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Baldness - What Causes and What Treatment ?

Baldness involves the state of lacking hair where it often grows, especially on the head. The most common form of baldness is a progressive hair thinning condition called androgenic alopecia or 'male pattern baldness' that occurs in adult male humans and other species.

The amount and patterns of baldness can vary greatly; it ranges from male and female pattern alopecia, alopecia areata, which involves the loss of some of the hair from the head, and alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the loss of all hair from the head and the body.


Most men are genetically predisposed to male pattern baldness. It is the effect of hormones on the hair follicle that produces male pattern baldness. Testosterone, a hormone that is present in high levels in males after puberty, is converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT has an adverse affect on the hair follicles. Acting on a hormone receptor on the hair follicle it slows down hair production and produces weak, shorter hair, sometimes it stops hair growth from the follicle completely. This process gradually depletes your stock of hair and is normal hair loss.

In general, most hair loss is not associated with systemic or internal disease, nor is poor diet a frequent factor. Thyroid disease can cause hair loss, but thyroid tests on people who have ordinary hair loss are usually normal. Although many medications list "hair loss" among their potential side effects, drugs are also not overall common causes of thinning or lost hair. On the other hand, with cancer treatments and immune suppression medications, hair loss is not uncommon.

One useful way to classify hair loss is by whether the loss is localized and patchy, or whether it affects large areas or the whole scalp.


To become gradually bald is a normal part of the ageing process for most men. No treatment is wanted or needed by most affected men. For some men, baldness can be distressing, particularly if it is excessive or occurs early in life. Treatment may then help.


Currently there are two medicines that help - finasteride  and minoxidil. Neither are available on the NHS, so you need to pay the full price for them.

It works by blocking the conversion of testosterone to dihydrotestosterone. The hair follicles are then not affected by this hormone, and can enlarge back to normal.

Some hair re-growth occurs in about 2 in 3 men who take a finisteride tablet each day. In about 1 in 3 men there there is no hair re-growth, but most do not have any further hair loss whilst taking finasteride. It has no effect in about 1 in 100 men. So, if you take finasteride, you have a good chance that hair will re-grow, or at least stop any further hair loss. Some points about finasteride include the following.

•    It takes about 4 months for any effect to be noticed, and up to 1-2 years for full hair growth.
•    The balding process returns if treatment is stopped. Therefore, if successful, you need to carry on treatment to maintain the effect.
•    Side-effects are uncommon. The most common is that about 2 in 100 treated men report loss of sex drive (libido).
•    It does not work in women with male pattern baldness.
•    It is expensive, costing around £30 per month (December 2003). You need a private prescription to get it from a pharmacy.

Minoxidil lotion is a rub-on treatment that you can buy at pharmacies without a prescription. It is not clear how it works. The higher strength solution (5%) is more effective than the 2% strength.

There is debate as to how effective it is. Probably about half of men who use minoxidil delay further balding. About 15 in 100 users have good hair re-growth. There is continued hair loss in about a third of users. However, some reports claim much higher success rates. It seems that it is best used to prevent further hair loss, but hair re-growth occurs in some users. Some points about minoxidil include the following.

•    It needs to be rubbed on the scalp every day.
•    It usually takes 4 months or more for any effect to be noticed.
•    Treatment needs to be continued indefinitely. Any new hair that does re-grow falls out two months after treatment is stopped
•    It is quite expensive.
•    It may work in some women who have male pattern baldness.
•    Side-effects are uncommon. For example, skin irritation or a rash sometimes occurs.


A wig is the traditional option for baldness.

Scalp surgery

Techniques such as hair transplantation, scalp flapsBusiness Management Articles, and other procedures have been used for a number of years. Success rates vary and a specialist opinion is needed if surgery is considered. It is expensive and not available on the NHS.

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