My neighbour Raju, has a lawn that looks lush green all the time. I hardly ever see him water it, use a lawnmower or hire a gardener to take care of his lawn. I on the other hand take great pains to water and move my lawn and still have stubby bushes and dry brown grass all over my lawn. Many times I get the feeling that Raju doesn't even care about his lawn but is blessed with a wonderful one. I am not talking about grass anymore am I? Your neighbour is well into his 40’s with a full head of hair but he doesn't groom it or comb it or even get it cut regularly. You on the other hand have always wanted to have long hair, wash your hair regularly, get a haircut every month, use the best shampoos and still are going bald even before the age of 30!

Androgenetic alopecia can occur in both men and women, and is increasingly seen at younger ages these days. What makes you go bald earlier than the others? The two most important factors are your hormones and your genes.

Hormones are produced by a few specialised cells in the body and have an effect throughout the body. The male hormones mainly testosterone and dihydrotestosterone (DHT) are responsible for all the “manly” attributes like facial hair, body hair, increased oiliness of the skin, more muscle mass, bigger bones and of course losing hair on the head. DHT is known to act on hair roots (follicles) on the top of your scalp and make the oil glands attached to hair follicles larger and makes the hair root smaller. Most balding men would also have experienced their scalp becoming more oily as they bald.

Genetic factors are either passed on from your side of the family or develop as a new feature in you. Both maternal (mother's) and paternal (father's) genes are implicated. Genetics factors predict who are more sensitive to the hormone DHT. Normal levels of DHT are found even in those losing hair and hence it is believed that the hair follicles of people going bald earlier is because they are more sensitive to the hormone.

How can you prevent going bald?

Androgenetic alopecia accounts for about 95% of the cases of hairloss with balding.

If you have good genes and your family members haven't gone bald well into their 50s, you are usually safer. If you have an oily scalp and you wash it regularly it helps to keep to delay your hairloss. Several medicines ranging from shampoos to lotions to tablets are available to block DHT or at least thought to block DHT. Among these the most useful is finasteride. It blocks conversion of testosterone (another male hormone) to DHT.

Finasteride taken as tablets is the most effective medicine for Androgenetic alopecia. However, several people are concerned that it may cause impotence and reduced sperm count by blocking this hormone. Although the possibility is very low, most people these days believe the side effect however small is not worth taking and ask the doctors to give them anything other than finasteride. The phobia to finasteride started like most phobias started in the United States and has now spread to all parts of the tech savvy world.

Shampoos containing ketoconazole also inhibits DHT on the scalp and since it acts only on the skin of the scalp it is a much safer alternative. It is used alone in mild cases where scalp is oily or a person has dandruff.

Minoxidil is the most popular medicine for hairloss which has been used for more than 20 years. It gives results similar to finasteride tablets without the side effects. Many dermatologists prefer using a combination of minoxidil and finasteride to give the best results to their patients. How minoxidil works in hairloss is still not known. There are theories stating that it may improve the blood supply to hair follicles. Minoxidil was used earlier to treat high blood pressure or hypertension and it was noticed to cause improvement in hairloss. It is no longer used to treat hypertension as many newer and safer drugs are available, but it has become the main drug in the treatment of Androgenetic alopecia and certain other types of hair loss

Hair Transplant

Hair transplant is surgical method of regaining your natural hair. Hair from other areas of the body or from other areas of the scalp  that are resistant to DHT are transplanted into the areas where the patient is losing hair.  newer techniques allow for large number of follicles to be transplanted in single or multiple  sessions.  hair transplant surgeons  use different techniques to cover the bald areas with your natural hair.

Newer medicines

Research is on into hairloss and many plant products have been promoted for hairloss therapy. Whether they are really effective remains to be seen. Capexil, stemoxidine and hair peptides show variable response. The amount of hair growth with most of the new medicines is very small to provide any practical benefit to the patient but it helps those who are allergic to minoxidil or find it problematic to use minoxidil. Procedures like PRP (Platelet rich plasma) are widely promoted. However it must be kept in mind that results for new medicines and procedures cannot be guaranteed. They are done for patients who are not satisfied with the growth achieved by conventional means or those who cannot use conventional medicines.

There is always hope!

For those of you going bald, remember that you can be treated. Androgenetic alopecia is a progressive condition and once the roots stop growing hair they undergo what we call perifollicular fibrosis. Follicles which undergo perifollicular fibrosis cannot be stimulated to grow new hair. In simple terms the more bald you get, the lesser effect medicines will have on you. Seek an opinion from a nearby qualified  dermatologist before spending time losing your hair to therapies that show no promise. The right medical therapy will show you response in as less as 3 months.