Hair Loss - Causes And Treatments
According to the American Hair Loss Association, By the age of thirty-five, almost 60% of American men will experience some degree of hair loss, and by the age of fifty, approximately 85% of men have significantly thinning hair. And, mistakenly thought to be a strictly male disease, women actually make up 40% of American hair loss sufferers.
THE KEY CAUSES OF HAIR LOSS
There are several common causes of hair loss:
Male Pattern Hair Loss (MPHL or “male androgenic alopecia”) - this is a progressive form of hair loss occurring over the course of years, with characteristic distribution (i.e. the vertex/crown of the head and a receding front hairline). This form of hair loss is primarily genetic, and these genetic factors can predispose patients to have a greater sensitivity to androgens in the hair follicle - leading to shedding. Sensitivity to these hormones in hair follicles can lead to a shorter cycle of hair growth as well as the growth of thinner, shorter strands of hair. Additionally, there can be a delay in the growth of new hair to replace the strands that are shed.
Female Pattern Hair Loss (FPHL or “female androgenic alopecia”) - this is the progressive form of hair loss with characteristic distribution (i.e. the frontal scalp and vertex/crown). Androgenic hair loss presents differently in women - the hair becomes thinner across the entire head, yet the hairline does not recede. Left untreated, women can see a slow decline in the density of scalp hair. Similar to MPHL, FPHL is caused by genetics and androgen sensitivity as referenced above.
Telogen Effluvium - this kind of hair loss presents as diffuse hair shedding throughout the entire scalp. Telogen Effluvium occurs as the result of an abnormal shift in the hair follicle cycles, leading to the premature shedding of hair. This disorder is more prevalent in women and can happen at any age - and it’s one of the most common causes of non-scarring hair loss. There are several causes of Telogen Effluvium:
Hormone shifts (birth control, pregnancy, menopause)
Medications (anti-depressants, steroids, etc.)
Nutrient deficiencies (anemia)
Stress
Thyroid disorders
Illness (in some cases, it can be important to address the underlying cause of Telogen Effluvium - assessing gastro-intestinal or hormone health)
When treating Telogen Effluvium, I focus first on determining the underlying cause. Once this is identified, I work with my patients to correct the fundamental issue - whether it’s medication revisions, nutritional alterations, or hormone support. Once baseline health is restored, regrowth of hair can often be accelerated with PRP, minoxidil, or spironolactone (see Treating Hair Loss section below).
Auto-Immune Alopecia (Alopecia Areata) - presenting as patchy hair loss, this form of baldness is caused by the immune system attacking healthy hair follicles and is more common in people with an existing AI disorder, such as thyroid disease.
TREATING HAIR LOSS
Once the cause of your hair loss is identified, an appropriate treatment can be determined. The leading treatments include:
Minoxidil (Rogaine®) is a highly effective treatment option suitable for both men and women. As the leading non-surgical treatment, it can be effective on its own or as a supportive treatment with PRP or a hair transplant. To prevent further hair loss, Minoxidil can be used at the first sign of loss. This treatment option can be effective, however, it must be used daily for the long term - once you discontinue use, hair loss can return.
Finasteride (Propecia®) is an effective blocker of DHT (a hormone that causes hair loss). This treatment is available by prescription for men and is taken orally. It is important to note, however, that this approach brings with it serious potential side effects including erectile dysfunction and a loss of libido. This can be used by women with androgenic alopecia (AKA FPHL) - but can pose similar sexual side effects.
Dutasteride is another DHT blocker and is a newer drug on the market. While it has been proven to be effective, it poses the same high-risk side effects as Finasteride.
Spironolactone - a medication that can blunt the effect of androgens in the scalp - is prescribed by some doctors for female pattern hair loss and, occasionally, Telogen Effluvium. I believe that spironolactone is a safer option than Finasteride with no risk of long-term side effects.
Platelet-Rich Plasma (PRP) / Stem Cell Treatments have been proven to be highly effective in promoting hair growth in both men and women. This in-office procedure is quick and easy - PRP is isolated from your own blood and injected over the scalp, resulting in the emergence of new hair - and can sometimes slow hair shedding.
Hair transplants are another option available to both men and women. The most popular today is called Follicular Unit Extraction (FUE) hair transplant, which is a minimally invasive, outpatient treatment that can be an effective, long-term solution. It is important to note that not everyone is a good candidate for this treatment option (it depends on the availability of hair on your donor site - typically the sides or back of the head).
Laser Caps are a studied technique that claims to slow down hair loss, strengthen existing hair, and boost hair growth. Appropriate for both men and women, these caps use Low-Level Laser Therapy (LLLT) to stimulate hair follicles into entering their growth phase.
Novel / Experimental Topicals - I have worked with our specialty pharmacy to create topical versions of spironolactone, finasteride, and latanoprost (the active ingredient in Latisse - a medication for eyelash enhancement) combined with a nutrient base.
As evidenced by the plethora of causes and the many treatments available, you can see that hair loss is not always a straightforward issue. Because of this complexity - I urge you to work with your doctor to identify the exact nature of your personal hair loss to find the best treatment solution.
If you have any questions about hair loss and the approaches we use in my practice - just give the office a call at 425-598-0113.
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