EXPERT GUIDE

Hair Loss Guide (2021)

Medihair Dr. Sternberg Thumb
Medically reviewed by Dr. Sternberg Written by David Stelzer on 7 Dec 2021

Over 80% of men and over 25% of women suffer from hair loss. The majority of those affected suffer from pattern baldness. But what are the causes? And what can be done to fight hair loss?
Use this page to discover the truth behind hair loss and what effective treatment options are available.

What is hair loss?

The majority of people will be affected by hair loss at some point in their lives with the most common cause being  pattern baldness, also known as androgenetic alopecia. It can affect hair all over the body or just on the head.

Older people are most commonly affected by hair loss. It is normal to lose fifty to one hundred hairs a day, which is a manageable, inconspicuous amount when there are over one hundred thousand hairs on the head.

 

Usually, new hair grows back to replace the lost hair, but  this is not always the case. Hair loss can take many different courses. It can occur suddenly or increase slowly over the years.

If you notice that you are losing more hair than usual, you should consult your doctor. They can find the reason behind the hair loss and inform you of potential treatment options.

Generally, hair growth is divided into three phases, the growth phase (anagen phase), the transition phase (catagen phase) and the resting or loss phase (telogen effluvium phase).

The growth phase contains about 85% of all hairs in the head. This phase lasts about two to six years and describes the time in which the hair actively grows, becoming longer and thicker.

The hair undergoes a “rebuilding process” in the transition phase. Here the cell division comes to a standstill and the hair root is no longer supplied with nutrients, so it starts to shrink. This phase usually lasts about two weeks and ends when the root is keratinized and  ready for the final phase, the loss phase. In this phase, the metabolic activity of the hair follicle is stopped, which causes the hair to die and fall out.

This process affects about 8% to 14% of the hair on the head for roughly three months, until the hair matrix forms new hair. The hair then falls out because the regrowing hair pushes the old hair out of the follicle. The hair cycle starts again with the growth phase.

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What are the causes of hair loss?

Male patten hair loss

Hereditary hair loss, also called androgenetic alopecia and male pattern hair loss, is one of the most common forms of hair loss in men. Also known as hereditary or hormonal hair loss, it is usually a gradual process.

The risk increases with age, so that by the age of 70, nearly 80% of men are affected. The predisposition is inherited from both parents, although the influence of the maternal side is probably stronger.

This form of hair loss can be characterized by the thinning hair in the forehead area initially with a receding hairline. The hairline will then continue to recede, leaving behind large bald spots on either side of the forehead.

Further along in the course of this disease, the hair at the back of the head (crown) also becomes visibly thinner, so that the affected areas slowly spread over the years. In addition, a tonsure, a bald spot on the crown of the head, can develop. The degree of male pattern hair loss is typically described by the norwood scale. According to our hair transplant study most of the patients have a medium hair loss degree (NW4)

One of the most common causes is a predisposition to hypersensitivity of the hair follicles. These react sensitively to the breakdown product of the male hormone testosterone DHT (5-alpha-dihydrotestosterone).

Most common prescribed hair loss treatments

Female pattern baldness

Hereditary hair loss, also known as androgenetic alopecia, can occur in women as well.

Even though women are less affected, this form of hair loss is still widespread. Currently 21 million women in the US and 8 million women in the UK suffer from some form of hair loss. In women, the hair at the crown of the head becomes thinner and lighter.

From the age of 30,  congenital hair loss in women can begin insidiously. However, the thinning of hair is most often noticed during menopause.The hair roots are inherently sensitive and react to the hormonal changes that occur during menopause.

Especially in the hair part, the scalp becomes more visible,though complete baldness in women is rather unlikely and very rare. In the case of hair loss caused by androgenetic alopecia, the usual remedies such as shampoo or a change in diet unfortunately cannot help.

Typical female pattern hair loss: The ludwig scale.

 

Alopecia Areata

Circular hair loss, also known as alopecia areata, is one of the most common inflammatory hair loss diseases.This form of hair loss often occurs in episodes and displayssymptoms such as pain in the affected area or itching.

The causes of alopecia areata have not yet been fully realized. There is neither an age-related nor a gender-specific correlation, it can affect anyone, whether young or old,  man or woman.

