What Causes Hair Loss?

As you see yourself balding, while others retain their hair, you may ask - why me? The basic answer is – your hair loss is due to your genetic make up

What Causes Hair Loss?
As you see yourself balding, while others retain their hair, you may ask - why me?

The basic answer is – your hair loss is due to your genetic make up. Your thinning hair is not due to anything you have done, whether wearing too many hats, washing your hair too much or too little or any other hair loss myths. Alopecia or hair loss is primarily genetic and is referred to as "Androgenetic Alopecia" in the medical community.

Your hair's future is largely determined before you're even born. Your follicles have been genetically programmed as to when, where and how much baldness (if any), you'll experience in your lifetime. But the fate of your hair can be altered or compensated for with modern hair loss treatments.

So what are the specific causes of hair loss?

Baldness is largely the result of certain hormones interacting over time with those hair follicles that are vulnerable to their effects.

Both men and women produce "male" hormones. The three most common are testosterone, androsteinedione, and dihydrotestosterone (DHT). Hair follicles, as well as the sebaceous glands, contain high levels of an enzyme called 5-alpha-reductase. This enzyme converts testosterone into DHT, via the blood. DHT is the source of most male pattern balding.

In some people, their follicles on the top of the head are genetically vulnerable to baldness. Over time, these genetically vulnerable follicles are acted upon by the hormone DHT. This hormone binds with the receptor sites of these vulnerable follicles and cause the hair follicle to weaken over time. Propecia is a drug that has been shown to slow the creation of DHT and can be helpful in slowing, stopping or in some cases, reversing hair loss when it is used early enough.

Hair grows naturally in cycles of approximately 3 to 8 years. At the end of the growth cycle, the hair shaft is shed from the follicle and a new hair grows. With thinning hair or balding, each successive growth cycle is shorter and the hair produced is thinner and finer. This is called 'miniturization'.

Men and women don't go bald overnight, it is a slow progression of thinning hair and hair loss that eventually produces baldness. In many cases, the balding has progressed to such a stage that hair loss treatment products aren't enough to reverse the balding process.

Few treatments have the dramatic effect of restoring hair like hair restoration surgery. Click here to learn more about hair restoration.

Not all hair loss is permanent. There are many causes of temporary hair loss that can be treated with diet, stress reduction and a visit to your doctor. Click here to learn about other causes of hair loss.

Androgenetic Alopecia

And rogenetic Alopecia, commonly referred to as 'genetic balding', is the main cause of male and female hair loss. This genetic 'programming' accounts for 95% of male hair loss.

For baldness to occur three factors need to be present:

1.The presence of and rogens, or male hormones.

2. A genetic pre-disposition to balding.

3. Time for the DHT to degrade the vulnerable hair follicles.

While they comprise less than ten percent of permanent hair loss, there are several other Causes of Hair Loss like stress, nutrition, health, age and hormones, that can cause temporary as well as permanent hair loss.

There are also several categories of treatments for hair loss which include drugs, topical lotions, hair care products, hair replacement systems and hair restoration surgery. To learn more about each, please visit our Hair Loss Treatment section.
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Hair loss - Race, Age, and Gender Considerations
Hair loss is a universal condition, affecting all ages, races, genders and nationalities. It’s estimated that “androgenetic alopecia,” or male and female pattern baldness affects 35 million men and 21 million women in the United States alone. This section examines how race, age and gender affect hair loss.

Race and Hair Loss

In physiological terms, human beings are all composed of the same bones, muscles, and everything else down to the cellular level. But there are specific differences.

Hair, in all of its variations, is one area in which human beings display their differences. Hair follicles can widely vary in terms of color, length, shape, thickness, strength and various other factors.

There are many ethnic groups to consider. But we will focus on the special considerations of Asians, Blacks (of African descent) and Caucasians.

Asian Hair Loss Considerations

Asian people typically have very straight hair. Their scalps contain fewer hairs per square centimeter, they actually have a lower hair density than that of Caucasian hair follicles. But because the individual hair follicles of East Asians are thicker, this gives the look and impression of greater hair density.

For these reasons, hair restoration techniques for East Asians, much like other races, must be sensitive to a variety of anatomic and cultural differences. For instance, East Asian females often have an increased likelihood of developing “diffuse alopecia,” or hair that thins evenly over the entire head than Caucasian females.

Even though it’s not a definite requirement, it’s very helpful for Asian patients to seek out doctors with experience in Asian hair.

