Bigger and balder

Last week we ended with the Apocalypse. And I am not talking about GMA running for the second district of Pampanga. Maybe.

Because, at the young age of 35 (but pending confirmation), dermatologist Dr. Jun Bormate of the Philippine General Hospital confirmed that my scalp has succumbed to a genetic travesty: the hair on the top of my scalp has started to miniaturize. But no, that is not a manifestation of a super-power. It is the manifestation of Male Pattern Hair Loss (MPHL). Or, as it is known in less polite company: baldness.

But is there hope for my scalp, my three female readers? Or is my baldness as inevitable as GMA winning a congressional seat?

The Truth Continues To Hurt

Philippine STAR: What do you mean I can’t miniaturize my head to match the size of my miniaturized hair? Isn’t that merely a function of biology!?

DR. JUN BORMATE: Your head does not miniaturize. It is just the fiber of your hair on the top of your scalp.

Why is biology so unfair? I’m cursed with a rug of chest hair, but the top of my scalp is engaged in illegal clearing operations. How come I have hair where I need it the least, and have it the least where I need it the most?

That’s the effect of testosterone being converted into dihydrotestosterone, which is responsible for the growth miniaturizing the hair on your scalp but its also responsible for the growth of your facial and chest hair.

I don’t know what kind of false promises this dihydro made to my testosterone, but it’s high time my scalp declared martial law.

But in your case, the (hair on the) back of your scalp is thick. There is a good density over there.

I do hear people say that I have good density. But they usually aren’t referring to my scalp in those instances.

But you have less density over here on top of your scalp, and that is a pattern we see in MPHL. 

Can’t we even have another pattern for my scalp, aside from plain? I wouldn’t mind plaid or paisley.

But at the age of 35, you still have a lot of hair. If you really want to keep it, you have to do something to keep it.

Sure thing. Who do I have to kill?

There are two approved medications. The first is Minoxidil: you apply it twice a day, every day, or as long as you need the effect. The second is Finasteride: it is a pill that you take daily, as long as you need the effect. So it’s a choice between both medications.

Do I even need to choose? Can’t I just combine both? I don’t mind if I grow enough hair on my scalp to resemble a troll doll.

You can combine both medications. But there are differences as far as side effects are concerned.

As long as the side effects will not affect any of my appendages, then I am fine.

Well, there are possible side effects of Finasteride that some DOMs might not like to have (laughs)…

(…And DOMs reading this column collectively hold their breath)

In two percent of people who take Finasteride, there is a risk of having erectile dysfunction, decreased libido and decreased ejaculate volume.  

So it’s a choice between the hair up there and the appendage down there? Why do these decisions always have to be so Solomonic, especially where volume is concerned?

There are also differences as far as the rates of effectiveness (of Minoxidil and Finasteride) are concerned. And the costs of these medications are a bit different as well.

Don’t fret about the cost, doc. I hear that the human body can survive for two weeks without food. But without hair? Not a day goes by….

With these medications, your hair (on the scalp) should improve. For Minoxidil, it’s roughly a 50 percent success rate. When I say 50 percent, it’s an effect that is perceptible. As for the other 50 percent, there is (hair) as well, but you won’t be able to appreciate it.

For the other 50 percent, can’t I just ask people to touch my scalp so that they know the hair is there even if they can’t see it? Para naman sulit yung bayad (So it’ll be worth the money).

The Finasteride tablet has a slightly higher success rate, about 60 percent to 65 percent. But you will only find out if it is effective for you after you use it for at least six months to a year.

For those of us who plan to take out a loan for our hair treatments, can you give us a comparative cost between Minoxidil and Finasteride?

The monthly cost for Minoxidil treatment would be about P700 to P800 if you use the local Minoxidil. The Finasteride pill costs about P65 per tablet. In a month that’s s roughly P1,950. And you have to use that for—

Six months right? Hmmm, I wonder if the human body can go without food for six months.

You need to use (both Minoxidil and Finasteride) for as long you need the effect. Six months is just to see if the medication really works for you or not because they also have a failure rate. If the medication is successful, then you have to keep on using it. But if you stop using it, you will lose whatever (hair) you’ve gained from these medications. You will go back to where (your hair) should have been if you hadn’t used any of these agents. 

What!? So after spending the equivalent of a house and lot on my scalp, it will still be a Pyrrhic victory, doc? Is that what you are trying to tell me!? 

It all depends on your attitude towards hair. The loss of hair, by itself, won’t kill you. 

That’s what you say.

It’s not a big health issue as far as MPHL is concerned. Of course, we are all concerned about what it means to have hair and not to have hair. So it is an individual’s decision if he wants to hold on to his hair or if he wants to let it go.

