I'll admit it: When a new study about balding comes out, I can't be objective. I've got some skin in this game. Tell me: Am I diseased, or just blemished?
Vendors of balding remedies seem to favor the diseased view, peppering the airwaves with language that instructs me that I am, for example, "suffering from a progressive condition called male pattern hair loss" (as opposed to suffering from a progressive condition called multiple sclerosis, or Alzheimer's, or what have you). They tell me that losing my hair is not normal, but reassure me, "You're not alone," because millions of other men have this not-normal condition. A local ad proclaiming "More hair, more life!" finally forced me to admit that what I'm really dealing with is a life deficit. All of these ads imply that this isn't about my personal appearance -- I have a disease, and I need to treat it.
So when a study in the British Medical Journal barged its way to the front of health care headlines last week (past more weighty topics, like news of a new and highly lethal flu strain in China), I was all ears... and scalp.
Researchers from Tokyo University tried to clarify the strength of a previously-recognized association between male pattern baldness and heart disease. Yes, hair loss increases one's risk of getting skin cancer of the dome, but does it increase the chance that you'll have a heart attack?
They piled through more than 800 medical studies to find just six that met their criteria. Six studies isn't a lot, but together they included nearly 37,000 participants. Association is no proof of causation, so don't lunge for the Rogaine, but for men of all ages, severe balding seemed to increase the risk of developing heart disease by 32 percent. The risk was higher -- 44 percent -- for men who developed severe baldness before their mid- to late-50s.
It was interesting to find that balding can be more objectively categorized than the informal scale I've been using: thinning, getting breezy, deep-denial-but-I-admire-the-effort, and comfortably bald. Several of the studies used the Hamilton-Norwood scale of balding and found that hair loss at the vertex -- the part of the skull where a beanie or kippah would be placed -- carried the strongest association with heart disease. The more severe the vertex hair loss, the higher the risk: 18 percent for mild, 36 percent for moderate, and 48 percent for severe. On the other hand, a receding hairline held no statistically significant association.
Why the association? Are our solar sex panels somehow absorbing mysterious atherosclerosis-causing radiation from the sun? Association is never proof of causation, but it almost always invites speculation. The authors of the study admit that the mechanism for any connection between heart disease and balding remains unclear, but they offer several hypotheses.
Resistance to the normal physiologic effects of insulin is a key component of adult diabetes and of a condition called the metabolic syndrome, both of which lead to heart disease. And insulin resistance has been show to cause constriction of the blood vessels to the scalp. The drug Rogaine (minoxidil) does cause blood vessels to dilate, but it's not clear that that's the way in which it promotes hair growth, and there are other medications that dilate blood vessels that don't stimulate hair growth.
Another hypothesis has to do with the fact that the bald scalp appears to have a more active version of the enzyme that converts testosterone into dihydrotestosterone (DHT), the hormone that causes hair follicles to shrink (the hair loss medication Propecia [finasteride] works by blocking this converting enzyme). There are reports that the heart and blood vessels contain this DHT enzyme. Perhaps, the authors suggest, the heart and blood vessels of the hair-challenged also carry the overactive version of this enzyme, and the excess DHT leads to atherosclerosis.
For all the attention it got, as a both a physician and a bald male, I'm not sure what to do with this piece of research. Anyone who has risk factors for heart disease (smoking, high cholesterol, diabetes, hypertension) should address them, regardless of his hairline. Until association is replaced by causation -- i.e., treating balding is shown to lower the risk of heart disease -- I'll continue to consider my male pattern hair loss to be a cosmetic issue, and a receding one at that. Comb-overs and toupees seem to be fading into the past, and bald males have come to understand that fully coiffed males deserve neither our sympathy nor derision: It's genetic -- they were born that way.
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