Wednesday, May 12, 2010

Hair Genetics and HairDX genetic test:

Hair Genetics and HairDX genetic test:           

Male or Female Patter Hair Loss aka Androgentic Alopecia (common Baldness) is genetic and has Poly genetic trait (that means there are more than one genes responsible for this condition) and there is an old wives’ tale that it is  inherited from Mother’s side but it is proven that it can be inherited also from father’s side although there is slightly higher chance of inheritance from Mother’s side. The genes that actually cause hair loss are still unknown however, there are two gene loci, recently identified, that appear to be associated with common baldness. The first is on the “Alteration in Androgen Receptor (AR) gene” carried on the x-chromosome and the second is a “non-sex chromosome 20p11” 

 

The variations result from small changes in the number or types of DNA building blocks (base pairs) that make up the AR gene. These genetic changes appear to be most frequent in men with hair loss that begins at an early age. Researchers believe that AR gene variations may increase the activity of androgen receptors in the scalp. Although androgenetic alopecia is related to the effects of androgens on hair growth, it remains unclear how changes in the AR gene increase the risk of patterned hair loss in men and women with this condition.

Since AR gene are on X chromosome – a sex linked chromosome (XX I females and XY in males) it is transmitted from Mother Side and the non sex linked 20p11 genes on 20th chromosome can be transmitted from both mother and father side.

If you have both the risk variants we discovered on chromosome 20 and the unrelated known variant on the X chromosome, your risk of becoming bald increases sevenfold."

"What's startling is that one in seven men have both of those risk variants. That's 14 per cent of the total population!"

  
What is the HairDX genetic test?


The HairDX (http://hairdx.com ) genetic test for Pattern Hair Loss (Androgenetic Alopecia) is a screening test for predicting hair loss. It allows diagnosis in an earlier or preclinical stage, so that treatment can be initiated at a time when intervention by medications and finasteride has a greater likelihood of success. Current diagnostic methods like videoscopy hair thinning is visible when you have probably lost about 50% of your hair in that area of your scalp. Because, the only FDA approved medications to combat hair loss, minoxidil and finasteride, are most effective at stabilizing hair loss rather then re-growth, the earlier you can predict Hair Loss, the more likely you are to save your hair. So early medical intervention prior to visible signs of hair loss, allowing you to retain your hair. 

 


The HairDX genetic test for Pattern Hair Loss is most appropriate for men and women 18 years of age or older who are concerned about hair loss esp when there is a familial history of hair loss.



Your genetic sample is collected using a cheek swab by your doctor and the sample is mailed for analysis to the HairDX laboratory. Once the genetic analysis is complete, your test results will be reported to your doctor.
 



The HairDX genetic test for Female Pattern Hair Loss provides women with a score, called the CAG repeat score. A smaller CAG test score is associated with a higher risk for significant hair loss (Ludwig grade II or III hair loss) while a larger test score is associated with a lower risk for hair loss. 

 



Women who have a smaller CAG test score should be advised that they are at a higher risk for significant hair loss (Ludwig grade II or III hair loss). According to scientists, the percentage of the female population with a CAG test score of 15 or less, NOT suffering from a Ludwig grade II or III hair loss was only a 2.3%.

These women may wish to consult with a physician specializing in hair restoration, who can develop a plan to monitor and treat early hair loss. For example, such women may be good candidates for minoxidil, especially if treatment is started early.

In contrast, women who have a larger CAG test score can be reassured that they are at low risk for significant hair loss. This avoids unnecessary concern or expense over premature hair loss. 




Interpretation for Men:


The HairDX genetic test for Male Pattern Hair Loss provides information on the presence of a specific variation in the androgen receptor gene (AR), found on the X chromosome. The variant AR causes changes in the hair follicle's response to dihydrotestosterone, leading to alterations in the hair growth cycle. 

 

  • The variant AR is found in more than 95 percent of bald men—60 percent of men who have the variant AR will develop baldness by age 40.
  • HairDX also provides information on a less common AR variant that predicts a very low risk of early-onset androgenetic alopecia—more than 85 percent of men who have this variant will not have hair loss by age 40.

