MEN'S HEALTH MATTERS:Male pattern hair loss will affect 50 per cent of men by age 50, writes Thomas Lynch
Q I'm 22 and over the past year and a half I have begun to lose my hair. I have noticed a lot of adverts for hair restoration treatment. Which would you advise?
AMale pattern hair loss (balding), also called androgenic alopecia, appears as a receding hairline with or without hair loss on the top of the head. It is an inherited condition.
Men who develop balding are genetically more sensitive to the effects of the hormone dihydrotestorone (DHT). It is thought that DHT shortens the amount of time the hair spends in the growth phase. It also causes the hairs to become smaller and finer (miniaturisation).
It was said that baldness was inherited from the mother's side of the family, but it is now believed that it can come from either side of the family. About 50 per cent of men by the age of 50 will have some degree of male pattern hair loss.
There are a number of treatments available for male pattern hair loss, with varying success rates. Probably the most common is Minoxidil. Minoxidil is a Rogaine TM.
This was originally a treatment for high blood pressure, but it was noted that unwanted hair growth was one of the side effects.
It has since been made into a topical solution for the treatment of hair loss.
The way it works it that it dilates small blood vessels, though the exact way it restores hair growth is uncertain. It is unfortunately something that needs to be done on an ongoing basis because if you stop the treatment you usually return back to your pre-treatment hair thickness within about four months. It has a varying success rate, and generally the hair growth is finer and thinner than that of your normal hair.
There is a tablet called Finasteride (PropeciaTM), which blocks the enzyme, which converts testosterone to DHT. As a result it decreases DHT's effects on the hair. It is taken once a day.
It is difficult to predict who will respond well and how much hair regrowth there will be. There have been some large clinical trials; these were limited to mild to moderate hair loss. It is not known exactly how long you have to be on the treatment, but it is probably indefinitely.
It does, however, have side effects, like all medications, and a more in-depth discussion with your doctor or dermatologist would be advisable if you are considering Finasteride.
Hair replacement surgery has also improved greatly over the past number of years, with the techniques becoming much more complex and, as a result, the cosmetic appearance been much more subtle.
Hair transplantation relies on the fact that there are areas of the scalp where the hair doesn't tend to be lost, commonly on the sides and back of the head.
Small pieces of hair and the hair roots from these areas are transplanted to the bald or thinning areas. This is usually a time-consuming and laborious process and the number of hairs or transplantations can vary to involve thousands of grafts.
It is not without its risks and is an expensive procedure. I would advise you to get as much advice from your own doctor, dermatologist, etc about who to attend and what type of treatment to have before embarking on any treatment.
Q My wife and I are having difficulty conceiving a baby. Is this a common problem? I have been advised to have my semen analysed and wondered what this actually entails. Is there anything I need to do to prepare myself for this test?
AInfertility is defined as failure to conceive after one year of regular coitus without contraception. It has been reported from population-based studies that about one in six couples during their reproductive years will seek help for infertility.
Often there is no absolute factor preventing a couple from conceiving and in many cases there are multiple factors. The contribution of male factors to infertility is about 30 per cent.
Evaluation and assessment of semen is very important and is usually done after three to seven days of abstinence. A shorter period of abstinence decreases the sperm count and longer abstinence decrease sperm motility.
If the first semen sample is within normal limits, there is no need to repeat it.
Artificially poor samples can occur secondary to stress, lack of adequate stimulation or loss of part of the ejaculate due to poor collection technique. General health consideration such as reduction in alcohol intake and cessation of smoking can bring about improvement in sperm function.
Prolonged hot baths, tight underwear and any infections can also affect sperm production. Prescription and recreational drugs may also have an effect and you can consult your doctor about this.
Ideally, sperm counts should be above 20 million sperm per mil of ejaculate, however one- quarter of fertile men will have counts below this level.
Azospermia refers to the complete absence of sperm in the ejaculate and constitutes about 1 per cent of all men and 10-20 per cent of infertile men.
Azospermia may be caused by testicular failure or obstruction to the flow of the sperm. In obstructive azospermia, the cause may be reversed in some cases by surgery such as with the reversal of a vasectomy.
When the obstruction is caused by absence of the vas deferens (tube that transports sperm from the testicles), preliminary screening for cystic fibrosis in both male and female partners is mandatory. In non-obstructive azospermia, other types of genetic screening and chromosomal analysis will be carried out.
The combination of semen analysis and advanced sperm function tests (done in specialised fertility clinics) provides important information for male fertility and is crucial for selection of patients for treatment with in-vitro fertilisation (IVF) or intra cytoplasmic sperm injection (ICSI).
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Patrick Ormond, consultant dermatologist and Dermatological Surgeon, St James's Hospital, Dublin