The BALD TRUTH: THE FIRST COMPLETE GUIDE TO PREVENTING AND TREATING HAIR LOSS - Softcover

Kobren, Spencer David; Eisman, Diane B.; Eisman, Eugene H.

Softcover

ISBN 10: 0671024892 ISBN 13: 9780671024895

Publisher: Pocket, 1998

Synopsis

Discusses the causes of baldness, considers the effects of diet, drugs, herbal preparations, surgery, and other methods of inhibiting or concealing hair loss, and recommends treatments

About this title

About the Author

Spencer David Kobren, is the Founder and Director of The Bald Truth Foundation, the only non-profit organization dedicated to consumer advocacy, education and funding research regarding hair loss. He is considered the country's most prominent and effective hair loss consumer/patient advocate. Kobren is the host of his own nationally syndicated radio program and is a feature columnist on three of the most respected hair loss web sites including Regrowth.com (the primary Internet hair loss resource for ABC-TV, and The Wall Street Journal). Kobren and his work are the focus of an upcoming Discovery Channel documentary also titled "The Bald Truth". His Book, The Bald Truth: The First Complete Guide to Preventing and Treating Hair Loss is the # 1 hair loss prevention and treatment guide in the country.

After years of researching hair loss and finally overcoming the early stages of his own male pattern baldness, which began more than ten years ago at only 22, he has dedicated himself to helping others prevent and treat hair loss. As a consumer advocate, he consults on issues of patient and consumer rights in this unregulated industry. Kobren lives in New York City.

Excerpt. © Reprinted by permission. All rights reserved.

Chapter 1: THE ROAD TO PROPECIA

Discovering the Cause and Treatment of Baldness

Innovation is not a random process. When it works, it works because someone has identified a real need and found a way to bring new ideas or new technologies to bear on that need.

-- Lewis W. Lehr

Ask any balding man when he first noticed his hair thinning, and odds are he'll remember. Like any other milestone in his life, he isn't likely to forget the event or its accompanying details, like where he was, what he was doing, and, most important, how he felt.

I was in bed, stretching and getting comfortable on the pillow, just like any other night. What made this one different, though, was that when I ran my fingers through my hair, out came, not one or two, but at least ten strands of hair. I couldn't miss it because my hair was worn well below my collar, so these were long strands; a man with shorter hair might not as easily notice the earliest stages of hair loss. I was "lucky."

My heart sank because when this happened, in February 1987, I was only twenty-two. Not that I wouldn't have still been upset had the balding process begun in my thirties or forties, but at twenty-two, with my adult life just beginning, the last thing I wanted to worry about was losing my hair.

The next morning, while in the shower, I noticed that the drain was completely clogged -- with my hair, I had a thick head of finely textured hair, and now I was faced with the possibility of losing it to male pattern baldness.

First I tried the then widely advertised Helsinki Formula, then KeraKare, a lotion that's applied to the scalp every night. Neither worked. In fact, some of the over-the-counter topical treatments that used to be marketed as baldness cures disappeared in the wake of the FDA ruling that a product couldn't advertise itself as a hair-loss treatment unless it had specific FDA approval as a hair drug. Yet many of these useless concoctions are still advertised and flood the market because of ineffective enforcement of the law.

For seven years I unsuccessfully experimented with every treatment on the market. I found that I really had two "careers." While running my video-production company, Spence-Comm, Inc., I was on an equally time-consuming quest to save my hair. Not only did I spend hours rubbing my head with lotions, I also had "top" New York dermatologists inject hormones into my scalp at $175 per very painful injection. I researched the biological effects of pulsed electrostatic-field treatment for hair, which turned out to be one of the biggest disappointments in the industry. Then, like so many other hopeful men, I ended up using minoxidil which was then available by prescription only but would eventually be marketed over-the-counter as Rogaine.

A so-called "prominent hair specialist" in New York City was providing me with his own concoction of minoxidil and Retin-A, and he told me to spray this on my scalp four times a day in order to grow hair. According to him, I was the perfect candidate for his potion: I was in my mid-twenties then and my hair loss was not that extensive. My crown was beginning to thin, and my hair line had receded by about half an inch. But I was losing a tremendous amount of hair every day; the balding process was progressing very quickly.

This Is Your Hair on Drugs

minoxidil (Ioniten) was the first drug approved by the FDA for the treatment of baldness. Unfortunately, it yielded more hope than results. For many years minoxidil had been widely used to treat high blood pressure. It had one strange side effect, though: It grew hair in a very bizarre manner. People grew hair on the backs of their hands, or on their cheeks, and some people even grew hair on their foreheads.

