Hair Loss

About Hair Loss


Hair loss affects about 35 million men and 21 million women in the United States alone. 40% of men have noticeable hair loss by age 35 and 65% by age 60. First you need to understand why hair loss occurs. Your hair loss has little or nothing to do with shampooing, hats, or any other practices. Hair loss is largely genetic.

There are many causes of hair loss in men and women, including disease, nutritional deficiency, hormone imbalance, and stress. By far the most common cause, however, is what is called androgenetic alopecia. Alopecia is simply the medical term for hair loss. Androgenetic refers to the fact that both genetic predispositions to balding and the influence of androgens, or male hormones, play a part in this type of hair loss.

There is a third factor, which is the passage of time, or aging.

So, in order for androgenetic alopecia to occur, there must be:

  • genetic propensity for balding
  • presence of androgens, or male hormones
  • aging time to allow the first two factors to exert their influence on the hair follicles

Both men and women produce “male” hormones. The most common of these are testosterone, androsteinedione, and dihydrotestosterone (DHT). Androgens are produced by the testicles and adrenals in men, and by the ovaries and adrenal glands in women. These hormones are important in both sexes, but occur in different concentrations, being much more predominant in males than in females. This, in part, is responsible for the typical differences between the genders.

The exposure of hair follicles to DHT over a period of time can lead to androgenetic alopecia, male and female pattern baldness, in people who are genetically susceptible to balding. The balding process can occur at any age and move at any rate. It can start in the teen years or late in life, develop rapidly, slowly, or even stabilize.

Hair loss is not a new phenomenon; Julius Caesar used wreaths to hide his thinning, and French King Louis XIV’s elaborate 15-20 pound wigs covered proof that he, too, suffered from male pattern baldness. History is filled with interesting tales of balding cover-ups.

Other Hair Loss Causes

Alopecia Areata

Alopecia areata (AA) is a recurrent disease, which can cause hair loss in any hair-bearing area. The most common type of alopecia areata presents as round or oval patches of hair loss most noticeably on the scalp or in the eyebrows. The hair usually grows back within six months to one year. Most patients will suffer episodes of hair loss in the same area in the future. Those who develop round or oval areas of hair loss can progress to loss of all scalp hair (alopecia totalis). The cause of alopecia areata is unknown but commonly thought to be an autoimmune disorder in which the body does not recognize the hair follicles and attacks them. Stress and anxiety are frequently blamed by patients as the cause of their hair loss. The most common treatment is with steroids (for example, cortisone) either topically or by injection. The steroid treatment is considered effective if results are seen during the first twelve months of the process. Results can be poor in adults who have seen the effects of the disease for longer periods of time. Minoxidil (Rogaine®) can help to slow down or stop hair loss, but rarely, if ever, is able to regrow hair. In some cases, it can help to grow some hair in the crown, but it will not develop a hairline or fill in an area of recession. Surgical treatment of this disorder is not recommended. If you have questions concerning Alopecia areata, please contact a NuHart physician.

Traction Alopecia

Traction alopecia is caused by chronic traction (pulling) on the hair follicle and is seen most commonly in African-American females associated with tight braiding or cornrow hairstyles. It is generally present along the hairline. Men who attach hairpieces to their existing hair can experience this type of permanent hair loss if the hairpiece is attached in the same location over a long period of time. Trichotillomania is a traction alopecia related to a compulsive disorder caused when patients pull on and pluck hairs, often creating bizarre patterns of hair loss. In long term case of trichotillomania, permanent hair loss can occur.

Scarring Alopecia

Hair loss due to scarring of the scalp is called scarring alopecia. Scarring can be due to a variety of causes. Traction alopecia over a period of time may lead to scarring and permanent hair loss. Trichotillomania (compulsive hair-plucking) can cause permanent scalp scarring over time.

Injury to the scalp caused by physical trauma or burns may leave permanent scars and permanent hair loss. Diseases that may cause permanent hair loss due to scalp scarring include (1) the autoimmune conditions lupus erythematosus and scleroderma, and (2) bacterial infections such as folliculitis, fungal infections, and viral infections such as shingles (herpes zoster).


