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Is Hair Loss in Men Hereditary, and What Hair Loss Products Actually Work?

Male pattern baldness is by far the most common type of hair loss and affects the majority of men to varying degrees. Traditionally, it has been held that male pattern baldness can be traced to one's mother's father but this perspective is highly simplified and distorted. In fact, there are many genes for hair loss and the inheritance pattern is complex and derives from both sides of the family.

Unfortunately, hair loss is progressive in nature. The earlier and more rapid the onset of hair loss in a man, the greater likelihood that this hair loss will progress toward extensive hair loss in the not so distant future. Fortunately, today there are medical solutions to manage male pattern baldness, which if started earlier can afford better results. The Internet is filled with hawkers of miracle cures, but there are only two FDA-approved products, finasteride (marketed as Propecia) and minoxidil (marketed as Rogaine) that have proven efficacy.

First, we must understand how we lose hair in order to understand how these products work effectively to combat hair loss. Male pattern baldness involves the slow but progressive transformation from thick, terminal hairs of youth to baby, short, wispy vellus hairs, and then finally to complete absence of hair. When 50% of hair is lost, noticeable thinning begins to be apparent. Finasteride and minoxidil both work toward returning vellus hairs back toward thicker, terminal hairs but they cannot work in the absence of discernible hair, i.e., so-called "slick baldness."

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Accordingly, the earlier in the process of hair loss that these medications are started, the more effective they will be to help slow down and reverse to a certain extent the existing hair loss. If started late in the process of hair loss, they are less effective in managing/reversing the hair loss condition.

The mechanism by which minoxidil works is not entirely clear but it is thought to act as a cellular proliferator or to keep hairs in their growth phase (known as anagen) for a longer period of time. Minoxidil, which is over the counter now, is a topical preparation meant to be applied to the scalp twice daily. Anecdotally, it is thought that the half life of minoxidil in the scalp may be close to 20 hours, meaning that even once a day application can be substantially better than not at all. The package insert reads that minoxidil is only indicated for the crown/vertex region. However, this information is outdated and reflects only the original FDA studies performed over a decade ago. Although new FDA trials were not financed, subsequent studies have shown almost the same benefit in all regions of the scalp.

Minoxidil can lead to temporary increased shedding 3 to 4 weeks after starting the product and that must be known in advance to limit fear on the patient's part. This temporary effluvium correlates with hairs cycling into the growth or anagen phase, which is a good indicator. In addition over 20% of individuals can experience a delayed (less than 72 hours) or immediate allergic skin reaction to minoxidil, which is significantly more common with the generic or brand named liquid version. The foam version that only comes as brand name Rogaine and only in the 5% male strength has virtually eliminated this problem by removing the propylene glycol component. Minoxidil typically starts to show effect rather quickly within 6 weeks to 3 months. As a reminder, hair loss will continue to occur. Minoxidil will simply slow down the hair loss as well as rethicken some miniaturized vellus hairs.

Finasteride, an oral pill taken once daily at a 1 mg dosage, is prescription only and helps to slow down and reverse some vellus hairs. It is a medication that takes typically 4 to 6 months to start showing benefit and unlike minoxidil is only indicated for men, as it can cause birth defects in women of childbearing age who take it and has shown little benefit in women who are postmenopausal. Of note, there is no negative effect on children for men who take the medication and impregnate a woman. Finasteride is a dihydrotestosterone (DHT) blocker, that inhibits the conversion of testosterone to DHT via the pathway of the 5-alpha reductase enzyme. The presence of DHT in the scalp causes hairs that are sensitized to possible loss of hair to lose that hair. Because DHT receptors are partly located within the blood vessels that reach the hair follicle, topical finasteride has not shown to be of commensurate benefit as oral medication.

The major side effect with finasteride is sexual, including erectile dysfunction, loss of libido, and possible breast tenderness and/or growth. The incidence of this side effect profile is 1% when compared against placebo and only shows statistical significance when all side effects are aggregated. Side effects are reversible with cessation of the medication, and 57% of men who continue to take the medication show a resolution of their side effects. 

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Minutes from CAE Spring 2013 Meeting:

The spring meeting was called to order by President Brian Amoroso at 6:30PM. A lecture was given by Dr. Hank Schiffman and the lecture topic was “The Potentials of Non-Surgical Retreatment.”

Dr. Balla presented the minutes of the meeting and the following was covered:

  • Mr. John Pintoro from Global spoke regarding the new LED light that is available that eliminates cords. He went over pricing and warranty. 
  • UConn post-graduate residents were well represented, Dr.Safavi could not attend. The UConn Endo Association paid for their dinners. 
  • Dr.Ken Sunshine will be replaced by Dr. Craig Herschberg from NJ as the District II Director. In 2016 the position returns to CT so we need to start thinking about someone for that position. 
  • Every few years we are required to certify our x-ray units. CT requires that be done by a radiation physicist. Forms were made available with the name of a physicist that had come highly recommended by a CAE member. Information is also available by e-mailing Dr. Amoroso. 
  • Lunch & Learn concept was discussed for November 13, 2013 for the upcoming CSDA meeting.

Nominating Committee proposed Dr. Robert Balla assume position of V.P./President & Dr. Ema Cabral Burke be nominated for Secretary/Treasurer. Nominations were entertained on the floor and were unopposed. Both Dr. Robert Balla & Dr. Ema Cabral Burke were elected to those respective positions of the CAE. (23 members were present and 6 proxy votes were secured to yield a quorum).

Dr. Balla made announcement about AAE convention in Hawaii that was the week to follow April 16th – 20th.

Dr. Balla discussed Mission of Mercy that was to be held June 7th and 8th 2013 at the Webster Bank Arena in Bridgeport, CT. Dr. Bruce Cha would be in charge of the endodontic clinic. Dr. Cha urged people to volunteer as more help was still needed and recommended doctors bring their own staff as staff is not allowed to sign up without their dentist. Dr. Cha also thanked the many UConn residents who participated in the 2012 Mission of Mercy. 5 chairs were being supplied by Sybron Endo & 5 chairs were being supplied by Dentsply. Dr. Phillip Mascia & Dr. Balla both spoke about how rewarding it was for them and their staff to participate in the MOM. The hope is that more endodontists would volunteer in 2013 so that fewer general dentists would be performing endodontics.

President Balla in conjunction with the Hartford Dental Society has secured Dr. Martin Trope for the 2014 Spring meeting on April 8th, 2014.

Newly elected President Balla thanked Dr. Brian Amoroso for his excellent job as past president of the CAE. Dr. Amoroso was recognized with a plaque for his dedication and unselfish service & leadership to the CAE.

President Robert Balla gave a heartfelt speech about how he has been practicing in CT for 24 years and has always felt welcome and how honored he is to accept the position of president of the CAE.

And for the Treasurer’s report: The beginning balance as of April 10, 2013 was $6761.90 and the ending balance as of today October 23, 2013 is $7690.21.

The Spring Meeting was adjourned at 9:30PM and motion was accepted.

Dr. Ema Cabral Burke.

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