However, there are some known factors which have relevance in the development of the disease. First and foremost, among these is a disorder of the immune system.

Consequently, a local inflammatory reaction occurs, which limits hair growth and leads to hair loss. The bald, round spots are mostly found on the head, but can also occur in other parts of the body such as eyebrows or beard.

Genetic predisposition also plays a role in the course of the disease. Circular hair loss  occurs more frequently in families.

In addition, this form of hair loss can, in some cases, also be attributed to high levels of stress. For example, circular hair loss can occur  after accidents or bereavements.This form of hair loss is also the result of malnutrition or harmful environmental influences.

The most severe form of circular hair loss can affect the whole body and is also known as ‘Alopecia areata universalis’.

 

Diffuse hair loss

Diffuse hair loss does not affect a specific area of the head, but thins the hair altogether. It is usually only noticed by those affected roughly four months after the causative event.

Usually, the increased hair loss is finally noticed when combing or washing the hair and the scalp becomes more visible through the thinning hair.

This form of increased hair loss can have several, very different causes. These can range from illnesses such as malfunctioning of the thyroid gland, infectious diseases, a diet with vitamin deficiency, to acute stress situations, hormonal changes or taking medication.

The following causes can play a role in diffuse hair loss:

 

Diseases

The following diseases can lead to diffuse hair loss:

  • Disturbed thyroid gland function such as hypothyroidism or – Overactive thyroid
  • Infectious Diseases
  • Venereal diseases like syphilis (lues)
  • Chronic intestinal diseases like ulcerative colitis and Crohn’s disease
  • Cancer diseases
  • Eating disorders like bulimia and anorexia
  • Diabetes mellitus
  • Systemic lupus erythematosus (SLE)

 

Drugs

Taking the following medications can lead to diffuse hair loss:

  • Chemotherapy with cytostatic drugs
  • Painkillers (analgesics)
  • ACE inhibitors and beta blockers e.g. for high blood pressure
  • Lipid reducers
  • Retinoids
  • Thyroid medication
  • Heparin (blood thinner)
  • Antibiotics

 

Radiotherapy and radiation accidents

Diffuse hair loss can be caused by radiotherapy or radiation accidents.

  • Hair loss is caused by ionizing radiation (3.8 Gray).
  • After about two months, the hair usually grows back.
  • A radiation dose above 8 Gray can lead to permanent hair loss.

 

External circumstances

Diffuse hair loss can be caused by external circumstances.

  • Extraordinary stress
  • Surgery, general anesthesia

 

Hormonal changes

Diffuse hair loss can be related to hormonal changes.

  • Develops in some women about two to four months after the birth of a child. The reason for this is an estrogen deficiency, as the concentration of this hormone drops after delivery, and excess hair produced during pregnancy falls out. Stress during childbirth can also promote hair loss.
  • Taking or discontinuing medication for contraception (e.g. the pill)

Menopause, particularly in the beginning

 

Nutrition

Malnutrition can lead to diffuse hair loss.

  • One-sided, unhealthy nutrition
  • Radical diets
  • protein or iron deficiency
  • vitamin, biotin or zinc deficiency, occurs rather rarely
svg Important!

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Hair Loss Myths

However, there are several factors that are wrongly considered to be the cause of hair loss, but do not cause it:

  • Shampooing hair: Frequent washing and shampooing does not lead to increased hair loss.
  • Wearing hats: Wearing hats or caps does not promote hair loss.
  • Sun exposure: Increased sun exposure does not cause hair loss.
  • Masturbation: Masturbation is also not associated with hair loss.
  • High testosterone levels: A naturally high testosterone level does not cause increased hair loss.
  • Mother’s genetic material: The mother’s genetic makeup is not exclusively responsible for hair loss.

How is hair loss diagnosed?

Most of the time, a patient with suspected hair loss goes to a dermatologist. The dermatologist can then use various methods to determine the cause and form of hair loss.

While a trichogram or trichoscan is sufficient to diagnose androgenetic hair loss, other forms of hair loss can be more difficult to diagnose and find the cause. In most cases, blood tests and detailed anamnesis interviews are used.

