Thursday 18 October 2018

Dear Dr Nina: 'I'm 21 and going bald - is medication safe to take?'

Male pattern baldness affects over 50pc of men over 50
Male pattern baldness affects over 50pc of men over 50

Nina Byrnes

Our resident GP answers your medical queries.

Dear Dr Nina: It would mean the world to me if you could offer some advice regarding hair loss. I'll start by saying that I'm only 21 years old and my hair has already begun to recede. This has taken its toll on my self-image. I'm currently on hair loss treatment product Regaine and have recently received a prescription for Finasteride from an online Irish doctor. However, I have not taken the medication yet as I'm extremely cautious of the potential side effects. I've heard that they can be irreversible among some users. Do you think I should give this treatment option a try? I would greatly appreciate it if you could advise me.

Dr Nina replies: Male pattern baldness affects 30pc of 30-year-olds, and 50pc of men over 50. In the majority of cases the cause is a hereditary condition called androgenic alopecia. While there are no known physical problems associated with hair loss, the negative psychological impact leads many men to seek possible remedies.

The exact pattern of inheritance isn't certain. It can pass through either side of the family. If you have a first-degree relative who is bald, your chances are increased by 50pc. Using hair products or wearing hats does not encourage hair loss. Those who have male pattern baldness do not have higher circulating testosterone and are not more virile than men with full heads of hair.

Male pattern baldness occurs in a very typical manner. Firstly, the hairline at the front recedes; next, a bald patch develops at the top of the head (vertex). Slowly these areas enlarge and eventually merge. Normal hair growth occurs in small pockets called hair follicles. Healthy hair grows for three to six years then sheds and a new hair grows.

In male pattern baldness, the follicles get smaller, leading to thinner, weaker hair. The growth cycle becomes shorter until eventually only a small stub of hair, that doesn't make it to the skin surface, remains. Male hormones play an important role in this. Testosterone is converted to dihydrotestosterone (DHT) in the hair follicles. Those with male pattern baldness have increased sensitivity to this, causing the follicle to shrink, and thus a destructive cycle ensues. It is not clear why only some hairs are affected at a time or why this process doesn't affect hair on other parts of the body.

There are a number of treatments available. Some literature recommends a diet low in processed or high fat foods. Others recommend lean protein and ensuring silica, iron and zinc in the diet. These are largely based on the fact that hair is composed of protein and evidence is largely lacking to support any major dietary benefit.

There are two medical compounds, which do show some benefit. Minoxidil (Rogaine and Regaine) is a solution applied topically twice daily. It comes in 2pc and 5pc strengths. The 5pc compound has shown more benefit, although is more unpleasant to apply. About 15 in 100 users report good results. It must be applied every day and takes four months for full benefit.

Finasteride (Propecia) is a prescription medicine initially designed to help with prostate problems. It is a tablet taken once daily at a dose of 1mg. It works by blocking the conversion of testosterone to DHT, thus allowing the hair to remain thicker. Research showed that two-thirds of men reported regrowth. In studies it only works on hair loss on the top of the head.

Both remedies are considered safe, although some side effects have been reported. With Minoxidil most are localised and include irritation and rash. Finasteride can cause reduced libido in approximately 2pc of users and has also been associated with breast enlargement or tenderness. Finasteride can also change the result of the PSA test. These can be expensive and need to be continued indefinitely.

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