Your hair could be thinning for any number of reasons or combination of reasons, and without a thorough medical examination by a physician, it is impossible to tell which is which with any degree of certainty.  Our goal in this article is to address the most common questions that we receive from our readers and to answer those questions in a very non-scientific manner, and perhaps even answer some questions that might be on your mind too.  To follow, is a brief discussion on the known causes of hair loss and how it can be treated medically.

In general terms, some of the most common reasons for hair loss or thinning are:

1. Genetics.
2. Illness.
3. Poor Diet.
4. Stress.
5. Medications.
6. Post-partum Alopecia.

Hair loss can actually be caused by many factors including genetics, diseases, poor nutrition, stress and even medications, but by far the most common cause of hair loss in men and women is hereditary male and female pattern baldness or 'androgenic alopecia.'  This accounts for 99% of all prematurely thinning or balding scalps.

According to conservative estimates, hair loss affects over 60 million Americans, two thirds of which are men.  So, if you seem to be getting a little 'thin on top,' you are not alone! Approximately 50% of all men over the age of fifty are experiencing this type of hair loss.  Thankfully, medical science has made some dramatic breakthroughs that can help you maintain the hair you've got left and possibly restore some of your lost locks.

While it is important to mention what causes hair loss, it is equally important to cover what DOES NOT cause hair loss.  Scientists have now determined that genetic male and female pattern hair loss (androgenic alopecia) is NOT caused by poor scalp circulation, 'clogged' hair follicles, microscopic scalp mites, the wrong shampoo or wearing hats or helmets, despite what the late-night infomercials may say.  In addition, different hair-care products can effect the manageability and styling of your hair, and even hair breakage, but have no effect on the hair loss process.

Although hair itself may appear simple, just think about the incredible number of combinations of hair on different parts of your own body.  For example, your eyelashes are different from your eyebrows, and the hair on your arms is different from the hair on your head.  It is this genetic code within each and every single hair follicle (the tiny organ in the skin that produces hair) that determines each hair's individual color, maximum length, curl, shaft diameter, etc.  It is also this genetic code that makes hair on different parts of your head react differently in the presence of certain hormones, even though these two types of hair start out 'looking exactly the same.' (more about this later)

It is your inherited DNA, passed on from EITHER parent, that will eventually determine your hair loss. For the purpose of this article, you need only understand that with current technology, your genetic code is beyond your control, although that may change within the next ten to fifteen years.  However, you should also be aware that today, like no other time in history, medical science is able to provide safe and effective treatment for hair loss.

THE HAIR LOSS PROCESS
The mechanism by which men lose their hair is better understood than the same process for women.  The extent to which someone is affected by male pattern baldness is determined by a combination of genetic factors and androgens, specifically, the circulating male hormones testosterone and dihydrotestosterone (DHT).  Unlike earlier reports, we now know that the tendency for male pattern baldness can be inherited genetically from either side of the family.  (Kuster W., Happle R. The inheritance of common baldness. To be or not to be? J Am Acad Dermatol; 5:921-926, 1984.)

In men, hair loss can start any time after puberty, usually in the late teens to early 20's.  Typical male pattern hair loss starts as a recession of the hairline with some thinning in the crown.  This can eventually progress over years or decades, to the familiar 'monk's ring' of hair. 

In general, women tend to see a slightly different pattern and different time of onset of hair loss.  Female pattern hair loss starts in the late 40's to 50's, usually without a recession of the hairline.  Some women experience just a thinning of density up top, and others tend to thin out over broader regions or the entire scalp.  Scientists are unsure of the exact causes of female pattern hair loss, but feel it is related to hormonal changes.

As previously mentioned, the hair loss process in men is better understood.  As a man ages, "genetically sensitive" follicles on the scalp begin to miniaturize in the presence of normal levels of the hormone DHT (dihydrotestosterone).  These follicles, found in the frontal hairline and extending into the top and crown of the head, become smaller and produce a hair that is progressively thinner and less pigmented. 

