Hair loss is a common complaint among our patients, both men and women. Although is it normal to shed hairs each day, excessive hair loss can lead to a thinning hair line, and areas of baldness. There are hair loss treatments that help promote hair growth or hide hair loss. For some types of hair loss, hair growth may return without any treatment.
Normal Hair Growth
To understand how hair loss happens, it is helpful to understand how hair normally grows. Each shaft of hair is produced by a hair follicle. The cells in the hair follicle produce hair for about 2-3 years. During this growth phase called “anagen”, each hair grows about 1 centimeter (1/2 inch) per month. After this growth phase, the hair follicle enters a resting phase called “telogen” during which the hair remains in place, but stops growing. This “resting phase” lasts about 3-4 months, after which the hair falls out. After the hair falls out, the hair follicle starts producing a new shaft of hair.
On average, 90% of the hairs on the head are in the “growth phase” at any one time (and 10% are in the resting phase). People normally shed hairs each day as the hair follicles reach the end of the resting phase and prepare to produce new hairs. 50 to 100 hairs are shed daily from a normal scalp.
Hair Loss Causes
The most common cause of hair loss among men is called male-pattern baldness, or androgenic alopecia. Men who have this type of hair loss usually have inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. With male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head (vertex).
Women may develop female-pattern baldness. With this form of hair loss, the hair can become thin over the entire scalp. Female-pattern baldness is much more common than is generally recognized.
Other less common causes of hair loss include:
- Alopecia areata: Alopecia areata is an autoimmune disease, in which the body’s own immune system mistakenly attacks the hair follicles, leading to hair loss. In most cases, the hair falls out in small, round patches about the size of a quarter. More severe cases can involve the entire scalp or other parts of the body.
- Extreme stress: 3-4 months after a severely stressful event, such as an illness or major surgery, large amount of hair may be lost. The stress caused the hair follicles to cease the growing phase prematurely. This stress-induced hair loss is temporary and the hair usually grows back.
- Hormonal problems: Hypothyroidism or hyperthyroidism can lead to hair loss, as can imbalances in androgens (males hormones) and estrogens (female hormones). For instance, anabolic steroids taken by athletes for performance enhancement can lead to premature hair loss. The correction of hormonal imbalances can, in some instances, return hair growth to normal.
- Post-partum hair loss: Many women experience hair loss 3-4 months after having a child. This hair loss is also related to hormonal changes due to pregnancy. Elevated levels of certain hormones during pregnancy lead to the hair follicles staying in growth phase longer than normal. When the hormones return to pre-pregnancy levels, those follicles enter the resting phase and start to fall out 3-4 months later.
- Certain medications: Some medicines, such as blood thinners (coumadin), anti-hypertensives, antidepressants, and birth control bills can lead to excessive hair loss. This type of hair loss usually improves when the medication is stopped.
- Fungal infections: Fungal infections of the scalp can cause hair loss in children. The infection is easily treated with antifungal medicines.
- Excessive tension on the hair: Wearing tight pigtails or cornrows or using tight hair rollers, can pull on the hair and damage the hair follicle. This can lead to a type of hair loss called traction alopecia. The hair can grow back normally, if the pulling is stopped before scars develop.
Hair Loss Treatments
Hair loss treatment are recommended based on several variables, including the type of hair loss, the degree of hair loss, your gender, and your personal preferences.
There are several hair loss medication that can help slow or prevent the development of common baldness (androgenic alopecia). The effectiveness of these medications depends on the cause of hair loss, extent of the loss, and individual response. Generally, hair loss medications are less effective for more extensive cases of hair loss. These hair loss medication require 3-6 months of regular use to determine if they are helping.
Rogaine® (minoxidil) is a non-prescription topical medication applied to the scalp to grow hair and to prevent further hair loss. It may also be used for the treatment of alopecia areata. New hair resulting from Rogaine use may be thinner and shorter than previous hair. But, there may be sufficient hair growth in some to hide bald spots and have the new hair blend with existing hair. It is important to note that hair growth stops after you discontinue the use of Rogaine. Side effects can include irritation of the scalp.
Propecia® (finasteride) is a prescription medication taken daily by mouth. It is available for use by men only. Many men taking Propecia experience a slowing of hair loss, and some may show some new hair growth. It may take several months for new hair growth to appear. Hair growth will stop after you discontinue the use of Propecia.
Propecia works by stopping the conversion of male hormones into dihydrotestosterone (DHT), which can shrink hair follicles in men who are susceptible to its effects.
Other hair loss medications that may be attempted in specific clinical cases include:
- Injections of corticosteroid into the scalp to treat alopecia areata. Treatment is usually repeated monthly. New hair growth may be visible four weeks after the injection. Doctors sometimes prescribe oral corticosteroids (prednisone) for extensive hair loss due to alopecia areata.
- Anthralin is usually used to treat psoriasis, but it may be used in some cases to stimulate new hair growth for cases of alopecia areata. It may take up to 12 weeks for new hair to appear.
Hair transplantation techniques have evolved considerably over the years to provide a treatment for male-pattern or female-pattern baldness when other measures have not succeeded.
Most hair transplantation procedures involve taking tiny plugs of skin, each containing one to a few hairs, from the back or sides of your scalp and implanting them into bald sections. Several transplant sessions may be needed, as hair loss may continue over time. Scalp reduction is another technique that involves the removal of bald areas of skin and closing in the space with hair-bearing skin. Scalp reduction may, in some instances, be combined with hair transplantation.
Hair transplantation procedures are painful and not usually covered by health insurance. Possible risks include infection and scarring.
Wigs and hairpieces
Wearing a wig or hairpiece provides a useful alternative to medical treatment. Quality, natural-looking wigs and hairpieces are now more readily available and can effectively cover areas of baldness.