Beavan, Colin New strategies to save your scalp.(male baldness) Esquire v127,n4 (April, 1997):108 (2 pages).COPYRIGHT 1997 Hearst Corporation.

Weitzner, Jay M. Alopecia areata. American Family Physician v41, n4 (April,1990):1197 (5 pages).

Colchamiro, Russ Rogaine gets new Rx competition. (Propecia) American Druggist v215, n2 (Feb, 1998):29 (1 pages).COPYRIGHT 1998 American Druggist, Inc.

Apgar, Barbara Two new treatments for male androgenetic alopecia.(Tips From Other Journals) American Family Physician v58, n1 (July, 1998):212 (2 pages).COPYRIGHT 1998 American Academy of Family Physicians

Hope for the bald.(Propecia) Maclean's v111, n28 (July 13, 1998):62 (1 pages).COPYRIGHT 1998 Maclean Hunter (Canada)

Franzoi, Stephen L.; Anderson, Joan; Frommelt, Stephen Individual differences in men's perceptions of and reactions to thinning hair. Journal of SocialPsychology v130, n2 (April, 1990):209 (10 pages).COPYRIGHT Helen Dwight Reid Educational Foundation 1990



Beavan, Colin New strategies to save your scalp.(male baldness) Esquire v127,n4 (April, 1997):108 (2 pages).COPYRIGHT 1997 Hearst Corporation.

With at least forty treatments for baldness patented in 1996 and $200 million budgeted for clinical trials in 1997, you'd think someone might have figured out by now why men lose hair. But the lab guys know only one big thing: Hair follicles shrink and die. They've proved that this tragedy is triggered by the body's especially potent testosterone derivative, DHT. But researchers can still only theorize about why the perfectly normal presence of DHT leaves some otherwise healthy men mourning their hair as it swirls down the drain.

According to Houston researcher Dr. Peter Proctor DHT fouls up the "grow hair" and "shed hair" mechanisms in follicle cells. The good guys, Proctor postulates, are nitric oxide (NO) molecules that are secreted from nearby blood-vessel walls. They trip the cellular "grow hair" switch. The villain is superoxide--a highly reactive chemical produced by immune cells that accumulates around hair follicles. Superoxide throws the "shed" switch.

Even healthy follicles release their hair about every four years, but balding men shed more often. Their follicles, when DHT attaches to them, may excrete a protein that is not recognized by the body. The immune system then sends in the cavalry, triggering the release of more superoxide. "It's like when a transplanted organ is rejected," says Proctor. It's bad enough that superoxide throws every shed switch in sight, but it seems to react with nitric oxide to form toxic chemicals that irritate the follicles the way a strong bleach burns the skin.

Under this onslaught, a balding man's follicles shrink and sicken until the growth cycle is reduced from four years to a pathetic four months. To add to the outrage, their shrunken size makes for fine and uncolored hair, baby fluff that can never camouflage a shiny pate.

According to Dr. Ken Washenik, director of dermatopharmacology at NYU Medical Center, such a process may not be reversible. "I am much more optimistic," he says, "that we can stop hair loss before it happens." The moral is that hair-loss treatment should begin before bare skin appears. Men seeking to hold their hairline are now turning to three main drugs.

MINOXIDIL

The now-ubiquitous minoxidil was first approved in 1979 as a blood-pressure medication. Unfortunately for women, who preferred their faces hairless, it made some people sprout hair everywhere. When topical application showed localized hair growth, the drug was rolled back into the lab and rolled out ten years later as Rogaine. Absorbed through the skin, minoxidil probably mimics NO, throwing the follicles' grow switches. In trials, it promoted moderate regrowth on only 39 percent of the men who used it for a year. But because it remains the only FDA-approved hair-loss drug, it's the bazooka in the balding man's battery. Practitioners like Washenik say it's the best bet for slowing the loss of existing hair.

PROPECIA

The next treatment to grind its way through the FDA-approval machinery, probably within the year, will be Merck's promising finasteride tablet, Propecia. Finasteride inhibits the enzyme that turns testosterone into DHT--the first domino in the chain reaction that ends in follicle death. It first appeared in the guise of Proscar, a drug that combats prostate enlargement, another problem caused by DHT. Merck's trial results have raised high hopes for Propecia's effectiveness: More than half of those treated had "clinically significant increases in growth of new hair." Some baldsters, wanting to get the jump on the approval process, are already cadging prescriptions for Proscar from their physicians.

