Bad hair days happen to us all but when hair loss becomes a real problem it can have a devastating impact on self-image and mental health.
Deborah Whelan, a trichologist or specialist in hair and scalp health, operates and manages the Galway Trichology Clinic and is a lecturer in hair science. During her 30 years of experience she has learned that the psychological impact of hair loss – alopecia, to give it is medical name – can be “destroying”.
“We are told that hair is your crowning glory,” she says. “That’s true for women but equally for men, who can begin to suffer from male-pattern baldness as young as 14, and it is just heartbreaking. It changes their behaviour at home, their view on life and their view of themselves.”
Initial consultations can be difficult – Whelan says patients invariably find it hard to even talk about their hair loss. “They are desperately unhappy and they only begin to open up when you give them some information and some hope but even at that they can be so angry.”
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Hair loss is surprisingly common in women – 75 per cent of Whelan’s patients are female. “There’s just far more that women can do to conceal the problem,” she points out. “They can get hairpieces known as ‘toppers’ or even just clip it up and hide it that way.”
Trauma or illness can also cause significant hair loss, she notes. “Anything that has shocked your system can do it – if you haven’t been eating properly your body will prioritise health over hair and detach a number of hair follicles from the blood supply and over the course of a few months release them.” she explains, adding that Covid-19 has been a trigger for significant hair loss in some people. This can be easily treatable – sometimes the person just needs to take some dietary supplements or perhaps stop their hormonal contraceptive.
Hair loss can cause serious distress, and is even associated with depression. As a result, psychological therapy is now a routine component of the medical management of hair loss
— Dr Kevin McDonald
With male-pattern baldness, there is typically family history – on the maternal side – but other factors such as stress contribute to hair loss, says Dr Kevin McDonald at Tir na nÓg Clinic in Dublin. He explains that he discusses lifestyle and family history with his patients before anything else, to help them understand and perhaps slow down their hair loss.
This means “the solution is then more holistic”, explains McDonald. “A patient’s approach to life and to hair loss is important to consider,” he says. “One size does not always fit.”
He echoes Whelan, saying hair loss can have a profound impact on a man’s sense of identity and self-worth. “Unfortunately, the stress caused by hair loss can exacerbate the problem,” he adds, noting that two thirds of his male patients are aged between 18 and 35.
“Our hair holds extraordinary symbolic importance in our society, representing youth, health, and self-expression. Hair loss can cause serious distress, and is even associated with depression.” As a result, psychological therapy is now a routine component of the medical management of hair loss.”
McDonald points out that men who are looking for treatment for their hair loss may find it equally frustrating and upsetting when trying to find the best option for them. “There is also a lot of time potentially wasted on wading through all the information online, trying to decipher what is fact and what is fiction,” he says.
The good news is that there are effective medical and surgical solutions available. Minoxidil (more commonly known as Rogaine/Regaine), when used at the optimal strength is extremely effective, Whelan notes. “It will help to slow down considerably the hair loss or even stop it,” she says. “It’s actually not hair fall that’s the problem, it’s a miniaturisation of the hair follicle until the hair becomes thinner and thinner so there is a reduction in the cosmetic value of the hair. As long as you wait a few months, minoxidil used at the right strength will increase the growth and coverage and even the lifespan of the hair.”
Whelan also uses low-light laser therapy, or LLLT, which she says is also very effective at restoring hair volume and she believes it will be used more widely in the coming years. Another medication called finasteride is also effective but must be used on an ongoing basis and carries the risk of some side effects, says McDonald.
Surgical treatment involves removing hair from a donor area, typically the back of the head, and placing it in the area you wish to treat – the recipient area. McDonald explains that careful assessment of a patient’s suitability for a hair transplant must take place in person so that there is a good match between how much hair is removed from the donor area and how much hair needs to be placed in the recipient area.
Follicles are removed individually, although he notes there is a limit to how much hair can be removed without this being detectable. “Over harvesting in the donor area must be avoided at all costs,” he says. “Assessment of the quality of the donor area must take place before the surgery and takes account of the density of the follicles, the number of the hairs per graft, and the volume of the actual hair available.”
His analogy is to compare the hair to a forest: “Just like the forest, foliage prevents light getting through to the forest floor; we are trying to place enough hair in the recipient area to prevent light getting through to the scalp.”
A hair transplant can cost between €2,000 and €4,000 but it is not suitable for everyone. McDonald emphasises the need for careful patient selection.
“Obviously hair transplant surgery is becoming more popular just as many other cosmetic procedures are. But we believe that its growing popularity must carry a warning,” he says. “Assessment by the actual surgeon who is about to perform your procedure is paramount to assess your suitability for surgery. This must be done before any procedure is contemplated.”