Another consideration for East Asians considering hair restoration surgery is the increased chance of developing keloid scars. A keloid is a thick, irregularly shaped and elevated scar with uncontrolled growth that results from excess fibrous skin tissue. East Asians typically have a greater likelihood of keloid development than Caucasians, but less than that of people of African descent. Therefore, before undergoing surgery, East Asians may want to consider being medically evaluated for keloids.

African Hair Loss Considerations

People of African descent usually possess naturally curly hair. This curly hair gives the visual impression of increased hair density for a given amount of hair, which is beneficial in hair restoration surgery.

The hair follicles beneath the skin of people of African decent also typically curve more than Caucasians. This can make harvesting the donor hairs, without severing or transecting the hair follicles beneath the scalp, more difficult. A hair restoration physician needs to be very aware of this difference and adjust to its requirements.

As in the case of East Asians, people of African descent possess some unique hair and skin characteristics. Some of these medical conditions are more common in black skin than in white skin. This may increase the risk for post-surgical complications.

Those of African descent have a higher chance of developing keloid scarring when injured. This in turn leads to a greater chance of noticeable donor scars. Keloids aren’t a widespread problem. But those with a history of them are carefully evaluated in regard to their existing scars. The evaluation usually involves a small "test procedure" to determine if there’s a normal healing rate.

Another issue is that of postoperative skin discoloration. With darker skin, there’s often a greater risk of both increased and decreased skin color after injury or surgery. These risks can be determined by the patient’s medical and family history.

Ingrown hairs are also a more common problem in darker skin. If a patient has a history of ingrown hairs or other minor skin infections, this may signal a higher risk for ingrown hairs post-hair restoration surgery. Again, this risk can be determined by a small test procedure.

Caucasian Hair Considerations

Caucasians (white people) may have a wide range of hair and skin types. However, if someone has dense and or coarse hair, as well as skin color similar to their hair color, they will generally achieve the best results for a given amount of restored hair.

Learn more about aging and gender hair loss
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Female Hair Loss - Treatment and Restoration
Female hair loss, otherwise known as Female Pattern Baldness (FPB), affects 1 out of every 4 women in the United States. Recent findings have found that the incidence of FPB has been reported to be as low as 8% and as high as 87%. And, it does appear to be as common for women as for men. Most often, menopause is the most frequent time for hair loss in women to become apparent.

For a woman to lose her hair can be even more troubling than for men. A woman with thinning hair is not generally accepted as part of the normal aging process. Society has come to expect a thick, luxurious head of hair as part of the attractiveness in women.

While males and females can both experience thinning hair, they typically do not lose their hair in the same order or appearance.

Women with thinning hair compared to Men

Typically men observe their hair loss earlier, whereas women will first notice it in their late 20's through their early 40's. Female Pattern Baldness (FPB) is often seen during hormonal changes. These include the use of birth control pills, following childbirth, or during or after the time of menopause.

Top view of patient, showing excellent growth of transplanted hair.

In addition, men typically have localized areas (patterns) of thinning, whilein women this usually occurs as thinning across the top, or over an even wider area. When women have very diffuse thinning over much of their scalp they are generally not good candidates for hair restoration surgery. However, women with localized hair loss, similar to the typical male pattern baldness, can successfully undergo hair restoration surgery.

Thinning hair in females is also characterized by an increase in the combination of normal thick hairs mixed in with finer, smaller hairs. This results in decreased density, and not total hair loss.

A woman's hair has also been proven to be more sensitive to the effects of stress than men's hair. Stress can result in hair loss in women and men. But this type of loss is not female pattern baldness. Rather, it is known as “telogen effluvium.” This type of hair loss is the shedding of hair in the resting phase when the body senses that it needs to divert its energies elsewhere. Therefore stress can temporarily changes the amount of hair that is shed. But the lost hair is likely to grow back.

The production of the hair loss-inducing androgens is also different among men and women. A woman produces a small quantity of androgens in the adrenal glands and the ovaries. The ovaries also produce pre-hormones, which are then converted to androgens on the outside of the ovaries or adrenal glands.

Generally speaking, a woman with hair loss will probably not experience total balding in a given area. But if there is total hair loss, this is most likely a sign of a previously hidden disease. For this reason, it’s important for females to have their hormone levels checked by a physician if they are experiencing heavy hair loss.

Finally, men and women react differently to various hair loss treatment options. In men, hair loss may be halted or even reversed by finasteride (brand named "Propecia"). However, Propecia is not safe for females or children. Minoxidil (Rogaine) can be effective for both men and women in treating hair loss.

