressants,20
beta-blockers for hypertension, anti-thyroid agents,21
and anabolic steroids.
ANATOMY AND PHYSIOLOGY (STRUCTURE AND FUNCTION)
Each hair originates in a deep pouch-like structure
in the epidermis (a hair follicle) which penetrates the
dermis. A hair root extends down into the hair follicle
and widens into an indented bulb at its base. Extending
into the indentation is the papilla (the center of hair
growth) which contains capillaries and nerves that
supply a hair. Newly dividing cells at the base of the
hair multiply, forcing cells above them upward. As cells
move upward, they gradually die and harden into a hair
shaft. A hair shaft has two layers: cuticle and cortex.
The cuticle (outer layer) consists of flat, colorless,
overlapping cells; the cortex is the inner layer. The
cortex contains pigment and keratin, a tough protein.
The cortex forms the bulk of a hair shaft. Coarse hair
such as scalp hair contains an additional inner core
(medulla). Hair is lubricated by sebaceous glands
located in hair follicles. Illness or stress can lessen
pigment secretion and cause hair shafts to whiten.
Age-related whitening is genetically determined. Hair
color is determined by pigment and air spaces in the
cortex and medulla. Hair color and texture are inherited
characteristics. Humans scalp hairs generally shed every
2 to 4 years; body hairs are shed more frequently.22
PATHOPHYSIOLOGY
In the scalp, a hair growth cycle has three main
phases: anagen, catagen, and telogen. The anagen phase
is the growth cycle typically lasts 3 to 5 years. On a
healthy scalp, hair numbers approximately 100,000 and
90% of the follicles are continually in the anagen phase
of hair growth. The catagen stage follows the end of the
growth period when a follicle begins to become dormant.
The telogen stage is a dormant or resting period that
lasts 3 to 4 months. When the dormant phase ends, an old
hair falls out. A hair follicle then returns to the
anagen stage and a new hair begins to grow.23
An average rate of hair growth is about half an inch
per month depending on hair follicles and age of an
individual. On average, 50 to 60 scalp hairs are lost
daily in a normal hair growth cycle and new hairs begin
to grow from these follicles. Hair loss begins when less
new hair begins the re-growth stage.
ETIOLOGY AND MECHANISMS OF ACTION
In male-pattern baldness, scalp hair in affected
areas becomes shorter, finer, and less pigmented with
successive growth cycles. This type of baldness,
androgenic alopecia, is thought to be associated with
the presence of dihydroxytestosterone (DHT), a
metabolite of testosterone. Eunuchs have low levels of
testosterone and do not lose scalp hair and men with
genetic deficiency of 5-alpha-reductase (the enzyme that
converts testosterone to DHT) do not have male-pattern
baldness.24
PHARMACOLOGY
Traditional Approaches
A biopsy may be required to determine baldness type.
A biopsy ascertains if hair follicles are normal.
Conventional choices can be used to treat hair loss:
take better care of the scalp, use minoxidil (Rogaine®)
and/or Proscar®, have hair transplants or a scalp
reduction, or have hair replaced non-surgically.
Successful prevention and treatment of accelerated
hair loss necessitates treating factors that are
involved in contributing to the hair-loss process
(excluding the genetic component).
Anti-Androgens
DHT (the male hormone dihydrotestosterone) is
associated with premature hair loss. A wide variety of
anti-androgens are used to prevent or reverse premature
hair loss: progesterone, spironolactone (Aldactone®),
flutamide (Eulexin®), finasteride (Proscar®), cimetidine
(Tagamet®), Serenoa repens (Permixon® and cyproterone
acetate (Androcur/Diane®). The most effective
anti-androgens are oral finasteride (Propecia®, Proscar®).
In hair-loss, an immune reaction caused by male
hormones (e.g., DHT) has perhaps the most significant
role. Stimulated by androgens, the immune system targets
hair follicles in genetically susceptible areas and
causes premature hair loss characteristic of
male-pattern baldness.25
Growth Stimulators
Topical oxygen free-radical scavengers (e.g.,
superoxide dismutases, SODs, enzymes that counter
excessive free-radical activity) are potent hair-growth
stimulators. SODs inhibits oxygen radicals and may
inhibit a localized immune response implicated in hair
loss and offset damage and inflammation.26
Unless immunologic factors involved in hair loss process
are effectively treated, potential for significant hair
re-growth may be very limited.
Available agents (e.g., Rogaine®) stimulate some
degree of hair growth in some individuals, but cannot by
themselves produce healthy hair and cosmetic benefits. A
multi-modal approach is required that combines
anti-androgens, autoimmune system protective agents,
oxygen free-radical inhibitors, and other hair-growth
stimulators to halt hair loss and generate hair
re-growth.
