Baldness (formally alopecia) is the state of lacking hair where it usually would grow, especially on the head. The most common form of baldness is a progressive hair-thinning condition that occurs in adult humans and many other ape species. Stress factors such as a regular lack of sufficient sleep may be able to accelerate the onset of hair loss in genetically prone individuals.
Male pattern baldness is thought to occur in varying forms in about 50% of adult males. It is characterized by hair receding from the lateral sides of the forehead, known as "receding hairline" or "receding brow." An additional bald patch may develop on top (vertex). The trigger for this type of baldness, which is also known as androgenic alopecia, is currently believed to be 5-alpha reductase, an enzyme that converts the hormone testosterone into dihydrotestosterone (DHT), which inhibits hair growth. Onset of hair loss sometimes begins as early as end of puberty, and is mostly genetically determined. Male pattern baldness is classified on the Hamilton-Norwood scale I-VIII.
Female pattern baldness, in which the midline parting of the hair appears broadened, is less common. It is believed to result from a decrease in estrogen, a hormone that normally counteracts the balding effect of testosterone, which normally occurs in women's blood. Female pattern baldness is being classified on the Ludwig scale I-III.
There are several other kinds of baldness. Traction alopecia is commonly found in women with ponytails or cornrows that pull on their hair with excessive force. Traumas such as chemotherapy, childbirth, major surgery and severe stress may cause a hair loss condition known as telogen effluvium. Some mycotic infections can cause massive hair loss.
The psychological implications for individuals experiencing hair loss varies widely. There can be a general societal anxiety surrounding the process of hair loss, but some individuals view it as nature taking its course.
Some balding men may feel proud of their baldness, feeling a kindred relationship with famous charismatic film actors such as Yul Brynner, Telly Savalas and Patrick Stewart, who have been considered masculine and handsome.
Preventing and reversing hair loss
It is easier to prevent the aging and falling out of healthy hairs than to regrow follicles that are already dormant. However, there are products that have good success rates with maintenance and regrowth, including the FDA-approved Propecia, Rogaine, and Tricomin. Baldness may be cured through prospective treatments such as hair multiplication/hair cloning or gene therapy in the next five to ten years.
The following treatments are some of the most prominent. Generic brands, with the same active ingredients, may be equally effective and are often cheaper. Articles on potential risks in some of these products can be found at www.hairloss-reversible.com.
- DHT Inhibitors
- Systemic (Inhibit production of DHT through the entire body)
- Topical (Applied to the scalp to inhibit DHT levels only in the scalp)
Minoxidil (Potassium channel opener: regrowth stimulant; thickens hairs) Brand name: Rogaine.
- Copper peptides (Topical; shorten resting phase of hairs, resulting in more hair follices on the scalp being in the growing phase (as opposed to the resting or falling out phase) at one time) Brand name: Tricomin.
Antiandrogens (Block DHT from binding with hair follicles)
Retin-A (Retinoic acid; chemical peel stimulation of scalp)
- Nizoral Shampoo (Has antiandrogen properties) or Neutrogena T-Gel
Minoxidil is applied topically to the scalp. Finasteride is taken orally and has a reported 29-68% success rate (vs 17-45% in patients receiving a placebo). Both are effective only for as long as they are taken; the benefit is lost within 6-12 months of ceasing therapy (Rossi, 2004).
Surgery is another method of reversing hair loss and baldness, although it may be considered an extreme measure. The surgical methods used include hair transplants , where patches of skin with hair are moved from one part of the head to another. Another method is scalp reduction , where parts of the scalp are removed, the skin is stretched over the area that had been removed, and everything is stitched back together.
Stem cells have been discovered in hair follicles and some researchers predict research on these follicle stem cells may lead to successes in treating baldness through hair multiplication within three or four years (as of November 2004). This treatment is expected to initially work through taking stem cells from existing follicles, multiplying them in cultures, and implanting the new follicles into the scalp. Later treatments may be able to simply signal follicle stem cells to transmit chemical signals to nearby follicle cells which have shrunk during the aging process, which respond to these signals by regenerating and once again making healthy hair. 
