1. Hair Loss Causes
About Hair Loss
Hair loss affects about 35 million men and 21 million women in the United States alone. 40% of men
have noticeable hair loss by age 35 and 65% by age 60. First you need to understand why hair loss
occurs. Your hair loss has little or nothing to do with shampooing, hats, or any other practices. Hair loss
is largely genetic.
Main Causes Of Hair Loss
There are many causes of hair loss in men and women, including disease, nutritional deficiency,
hormone imbalance, and stress. By far the most common cause, however, is what is called androgenetic
alopecia. Alopecia is simply the medical term for hair loss. Androgenetic refers to the fact that both
genetic predispositions to balding and the influence of androgens, or male hormones, play a part in this
type of hair loss.
There is a third factor, which is the passage of time, or aging.
So, in order for androgenetic alopecia to occur, there must be:

genetic propensity for balding

presence of androgens, or male hormones

aging time to allow the first two factors to exert their influence on the hair follicles
Both men and women produce “male” hormones. The most common of these are testosterone,
androsteinedione, and dihydrotestosterone (DHT). Androgens are produced by the testicles and
adrenals in men, and by the ovaries and adrenal glands in women. These hormones are important in
both sexes, but occur in different concentrations, being much more predominant in males than in
females. This, in part, is responsible for the typical differences between the genders.
The exposure of hair follicles to DHT over a period of time can lead to androgenetic alopecia, male and
female pattern baldness, in people who are genetically susceptible to balding.
The balding process can occur at any age and move at any rate. It can start in the teen years or late in
life, develop rapidly, slowly, or even stabilize.
2. Hair Loss In Men
Some men gradually lose their hair over the front, top, and crown of their head, but most men still do
not understand the root cause of hair loss. This is a natural phenomenon called “male pattern baldness”
or androgenetic alopecia. “Andro” refers to the androgens (testosterone, dihydrotestosterone)
necessary to produce male-pattern hair loss (MPHL). “Genetic” refers to the inherited gene necessary
for MPHL to occur.” The hair follicles in these areas react negatively to the hormone testosterone,
resulting in gradual hair loss. The hair on the sides and lower back of the head is genetically
programmed not to be affected and does not fall out. Because of this genetic programming, this hair can
be permanently transplanted by a Nu/Hart hair transplant physician to the thinning and balding areas.
This donor hair will not fall out and can be cut, combed, and styled just as the hair it has replaced. It will
continue to grow for the rest of your life and will not be affected by any hormone changes.
Scale of Male Pattern Baldness
I. represents a normal head of hair with no visible hair loss.
II. is characterized by the beginning of a receding hairline and a “widow’s peak” on the forehead.
III. patients exhibit a more significant decline in hair above the temples as well as receding from the
forehead. In Class 3 Vertex, hair loss is starting to become significant on the crown.
IV. hair loss may become more noticeable on the crown or patients may have significant hair loss above
the temples and/or front anterior areas.
V. hair loss approaches significant levels with most hair loss occurring on the top of the vertex and
crown. Hair transplantation for this Class and higher Class levels may require more grafts to provide
coverage and density.
VI. patients show major hair loss, but still have areas with donor hair available. Transplanting this hair
can still have excellent results.
VII. patients show the most significant loss of hair. There may still be sufficient donor hair for
transplantation; however, results may be limited.
It is estimated that 35 million men in the United States are affected by male pattern baldness. In men
who develop male pattern baldness the hair loss may begin any time after puberty when blood levels of
androgens rise. The first change is usually recession in the temporal areas, which is seen in 96 percent of
mature Caucasian males, including those men not destined to progress to further hair loss.
Hair loss in men is likely to occur primarily between late teen-age years and age 40-50, in a generally
recognizable “male-pattern” baldness known as androgenetic alopecia. Men with male-pattern hair loss
may have an expectation of hair loss if they have male relatives who lost hair in a recognizably male
pattern. Although the density of hair in a given pattern of loss tends to diminish with age, there is no
way to predict what pattern of hair loss a young man with early male pattern baldness will eventually
assume. In general, those who begin losing hair in the second decade are those in whom the hair loss
will be the most severe. In some men, initial male-pattern hair loss may be delayed until the late third to
fourth decade. It is generally recognized that men in their 20s have a 20 percent incidence of male
pattern baldness, in their 30s a 30 percent incidence of male pattern baldness, in their 40s a 40 percent
incidence of male pattern baldness, etc. Using these numbers one can see that a male in his 90s has a 90
percent chance of having some degree of male pattern baldness. The onset, rate, and severity of hair
loss are unpredictable. The severity increases with age and if the condition is present it will be
progressive and relentless.
The amount of androgens present does not need to be greater than normal for male pattern baldness to
occur. If androgens are present in normal amounts and the gene for hair loss is present, male pattern
hair loss will occur. Axillary (under arm) and pubic hair are dependent on testosterone for growth. Beard
growth and male pattern hair loss are dependent on dihydrotestosterone (DHT). Testosterone is
converted to DHT by the enzyme, 5 -reductase. Finasteride (Propecia®) acts by blocking this enzyme and
decreasing the amount of DHT. Receptors exist on cells that bind androgens. These receptors have the
greatest affinity for DHT followed by testosterone, estrogen, and progesterone. After binding to the
receptor, DHT goes into the cell and interacts with the nucleus of the cell altering the production of
protein by the DNA in the nucleus of the cell. Ultimately growth of the hair follicle ceases.
The hair growth cycle is affected in that the
percentage of hairs in the growth phase (anagen) and the duration of the growth phase diminish
resulting in shorter hairs. More hairs are in the resting state (telogen) and these hairs are much more
subject to loss with the daily trauma of combing and washing.
The hair shafts in male pattern baldness become progressively miniaturized, smaller in diameter and
length, with time. In men with male pattern baldness all the hairs in an affected area may eventually
(but not necessarily) become involved in the process and may with time cover the region with fine
(vellus) hair.
Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in
color. The lighter color, miniaturized hairs cause the area to first appear thin. Involved areas in men can
completely lose all follicles over time. Male pattern baldness is an inherited condition and the gene can
be inherited from either the mother or father’s side. There is a common myth that inheritance is only
from the mother’s side. This is not true.
In summary, male pattern hair loss (Androgenetic Alopecia) is an inherited condition manifested when
androgens are present in normal amounts. The gene can be inherited from the mother or father’s side.
Medical science has come to learn that baldness genes are actually passed down from both sides of the
family—and they affect hair loss in women as well as men. Baldness genes may also skip generations
and are utterly random in terms of which siblings (male or female) they will affect. They may even have
very different effects on siblings in the same family. Nu/Hart Specializes in state-of-the-art hair
restoration procedures.
3. Hair Loss In Women
Female pattern baldness is very common. Studies show that incidence of hair loss in women increases
from 3% in their twenties to 30% of women in their eighties. Approximately one quarter of all women
are affected by some hair loss by the time they are in their fifties.
Women go to great lengths to hide it cosmetically with various hair styles and treatments but the hair
loss is common and can be emotionally traumatic.
Female Baldness