DHT also affects these follicles' growth cycles, causing them to produce shorter and shorter hair until these follicles finally "die."  It is at this point that hair production ceases forever in those follicles and microscopic scarring occurs.  The hair found at the side and lower back of the head is relatively permanent because the follicles in that area are not sensitive to the effects of DHT; and this is why nearly all male pattern hair loss ends in a similar "pattern," hence the term, 'male pattern baldness.'  Because of this odd genetic code, hair growth rates may vary with age, and hair loss typically does not occur on other parts of the body.  This is why a man's beard may still be strong and full, while he is losing hair on his scalp.

HAIR RESTORATION OPTIONS FOR MEN AND WOMEN
      Through history, artificial hair replacement in the form of a hairpiece might have been a balding person's only option. Hannibal, the great Carthaginian military leader, wore one into battle in 200 B.C., and a myriad of cosmetic creams, sprays and powders are also currently available to those who would like to camouflage their hair loss. However, men and women who once might have chosen to cover their hair loss with attached artificial "systems" of wigs, weaves, toupees or hair extensions, now have truly viable medical and surgical options available to restore and maintain their hair.

Expertly done transplants have the complete approval of hair-news.com, and although it is a simple but exacting process, it requires an expert surgeon who has the expertise to perform the process, and the level of sincerity and attention to detail that is necessary for successful results.  For this reason hair-news.com has allied itself with the well known, respected and talented Dr. Alan J. Bauman, M.D. for the purpose of this article, and advising hair-news.com on other hair related medical issues in the future.

In addition, truly effective and safe medical treatments like the once-a-day pill, Propecia® (Finasteride 1mg) for men, or twice-a-day Rogaine® (Minoxidil 2% or 5%) spray, are also suitable options that can be used alone, or in conjunction with surgery.

PROPECIA®
      Propecia® (Finasteride 1mg), manufactured by Merck & Co., Inc. is available by prescription only, and was introduced into the market with great excitement in December of 1997 as the first oral treatment for male pattern hair loss.  For now, Propecia® is for men only and is not indicated for women.

Through four years of rigorous scientific studies, it has been shown to re-grow natural hair in 2 out of 3 men, and actually stop hair loss in 5 out of 6 men.  On a technical level, Propecia® works by decreasing the formation of DHT from testosterone by blocking a certain enzyme in the body.  By decreasing the amount of DHT, affected follicles that were producing thin wispy hair, tend to 'bounce back' producing a thicker caliber, more pigmented, longer hair.  It tends to be this effect that eventually gives men that are thinning in the crown, visible coverage.  It should be noted that it could take 6-12 months before results are noticed with the Propecia® treatment.

WHAT ABOUT SIDE EFFECTS OF PROPECIA®?
     What about the side effects?  Most men who inquire about Propecia®  (Finasteride 1 mg) are concerned about the possible sexual side effects of the medication; "But Doc, is it going to take the lead out of my pencil?", and it is of course every man's fear that now that he has attracted beautiful women with his new youthful locks of hair (motivation for many men seeking hair restoration), he will be unable to "perform" at his peak. 

What a patient needs to realize is that Propecia®  lowers levels of DHT, the hormone primarily responsible for male pattern hair loss, without decreasing levels of testosterone - the male hormone responsible for masculinity.  The male sexual side effects (described as difficulty maintaining erection or decreased sexual drive in the clinical trials) are therefore mild and rare, occurring in less than 2% of all patients.  (And of course there's always Viagra® !)  But seriously, any uncommon side effects that do occur have been shown to be temporary, and disappearing completely when the medication is discontinued.  It should also be noted that the side effects usually go away even when the patient continues the medication. 

The medication in Propecia® , Finasteride, has actually been available for over ten years to effectively treat men with enlarged prostates, and has demonstrated an excellent safety profile over that time.  It is important to remember that Propecia®  must be taken daily in order to sustain results.  If the medication is discontinued, any hair previously gained is lost over the following 12 - month period.  Propecia®  tends to work best in the crown of patients experiencing early to moderate hair loss and is effective in slowing and / or reversing male pattern hair loss in many men.  If you are experiencing male pattern hair loss, Propecia® might be beneficial.

ROGAINE® SPRAY:  FOR MEN AND WOMEN.