Men who test positive for the variant AR should be advised that they are at a high risk of developing early-onset Male Pattern Hair Loss. These men may wish to consult with a physician specializing in hair restoration, who can develop a plan to monitor and treat early hair loss. For example, such men may be good candidates for finasteride (Propecia), especially if treatment is started early.

In contrast, men without the variant AR can be reassured that they are at low risk of early-onset Male Pattern Hair Loss. This avoids unnecessary concern or expense over premature hair loss.



Hair DX (hairdx.com), costs about $150.  It is important to realize that, at this point, there is just an association with this gene and hair loss; the cause and effect has not been proven and the association is not anywhere near 100%. A danger is that patients may overreact to the relatively incomplete information that the test provides. 



New Gene in Hair Loss APCDD1

A team of researchers lead by Dr.Angela M. Christiano, Ph.D., professor of dermatology and genetics & development at Columbia University Medical Center found that the gene, called APCDD1 ( located in a specific region on chromosome 18), which causes a progressive form of hair loss beginning in childhood (known as hereditary hypotrichosis simplex). The disease is caused by a phenomenon called hair follicle miniaturization -- the same key feature of male pattern baldness. When hair follicles go through this miniaturization process, they shrink or narrow, causing the thick hair on the head to be replaced by thin, fine hair, known as "peach fuzz."

The identification of this gene underlying hereditary hypotrichosis simplex has given an opportunity to gain insight into the process of hair follicle miniaturization, which is most commonly observed in male pattern hair loss or androgenetic alopecia It is important to note that while these two conditions share the same physiologic process, the gene discovered for hereditary hypotrichosis does not explain the complex process of male pattern baldness.

APCDD1 inhibits a signaling pathway known as the Wnt signaling pathway, to turn on or off hair growth in mice, but, until now, the pathway did not appear to be involved in human hair loss. This finding is significant because it provides evidence that hair growth patterns in humans and in mice are more similar than previously believed.

"We have at last made a connection between Wnt signaling and human hair disease that is highly significant," said Dr. Christiano. "We have years of beautiful data in our field about hair growth in mice, but this is the first inroad into showing that the same pathway is critical in human hair growth. This is the first mutation in a Wnt inhibitor that deregulates the pathway in a human hair disease."

These findings suggest that treatments involving manipulating the Wnt pathway would be non-hormonal, which may enable many more people suffering from hair loss to receive such therapies.



Gene That Regulates Hair Growth: Lhx2

Activation of the gene Lhx2 leads to increased hair growth. This is shown by Leif Carlsson's research team at Umeå University in Sweden. The transcription factor Lhx2 as an important regulator of hair formation. The Lhx2 gene is active during the hair follicle's growth phase and is turned off during the resting period. Lhx2 is expressed periodically, primarily in precursor cells that are distinct from the cells in the bulging region of the follicles. Hair follicles in which Lhx2 has been inactivated cannot produce hair. Moreover, the activation of the Lhx2 gene in hair follicles has been shown to activate the growth phase and hence the formation of hair. Thus, Lhx2 is a gene that is important for the regulation of hair growth.

In stark contrast to previously published research findings from other teams of scientists, Leif Carlsson and his colleagues found that Lhx2 is primarily expressed outside the so-called bulge region of the hair follicle, where the follicle's stem cells are found. The Umeå researchers have also shown that Lhx2 is necessary for the hair follicle's growth (anagen) phase to proceed and for the hair follicle's structuring. Moreover, transgenic expression (gene or genetic material that has been transferred naturally or by any of a number of genetic engineering techniques from one organism to another) of Lhx2 after birth is sufficient to activate the growth phase and stimulate hair growth.



