Causes of Hair Loss

I started receding during my late teens and experienced some minor thinning of the crown at around 34. At this point, I started using finasteride which I have taken for the last 6 years. I am now 41 and have responded well to finasteride where the crown has stabilized with some limited thickening. A hair transplant is taking care of the frontal recession.

I’m content with the crown as it is. However, should I start to use minoxidil or shall I wait in case finasteride starts to lose effectiveness and then, at this point, use minoxidil to help the crown? My concern is if I start on minoxidil now it may lose its effectiveness over time. So should I leave it until I really need it?

propecia-vs-rogaineIt’s important to note that Rogaine (minoxidil) is not a substitute for Propecia (finasteride). These hair loss drugs work in very different ways and, therefore, affect different hairs. Thus, waiting for finasteride to “lose its effectiveness” before starting minoxidil is not the best option.

Finasteride works to slow the advance of androgenic alopecia and regrow hair by inhibiting the conversion of testosterone to the hormone dihydrotestosterone (DHT). Minoxidil, on the other hand, is a vasodilator and is thought to treat thinning hair by widening blood vessels and increasing blood flow to miniaturizing follicles.

Many hair restoration physicians believe that the best course of action is to use these two medical hair loss treatments in combination. It is thought that they work synergistically, each enhancing the effects of the other

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

I know this is an old tune I’m singing but I keep hearing that wearing a hat, even months after hair transplant surgery, can slow or even limit hair growth.

In my mind it doesn’t make sense. The grafts and just hair in general need blood not oxygen from the air. Can someone give me some input on this? Can hats really make a significant difference on how your hair grows? I’ve been wearing one non-stop since my hair transplant and my results, although it’s early, seem slow.

Dr_Lindsey_photoWe’ve worked with two fighter pilots and one competitive motorcycle racer. All three were “back in the helmet” so to speak at 12-14 days after hair restoration surgery and all three grew as fast as or faster than predicted.

Three results do not make a study, but may reassure you.

Dr. William Lindsey – McLean, VA

David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

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This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey

I’m interested in receiving Botox injections in my forehead, but I’ve heard this may cause hair loss. Is this true? Can Botox injections cause hair loss?

Dr_Lindsey_photoHaving treated roughly 1,000 people with Botox over the last 18 years as a facial plastic surgeon and hair transplant specialist, I state that I have never seen Botox grow OR kill one single hair. If Botox truly had an effect on hair growth or hair loss, it would likely be apparent by now. Because of this, one can comfortably state that Botox does not cause hair loss.

Dr William Lindsey 

Blake – aka 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

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

I’m a male who has struggled with hair loss for a number of years. Recently, I was diagnosed with type I diabetes, and I’m wondering if this could be related to my hair loss? Is there a connection between diabetes and hair loss? Can the diabetes medications (insulin) make the hair loss worse?

diabetesUntil recently, the link between diabetes and hair loss was not overly clear. Many physicians noted an increase in the number of patients suffering from alopecia and diabetes, and inferred a connection between the two conditions.  Because uncontrolled diabetes leads to severe disease in small blood vessels, doctors assumed diabetes caused hair loss by significantly decreasing blood supply to the scalp. However, endocrinologists (hormone and diabetes specialists) started to look at this issue a bit more closely and noticed something interesting: men with diabetes (both type I and II) and alopecia exhibited hair loss patterns that resembled the diffuse thinning seen in women (classified by the Ludwig hair loss scale); not the “patterns” seen in men (classified by the Hamilton-Norwood scale).

While the link isn’t still overly clear, endocrinologists know a few things: first, that the diabetes associated alopecia is very likely caused by the disease itself, not the medications (such as the insulin mentioned earlier); second, that females with “patterned” hair loss (which is more diffuse thinning and described by the Ludwig scale) have unique hormone derangements that are different than men with androgenic alopecia (“male pattern baldness“); third, that men with diabetes and alopecia likely have hormone dysfunction similar to women suffering from hair loss, which is why they exhibit these feminine patterns.

dupaMost hair loss is the result of androgenic alopecia, also known as pattern baldness. However, there are other forms of alopecia that affect both men and women with thinning hair. One of these is known as diffuse unpatterned alopecia or DUPA.

DUPA is characterized by diffuse balding throughout the entire scalp with no stable permanent zone. It affects both men and women but is about 10 times more common in females. To learn more about DUPA, its diagnosis and treatment options, see the article, “Diffuse Unpatterned Alopecia (DUPA) Causes and Treatment” at the Hair Loss Learning Center.

To learn more about other forms of alopecia, click here.

David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

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Hi. I used Rogaine for several years with very good results. I started to notice that my hair and scalp were getting very dry so I decided to stop using it. I stopped for two years and my heir never fell out. It was thick and strong. Just some hair that was growing on my forehead was lost. Then, last year my hair started to fall out because my doctor raised my thyroid medication and I became hyper.

After that, I went to see a dermatologist and he suggested I try minoxidil again. I did only twice but those two times caused my hair to get dry and it started to break off. Did I do permanent damage to my hair follicles by using Rogaine? My hair is still very dry and still breaks off and there is not much hair growth. The worst part is the front of my hair. It got very thin. Is this permanent?

rogaine-extra-strength-1month-thumbIt is important to note that dry and brittle hair can also result from a thyroid condition. Are you certain that Rogaine is the cause?

