Causes of Hair Loss


This question comes from a member of our hair loss social community and discussion forums:

I saw an online ad for an “at home” dihydrotestosterone (DHT) test. The kit comes with a device that measures the level of DHT – the hormone responsible for male pattern baldness (androgenic alopecia) – in the blood and determines the severity of your hair loss. Do these at home DHT tests work?

DHTLike you said, DHT is the hormone responsible for male pattern hair loss or androgenic alopecia. It stands to reason that measuring the level of DHT in the blood would predict the nature of your hair loss.

However, I don’t think the home DHT tests are very well received. The information may be useful if you are trying to trend how your DHT level is dropping while using an anti-androgen medication like Propecia (finasteride). Otherwise, the level of DHT in your blood doesn’t really matter much; it’s more about whether or not your follicles are susceptible to it. If you have follicles primed to miniaturize when exposed to DHT (ie androgenic alopecia), they will likely shed whether the level is high or low. If your follicles don’t possess certain hormone receptors, they are resistant to the androgenic alopecia process and won’t shed – even if your DHT levels are high.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

This question comes from a member of our hair loss social community and discussion forums

I was recently diagnosed with low testosterone. My doctor recommended I take hormone replacement therapy (HRT), specifically testosterone replacement therapy (TRT). I underwent hair transplant surgery several years ago, and I’m afraid the hormone therapy will make these hairs shed. Can testosterone replacement cause hair loss?

low TFirst, the transplanted follicles should not be affected by the hormone replacement therapy (HRT). These follicles are highly resistant to dihydrotestosterone (DHT), the hormone responsible for male pattern hair loss, and should not shed with reasonable testosterone increases.

Second, follicles susceptible to hormones – the non-transplanted follicles – could potentially shed more with increased testosterone levels. Note I said “could” shed more, not “will” shed more. There are also several available medications that should protect against this shedding, and increases in testosterone won’t necessarily cause increased hair loss. The first, and likely most effective in this situation, is finasteride (Propecia). The next would be minoxidil (Rogaine). Minoxidil doesn’t possess as much hormone blocking effect, but will likely still help.

So, can HRT theoretically increase loss of hormone-susceptible follicles? Yes. This isn’t certain, but it’s possible. Most hair loss experts would probably recommend protecting against the increased hormone levels with minoxidil and finasteride.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

This question comes from a member of our hair loss social community and discussion forums

Several months ago, I underwent a Follicular Unit Extraction (FUE) hair transplant procedure. My donor area now looks “thinner” and “patchy” in some areas where grafts were extracted. Is this shock loss? Can FUE cause shock loss?

FUE shock lossExtraction in the donor region – both via the strip technique (Follicular Unit Strip Surgery) and FUE – can cause shock loss. Shock loss in the donor region is almost always temporary. The hair follicles in this region are highly resilient and should grow back within 3-4 months after the shock loss occurs. This is different than shock loss in the recipient region, where weakened native follicles may shed permanently after a hair transplant procedure.

The thinning appearance in the donor region could be temporary shock loss. However, this isn’t the only plausible explanation. In some instances, donor regions can be “over harvested” during an FUE procedure. This means too many grafts are extracted from a small area of donor scalp. This can create a “moth eaten” appearance that may resemble shock loss – though shock loss is normally more severe and obvious.

Either way, discussing the situation with your hair transplant surgeon will clarify if you are suffering from shock loss after the FUE procedure and how you should proceed.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

This question comes from a member of our hair loss social community and discussion forums:

After wearing my hair in tight braids for years, I now suffer from traction alopecia. I’m wondering, can this be repaired with hair transplant surgery?

traction alopecia before and afterTraction alopecia is defined as a focal (concentrated in one location and non-patterned), non-scarring type of alopecia. It’s generally caused by a prolonged period of pulling – “traction” – on hair follicles. It’s most commonly seen in individuals who wear their hair in tight braids for long periods of time, or individuals who wrap their hair in tight dressings for cultural or religion regions. These situations both put excessive strain on the follicles and cause hair loss over time.