Finasteride
Finasteride (Proscar®) was originally developed to
treat benign prostatic hyperplasia (BPH). It is
available by prescription in 5-mg tablets. Finasteride (Propecia®)
is FDA-approved for hair loss treatment. It is available
by prescription in 1-mg tablets for men at $45 to $50
per month. Propecia cannot be taken by women.
Finasteride was once thought to be useless for
androgenic alopecia treatment because it primarily
affected 5-alpha-reductace, the type 2 DHT-producing
enzyme. However, finasteride in doses as low as 0.2 mg
daily maximally decrease scalp, skin, and serum DHT
levels.27
Finasteride can produce visible hair growth in most
men with mild-to-moderate alopecia and can stop hair
loss in a majority of patients. Finasteride (1 mg daily
over 5 years) was well-tolerated, produced durable
improvement in scalp hair growth, and slowed further
hair loss progression that occurred with no treatment.28
The most common side effect is decreased sexual desire
or lowered amount of ejaculate (less than 2%, although
men receiving placebo experienced the same side
effects). Initial results of the Prostate Cancer
Prevention Trial, produced concerns that finasteride
might promote prostate cancer: finasteride was thought
to reduce incidence of prostate cancer in men over 55 by
one researcher; trial participants who developed
prostate cancer had slightly more high-grade tumors.29
Dutasteride
Dutasteride (GG745), similar to Propecia®, blocks
enzymatic conversion of testosterone to DHT. Unlike
finasteride, dutasteride blocks two enzymes that create
DHT rather than one and may be a more potent treatment
for hair loss.30
Azulfidine
Azulfidine is an anti-inflammatory sulfa drug used to
treat autoimmune disorders (e.g., rheumatoid arthritis
and Crohn's disease). It is used in alopecia areata.
Azulfidine completely reverses alopecia areata in 23% of
participants. Although some re-growth occurred in other
participants, the majority had no effect.31
Minoxidil
Originally used to treat high blood pressure,
minoxidil is now widely used as a topical solution
applied twice daily to treat male-pattern baldness. It
may improve hair growth in 10 to 20% and slow hair loss
in 90% of users. How minoxidil acts is unclear, but when
effective, minoxidil appears to prolong the growing
phase in the hair growth cycle, enlarge follicles, and
cause dormant follicles to grow. 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.
Newly grown hair may not be as long or thick as normal
hair. Minoxidil is more effective in young men and men
with recent-onset hair loss.32
Hair Transplantation
Early hair-grafting techniques were somewhat crude,
often leaving a “patchwork” appearance. Newer techniques
transplant productive hair follicles from a donor area
on the scalp to a balding area. Hair follicles are
commonly taken in plugs of one or two hairs (micrografts)
from the sides or back of the head and moved to the
front and/or top, slowly reconstructing a hairline.
Larger plugs of up to 10 hairs can be used. Donor sites
with full hair produce more successful transplants. The
flap technique transplants larger areas of hair from the
sides and back of the scalp to the top of the head. Some
scarring at the donor site may result. Transplanted
follicles can be permanent or last only a few years.
Scalp Reduction
Balding scalp areas can be surgically removed to
decrease an appearance of baldness. Scalp reduction is
usually used in conjunction with grafts or flaps. Prior
to reduction, the scalp may be stretched to expand areas
where hair is growing. Effectiveness of scalp reduction
depends on degree of hair loss and scalp elasticity.
NUTRITIONAL THERAPY
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.
Life Extension Mix
Life Extension Mix™ contains 92 unique vegetable,
fruit and herbal extracts, amino acids, vitamins,
minerals, and special antioxidants. Life Extension Mix™
formula is fortified with botanical extracts that help
to maintain healthy cells via physiological processes
separate from traditional antioxidants. Consumption of
these types of plants is based on research from
prestigious medical centers.
L-Lysine
A United States patent has been issued for L-lysine
for treatment of various types of hair loss, including
androgenetic alopecia. L-lysine (an amino acid) inhibits
5-alpha-reductase.33
L-Arginine
Hair follicles use nitric oxide to maintain and
promote new hair growth. L-arginine is required to
produce nitric oxide.34
Note:
See Appendix C for
Cautions and Contraindications
Saw Palmetto
Saw Palmetto (Serenoa repens) is a palm-like plant
that is native to North America. An extract derived from
saw palmetto berries contains fatty acids and sterols.
Saw palmetto is commonly used to treat benign prostatic
hyperplasia because it inhibits testosterone’s action on
the prostate. Extracts of Saw Palmetto block
5-alpha-reductase, reduce DHT uptake by follicles, and
block binding of DHT to androgen receptors. The
liposterolic extract of saw palmetto combined with beta-sitosterol
(a phytosterol common to many plants and grains)
produced marked improvement.35
Green Tea Extract
Topical agents such as finasteride inhibit type II
5-alpha-reductase in hair follicles. Agents from tea (catechins,
(-)epigallocatechin-3-gallate and
(-)epicatechin-3-gallate) affect type I
5-alpha-reductase activity responsible for converting
testosterone to DHT. All tea is derived from the same
plant species, but types and varieties differ according
to where and how the plants are grown and how the tea is
produced. Catechins in green tea leaves are more potent.