However, for some women the causes of their hair loss are much more complex than the classic "male pattern baldness". Thus proper diagnosis of the underlying cause is vital before any hair loss treatments are attempted.

The following physicians are nationally well known experts in female hair loss. Feel free to contact them.

David Whiting in Dallas, Texas - 214 824-2087

Vera Price in San Francisco, California 415 353-4163

Maria Hordinsky in Minneapolis, Minnesota 612 625-1493

Wilma Bergfeld in Cleveland, Ohio 216 444-5722

For a web community that is dedicated to female hair loss visit HerAlopecia.com
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Child Birth
Childbirth may result in hair loss. It's common for many women to notice hair loss about 3 months after they've had a baby. This too, is caused by hormones. But this is not something to worry about. You see, during pregnancy, hair that normally falls out is kept in by high levels of hormones. Once the hormones have returned to pre-pregnancy levels, this extra hair falls out. The normal cycle of hair growth and loss then begins again.
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PCOS (Polycystic Ovarian Syndrome) and Female Hair Loss
In women with PCOS(polycystic ovarian syndrome), high levels of androgens (male hormones) in the body may cause hair loss. DHT (dihydrotestosterone), more abundant in men, is created from a combination of testosterone and5-alpha-reductase enzymes. DHT can bind to hair follicle sites, accelerate the natural hair growth cycle, and cause hair to go into resting (catagen) sooner causing thinning hair with each cycle.

Women with PCOS are more susceptible to androgenic alopecia, more commonly referred to as male pattern baldness or genetic female hair loss. Androgenic alopecia is also the number one cause of hair loss and thinning hair in the world.Women with androgenic alopecia typically lose hair in a pattern similar to the ludwig scale,and less commonly the norwood scale.

If you suspect you have PCOS, you should consult with a physician and get tested for it. Only a physician can diagnose you and recommend a proper treatment.
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Female Hair Loss and Birth Control Pills
Birth control pills can be a great way of preventing conception however;all medication comes with potential side effects. In addition to the many serious possible side effects associated with birth control pills, some come with a risk of female hair loss. By suppressing ovulation due to the combined actions of hormones progestin or estrogen, women who are predisposed to hormonal related hair loss may experience varying degrees of balding while on the pill, or even more likely, a few weeks to months after coming off of it.

Yasmin is a birth control pill that combine sethinyl estradiol and drospirenone Because Yasmin may induce hair follicles into the telogen phase (hair shedding) of the hair growth cycle, hair loss is a reported side effect

We recommend women to use only low-androgenindex birth control pills. For women with a strong predisposition for genetic hair lossin their family, we recommend use of other non-hormonal birth control pills or other forms of contraceptives for the prevention of conception.

For your reference, here is a list of birth control pills ranging from the lowest androgen index to the highest: Desogen,Ortho-Cept, Ortho-Cyclen, Ortho Tri-Cyclen, Micronor, Nor-Q D, Ovcon-35,Brevicon/Modicon, Ortho Norvum 7/7/7, Ortho Novum 10-11, Tri-Norinyl, Norinyland Ortho 1/35, Demulen 1/35, Triphasil/Tri-Levien, Nordette, Lo/Ovral,Ovrette, Ovral, Loestrin1/20, Loestrin 1.5/30.
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Non Genetic Causes of Hair Loss
We know that and rogenetic alopecia or male pattern baldness is by far the most common cause of hair loss, accounting for 95% of hair loss in men and women. But there are a variety of other causes for hair loss in men and women. These include disease, aging, improper hair care, poor nutrition, and stress.

Disease and Illness

It's a proven fact that medical conditions, as well as treatments and procedures, may lead to hair loss. Many people have experienced sudden and large amounts of hair loss about 3 or 4 months after an illness or a major surgery. Fortunately, this hair loss is usually temporary, and is related to the stress of the illness.

Hair loss may also signal a previously hidden disease,including lupus, thyroid disease or diabetes. Because hair loss may be an early sign, it's a good idea to identify the problem and begin treating it at this time.

Psychological disorders such as Trichotillomaniamay be responsible for self-inflicted hair loss Men and women suffering from this condition pull their own hair out by the roots.

Hair loss may stem from taking certain medicines, but this normally stops once the medication is no longer taken.

Hormonal Changes

Another cause of medical hair loss is hormonal problems. Essentially, having an overactive or under active thyroid gland may cause your hair to fall out. Treating the thyroid disease will usually help this hair loss. Hormones can also cause hair loss if male hormones (androgens), or female hormones (estrogens), are out of balance. However, if the hormone imbalance is corrected, the hair loss should stop.