Fortunately, traction alopecia can be repaired with hair transplant surgery. In fact, it usually responds very well to hair transplantation. Interested in what can be achieved with hair transplantation in patients with traction alopecia? If so, please review this excellent case presented by recommended hair transplant surgeon Dr. Tejinder Bhatti: 2,453 Grafts for a Traction Alopecia patient. 

Those interested in a similar repair may benefit from reviewing our recommended hair transplant surgeons and considering a consultation.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

Watch hair transplant videos on YouTube

This question comes from a member of our hair loss social community and discussion forums

I recently dyed my hair a darker color. After the color treatment, however, it looks like I’m losing my hair! Can hair dye cause hair loss? Is it temporary? Any other explanations for what’s going on?

hair dyeHair dyes normally cause alopecia via structural damage to the hair shaft – also known as trichorrexia nodosa. This would manifest as shorter “broken hairs” – in the shower, sink, on the pillow, etc – without a bulb at the end, or the appearance of a variety of small, thick hairs growing near the scalp surface.

Some people have a genetic predisposition to shaft breakage that is “set off” by a harsh environmental factor – brushing, chemical dyes, harsh shampoos, etc. This could be the case here.

While hair loss from harsh dye is possible, there may be another explanation: a starker contrast between scalp color/tone and hair shaft color/tone always creates a “thinning” appearance. This is the reason why Caucasian men with lighter hair can undergo hair transplantation at lower densities and still achieve good results. It’s possible that you dyed the hair darker and it now simply looks thinner because of the more obvious contrast with your scalp.

If it is related to trichorrexia, it should naturally reverse itself; if it is related to contrast, you should see a difference after the hair grows out.
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Blake Bloxham – formerly “Future_HT_Doc”

This question comes from a member of our hair loss social community and discussion forums

I’m going to see a doctor about my hair loss. I think I suffer from androgenic alopecia or male pattern hair loss; however, I want an evaluation to see if something else is causing the thinning. Should this work up include blood testing? If so, what type of blood work should I get to evaluate the hair loss?

blood workGenerally, male pattern hair loss is a clinical diagnosis made by closely examining the scalp. Furthermore, there is really no defined “hair loss” blood panel. However, some cases of alopecia – especially in female patients – aren’t as obvious, and many doctors check blood levels of: thyroid stimulating hormone (TSH) , total and free testosterone, estradiol, DHEA(S), hemoglobin (a complete blood count to assess anemia), vitamin D, iron, and maybe DHT, ANA (autoimmune), and prolactin. Some of these blood tests are more specific than others, and doctors will chose which are best for each individual patient.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

Watch hair transplant videos on YouTube

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This question comes from a member of our hair loss social community and discussion forums

I’m feeling depressed about my hair loss; what should I do?

depressionPatients feeling truly depressed by hair loss must seek out the help of a mental health professional as soon as possible. While alopecia itself is a legitimate symptom and requires treatment, the depression is more urgent. It’s also important to address the depression before treating the hair loss. A mental health professional will understand that the alopecia is a component of the depression, and treat it alongside the depressed thoughts. For example, a mental health provider may help analyze why the hair loss is causing depressed mood, provide coping mechanisms to help get through the day, and also refer to a hair loss physician to treat the alopecia.

While this may seem excessive, it’s important not to simply treat the hair loss and ignore the depression. It may seem like fixing the alopecia will fix the depressed mood; however, the depression may be related to a variety of issues, and ignoring it or assuming things could make the situation worse.
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Blake Bloxham – formerly “Future_HT_Doc”

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

Watch hair transplant videos on YouTube

Technorati Tags: hair loss

This question comes from a member of our hair loss social community and discussion forums

I’ve been losing my hair for several years. I initially thought I suffered from androgenic alopecia or male pattern hair loss; however, members of online forums now say it may be diffuse unpatterned alopecia or DUPA. What is DUPA? Can it be fixed with hair transplant surgery?

