Readers' questions are answered as examples of general problems commonly met in practice. It is a good rule in medicine that only their own doctors know the patient well enough to pontificate on the case as there are often other factors unknown to strangers.


Is there any proven cure for hair recession? I've seen items such as regaine on the shelves but I'm slightly loathed to put any chemical on my head if it's already known that it will achieve nothing! Appreciate your response. Name and address withheld

Regaine minoxidil works, but not for everybody. The best results are obtained if treatment starts as soon as the first signs of male pattern baldness appear, whether this has started as a retreat from the forehead or a monk type patch in the crown of the head. Regaine is therefore better at slowing the progress of baldness than it is in reversing it. Results are obtained by using five per cent Regaine rather than two per cent. The only way of finding out if you are a man or woman (it is equally likely to be effective in either sex) who is going to benefit by Regaine is by trying it for four or five months. Result aren't instantaneous. If you are one of the lucky ones you are advised to continue to use it, or the hair loss recurs.

I'm familiar with Regain but can you tell me anything about the effectiveness of a product I've seen called Procerin? Its based on natural ingredients and is described to have no adverse side effects. Name and address withheld

I have no knowledge of Procerin, apologies. The two orthodox medical products that work to some extent in some men and are worth a try are Regaine or Propecia finasteride. Propecia is a 5 alpha reductase inhibitor, its better known use is in the treatment of benignly enlarged prostates. When used for this latter purpose it is marketed as Proscar. The standard way of using Propecia is to take one mg daily for at least three months so as to test response. Long term administration of Propecia has demonstrated that improvement, or slowing of the hair loss is maintained for at least five years. Experiments have been tried of using finasteride as an application rather than taking a tablet by mouth. When used as an application there was limited improvement but as yet Propecia isn't marketed in this form. Finasteride is paradoxically used in women, provided there is no chance of them becoming pregnant, as a treatment for hirsutism - excessive hair.

I am 22 years old and suffer from mild to moderate hair loss. I am currently taking finasteride and applying minoxidil at recommended dosages. I feel that finasteride is helping in the reduction of hair loss but I’m concerned about the potential side effects on the liver and function of the brain. I have no history of liver problems and from reading the literature there seems to be no significant long term effects established as yet. Could you help with this? Name and address withheld

Although finasteride isn't recommended for anyone with abnormal liver function tests liver damage to a healthy liver is not a recognised side effect. Nor should Propecia, finasteride affect either your mood or intellect. One problem with Propecia is that although it has only a fifth of the amount of finasteride, one mg instead of five, when it is used to treat prostates there have been occasional reports of some reduction in the potency in those who use it. It is also worth bearing in mind that the use of finasteride lowers the PSA and this has to be taken into account when testing for prostatic cancer.

I have recently had a course of chemotherapy (with the drugs cisplatin and gemcitabine) which has caused my hair to become considerably thinner. I had the last infusion five weeks ago and my hair is still coming out although at a slower rate than before. When can I expect the fallout to cease and when can I expect my hair to start growing again? Alison Harrup, Leicester

Many of the chemotherapeutic agents produce hair loss, the extent varies from drug to drug and person to person. Likewise recovery time is different. Hair does re-grow and many people have described to me how when it returned it appeared to be a better head of hair, and a healthier looking one, than it had been previously. After my brother had a long course of chemotherapy I was quite jealous of his fine head of hair once it had recovered. Re growth of the hair won't always occur if the scalp has been irradiated in any way. Most people have to think in term of months, rather than weeks, before they will be out and about scarfless.