Interestingly, placebo treatments in studies often have high success rates, though not as high as proven products, and even similar side-effects (such as sexual dysfunction) as the FDA-approved products . Proponents of alternative and herbal medicines believe that the majority of cases of hair loss that progress despite treatments do so because the people believe no such cure can occur. In this view, this belief, which is prevailing in the modern civilised world and continuously reinforced by medical science, is the main obstacle for effectively finding and applying a cure.
Concealing hair loss
One method of hiding hair loss is the comb-over, which involves restyling the remaining hair to cover the balding area. It is usually a temporary solution, useful only while the area of hair loss is small. As the hair loss increases, a comb-over becomes less effective.
Another method is to wear a hairpiece - a wig or toupee. The wig is a layer of artificial or natural hair made to resemble a typical hair style. In most cases the hair is artificial. Wigs vary widely in quality and cost. The best wigs - those that look like real hair - cost up to tens of thousands of dollars. Organizations such as Locks of Love and Wigs for Kids collect individuals' donations of their own natural hair to be made into wigs for young cancer patients who have lost their hair due to chemotherapy or other cancer treatment.
Of course, instead of concealing hair loss, one may embrace it. Many celebrities and athletes shave their heads. The St. Baldrick's Foundation spreads the message of baldness by shaving the heads of adults to raise money for curing childhood cancer, which often causes children to lose their hair. See Head shaving.
Common baldness myths
There are many myths regarding the possible causes of baldness and its relationship with one's virility, intelligence, ethnicity, job, social class, wealth etc. Most of them can be dismissed by the existence of many counterexamples or by a lack of sufficient scientific research.
Some of these myths are:
- "Intellectual activity or psychological problems can cause baldness."
This myth probably was inspired by the fact that the human brain is located inside the skull, very close and just below where hair grows, and so it was thought that the use and abuse as well as mental diseases could have negative effect on hair growth and number.
This is sometimes used as a stereotype in movies, where the more intellectual or rather frustrated characters are most usually portrayed as bald and generally unattractive, as opposed to the main characters which are usually portrayed as attractive, fit, mentally stable and generally with no apparent hair problems.
This same myth normally extends to considering people having intellectual jobs more prone to baldness problems compared to manual laborers, sometimes further extending the myth to male college or university students when compared to workers of the same age. The myth is suspect because counterexamples can be found in any case.
- "Baldness can be caused by emotional stress, sexual frustration etc."
While emotional stress can have a part in causing baldness, again it is easy to find counterexamples like non-frustrated and non-stressed people with hair loss problems as well as stressed and/or frustrated people with no hair loss problem at all. This myth also suggests that a vicious circle between hair loss and emotional stress/sexual frustration can take place, although only one part of it can be scientifically explained (hair loss causing low esteem and then frustration, but not vice versa).
- "Bald men are more "virile" or sexually active than others."
This myth probably stems from the fact that some forms of baldness in some predisposed individuals are caused by androgens, and removal of androgens (by castration) prevents baldness or stops it from progressing further. Yet counterexamples can be found, like men with perfect hairlines and similar levels of androgens or men with sensitivity to androgens causing hair loss but which are not very sexually active.
- "Shaving hair makes it grow back stronger"
Proposed as a popular remedy against baldness, it's very probably just an illusion similar to the one perceived after shaving one's beard or mustache. Shaving one's head doesn't increase the number of healthy hair present on the scalp, and, when the remaining hair has grown a few millimeters, no enhancement in thickness or overall quality can be observed.
- "Some human races or ethnic groups are less prone to baldness problems then others."
It is true that by observing many pictures of men of European descent and then comparing them to pictures of men of Asian or American Indian descent it is very likely that a random observer will deduce that baldness problems seem to be much more frequent among the "European" group than in the "Asian" one.
Similar observations can be done regarding the people living in most Western countries when compared to people living in "underdeveloped" or Third World countries, but lacking any official anthropological, medical and scientific research to back them up, such observations degenerate into a racial/social stereotype.
A very similar stereotype exists even between the various European ethnic groups, when comparing people of Southern European descent with those of Northern European, Germanic or Slavic origins, with the stereotype summarily describing the "Southern Europeans" as darker-skinned, with more body hair, with the women more prone to cellulite problems and the men more prone to baldness, a stereotype probably developed under times of war or diplomatic tensions between European countries.
Consumer information pages
Hair loss specialist directories