Hair Loss Overview
It is difficult to explain and describe “hair loss” in a concise overview. Over 56 million Americans suffer from hair loss. More than half of American men will experience hair loss by the age of 50. Hair loss can also be caused by a variety of medical conditions, side effects of medications, and other physical factors. Hair loss can occur in many ways. Treatments for each type of hair loss are different for children, men, and women. Although it can be difficult and stressful, a professional can diagnose the problem and provide treatment. It is essential to learn more about hair loss and the causes.
What is “Hair Loss?”
Alopecia, also known medically as hair loss, refers to either the loss of hair follicles or their dysfunction in a particular region. Alopecia can affect any hair-follicle in the body. This includes hair follicles located on the scalp and any other areas of the body, such as the arms, legs, or face. It may appear as gradual, progressive hair loss. However, it can also occur in a dramatic manner where certain “patches” seem to disappear suddenly. It is important to know what ” is hair loss” is.
The complex organ of a human hair follicle is made up many stem cells. This complex interaction allows for the growth of hair. This communication takes place in transitional phases. The “anagen” phase also known as growth phase lasts for approximately 3-4 years and is responsible to growing hair continuously. Anagen growth is able to grow approximately 0.5 inches per month. This means that a healthy hair follicle can grow about 6 inches per year. The “telogen”, also known as the “resting phase”, lasts around 3-4 months. It is a time when hair loss or follicular activity ceases. This period, and partially the transitional phase “catogen”, sees hair follicle activity temporarily stop and hair shafts are shed. Around 10% of hair follicles can be found in the resting or telogen phase at any one time. This is important information. A “resting” hair shaft releases its hair shaft, and the hair then “sheds” from your scalp. A healthy, normal scalp will shed between 50 and 150 hair shafts each day. These shafts can be seen while you are washing your hair or combing it. They also appear on your pillow when you wake up in the morning. These naturally falling hairs can be misinterpreted as true hair loss by many people. This is normal and does not indicate any underlying disease or problem. A hair loss doctor should evaluate your scalp if you notice more than 50 to 150 hair shafts falling out per day, large clumps of hair shedding at once, sudden patches of skin changes or patches appearing in the scalp.
Hair Loss in Men
Hair loss is most common in adult males. The hair loss usually starts in late teens, but it can happen much later. Around 30% of males experience hair loss before age 30. This number rises to about 50% at age 50, and then to around 80-90% by the time men enter their eighth decade. Genetic male pattern hair loss is the most common cause of hair fall in men. This is also known as “androgenic” or “androgenetic hair loss” or, more commonly, “male pattern baldness.” “Andro” refers specifically to male hormones such as testosterone. “Genetic” refers only to human genes. Androgenic alopecia is hair loss that occurs due to your genes, but caused by a hormone. There are many genes that can be associated with androgenic hair loss. Experts believe that not all genes may be involved in androgenic alopecia. These genes can be passed from the maternal (mother) or paternal (father), and can be uniquely expressed in different people. This means that different levels of hair loss can occur for individuals with identical genes. Dihydrotestosterone, or “DHT”, is the hormone that causes hair loss. It is a common byproduct of testosterone.
The most common manifestation of genetic male pattern hair loss is thinning and eventual baldness in the classic “patterned” areas. The most common areas affected are the edges of the frontal hairline, and the “crown” or vertex region at the back of your scalp. The Norwood/Hamilton Scale is used to grade androgenic alopecia. Patients who lose only a small amount of hair at the frontal hairline are considered low on the scale. These patients typically receive a Norwood I and II. Advanced hair loss across the entire scalp (apart from the back and sides where the follicles can be immune and will never shed, regardless of the severity of androgenic-alopecia) is high on the Norwood scale. These patients are usually a Norwood VI or VII. This is the highest and most advanced grade. Androgenic hair loss is unpredictable and progressive. It’s most active between 20 and 50 years old. However, it tends to stabilize slightly after that time. Many men still experience a diffuse thinning of their hair shafts known as “Senile Alopecia.”
After a thorough medical history and scalp examination, a hair loss physician will diagnose androgenic or sporadic alopecia. There are two options for treating androgenic alopecia. Two preventive medications have been approved by the US FDA for androgenic alopecia treatment: finasteride (sold as Propecia and Proscar), a medication that inhibits testosterone’s conversion to dihydrotestosterone and topical minoxidil, which is sold under the name “Rogaine”. Shampoos containing ketoconazole, an anti-fungal, anti-inflammatory agent, herbal and holistic supplements, as well as low-level laser therapy (LLLT), therapy are all popular but not approved.
The most popular and effective treatment for androgenic hair loss is surgical hair restoration, or Hair Transplant surgery. Follicular Unit Transplantation, also known as FUT or Follicular Unit Strip Surgery – “FUSS” or Follicular Unit Excision (also called “FUE” or Follicular Unit Extraction) is the most modern method of hair transplant surgery. This allows patients to restore large areas with thick and refined results. Those interested in surgical hair restoration should review patient cases presented by hair transplant experts on the Hair Loss Help Forums/Hair Loss Doc (www.hairlosshelp.com/forums, www.hairlossdoc.com) and Hair Transplant Web (www.hairtransplantweb.com). Platelet Rich Plasma, or “PRP”, is another popular procedure in the office for androgenic hair loss. A sample of the patient’s blood will be taken and placed in a tube. The test tube will then be spun in a centrifuge to extract natural growth factors. Although PRP is controversial, the process is not well-known and results can vary (and are usually temporary).