I am an active 64-year-old lady. I have an extremly healthy lifestyle Work out at gym three times a week. About nine months ago my hair started to fall out, especially when I wash it. I have always had very thick,slightly curly hair,and straighten and colour it ,and have done so without any ill effects. My Doctor did not seem to be particulary interested, but did a blood test,and discovered that I needed iron.I am on Galfer for this. I also take Adizem 300and Approvel 300,Premarin 0.25. Could any of these be responsible? Are there any products that would help? Dorothy Tinman, Bangor

So called male pattern baldness is a misnomer as both men and women lose hair as they grow older, however good their diet and however healthy their lifestyle. Adizem is a calcium antagonist used to treat high blood pressure. Occasionally skin reactions have been reported to it but not so far as I am aware alopecia (hairloss). Aprovel is also used to treat high blood pressure but there is no evidence that that should cause thinning hair. Premarin is an oestrogen only HRT. This should be of advantage to your hair rather than vice versa. I assume that since you are taking oestrogen without any progesterone you may well have had a hysterectomy and that your ovaries were removed at the same time. It would be worthwhile discussing with your doctor whether your blood oestrogen levels need measuring to make certain that you are now getting enough oestrogen. In all women with hair thinning I also arrange thyroid function tests.

I have been diagnosed with PCOS. When I noticed my hair was getting even finer at the front, I began to use a Progaine-type spray on treatment twice a day and also took 10 mg of Biotin each day. This seemed to be helping, but then I was diagnosed with severe anaemia and Iron deficiency. Is there any way to counteract the illnesses and regain healthy hair? Genie Hughes, Freihung, Germany

PCOS is often part of the metabolic syndrome. As well as the polycystic ovarian features of this condition there is usually trouble with ovulation and periods, difficulty in keeping the weight down, a tendency to diabetes type 2, high blood pressure, an oily skin and thinning of the hair. I always seek the advice of a specialist interested in the metabolic syndrome, as well as a gynaecologist who is interested in endocrinology, when I discover that one of my patient has PCOS.

I understand that hair can become thinner as a result of autoimmune under-active throid disease, but does it normally grow back again when the thyroid is balanced with Thyroxine? Also, does long term work-related stress (working under high levels of pressure for many years)cause hair thinning? My hair used to be very thick, but it became very thin when I was ill with my thyroid problem, and despite this being balanced for about 5 years it remains very thin, so am wondering if stress could be the other cause. Name and address withheld

One of the problems of alopecia is that it is easier to prevent hair loss than it is to achieve restoration of hair. I am glad to hear that your thyroid balance is now corrected. It is amazing how often too little thyroid is overlooked as a factor in hair thinning. There is a good argument for doing routine thyroid tests on anyone with thinning hair whatever their age group. Stress does may result in hair loss. Discuss the use of Propecia and Regaine with your doctor.

My hair started to fall after I began on beta blockers for high blood pressure. Is this normal? How can I reclaim my hair? Name and address withheld

Beta blockers are sometimes associated with thinning hair. Propecia and Regaine are worth a try. Beta blockers are an enormously important group of drugs but there are alternatives available now that are equally effective at treating blood pressure. If your baldness (alopecia) is very marked, and this is distressing you I should discuss the problem with your doctor.

My mother's hair fell out in huge clumps a few years ago after her GP told her to stop HRT as he felt she had been on it long enough. The hair loss devastated her as her hair was thick and wavy all her life. the hair has only grown back very thinly and is very dry and brittle. the GP said sudden cessation of the HRT woul not have been a contributory factor but I feel due to the timing of the air loss within a fw months of stopping HRT seems to much of a coincidence. What are your thoughts on this? My mothers general health is very good. Susan Nixon, Cheshire

HRT helps women to retain a more youthful head of hair. A sudden change in an older woman's hormone levels might well be one of the factors that could contribute to some male pattern hair loss. The reasons for abandoning routine HRT are well known and deciding who should stay on it is a matter of assessing relative risks. I would be surprised if severe alopecia after abandoning HRT was the only cause of such severe hair loss as you describe. I assume that your mother has had all the standard biochemical and haematological tests useful in making certain that she is not suffering from too little thyroxin, iron or one of the other trace elements.

I've seen adverts on hair replacement therapy using laser treatment. It has been endorsed by sports stars such as Graham Gooch and Austin Healey. Does it work? Pete Smith, Derby

A better appearance after a hair transplant is achieved by using very small transplants so that the tufted grass effect is lost. Lasers may be helpful in achieving this. Taking very small transplants from the still hairy parts of the scalp also means that more tiny transplants can be carried out in each session.