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50 most frequently asked questions about hair loss / Baldness / alopecia areata

1 – What causes hair loss?
Hair loss which is technically known as alopecia, is not due to one single cause. Our scalp has some 100,000 hair, of which 80,000 are in the growing phase, while 20,000 inactive hair can be said to have gone in the sleeping phase. It is normal to lose roughly a 100 hair every day. Such a loss will not affect the total number of hair. Shaving and menstruation do not have any effects on hair growth. One can lose hair due to a number of causes, of which androgenic alopecia or male pattern baldness is by far the commonest. Alopecia areata is however not uncommon at all. Male pattern baldness usually starts in the 3rd to 4th decades of life, and mainly affects the top of the head and the temples, with the effect that the hair line starts receding gradually. The exact mechanism of this hair loss in not known, but it is fairly certain that there is a strong association between high levels of male hormones and this type of baldness. Excess of male hormone can cause a similar type of baldness in women as well.
2 – Is stress a factor in hair loss?
Any direct relationship between stress and permanent hair loss has not been established to date. Stress can however cause temporary hair loss as seen after pregnancy, which is short lived. It is also presumed that stress can aggravate an existing alopecia.
3 – What is DHT and how is it involved in hair loss?
DHT or dihydrotestosterone is the active form of testosterone. Scientific evidence suggests that high levels of DHT are responsible for baldness in genetically influenced people. Ministered, one of the pharmaceutical agent used for treating baldness, basically acts through interfering with the action of DHT.
4 – What is the relationship between genetics and hair loss?
Genetic predisposition certainly plays an important role in baldness but it is not the primary cause of male pattern baldness. The genetic effect is moreover not simple. Multiple genes are involved and it is difficult to predict whether the offspring of a bald parent would inherit this problem or not.
5 – Can hair loss occur in young adults?
Male pattern baldness usually starts in the twenties and thirties, but it has been seen as early as 15. If older blood relations in the family have had an early onset of baldness, risk for the younger members is substantially increased. Alopecia areata and stress induced hair loss (telogen effluvium) can however occur even in the first year of age.
6 – What can be the cause of a sudden loss of a large mass of hair?
A sudden but temporary loss of large mass of hair is possible, and usually occurs when the ratio between resting and the growing hair is drastically disturbed and a large volume of growing hair shift to the sleeping phase, and start falling. It is usually results from severe physical or emotional stress like pregnancy, extreme weight gain or loss, illnesses like high fever, and the use of certain drugs. Such hair loss is usually temporary, but medical advice should certainly be sought.
7 – Do shampoos and other hair products cause hair loss?
Good shampoos are usually safe, but an allergic reaction against any of the constituents different hair cosmetics and products is always possible. Hair products made from strong and poor quality chemicals in the form of caustic hair dyes and straighteners can damage the skin and secondarily affect hair health.
8 – Can my hairstyle cause my hair to fall out?
A hair style which exerts a strong, sustained and a repetitive pull at the hair bases can lead to hair loss because of traction. Tight braids and pull backs are typical examples. It is important to understand that hair loss due to this kind of traction has very little possibility of re-growth.
9 – How does minoxidil work?
Minoxidil (Rogaine) was basically developed and used as a strong medicine for lowering the blood pressure. It was however noted that bald patients on this medicine, experienced significant hair re-growth. It was later found that the beneficial effect on baldness could also be achieved with local application to the scalp, but no effect on the blood pressure. The exact mechanism of this action is not clearly understood, but it is generally believed that it is due to dilatation of the blood vessels in the scalp which results in improved blood supply and better nutrition of hair follicles. That is why minoxidil only preserves the existing hair. The beneficial effect of minoxidil on hair loss is however temporary and hair start falling again when the application is stopped.
10 – Are high-strength minoxidil formulas better than lower-strength ones?
Minoxidil is available in two strengths, 2% and the 5% sprays. The 5% is believed to be more effective than the 2% solution. Many doctors prefer not to give the 5% solution to the women to fear of hair growth on thee sides of the face. There are others however who do not hesitate in prescribing it to the women as well although with caution.
11 – When should I consider surgery to treat hair loss?
