Hair loss, as a man or woman, is frustrating. Dr. Irwin answers your hair loss questions and provides information on causes and treatments

Hair Loss In Depth | Causes and Treatments for Men and Women

Written by guest dermatologist and hair loss expert, Dr. Peter M. Goldman.

Hair loss is a very complex medical condition and there are many causes for hair loss. What many people do not realize is that there are effective treatments available. A board-certified dermatologist (a doctor for hair skin and nails), is the best option to treat loss of hair. If you are experiencing hair thinning, hair falling out, or large amounts in your comb, you should make an appointment with a dermatologist. This article will give you the information you need to ask the right questions with your dermatologist.

 

Male Hair Loss:

Norwood Hamilton Scale of Male Hair Loss

Norwood Hamilton Scale of Male Hair Loss

The medical term for hair loss is alopecia. The most common type in men is called male pattern hair loss (MPHL). MPHL is characterized by hair receding from the lateral sides of the forehead, often referred to as a “receding hairline”. Typically, receding hairlines are seen in males around the age of 20, but can also be seen as early as in the late teens. In some cases, a bald patch may develop on the top of the head.

MPHL is caused by a genetic sensitivity of the hair follicles to the hormone dihydrotestosteron (DHT), which shrinks the hair follicles. As sensitive follicles are exposed to DHT, hair growth slows and a weaker, and shorter hair is produced. The exposure to DHT ultimately shortens the lifespan of the follicle and prevents them from producing hair normally.

At-Home Treatments for Men:

Male Hair Loss Before and After Photos

Before and After Photos, No Surgery, courtesy of Dr. Peter Goldman

1. Propecia: Propecia is an FDA-approved once-a-day pill proven to help reduce DHT by inhibiting the formation of DHT in your scalp. It was developed to treat mild to moderate male pattern hair loss on the vertex (top of the head) and anterior mid-scalp area (middle front of the head) in men. Propecia helps reduce further hair loss and regrow visible hair. Propecia must be taken every day in order to be effective.

2. 5% Minoxidil – Rogaine: 5% Minoxidil, Rogaine, is a topical solution used to regrow hair. Minoxidil is directly applied, twice a day, to the hair loss area on the scalp. To keep existing hair and for regrowth, it is necessary to use the product continuously. New hair regrowth is expected to appear in about 12 weeks.

3. Matrix 5,000: Matrix 5,000 by Elon is a supplement that contains biotin, a dietary supplement in the B vitamin group, which helps extend the hair growth period. Matrix 5000 is the only brand endorsed by the American Academy of Dermatology, and should be treated as a good compliment to other hair loss treatments.

4. Scalp Injections: Scalp Injections are a localized injection of progesterone to block the DHT that shrink the hair follicles, which causes the hair to get thinner. Once the DHT is blocked, the hair follicle stops shrinking and often starts regrowing. Typically, scalp injections are recommended every 1-3 months. Although this therapy is not yet 100% accepted in the medical community, I have been using it for over 20 years and have seen much success.

Female Hair Loss

Ludwig Scale of Female Hair Loss

Ludwig Scale of Female Hair Loss

It may seem as if hair loss is more prominent in men, but in reality women are almost as likely as men to lose or have thinning hair. In fact, roughly 50% of women experience some degree of hair loss by the age of 50.

The most common type of hair loss seen in women is called androgenetic alopecia, also known as female pattern alopecia or baldness (here Dr. Irwin writes a reader about testing to see what the cause of the hair loss is). This type of hair loss is predominately on the top and sides of the head. Typically, women experience it after they have reached menopause, but can begin as early as puberty.

A normal woman loses between 100-125 hairs per day, but new hairs replace lost hairs at the same rate. True hair loss is when the lost hairs do not regrow or when daily hair shedding exceeds 125 hairs. Genetically, as with men, hair loss can come from either side of the family genes.

Other Causes of Female Hair Loss May Include

  • Physical stress
  • Emotional stress
  • Thyroid abnormalities
  • Medications
  • Hormonal causes
  • Dieting

At-home Treatments for Women

Female Hair Loss Before and After Photos

Before and After Photos, No Surgery, courtesy of Dr. Peter Goldman

Many of the at home treatments for female hair loss are similar to male at home hair loss treatments. Treatment for female hair loss may include the following. See male treatment list for details on these treatments.

1. Spironolactone: this is a Androgen receptor–blocking drug. 

2. Progesterone lotion: Progesterone is a hormone produced by the female body. It is linked to the production of other important hormones likeestrogen and cortisone. Progesterone prevents the conversion of testosterone to dihydrotestosterone or DHT. As I said above, exposure to DHT ultimately shortens the lifespan of a hair follicle and prevents them from producing hair normally.

3. 5% Minoxidil – Rogaine: See above male treatment details for more info.

4. Scalp injections: See above male treatment details for more info.

 

Temporary Hair Loss

Alopecia Areata is the medical term for one type of temporary hair loss. Hair loss usually occurs in small, round, smooth patches about the size of a quarter. Usually the disease doesn’t extend beyond a few bare patches on the scalp, but it can cause patchy hair loss on any area that has hair, including eyebrows, eyelashes and beard. In rare cases, it can progress to hair loss over the entire body. Soreness and itching may precede the hair loss, but symptoms are often minimal.