Trichotillomania is the name given to habitual, compulsive plucking of hair from the scalp or other hair-bearing areas of the body. Over time, continual plucking of scalp hair will result in a hairless area-a bald spot. Long term trichotillomania can result in permanent damage to scalp skin and to scarring alopecia. It is not known whether trichotillomania should be classified as a habit or as obsessive-compulsive behavior. In its mildest form, trichotillomania is a habitual plucking of hair while a person reads or watches television. In its more severe forms, trichotillomania has a ritualistic pattern and the hair-plucking may be conducted in front of a mirror. The person with trichotillomania often has guilt feelings about his or her “odd” behavior and will attempt to conceal it.

Triangular Alopecia

The cause of triangular alopecia is not known, but the condition can often be treated medically or surgically. The characteristic pattern of hair loss in triangular alopecia is thinning or complete loss of hair in the scalp area around the temples. If hair loss is not complete, the remaining hairs are often “miniaturized”-fine-textured hairs of thin diameter. Triangular alopecia sometimes begins in childhood with unexplained hair loss in the temporal areas of the scalp.

Telogen Effluvium

Telogen effluvium is the name given to hair loss that is caused when a large percentage of scalp hair follicles are shifted into the telogen or “shedding phase” of hair growth. See NuHart’s Hair Growth Cycle for more information. The cause of this abnormally timed telogen phase may be hormonal, nutritional, drug-related or associated with stress.

Loose-Anagen Syndrome

Loose-anagen syndrome occurs most frequently in fair-haired persons. During the anagen (growth) cycle of hair, scalp hairs sit so loosely in the follicles from which they grow that they can be easily extracted by combing or brushing. The condition may appear in childhood and gradually improve or disappear over time.

Hair Loss In Men


Some men gradually lose their hair over the front, top, and crown of their head, but most men still do not understand the root cause of hair loss. This is a natural phenomenon called “male pattern baldness” or androgenetic alopecia. “Andro” refers to the androgens (testosterone, dihydrotestosterone) necessary to produce male-pattern hair loss (MPHL). “Genetic” refers to the inherited gene necessary for MPHL to occur.” The hair follicles in these areas react negatively to the hormone testosterone, resulting in gradual hair loss. The hair on the sides and lower back of the head is genetically programmed not to be affected and does not fall out. Because of this genetic programming, this hair can be permanently transplanted by a NuHart hair transplant physician to the thinning and balding areas. This donor hair will not fall out and can be cut, combed, and styled just as the hair it has replaced. It will continue to grow for the rest of your life and will not be affected by any hormone changes.

Scale of Male Pattern Baldness

I. represents a normal head of hair with no visible hair loss.

II. is characterized by the beginning of a receding hairline and a “widow’s peak” on the forehead.

III. patients exhibit a more significant decline in hair above the temples as well as receding from the forehead. In Class 3 Vertex, hair loss is starting to become significant on the crown.

IV. hair loss may become more noticeable on the crown or patients may have significant hair loss above the temples and/or front anterior areas.

V. hair loss approaches significant levels with most hair loss occurring on the top of the vertex and crown. Hair transplantation for this Class and higher Class levels may require more grafts to provide coverage and density.

VI. patients show major hair loss, but still have areas with donor hair available. Transplanting this hair can still have excellent results.

VII. patients show the most significant loss of hair. There may still be sufficient donor hair for transplantation; however, results may be limited.

It is estimated that 35 million men in the United States are affected by male pattern baldness. In men who develop male pattern baldness the hair loss may begin any time after puberty when blood levels of androgens rise. The first change is usually recession in the temporal areas, which is seen in 96 percent of mature Caucasian males, including those men not destined to progress to further hair loss.

Hair loss in men is likely to occur primarily between late teen-age years and age 40-50, in a generally recognizable “male-pattern” baldness known as androgenetic alopecia. Men with male-pattern hair loss may have an expectation of hair loss if they have male relatives who lost hair in a recognizably male pattern. Although the density of hair in a given pattern of loss tends to diminish with age, there is no way to predict what pattern of hair loss a young man with early male pattern baldness will eventually assume. In general, those who begin losing hair in the second decade are those in whom the hair loss will be the most severe. In some men, initial male-pattern hair loss may be delayed until the late third to fourth decade. It is generally recognized that men in their 20s have a 20 percent incidence of male pattern baldness, in their 30s a 30 percent incidence of male pattern baldness, in their 40s a 40 percent incidence of male pattern baldness, etc. Using these numbers one can see that a male in his 90s has a 90 percent chance of having some degree of male pattern baldness. The onset, rate, and severity of hair loss are unpredictable. The severity increases with age and if the condition is present it will be progressive and relentless.