TRICOMIN

Developed at ProCyte in Kirkland, Washington, Tricomin is expected to come out in the next year, too, not as a drug but as an additive in shampoos and conditioners. Early trials of a Tricomin topical solution resulted in 40 percent denser hair growth in 80 percent of participants, but its approval by the FDA could be years away. The copper-peptide compound may neutralize the superoxide that makes follicles shed. Meanwhile, some balding men already slather on another of ProCyte's copper-peptide compounds, Iamin, an over-the-counter gel originally developed to help heal wounds.

As these new drugs head toward FDA approval, experience has already shown that they often work best in combination, each combating a different facet of the balding process. While finasteride, for example, prevents further DHT damage to follicles, minoxidil coaxes those already weakened into growing good hair again. Thus, some practitioners prescribe minoxidil and Proscar together. Other physicians tout proprietary mixtures. Proctor's laboratory produces Proxiphen, a prescription of compounds that mimic the NO grow message, neutralize superoxide, and prevent DHT formation. In New York, Dr. Adam Lewenberg supplies a prescription hair-spray combining minoxidil with the antiaging skin treatment Retin-A, which seems to assist absorption. He claims that his combination grows new hair in go percent of patients.

Before you pester your doctor for prescriptions, however, beware the risks of using drugs "off-label"-- for purposes other than those they were approved for. Proscar, for example, was developed for use in older men; its long-term safety in younger men has not been established. So for now, you might want to stick to Rogaine.

Or you could join the likes of Michael Jordan and Patrick Stewart and be cool with your heritage.

RELATED ARTICLE: The Hair Net

Hair-challenged guys now chatter via the Internet about dosages, doctors, and treatments. At the Internet newsgroup alt.baldspot, members post a hundred or more messages a day, sometimes making cryptic arrangements to score Proscar prescriptions for one another. But in its more high-minded moments, the group provides a forum where baldness researchers mix like gurus among the masses and hair-loss anxiety recedes like, well, a balding man's hairline.

RELATED ARTICLE: How to Let It Go Gently

HE MAY HAVE ALL IN HOLLYWOOD, BUT IS MATTHEW McCONAUGHEY starting to lose it?

"Did you see him in A Time to Kill?" asks Losi, who cats men's hair at Pierre Michel ID New York. "Matthew is going to lose his hair so fast. . . the poor thing."

Losi, who has trimmed the likes of Paul Newman, Harrison Ford, and Liam Neeson, as well as countless men for Esquire's fashion shoots, says it's easy to spot the first signs of trouble up top: Your widow's peak starts to go, or your hair becomes a subtle shade lighter and thinner. Here are four strategies she deploys to help you cope with loss:

THINK ABOUT PARTING WAYS. If you've always worn your hair straight back, consider parting it; or, if you part it already, try moving the part to the other side. "The way you've worn your hair is just not going to work anymore," Losi says. By changing the way your bar lies, you'll be ebb to push it slightly forward and make it look thicker.

NO SHAGGING ALLOWED. When men think they're losing their hair, they panic and grow it long. "But that's the worst thing you can do," Losi says. She recommends a shorter cut, one that won't weigh your hair down: "It'll look fuller, no question."

But be warned. "Women love long hair on men and always want their man's hair longer," she says. Consider a little talk before you take it off. Losi recalls that for one client an impromptu cut almost led to a divorce. "I'm not kidding," she says.

USE, BUT DON'T ABUSE. Gels and mousses work fine for thickening your hair, but be sure to dry your hair with a towel before applying them. "If you don't," she cautions, "you'll get that Gekko look going. It's not attractive."

DON'T BE AFRAID TO DYE. "We're not talking peroxide," she stresses. "We're talking vegetable dyes." Using one that matches your hair color is a seamless way of adding body to hair; the dye bonds to each strand, giving you a fuller look. Men are a little jittery at first she says, but "once they do it, they love it."

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Weitzner, Jay M. Alopecia areata . American Family Physician v41, n4 (April,1990):1197.