I do not believe that Rogaine is capable of causing permanent damage or hair loss. When hair is damaged to the point of breakage from the application of chemicals, there is no reason why it should not regrow once the application is stopped, unless the scalp itself has been damaged.

If it’s liquid minoxidil that is causing you problems, you may want to try Rogaine Foam. It does not contain the same harsh chemicals as the liquid.

I am currently an 18 year old teenager worried about his hairline. I have blonde/dirty blonde hair which has been very fair and thin/soft from birth, and I may just be paranoid but I seem to have started to notice my hair going backwards from my temples, just above my forehead. I have a grandfather from my mother’s side who was bald on his scalp by the age of 42-45 so I might be genetically predisposed.

I have a few questions I would like you to answer (see below), as you seem to be a professional, experienced and accredited site.

Thank you very much in advance,

100108_teenOf course, without photos, I cannot comment on whether or not your concerns are justified. But, at the age of 18, you are most likely not yet a candidate for hair transplant surgery. The donor hair available for surgical hair restoration is indeed limited. We have a finite number of hairs in the permanent donor area that are genetically programmed to resist the effects of androgenic alopecia (male pattern baldness). A very young man such as you, attempting to restore a juvenile hairline, would require many subsequent procedures as your hair loss progresses. That could exhaust the donor supply early, not leaving enough grafts to address future balding.

However, it’s certainly a great idea to be proactive. If you do have the baldness gene, then starting medical hair loss treatments early will provide you with the best opportunity to save your existing hair and regrow hair that you’ve already lost.

diabetesDiabetes Mellitus – a dysfunction of the body’s sugar regulation system – is one of the fastest growing chronic disease in the United States. Although the disease is related to a number of serious health concerns, such as blindness, kidney disease, and coronary artery disease, researchers often question if it is associated with another issue: hair loss.

According to endocrinologists (diabetes and hormone specialists) and hair loss experts, diabetes may actually cause thinning hair. The mechanism behind diabetes-related hair loss may occur via several mechanisms:

First, because the disease causes damage to blood vessels, chronic diabetes can eventually reduce blood flow to the scalp. If hair follicles are deprived from the crucial oxygen and nutrients found in blood for a long period of time, they may miniaturize and eventually die.

Second, many experts believe chronic diabetes causes hormonal imbalances in the body. If these imbalances affect testosterone or dihydrotestosterone (DHT) levels, it may cause baldness.

Third, many diabetes patients report new episodes of hair shedding after beginning their diabetic medications. While this connection has not be established scientifically, many patients believe balding is a side effect of a number of diabetes medications.

Fourth, chronic diabetes may place the body in a state of oxidative stress. This stress increases the number of tissue-damaging free radicals in the body, many of which could damage hair follicles.

What’s more, because diabetes causes slower and less complete healing, diabetic patients may have increased healing time after hair transplant surgery.

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

After years of wearing my hair in tight braids, I noticed hair loss in my hairline and temple regions. I saw my physician, and he diagnosed the hair loss as traction alopecia. I’m wondering: what is traction alopecia, and can it be repaired with hair transplant surgery?

tn-female-traction-alopeciaTraction alopecia is hair loss that is caused by excessive “pulling” of hair follicles over a long period of time. The constant pulling and traction on the hair follicles causes progressive damage and eventually leads to noticeable hair loss in regions where the pressure was most apparent (i.e. the hairline and temporal regions). Normally, traction alopecia is most apparent in individuals who wear their hair in very tight braids for a number of years, or those who wear hair pulled tightly in head wraps for cultural or religious purposes. For example, traction alopecia is very common in African American females who wear hair tightly braided for years, and Punjabi males who wear turban headwraps.

Medically, traction alopecia is classified as a “focal” (located in one region of the scalp, but not patterned like “androgenic alopecia” or “genetic patterned baldness”) “non scarring” (meaning the hair loss is not occurring because of repeated inflammation and destruction of hair follicles) type of alopecia, and is treatable with hair transplant surgery.

Propecia (1mg finasteride) is arguably the most effective non-surgical hair loss treatment currently available for men with androgenic alopecia (genetic hair loss).

Androgenic alopecia is a genetic form of hair loss dependent on the hormone DHT (dihydrotestosterone). DHT is produced in the body as a result of the male hormone testosterone and 5-alpha-reductase enzymes coming together. Finasteride works to slow or even stop further hair loss and improve hair growth in balding men by inhibiting type 2 5-alpha-reductase enzymes, thus minimizing the amount of DHT in the body. Finasteride however, does nothing to inhibit type 1 5-alpha-reductase enzymes. A study conducted by University of Oklahoma Health Sciences in 1999 attempted to determine the effect of finasteride on scalp skin and serum androgens.


Men with androgenic alopecia underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days.


With placebo, scalp skin and serum DHT levels declined by 13.0% and less than .001 respectively. The tables below show the effects of finasteride doses between .01  and 5 mg on scalp skin and serum DHT levels.




In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern baldness at doses of finasteride between 0.2 and 5 mg.


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