Going bald: Why you should worry about pubic hair loss

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"I am 21 years old and have no armpit hair. Is something wrong with me?" Asked a young adult  recently on a social media platform using a pseudonym account.

Hair growth in the the underarm and pubes is generally considered a marker of normal development into adulthood. It starts in puberty, typically between the ages of 8 and 13 for girls and between 9 and 14 for boys.

Hashim Shauktali Kaderbhai, consultant dermatologist and venereologist at the Aga Khan University Hospital, however says that growing underarm hair much later in life, or sometimes, never, is also normal.

"The absence or reduced growth of armpit hair is generally considered normal and not a cause for concern. On the other hand, not having or starting to lose pubic hair at a certain age or stage of life could be a form of a disorder," Dr Hashim notes, adding that  having sparse or thick pubic hair should not be a big concern as the amount varies from people to person.

He says the lack of pubic hair growth can be caused by conditions such as hypogonadism, which involves imbalances in hormone levels, therefore affecting hair growth.

The growth of underarm hair, he says, is influenced by hormones like testosterone and estrogen, meaning that fluctuations in their levels can impact the amount and thickness of underarm hair.

"Testosterone promotes hair growth in men, including the development of underarm hair, while estrogen, the primary hormone in women, also contributes to underarm hair growth to a lesser extent," he says.

Genetics can also play a role in hair growth, as certain traits related to hair growth can be inherited from family members. Additionally, differences in hair growth patterns can be influenced by individual variations in hormone receptors and sensitivity to hormones.

In some cases, Dr Hashim points out that individuals may have a condition known as androgen insensitivity syndrome, a genetic disorder in which the body's tissues are partially or completely insensitive to the effects of androgens (a group of sex hormones), including testosterone. This can lead to reduced or absent underarm hair growth, among other physical characteristics.

Some conditions that can affect underarm hair growth include;

Hypothyroidism: This is a condition characterised by an underactive thyroid gland, which leads to reduced production of thyroid hormones.

Thyroid hormones play a role in regulating metabolism, growth, and development, including hair growth. In cases of hypothyroidism, hair growth in the armpits may be sparse.

Menopause: During menopause, a woman's estrogen levels decrease significantly. This can lead to changes in hair growth patterns. Some women may experience a decrease in underarm hair growth, while others may notice an increase.

Medication: Certain medications and cancer treatments like chemotherapy and radiotherapy can cause rapid hair loss by harming hair follicles and disrupting the natural growth cycle. This can occur anywhere on the body, including the pubic area, with the most noticeable loss happening in the treated area. Pelvic radiotherapy can also lead to hair loss in the pubic region.

Ageing: As you age, your pubic hair, like the hair on your head, will naturally start to thin and turn grey. Hair loss and a slowing down of the rate of hair growth are part of the ageing process.

"If you're losing a significant amount of pubic hair and don't think it's due to ageing, it could be a symptom of a serious condition," says Dr Hashim.

The treatment

Dr Hashim explains that there are treatments available for hormonal imbalances that can help with hair growth. However, the specific treatment options depend on the underlying cause of the hormonal imbalance.

Hormone replacement therapy is commonly used to address hormonal imbalances related to menopause or hypothyroidism.

"For menopause, estrogen replacement therapy can aid in improving hair growth and reducing hair thinning. In the case of hypothyroidism, thyroid hormone replacement can help restore normal hormone levels and potentially improve hair growth," says Dr Hashim.

In situations involving hypothyroidism, he says treatment with thyroid hormone replacement medication can assist in normalising hormone levels, which may lead to improved hair growth and reduced hair loss associated with the condition.

Dr Hashim emphasises that there is no specific timeline for when a patient will see hair growth after treatment. For hypogonadism, the treatment duration may be longer.

"Hair growth is a gradual process, and it may take time for changes to become noticeable. Individuals need to be patient and consistent with the treatment approaches they choose to try," he says.

He points out that while pubic hair loss is not harmful to a person's physical health, it can cause psychological distress.

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