Abstract: Alopecia areata is a condition involving hair loss in one or many areas of the scalp for no identifiable reason. It can affect men or women, and is most common in people between the ages of 20 and 50. Sufferers from alopecia totalis lose all their scalp hair, and victims of alopecia universalis lose their body hair. Alopecia areata usually begins with hair loss in one patch on the scalp, then involves other patches. Some areas of baldness may regrow hair. The hairs at the periphery of the widening bald patch are tapered and lighter toward the base and called 'exclamation point' hairs. Signs of inflammation can be seen in microscopic sections of skin from the affected region. Alopecia areata may be familial and is associated with certain diseases, such as Down syndrome and certain thyroid diseases. Nail changes may also occur. Since the condition has a high relapse rate, the success rates of different treatments are hard to evaluate. Triamcinolone acetonide, injected into the affected area, corticosteroids, and minoxidil (Rogaine) are often used. These agents do not produce continued regrowth after the patient stops using them, and side effects may occur. An allergic contact dermatitis (local allergic reaction) may also induce hair growth as may the application of ultraviolet irradiation. Drugs that stimulate the immune system have also been found effective. Since alopecia areata leads to physical changes that many people find distressing, physicians should offer support and make patients aware of the support groups that exist. (Consumer Summary produced by Reliance Medical Information, Inc.) Abstract: Alopecia areata is an asymptomatic, nonscarring hair loss with spontaneous remissions and exacerbations. Although the etiology is unknown,the disorder is associated with vitiligo, atopy, pernicious anemia, Downsyndrome and thyroiditis. The area of hair loss may remain localized or mayinvolve the entire scalp or all body hair. Treatment is difficult to assessbecause of individual response and spontaneous remissions, as well as a highrate of relapse. intralesional injection of corticosteroids is the most commonmode of treatment, although systemic steroid therapy, contact allergens,minoxidil, psoralens plus ultraviolet light, and other agents have been tried.COPYRIGHT American Academy of Family Physicians 1990.

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Colchamiro, Russ Rogaine gets new Rx competition. (Propecia) American Druggist v215, n2 (Feb, 1998):29 (1 pages).COPYRIGHT 1998 American Druggist, Inc.

Merck has launched Propecia (finasteride), the first treatment for hair loss in a pill form. Its approval as a prescription drug follows the December over-the-counter approval of Pharmacia & Upjohn's Rogaine 5%. Both products are indicated only for men. An estimated 33 million American men have male pattern baldness.

Jack Lamberton of NatWest Securities Corp., forecasted peak annual sales of Propecia of $1.5 to $2 billion in a Dec. 19 article in The Wall Street Journal. Meanwhile, sales of 2% Rogaine, a product indicated for both men and women, totaled $81 million in supermarket, drug stores and mass merchandising stores in the 52-week-period ending Dec. 7, 1997, according to Information Resources, Chicago.

With Propecia, it can take three or more months before any benefits are noticeable. And if treatment stops, any hair growth will likely be lost.

Pharmacia & Upjohn says its new, stronger version of Rogaine with 5% minoxidil grows 45% more hair than the regular strength Rogaine, with effects taking place in two months, compared with four months for the 2% strength.

Both Rogaine products may cause side effects such as itchy, dry scalp, while infrequent Propecia side effects relate to sexual function in men. Rogaine 5% may cause facial hair growth in women, while Propecia may cause birth defects. Also, women who are or intend to become pregnant should not handle crushed or broken Propecia tablets.

The active ingredient in Propecia was initially approved in 1992 as Proscar, a treatment for prostate enlargement. It was observed that some patients taking finasteride had some regrowth of hair in areas of male pattern baldness. Propecia contains 1 mg of finasteride as compared to 5 mg for Proscar. Propecia works by inhibiting the conversion of testosterone to DHT (dihydrotestosterone).

Three one-year, double-blind, placebo controlled, multicenter trials of Propecia involved 1,879 men aged 18 to 41 with mild to moderate hair loss of the vertex and anterior mid-scalp regions. In addition, 1,215 of the men with hair loss at the vertex were studied for another year.

Hair count increased during the first year and was maintained in those men taking Propecia for 24 months. Meanwhile, men in the placebo group continued to show progressive hair loss. Of the men studied for up to two years, only 17% demonstrated hair loss while 83% had the same or higher hair count.

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Apgar, Barbara Two new treatments for male androgenetic alopecia .(Tips From Other Journals) American Family Physician v58, n1 (July, 1998):212 (2 pages).COPYRIGHT 1998 American Academy of Family Physicians

The U.S. Food and Drug Administration (FDA) recently approved two new formulations of drugs for the treatment of male androgenetic alopecia: finasteride (1 mg) for oral treatment of male pattern baldness and minoxidil (5 percent), a topical solution for over-the-counter use. A lower strength of topical minoxidil (2 percent) is currently marketed for use in both men and women. Consultants for The Medical Letter on Drugs and Therapeutics reviewed the data on the new formulations.