DUPAI’m not 100% sold on the idea of “DUPA” or it’s cousin “diffuse patterned alopecia” (“DPA”).

Traditionally, non-scarring alopecia is broken down into several categories: focal, patterned, and diffuse. Focal alopecia includes conditions like alopecia areata; patterned includes androgenic alopecia and female pattern hair loss; and diffuse covers conditions like telogen effluvium, anagen effluvium, loose anagen syndrome, atrichosis, and hyoptrichosis. However, it does not – traditionally – include “DUPA” or “DPA.” Maybe the categorization is out of date, but I generally try to stay away from these terms – or at least from DPA. I do understand that “DUPA” is a good description for one clinical picture – which I will explain below.

I would classify hair loss fitting this diffuse pattern as follows:

Either: diffuse androgenic alopecia that is best described by the Ludwig and not the traditional Hamiltion-Norwood hair loss scale; OR you could call it diffuse unpatterned alopecia if you are experiencing thinning in the donor region (which is the only time I really think this term is appropriate).

This question comes from a member of our hair loss social community and discussion forums

I’ve taken an antidepressant medication without side effects for years. During this time, I also experienced some hair loss. I always attributed the thinning hair to “male pattern hair loss”, but I recently read about antidepressant drugs causing alopecia, and now I’m wondering: is an antidepressant causing my hair loss? Is it true that antidepressants can even cause hair loss?

antidepressantsIn a perfect world, pharmaceutical medications would treat diseases effectively with no adverse side effects. We, unfortunately, do not live in this world. Medications are not perfect. While many are considered “modern miracles,” and cure people of ailments responsible for significant morbidity and mortality in the past, these powerful “wonder drugs” often come with a set of equally powerful – but much less wonderful – side effects. Unfortunately, hair loss is a side effect of several trusted and proven antidepressant medications.

However, all is not lost …

Of the numerous types of antidepressants available today, two classes are (most commonly) associated with hair loss: tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI). Both classes of drugs officially list “hair loss” as a potential side effect; however, both also report hair loss occurring only in a very small number of medication users. For example, several types of SSRIs list hair loss as a “rare” side effect that occurs in approximately 1-2% of users. Even more encouraging, many see a reversal of the hair loss after stopping the medication. This is, however, not guaranteed – as many drugs “unmask” dormant permanent types of alopecia like androgenic alopecia (“male pattern baldness”). In these cases, the hair loss is not reversible. In these instances, however, it’s important to understand that the drug only revealed or accelerated an underlying condition; it did not actually cause a primary hair loss.

AA before and afterTwo months ago, news broke that tofacitinib citrate – a rheumatoid arthritis drug – regrew a full head of hair in a patient suffering from alopecia areata. Now, it appears as if alopecia areata sufferers have more cause for celebration: Earlier today, Columbia University Medical Center announced that ruxolitinib, a drug used to treat a bone marrow disorder called myelofibrosis, restored hair in patients suffering from alopecia areata.

Alopecia areata differs from traditional androgenic alopecia, or male pattern hair loss, in several important ways: first, it is defined as an “autoimmune alopecia” – meaning it occurs when the body’s immune system mistakenly attacks and damages hair follicles; second,  it can progress and cause hair loss in regions of the face and body (this is commonly known as alopecia totalis and alopecia universalis); and third, it was, until very recently, extremely difficult to treat and caused disfiguring hair loss in an estimated 6.5 million in the United States alone.

One of these 6.5 million is Dr. Angela Christiano, a researcher in the dermatology department at Columbia University. Dr. Christiano’s team spent years determining the specific cause and underlying pathway behind alopecia areata, and came to the following conclusions: alopecia areata is caused by immune cells in two specific pathways; and both pathways could be blocked by a class of drugs known as JAK inhibitors.

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