FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER WITH THINNING HAIR UNLIKELY TO BE AS BALD AS HER GRANDMA

Question: I'm a 36-year-old woman, and I'm worried about becoming as bald as my grandfather. My hair is definitely thinner than it was a few years ago. My doctor wasn't very helpful when I explained my concerns to him. Do you have any suggestions about how I can determine if I'm going to go bald, and if so, what I can do to prevent it?

Answer: Hair serves several important, but not essential, functions. It provides important insulation for the head, as bald-headed old men like myself are reminded every time we go outside in the winter without a hat. Hair's role in temperature control is important -- but seldom critical -- as part of your body's overall efforts to keep its various regulatory processes "on track."

Hair's most important role, then, is in its contribution to self-image. Hairstyle, when considered in reference to society, is an important clue to how you view yourself and how you want to interact with others. This is much like the impact on our interpersonal interactions made by the style and color of clothing we choose to wear. Consequently, the loss of hair has impact upon one's self-image. Since this change is not planned, it is generally viewed as undesirable.

Both men and women lose hair for a number of reasons. The most common culprits are anemia, low thyroid levels, infections of the scalp, hormonal disorders involving estrogens and androgens, autoimmune diseases and a serious illness of any cause. The vast majority of male and female hair loss, however, can be directly traced to your heredity. If your parents and grandparents had thin hair or bald heads, you probably will too. Consequently, your family photo album is a helpful tool in predicting your risk.

There are some subtle differences between men and women in the common hair loss patterns that come -- almost universally -- with advancing age. Men usually have recession of their hairlines at the forehead, while women typically do not. Both have a decrease in the number of hairs on the top of the head while simultaneously having a much smaller decrease in the hair count on the sides and back of the head. Men also have a substantially greater chance of losing all hair from the top of the head rather than the just experiencing, as is typical of women, a general "thinning" throughout that region of the head. So it's unlikely that you'll end up looking like your grandfather.

Since your doctor didn't offer you much help, I'd suggest that you see a dermatologist. He or she will probably want to do some blood tests to be sure that you don't have one of the conditions like iron deficiency anemia that requires specific treatment. If you have the common inherited disorder that I've talked about, we doctors will then call your condition "pattern alopecia." Currently there is only one medicine that works safely for this disorder -- minoxidil applied to the scalp every day. This works to maintain the present hair count in most women (and men), and some even grow more hair. It is available without prescription. Its major drawback is that it doesn't cure the underlying condition. When you stop using it, hair loss resumes.

There are other medicines that are being evaluated in research programs for women with pattern alopecia, but these are not available yet. One of these is the drug finesteride that has proven of benefit for men, but it can cause birth defects. Therefore, it can't be used by women of reproductive age. You should also be aware of the influence of other drugs on this condition. For instance, women who take birth control pills should be on "estrogen dominant" pills, and older women on hormone replacement therapy should take the lowest dose of progestin. This minimizes the level of the hormones that tend to promote hair loss. Talk to your family doctor or dermatologist. He or she can advise you about these treatment choices.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.