DocSpot: Hair loss

Three questions about hair loss this week. If you have other queries about baldness, take a look at our section on Hair loss.

Dear Dr Margaret
Can wearing a baseball cap cause baldness and thinning of hair? I have been told it can. Men who wear a baseball cap all the time end up bald, especially on the top of the forehead.

I don’t think that wearing a baseball cap (or any other type of hat) causes baldness. It may simply be that some men who think they are becoming bald feel ultrasensitive about it, and wear a cap as a cover-up. By the time other people notice their hair loss, they have been wearing the cap for some time, so people might think the cap was the cause.

There is one other possibility. If you are in the habit of ramming your cap on tightly, and then tugging to take it off, you could be breaking the hairs at the front of your hairline. This could give the impression of hair loss. The broken hairs would be easy to see if you look closely.

Dear Dr Margaret
Can hair gels and pomades cause baldness?

No, the normal hair gels and other dressings for hair that you would buy from a pharmacy do not cause baldness. In fact, some essential oils are reported to encourage hair growth in patchy baldness (alopecia areata) – take a look at our new section on Bald patches for more details.

It is certainly true that some chemicals can damage hair, so the hairs become fragile and break. This would make the area look bald. Also, a strong chemical could ‘burn’ the scalp, which would damage the hair follicles and cause baldness. But I think you can be confident that hair gels from a well-known manufacturer will not contain any damaging chemicals.

If you are allergic to one of the ingredients in a hair gel or other dressing, your scalp might become inflamed and there might be some temporary hair loss, but this is a very unlikely scenario.

Dear Dr Margaret
I am a 30-year-old woman. I have been suffering from male pattern baldness for almost 10 years. I have a bald area on top of my head, which I manage to cover with my hair, but I find it hard to cope with. To make things even worse, I have excess body hair on my arms, legs and face and I suffer from acne. I am terrified of relationships with men in case they hurt me for being this way.

From what you say, it is unclear whether or not you have seen a doctor about your problem. I strongly urge you to do so. You need a check-up and some hormone tests to sort the problem out.

The most likely cause is polycystic ovary syndrome (known as PCOS). This is a fairly common condition that affects 5-10% of all women, some only mildly. In PCOS, the hormones have become slightly out of balance. It causes hairiness, acne, weight problems, and scanty or irregular periods. It can also cause loss of hair, but this is usually at the sides of the forehead, rather than on the top of the head. Women with PCOS have a higher risk of diabetes and arterial disease later, so your doctor will do a blood sugar test. There is more information about PCOS in our section on Hairiness in women.

Your doctor will decide whether you do have PCOS, or find out if there is another reason for your hair loss. If you do have PCOS, your doctor will probably prescribe a hormone drug called cyproterone acetate to correct the hormone imbalance. This will reduce hairiness and acne. However, losing any excess weight is also very important.

Dear Dr Margaret
After years of going bald from the age of 18 (I’m male, and now 23), I have spent over £7000 on lotions, transplants and hair weaves. None have given me any worthwhile confidence in the outside world and I still continue to wear a baseball cap when I go out. Most treatments, if not all, are a complete waste of money, which I totally regret now. The money would have been better spent somewhere else, but places give you false hopes that the impossible can be achieved. I feel cheated, not only out of my youth, but out of my money as well.

Thank you for this comment. I feel quite angry about all the so-called ‘cures’ for baldness that are touted in magazine and newspaper ads and, especially, on the internet. People are being fleeced of their money, and end up angry and disappointed, as you describe.

There is nothing wrong with male baldness. It’s not a disease, it’s perfectly natural, and it shows you have male hormones flowing through your bloodstream. Of course, the problem is how you feel about yourself, how you feel people react to you, and perhaps how they do actually react to you.

The good news is that there seems to have been a real change in attitudes over the past 5 years or so. I honestly think people hardly notice baldness now, because so many men shave their heads simply to look good. (Thank you, Beckham.) But I think it will take a while for many bald men to recover their self-esteem, because of the jokey attitudes to baldness that prevailed until recently. Meanwhile, a lot of people are making money out of the situation.

It’s ironic that just as baldness is becoming totally acceptable, there are a couple of remedies that do work – minoxidil (lotion) and finasteride (tablet). However, they don’t work for everyone, they are costly and if you stop you will be back to square one after a few months. Before starting any baldness treatment, take a calm look at the evidence for its effectiveness and what the likely result will be, and the cost to you in terms of money, hassle and possible disappointment.

The best practical tip is to keep your remaining hair very short – avoid the comb-over at all costs! But, more importantly, actively try to improve your self-esteem, so that your baldness will no longer dominate your life. There are many excellent psychology self help books – look in your local library.

Last updated; Monday, March 29th 2010 at 6:38 am

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