Minoxidil 2% (Rogaine®) solution for application to the scalp has been available for over 10 years and is now available without a prescription in the US.  It can be used by both men and women who are experiencing hair loss.  Originally used for the treatment of high blood pressure, physicians noted that one of its side effects was promoting hair growth.  Although its mechanism is not completely understood, it seems to work best to stop or slow further hair loss and works more effectively on the crown than at the frontal hairline.   A more potent concentration of Rogaine® (Minoxidil 5%) is now available and has been shown to be more effective than the 2% solution. 

Like Propecia® (Finasteride 1mg), Minoxidil must be used continuously and applied twice daily to sustain results. Both may be used alone or concurrently but, if discontinued, the natural balding process resumes.  Discontinuation of Rogaine®  typically results in a rapid shedding of hair (usually within a fairly short period of time). 

Propecia® or Rogaine® (Minoxidil 2% or 5%) can be successfully used by themselves or together (with added benefit) because of their different mechanisms of action.   As part of a total treatment plan to restore and maintain scalp hair, medication can be used either alone or in conjunction with a surgical procedure. 

WHAT IS A HAIR TRANSPLANT?
      Taking advantage of the relatively permanent hair on the sides and back of the head, hair transplant surgeons redistribute hair-producing follicles to thinning or balding areas of the scalp.   Current techniques in surgical hair restoration involve the removal of a strip of permanent, hair-bearing skin from the donor area, which is then typically dissected into micrografts (containing 1-3 hairs) and minigrafts (3-8 hairs each).  The donor area is sutured closed and the tiny grafts are then meticulously “planted” into the recipient area.   Critical to the aesthetic outcome of the procedure, the tiny incisions determine the angle, orientation and position of each individual graft. 

DOES IT LOOK NATURAL?  I DON’T WANT PLUGS!
      The use of very small micrografts, called follicular units, and advances in surgical technique now allow the creation of highly aesthetic, feathery and natural hairlines-avoiding the “pluggy” look that was typical of old-style transplant techniques.  (Older techniques utilized circular punches of skin, or “plugs,” that contained 15-20 hairs each.  This typically yielded a very noticeable, unnatural result-commonly referred to as “dolls’ hair.”)  Today, a hair transplantation done with the latest techniques should result in a completely natural-looking hairline. 

WHAT HAPPENS DURING A HAIR TRANSPLANT PROCEDURE?
      A hair transplant specialist and his team can transplant 1500-3000 micrografts in a single session, depending on the quality of the donor area.  Additional procedures may be required to achieve a greater density and as hair loss progresses.   Hair transplant procedures are typically performed under local anesthesia and there is little or no pain during the procedure.  A patient is seated comfortably in a dental-type chair and can watch videotapes, listen to music, or nap during the procedure.  While the procedure is underway, there is no sensation in the area where the work is being done. 

When the procedure is completed, the patient may or may not require a bandage overnight.  After the procedure, most patients have no discomfort and require no pain medication.   On each transplanted graft, small crusts form within 24 hours, which are shed in 10-14 days.   The sutures in the donor area are removed between 7-12 days after the procedure.   With proper surgical technique, the minor scars that occur in the donor scalp are typically narrow, about the width of a pencil line, and are easily hidden by the surrounding hair. 

The graft sites in the recipient area usually heal with no visible scarring and are covered by the transplanted hair.  The grafted follicles typically begin to grow hair in 6-12 weeks and will continue to grow for a lifetime.  The transplanted follicles are permanent, growing hair that will never fall out. 

WHO IS A GOOD CANDIDATE FOR A HAIR TRANSPLANT?
       Patients may undergo hair restoration surgery at any age.   As long as a patient has some donor hair, the hair transplantation is possible.  It is often wise to begin treatment before you are completely bald so that existing hair can be used to camouflage the procedures.  However, because hair loss tends to be gradual and progressive it is often unwise to begin surgical treatment in someone very young.   For men with mild to moderate hair loss, the use of medication, such as Finasteride and Minoxidil, can help preserve thinning hair in the crown area.   Hair transplants can be used to fill-in or re-establish a frontal hairline as well as increase the density in the front half of the scalp.  Medical treatment can be used to maintain your existing hair and thereby enhance the long-term results of hair restoration surgery. 