Aging

Did you know that 40% of men have noticeable hair loss by age 35, and 65% by age 60?

Aging is one of the factors necessary for and rogenetic alopecia to occur, along with a genetic predisposition and the presence of hair loss-inducing hormones. Hair loss is dependent on exposing the vulnerable hair follicles to the proper hormones over time.

Improper Hair Care

Isn't it frustrating to see people with thick, full heads of hair treat it so badly? Dyes, bleaching, pigtails -- it all takes its toll on hair.

The chemicals used for dying, tinting, bleaching, straightening or any other hair-altering procedures can lead to hair becoming strained or damaged. Eventually, this hair may even break off.

But it's not any better in the hair salon, as excessive styling that pulls the hair too tightly may also lead to a type of hair loss, called "traction alopecia." As long as this pulling is stopped before the scalp scars, the hair will grow back normally. But be warned, scarring can cause permanent hair loss.

It's also not a good idea to subject your hair to hot oil treatments or the chemicals used in permanents. These may cause inflammation of the hair follicle. This too, may lead to scarring and hair loss.

Improper Nutrition

Researchers have found that some hair loss may be due to insufficient protein or iron in your diet, as well as malnutrition, in general. As effective as "miracle" or "fad" diets sound, they may cause damage. Vitamin deficiencies, as well as certain illnesses related to eating, such as bowel disease or eating disorders, can also cause poor nutrition. These may all cause hair loss.

Stress

Stress can be harmful to the entire body, and the hair on our heads is no exception. Regardless of the cause - illness, a traumatic experience, nutritional deficiency - our rate of hair loss may increase.

However, it should be noted that stress-induced hair loss is not a cause of male-pattern baldness. Rather, this type of balding is known as "telogen effluvium." Telogen effluvium is caused when the body senses a problem and diverts its energies there. This results in hair being shed, although it's usually reversible.

Stress affects the hair of men and women differently. It's been foundthat women's hair is more sensitive to stress' effects than men's hair. One possibility is that stress (along with DHT and other things) may facilitate hair loss for women who are genetically predisposed towards it While the cause of genetic female hair lossis a bit of a mystery, women experiencing hair loss are advised to consult a dermatologist or hair restoration specialist to determine its cause Many causes of thinning hair in females are non-genetic and hair loss is often reversible by treating whatever condition is promoting it.
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Trichotillomania and Treating Hair Loss
Men and women who have the impulse to pull their own hair out may be suffering from trichotillomania. Trichotillomania is an impulse control disorder characterized by the repeated urge to and behavior of pulling out one's own hair. Impulse control disorders resemble substance addictions because the patient feels out of control of his or her own behaviors. Men and women with trichotillomania live relatively normal lives but typically show signs of hair loss, thinning, and bald spots all over the scalp and body from pulling it out.

Treating trichotillomaniagoes far beyond trying to stimulate hair regrowth.Even if Rogaineor laser therapy for hair losswere to regrow hair, there is a strong possibility that trichotillomania patients will continue to pull their hair out. Patients with trichotillomania therefore, should be treated at the source of the disorder in conjunction with using proven hair loss treatments.

In addition to medication, Habit Reversal Training (HRT) by a trained counselor has proven to be successful in treating trichotillomania. With Habit Reversal Training, the individual is taught to recognize and redirect their impulse to other more constructive activities. Often times, trichotillomaniapatients are asked to keep a journal of their hair pulling episodes. This can help the counselor and patient to identify and develop strategies to avoid situations that might trigger hair pulling episodes. Journals often include the location of the incident, number of hairs pulled, date, time, and their feelings and thoughts during the episode.

Treating a trichotillomania patient's baldness may be done simultaneously or after proper treatment of the disorder. Rogaine (minoxidil)can be a helpful aid to HRT by stimulating the follicles underneath the scalp, potentially facilitating or expediting hair growth.Treating a patient’s hair loss while they continue to pull their hair out is not constructive. Since this type of balding is not genetic due to the production of DHT, Propecia (finasteride)won't likely help.

Patients who've suffered from trichotillomania for awhile may damage or even remove the hair roots by excessive pulling, making non-surgical hair regrowth next to impossible. Surgicalhair restorationmay be an option for trichotillomania patients whose hair roots are too damaged to produce new hair on their own. Hairrestoration surgeryshould be reserved only for patients who've been successfully treated and no longer suffers from trichotillomania.

Catching and treating trichotillomania early will most likely reduce damage done to the hair follicles and eliminate the need for hair loss treatment, since undamaged hair will return on its own.
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