Losing hair? Don't lose hope


Wednesday, Nov 23, 2011
AsiaOne (Singapore)
Losing hair? Don't lose hope
Hair loss can be a traumatising experience for both women and men of all ages. Often hair-loss sufferers suffer a blow to their self-esteem, and many are embarrassed about talking about the issue.

However, hair loss is a very common health problem that has an assortment of medical remedies to remedy it. Read on to know more about the common underlying cause, and what you can do to treat it.

Androgenetic alopecia
Androgenetic alopecia, also known as AGA, is the most common hair loss condition caused by genetics.

It is a condition whereby genes inherited from either one or both parents, reduces the amount of visible hairs seen over time.

Patients do not have any discomfort. They will notice that over time, hair becomes less in certain areas. The hair becomes shorter, finer and takes longer to grow.

Hair loss may be a benign medical condition but it can cause great emotional stress and lead to a reduced quality of life.

While hair loss is more commonly associated with men, it also impacts women, with variants for male pattern hair loss (MPHL) or female pattern hair loss (FPHL). This hair loss is seen in a distinct pattern for either sex.

Some of the common emotions associated with female pattern hair loss (FPHL) include reduced worth, dissatisfaction with body image, self-consciousness and in some extreme cases, depression.
 
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How does a person's genes affect their hair loss? What exactly happens?
Our hairs are susceptible to a hormone called dihydrotestosterone, which causes hairs to miniaturise.

For example, hairs grow for a shorter time before they fall off. When that happens, sometimes hairs become so short they cannot push through the scalp, so it appears as a balding spot on the head. Not all hairs on the scalp are so sensitive to it, so as a result a pattern forms after many years.

 
Hair growing for a shorter period over time

Who is at risk of it?
Every man is at risk of having androgenetic alopecia if they live long enough, and balding can start at any age for both sexes. Patients as young as nine-years-old have been encountered.

Approximately 20 per cent of men in the 20s have a Hamilton grade II pattern, 50 per cent at 50s have a grade V pattern etc. (Please refer to the photo below for reference.)
 
Male pattern hair loss (MPHL)
For women, about 30 to 50 per cent may have some form of FPHL in their lifetime.

Female pattern hair loss (FPHl) is different from male pattern hair loss (MPHL) simply due to the pattern involved. (Please refer to the diagram below.)

It is mainly a slow progressive widening of the central partline only on top of the scalp in women.
 
Female pattern hair loss (FPHL)



What are the causes?
The causes for androgenetic alopecia are genetic. However, there might be conditions that stress the body, which in turn impacts the hair.

For example, telogen effluvium or extensive alopecia areata can cause excessive hair fall. When the new hairs grow back, they may appear finer and shorter and so may bring forward the ultimate appearance of MPHL or FPHL.

This condition, due to stress on the body and hair, may appear more apparent at an earlier age.

How do we know the hair loss is not from other factors? If it's temporary or permanent, for example pregnancy?
For almost all women with FPHL, doctors do blood investigations to make sure they exclude contributory reversible causes. Examples of tests include thyroid hormone levels, iron levels etc.

This is as a few other hair loss conditions may mimic FPHL.

There is a temporary hair loss condition called telogen efluvium. It is due to the stresses on the body, for example, post pregnancy, after serious illness, after a bad accident or surgery. This condition would generally correct itself after three months or so.

You can request for your doctor to do blood investigations if he or she has not already done so.

What can women do to offset the effects of balding?
The first step is to avoid preventable causes such as crash dieting, excessive exercise and weight loss.

Having a well balanced diet helps to keep balding at bay. Avoidance of excessive styling of hairs, for example, using chemical, harsh products or heat, will prevent unwanted hair loss.


What are the treatment options available?
Female pattern hair loss is treatable.
There are five options, including: 1. Minoxidil lotions or foam, 2. Oral medication (tablets), 3. Low level light therapy, 4. Hair transplant surgery, 5. Cosmetic cover-ups such as hair pieces, powders etc.

Regardless of the treatment option, it will require long term maintenance, follow-up and commitment/care from patients.

As all medication will take at least 12 to 24 months to see maximal benefits, there is also a need to assess patients individually to decide which is best for them and the potential benefits.

It will take up to 18 months for full results to show, which is similar to being on medications. The final result of undergoing a hair transplant procedure is to enhance the cosmetic appearance of a balding scalp.

Changi General Hospital is one of the few public hospitals that offer hair transplant services in Singapore. The team currently specializes in the following hair transplant procedures:
  • Follicular Unit Transplanting (FUT) – this is a more common procedure that involves harvesting hair from the back of the head through individual strips, cut into seedlings and planted into the tiny holes on the bald recipient site.
  • Follicular Unit Extraction (FUE) – this involves punching out individual clumps of hair and planting planted them into the sites where there is hair lacking. This is less tedious a process and used for treating specific areas, for example, where hair loss has occurred through accidents.
It is estimated that the treatment will cost slightly under S$10,000 per session for a hair transplant procedure in CGH.

How will it improve my quality of life?
Many reviews have shown that when a person loses hair, it affects confidence and self image issues arise.

This impacts the quality of work, personal relationships and overall well-being, which may lead to depressive symptoms. Ultimately, it may result in overall decrease in the quality of life.

Many female patients have expressed that they are glad to have gone through the hair transplant procedure because it helped with self confidence. This is especially so for women who are looking for life partners or looking to boost their professional image at work.

The information in this article was provided by Dr. Lynn Teo, Consultant at the Department of Dermatology, Changi General Hospital.


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