The decision to go for hair transplant surgery should be taken in consultation with a hair transplant surgeon and can be taken at any time. The success of a prospective hair transplant will depend on numerous factors which include the thickness of hair in the donor area, health of the scalp and of course the surgical skill and experience of the surgical team. It may not be very effective for those have lost almost all the scalp hair.
12 – How effective is hair transplantation?
Hair transplantation is an outdoor surgical procedure in which hair from back of the scalp are surgically transplanted to the bald area. The procedure may involve transfer of single hair shafts as well as micro-grafts of skin containing small bunches of numerous shafts. It is a highly effective treatment for male pattern baldness as well as camouflage of the hairless scars. Hair transplant can be effective on hair bearing areas other than scalp as well, the best example being eye brows. The best thing about this treatment is that it is a permanent remedy. Hair transplant affords better results in women because their hair loss is more diffuse and it is easier to give full coverage to the affected areas.
13- Is there any way to protect my hair before I lose it?
You can expect good results from using shampoos made especially for dry and damaged hair, along with a cream rinse. The Following can also be helpful
Start using a comb and brush which has wide teeth and preferably ball end bristles
Strop using chemical hair dyes or perms
Avoid using things that stress and exert a pull on your hair like curlers, pony tail elastics or fasteners, hot rollers or bobby pins
You shall do yourself a favor if you stop using a hair drier and use a towel instead. If you must however use a drier, keep it on the low setting and blow your hair from a farther distance.
A cotton stretch cap can be worn at bed time to slow down stress to the hair and catch the loose hair.
You should seek the advice of your medical advisor before changing your hair cosmetics.
14 – What about the hair on my body?
Male pattern baldness which is by far the commonest of all, does not usually cause hairloss from places other than the scalp. Other diseases may however result in hair loss from odd places, of which loss of eyebrows is the most unsightly, and can usually be managed well with camouflage or hair transplant if necessary.
15 – How do I care for my skin I am bald?
The hairless skin of the scalp is more exposed to the environmental stresses and insults, which need to be guarded. You can use mild and moisturizing soaps, and apply a body cream at night. You’ll find the following tips very helpful as well.
If you are not using a camouflage for the bald area, it must be protected by a good and potent sunscreen. A daytime moisturizer or a hat or cloth cover may also very effective.
Always consult a health care professional before using a new hair product.
16 – What is hair growth cycle?
Our hair of the scalp keep cycling through a repititive cycle of three phases. The longest of all phases is the growing phase and roughly 90% of our hair are in this phase. This phase lasts from 2-5 years and longer this phase lasts in you case, the longer are you hair, because they have a longer period to grow. The second is the phase of transition which lasts less than 2 weeks in which the root shrinks and shortens. Only 1 % of the hair are in this phase at any given time. Transition ends with the resting phase, which ends the hair growth and some 10% of pour hair are in this phase at any given time. This phase lasts for about quarter of a year. Since all the hair of our scalp are not in the same phase, it is normal for some of the hair to fall everyday.
17 – Why do women lose hair?
Women can lose hair because on many causes, but the most common of all is the androgenic (male pattern) baldness. It usually starts at the top and is more diffuse than in men. It starts usually in the thirties but early cases may report in twenties as well. The hair loss usually becomes noticeable in forties and may even continue beyond menopause. It is presumed to be due to a combination of heredity, aging and an excess of male hormones which leads to thinning and weakening of the hair follicle and eventual loss of the shaft. Other cause of hairloss may also be operative in women like pregnancy, stress and alopecia areata etc, and it is wise to assess every case on individual basis.
18 – Does Wearing a hat causes hair loss?
There is basically nothing wrong with wearing a hat, but it can harm the hair indirectly at times. Tight and ill fitting hats can not only compromise the blood supply to the hair follicles but can cause physical damage to the hair in the form of friction and traction. Accumulation of sweat, sebum and inspissated dirt in the scalp can sometime ad injury to the insult.
19-Who is most likely to have hair loss?
Hairloss and baldness are fairly common problems and the risk depends on your family history along with racial ethnic and local unidentified factors. It would be best to inquire the local incidence of baldness form your health care provider.
20-Is my hair loss a symptom of a more serious disease?
