Causes of Hair Loss


I am a 50 year old woman and my hair has always been super thin. It now has not grown for years and the back is thinning so much I am looking bald in one spot. What can I do? I am presently living in Singapore and get lots of herbal hair loss treatment suggestions that really don’t work.

female hair lossThere are many potential causes of female hair loss. Your first step should be to consult with a dermatologist specializing in hair loss or a skilled and experienced hair restoration physician.

As you’ve discovered, herbal remedies are highly unlikely to regrow hair. Rogaine (minoxidil) is the only clinically proven and FDA approved hair loss treatment currently available for females. As with any hair loss drug, Rogaine must be used indefinitely.

Once the drug is discontinued, thinning will resume. For this reason, we always recommend that hair loss sufferers continue to apply Rogaine as directed for between 6 months and one year before assessing their results.

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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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newton gravityAlthough androgenic alopecia (male pattern baldness) is a complicated condition, scientists have understood the mechanism behind this type of hair loss for a number of years: In androgenic alopecia, genetically susceptible hair follicles  are exposed to high levels of dihydrotestosterone (DHT) hormone, which causes abnormal cycling and eventually permanent loss of function in these follicles. This process causes a gradual hair thinning and eventually leads to permanent patterned baldness. For years, the inciting factor or underlying cause of androgenic alopecia was cited as simply genetics; however, Turkish plastic surgeon Dr. Emin Tuncay Ustuner recently proposed a new theory to explain the underlying cause of male pattern baldness: gravity.

Yes, gravity! As strange as it sounds, Dr. Ustuner believes the effect of gravity explains not only male pattern baldness, but also why body hair and scalp hair react differently to DHT and why females experience more hair loss after menopause. According to Dr. Ustuner, the force of gravity on the scalp puts excessive pressure on hair follicles and eventually causes hair loss. In younger individuals, the layer of fat under the superficial scalp is thick and “well hydrated,” and this creates a cushion that prevents the hair follicles from being suffocated as gravity forces the scalp down toward the skull. However, as individuals age, the amount of fat decreases and gravity begins to cause follicle damage and hair loss. The hair follicles in the back and sides of the scalp – those normally spared in androgenic alopecia – aren’t affected by gravity because they don’t lay under the top of the scalp and do not experience the increased pressure from gravity. What’s more, because the female sex hormone estrogen promotes fat building, Ustuner believes the association between female hair loss and menopause (cessation of normal estrogen cycling) can be explained by a decrease in scalp fat with decreasing levels of estrogen.

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

After being told by my doctor that my estrogen hormone levels are abnormal, I began to notice hair loss. I’m now wondering if changes in my hormone levels can cause hair loss and what I can do to treat this? Can changes in hormone levels cause hair loss in women?

female hair lossFemale pattern hair loss is a complicated condition. Unlike androgenic alopecia or male pattern hair loss – which is usually caused by a derangement of a single hormone (DHT or dihydrotestosterone) – female hair loss can often be traced to a variety of blood level abnormalities. Abnormal levels of elements such as sex hormones (testosterone, DHT, estrogen, progesterone, etc.), iron, thyroid hormones, blood glucose (sugar), and a variety of other important metabolic substrates can be attributed to hair loss in women.

This  means fluctuating hormone levels or changes in normal blood hormone levels can lead to female hair loss. Treating this would likely involve first seeing an endocrinologist (hormone specialist) to determine if a hormone derangement is present, and next seeing a hair loss specialist for treatment (unless the endocrinologist feels comfortable treating the hair loss as well). Though female pattern hair loss from hormone imbalance is a complicated issue, it can often be reversed and treated with proper care.
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Blake – aka 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:

I recently shaved (“buzzed”) my head and noticed two things: first, I’m suffering from hair loss; second, I’m suffering from dandruff. I never noticed the hair loss (or dandruff) before closely shaving my head, and I’m wondering if the dandruff is causing the thinning? Can dandruff cause hair loss? If so, how can I treat it?

dandruffIt may be difficult to attribute the hair loss solely to your dandruff issues. On one hand, dihydrotestosterone (DHT) – the hormone responsible for genetic male pattern hair loss – often causes excessive scalp sebum (oil) production. This can sometimes look like oily, flaky dandruff. However, large oily flaking may be indicative of  something like seborrheic dermatitis, which can cause some hair loss as well. In theory, this should reverse if it is treated.

However, if it is DHT causing the “dandruff” then you may only be able to reverse the hair loss by treating the hormone excess (which is what drugs like finasteride (Propecia) do). Also, remember that the dandruff and the hair loss may not even be related. You could be someone with androgenic alopecia and excessive dandruff. Because of this, I think having an experienced hair loss physician evaluate your scalp is imperative. The doctor should be able to identify the cause, recommend treatment, and determine whether or not the dandruff is causing your hair loss.
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Blake – aka Future_HT_Doc

ISHRSEvery year the International Society of Hair Restoration Surgery (ISHRS) holds its annual scientific meeting to discuss hair loss and advancements in medical and surgical hair restoration. This year, the ISHRS meeting was held in San Francisco, CA and the topics discussed were in stark contrast to those that were on the agenda at the first San Francisco meeting 14 years ago.

In 1999, hot topics included whether microscopes were necessary for graft dissection; scalp reduction, extension and flaps; and the evolution from mini-grafts to follicular unit transplantation. There was no mention of follicular unit extraction (FUE), a topic that dominated this year’s meeting.

Refinements in FUE tools and techniques have led to increasing patient demand for the procedure over the past few years. Accordingly, much of this year’s meeting was devoted to discussing the evolution and current techniques in FUE. This includes comparing advanced FUE to state of the art follicular unit strip surgery (FUSS) and automated FUE hair transplant surgery. Other hot topics included updates on Dr. Wesley’s new Pilofocus scarless hair transplantation, ACell, Platelet Rich Plasma (PRP), the safety and efficacy of Propecia (finasteride) and an update on low level laser therapy for hair loss.

The below highlights from this year’s conference come from presentations and interviews with Coalition members; Dr. Mike Beehner, Dr. Robert Bernstein, Dr. Jerry Cooley and Dr. Carlos Wesley and recommended hair restoration physicians; Dr. Shelly Friedman, Dr. James Harris and Dr. Parsa Mohebi.  A special thanks to these expert physicians for providing this community with their feedback on the latest innovations discussed at the 2013 ISHRS meeting.

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
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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 

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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

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 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.

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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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