I have been holding on to my hair. But it’s the hair that’s been letting go. So what about getting hair transplants, doc? I can’t seem to get my hair from the less visible regions of my anatomy to migrate northwards.

Hair transplants definitely work. They take the hair from the back of your scalp because you usually retain good density (of hair) at the back of your scalp.

Sometimes it pays to be dense.

But you have to a good (hair) transplant surgeon. For example, if you are still young and you want to have a hair transplant, a hair transplant, you wouldn’t know how (your scalp) will look like when you reach your 40s. Remember that whatever hair that is transplanted is bound to stay.

Unless they plan on going TNT.

And if you transplant hair from one part (of your head to another part), but your hair recedes only up to a specific part, (then) it might look funny if your head has “hair islands” while you have a completely bald spot at the back of it.

That’s the stuff of nightmares, doc. 

I Swear By My Hair

How about some of these traditional hair remedies out there? Do they really work or are they as genuine as the 2004 Presidential election results? I’ve heard that gingko biloba, henna and gugo are effective remedies. In fact, my dad swears by aloe vera. He’s been using for the past 25 years and I can still see my reflection on his scalp. So we all know how effective aloe vera is.

We don’t have enough evidence to say whether it is effective or not effective. But the weight of the evidence for most of these botanical agents is not that strong

Well, maybe the hair on your scalp might not grow back. But at the very least you could have a nice flowering garden on your head.

You have to realize that if it’s MPHL, it is a life-long condition. You have to keep on using whatever it is that sustains the effect (of hair growth) like Minoxidil or Finasteride. So why gamble your hard-earned money if you’re going to try a product that is expensive and unproven?

Sigh. So how do I tell my dad to give up his aloe vera plantation? How about a scalp massage? Does it stimulate hair growth? Among other things?

If you massage the scalp, it is supposed to promote good circulation. But again, we don’t have enough evidence to say that it is indeed beneficial as far as hair growth is concerned. The scalp already has a very good blood supply. You don’t need to massage it to have a better blood supply.

There goes yaya’s favorite pastime. How about your lifestyle? I have heard that stress can cause you to promote deforestation on your scalp.

If you are referring to psychological stress, then it can probably aggravate hair loss. But it is not enough to cause it. 

Now there goes my excuse for skipping work. How about thinking too hard?

I don’t think it can (cause baldness).

That’s a relief, or else I wouldn’t even have any body hair. And — this was a phone-in question from concerned male adolescents — can frequent ejaculation cause baldness too?

Depends on how frequent it is for you (laughs).

Not to mention the loss of protein.

Don’t Flake Out On Me

I have heard from unimpeachable sources that dandruff can actually aggravate to hair loss? Do you mean to tell me that my personal hygiene is actually a cause of my impending baldness!? I don’t always apply deodorant but does that mean my arms might fall off?

There are many ways that dandruff can aggravate hair loss. One commonsense way of looking at it is: we know dandruff is itchy. If you keep on scratching your scalp and your hair, you can damage your hair and it will lead to breakage.

Those restraints my wife bought me for Christmas will finally come in handy.

And there are some studies that connect dandruff and hair loss. They compared the hair loss of people who don’t have dandruff compared to the loss of people who have dandruff. They noted that those that have dandruff tend to shed hair more. It’s normal to lose 50 to 100 hairs a day.

It’s an average of 63. I’ve got a logbook.  

Those with dandruff lose more hair than that, especially if you have thinning hair. There was a study showing the benefits of anti-dandruff shampoos as far as hair loss is concerned. They conducted a study using ZPT (zinc pyrithione, an active ingredient found in anti-dandruff shampoos) and they noted that there was an increase in the hair count from using ZPT versus the group that was using a placebo... but it doesn’t necessarily have to be hair loss from MPHL, but from normal hair shedding which is about 50 to 60 strands.

But every strand counts at that point. Walang iwanan (Nobody gets left behind).

Because It Had To Be Asked

I am sure many single men have contemplated this question on a lonely and rather boring night: What really is the purpose of our pubic hair? Is it a buffer zone? A breeding ground? Or a conversation piece?

(Laughs) I think it’s a vestigial effect. There are supposedly a lot of apocrine glands located there and apocrine glands are supposed to produce pheromones (a chemical signal that triggers a natural response in another member of the same species). So that could have been the purpose (of pubic hair) before. 

And so our pubic hair has been around for millions of years waiting for its new purpose?

Well, maybe it’s decorative?

I’m glad we found a purpose for them right before the holidays.  

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Thanks to the Head & Shoulders team for helping arrange the interview with Dr. Jun Bormate.