Middle age is a time of many ironies – like increasing wisdom amid shrinking job options – but one of the most medically bizarre is this: At midlife, we start losing hair where we want it and start growing it where we don’t.
Many men, especially those with genetic bad luck, start growing hair on noses and ears just as they lose it on top.
Many women, smooth-faced for decades, look in the mirror one menopausal morning and discover – gasp! – a mustache, enough chin hairs to make up a small beard and maybe even sideburns.
To be sure, too much hair or hair in the wrong places is a problem for millions of Americans, regardless of age. In fact, we seem to be on constant hair alert.
We shave. We pluck. We bleach. We wax. We zap. We slap on creams that turn hair to jelly. Soon, those of us with a lot of both hair and money, may explode away those pesky hair follicles a new way – with lasers.
This obsession – and the booming hair removal business it supports – will likely sprout new growth as Baby Boomers hit midlife and discover hairy ears and unladylike beards.
Doctors have long known that women can develop excessive hairiness, or hirsutism, early in life from genes that cause high levels of male hormones or from diseases like polycystic ovary syndrome that make them overly sensitive to normal, low levels of male hormones in their bodies.
But nobody really understands what triggers the crazy hair growth of midlife – for men or women.
For men, the most important predisposing factor for hairy ears or nasal hair is probably genetics, says Dr. Howard Baden, a dermatologist at Massachusetts General Hospital, though nobody knows why this tendency kicks in as a man ages.
For women, the leading theory is that declining levels of female hormones at menopause trigger the sprouting of facial hair.
But “the fact that female hormones drop is not a real good explanation for why postmenopausal women have more hair on their faces, because they’re also losing pubic hair,” he says.
So what can you do if you find yourself growing hair in the wrong places faster than those Chia pets on TV?
Lots.
– Shaving. This is the cheapest and simplest solution, and, contrary to widespread belief, does not make hair grow back faster or thicker, the American Academy of Dermatology says. For best results, soak skin with warm water, use a shaving gel or foam and shave with, not against, the grain of hair growth.
– Plucking. This is also cheap, safe and simple but it can hurt and take time. For the brave and technologically inclined, there are mechancial plucking devices with rotating springs.
– Bleaching. Over-the-counter bleaches makes hair less visible but don’t get rid of it. In general, dermatologists say, bleaches are safe, but if you bleach facial hair, be sure to use products designed for the face.
– Depilatories. These over-the-counter chemicals break the disulfide bonds inside hair, turning hair to a jelly that you wipe off. Again, be careful with your face – body depilatories are too strong. Depilatories may also cause allergies.
– Waxing. In this age-old method, a thin layer of warm wax is applied, then allowed to cool. When the wax is ripped off, hair comes with it, which – no surprise – can hurt. Waxing lasts several weeks because the hair is yanked from under the skin.
But waxing can cause folliculitis, inflammation of the follicle from which hair grows, and may – rarely – trigger skin damage, as Amy Macdonald of Cambridge found, to her horror.
Thirteen years ago, a day before she was to be a bridesmaid in a wedding, Macdonald decided to have her legs waxed.
“My skin came off,” she says. “It was a bloody mess.” It hurt . . .and there were scars on it for a year and a half.”
– Electrolysis. This is the only safe way to remove hair permanently, according to the dermatology association. But whether it is truly permanent is debatable and the US Food and Drug Administration, which regulates medical devices, is re-evaluating its policy on the matter.
During electrolysis, sterilized needles are passed down the hair shaft to the follicle. It can be painful, though Cambridge electrologist Judy Feiner says, “I have people who can fall asleep during treatment.”
When electric current is applied, the hair root is destroyed. But because hair grows in cycles and the needle doesn’t always reach the root, the process can take many treatments.
Success also depends heavily on the skill of the operator; in the wrong hands, electrolysis can cause scarring and infection, which is one reason that Massachusetts and some other states require that electrologists be licensed.