Sunday, May 9, 2010

Celebrity Hair Transplantsp politicians, Film stars, Singers, Players

Many Players, Politicians or Film stars have found their losing hair as a big challenge to their personality or even their carrier. Some have chosen to go for the artificial solutions like hair piece and some have chosen to go shaven head and some have preferred to go for a permanent solution of Hair Transplantation. Some of the examples are given here who are believed to have undergone hair Transplant surgery to give a more youthful Hair line. The information is not first hand but mostly through internet search. Abhijit an Indian Playback singer, Elton Johns, Brndan Fraser, Sunil Gavaskar, George Cloony, Harsha Bhogle, Italian Prime Minister Silvio Burlusconi, Jude law, James Nesbitt , Joel McHale, John Cleese, Kevin Kosner, Matthew Mcconaughtey,  Mel Gibson, narendra Modi Gujarat,s CM, Nicolas cage, Rana Naveed Ul hassan ( Pakistani Cricketer), Ravi Shashtri ( Indian Cricketer), Salman Khan ( Indian Film Star) Virendra Sehwag ( Indian Cricketer), Nawaz Shareef ( Pakistan ex PM) and brother , Tom Arnold, Tom Hanks, Will young are to name a few.

 
 

Saturday, April 24, 2010

BHT ( Body Hair Transplant)


Body hair transplant (BHT):
For common baldness usually the hair roots from the back of the head is preferred but in some situations hairs roots from other part of the body are used which is called BHT
Body hair transplant (BHT): Procedure: Essentially it is FUE (Follicular Unit Extraction) but often bulky soft tissue underneath without strong bony support makes it difficult than that from the scalp. Usual sites are Beard, Pubic, Chest and Back.
Advantages:
  • Esp. valuable when scalp donor is exhausted or limited Minimal evidence of scaring due to FUE technique used
  • Large Donor area
  • May be a better choice for eyebrow reconstruction where one can have better matching hairs then the fast growing thick scalp hair
  • Some believe unlike scalp hair which is weakened by the male hormone DHT, body hair thrives and grows thicker and longer as time goes on
  • BHT can be used to feather out the hair line by cherry picked fine BHT in patients with coarse donor hairs in the occipital area.
Disadvantages:
  • Slow procedure and very taxing for surgeon not only due to awkward positioning but also this is due to acute angulations of more superficially placed follicles. The follicles are often in the more bulky soft tissue with less bony support. Some of the Body Hairs are not strong shafted to facilitate easy extraction.
  • Not all Body Hairs are of good quality some may take long time to grow, and may not even grow long & thick enough (We believe Beard, armpit and Pubic hairs are of better quality hair for head hair replacement) This May leave pigmented or Hypo pigmented marks in donor site esp. in dark skin
  • Most FU have one and very few have 2 hairs. 3 and 4 hair FU in BHT are practically non existent. So we are transferring less number of hairs and therefore turns out more expensive to patients.
  • There is cyclical variation in the amount of coverage that the body hairs provided (due to natural body hair growth/resting cycles). Body hairs did grow longer than in their original location, but not as long as scalp donor hair.
  • Persons with Fitzpatrick type 3-6 skins are prone to healing with initial hyperpigmentation (much like the dark marks that you get temporarily subsequent to an acne attack) Sometimes, instead of dark pigments, you could get lighter pigmentation (hypopigmentation) in the initial phase as well. The improvement of hyperpigmentation (dark spots) can be hastened by the use of fading creams. Wounds that heal initially by hyperpigmentation can end up finally with a much shrunken spot that is either normal in color relative to the surrounding skin or may assume a relatively faintly hyper or hypo pigmented hue.
Precaution:
For avoiding the telogen hair from extracting you need to shave the area about 4-5 days in advance of the procedure because the telogen hair are likely to be damaged during extraction due to the nature of their structure.
Body hair varies in calibre, texture and color. It is recommended to mix body hairs with scalp hair to achieve a uniform look and feel.

