Beth Stein, a 39-year-old New Jersey advertising copywriter, began losing her hair at 19 -- presumably because of the genes that affect everyone in her family, male and female.
Eventually, her hair became so thin it was hard to style in a way that covered her head.
"When this happens to people, especially to a woman, it's extremely emotionally distressing and socially crippling," she 11 says. "I tried a lot of phony treatments. I cried a lot. It was pretty devastating."
Then, several months ago, she spotted an ad in the Yellow Pages for a New York doctor touting a new way to make hair grow.
It turned out to be a hair spray made from two drugs already approved by the Food and Drug Administration: minoxidil, the active ingredient in Rogaine, an over-the-counter potion that boosts hair growth in some people, and tretinoin, the chief constituent of Renova and Retin A, prescription-only drugs that combat wrinkles and acne.
Never mind that the doctor's homemade concoction, though not illegal, had never been tested in controlled clinical trials, so there is no solid proof that it's safe and that it works.
Like many of America's 20 million balding women and 40 million balding men, all that Beth Stein wanted was more hair.
Until recently, at least, that has been a quixotic quest. Though most of us couldn't care less until something surprising happens -- like waking up one day and realizing a once-robust hairline is drifting out of sight -- our hair grows, falls out and grows again in a steady cycle throughout life.
In the growth, or "anagen" phase, scalp hair grows for about two years, says Barbara Gilchrest, who chairs the dermatology department at Boston University School of Medicine.
If you can grow hair down to your knees, it means you have an unusually long anagen phase; if you can't grow it past your collar, you've got a short one.
At the end of the anagen phase, the hair follicle, from which the hair shaft grows, enters a short "catagen" phase in which it shrinks back to a smaller size. In the third or "telogen" phase, the follicle just sits dormant for several months.
Eventually, the hair gets loose and falls out, and the cycle begins again.
But in many men and women, hair follicles eventually wimp out, probably because of the effect of male hormones called androgens. New evidence suggests a female hormone, estrogen, may be involved, too.
With each hair cycle, male hormones activate receptors in the follicle, slowly turning large follicles into small ones that produce only wispy hairs. This process is especially pronounced in people who are genetically predisposed to balding.
"It's as if the factory wears out," says Robert Stern, a dermatologist at the Beth Israel Deaconess Medical Center.
Researchers have been hustling to find options for both men and women with hair loss. Here's what they're coming up with:
Rogaine. Since February, Pharmacia & Upjohn has been selling its 2 percent minoxidil product over the counter, though results are often less than dramatic. About 25 percent of men and 20 percent of women can achieve what the FDA calls "meaningful" hair for $1 or so a day.
Minoxidil, which may work by increasing blood flow to the scalp, seems to help most those who need it least -- people who are thinning, but not yet bald.
And if you stop using it, you lose whatever gains you made.
Propecia. This new anti-balding drug, still unapproved by the FDA, is a weaker form of Proscar, Merck's anti-prostate enlargement drug, also called finasteride.
Finasteride combats hair loss by blocking the conversion of the male hormone testosterone to DHT, or dihydrotestosterone, which turns big, healthy hair follicles into wimps.
In a six-month trial of Propecia tablets in 466 men ages 18 to 35, the majority of those on the drug had "clinically significant" growth, says Merck, which hopes to market the drug soon.
Estrogen blockers. So far, this is just an idea -- but an intriguing one. In a study, Robert C. Smart, a molecular toxicologist at North Carolina State University, found that blocking estrogen makes hair grow faster than normal in mice.
Would it work in people? Nobody knows, though Ulrike Lichti, a physician and hair-follicle investigator at the National Cancer Institute, notes that "the hair cycle in mice and humans is very different." And estrogen is important for healthy skin, so spreading an anti-estrogen cream on the skin could be harmful.
Parathyroid blockers. Researchers have long known that a substance called parathyroid hormone related peptide (PTHRP) turns off cell division in skin cells, including the thousands of cells that make up hair follicles, says Michael Holick, chief of the Boston University endocrinology, nutrition and diabetes department.
So his team has been trying to find ways to block PTHRP in order to turn cell division back on, and thus encourage hair follicles to grow. So far, he says, he has found one experimental PTHRP blocker that makes resting hair follicles go into the growth phase and stay there longer than normal, at least in mice. Tests will soon begin in people.
Gene therapy. Researchers at AntiCancer Inc. in San Diego have shown they can use a cream made of liposomes -- small fat bubbles -- to deliver genes, like those for hair color, into hair follicles in mice. Nobody has found the gene or genes that control balding, and AntiCancer isn't looking. "But if such a gene is discovered," says company biochemist Andrew Perry, "we can get it into the hair follicle."
Minoxidil-tretinoin. In New York, business is booming for Lewenberg, who says his "proprietary" hair spray is a combination of 2 percent minoxidil and 0.025 percent tretinoin.
The idea of mixing the two drugs makes sense to some dermatologists, who say that tretinoin might increase the penetration of minoxidil into the scalp, giving it more punch.
So far, Lewenberg says he has sold, for $180 a month, his concoction to more than 2,000 patients, and that 90 percent have had improvement in hair quality after three months.
That's hardly a scientific study, but Beth Stein, one of his patients, says she's pleased that at least her hair has stopped falling out. She calls her results "encouraging but not dramatic."
But if nothing that you've tried for hair growth works and you find yourself still pining for the puffy plumage of youth, take heart. Things may be better when your kids are your age.
With the new molecular understanding of how the hair follicle functions, "there really is hope," says Holick. "Within a decade or two, balding could be a thing of the past."
Pub Date: 12/03/96