Common forms of alopecia (hairloss) like androgenic hairloss and alopecia areata, do not cause any physical damage or pain. The suffering is usually psychological and emotional which may be worse than the physical pain. In Alopecia Universalis however, the fall of eye-lashes, hair from the nostrils and the ears may predispose the individual to unguarded access of dust foreign bodies and germs.
21-will my children be affected by hairloss as well?
The answer is yes and no at the same time. The common forms of alopecia (hairloss) like androgenic hairloss and the alopecia areata have a genetic component, but it is not simple inheritance. The children have a higher than usual chance of being affected, but it is not a certainty. Genetics only predisposes you (or your children) to baldness, but some environmental factor may be required to trigger the process.
22-Will my hair ever grow back?
Re-growth of hair is always a possibility in most of the cases. It varies however from cause to cause and person to person. The hair may start regrowing at an early stage or the good new may come very late. They may even start falling again after an initial regrowth. It is also may happen in some individuals that the hair are fallinh in one place and coming back in the other areas. At best, we can summarise by saying that regrowth is a definite possibility but it is highly unpredictable.
23-Should we expect a hairloss cure in near future?
It is difficult to predict how far is the cure, but advances are being rapidly made in all aspects of the disease, from understanding of the basic process to the treatment for permanent cure. A few interesting horizons of research are
Many new medications which are effective in psoriasis may also be useful in alopecia areata. Similarly new agents for some autoimmune disorders like rheumatoid arthritis and lupus may also be helpful in alopecia areata.
New methods of administering the treatment are also being developed in which it is hoped that we shall be able to deliver the medicine directly to the hair follicle
24-How quickly does hair go once it begins?
It depends on many factors. Hair loss starting at an early age may persue a rapid and aggressive course. Similarly poor care can also expedite the fall of hair.
25-How quickly does hair go once it begins?
It depends on many factors. Hair loss starting at an early age may persue a rapid and aggressive course. Similarly poor care can also expedite the fall of hair.
26-I’m 38 and havent lost my hair yet – am i safe?
You are relatively safe but not immune. In fact the incidence of hair loss rises with age in men and nore than 60% of the men have partial or complete baldness when they cross 60th birthday!
27-Whats the best way to style thinning hair?
If your hair is short, it conveys the impression of a thicker growth. You can also try a French crop to cover the balding forehead, in which the hair is brushed forwards. You can also part your hair creatively to camouflage the balding area.
28-Why does hair loss and baldness increases the risk of heart attack?
Hairloss (balding) has been shown to be directly related to the risk of heart disease in a research on 22000 subjects (1989-2000 Harvard & Brigham study). The increase in risk may be anywhere between 9 and 36 % in proportion to the severity of hair loss. The male hormones testosterone and DHT have been incriminated in this regard. Their contribution is considered to be more in case of men and relatively less in women. It may however be interesting to note that balding individuals may not necessarily have higher levels of male hormones. It is believed that these individuals have a larger number of receptors for these hormones.
29-Is there a minimum age for hair loss surgery?
There is no specific age for baldness to come, and similarly no age limits for treatment. Most of the people however who have hair transplant surgeries range from 20 -80. If you are balding at an earlier age it is better to address the matter as early as possible. It has a double advantage. With a healthy bulk of normal hair, your surgeon has more options for donor sites, and secondarily you do not go very bald at any stage. You have a relatively presentable appearance throughout. Then why wait to treat while there is little hope for spontaneousreversal?
30-Won’t bare scalp be showing in the back of my head once the donor hair is taken?
Not at all! The scalp is very elastic and the gap is filled by pulling in of the scalp skin from surrounding areas. If at all there is any scarring, it is covered under the hair. The success of hair transplant surgery lies in the fact that its traces are completes camouflaged.
31-Does Hair Transplantation hurt?
Hair transplant surgery is a very well tolerated procedure. Although it is customary to offer painkillers in the forst week but very few people will require it after the first 1-2 days.
32-How long will it take to recover?
Hair transplant surgery is a totally out patients procedure and majority of the people will not find it hindering their daily routines after a few days. The total period of convalescence will however depend upon variables like the type and level of activity of the patient and of course also on the type of surgery as well.