Telogen effluvium is a type of sudden hair loss, most often after a significant illness or major life stress. Handfuls of hair may come out when combing or washing your hair or may fall out after gentle tugging. Typically, this type of hair loss causes overall hair thinning and not bald patches.

Contact a doctor if you notice sudden or patchy hair loss or more than usual hair loss when combing or washing your hair. Sudden hair loss can signal an underlying medical condition and may require medical treatment.

Frequently Asked Questions About Hair Loss

Q: What causes hair loss? Hair loss causes?
A: There are a number of things that can cause excessive hair loss. Genetics, a major illness, stress, or hormone imbalances have all been related to hair loss. Hair loss can occur in males and females and is different between each person.

Q: Are there treatments for hair loss? Hair loss treatments?
A: The type of treatment is dependent on the type of hair loss. It is important for a doctor to determine the cause of your hair loss so an appropriate treatment plan can be created.

Q: What is DHT?
A: Dihydrotestosterone (DHT) is produced from the male hormone testosterone by the enzyme 5-alpha reductase. DHT is believed to be the hormone most responsible for male pattern baldness. DHT has a very high affinity for the androgen receptor and is estimated to be five to ten times more potent than testosterone.

Q: How long will it take to see results from hair loss treatment?
A: Results should appear in about two to three months, although sometimes it can take longer. However, the best, most noticeable results are seen after about two-years because of the cycle of hair growth. Hair follicles undergo a relatively long dormancy period in between hair growth cycles and it takes several growth cycles for the hair to get stronger, thicker, and longer. So, it will take a while for the full results to appear.

Q: How many office visits are needed to complete the hair loss treatment and how long do the visits take?
A: The number of visits is dependent on the individual and their hair restoration objectives. For non-surgical treatments, it is recommended that patients come in monthly for the first five months. At the end of this time period, your situation is reassessed and a future treatment plan is determined, if necessary. For surgical hair restoration, most people require only one surgery. However, each case is different and it is difficult to assess how many treatments you will require without a consultation. Results are usually seen within three to six months, although sometimes it may take longer. Most re-thickening is seen between the one and two-year mark.

Q: What is the best hair loss treatment?
A: Each patient’s is different. Their level of hair loss is different and their hair growth objectives are different. Therefore, there is not one “best hair loss treatment.” This is why it is crucial to see a dermatologist with expertise in hair loss as they can best determine the best course of treatment for you.

Hair Transplant Surgery

A hair transplant is a surgical technique that involves moving individual hair follicles from one part of the body (donor site) to the bald or balding parts (the recipient site).

Hair Transplant SurgeryMicrograft and follicular unit transplant (FUT) is an in-office medical procedure that redistributes healthy hair follicles from non-thinning areas at the sides and very back of the head to the thinning or balding areas on top. Since hair naturally grows in follicle groupings of one to four hairs, these naturally occurring follicular units can be transplanted and achieve a natural appearance.

Healthy hair follicles are found in good supply in most people. In men, these strong, hormone-resistant hairs tend to be concentrated in a horseshoe-shaped area at the very back of your head (the donor site). Your surgeon will choose hairs of various textures to transplant to the areas where the hair is needed. A strip of tissue is removed from the donor site and closed with sutures. The resulting scar is well concealed under the hair once it has healed. The strip contains the individual follicles, which grow naturally in groups of one to four hairs each. The follicles are carefully prepared under magnification, and the individual follicular units are then transplanted to the balding area.

Patients usually see beginning results within 6 months and hair growth continues to improve over the course of 9-12 months. The transplanted hair is natural and permanent.

Hair Transplant Cost

Hair Transplant Before and After Photos

Hair Transplant Before and After Photos, Courtesy of Dr. Peter Goldman

Hair transplant costs vary by city and by the level of the physician’s experience. At my practice cost can vary from patient to patient, depending on the number of grafts needed. During the consultation process we will determine how many grafts you need and what price your particular needs will cost. It is extremely important to be wary of physicians offering large discounts on hair transplants. These doctors may not be as experienced or do a high-quality job and you do not want to lose the quality treatment that an experienced doctor provides (at a higher price).

But overall, I would say on the low end, a single hair graft can cost $5. If you go to one of the leading experts in the field of hair loss, a single hair graft can cost up to $20.

 

Conclusion

Ultimately, if you are experiencing hair loss, please find a dermatologist experienced with hair loss in your area. If you start treatment early and are compliant with the medication/treatment regimen, there is a good chance you can avoid the need for hair transplant surgery. Good luck!

Peter M. Goldman

Peter M. Goldman, M.D.
Board-Certified Dermatologist
Goldman Dubow Dermatology Group
Cedars-Sinai East Medical Tower
8631 W. Third Street, Suite 635
Los Angeles, CA
310-855.1160
www.GDderm.com

See Dr. Irwin’s expert answers to other reader’s questions on hair loss:
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