No standard healthcare insurance in India covers hair treatments, including transplants, calling them cosmetic or aesthetic procedures.There is a common belief people and policy makers are holding tight — hair fall is …

No standard healthcare insurance in India covers hair treatments, including transplants, calling them cosmetic or aesthetic procedures.There is a common belief people and policy makers are holding tight — hair fall is not essentially a medical problem.However, this assumption does not sit well with Dr Debraj Shome, a cosmetic and reconstructive surgeon, who has spent hours with cancer survivors and those suffering from alopecia, a hair loss disorder, affecting the social and mental well being of a person.“If you sit with them, you will know that hair is not vanity, it can be one’s whole identity,” said Dr Shome anecdotally sharing an instance where a 20-year-old breast cancer survivor at Tata Memorial hospital had blatantly questioned him: “My cancer is gone but what am I without my breast and hair?”The reporter at DH also happened to witness a pancreatic cancer patient who seemingly was worried after not finding a suitable wig to cover her head ahead of a chemotherapy session.Hair Fall Treatments: When Should You Consider Medical Options?Alopecia: A receding hairlineWhile most people associate pathological baldness with cancer therapies, there is yet another condition which has robbed many men and women of having a fulfilling social, emotional and even sexual life—- clinicians call it alopecia.According to Healthline, alopecia is an umbrella term for all hair loss conditions which are not contagious, making people lose hair in places where it is supposed to grow naturally.As per records, at least 40 per cent women suffer from it across their lifetime. It could be patchy, strained or any other form of hair loss.Genetics, hormones, dietary factors, inflammation and an over reactive immune system are some factors driving it.Sometimes, tight pulling of the hair while keeping certain hairstyles or physical injury can also trigger hair loss by damaging the hair follicle (a structure beneath the scalp skin forming hair).Perception across culturesHistory has treated a receding hairline differently across cultures and timelines. The Conversation dug out pictures of aristocratic women of the medieval and renaissance ages having a high hairline and being celebrated for it, with people admiring it as a symbol of intelligence, particularly in English culture.Even in India, baldness has been associated with a loss of ego and rise of divinity.Today, alopecia is being seen more commonly through clinical and cosmetic eyes. While science recognizes it as a debilitating health condition largely affecting one’s quality of life, health policies across many cultures continue labelling it as a cosmetic problem.Hence, its social position is still disputable among the scientific and legislative communities.What is beneath the iceberg?Nearly every culture associates thick, luscious hair with beauty and good health.As per the scientific community, to live with hair loss disorder or alopecia is comparable to an ‘iceberg’, the concept introduced in 2019, where just the surface of the struggle is visible to others.While most people see alopecia as a physical or cosmetic problem, they tend to miss out on the psychosocial burdens like anxiety, depression and even having suicidal thoughts ( as seen in rare cases) that tag along with it.“Hair is a high metabolic item. It speaks volumes about one’s health. It not only can tell what may be happening inside your body but it can also affect the way a person literally shows up in their life,” said Dr Shome.Speaking to DH, Kisshori and Arushi, both in their thirties, shared how it is to be a woman and to live with alopecia.Alopecia and love: ‘You don’t need hair to be a woman’“There are days when it occupies very little of my attention, and others when an ordinary moment in front of the mirror reminds me of it,” said Kisshori (name changed for privacy concerns), who lives in Agra, have worked with multiple global fashion icons and home decor brands before starting a business of her own.Kisshori has been battling with alopecia for almost three decades now.Brushing it off as a stubborn acne which can be easily concealed, Kisshori treats her hair gaps in a similar way and continues to go about her day.She had started to develop symptoms at the age of three (1993), in times when no doctor in her vicinity could make a straightforward diagnosis.“Every doctor studied about it and then reached back to us, confirming that there’s no solution out there,” Kisshori told DH.Sitting with the discomfort for some years, she finally accepted her fate.Surrounded by an emotional safety net, Kisshori never allowed herself to derive validation from her hair.“Alopecia has made me question why we attach so much meaning to a physical feature that a person may have little control over,” she said.When DH asked her if alopecia has affected how she put herself out there, open to be admired, desired and loved as a woman, she said feminine beauty lies much beyond a free flowing cascade of hair.She said: “I don’t believe a woman must reject beauty or stop caring about her appearance to demonstrate self-acceptance. I want to look beautiful while realizing that my worth extends far beyond it. I am not a prisoner of global beauty standards.”“As far as being a woman is considered, I can show warmth, intelligence, creativity, sensitivity, confidence and show up in all the ways a woman relates to the world. None of these qualities requires a particular hairstyle or a certain amount of hair,” Kisshori added.When asked if the condition was an obstacle in her dating or romantic relationships, Kisshori said alopecia has naturally added a filter to her love life which keeps superficial proposals at a bay.“I’ll not pretend that appearance plays no role in attraction. It does. But attraction is also shaped by personality, humor, warmth, intelligence, shared values and the experience of being understood by another person,” she said.“I want a relationship in which I could be honest about my alopecia without feeling that I had to apologise for it or compensate for it in other ways. I don’t see love as a threat to my individuality, I want companionship, affection, shared experiences and the freedom to be vulnerable with someone. At the end of the day, genuine love stories are rarely built on fragile strands of hair,” said Kisshori.With a chuckle on her face, she mockingly said the condition also saves her a lot of time. A quick fix to her hair and she is ready to go.Alopecia and love: ‘Just trying to protect my heart’Arushii Biidhuri, a journalist based in Delhi, for the longest time could not understand the pattern of hair loss affecting her.Battling Polyendocrine metabolic ovarian syndrome (PMOS) since 2011, she related hair thinning to her hormonal condition.