Some enterprising researchers had the notion that applying minoxidil topically, directly on the head, might grow hair on balding areas. Well, it did -- sort of -- and at the time it was revolutionary.

minoxidil does not work for the majority of people who try it. In the beginning, you think that something wonderful is going on inside your scalp. You feel the tingle that is supposed to ensure effectiveness. You may even see some tiny hairs sprout or notice that you're not losing as much hair as you were before. But none of that lasts very long.

The fact is, minoxidil has not proven to be a very effective drug in the long-term hair-loss battle. One theory about how minoxidil might work -- on the very few people it does work on -- is that it somehow prevents testosterone from adversely affecting the hair follicles. If this is the case, it is only temporary. A topical solution cannot permanently stop, regulate, or affect the body's hormones strongly enough to do much good. A topical solution will always lose the battle in the end.

The studies regarding the results of minoxidil vary. Some clinical studies indicate that minoxidil helps less than forty percent of the patients who have tried it. Unfortunately, for many men, minoxidil (in its standard or extrastrength formula) does not grow cosmetically acceptable hair -- that is, hair that can be styled or even combed. Patients who do grow hair only grow a thin type of peach fuzz (called vellus hair), and according to the November 1997 issue of Men's Journal, Dr. George Cotsarelis -- a dermatologist and hair researcher at the University of Pennsylvania Medical Center -- reports that even this only occurs in about 10 percent of those using minoxidil. Based on this report, minoxidil is unsuccessful 90 percent of the time, but it has still sold more than $162 million worth of product in 1996 alone.

Although the amount of minoxidil absorbed in the scalp is too small to affect blood pressure or cause serious side effects in healthy people, minoxidil is not advised for anyone who has heart disease because of the potential for cardiac side effects. Some form of heart-related problem is common in many middle-aged and older men, even if it's only partially clogged arteries that they may not even be aware they have. In this case, it may not be worth the risk for a drug that does not prove successful for the majority of patients.

Even the general information provided for physicians' pharmaceutical reference books, as well as those for consumers, admits that minoxidil is not particularly promising.

"The ideal candidate for minoxidil's hair-restoring effect is a man who has just started to lose his hair. Women may be helped by minoxidil lotion, too. The drug won't help unless hair in the balding area is at least a half-inch long," notes perhaps the best consumer book of its kind, The Pill Book (Bantam Books, 6th edition). "It takes four to six months of application before an effect can be expected. This regimen must be followed carefully because stopping the medication will nullify any benefit you have gained and any hair you have grown will fall out. Some men who used Rogaine continuously for a year found they continued to go bald, but the rate of hair loss was slowed."

The book flatly states that "applying this solution does not work for all people who try it," and this admission was provided by the pharmaceutical company.

Besides providing positive long-term results only rarely (and then only short term), minoxidil is a pain in the neck to use. You must either spray it or slather it on your scalp, depending upon the type of application, at least twice a day. Not only is this visually unappealing, but the alcohol in the preparation will in most cases cause a great deal of irritation, even itching, to the applied areas. When I used it I could hardly keep from scratching my head. Although it did slow the thinning process for a while, my head was always irritated and my hair looked like a tossed salad.

After two years on minoxidil, the product was no longer slowing down my hair loss. Every time I saw the hair specialist, he would tell me that my hair was getting fuller in an effort to keep me returning and buying his concoction. But my hair wasn't getting fuller -- only my bathtub drain was getting fuller -- my hair was getting worse. To minoxidil's credit, it did buy me a bit of time until science caught up with hair loss and a truly effective treatment that actually dealt with the cause of baldness could be obtained. I became aware of that revolutionary treatment shortly after a particularly ridiculous discussion with my hair specialist, who suggested that instead of being concerned by my hair loss I should take an antidepressant, for which he'd be happy to write a prescription. The problem wasn't in my head, though, it was on my head. I didn't fill the prescription.

The DHT Connection and Finasteride

By late 1994, I had amassed quite an amount of information on baldness, so when I read in the New York Times that a number of drug companies had committed to putting the next baldness breakthrough on pharmacy shelves, I was intrigued that among the drugs that were being studied was finasteride, the prescription prostate drug that Merck & Co., the pharmaceutical company, manufactured and marketed in a 5 mg. dose under the brand name Proscar. Finasteride prevents testosterone from converting into DHT (dihydrotestosterone), the androgen that can cause not only prostate problems but the demise of hair follicles. I knew from my reading about testosterone that Merck was on to something. Only a product that changes the body's chemistry, introduced internally (with a pill, for instance), could combat the hormonal assault on hair follicles.

