It may seem hard to believe, but as late as 1942, male patients in some mental hospitals were castrated to quiet them. This extreme treatment did have some scientific basis, since testosterone, the male sex hormone produced by the testes, has been linked with aggression. One of the positive offshoots of this barbaric treatment was the knowledge gained about the effects of testosterone on the body Winfield State Hospital, a mental hospital in Kansas, became an ideal place for Yale anatomist James Hamilton to conduct a study of castrated men. One day, one of the patients who had been stripped of his manhood received a visitor, his identical twin brother. Dr. Hamilton was struck by the fact that the man was completely bald, while the inmate had a full head of hair. Could testosterone have something to do with baldness, the researcher wondered? To investigate this possibility Hamilton got permission to inject the castrated man with testosterone. Within six months the mental patient became as bald as his brother who had been progressively going bald over a twenty-year period. The baldness unfortunately was irreversible, but Dr. Hamilton had demonstrated clearly that testosterone levels could be linked to hair growth.
Of course, no matter how hair-challenged a man may be, he is unlikely to look to castration as a treatment. However, since Dr. Hamilton's observations, the details of testosterone's role in hair growth have been worked out and have resulted in a treatment that does not involve the loss of manhood. It turns out that it is actually a metabolic product of testosterone, known as dihydrotestosterone, that causes hair loss. This is the same substance that also causes enlarged prostates in men. Indeed, finasteride, (Proscar), a medication for enlarged prostates works by blocking the conversion of testosterone to dihydrotestosterone and is also sold at a different concentration as Propecia, a treatment for male pattern baldness (androgenetic alopecia).
Finasteride is not a wonder drug. There is no point in scrutinizing your mirror image the day after initiating treatment, Or the week after. Probably not even a month after. But give it a few months and you may notice something. What? That your hair looks about the same as when you started treatment, meaning that you have sort of hit the “pause button” of hair loss. In one study, 83% of men experienced no change in hair count after two years of finasteride use while only 28% of those on placebo experienced no change. Some men even experience modest regrowth. Finasteride’s efficacy can be improved when used in combination with topical minoxidil, a drug that boosts blood flow to the scalp and encourages follicles to switch to the growth phase (anagen), of the hair growth cycle from the resting phase (telogen). Finasteride is not approved for use by women who experience hair loss because animal studies have shown a link with birth defects. Minoxidil on the other hand can be used by women.
Another interesting possibility that may account for hair loss that has cropped up in the scientific literature is insulin resistance. This occurs when a person cannot respond well to insulin as it is churned out by the pancreas with the result that glucose isn’t absorbed into cells and elevated levels of glucose can damage hair follicles. More and more insulin is then released, and it is the high levels of this hormone that may be linked to baldness.
Unfortunately, in spite of much research baldness treatment leave much to be desired. True, we have come some way since the days of Hippocrates when a potion of opium, horseradish and pigeon droppings was recommended to treat hair loss. Along the way we’ve tried cold tea brushed on the scalp, cow saliva and chicken poop. Still by the age of 40, about 40% of men and 10% of women are going bald. Maybe we should just listen to the Bald Headed Men of America, an organization that maintains that baldness is a sign of evolution and that bald men are further away from our hairy ancestors. Members also believe that “the Lord is just and the Lord is fair; he gave some people brains and the others hair." Hmmmm. We can all think of people who have lots of hair but are lacking in brains.