What to know about hair loss and how it is treated

The most common cause of alopecia, the medical term for hair loss, is hereditary. This condition is known as male pattern baldness (MPB) and female pattern baldness (FPB). Alopecia affects about 35 million men and 21 million women in the United States. More than 40% of men have noticeable hair loss by age 35, and 65% of women experience significant hair loss by age 60.

MPB typically begins at the crown and temples and may progress to near-complete baldness, leaving hair on the sides and back of the scalp, depending on family history. Onset can occur anytime from the 20s through the 70s.

FPB, by contrast, usually appears as an oval-shaped area of thinning in the center of the scalp and may include the hairline.

Hormonal changes are another common factor. In women, menopause, pregnancy, childbirth and thyroid problems may contribute to hair loss. In men, the primary cause is the conversion of testosterone to dihydrotestosterone (DHT).

Certain medical conditions may also lead to alopecia. Alopecia areata causes patchy hair loss and is typically diagnosed with a small scalp biopsy. Other contributing conditions include infections such as ringworm, dermatological disorders and trichotillomania, a psychological condition in which a person pulls out their own hair. Diabetes and autoimmune disorders may also play a role.

Some medications and treatments can contribute to hair loss. Anabolic steroids may elevate DHT levels, leading to permanent hair loss in many cases. Other causes include chemotherapy, general anesthesia and excess thyroid hormone medication. Anorexia nervosa, an eating disorder marked by severe food restriction, is also commonly associated with alopecia.

Stress is another contributing factor. The loss of a loved one or prolonged emotional or physical strain may trigger hair loss.
Hairstyling practices can also have an impact. Styles that place constant tension on the hair, such as braids, pigtails and buns, may lead to traction alopecia, a form of permanent hair loss.

Lifestyle and environmental factors may also contribute. Smoking has been linked to hair loss. Exposure to pollutants, including heavy metals such as mercury and lead, as well as chlorine, smog and smoke, may also play a role.

Treatment should focus on identifying the underlying cause of alopecia.

Topical therapies include minoxidil 5% or Spectral DNC spray for both men and women. Patients often prefer the foam formulation of minoxidil.

Hair growth stimulation treatments may also be used. Platelet-rich plasma, or PRP, has been used in the past. Another option is a growth factor serum applied to the scalp using a sonogram device rather than injections.

Medications may be prescribed in some cases. Finasteride is an oral medication that reduces the conversion of testosterone to DHT. Patients should be fully informed of potential side effects before beginning treatment.

Hair transplantation is another option. The procedure involves moving hair follicles from the back of the scalp to areas of thinning or baldness. Results depend on proper evaluation and the experience and skill of the specialist. When performed correctly, outcomes may appear natural and last for many years. The procedure is typically done under local anesthesia, with or without sedation.

The first step is to consult an experienced physician who specializes in hair loss.

Dr. Ronald Finger, MD, FACS is a board-certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com.