What is hair loss?

The average person can lose as many as 100 hairs per day. Excessive hair loss (also known as alopecia) affects men and women. Hair loss can be widespread or patchy and can be caused by genetic conditions, disorders or diseases. If hair loss is severe or premature, it can cause distress.

The most common cause of hair loss in men is male pattern baldness (androgenic alopecia) and is a result of hormonal and genetic factors. Hereditary baldness is so common that many people see it as part of the ageing process.

If you start to notice significant hair loss or hair thinning, consult a dermatologist to see if the cause and available treatments can be identified. Hair loss treatments can reduce, slow, and stimulate partial hair regrowth.

How does hair grow?

Hair follicles cover all parts of your body except the soles of your feet, palms of your hands and lips. Hair is made from a protein called keratin, which grows, rests and renews. Your hair follicles are skin cells that contain the hair root. Many of these hairs don’t grow long enough to extend from the pore.

Your follicle supplies nutrients and oxygen to the hair root as it lubricates your hair with sebum. The root of your hair is attached to the base of the follicle. It’s the only living part of your hair.

What causes hair loss?

Hair loss (alopecia) can be caused by a number of factors and conditions. Some people can experience temporary hair loss (telogen effluvium) while others experience long-term hair loss.

Several genes in your mother’s and father’s family determine your susceptibility to hair loss. Genetic factors play a bigger role in hair loss than environmental factors. Studies show that identical twins lose their hair in the same pattern, at the same rate and at the same age. Androngenetic hair loss is caused by androgen hormones and occurs in people with a genetic susceptibility.

Hair loss in men

Androgenic alopecia can affect both men and women. It’s commonly known as male pattern baldness or female pattern baldness. This hereditary genetic condition can cause hair loss to occur in teenage years.

Androgenic alopecia develops because of:

  • A genetic predisposition,
  • The ageing process, and
  • The presence of hormones and corresponding receptors.

Hair loss and baldness in men is a result of the male sex hormone DHT triggering hair follicles to shrink over time (follicular miniaturization) and stop growing new hair. Men typically experience hair loss at the crown and hairline, which extends around the back and side of the head, creating a horseshoe hair shape.

Hair loss in women

Androgenic alopecia can trigger female pattern baldness. The same sex hormone (DHT) that activates male pattern baldness also activates female pattern baldness.

Hair loss in women produces a scattered thinning over the top of the scalp instead of a bald spot, with the hairline being maintained. Over 55% of women experience minor hair loss as they age. Moderate to severe hair loss is experienced by about 20% of women.

Other causes of hair loss

Some causes of hair loss include:

  • Alopecia Areata: An autoimmune condition with an unknown cause that leads to patchy hair loss on the scalp.
  • Alopecia Totalis: An autoimmune condition with an unknown cause that leads to loss of all hair on the scalp.
  • Alopecia Universalis: An autoimmune condition with an unknown cause that leads to loss of all hair on the body and scalp.
  • Disease: Including cancer, diabetes, and lupus
  • Hair styling: Can cause hair loss if hair is excessively styled, straightened or brushed. Hair loss can also occur because of dying, bleaching or perming treatments.
  • Hormonal changes or imbalances: This may occur during pregnancy, birthing, discontinuing use of birth control medication or devices that affect hormones, the onset of menopause, thyroid conditions, or severe emotional trauma and shock.
  • Hyperhidrosis: This condition causes excessive sweating that can lead to lactic acid secretion harming the scalp and hair.
  • Infections: Tinea capitis (ringworm of the scalp) is a contagious fungal infection that can cause patches of hair loss.
  • Medical treatments: Radiation therapy and chemotherapy for cancer can cause hair loss.
  • Medications: Medications including Accutane, blood thinners, anti-inflammatories, anti-fungals, drugs used to treat depression, high blood pressure, ulcers, thyroid disorders, Parkinson’s, heart disease, gout, glaucoma, epilepsy, cholesterol can lead to hair loss.
  • Nutritional deficiencies: Hair loss can be caused by unhealthy dieting, eating disorders, or generally poor nutrition,
  • Traction alopecia: This condition occurs when the scalp is scarred and hair roots are damaged from over styling or pulling hair too tightly in hairstyles like ponytails, braids, or pigtails.
  • Trichotillomania: This psychological disorder causes people to compulsively pull out their hair from the scalp, brows, or elsewhere on their body.

Hair loss treatments

While there is no cure for hair loss, a number of treatments can slow or reduce hair loss, stimulate partial regrowth or replace damaged hair. Men with advance balding find that surgical hair transplantation is beneficial.