NuHart Hair Loss in Men

The amount of androgens present does not need to be greater than normal for male pattern baldness to occur. If androgens are present in normal amounts and the gene for hair loss is present, male pattern hair loss will occur. Axillary (under arm) and pubic hair are dependent on testosterone for growth. Beard growth and male pattern hair loss are dependent on dihydrotestosterone (DHT). Testosterone is converted to DHT by the enzyme, 5 -reductase. Finasteride (Propecia®) acts by blocking this enzyme and decreasing the amount of DHT. Receptors exist on cells that bind androgens. These receptors have the greatest affinity for DHT followed by testosterone, estrogen, and progesterone. After binding to the receptor, DHT goes into the cell and interacts with the nucleus of the cell altering the production of protein by the DNA in the nucleus of the cell. Ultimately growth of the hair follicle ceases.

The hair growth cycle is affected in that the percentage of hairs in the growth phase (anagen) and the duration of the growth phase diminish resulting in shorter hairs. More hairs are in the resting state (telogen) and these hairs are much more subject to loss with the daily trauma of combing and washing.

Hair Loss in Men

The hair shafts in male pattern baldness become progressively miniaturized, smaller in diameter and length, with time. In men with male pattern baldness all the hairs in an affected area may eventually (but not necessarily) become involved in the process and may with time cover the region with fine (vellus) hair.

Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in color. The lighter color, miniaturized hairs cause the area to first appear thin. Involved areas in men can completely lose all follicles over time. Male pattern baldness is an inherited condition and the gene can be inherited from either the mother or father’s side. There is a common myth that inheritance is only from the mother’s side. This is not true.

In summary, male pattern hair loss (Androgenetic Alopecia) is an inherited condition manifested when androgens are present in normal amounts. The gene can be inherited from the mother or father’s side. Medical science has come to learn that baldness genes are actually passed down from both sides of the family—and they affect hair loss in women as well as men. Baldness genes may also skip generations and are utterly random in terms of which siblings (male or female) they will affect. They may even have very different effects on siblings in the same family. NuHart Specializes in state-of-the-art hair restoration procedures.

Hair Loss In Women


Female pattern baldness is very common. Studies show that incidence of hair loss in women increases from 3% in their twenties to 30% of women in their eighties. Approximately one quarter of all women are affected by some hair loss by the time they are in their fifties.

Women go to great lengths to hideit cosmetically with various hair styles and treatments but the hair loss is common and can be emotionally traumatic.


  • Grade 1 female baldness is the least severe with thinning on the top of the head.
  • Grade 2 hair loss in women is more significant with areas of the scalp showing through thinning hair.
  • Grade 3 patients may completely lose hair on the crown of the head. In this case, more donor hair will be required to obtain full coverage.


The patterns of hair loss in women are not as easily recognizable as those in men. Unlike hair loss in men, female scalp hair loss may commonly begin at any age through 50 or later, may not have any obvious hereditary association, and may not occur in a recognizable “female-pattern alopecia” of diffuse thinning over the top of the scalp. A woman who notices the beginning of hair loss may not be sure if the loss is going to be temporary or permanent—for example, if there has been a recent event such as pregnancy or illness that may be associated with temporary hair thinning.

In women as in men, the most likely cause of scalp hair loss is androgenetic alopecia—an inherited sensitivity to the effects of androgens (male hormones) on scalp hair follicles. However, women with hair loss due to this cause usually do not develop true baldness in the patterns that occur in men—for example, women rarely develop the “cue-ball” appearance often seen in male-pattern androgenetic alopecia.

Patterns of female androgenetic alopecia can vary considerably in appearance. Patterns that may occur include:

  • Diffuse thinning of hair over the entire scalp, often with more noticeable thinning toward the back of the scalp.
  • Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp but not involving the frontal hairline.
  • Diffuse thinning over the entire scalp, with more noticeable thinning toward the front of the scalp, involving and sometimes breaching the frontal hairline.


Unlike the case for men, thinning scalp hair in women due to androgenetic alopecia does not uniformly grow smaller in diameter (miniaturize). Women with hair loss due to androgenetic alopecia tend to have miniaturizing hairs of variable diameter over all affected areas of the scalp.