Body Hair Transplant (BHT)




There are about one hundred thousand hairs on the normal human head and about 1 million hairs of the body. Person having major loss of class 7 (almost 75000 hair out of 100000 are lost) may not have enough donor hairs at the back and side of the head (only 12500 out of remaining 25000 may be transplanted). Often donor hair may be even less. This situation made some surgeons to look for other Body hairs. Dr. Woods , Dr. Cole, Dr. Poswal and Dr Umar may be the torchbearers. Body Hair Transplant (BHT) as a major plus point may become donor hair because they are not genetically DHT susceptible hairs as some of the scalp hairs in MPB. But there are many issues with the effective use of BHT as routine. The conventionally used donor hairs from the back and sides of the scalp are very much similar to the hairs to be replaced in MPB but the characters of the BH has many variations such as thickness, length, colour, texture, the growth period etc. As a result for many years BHT was given the back seat. But some studies have shown that BHT hairs may change some of the character if not fully but partially when transplanted to the scalp (recipient "co-dominance" - or partial donor dominance) and this generated more interest and BHT is now being seen more seriously. . BHT is not widely practiced because, it requires special instruments, is very time consuming and the results can be somewhat unpredictable. Results are typically not at par with scalp hair yields Many patients consider body hair unnecessary and try to remove it. A body hair transplant serves a dual purpose by moving unwanted body hairs to the scalp, where they are more productive.


Body hairs from various areas have been used:
Dry zone: Beard, chest, back, limbs, abdomen
Wet zone or Apocrine zone : armpits and pubic hairs (so called because of Apocrine nature of sweat glands- In the case of sweat produced by the apocrine glands, which are located near hair follicles on the scalp, underarms, and groin area, the sweat contains fatty compounds. Bacteria feed on this sweat when it is secreted to the skin´s surface, and the resulting waste products, fatty acids, ammonia, and chemical reactions form a palpable odor which is unique for every individual.


 

Possible Uses of BHT:
1.      Obviously the most common use of BHT is as a viable option for those whose traditional donor hair supply is depleted.
2.      To feather out hair line by cherry picked thin and soft body hairs esp. in the people with strong and coarse scalp hairs where taking the thin hairs from the nape of the neck or per auricular area may not be a good option because they do not belong to what is conventionally called safe donor zone of scalp.
3.      To camouflage the widened strip scars of already depleted donor area where taking further the hairs from the scalp either by strip or FUE is not a sensible option. Coarse Beard hairs and other BHT from Apocrine area which grow thick and long is a good option.
4.      Body hair is an excellent filler to increase the density for use in between naturally thinning hair
5.      Transplanted scalp hair for the eyebrow restoration may not be the best match and grow very fast and need to be trimmed often. Some body hair with better match ( lighter colour, thinner diameter and slow growth than that of scalp hairs).
6.      Body hairs may be used for restoration of the hairless scar etc which become more obvious in the exposed part of the body.
7.      Donor recharging or Donor sealing of the scalp donor area by BHT esp. when the scalp donor area is very thin.

Problems:
·        Tiny Hyper or hypopigmented marks may be visible in some
·        Follicluitis esp. in case of buried or transected follicles with ingrown hairs may sometimes need antibiotics or steroid to resolve.
·        Keloid esp. is possible in the chest and shoulder area- one may doe a small test grafting
·        Redness for few weeks may be possible avoid sun exposure and use steroid application
·        Unpredictable growth at times
·        Long time to grow at times after transplant
·        Synchronous cycles
·        Due to difficulty in extraction compared to scalp hair may be more expensive and time consuming ( slow extraction and less yield per day) due to difficult positioning of doctor and patient.

It is a general perception that the short hair style gives the less ugly feeling of baldness than when the side and back hairs are kept long. Also, keeping the hair shorter might cut down on the number of grafts needed to diminish the bald look. BH usually do not grow very long (1 to 2 inches or less because their hair cycle is short) since it will not grow as long as scalp hair, a shorter hair style should ultimately be preferred.


Technical issues for BHT:

1.      The acuity of direction makes it demanding to use the instruments with more precision
2.       Most BH do not have as close a Bony support to the skin as that to the scalp hair (except in case of sternum and shin of tibia etc.). Some firm background support makes it easier to extract the grafts and in case of pubic and abdominal area due to minimal firm support at the back ground may make extraction more challenging.
3.      Many body hairs are not robust and without the good bony background it may nor be easy to harvest such hairs in some areas esp. when they are acutely placed and every other hair grows in different direction. This makes the extraction process very slow.