Age-related hair loss and hereditary forms of hair loss are hard to reverse. Hair loss treatments can control alopecia areata and in some cases hair thinning stabilises so baldness can be avoided.

Cosmetic hair loss and alternative treatment options:

Some men and women who are experiencing hair loss discover that wearing wigs and hairpieces can help them feel like themselves again.

Other treatments suggested for hair loss include:

  • Massage,
  • Vitamin supplements,
  • Herbal remedies like saw palmetto,
  • Zinc,
  • Amino acids,
  • Hair lotions and
  • Tonics.

It’s important to note that none of the above treatments have been scientifically shown to prevent hair loss or promote hair growth. The use of laser therapy to prevent hair loss has no scientific evidence either. Consulting with your doctor before starting any hair loss treatment is the best course of action.

Male pattern baldness treatments (androgenic alopecia)

While there are a number of treatments available for male pattern baldness, it’s important to understand there is no known cure. Treatments include Minoxidil lotion and Finasteride tablets, which are available on prescription. Cosmetic options include camouflage sprays, wigs and hair transplant surgery.

Hair loss in women (androgenetic alopecia)

A number of treatments are available for female pattern hair loss, including topical Minoxidil lotion (not recommended for pregnant or breastfeeding women) and tablets such as spironolactone, which have antiandrogen properties (they lower the levels of male hormones). These are available on prescription and require a doctor’s supervision.

Non-surgical hair loss treatments include lotions and tablets that can maintain regrowth. If you stop these hair loss treatments, the regrowth will cease and your hair loss will start again.

Hair loss lotions include:

Minoxidil

This over the counter lotion is available at pharmacies and has been used for hair loss treatment since the 1970’s. Minoxidil (Rogaine) comes in drops or a foam preparation that needs to be applied in the morning and at night. It’s important to note that hair regrowth can take six months to appear. This lotion is not suitable to use if you’re on high blood pressure medication, are pregnant or breastfeeding.

Hair loss tablets include:

Finasteride:

Since the late 1990’s, Finasteride (Propecia) has helped stop hair loss in over 90% of men. This prescription tablet is taken once a day and has stimulated hair regrowth in over two-thirds of men who have taken it. While regrowth is visible at 6 months, it can take 2 years for visible results. It’s important to note this is only suitable for men.

Spironolactone:

Developed in the 1960’s this prescription medication is effective for women with hair loss as it blocks the effect of androgen hormones. These hormones lead to acne, oily skin, unwanted facial and body hair and hair loss on the scalp. This hair loss medication isn’t suitable for men, pregnant or breastfeeding women.

Cyproterone acetate:

Developed in the 1960’s this prescription medication will block the effect of androgen hormones. As a weak progesterone it’s also used in some oral contraceptives. Cyproterone acetate is effective at treating acne, unwanted body and facial hair and hereditary hair loss in women. This oral hair loss treatment is not suitable for men.

Hair transplantation surgery

Hair transplantation surgery uses techniques that include micro-grafts, follicular unit transfer, and single unit transfers on patients who want a fuller, thicker head of hair. These hair transplantation techniques produce a much more natural appearance than older techniques of plug grafting. For optimal hair loss, multiple techniques can be used.

This type of hair loss treatment has been popular since the 1950’s. In the early years, unsatisfactory and unnatural-looking results occurred because large plugs of hair were used.

Hair transplantation treatment is best suited to hair loss patients including:

  • Men who have androgenetic hair loss, or
  • Patients who have experienced hair loss due to an operation or an accident

During hair transplantation surgery (under a local anaesthetic) the surgeon removes hair plugs at the sides and backs of your scalp. To ensure adequate blood flow during the healing process, the surgeon needs to place them in the right areas.

It’s important to note that you will need several hair transplantation treatments over a few months. This ensures you get a progressive increase in your hair growth.

Complications and risks of hair transplantation surgery

Before you have hair transplantation surgery, it’s important to be aware of complications and risks. They can include:

  • Bleeding: if this happens, it’s usually controlled during your post-operative care
  • Infection: your skin needs to be incised during the procedure. Any infections can usually be treated with antibiotics
  • Scarring: up to 11% of hair replacement patients have a tendency to scar
  • Temporary hair loss: this condition is known as telogen effluvium and can occur in about 5% of people having hair replacement surgery

It’s important to note that some hair replacement patients experience unacceptable cosmetic results. This usually occurs if they have had their hair replacement procedure performed by inexperienced or poorly trained practitioners.

To avoid any complications happening with your hair transplantation procedure we suggest you consult with a specialist dermatologist.