“I never really lost a large chunk of hair in one go. So, it was hard for me to figure out what was happening beneath the scalp,” said Biidhuri.After her father’s illness and demise in 2018 and then undergoing a double bout of Covid infection in both waves (one and two), Arushii finally started to see that this hairfall was not random. “My hair was thinning in a prominent manner. At that point, it hit me like a rock. I just knew I needed to see a doctor,” told Arushii.According to Dr Shome, timing of treatment initiation is of key importance in alopecia patients with most people losing nearly 30 per cent of their potent hair by the age of 19 years. Comparing the condition to diabetes, he informed that alopecia is a chronic illness. The more time a person spends without treatment, the more shrinkage and loss of hair follicles will occur.On getting to know that she has Cicatricial alopecia, a hair loss disorder caused by inflammatory conditions, Arushii spent lakhs of rupees to seek treatment.She tried platelet rich plasma injectables (PRP), stem cell therapy, regenerative therapy, tried sprays and finally found some comfort with hair toppers, a hairpiece designed to cover hair loss.“It’s easier said than done to say your hair does not define you. It does make me conscious but I’m slowly moving towards a realization that hair is not the only thing people notice about me in one go,” said Arushii, sharing her deepest vulnerabilities.When DH asked her how confident she was to put herself out there for dating or marriage, she said: “My first instinct was to hide alopecia in fear of my hair resembling that of a 70-year-old woman.”She described how even at work if someone stared at her for a minute longer or if a friend cracked a joke around hair, she felt like escaping the situation.“Whenever I spoke to a guy, I would often think if I told him about my hair later on in the connection, it would be catfishing. If I disclose too quickly, I should be ready for rejection or mockery. I’m trying to be at a place where I accept these feelings without having to lose myself but to be honest, I’m not there yet. I totally avoid dates or proposals for now. The world isn’t a very kind place and often people are not very idealistic. Appearances do matter to some people. I’m just protecting myself from difficult and hurtful emotions,” said Arushii.However, as a step ahead, Arushii has recently started to share her personal journey on social media.Alopecia and sexTalking about a research conducted in 2019 on around 800 people with hair loss, Dr Shome shared that a reasonable percentage of men with hair loss or baldness were found to be facing impotency.As per the reconstructive surgeon, alopecia has an effect on one’s bedroom life — be it dating, marriage and even physical intimacy.“I won’t name the star but a Bollywood celebrity with alopecia had visited us for consultation. With an admirable persona and a strong build, the man fell so weak when in a fit of passion, his sleeping partner accidentally tossed off the wig from over his head. This intimate encounter made that man feel so embarrassed and vulnerable. It is even harder when the person is a woman,” said Dr Shome, however suggesting that even men find it hard to find companionship when they have hair loss.“It is no longer a gendered thing,” clarified Dr Shome.Some studies have found an association between alopecia and decreasing desire for sexual intimacy due to psychosocial impairment.Just like any other chronic diseaseAccording to Cleveland Clinic, hair grows out of tiny structures beneath one’s scalp, called hair follicles.Sometimes conditions like systemic inflammation, genetic or environmental factors, oxidative stress, immune response, dietary deficiencies and even some diseases can disrupt follicular growth. This can result in hair thinning, loss of hair volume or baldness.“Hair follicle miniaturization naturally happens as one ages. The follicles start to get shrink and this can show up as hair thinning or a receding hairline,” said Dr Shome.The expert said there is a harmful assumption among people that makes them believe children are not supposed to take hair treatments.He said: “Just like diabetes, hypertension or any other chronic illness, hair loss needs to be treated at the earliest and regularly. My youngest patient was 12 years old. It is high time we start to take hair as any other body part and take clinical help when things go south.”As per a study, about 30 to 60 per cent of people with dermatological disorders have psychiatric concerns.Hence, living with alopecia can equally affect a person’s mental health.Treatment and hopeWhen DH asked how medicine can help people with alopecia, Dr Shome said the stage of the disease decides what treatment course will be followed.“For most people, hair loss is either genetic or hormonal (androgenic). First, we may run traditional treatments like drugs, including Minoxidil and Finasteride which can slow down the rate of hair fall. Then, we can try out new regenerative therapies like QR678, an engineered cocktail of peptides which can help in hair regrowth. We simply try to use this solution to convert dead and dying hair into living again,” he informed, saying the initial course of treatment involves a combination of traditional and new age methods.When DH asked if hair transplant can be an option for people with alopecia, Dr Shome said that just like any other branch of medicine, surgery is the last resort.To clarify a false assumption, the surgeon informed DH that during a hair transplant, no new hair is added to the patient’s scalp. He explained that some hair from the back of one’s head is simply displaced to the front where the volume seems to be shrinking to make the scalp look fuller.“There are some prerequisites to transplant as well — the patient must have enough donor region for the surgeon to transfer,” added Dr Shome.As per experts, hair loss is a chronic disease and its management becomes difficult if the patient has lost a good margin of hair follicles before they turn up to a clinic for help.Talking about patients with advanced alopecia who are encouraged to use hair alternatives like wigs, hair toppers and others, Dr Shome said: “There will always be 2 to 5 per cent of the patients we won’t be able to help much. However, we can ensure to create a safe space for them to live with this chronic condition. That is the least we all can do. Disease must not stop a person from being taken care of, respected or loved.”

Source: Deccan Herald