While miniaturizing hairs are a feature of androgenetic alopecia, miniaturization may also be associated with other causes and is not in itself a diagnostic feature of androgenetic alopecia.

In post-menopausal women, for example, hair may begin to miniaturize and become difficult to style. The precise diagnosis should be made by a physician hair restoration specialist.

It is important to note that female pattern hair loss can begin as early as the late teens to early 20s in women who have experienced early puberty. If left untreated, this hair loss associated with early puberty can progress to more advanced hair loss if it is left untreated.


In women more often than in men, hair loss may be due to conditions other than androgenetic alopecia. Some of the most common of these causes are:

Trichotillomania – compulsive hair pulling. Hair loss due to trichotillomania is typically patchy, as compulsive hair pullers tend to concentrate the pulling in selected areas. Hair loss in women due to this cause cannot be treated effectively until the psychological or emotional reasons for trichotillomania are effectively addressed. Therefore, hair transplantation would not be an appropriate treatment option.

Alopecia areata – a possibly autoimmune disorder that causes patchy hair loss in women that can range from diffuse thinning to extensive areas of baldness with “islands” of retained hair. Medical examination is necessary to establish a diagnosis.

Triangular alopecia – loss of hair in the temporal areas that sometimes begins for a woman in childhood. Hair loss may be complete, or a few fine, thin-diameter hairs may remain. The cause of triangular alopecia is not known, but the condition can be treated medically or surgically.

Scarring alopecia – hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top of the scalp and occurs predominantly in women. The condition frequently occurs in African-American women and is believed to be associated with persistent tight braiding of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring. We also refer to this as traction alopecia, a slow chronic pull on the hair root that eventually kills the root system causing balding.

Telogen effluvium – A common type of hair loss caused when a large percentage of scalp hairs are shifted into “shedding” phase. The causes of telogen effluvium in a woman may be hormonal, nutritional, drug-associated, or stress-associated. Loose-anagen syndrome—a condition occurring primarily in fair-haired persons in which scalp hair sits loosely in hair follicles and is easily extracted by combing or pulling. The condition may appear in childhood, and may improve as the person ages.

Postpartum Alopecia – Another common form of hair loss, postpartum alopecia is caused by hormonal changes during the course of a pregnancy. The changes cause an alteration in the growth pattern of the hair follicles. There is usually very little sign of these changes during the pregnancy itself, but rather a sudden and very excessive loss of hair from three to nine months after the birth of the child. While this is often very traumatic for the new mother suffering from the hair loss, the hair’s growth cycle typically returns to normal within a year after the end of the pregnancy. Therefore, hair transplantation is not a necessary treatment option.

Hypopituitarism and Thyroid Disorders – Female hair loss can be the result of a hormonal change or imbalance. There has been a report describing a young women with hypopituitarism who presented with clinical and histological features of female pattern baldness in the absence of detectable levels of circulating androgens (testosterone and other male hormones) showing this pattern of hair loss is not androgen dependent. Hair transplantation is usually not an initial treatment option in these instances.

Accident or Surgery Related – Women who have had facelifts or other procedures in the scalp that have left scars or, as in the case of brow lifts, has left the hairline too high. In general, these types of hair loss respond well to transplants.

If you are a woman with thinning or lost scalp hair, your first necessary step is to have the condition correctly diagnosed by a NuHart hair restoration physician specialist.

Treatment Options


Hair Transplantation

Hair transplantation is the simple in-office procedure of removing hair from the donor area (the back or sides of the head) and inserting this hair into the thinning and balding area. Hair from the donor area is genetically programmed to grow for the rest of one’s life. As a hair restoration option, hair transplantation is the only natural and permanent solution that restores a hairline and adds density to the thinning area. For these reasons, it’s the ultimate solution to the main cause of hair loss.

