ESTROGEN AND HAIR LOSS
Question: I’m a 67-year-old woman and have recently gone on estrogen replacement therapy for thinning bone. But now my hair is thinning. I’ve read that hormone treatment is a likely culprit. Is it?
Answer: Actually, estrogen therapy is more likely to stop or even reverse the hair loss that occurs in many postmenopausal women. That’s because the most common cause of hair loss in women is a combination of declining estrogen levels and simple aging. In addition, as female hormones dwindle after menopause, the small quantities of male hormones still produced by the ovaries cause further hair loss on the scalp.
If you’re concerned about excessive hair loss, see your physician to rule out an underlying disorder that might be remedied. Possibilities include anemia, psoriasis, and disorders of the adrenal or thyroid glands. To safeguard what hair you’ve still got, treat it gently: Don’t rub your scalp too vigorously; don’t comb or brush too hard; avoid hot rollers and curling irons; set your blow dryer to low; and don’t color, bleach, or perm your hair.
VITAMIN A AND HAIR LOSS
Question: I’m a 42-year-old man with thinning hair; I’ve read that too much vitamin A can cause hair loss. Since I eat large amounts of vegetables that are high in vitamin A, could that be partly responsible for my problem?
Answer: That’s highly unlikely. While you could eventually suffer hair loss and other ill effects from taking supplemental megadoses of vitamin A, it’s virtually impossible to overdose on the vitamin through the foods you eat. That’s because the vitamin A in foods is mostly in the form of certain carotenoids—nontoxic vitamin-A precursors such as beta-carotene. Consuming large amounts of carotenoids can tint your skin orange. But that’s not at all harmful, and it’s reversible.
Thinning hair in a man your age is most likely due to male-pattern baldness, an inherited trait. Your physician can rule out other, uncommon causes of hair loss, such as an infection.
HAIR TODAY, GONE TOMORROW
Question: Is there a safe way to remove unwanted hair permanently?
Answer: Electrolysis is the only technique for permanent hair removal. A fine needle inserted into the hair follicle delivers an electrical impulse that kills the hair root.
Even the most skillful electrologist can have problems with the technique. Applying too much electrical stimulation can scar the tissue around the hair follicle. Too little can fail to destroy the root. Rather than risk scarring, it’s better to err on the side of understimulation and repeat the procedure, if necessary. However, doing so can become a prolonged, expensive process.
WHEN WOMEN LOSE THEIR HAIR
“It started about six months ago, and it’s getting worse,” a distraught 53-year-old stockbroker told me. “At this rate, I’m afraid I’ll go bald in a year.”
She had every reason to be upset. In a culture that worships a full head of “luxurious” hair, it’s understandable that hair loss can be accompanied by a sense of emotional loss as well—especially for women. A balding man, at least, has plenty of company; a woman who’s losing her hair may feel abnormal. According to a recent poll, about two-thirds of women who are experiencing hair loss say they feel less sexually attractive, compared with about one-third of men. And while a third of those men do nothing special to try to hide their hair loss, virtually all of the women do try.
Some hair loss is inevitable. But when a woman loses more hair than is typical for her age, there is often an underlying cause that can be corrected—or that will correct itself. If hair loss can’t be reversed, you can still take steps to minimize the loss.
THE ROOT OF HAIR LOSS
To determine whether you’re really losing hair faster than normal, count the hairs you lose during bathing and brushing every day for a week. (Use a strainer over the tub drain, and brush your hair over the sink.) The typical adult sheds about 100 hairs a day. If you consistently find many more than that, you probably are losing ground.
Every hair follicle goes through a cycle: It grows a hair for two to five years, rests for up to six months, sheds the old hair, and starts on a new one. Anything that shortens the growing phase or prolongs the resting phase will cause gradual hair loss until a new balance is achieved.
Many factors can upset that delicate balance. The most common factors are hormones and heredity: In some people, the hair follicle in the scalp shuts down in response to male hormones. That response can cause both male- and female-pattern baldness. In men, the hairline typically recedes around the temples and over the crown. Women tend to lose hair more evenly, without developing actual bald spots.
In women, this hormonal sensitivity often shows up after menopause. As production of the female hormone estrogen declines, the small quantities of male hormones still produced by the ovaries are free to function unopposed. The same phenomenon can occur temporarily after childbirth or when a woman goes off oral contraceptives.
A wide range of disorders can also temporarily disrupt the growth-rest balance. Possibilities include a major illness, such as a heart attack; serious physical trauma, such as an auto accident; malnutrition; anemia; and disorders of the endocrine ¿aid thyroid glands. Certain drugs, especially chemotherapy for cancer, can also cause temporary hair loss.