Doctors and patients discovered that Proscar, originally prescribed to treat benign prostate enlargement, had an exciting, positive side effect: It grew hair on bald men's heads -- "regular" (called terminal) hair, not peach fuzz. The stage was finally set for a truly effective balding treatment.

To understand why this is the case, here's a crash course on how testosterone causes hair loss: For many years, the scientific community and the rest of us were under the impression that androgenetic alopecia (male pattern baldness) was caused by the predominance of the male sex hormone, testosterone. While testosterone does play a role in the balding process, the accumulation of scientific study over the course of decades has revealed that dihydrotestosterone (DHT), a derivative of testosterone, is actually the main culprit.

Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha-reductase, which is held in a hair follicle's oil glands. Scientists now believe that it is not the amount of circulating testosterone but the level of DHT binding to receptors in scalp follicles that determines hair loss. DHT shrinks hair follicles, making it impossible for healthy hair to survive.

The first evidence of the relationship between male pattern baldness and testosterone was discovered by a psychiatrist early in the twentieth century. At the time, castration was commonly performed on some of the more uncontrollable psychiatric patients in sanatoriums. Castrating these patients not only eliminated their sex drive, it also produced a calming effect, much like a sedative.

This particular doctor noted that one of his castrated patients had a full head of hair, while the patient's uninstitutionalized twin brother who came to visit was very bald. The doctor then noted that the mentally ill twin had been castrated before the onset of puberty. The doctor was curious: If a pure form of testosterone was injected into the castrated twin, would it affect his full head of hair? Within weeks of the injection, the twin began to lose his hair.

In 1942 James B. Hamilton of Yale published a report in the American Journal of Anatomy detailing his studies of men whose testes had been removed before puberty for medical reasons and noting the fact that these men never went bald, even if they had bald relatives. When these castrated men were given testosterone injections, however, their hair began to fall out, and they were soon almost as bald as some of their relatives. If the testosterone injections stopped, their hair loss stopped progressing. Interestingly, if the men came from families with few bald men, the testosterone injections didn't cause much baldness. This was the first time science had noted that baldness was linked to both hormones and genes.

These studies revealed that if testosterone has never been introduced into the hormonal pool, then hair loss will not occur. But once testosterone is activated (at puberty, for those who have not had the misfortune of being castrated), it creates a biochemical reaction in people who have a genetic predisposition to androgenetic alopecia, male pattern baldness.

In the case of the twin at the sanatorium who grew bald once testosterone was introduced into his body, it's important to note that when the doctor stopped giving him testosterone, the twin did regrow some of his hair, but not all of it, since many of his hair follicles had died.

Only decades later would scientists discover that follicles die not from the testosterone itself but from its follicle-killing derivative, DHT, and that hair will not grow from dead follicles.

The drug finasteride was the result of a long-term research project at Merck that began initially in the mid-1950s, according to the company. At that time, Merck scientists were conducting research into the role of androgens (like DHT) in benign prostate enlargement and male pattern baldness. By the 1960s, Merck researchers had learned that Type II 5-alpha-reductase (an enzyme) was necessary to complete the conversion of testosterone to DHT and this was the basis for the development of finasteride, which inhibits this particular enzyme.

Merck decided to focus first on prostate enlargement, the company says, because the medical need for a treatment of the condition was greater.

The 1970s brought more confirmation of the DHT and Type II 5-alpha-reductase connection to male pattern baldness. Scientists in the Dominican Republic were looking at the cases of male children who, though born with XY chromosomes, grew up looking like females. Only when they went through puberty was it apparent that they were male. Their genitalia were almost nonexistent as children, but they then grew to normal size once the body manufactured testosterone at the onset of puberty.

The researchers noted that these boys never lost their hair as they grew older. Although all of these boys had normal -- and in some cases raised -- levels of male hormones, they all had no trace of Type II 5-alpha-reductase, the enzyme that converts testosterone to DHT, which then kills hair follicles in the male pattern baldness areas of the scalp.

In the mid-1980s Merck scientists working with their prostate drug finasteride, marketed as Proscar, knew that cases of male pattern baldness were rare in men with low levels of Type II 5-alphareductase. The company then turned its attention to using finasteride to treat male pattern baldness. They would need separate FDA approval to market finasteride as a hair-loss drug treatment, though, so in 1992 Merck began testing the drug (which they would eventually ...

Edition details

• Publisher: Pocket
• Publication date: 1998
• ISBN 10: 0671024892
• ISBN 13: 9780671024895
• Binding: Paperback
• Language: English
• Number of pages: 224