Hair Loss 101

What is causing my hair loss, and what can I do about it? Millions of men and women ask themselves these questions every day. While there are several conditions that cause thinning hair and baldness, in most cases it is a result of Androgenic Alopecia, also known as Male Pattern Hair Loss (MPHL), or Female Pattern Hair Loss (FPHL). Androgenic Alopecia is extremely common affecting 80% of men and 50% of women during their lifetime. It is thought to be caused primarily by genetics, and is characterized by loss of hair in specific areas of the head.

Male pattern hair loss often begins at the temples and sometimes the vertex or crown of the head, resulting in a receding hairline and/or a bald patch, and eventually progressing to complete baldness. Female pattern hair loss is often more subtle and diffuse, rarely progressing to full baldness. Women may have concentrated areas of thinning at the vertex, and at the temples. However the exact pattern and progression of hair loss varies from person to person.

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The Hamilton-Norwood scale, showing common patterns and progression of androgenic alopecia in men. 

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The Ludwig-Savin scale, showing common patterns and progression of androgenic alopecia in women.

The Hair Cycle

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So what is actually going on when a person is affected by androgenic alopecia? To understand this, it is first important to understand that each hair on your head and body arises from a follicle, which is essentially a miniature organ, that is, a collection of cells working together for a single purpose. In the case of a follicle organ, this purpose is to produce a hair.

Each follicle will grow it’s hair in a characteristic cycle with several phases. During the Anagen, or growth phase, the follicle is actively lengthening its hair. This phase can last several years before the follicle transitions to the Telogen, or resting phase, where growth stops, and the hair remains at a constant length and thickness. After several at months at rest, the follicle sheds its hair, and re-enters the growth phase to begin growing a new hair. It should also be noted that the cycles of different follicles are not in-synch, that is at any given time a different follicles may be either growing, resting, or shedding their hair.

The Hair Cycle

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With androgenetic alopecia, certain hair follicles undergo a process called miniaturization. During miniaturization the dermal papilla, a specialized group of cells at the base of the follicle begins to shrink in size, and the phases of the hair cycle undergo changes in their duration. The growth phase shortens, the resting phase lengthens, and the whole cycle shortens in duration causing hairs to be shed at a faster rate. This process continues, resulting in each cycle of the follicle producing a hair that is shorter and thinner than the last.

Eventually the hair may become so small that it does not even break the surface of the skin. When enough follicles become extensively miniaturized in this way a person's hair will become noticeably thin and bald areas may appear.  Miniaturization arises from interactions of the follicle with the hormone dihydrotestosterone, or DHT. Only follicles in certain areas of the scalp are genetically susceptible to the effects of DHT, resulting in the characteristic patterns of thinning and baldness seen with androgenetic alopecia.

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Excessive miniaturization of hair follicles results in areas of thinning and baldness

So How Can I Treat My Hair Loss?

A number of treatments are available for pattern hair loss. Many that you will find are unfortunately not supported by strong scientific evidence. However there are several treatment options which most medical professionals agree are effective:

  • Minoxidil - One of the most established treatments for hair loss, minoxidil is the active ingredient in Rogaine, but can be puchased in many other forms both over the counter and by prescription. Minoxidil is usually applied topically as a liquid solution, cream, or foam that is spread onto the scalp. It acts as a potent vasodialator, increasing blood flow to the hair follicles to inhibit miniaturization. Minoxidil is FDA approved to treat pattern hair loss in men and women.
  • Finasteride - Another established treatment for hair loss in men, also known as Propecia. Finasteride is a prescription medication normally taken in oral pill form, and works by inhibiting production of DHT. It is proven to be safe, and well tolerated in most patients, although has been shown to cause adverse sexual side in a small proportion of men. Finasteride is FDA approved to treat pattern hair loss in men, but is not recommended for use in women.
  • Dutasteride - A prescription oral medication, which can be used as an alternative to Finasteride, as it also blocks the production of DHT. Also like Finasteride, Dutasteride has been associated with sexual side effects in a small proportion of men, and is not recommended for use in women. Dutasteride is not FDA approved for hair loss. However it has been approved for treatment of pattern hair loss in several other countries, and can be prescribed off-label in the United States.
  • Spironolactone - A prescription medication, which can be used to treat female pattern hair loss. Spironolactone may be taken as an oral pill, or applied topically. It works to combat hair loss by inhibiting production of androgen hormones including DHT. Spironolactone is not FDA approved for treatment of hair loss but can be prescribed off-label. It should not be used by men.
  • Hair Transplant Surgery - A surgical procedure which involves moving healthy follicles from the back of the head to areas of thinning and balding. Hair transplant surgery is commonly categorized as either traditional Follicular Unit Transplantation (FUT), or Follicular Unit Extraction (FUE), a newer and more minimally invasive procedure. Although hair transplant surgery has gotten a bad rap (think hair plugs), advances in technology and technique have dramatically improved outcomes. If performed properly, patients who are nearly bald can gain a full head of real hair that is permanent and looks 100% natural. However transplant can be prohibitively expensive for many people, and results may vary substantially depending on patient genetics, pattern of hair loss, and the skill and experience of the surgeon. Hair transplant surgery is usually best in cases of more advanced hair loss, after other less invasive treatments have been tried.
  • Platelet Rich Plasma (PRP) - A newer procedure for treatment of hair loss, performed in the doctor's office. PRP involves taking a small sample of blood, processing it to isolated certain cells (platelets), and re-injecting this solution into the patient's scalp. PRP is minimally invasive, generally painless, takes under an hour to complete, and can be effective in both men and women. Although research on PRP is still ongoing it is thought to promote hair re-growth via release of growth factors from the platelet cells. Other treatments such as injection of stem cells, or stromal vascular fraction may promote hair growth via a similar mechanism.
  • Low-Level-Laser Therapy (LLLT) - Also known as Low-Level-Light Therapy, Photobiomodulation Therapy, cold laser therapy, or laser hair therapy, LLLT is a effective, safe, and versatile, treatment for pattern hair loss in both men and women. Uniquely, LLLT does not involve drugs or surgery, is not associated with any serious averse side effects, can be used by both men and women, and can be used in combination with all other hair-loss treatments. Several LLLT devices haves been FDA-cleared for treatment of androgenic alopecia in men and women, including The Original LaserCap! Check out our About Low-Level-Laser Therapy page to learn more.