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October 5, 2010 | Comments: 4

Hair-Raising Concerns

Hair loss is a normal part of aging for most men. But just because it’s normal doesn’t mean it’s not distressing. Here’s what you can do about hair loss. 

Just about every man’s hair thins with age. But androgenetic alopecia (“andro” referring to androgen hormones, and “alopecia” meaning baldness) runs in families. Also called male-pattern balding, it is the most common form of hair loss, affecting about 50% of the population by age 50 to some degree—and as many as 95% of white men over 65. Men with hereditary hair loss produce too much of an enzyme that converts testosterone to dihydrotestosterone (DHT), a hormone that causes hair follicles to shrink and eventually shut down. Though it’s been linked to the mother’s side of the family, recent research shows that early male-pattern hair loss can be passed down from the father’s side as well.

Drugs today, hair tomorrow?

Two drugs are approved by the FDA for hair loss in men: minoxidil and finasteride. The key is to start as early as possible, because once an area is completely bald, the drugs do not work. It may take several months to see results, and the effects vary greatly between people. And if you stop the drugs, hair loss will resume. Many other remedies on the market are not approved by the FDA for hair loss and have little or no evidence to back them.

• Minoxidil (Rogaine and generics) is an over-the-counter topical solution. Originally used as an oral drug to treat high blood pressure, it may halt hair loss in some people when applied to the scalp, and possibly encourage some hair regrowth. A new foam formulation doesn’t drip like the liquid does, dries faster, and is less likely to irritate skin, but both versions can cause unwanted hair growth on the face and should be used with caution in people with heart and kidney disease. The nonprescription topical solution from Avacor (a heavily promoted supplement line marketed for baldness treatment) contains minoxidil, but at a higher price than generic minoxidil.

• Finasteride (brand name Propecia) is used for hair loss, at a 1-milligram dose. (Finasteride, under the brand name Proscar, is primarily used to treat urinary symptoms in men with enlarged prostates, but at a 5-milligram dose.) Even smaller doses may also be effective for hair loss, some research shows. The drug’s benefits are well documented in men: it blocks the hormone that shrinks hair follicles. Side effects, including erectile dysfunction and loss of libido, are relatively uncommon. Men with liver disease should probably avoid it. Propecia lowers PSA levels, making it harder to detect prostate cancer, so if you take it for hair loss, be sure to remind your doctor before having a PSA test. Though there’s no evidence of serious problems, we still hesitate to recommend Propecia, especially in younger men who would need to take a drug that affects their hormones for decades to maintain its effects.

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