4.      At a  given time 80 to 90% of scalp hair are in anagen ( growing phase) and only about 40 to 60% of Body hair  are in anagen phase Some studies show that body hair has a very short anagen phase and a very long telogen phase.
Their duration of anagen is much shorter (12 to 16 weeks) as compared to the scalp donor hair (2 to 5 years).This means that body hair grows in a period of about six months to about 2 inch long, and they then rest on this length for some years. In Body Hair Transplantation when hair is transferred from the body to the scalp, it may have considerable delay in growth due to their long telogen phase. That does not mean that 10% to 20% of head hair and 40 to 60% of body hair died. It means that those percentages should always be resting or in telogen. As one hair cycles out, another cycles in and begins to grow. since body hair growth cycles are faster and more hairs are resting at any given time, it takes more body hair ( and even more BH follicular unit grafts- because most grafts have only one hair unlike the scalp grafts which may have up to 4 hairs) than scalp hair to create the same illusion of density. In Body Hair Transplantation when hair is transferred from the body to the scalp, it may have considerable delay in growth due to their long telogen phase.
5.      The dermal components of the hair, secondary germ cell and the dermal papilla are attenuated in telogen hairs, and more prone to damage during individual follicular extraction. Transactions by shearing forces will be higher with a higher chance of leaving behind vital cells that are essential for the healthy regeneration of the hair follicle.
 Therefore, only body donor hair follicles in the active anagen phase (which are strong even at the dermis level) are preferred for transplant. The hairs are shaved flush with the skin, 4-5  days prior to extraction. At the end of three to four days, the actively growing hair is easy to identify due to their increased length. If telogen hair is successfully extracted it will be bulbless hair and if transplanted will grow villous or thin hair  if at all it ever grows.
6.       Pre shaving pinpoints body donor hair whose growth cycles are more closely synchronized. Transplanting these hair results in a closer synchronization of the growth and synchronized shedding phase of these hairs at least, in the initial growth cycles. However, over couple of years, as the hair go through repeated growth cycles, the growth phase of these transplanted body hair lose their synchronicity. Without preshaving and selection of only non growing hair, a certain proportion (perhaps 10-30%) of the early anagen hairs could be mistaken for telogen hair because of factors like clear bulbs that are yet to get pigmented.
7.      Positioning of surgeon and also that of patient varies greatly from one area of body to that of other and even in the same area due to variable direction of hairs the angling and direction of instrument keeps changing unlike in case of scalp hair extraction.
8.      It has been said that the rate of growth: Body hair grows about 0.2 mm per day while scalp hair grows about .44 mm per day. The same body hair transferred to the scalp grows about .34 mm per day.
9.      predictability of growth- somewhat less than the scalp hairs
10.  Mix the various body as well as scalp donor hair in any particular area of scalp to achieve a uniform look and feel

Friday, April 16, 2010

Masturbation does it cause Hair loss or baldness?


well research has shown that it is not masturbation or sex that increases the testosterone level but it is the abstinence ( staying away from sex)  that may raise the level of testosterone ( check this link:   http://www.ncbi.nlm.nih.gov/pubmed/11760788?ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

On the contrary it is the raises Testosterone level that may induce Masturbation or sexual urge.


On the link that you have sent if you read in the website on this page ( http://www.herballoveshop.com/product.asp?PID=1007) you find this:
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"The essential ingredients in MoodMax help the liver excrete the excessive hormones which are very harmful to cells. Binding of excessive testosterone, DHT or estrogen to hair roots or hormone receptor cells causes hair loss or alternates genes for the malicious development"
-->

They want to sell their product by taking advantage of your ignorance and your psychological fear about sexual myths and and they do not do this by spreading actual facts.You should be aware that Masturbation or sex may stabilize or perhaps temporarily reduce the testosterone level and would not increase the level. DHT perhaps have similar effects. Regular Masturbation or sex ( a biological response) may therefore  stabilize or reduce Testosterone or DHT level and this means that regular masturbation oor sex may  stabilize your hair loss! (Although this is never been studied or researched).

