Causes of Hair Loss

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Hair loss can be caused by one or a combination of several factors. Some will result in permanent hair loss whilst others will cause only temporary loss. Hair loss can occur in both men and women, and some factors are common to both sexes, others being sex-dependent. These factors include thyroid or other hormonal imbalances, nutritional deficiencies, auto-immune disorders, medication side effects, hair and scalp trauma, stress and several others, including some related to the environment.

Before undergoing any form of treatment, diagnosis by a qualified professional is essential in order to determine the underlying cause or combination of causes for the loss of hair. However the commonest problem for which the majority of patients seek hair restoration is pattern hair loss, which occurs in both men and women.

Pattern Hair Loss in Men

Male pattern hair loss is the result of genes, age and the action of male hormones. It is known medically as androgenic alopecia, since the gradual loss of hair with age is caused by the action of the male sex hormones, the androgens. The effect of androgens on the male hairline can begin as early as the teenage years and most men will have experienced some degree of pattern hair loss by the time they reach their fifties. The pattern typically begins with hair receding in the temple areas and the crown, which can gradually progress until only a thin lineof hair is left around the edge of the scalp. It is however difficult to predict the ultimate extent and pattern of hair loss for any individual patient.

The Norwood-Hamilton Scale is frequently used to describe the progression of male pattern baldness.

Norwood-Hamilton Scale for Male Hair-loss

Pattern Hair Loss in Women

Whilst hair loss is often considered to be a problem that typically affects many men, women too can suffer from hair loss. For women this can be particularly upsetting and can have a very negative impact on self-esteem. There are numerous medical conditions that can cause hair loss in women, many of which are also common to men. However in women hair loss can also be associated with other factors such as pregnancy and various hair fashions and product treatments.

However, as with men, the most common cause of hair loss in women is inherited androgenic pattern baldness. But in women the pattern is usually different from that observed in men. It is occasionally possible for female pattern hair loss to start in the earlier years, but more often it will begin later than for males. And in women it often takes the form of a diffuse thinning effect over the entire region of the scalp with the exception of the front hairline.

The Ludwig Classification is often used in describing the progression of female pattern baldness.

Ludwig scale for female hair loss

Other Hair Loss Causes in Men and Women

In addition to pattern baldness, there are several other factors that can contribute to hair loss, many of which are common to men and women. The following is a list of some of the most frequently encountered factors:

Lifestyle and Enviromental Factors

  • Diet. A diet which is lacking in essential vitamins and minerals can affect the condition of the hair and can even cause hair loss.
  • Smoking. It is widely recognised that smoking causes a whole range of health problems, and recent evidence has found a link with hair loss, with research suggesting that it affects blood flow to the hair follicles in addition to its circulation throughout the body as a whole.
  • Stress. Stress not only affects men and women mentally and physically, but it can also cause temporary hair loss. This is due to the action of hormones such as cortisol and noradrenaline during periods of stress in which they will disrupt the normal hair growth cycle. The resultant abnormal cycle causes the hair to become thinner and eventually fall out. This will continue throughout the period of stress, but it can be overturned once the cause of stress is removed.
  • Pollution. Environmental factors can also lead to hair loss. Those living in cities are most at risk due to pollution caused by exhaust fumes. But even in the countryside links have been identified between certain crop pestisides and hair loss. And in the home itself, exposure to dust, cigarette smoke and the smoke from open fires can be contributory factors.
  • Sun. Over-exposure to the sun not only has a harmful effect on the skin but also causes the hair to become dry and brittle, characterised by split ends and a lifeless condition.

Chemotherapy / Radiation Therapy

Chemotherapy employs very powerful drugs to kill cancer cells. However in traditional forms of chemotherapy, healthy cells, including hair follicles, will also die, disrupting the hair growth cycle with the result that the hair thins and falls out. This may result in the loss of all the hair or patches of hair loss.

Radiation therapy can have a similar effect to that of chemotherapy, with the radiation affecting hair follicle growth. Symptoms differ between individuals, with some people experiencing total hair loss from the treated area, and others hair loss in patches.

Trichotillomania

Trichotillomania is a psychological disorder, one symptom of which can be hair loss. It is characterised by a compulsion in which the sufferer gets the urge to pull out their hair by its roots. This hair can be on the scalp and sometimes also on other parts of the body, including the eyelashes and eyebrows.

Medication

The problem of hair loss due to medication is not limited to chemotherapy drugs. Indeed many well-known medications can also cause hair loss. However it is important to be aware that if one particular form of medication causes hair loss in someone else then this does not necessarily imply that this medication is responsible for your problem, since there may be an underlying medical condition or some other causative factor.

Do not stop taking any prescribed medication because you are concerned about hair loss. Always visit your GP first for their advice and guidance. They might be able to propose a suitable alternative which does not affect the hair.

Medicines that can cause hair loss include but are not limited to:

  • Anti-depressants (e.g. Prozac)
  • Beta-blockers and Warfarin
  • Zantac
  • Ritalin
  • Arthritis medicine
  • Anabolic steroids
  • Contraceptive pills

Even certain over-the-counter medicines such as vitamin supplements and cod liver oil can cause hair loss if they are taken in a dosage exceeding the recommended level.

Hair Products

Hair products such as gels, styling mousse, sprays, colours and conditioners enable people to have their hair looking the way they want it, but like any product, they can cause problems if used to excess. Too frequent use of many such products can lead to damage to hair strands and even hair loss. However the products that can be most dangerous to the hair if used excessively are hair dyes and perms.

Hair dyes often contain harsh chemicals which can dry out hair strands or lead to split ends. Perms can have a similarly damaging effect if the solution is too strong or it is left too long on the hair.

Alopecia

Alopecia is the medical term used to describe hair loss which is usually confined to the scalp, although body hair can sometimes also be affected. Whilst often thought of as a single condition, in fact there are 11 different types of Alopecia, each of which affects the body in different ways, although most of them share the same cause. Whilst frequently the result of an auto-immune disorder in the body, there can also be other causes.

The type of Alopecia known as Alopecia barbae affects only men and causes the loss of facial hair, usually from the beard.

Illness

It is possible that loss of hair is a symptom of an underlying illness, disease or infection, particularly in those who have always had a full head of hair. There are several illnesses which can cause hair loss. Some of the most well-known include:

  • Cushing’s Syndrome. A disease of the endocrine system.
  • Malnutrition. This can be caused by “crash dieting”, problems of the digestive system or simply not eating the right types of food.
  • Hyper/Hypothyroidism. Diseases of the thyroid glands.
  • Systematic Lupus Erythematosus (SLE). A disease of the auto-immune system which in some cases disrupts the normal hair growth cycle, leading to temporary hair loss.
  • Anaemia. There are 3 types of anaemia – pernicious, iron deficiency, copper deficiency – all of which can lead to hair loss.
  • Fungal infections. There are many types of fungal skin infections that can affect different areas of the body. One such type is ringworm of the scalp which causes inflammation and hair loss.
  • Tooth infection. This results from the body’s immune system response to the the infection in a tooth. Infection-induced alopecia tends to occur closest to the site of the infection.

Hair Loss Causes Specific To Women

Contraception

Many women are unaware of this potential side effect of taking birth control pills. Fortunately, a positive aspect is that any resultant hair loss tends to be temporary.

Hair loss can be caused by oestrogen which affects the hair growth cycle. This is known as telogen effluvium, which is classed as a medical condition, although without the requirement for treatment since hair growth restarts once the body has adjusted to the increased oestrogen level. The condition rarely lasts more than 6 months, after which the hair will normally recommence growing.

Pregnancy

The female body undergoes a wide range of changes during pregnancy, one of which includes hair loss. The main reason for this being hormonal changes in the body resulting from increased oestrogen production which affects the normal hair growth cycle.

During pregnancy hair will typically become longer, thicker, shinier and overall healthier than before. Unfortunately following childbirth the opposite will occur due to the falling oestrogen levels, and many women find that they lose a significant amount of hair during this time. However, once the body returns to its normal, pre-pregnancy state then the hair growth cycle also returns to normal. This is typically about 6 months after childbirth.

Menopause

One of the several symptoms of menopause is hair loss. And this will occur to some extent in almost half of all women. Fortunately, as the symptoms of menopause pass over time, so also will the hair loss. The symptoms are hair thinning around the temples and over the top of the scalp, typically without resultant bald patches. This type of hair loss is usually temporary.

Hair Loss Treatment Options

Hair loss can be upsetting, embarrassing and even distressing, but in most cases it is a temporary state, often resolving itself without the need for intervention. However more serious cases, such as permanent hair loss, require some form of treatment.

Treatment for hair loss ranges from vitamin supplements and scalp massage through to electric pulse treatment, infra-red light treatment, hair transplant surgery and, most recently, PRP hair restoration therapy.

Hair loss that occurs due to hereditary reasons is a natural condition which cannot be “cured”. But hair which is lost for any reason other than genetic predisposition needs to be explored further. A first point of call might be a patient’s General Practitioner. For a more in-depth assessment it may be advisable to see a trichologist – a specialist in the hair and scalp.

If a patient’s hair loss is determined to be a form of alopecia such as androgenetic alopecia (pattern baldness) which has occurred as a result of an auto-immune disease or some other cause, then there are a variety of available treatments.

Androgenetic alopecia can be treated either by hair transplant surgery, a wig or toupée or hair restoration treatment.

If the hair loss is caused by hair products such as gels or sprays then it is best to stop using these products until the scalp and hair has had the opportunity to heal and then re-grow.

Hair loss that occurs due to a thyroid condition, infection or anaemia requires further investigation and treatment.

Other causes of hair loss such as stress, medications, chemotherapy or extreme dieting will also require medical help.

Other Medical Treatments for Hair Loss

Medications

Medication is frequently used in the treatment of hair loss and also in its prevention. Indeed it can be very helpful in the early stage of balding. Because medical therapies work to thicken hair in areas that are thinning rather than grow hair once it has been lost, medical treatment is best started as soon as genetic hair loss has been diagnosed.

There are two FDA-approved medications for male pattern baldness: Finasteride and Minoxidil. The oral medication Propecia (containing 1mg finasteride) and the topical medication Rogaine (that contains Minoxidil) are the commercial products. The most effective of the two when used alone is Propecia, but the combination of both Propecia and Rogaine are considered to be particularly effective.

Low-Level Laser Therapy (LLLT)

This is a hair loss treatment based on the principle of photo-biotherapy, and uses laser light to stimulate cellular growth by stimulating hair follicles on the scalp, tesulting in thicker hair shafts and a fuller appearance.

Low-Level Laser Therapy is considered to be most useful in patients with diffuse hair loss – which is typically found in female pattern baldness. As with the drug treatments mentioned above, patients who seem to respond best to LLLT have areas of hair thinning rather than areas of the scalp that are completely bald.

Herbal Hair Loss Treatments

There are several herbs that are claimed to have restorative properties for hair, the most frequently employed being Saw Palmetto. This is a small plant containing oils, fatty acids and sterols. However the precise mechanism by which it works is unknown. Saw Palmetto is used as a herbal treatment for several ailments, and is probably most frequently employed in the treatment of prostate enlargement. However, there have not been any controlled scientific studies to demonstrate definitively that it can indeed restore hair. The same is true of all herbal treatments.

Camouflage Methods

Employing camouflage of a cosmetic variety is a frequently-used way of concealing hair loss and is often used by those whose hair is just starting to thin, particularly on the crown.

Several over-the-counter products are available that can make the hair appear thicker. They include powders, sprays and creams. However they all have the drawback, unless a user has a significant amount of hair to hold the cosmetics in place, of not producing natural-looking results.

Additional to the cosmetic products, there are of course also wigs and toupées which have been used for many years in concealing balding. And more recently, some elaborate hair systems have been developed which are attached either by glue or are sewn into the existing hair. However the problem common to all such devices is that they require frequent adjustment, involving salon visits and not insignificant expense. They are also difficult to clean and frequently give the wearer the appearance of having too much hair.

However, it is important to note that, in spite of there being a very wide variety of readily-available alternative treatments for managing hair loss, the only method that offers permanent results is Hair Transplant Surgery. Although, dependent upon the nature of the hair loss in individual patients, it will sometimes be advantageous to combine FUE surgery with supplementary treatments such as PRP Hair Restoration, Minoxidil and other medical treatments.

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