While androgenic hair loss is the most common cause of hair loss in adults, there are other possible causes, such as auto-immune conditions or other hormonal imbalances, medication side effect, infection, or chronic conditions like Psoriasis. A dermatologist should evaluate all patients suffering from atypical hair loss. Additional treatment and diagnosis may be required.
Hair Loss in Women
Hair loss can affect a large number of females just like it does for their male counterparts. It is believed that as many as 40% of women will experience hair loss before the age of 40. Hair loss in women is more complex than in men. The most common cause for hair loss in women, just like males is “genetic feminine pattern hair loss” (or “FPHL”). Although FPHL is often compared to genetic male hair loss, the actual mechanism behind it is more complex, less understood and much more difficult. FPHL is usually caused by hormonal imbalances. However, these imbalances aren’t as simple or direct as the mechanism of dihydrotestosterone in genetic male patterned hair fall (DHT). Many FPHL patients have abnormalities in both the “male”, androgen hormones, like testosterone, as well as the “female,” hormones such estrogen. Many patients notice hair loss only after a major hormonal shift such as pregnancy or menopause.
Patients who are female describe hair loss as a “widening” of their part. Female hair loss is more severe than male-patterned hair loss. It starts in the middle of the scalp and moves outwards. The “Ludwig scale” is used to grade the severity of hair loss. Ludwig level I is a slight spreading of hair in the middle; Ludwig level II is a diffuse spreading pattern that reaches the hairline in front, the posterior region above the crown and the lateral areas above the ears. Ludwig level III is the most severe.
Hair loss can be caused by a number of other factors. Hair loss can also be caused by hormonal imbalances such as those related to thyroid function or deficiency in certain vitamins and minerals. This type of diffuse spreading pattern is a sign that a female should have extensive bloodwork done and consult an endocrinologist. Simple treatments such as oral estrogen pills and fixing a blood deficiency can greatly improve female hairloss. Telogen effluvium, which is temporary but still very noticeable in female patients, can also be a cause of hair loss. This happens when an external stressor “shocks”, a higher than usual number hair follicles into the resting, or telogen, state. This usually resolves itself within three to four months.
A common cause of hair fall in females is immunemediated alopecia. This refers to hair loss that is related to the immune system. This can also occur in men, but it seems to be more common in women. The immune-mediated hair loss is more obvious and unusual. It appears as “patches” or clusters of hair that suddenly fall out and leave behind very smooth, well-defined, bald areas. Hair loss can also be caused by inflammation or hardening of skin. These types of hair loss may be more common in females with immune-related conditions, such as Lupus or thyroid problems. These types of hair loss are more common in female patients who have not been evaluated by a dermatologist. Although many of these conditions can usually be treated, expert diagnosis and testing are required.
Hair styling and hair treatments can cause hair loss in female patients. Traction Alopecia is a condition in which hair falls out because of the constant tension on the hair follicles. Hair shaft disorders can also be caused by excessive styling or chemical treatments. Hair shaft disorders can cause excessive shedding, which results in a thin appearance and visible scalp.
Female hair loss is more complex and varied than classic male hair loss. This makes it more difficult for female patients to have their hair restored. For a complete evaluation, female patients who are considering hair transplant surgery should see a hair restoration doctor. This will likely mean that these patients will be referred to an endocrinologist or dermatologist for further testing before proceeding with the surgery.
Hair Loss in Children
Alopecia is a complex condition that affects children. Alopecia in children as young as three years old is often due to genetic conditions. These complex genetic conditions can cause hair shaft abnormalities. Hair shafts can be misshaped or not properly anchored to hair follicles. This causes a thin appearance on the scalp and leads to frequent hair loss. Hair loss in children can also be caused by scalp infections, most often fungal infections. They usually appear as a well-defined, large, raised, circular and well-defined area of hair loss. These infections can usually be treated and the hair loss will often improve or reverse itself. The same immune-related hair loss that affects adults can also be experienced in children. Alopecia Areata, a type of immune-mediated hair fall that affects children, is characterized by circular patches on the scalp. The patches are usually extremely smooth and devoid of hair. These can either be treated with steroids injections or they will resolve themselves. Children are more likely to suffer from chronic hair pulling, or “Trichotillomania,” which is also known as “Trichotillomania.” It can be caused by a psychological issue, or a life stressor. However, the persistent pulling or plucking on the scalp, eyebrows, and sometimes even eyelash hair can result in patches of hair loss. Although hair can regrow if compulsive behavior is stopped, permanent hair loss may be possible. Hormone-related hair loss can occur in teenagers and older children. Thyroid hormone abnormalities, or conditions related to estrogen or testosterone may cause hair loss in teenage girls. These conditions can often be treated with oral hormone replacement therapies. Early androgenic hair loss may also occur in teenage boys. Many teens with a history of severe hair loss in their families experience thinning as young as high school. Preventive medication like minoxidil and finasteride may be an option for patients too young to undergo hair transplant surgery. It is important to discuss the possibility of starting medication too young with your hair loss doctor.
Hair loss can be a complicated subject. Sometimes it’s easy to treat and is easily treatable. Other times, it can be complex and poorly understood and hard to treat. No matter your age, gender, or type, it is important to consult a qualified physician in order to understand and possibly treat this problem. This hair loss primer will help you identify what might be happening and find the right expert to address it. We hope that this overview will help hair loss sufferers to regrow their hair and regain some of their identity.