Thursday, April 8, 2010

Mesotherapy for Hair Loss and Baldness


Mesotherapy (from Greek mesos, "middle", and therapy from Greek therapeia, "to treat medically") is a non-surgical cosmetic medicine treatment. Mesotherapy employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat. Dr. Michel Pistor (1924-2003) performed clinical research and founded the field of mesotherapy. There is no conclusive research proof that these chemical compounds work to target adipose (fat cells) specifically. Some physicians[have expressed concern over the efficacy of mesotherapy, arguing that the treatment hasn't been studied enough to make a determination. It is expressed by Rod Rohrich, M.D., Chairman, Dept. of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas: "There is simply no data, no science and no information, to my knowledge, that mesotherapy works," For experiences of Mesotherapy one can refer to this link as well: http://www.realself.com/Mesotherapy/reviews
Besides ineffectiveness the possible allergy and long term side effects of the drugs are never studied well. More over it is advised to be taken and continued at few weeks interval for maintenance


Usually by a thin needle of 30 number gauge either manually or by a mesotherapy computerized mesogun aided injection (or as some people use dermaroller which makes tiny tunnel to channel the drug in the skin) of liquid containing vitamins, minerals and hormones or in case of hair loss treatment Finasteride or Minoxidil area injected in subdermal layer in a very small quantity at say every 1 cm distance of the bald area of scalp Skin. It is said that Vit. B 6 or pyridoxine, Azailic acid and Zinc are found to be 5 alfa reductase enzyme inhibitors (and in turn DHT inhibitors) in some research and some people inject these molecules as well. There is although always a concern of Hypotension ( drop in blood pressure) if Minoxidil is directly injected as it is the Hypotensive medication when given systematically. Finsteride has not been found to be effective locally any ways. These appear to be just claims rather than good science in this treatment, so one should be cautioned about this. In case od Dermaroller the needles penetrate the stratum corneum, the hard outer surface of the epidermal layer of the scalp.It is claimed that hundreds of tiny channels are created through the stratum corneum, which facilitate the passage and absorption of Minoxidil into the dermis to maximize it’s absorption by the hair follicles. The Derma Roller also stimulates blood flow to the hair follicles via direct scalp massage. The dermal damage induces the release of growth factors that stimulate the production of new collagen and elastin and stimulates the miniaturized hairs to grow stronger.

Saturday, April 3, 2010

Why male pattern hair loss occurs on the top horse shoe area of scalp?




The Pattern loss is genetic hair loss where the hairs at the top central and horse shoe shaped are is where the hairs gradually miniaturize and die because these hairs are  Genetically Hormone (5DHT) sensitive. This is the reason this hair loss is also called Andro Gentic Alopecia (AGA).

When the head is developed from embryo the frontal and parietal bone area of the head has migrated Neural crest tissue but the occipital and temporal bone area ( back and side of the head ) does not have this tissue of origin. It is believed that certain genes responsible for AGA affect only these hairs which are having Neural crest origin and the area at the back and sides escape the effect of these genes.