Black pekoe is allowed to dry and ferment, but green tea
is not, thereby preserving catechin integrity.36
Note:
See Appendix For
Cautions and Contraindications
Proanthocyanidins and Procyanidins
Proanthocyanidins and procyanidins (specifically OPCs,
oligomeric proanthocyanidins) are a class of flavonoids
found in woody plants. Two common sources of OPCs are
grape seeds (Vitis vinifera) and white pine (Pinus
maritima, P. pinaster). Procyanidin B-2 and procyanidin
B-3, which directly stimulate epithelial cell growth and
check the growth-inhibiting effect caused by TGF-beta2,
are of specific interest. Supplementing with 100 to 200
mg proanthocyanidins daily in the form of OPC Grape Seed
Extract is suggested for adults.37
Complementary Topical Treatment
Dr. Proctor's Hair Formulas
Dr. Peter Proctor has developed a unique,
multi-ingredient hair formula for balding that requires
no prescription. Dr. Proctor's Hair Shampoo includes
3-carboxylic acid pyridine-N-oxide (NANO, known as
"natural" minoxidil). This product can be used as a
shampoo.
Dr. Proctor's Advanced Hair Formula includes NANO
with natural hair protection and hair growth agents:
endothelium-derived relaxing factor (EDRF) enhancers,
SODs, and free-radical scavengers. Zinc sulfate and
copper peptides are anti-androgens enhancing production
of EDRF.38,39
This product is a liquid which can be applied to the
scalp using eight to ten drops once or twice daily on
thinning areas.
SUMMARY
Several factors lead to hair loss in men and women,
most notably androgenic alopecia, an inherited
condition. Treatment is available. Early treatment
produces better results. Balding is a cosmetic
condition, usually resulting from genetic influences,
aging, skin conditions, or certain medications. The most
common forms of balding are male- and female-pattern
baldness. Baldness has no cure. Oral prescription drugs
such as Propecia® and Proscar® are available by
prescription and over-the-counter preparations which
contain minoxidil have benefits. Most hair-growth drugs
prevent hair loss better than they re-grow hair. Taking
aggressive steps today helps maintain healthy hair.
LIFE EXTENSION’S INTEGRATED PROTOCOL
Hair loss has many causes, including aging, genetic
pre-disposition, thyroid imbalance, eating disorders,
illness, hormonal effects of birth control pills,
pregnancy, menopause, and certain medications and
medical treatments. There is no single “cure” for
baldness. A product that is effective for one individual
may provide only limited results for another. Combining
traditional treatments with nutritional supplements and
natural topical solutions improves chances of inhibiting
pattern hair loss.
Conventional Therapy
- At the first sign of thinning hair, consult a
dermatologist to determine the cause.
- Ask your physician if any prescription drug you
take causes temporary hair loss.
- Ask your physician about drugs that may revive
hair growth.
Lifestyle Modification
- Maintain a healthy diet that is low in fat and
rich in whole foods.
Nutritional Supplements
- L-lysine: 700 mg daily
- L- arginine: 900 mg two times daily
- Saw palmetto: 160 mg two times daily
- Green tea extract: 725 mg daily
- Grape seed extract: 100-200 mg daily
- Life Extension Mix: Tablets, capsules or powder.
Follow suggested dosage as listed on bottle
Product Availability
Life Extension Mix,
L-lysine,
L-arginine,
saw palmetto,
green tea extract,
grape seed extract,
Dr. Proctor's Hair Shampoo and
Advanced Hair Formula may be ordered by calling
(800) 544-4440. European Prescription Hair Formula is
available by prescription from a compounding pharmacy.
Call (713) 960-1616 for details.
For More Information
The National Alopecia Areata Foundation, P.O. Box
150760, San Rafael, CA 94915, (415) 456-4644.
The American Hair Loss Council, 401 North Michigan
Avenue, Chicago, IL.
This Protocol was written by Karyn Siegel-Meier is a
freelance writer and book author with an expertise in
healing with herbs, alternative medicine, nutrition,
general health, and new-age issues. Her work appears in
many industry and consumer publications in the U.S.,
Canada, and the U.K.
Sections were written and edited by Randall Lee Kohl,
Ph.D., R.Ph., F.C.P., Senior Editor for LE Publications,
Inc. Address your comments only to: rkohl@lef.org.
Direct your questions to the Life Extension Health
Advisory staff at (800) 544-4440. |