Hair transplantation can be used to camouflage or repair old ‘plug-style’ transplants, restore eyebrows, eyelashes, sideburns, moustaches and beards.   Hair transplants can also cover scars due to scalp injuries or previous surgery.  Before embarking on a course of treatment, it is vital for you to work closely with the hair restoration physician to design an individualized plan that best fulfills your specific needs in the present, as well as the future.  This usually occurs during an in-depth, one-on-one consultation.  Realistic expectations are, of course, always essential when planning a hair restoration strategy or cosmetic procedure of any type.  Typically, a combination of available medical and surgical “tools and techniques” are used in order to achieve someone’s treatment goal. 

For additional information on this subject and what kind of treatment may be right for you, we recommend that you speak with our Hair-Styles.org expert, Dr. Alan J. Bauman, M.D., of the Bauman Medical Group, P.A., at www.baumanmedical.com.  You can email him directly with your questions at doctorb@baumanmedical.com .    As a member of the International Society of Hair Restoration Surgery, he is well versed in the latest medical and surgical techniques used to maintain and restore hair.   His medical practice is devoted exclusively to hair loss. 

Other than the solutions that we have outlined, there are of course any number of snake oil salesmen just waiting to separate you from your money with miracle cures such as CM (chicken manure) or some ancient forgotten remedies like rat entrails. Don't buy into "Hair Voodoo". Go with hair science.

ILLNESS & POOR DIET
    When you are ill, your body taps reserves of stored nutrients and when these are depleted, your body takes these nutrients from wherever it can, thus robbing other parts of your body of nutrients that they require.  For example, when you see pictures of starving children (and sadly, we see these pictures all too often, or perhaps not often enough), they are usually bald.  Their little bodies are using any available nutrients for more essential functions.

If you think that you are rapidly losing hair, check your diet and seek medical attention from a hair loss physician.  Remember that Biotin and Zinc are especially good for hair growth.  In most cases a simple inexpensive daily multi vitamin such as 'Centrum' or 'One-A-Day' will be ample to cover any unusual nutrient loss.  In some cases a larger dosage may be required, and may be acquired from most health-food stores.  Please check with your physician for your exact needs.  There is a lot of unnecessary junk for sale out there and many stores will readily sell you expensive supplements that you do not need and that have little if any benefit, except to the pockets of the store that sold them to you.

Remember, certain diseases, like thyroid disease, and anything associated with high a high fever can cause hair loss, so check with your doctor.

POST PARTUM ALOPECIA
     Lets begin with pregnancy itself.  In a study published some years ago in The Journal of Obstetrics and Gynecology (sorry, date unknown), a three year study of 375 women resulted in the following findings:

The most frequently asked question by women was how pregnancy would affect their hair.  About one third of the women studied believed that their hair changed for the better, one third believed that their hair changed for the worse, and about one third reported no change at all.

Hormonal changes during pregnancy include an increase in estrogen and a decrease of sebum production.  When less sebum is produced, the hair seems drier and fuller because it is not weighed down with the oily sebum and it therefore feels thicker.  Increased estrogen's do seem to extend the growth cycle of hair, thus allowing hair to grow longer than it normally would.  Naturally, this phenomena stops with the termination of the pregnancy.

Why then do women report different conditions of their hair during pregnancy.  As stated earlier, we know far less about the hormonal affects on female hair than on men.  What we do know is that hormonal changes in women during pregnancy vary and that the susceptibility of the hair follicles to these changes also varies, we just don't know how or why.  Therefore it is impossible to predict what the effects will be on any individual person.

Post pregnancy however, about 50% of women report hair loss.  We call this condition, post-partum alopecia.  Although the condition is well known, the reasons again, are not.  The symptoms of the condition usually begin to manifest themselves 10 - 14 weeks after the end of the pregnancy, and usually last for another three months.  After that time the hair usually returns to normal, although not always.  If it does not return to normal, a blood test may reveal an underlying cause. 

As a general rule, the more babies you have, the thinner the hair will grow back in, but that may also be because the more babies you have, the older you are.

The amount of hair loss from post-partum alopecia can be alarming, and even frightening.  Many women panic at this stage which drastically increases stress factors and makes the situation even worse.  If you are prepared for this hair loss, you will be better equipped to combat the related stress.

Why does this happen?  We don't really know, although we have an idea.  Remember earlier when I said that the increased estrogen prolongs the life cycle of hair?  Well, that could also be the cause.  Hair that normally would have fallen out during the pregnancy, did not, but once the baby is born and the hormone levels return to normal, all of that hair comes out plus the hair that is normally ending its cycle at this point.  The result will be some very fine and short hair for a few months until the growth cycle has re-established itself.

You may be wondering if there is anything you can do about this?  Not really, but in a year or so your hair should be all better, right along with your bruised ego.  Ah, the little joys of motherhood.

There is a myth circulating that the reason some women report increased hair growth is because of the pre natal pills they have been prescribed.  Many people have written to hair-news.com about this and many of the people who write to us are actually taking pre natal pills to stimulate hair growth, including men.  This is nonsense.  Pre natals pills are little more than glorified vitamins meant to replenish increased demands on the the womans body by the fetus.  There is no hair growth related benefit to these pills.

HAIR CARE PRODUCTS
     The notion that hair care products can either combat hair loss or cause it, is simply silly.  Hair care products such as shampoos and conditioners do however affect the condition of the hair that you have, and the manageability of that hair, or to be precise, the way you look and feel.

This brings us to the old question of if salon products are better than drugstore or grocery store products.  We already have an extensive article on this subject titled, Are Salon Products Really Better. 

Poor quality shampoos and conditioners can certainly effect the condition of your hair and even cause hair breakage. (Not the same as hair loss).  Many over the counter products contain a silicon like substance that yields great results in the beginning but then gradually coats your hair in a brittle silicon shell which causes hair to become static, and eventually break.  Yet others contain ingredients to hook you on the product. Dandruff shampoos in particular are guilty of this in our opinion, containing an acid that actually burns and scars the scalp, making the flaking a perpetual motion machine without end.  Once these shampoos have been discontinued and replaced with good quality products, the dandruff will disappear.

The big difference between salon shampoos and over the counter shampoos is ingredients.  Usually salon shampoos contain much better ingredients than their over the counter competitors and are not nearly as harsh or destructive.  Having said that, the gap is narrowing.  An over the counter shampoo here and there is beginning to upgrade their ingredients, and ironically, some salon lines are actually decreasing the benefits of their ingredients. To some extent this is intentional as many companies that produce over the counter products have purchased the salon professional lines and changed the formula of their ingredients.

MEDICATION / MEDICAL TREATMENTS
     Many medications or medical treatments add a hormone to your system to combat an otherwise life threatening condition.  These same compounds can also affect you hair condition.  After some cancer therapies, hair that was straight and blonde comes back in curly and red, and so on.  There is really nothing that can be done about this without otherwise endangering your life, so please don't try.  Stick with the program.  Losing a little hair is a small price to pay for the privilege to be alive.  Usually, chemotherapy patients experience at least some re-growth after the medication is discontinued.

STRESS
     Environmental and emotional stress can lead to a sudden onset of hair thinning or patchy hair loss that does not correspond to the typical pattern of male or female pattern hair loss.  This can be because of some medical condition which has not yet been identified and treated, or stress.  Reduce stress if you can and if the loss persists, seek medical attention.  We know that this is easier said than done, but that is the only remedy.

Well, in a nutshell, that's it.  Yes, there are any number of other products, remedies, therapies and whatnot's that we have not mentioned, and for good reason.  They don't work, no matter what you may have heard.  These remedies range from old wives tales, to such miracle cures as CM (chicken manure) and old forgotten ancient cures like rat entrails and urine.  We refer to these things as 'Hair Voodoo'.  Do yourself and your bank account a favor and go with hair science, not hair voodoo.

For additional information on this subject and what kind of treatment may be right for you, we encourage you to speak with our Hair-Styles.org expert, Dr. Alan J. Bauman, M.D., of the Bauman Medical Group, P.A., at www.baumanmedical.com.  You can also email Dr. Bauman directly with your questions at doctorb@baumanmedical.com .  As a member of the International Society of Hair Restoration Surgery, Dr. Bauman is well versed in the latest medical and surgical techniques used to maintain and restore hair.  His medical practice is devoted exclusively to hair loss.

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