Look what Mr. Smith hid in the dining room. You can’t tell him we found it,” was the secret my grandmother shared with me. It was the 1950s and my maternal grandmother always called her husband – my grandfather – Mr. Smith. This amused us grandchildren and friends our age. Hidden on top of a china cabinet where my taller grandfather could reach was a bottle of some kind of dark, thick, smelly patent medicine to rub on his head to promote hair growth. The name of this concoction is lost in my memory but my grandmother surmised that my grandfather saw an ad for it in some popular magazine of the day and had ordered it from Chicago.

HEALTH: HAIR TODAY, GONE TOMORROWMy grandfather was the baldest man I had ever seen. He was sidelined with tiny fluffs around both temples that met behind his head. He was so bald that the barber only charged him half-price.

My father was also bald. Since a sixth grade science fair project I did on the genetics of hair color in hamsters, I had no doubts about my scalp hair future – even though male-pattern baldness is a complex polygenic trait not ruled by simple Mendelian genetics.

 “Both parents can have full heads of hair and their child can be a billiard [ball] at a young age,” says Dr. Nia Terezakis, a local dermatologist with an international reputation for successfully treating both male and female hair loss.

Common male-pattern baldness has another name — androgenetic alopecia – referring to hair loss generated by a combination of genetic and male hormonal factors. There is usually an orderly progression beginning with loss of hair thickness around the temples. Then the frontal hairline starts to recede and a hairless crown better known as a bald patch emerges on the top of the head towards the back.
 
There is no blood test to diagnosis androgenetic alopecia. One look and the diagnosis is instantly recognizable by all. About 30 percent of men have some noticeable baldness by the age 30 and 50 percent by age 50.

 “Hair loss is not related to hormone excess or deficiency,” adds Terezakis as she explains a hormonal and genetic driven process that shrinks and preordains hair follicles to a premature demise.

Except for toupees, often badly made and a favorite topic of comics, balding men either live with their fate or are tempted with various snake oils such as the one my grandfather purchased in the 1950s.

After centuries of quackery involving patent medicines and even devices such as electrical hats to stimulate hair growth, several readily available medical treatments can arrest progression of hair loss and/or stimulate hair re-growth. Additionally, refined surgical advances can restore a receding hairline.

Minoxidil lotion marketed under the trade name Rogaine was the first FDA approved medication to stimulate hair growth. Both 2 percent and 5 percent formulas are now available without prescription, but the 5 percent is the way to go unless it causes scalp irritation, which is rare according to Terezakis.

“The optimal time to initiate Rogaine is when hair loss is first noted. Even if hair stubs are only a quarter of an inch long, Rogaine will make hair grow longer. The foam-based product is much easier to use than the old lotion-based solutions,” says Terezakis.

Initial results after twice-daily applications can include a surge in the growth of small peach fuzz hairs for a month or two as resting hair follicles awaken. The hairs then thicken and their density improves, effects that vanish if Rogaine applications cease. Results vary from no effect, to simply slowing down the rate of hair loss, to occasional successful repopulation of thinned areas with normal appearing hair. It seldom works over shiny bald spots.

Propecia is a more potent drug that can stop hair loss in over 80 percent of men who have the genetic predisposition and are just beginning to experience hair thinning. It is an oral medication containing the same ingredient as Proscar, a drug prescribed to shrink expanding prostates.

“Propecia has essentially no adverse effects. The minute you notice hair loss is the best time to begin Propecia but it helps at any point in hair loss cycle. Like Rogaine, Propecia is a long term commitment,” says Terezakis.

A daily oral dose of one milligram blocks the enzyme that stops hair growth by prematurely shutting down hair follicles and arresting further hair loss. Propecia acts at the follicular level to promote thicker, longer and faster growing hair but patience is essential. It can take up to a year to obtain noticeable results.

Using a combination of both Rogaine and Propecia gives the best results. Even though Rogaine is available without a prescription, it makes sense to see an experienced dermatologist for an optimal treatment plan.

Terezakis has time proven approaches to the re-growth of hair, including high-potency Rogaine custom blended with other ingredients to increase absorption, decrease inflammatory changes and speed up hair growth. There is an area where art meets science and the “art” is not available on a drugstore shelf.

Hair transplantation techniques caught on in the 1960s. Cornrows of plugs marked the early era but technical advances now allow a much more natural look, utilizing micrografts of one to three hairs. After a few months, a good outcome yields natural looking and permanent hair.

Like many specialized medical procedures, dermatologists who do these procedures on a volume basis are most likely to have optimal results.

The majority of men simply do nothing; no one dies of male pattern hair loss. But this old barbershop joke is no longer true: “The only thing that will stop your hair from falling is the floor.” 

If you have excessive or premature hair loss or are distressed about thinning hair for whatever reason, remember the most favorable outcomes go to those who take action when thinning first begins. Be prepared for a long-term commitment.

Hair loss treatments through the ages
3000 BC: Wigs and hairpieces are popular among upper class Persians and Greeks.
1500 BC: Wigs are popular among Egyptian royalty – well-preserved hairpieces are found in tombs when excavated.
420 BC: Hippocrates self-prescribed a concoction of opium, horseradish, pigeon droppings, beetroot and various spices.
44 BC: Julius Caesar grows his hair long in the back and combs it straight forward over his bald spot — a comb forward instead of a comb over. This is eventually replaced by a laurel wreath to hide his hair loss.
1624: King Louis XIII in France wears a full wig to camouflage his thinning hair – wigs quickly become symbols of power.
1660: King Charles II brings the French wig craze to England.
1700s: Upper class American colonists wear false hair but the style falls out of favor after the Revolutionary War.
1800s: The heyday of the “snake oil” salesmen, a tradition that continues even now by mail, cable television and over the Internet.
1905: A St. Louis company markets a suction device that “exercises the scalp and helps to circulate stagnant blood, feeding the shrunken hair roots and causing the hair to grow …”
1920s: Electrical devices, including an electrified comb, replace mechanical hair restoration machines.
1939: First published account of a modern hair transplantation technique by a Japanese dermatologist occurs.
1952: New York City – first reported hair transplant in the U.S. occurs.
1968: The subsequent founder of the Hair Club for Men receives his first hairpiece at age 27.
Late 1960s: New Orleans dermatology residents perform regular hair transplants as part of their training.
1980s: Large plugs of transplanted hair are replaced by minigrafts and then by micrografts.
1988: Rogaine becomes the first FDA approved treatment for hair loss.
1991: Hair Club for Men introduces an adhesive to attach hair appliances directly to the scalp and glued-on hairpieces soon become the industry standard.
1995: Micrografting evolves into Follicular Unit Micrografting – the current state-of-the-art method of hair transplantation.
1998: Propecia becomes the second prescription medication approved by the FDA as a hair loss treatment.

Adapted from The Complete Book Of Hair Loss Answers: Your Comprehensive Guide To The Latest And Best Techniques by Peter Panagotacos, M.D., and available free, on-line: http://www.hairdoc.com/book/intro.html.