Grade 1 female baldness is the least severe with thinning on the top of the head.

Grade 2 hair loss in women is more significant with areas of the scalp showing through thinning
hair.

Grade 3 patients may completely lose hair on the crown of the head. In this case, more donor
hair will be required to obtain full coverage.
The patterns of hair loss in women are not as easily recognizable as those in men. Unlike hair loss in
men, female scalp hair loss may commonly begin at any age through 50 or later, may not have any
obvious hereditary association, and may not occur in a recognizable “female-pattern alopecia” of diffuse
thinning over the top of the scalp. A woman who notices the beginning of hair loss may not be sure if
the loss is going to be temporary or permanent—for example, if there has been a recent event such as
pregnancy or illness that may be associated with temporary hair thinning.
In women as in men, the most likely cause of scalp hair loss is androgenetic alopecia—an inherited
sensitivity to the effects of androgens (male hormones) on scalp hair follicles. However, women with
hair loss due to this cause usually do not develop true baldness in the patterns that occur in men—for
example, women rarely develop the “cue-ball” appearance often seen in male-pattern androgenetic
alopecia.
Patterns of female androgenetic alopecia can vary considerably in appearance. Patterns that may occur
include:

Diffuse thinning of hair over the entire scalp, often with more noticeable thinning toward the
back of the scalp.

Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the
scalp but not involving the frontal hairline.

Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the
scalp, involving and sometimes breaching the frontal hairline.
Unlike the case for men, thinning scalp hair in women due to androgenetic alopecia does not uniformly
grow smaller in diameter (miniaturize). Women with hair loss due to androgenetic alopecia tend to have
miniaturizing hairs of variable diameter over all affected areas of the scalp.
While miniaturizing hairs are a feature of androgenetic alopecia, miniaturization may also be associated
with other causes and is not in itself a diagnostic feature of androgenetic alopecia.
In post-menopausal women, for example, hair may begin to miniaturize and become difficult to style.
The precise diagnosis should be made by a physician hair restoration specialist.
It is important to note that female pattern hair loss can begin as early as the late teens to early 20s in
women who have experienced early puberty. If left untreated, this hair loss associated with early
puberty can progress to more advanced hair loss if it is left untreated.
Causes of Hair loss in Women
In women more often than in men, hair loss may be due to conditions other than androgenetic alopecia.
Some of the most common of these causes are:
Trichotillomania— compulsive hair pulling. Hair loss due to trichotillomania is typically patchy, as
compulsive hair pullers tend to concentrate the pulling in selected areas. Hair loss in women due to this
cause cannot be treated effectively until the psychological or emotional reasons for trichotillomania are
effectively addressed. Therefore, hair transplantation would not be an appropriate treatment option.
Alopecia areata— a possibly autoimmune disorder that causes patchy hair loss in women that can range
from diffuse thinning to extensive areas of baldness with “islands” of retained hair. Medical examination
is necessary to establish a diagnosis.
Triangular alopecia— loss of hair in the temporal areas that sometimes begins for a woman in
childhood. Hair loss may be complete, or a few fine, thin-diameter hairs may remain. The cause of
triangular alopecia is not known, but the condition can be treated medically or surgically.
Scarring alopecia— hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top
of the scalp and occurs predominantly in women. The condition frequently occurs in African-American
women and is believed to be associated with persistent tight braiding of scalp hair. A form of scarring
alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and
subsequent scarring. We also refer to this as traction alopecia, a slow chronic pull on the hair root that
eventually kills the root system causing balding.
Telogen effluvium— A common type of hair loss caused when a large percentage of scalp hairs are
shifted into “shedding” phase. The causes of telogen effluvium in a woman may be hormonal,
nutritional, drug-associated, or stress-associated. Loose-anagen syndrome—a condition occurring
primarily in fair-haired persons in which scalp hair sits loosely in hair follicles and is easily extracted by
combing or pulling. The condition may appear in childhood, and may improve as the person ages.
Postpartum Alopecia—Another common form of hair loss, postpartum alopecia is caused by hormonal
changes during the course of a pregnancy. The changes cause an alteration in the growth pattern of the
hair follicles. There is usually very little sign of these changes during the pregnancy itself, but rather a
sudden and very excessive loss of hair from three to nine months after the birth of the child. While this
is often very traumatic for the new mother suffering from the hair loss, the hair’s growth cycle typically
returns to normal within a year after the end of the pregnancy. Therefore, hair transplantation is not a
necessary treatment option.
Hypopituitarism and Thyroid Disorders—Female hair loss can be the result of a hormonal change or
imbalance. There has been a report describing a young women with hypopituitarism who presented
with clinical and histological features of female pattern baldness in the absence of detectable levels of
circulating androgens (testosterone and other male hormones) showing this pattern of hair loss is not
androgen dependent. Hair transplantation is usually not an initial treatment option in these instances.
Accident or Surgery Related—Women who have had facelifts or other procedures in the scalp that have
left scars or, as in the case of brow lifts, has left the hairline too high. In general, these types of hair loss
respond well to transplants.
If you are a woman with thinning or lost scalp hair, your first necessary step is to have the condition
correctly diagnosed by a Nu/Hart hair restoration physician specialist.