33-Can nutrition help in hair loss?
Response to nutritional therapy in hair loss is better in women than in their male counterpart. A high protein diet (70-80 grams / day) may help women to manage the loss of their hair. It generally means they have to take a lot of meat. Vegetarians can however use protein pills and capsules. The following nutritional considerations may also be helpful Zinc deficiency is one of the common nutritional abnormality found in balding people and can be rectified easily by regular intake of a multi-mineral food supplement. The response however in sot visible overnight. You may have to wait for months before you start seeing your hair healthier than before. If you have lost your hair because of stress, the relief of stress and some exercise should be the first remedy. It may however be supplemented by vitamin C and, pantothenic acid.
34-What is Androgenetic Alopecia or AGA?
Androgenetic alopecia or AGA is the most common cause of hair loss in adults in general and men in specific. The hair loss is due to a genetic predisposition and excessive action of male hormones (androgens). The Pattern of hair loss is quite specific ( measured by Norwood Scale and the Ludwig Scale) in which the hair are lost from the temporal, frontal, vertex and crown areas. This leaves a frill of hair on the back and the sides of the head. This kind of baldness is more common in men but women are not immune.
35-Can my diet cause hair loss?
There is no evidence to suggest that any specific nutritional ingredient can lead to hair loss directly. Malnutrition and deficiency of vitamins and minerals can however be associated with baldness. There are some authorities who believe hair loss can be precipitated / aggravated by high levels of cholesterol and sugar in people who are genetically predisposed to androgenetic alopecia. They should hence avoid foods that can cause the sugar and cholesterol to rise in their blood.
36-What are the types of hair loss?
Hair loss is not a single entity. It is a group of disorders with a common manifestation in the form of hairloss ( baldness). These types include
Androgenetic alopecia or male pattern baldness is the commonest type hairloss, which is commonly seen in men but not uncommon in women as well. It results from a genetic predisposition which is precipitated by the excessive action of male hormones (androgens)
Alopecia areata, which is a well circumscribed hairloss in the form of single or multiple, non-scarring patches of hair loss. It is currently believed to be due to autoimmunity.
Telogen effluvium, is temporary loss of large masses of hair due to derangement of the hair growth cycle. The hair prematurely enter resting phase (telogen) in this condition.
Traction alopecia, is a hair loss due to sustained pull on the hair, and generally results from poor hair-styling practices.
Anagen effluvium is sudden hair loss of large masses of hair, generally as a side effect of chemotherapy.
Scarring alopecia is the hair loss associated with mechanical damage to the hair follicles due to scarring of inflammatory lesions like burns infections and trauma.
37-How widespread is male pattern hair loss?
Approximately 50% of all men will have male pattern hair loss at some stage in their lives. The Incidence may vary in different geographic units, probably due to differences in genetic background of these units. Caucasian males for example are affected in higher proportions than the Japanese and the Chinese men.
38-Is hair loss just a cosmetic issue?
Male pattern baldness (hairloss) can have profound impact on the psychosocial wellbeing of the affected individual. Younger the age at onset, greater is the impact. Some European studies have shown that baldness (hairloss) can be lead to loss of self-esteem, feelings of unattractiveness, introversion, and depression. Attitudes in the western societies may be even more depressing for balding people, where it may be difficult for them to find partners and jobs involving personal interaction with customers and clients.
39-What is the hair atonmy
The hair consists of two main components, the follicle and the shaft. Follicle:- hair follicle is that part of the skin which forms the hair. It is made up of several layers of skin , each with a distinct function. Each hair follicle has a papilla at the bottom which supplies nutrients through blood circulation to the hair. Cells in the follicle divide at a very rapid rate and lead to growth in the hair length. Each hair follicle has a sebaceous gland attached to it. Shaft: – The visible hair is the shaft, which is the dead portion of the hair. It is mainly composed of keratin which is a hard protein. The shaft is composed of three layers. Innermost layer is called medulla and not present in all phases of hair cycle. It is surrounded by a cortical layer which makes the major bulk of the hair. Cuticle is the outermost layer which covers the cortex. This cuticle is made is compacted scales. The pigment cells which give your hair a peculiar color are found in the cortex.