Laser Hair Therapy

Based on the scientific principal of photo-biotherapy, Laser Hair Therapy is a process whereby stimulation of the scalp through Low Level or “cold” lasers, increases blood flow and blocks the harmful hair loss effects of Dihydrotestoterone, also known as DHT. This photo-biotherapy occurs when laser light is absorbed by cells, which causes stimulation of cell metabolism and improved blood flow. Low Level Laser Therapy is an effective, non-surgical, drug-free solution for hair loss and thinning hair. It may also be extremely helpful in aiding hair growth after a transplant procedure. Laser Hair Therapy may make your hair look healthier and fuller, reducing the appearance of thinning hair. It can work extremely well on its own and may also speed up the process of hair growth after a hair transplant procedure. Many users of Laser Hair Therapy feel they experience an improvement in hair thickness and texture, as well as a deceleration in hair loss and/or miniaturization of hair follicles. There are no known negative side effects of Laser Hair Therapy, and it is recommended for both men and women.

Hair Systems

Hair systems have become more sophisticated in design with the integration of more natural looking hair into almost undetectable base material. They are now more comfortable and durable for use by active and athletic people. This is the perfect solution for people who cannot have hair transplants due to medical or other restrictions.



Rogaine or Minoxidil is the first medication approved by the United States Food and Drug Administration (FDA) that has been proven to grow hair. It is also available in a stronger 5% solution for men who found the 2% solution not to be effective. Most men with male pattern baldness are concerned with their frontal hairline. UpJohn and Pharmacia admit that Rogaine has little or no effect in this critical area. The greater benefit of Rogaine and Propecia is the slowing down of hair loss.


The FDA gave approval in 1998 to the Merck Company to market the first pill to fight thinning and balding called PropeciaTM (Finasteride). Propecia is really a smaller dosage of Proscar, a prostate enlargement medication. It has demonstrated some ability to slow hair thinning and promotes hair growth in some men. It cannot completely restore hairlines and is more effective in the crown and vortex areas.


Vitamin and Herbal Hair Restoration Options

There are a number of products available to the consumer that claim to promote healthy hair, reduce or stop hair loss, or speed up the recovery time following a hair transplant procedure.

One of these products is Reviovogen. This product does not appear to offer any clinical advantage nor do anything positive for the hair loss client.

Saw Palmetto has been proven to reduce the DHT your body produces and may reduce hair loss. In a small percentage of individuals, it has even been shown to regrow hair. In one study, Saw Palmetto was shown to be just as effective in reducing the prostate size as 5mg of finasteride, though it has not been studied clinically in comparison to Propecia for hair loss.

Nutritionalists know how important biotin is in skin, nail, and hair health. Biotin is an essential water-soluble B vitamin.You can simply make sure that that biotin is in your daily diet or take a supplement.

Zinc is an essential vitamin for healthy hair. However, zinc supplementation should be undertaken only under medical supervision; zinc overdose is associated with a number of adverse physical effects.

Other Hair Loss Problems


Eyebrow Loss

Unlike the loss of scalp hair, the loss of one’s eyebrows is not viewed as a natural process and is, therefore, not cosmetically acceptable. Eyebrows may be lost for a variety of reasons including thyroid and other systemic diseases, alopecia areata, burns, tattoos, infections, repeated plucking, congenital inability to grow eyebrows and a genetic tendency for eyebrows to thin, or disappear, over time.

Eyebrow restoration is similar to other hair transplant procedures performed on the scalp, in that, for appropriate candidates, the transplanted hair is permanent. However, because eyebrows have their own unique attributes, eyebrow transplants differ from hair transplants in a number of important ways.

Gaps in Facial Hair

Alopecia areata is a fairly common form of hair loss in which the hair falls out in small coin-sized spots anywhere on the scalp. Severe forms rarely progress to complete hair loss. This is a medical, not a surgical problem, and it should not be treated with transplants unless it has remained stable for many years. Even then, the transplanted hair will likely fall out if the disease is reactivated.


Various primary dermatologic diseases can affect the scalp, leading to hair loss due to scar formation. Treatment is aimed at medical control of the disease. If the disease remains under control for years, transplants can be considered for the scarred areas, but just like with alopecia areata, if the disease returns, that transplanted hair could be lost. On the contrary, scars due to injury or accident are nicely concealed through hair transplantation, and NuHart has had great success with these types of restoration procedures.

Hair Pulling

Rarely, patients will actually pull out their own hair. This condition is known as trichotillomania. In adults, it is usually seen in the setting of psychological problems such as anxiety, depression, or frank psychosis. Again, this can be treated with transplants, but it is not uncommon for patients to relapse and begin pulling out the hair again.