And because electrolysis destroys hairs one by one, costs are high. This year, Americans are expected to spend $ 1 billion on electrolysis, and per patient costs can run to hundreds or thousands of dollars.
One 44-year-old Newton woman, for instance, began growing a mustache during pregnancy, as many women do. In one year alone, she spent $ 500 on electrolysis – to little avail.
“They give you the impression that after five growths of the same hair, you can kill it,” says the woman, who requested anonymity. “But it was still growing in after a year.”
– Lasers. The hair removal trend of the future, at least according to laser scientists, is lasers because “large areas of hair can be treated at once,” says Dr. Roy Geronemus, director of the Laser and Skin Surgery Center in New York.
So far, the FDA has approved only one hair removal laser, a device made by ThermoLase in San Diego, and clients must go to a special salon, Spa Thira in La Jolla, for treatment. Other spas are expected to open this year, though not in Boston.
In the ThermoLase system, hair is removed by waxing to open a path to the follicle. Then a black, carbon-based cream is spread on the skin. The carbon seeps into the follicle, the laser heats the carbon and the follicle explodes.
Not a pretty process, and not a entirely pain-free one either – for the skin or the wallet. In fact, laser removal of a woman’s mustache costs $ 1,400, according to the company price list, and zapping away her chin hairs costs $ 2,300.
There is also a theoretical concern that lasers could destroy the pigment in skin, leaving white spots, laser researchers say, though this risk is probably only about 1 percent.
One client who has tried laser hair removal, a California man named Paul who did not want his last name used, says he has spent $ 1,500 for three treatments on his upper back and neck.
Because he had a lot of hair, the waxing “was painful,” he says. “You don’t pass out, but it’s not fun.”
By comparison, he says, the laser treatment itself didn’t hurt much. In most spots it merely tingled or felt like a rubber band snapped on his skin.
So far, he says, each treatment has kept about 50 percent of his hair from growing back – roughly the success rate that Dr. Rox Anderson, research director for the Massachusetts General Hospital Laser Center, has found in two pilot clinical trials.
In one study of 13 people, Anderson found that a ruby laser made by Spectrum Medical Technologies in Natick produces a delay in hair regrowth of about six months. In another study, Anderson got similar results with a different laser, plus a cream containing ALA (aminolevulinic acid), a natural substance that makes cells, including hair cells, sensitive to light.
So far, he says, laser hair removal has not been directly compared to electrolysis or proved to be permanent.
But Dr. Melanie Grossman, research director at New York’s Laser and Skin Surgery Center says the hope is that “lasers will prove to be more efficient than other methods of hair removal, though we don’t have the answer to that yet.”
Laser treatments do appear safe, however, have not caused scarring or permanent changes in skin pigment and should get cheaper with time, says Anderson. And if the Spectrum laser under review by the FDA is approved, the technique could be available in Boston soon.
Still, he cautions, laser hair removal, like electrolysis, is not an intrinsically gentle process. Both methods are designed “to destroy living cells in hair follicles. . . God did not intend this to happen.”
So does this mean Boomers who sprout hairy ears and postmenopausal beards should just go back to shaving?
No, he says. If you’re sure you never want that hair again, go ahead and zap it – one way or another – forever.
But if you’re not sure, simple solutions like shaving may be the answer. After all, he says, “shaving is elegant, and it’s kind of fun.”
To learn more
To check whether your hair removal specialist is licensed, you may call:
– For electrolysis: The Board of Registration of Electrologists, 727-3080.
– For waxing: The Board of Registration of Cosmetologists, 727-3067. (This board also licenses estheticians).
– For lasers: Rules vary from state to state, but laser hair removal usually must be done physicians, nurse practitioners or physicians’ assistants. A state board cannot tell you whether your health care professional has had special training in lasers; it can tell you whether he or she is licensed.
The Board of Registration in Medicine (doctors) may be reached at 727-3086; the Board of Registration in Nursing (nurses and nurse practitioners) at 727-9961; and the Board of Registration of Physicians’ Assistants at 727-3069