Friday, April 2, 2010

Turban Alopecia in Sikhs










Although Sikh men are as susceptible to other forms of hair loss as anyone else, they commonly suffer from what is known as traction alopecia. This occurs when the knotting of long hair pulls on the hair over time so that its roots are damaged. It is different from pulling hair out accidentally when taking the turban on or off. It is a
slow process but it can be irreversible.
Sikhs males have religious reasons not to cut their hairs throughout the life. The long hairs are kept hidden under their turban after winding them in a ‘Rishi knot’. It is an irony that this long hairs due to constant traction on the root due to this knot result in premature hair loss over the years. This especially happens in the frontal and temple area where the traction stress is maximum. This is common to all those Sikhs round the world may be in millions. It's a subject rarely discussed because it's relatively easily hidden, but hair loss is a big problem among Sikh men and covering it up doesn't take away the associated distress.
Traction alopecia can be exacerbated by the ritual combing of the hair. This can be alleviated by straightening out the hair and working through tangles with the fingers before combing, thereby reducing the pull of the comb. It's important to keep the hair soft and in good condition even if you're not worried about other people seeing it.
To prevent this problem, I would advise avoiding unnecessary stress on the hair by winding the
‘Rishi’ knot less tightly. The problem is not with wearing the turban, but with improper hair care.  Hair must be combed down at night and then joora retied in the morning. Keeping joora tied all the time does not allow hairs to relax properly.
Use a light fabric and only use as much fabric as is absolutely necessary to contain the hair. The weight of extra fabric will put added strain on your hair. Be careful not to bind the turban too tightly - it's better to secure it with grips further back on the scalp if necessary, as hair is most vulnerable toward the front of the head. With Be careful to position your hair directly on top of your head before you bind it. This will enable your head to support most of the weight of your hair directly when you are upright. If you tend to lean backwards when sitting, be careful to keep your head upright.
Some Sikhs who suffer from traction alopecia choose to give up on wearing turbans altogether and to keep their hair in pony tails instead. If you do this, make sure that you don't draw it back too tightly from your head and that you secure it loosely.
It is interesting to note that traction alopecia often occurs as a result of various headwear and hair styles, including hair extensions, wearing tight ponytails and wearing tight fitting-hats.

But if you take care to look after your hair and bind it appropriately, you are likely to be able to keep much of the length of it at the back for most of your life.
As a permanent solution to restore hair, hair Transplant is recommended as it is not possible to medically restore lost hair as shown in one of my patients.


Turban Alopecia in Sikhs




Although Sikh men are as susceptible to other forms of hair loss as anyone else, they commonly suffer from what is known as traction alopecia. This occurs when the knotting of long hair pulls on the hair over time so that its roots are damaged. It is different from pulling hair out accidentally when taking the turban on or off. It is a slow process but it can be irreversible.

Sikhs males have religious reasons not to cut their hairs throughout the life. The long hairs are kept hidden under their turban after winding them in a ‘Rishi knot’. It is an irony that this long hairs due to constant traction on the root due to this knot result in premature hair loss over the years. This especially happens in the frontal and temple area where the traction stress is maximum. This is common to all those Sikhs round the world may be in millions. It's a subject rarely discussed because it's relatively easily hidden, but hair loss is a big problem among Sikh men and covering it up doesn't take away the associated distress.
Traction alopecia can be exacerbated by the ritual combing of the hair. This can be alleviated by straightening out the hair and working through tangles with the fingers before combing, thereby reducing the pull of the comb. It's important to keep the hair soft and in good condition even if you're not worried about other people seeing it.
To prevent this problem, I would advise avoiding unnecessary stress on the hair by winding the
‘Rishi’ knot less tightly. The problem is not with wearing the turban, but with improper hair care.  Hair must be combed down at night and then joora retied in the morning. Keeping joora tied all the time does not allow hairs to relax properly.
Use a light fabric and only use as much fabric as is absolutely necessary to contain the hair. The weight of extra fabric will put added strain on your hair. Be careful not to bind the turban too tightly - it's better to secure it with grips further back on the scalp if necessary, as hair is most vulnerable toward the front of the head. With Be careful to position your hair directly on top of your head before you bind it. This will enable your head to support most of the weight of your hair directly when you are upright. If you tend to lean backwards when sitting, be careful to keep your head upright.
Some Sikhs who suffer from traction alopecia choose to give up on wearing turbans altogether and to keep their hair in pony tails instead. If you do this, make sure that you don't draw it back too tightly from your head and that you secure it loosely.
It is interesting to note that traction alopecia often occurs as a result of various headwear and hair styles, including hair extensions, wearing tight ponytails and wearing tight fitting-hats.

But if you take care to look after your hair and bind it appropriately, you are likely to be able to keep much of the length of it at the back for most of your life.
As a permanent solution to restore hair, hair Transplant is recommended as it is not possible to medically restore lost hair as shown in one of my patients.