Various other disorders can attack the hair follicle itself, sometimes leading to permanent hair loss. These include diseases that affect the scalp, such as psoriasis, discoid lupus, and fungal and bacterial infections, as well as an autoimmune disorder known as alopecia.
TREATING HAIR LOSS
My patient had already seen a dermatologist. He found no evidence of scalp disease and referred her to me. During my examination, I spotted no other possible underlying disorder.
I did learn that this patient had begun menopause about a year before. So her hair loss might have been caused by declining estrogen and a hereditary sensitivity to male hormones. If so, estrogen replacement therapy could have helped reverse the problem. But while such hormone therapy is warranted for women at risk of osteoporosis or possibly coronary heart disease, thinning hair alone doesn’t justify that treatment.
I told my patient that she could wait a few months to see if her hair stopped thinning, or she could try to regrow some of her lost hair by using the over-the-counter drug minoxidil. Sold under the brand name Rogaine For Women, it comes in a liquid or spray that you apply to your scalp twice a day. (There’s now a more concentrated minoxidil product as well as the prescription pill finasteride, sold under the brand name Propecia, but those options are approved only for men and they’re not significantly more effective.)
Using minoxidil means making a heavy bet on a long shot. In clinical studies, only about one in five women with mild-to-moderate female-pattern hair loss experienced at least modest regrowth. It can take many months for any new hair to be visible.
If it works, you must use the drug indefinitely at an annual cost of $200 to $350. In some people, it causes itching and skin irritation.
And that’s the approved treatment. None of the many over-the-counter remedies that have sprung up over the years has been shown to grow any hair at all. So they’ve been declared illegal, though enforcement is difficult. Bogus remedies to avoid include vitamins and other supplements, hair tonics, electric massagers and other devices, and anything else you might come across in the back pages of pulp magazines.
Surgical hair transplants are one rather drastic way to get hair to grow where it otherwise wouldn’t—for example, where the follicles have been destroyed by scalp disease. The procedure involves moving small patches of scalp with healthy follicles to balding sites. That can be effective for male-pattern baldness. But it’s harder to get good results in women, whose hair loss tends to be more diffuse.
Hair transplants can be quite costly; the procedure typically takes two to three sessions, at $4,000 to $12,000 apiece. They’re usually not covered by medical insurance. The whole process can take a year or two to complete, and it’s painful. I recommend a high-quality hairpiece instead. While a good wig can cost up to $2,000, it’s painless and the results are immediate.
HOLD ON TO YOUR HAIR
My patient decided not to gamble on minoxidil. Within a few months, the thinning stopped on its own. Meanwhile, I had given her some suggestions on how to treat her hair more gendy.
Whether or not you’re troubled by hair loss, here’s how to safeguard what hair you’ve got:
• Don’t pull your hair. When washing, don’t massage your scalp vigorously. Dry your hair gently with a towel, or let it dry naturally. Avoid brushes or combs that pull your hair, and don’t brush vigorously or any longer than you must.
• Don’t heat your hair. Heat can weaken the hair shaft and even damage the follicle. Avoid hot rollers and curling irons. If you use a blow dryer, set it on low heat. Use a hat to protect your hair and scalp from the sun.
• Don’t use chemicals. Anything that dries the hair weakens it. So don’t color, bleach, or perm your hair. Wear a swimming cap to hold off pool chemicals.
• Don’t go on a crash diet. That can result in malnutrition and throw off the growth-rest cycle.
NOT TONIGHT-I’LL GET A HEADACHE
Question: I sometimes get a headache during sexual activity. Your report on special imaging tests mentioned that as one reason to see a doctor. Why ?
Answer: To rule out the unlikely possibility of a brain tumor or aneurysm, which can cause headaches during certain types of exertion, such as coughing, bending over; straining during a bowel movement, or having sexually. More likely, though, your headaches reflect muscle tension or vascular changes that occur as orgasm nears. “Benign sexually headache,” as it’s called, most often strikes when the victim is tired, under stress, or having repeated intercourse. Some people first notice a dull ache at the back of the head.
If your headaches follow that pattern and a CT or MRI scan shows nothing wrong, you may be able to avoid trouble by taking a breather when you suspect an impending attack or by skipping sexually during susceptible times. The prescription drug propranolol (Inderal) can usually prevent sexually headaches, but it can also diminish potency or impair orgasm. Some people are helped by migraine medications.
Question: What causes the brief but excruciating headache you get when you eat ice cream too fast?
Answer: Sudden, intense facial pain can follow the application of any ice-cold substance to the back of the mouth and the upper part of the throat. Apparently, cold triggers a reflex spasm of the blood vessels there. The pain may result from interrupted blood flow to the tissues. Similar pain can occur in sub-zero temperatures.
Health handbook introducing you to read the article: FOOT AND LEG PAINS: BONE SPURS
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