Finasteride is a specific inhibitor of type II 5 [Alpha]-reductase, preventing the conversion of testosterone to a more potent metabolite, dihydrotestosterone. It is known that male pseudohermaphrodites with genetic deficiency of 5 [Alpha]-reductase do not lose their hair. After a 1-mg dose of finasteride, serum concentrations of dihydrotestosterone decrease by 65 percent within 24 hours. Finasteride is well absorbed and has a half-life of five to six hours. The 5-mg tablets have been reported to cause erectile dysfunction, gynecomastia, severe myopathy and loss of libido in older men. Adverse events are reduced with the 1-mg tablets.

Because of teratogenic effects in animals, women of reproductive age are warned not to handle crushed or broken tablets. To date, no clinical studies of finasteride for treatment of hair loss have been published, although the results of three double-blind trials have been presented as abstracts. In two studies, 1,553 men with male pattern baldness took 1 mg of finasteride or placebo for one year. After one year, men taking the active drug had an average of 107 more hairs (a 12 percent increase) in a one-inch diameter circle on the scalp than did those who took placebo. Hair counts were maintained up to 24 months in the men who continued active drug therapy. In the other study of 326 men, those who took finasteride had significantly higher hair counts in the frontal area. However, 30 percent of the men taking placebo said they believed their appearance had improved.

Although its mechanism is not completely understood, minoxidil appears to have a direct effect on hair follicles, which increase in size with treatment. Serum concentrations are much lower after topical application than with use of oral minoxidil. Four unpublished studies presented to the FDA compared preparations of 2 percent and 5 percent minoxidil with placebo. The studies in women found no difference in net hair gain between the two active drugs. In men, new hairs increased by five per [cm.sup.2] in the placebo group, 30 per [cm.sup.2] with 2 percent minoxidil and 39 per [cm.sup.2] with 5 percent minoxidil. When the drug therapy was stopped, the newly regrown hairs were shed. In one double-blind study, topical use of 2 percent minoxidil caused significant increases in left-ventricular end-diastolic volume, cardiac output and left ventricular mass. No studies on the safety of 5 percent minoxidil have been published. Local reactions such as erythema have been reported. Oral minoxidil is associated with hypertrichosis of the fetus and multiple congenital anomalies.

Medical Letter consultants conclude that both 5 percent minoxidil topical solution and 1 mg oral finasteride can produce a modest increase in hair in young men with mild to moderate hair loss, but both medications must be continued indefinitely to maintain the effect. The long-term safety of either formulation has not been determined. The slight difference in new hair growth between the old 2 percent minoxidil solution and the new 5 percent minoxidil solution does not justify the higher cost and the increased risk of adverse events.

Medical Letter consultants. Propecia and Rogaine Extra Strength for alopecia. Med Lett Drugs Ther February 27, 1998;40(1021):25-7.

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Hope for the bald.(Propecia) Maclean's v111, n28 (July 13, 1998):62 (1 pages).COPYRIGHT 1998 Maclean Hunter (Canada)

For the first time, a drug that can help many balding men regrow at least some of their missing hair is available in Canada. According to Kirkland, Que.-based Merck Frosst Canada Inc., Propecia works for about two-thirds of men afflicted by male-pattern baldness, which can begin eroding the hairline in men in their 20s and eventually affects about 70 per cent of Canadian men. Dr. Jerry Shapiro, director of a hair research and treatment centre at the University of British Columbia, said that in clinical trials of the drug, about six per cent of the men tested experienced "dense" regrowth of their hair, while about 60 percent had mild to moderate regrowth. The pill has to be taken daily, at a cost of about $1.50 each; if discontinued, hair loss will return. Merck Frosst officials said the pill is largely free of side-effects, but noted that fewer than two per cent of the men tested experienced a loss of sexual desire and a decrease in semen production.

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Franzoi, Stephen L.; Anderson, Joan; Frommelt, Stephen Individual differences in men's perceptions of and reactions to thinning hair. Journal of Social Psychology v130, n2 (April, 1990):209 (10 pages).COPYRIGHT Helen Dwight Reid Educational Foundation 1990

Abstract: Data obtained from 91 American male respondents, ranging in age from 23 to 66 years of age, indicated that a personality trait, public self-consciousness, pertaining to habitual attention to and concern for public self-aspects, was related to both perceptions of men with thinning hair and reactions to one's own thinning hair. Men with high public self-consciousness were not only more likely to believe that balding men were less attractive, but were also more likely to believe that balding men were less desirable romantic partners for women. Furthermore, faced with their own hair loss, they expressed greater concern and were more willing to try prescription hair remedies to grow thicker hair than were their low self-consciousness counterparts. Despite the concern that hair loss appears to cause many men, there was no evidence that the onset of hair loss caused changes in level of public self-consciousness.

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