Friday 20 September 2019

Dear Doctor: What can my boyfriend do about going bald so young?

Hair loss at an early age can cause significant psychological distress for patients.
Hair loss at an early age can cause significant psychological distress for patients.

Dr Jennifer Grant

Dear Doctor, My 29-year-old boyfriend has started to go bald and he is quite insecure about the whole thing.

He’s looking into various treatment options. Is there one you would recommend or should he be trying to become more secure with the change?

Answer: Hair loss at an early age can cause significant psychological distress for patients. Male pattern hair loss (male androgenetic alopecia) is a genetic condition inherited from both mother and father, and usually begins with a receding frontal hairline that can progress to a bald patch on top of the head.

The rate of normal hair loss ranges from 50 to 100 hairs per day. In general, autoimmune diseases can cause frontal thinning. These conditions include thyroid disorders, rheumatoid arthritis, type I diabetes and lupus. 

Unfortunately, even good adherence to medication with these conditions will not prevent the associated hair loss. Significant weight loss, iron deficiency anaemia and major psychological stress are other common causes of hair loss. In these cases, the chance of hair regrowth improves with the treatment of the underlying condition.

Hair loss disorders can be either scarring scalp conditions (e.g. discoid lupus or frontal alopecia), which tend to cause permanent hair loss, or non-scarring scalp conditions (e.g. alopecia areata or female pattern hair loss), where the hair follicle is not destroyed and spontaneous or treatment-induced hair regrowth can occur in some cases.

James Nesbitt in 2002, left, and in 2017, after his second hair transplant, right
James Nesbitt in 2002, left, and in 2017, after his second hair transplant, right

Another common type of non-scarring hair loss is male pattern hair loss (male androgenetic alopecia) that has the characteristic progressive loss of terminal hairs described above and occurs slowly over the course of years.

Your GP can help to assess which of the above is affecting you and check your boyfriend’s male sex hormone levels as well as thyroid function tests.

Rarely, patients need referral to a dermatologist. Treatments include minoxidil 5pc solution and oral medications, such as finasteride, which inhibits the conversion of testosterone to DHT. Remember, once he starts these treatments, he needs to stay on them!

Lastly, hair transplantation or plugging of hair follicles from the back of the scalp to the front can work well for most causes of hair loss, with the notable exception of alopecia areata as the hair will not grow in that area. Hair transplant results can vary depending on the technique and skill of the hair restoration surgeon.

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