Beth Stein, a 39-year-old New Jersey advertising copywriter, began losing her hair at 19 – presumably because of the same bad genes that affect everyone in her family, male and female.
At first, her part just seemed to be getting wider. Soon, whenever she shampooed her hair, she’d wind up with 15 or 20 strands in her hands. Eventually, her hair became so thin it was hard to style it in a way that covered her head.
“When this happens to people, especially to a woman, it’s extremely emotionally distressing and socially crippling,” she says. “I went to doctors. I tried a lot of phony treatments. I cried a lot. It was pretty devastating.”
Then, several months ago, she spotted an ad in the Yellow Pages for a New York doctor touting a new way to make hair grow.
It turned out to be a hair spray made from two drugs already approved by the Food and Drug Administration: minoxidil, the active ingredient in Rogaine, an over-the-counter potion that boosts hair growth in some people, and tretinoin, the chief constituent of Renova and Retin A, prescription-only drugs that combat wrinkles and acne.
Never mind that the doctor’s homemade concoction, though not illegal, had never been tested in controlled clinical trials, so there is no solid proof that it’s safe, and that it works.
Never mind that the doctor isn’t a dermatologist, the type of medical specialist who usually treats hair growth problems.
Never mind even that the physician, Dr. Adam LewenbergCQ, was using an idea originally developed by someone else, Louisiana biochemist and use patent holder Gail S. BazzanoCQ, who has a tale to tell of running afoul of a giant cosmetics company in her quest to get her hair growth product on the market.
Like many of America’s 20 million balding women and 40 million balding men, all that Beth Stein wanted was more hair.
Until recently, at least, that has been a quixotic quest.
Though most of us couldn’t care less until something surprising happens – like waking up one day and realizing a once-robust hairline is drifting out of sight – our hair grows, falls out and grows again in a steady cycle throughout life.
In the growth or “anagen” phase, scalp hair grows for about two years, says Dr. Barbara Gilchrest, chairman of the dermatology department at Boston University School of Medicine.
If you can grow hair down to your knees, it means you have an unusually long anagen phase; if you can’t grow it past your collar, you’ve got a short one. (The reason eyebrows never get very long – in case you were pulling your hair out over that one – is that eyebrow hairs have a very short, 2-month cycle.)
At the end of the anagen phase, the hair follicle, from which the hair shaft grows, enters a short “catagen” phase in which it shrinks back to a smaller size. In the third or “telogen” phase, the follicle just sits dormant for several months.
Eventually, the hair gets loose, falls out, and the cycle begins again. At any given moment, about 90 percent of hairs on the scalp are in the growing phase and 10 percent are resting – and in some lucky souls, this process continues throughout life.
But in many men and women, hair follicles eventually wimp out, probably because of the effect of male hormones called androgens. New evidence suggests a female hormone, estrogen, may be involved, too.
In men, who often have what’s called “male pattern baldness,” thinning starts at the forehead and works its way back, sometimes merging with another bald spot that begins at the crown of the head. Women don’t usually have creeping hairlines, but wind up with thin spots or very sparse hair all over.
With each hair cycle, male hormones activate receptors in the follicle, slowly turning large follicles into small ones that produce only wispy hairs. This process is especially pronounced in people who are genetically predisposed to balding.
“It’s as if the factory wears out,” says Dr. Robert Stern, a dermatologist at the Beth Israel Deaconess Medical Center. “The factory starts to turn out an inferior product, then it just goes out of business.”
Still, there is enormous variation in the degree of hair loss in both men and women. At the same hormone levels, for instance, some men are as bald as the proverbial billiard ball, and some as hairy as the Biblical Samson on a good day.
Eunuchs, by the way, always have lots of hair because they have been castrated and have very low levels of male hormone, a link that was discovered almost 50 years ago in a chance comparison of two twins.
One brother was mentally ill and confined to an institution, where he was castrated. Years later, the other brother went to visit and doctors were shocked – the institutionalized man had a full head of hair while his brother was bald, says Dr. Michael Holick, chief of the BU endocrinology, nutrition and diabetes department.
When the first brother was given hormones, he went bald, too.
Because most guys consider castration a high price to pay for a manly mane, researchers have been hustling to find other options for both men and women with hair loss. Here’s what they’re coming up with: