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Hair Loss: Patterns and Causes in Men and Women

Hair Loss: Patterns and Causes in Men and Women

Hair loss in adult male and female is not uncommon. Adults lose about 10,000 scalp hairs each and every day. Hair normally lives for around five years. Male and female baldness happen when these hairs do not always get replaced (which they normally would) and gradually bald areas appear. There are a lot of hair loss treatments as well as hair loss remedies in the market today. But how effective are they? Let's have a post mortem of the causes of hair loss and the hair loss treatment available today and find out which products or treatments suit you the most.

The Normal Cycle of Hair Growth and Loss

The normal hair cycle growth lasts between 2 to 6 years. Each hair strand grows at the rate of approximately 1 centimeter per month during this phase. As a matter of fact, about 90 percent of the hair on your scalp is in the active growing phase while the rest 10% is in dormant phase. Once a hair strand enters a dormant phase (hair stop growing), it will stay on the scalp for 2 to 3 months, then fall out. It is normal to shed some hair each day (average of 100 strands) as part of this cycle. However, some people may experience excessive (more than normal) hair loss. Hair loss of this type can affect both men and women and even children. 

Causes of Hair Loss

Illness

A number of things can cause excessive hair loss. For example, about 3 or 4 months after an illness or a major surgery, you may suddenly lose a large amount of hair. This hair loss is related to the stress of the illness and is temporary. Hormonal problems may cause hair loss, which more often than not, caused by stress. If your thyroid gland is overactive or underactive, your hair may fall out. Certain infections can cause hair loss. Fungal infections of the scalp can cause hair loss in children. Finally, hair loss may occur as part of an underlying disease, such as lupus or diabetes. 

Scalp Cleanliness

If you have dandruff, you need to get rid of it. Dandruff can be a source of hair loss when it combines with dirt, shampoo chemicals, and excess sebum follicle oil. Over time this combination of chemicals can create a film on your scalp that hardens and start to plug up your hair follicles. Once plugged, your follicles can't support hair growth. 

DHT (di-hydro-testosterone)

When excessive amounts of testosterone are converted to DHT by the enzyme 5-alpha reductase, this DHT accumulates at the hair root where it blocks blood circulation to that hair follicle. This decrease in blood to the hair root weakens it and it loses its health. 

Male Pattern Baldness

The male pattern baldness form of androgenetic alopecia  (inherited hair loss pattern) accounts for more than 95% of hair loss in men. By age 35, two-thirds of men will have some degree of appreciable hair loss and by age 50 approximately 85% of men have significantly thinning hair. About 25% of men who suffer from male pattern baldness begin the painful process before they reach 21. In male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head. Most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of their life. It affects interpersonal relationships as well as their professional life. It is not uncommon for men to change their career paths because of hair loss. 

The Causes of Male Pattern Baldness

Most men are genetically predisposed to male pattern baldness. It is the effect of hormones on the hair follicle that produces male pattern baldness. Testosterone, a hormone that is present in high levels in males after puberty, is converted to dihydrotestosterone (DHT) by an enzyme called 5-alpha reductase. DHT has an adverse affect on the hair follicles. Acting on a hormone receptor on the hair follicle it slows down hair production and produces weak, shorter hair, sometimes it stops hair growth from the follicle completely. This process gradually depletes your stock of hair and is normal hair loss. 

Female Pattern Baldness

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. 

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.  

The Causes of Female Pattern Baldness

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. 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 or suitable hair treatment products. 

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.

 

Non-Pattern Causes of Hair Loss in Women

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 due to this cause cannot be treated effectively until the psychological or emotional reasons for trichotillomania are effectively addressed. 

Alopecia areata— a possibly autoimmune disorder that causes patchy hair loss 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 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 or "corn-rowing" of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring. 

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 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. 

There are various hair loss products as well as hair loss treatments available in the market. It is recommended that users should conduct due diligence to identify which product suit them most, in order to stop hair loss and hair thinning.

References:

Olsen EA (ed). Female Pattern Hair loss: Clinical Features and Potential Hormonal Factors. J Amer Acad Dermatol 2001; 45:S-70-S80.

Olsen EA. Hair disorders. In: Freedberg IM et al (eds.) Fitzpatrick’s Dermatology in General Medicine, 5th ed. New York: McGraw-Hill, 1999:729-751.

International Society of Hair Restoration Surgery

 

About the Author

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