 

Visual diagnosis

A visual diagnosis can be made by the doctor using various methods. One is hair parting, where the hair is examined under a bright lamp and the hair structure, hair density and scalp are observed. Depending on the type of hair loss or scalp disease, it may also be necessary to examine body hair.

Another way to visually diagnose hair loss is the hair rubbing test, where the doctor rubs some hair between his fingers. In this way, he can determine whether the hair is brittle or whether there is damage to the hair structure.

If this is the case, further examination methods are carried out, as this test cannot determine the cause of hair loss. Also, by roaming through the hair, it can be determined whether there is increased hair in the resting phase, so-called ‘telogen hair’.

In this case, the doctor grasps the patient’s hair with spread fingers and slowly pulls the fingers in the direction of hair growth. If more than ten hairs remain in the fingers, this can be an indication of increased hair loss.

Hair loss symptoms

Blood test

Since drugs, certain diseases or deficiencies can be the cause of hair loss, blood testing is another way to diagnose hair loss.  The doctor takes blood samples to check, for example, thyroid or iron levels. Once the findings are available, such diseases or deficiencies can be treated..

 

Plucking test (epilation test)

In the plucking test or epilation test, you grab a tuft of hairs at different parts of the head with your hand and try to pull them out with a gentle jerk.

If several hairs can be pulled out painlessly in this way at different places repeatedly, this indicates pathological hair loss. Depending on how easily the hairs are pulled out of the scalp, the severity of the hair loss can be determined.

The cause of hair loss, however, cannot be determined with this method. This test only serves to roughly estimate the extent of hair loss. A doctor will then perform further tests to make a final diagnosis.

 

Microscope

Microscopic hair analysis, or trichogram, is an examination of the hair root. Here, hairs are taken from the patient to determine their condition and the current phase of development microscopically.

The hair roots and hair shafts are subjected to microscopic examination and are plucked or epilated together with the root. For this method, the doctor removes about 50 hairs from the patient’s head and examines their condition and stage of development.

Finally, the trichograms of the different areas of the head are compared and evaluated, paying particular attention to pathological changes in the hair roots. Based on the findings, the doctor can determine whether androgenetic alopecia is present. If this is the case, there will be considerably less hair in the growth phase, whith about 50% of the hairs in the resting phase. This phase precedes the imminent death or loss of hair.

The trichogram method for diagnosing hair loss is used mainly to predict the expected hair loss. It shows episodic progressions, which is typical in the case of androgenetic alopecia.

For women it can also reflect fluctuations in the hormone balance.

 

Phototrichogram

This method requires shaving a round area of 2 cm in diameter to a length of 1 cm, because of this it is mainly used for research purposes.

The shaved area is then photographed and then all hairs are shaved to scalp level and the area is photographed again. After three days, the selected area is photographed one last time and the images are evaluated.

The hairs that are in the growth phase should now be 1 mm long. With direct comparison, the percentage distribution of hair in the growth and resting phase can be determined.

 

Trichoscan

The Trichoscan is a digital hair scan that provides a snapshot of the current hair situation. This digital procedure is one of the most modern methods of diagnosis and therefore also very expensive. However, this method also has its advantages, with the treatment being completely painless.

This photographic and computer-assisted method measures the condition of the remaining hair roots and the ratio of terminal and vellus hair. The proportions of anagen and telogen hair are determined based on the growth behavior of the two hair types. The Trichoscan provides the hair density and the proportions of terminal and vellus hair as additional measurement parameters.

For this method, the hair is shaved using a template and the next day the slightly regrown hair is dyed black for better visibility. A digital microscope camera produces a twentyfold magnified image of the shaved area, which is automatically evaluated by a special software. The total number of head hairs and the number of anagen hairs is determined.

The anagen hairs can be recognized by the fact that they have grown slightly since shaving.

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Treatment options

Which treatments and remedies actually help fight  hair loss? You can stop or even reverse hair loss with aggressive treatment, especially if it is caused by an underlying disease. Hereditary hair loss can be more difficult to treat. However, certain procedures such as hair transplants can help to revise the hair loss. In the following, we will show you different therapies for hair loss and analyze their effectiveness:

Adjust lifestyle

  • Hair loss risk can be reduced by a few specific nutritional measures.
  • Increase exercise
  • Avoid stressMediterranean diet with a lot of vegetables, fish, nuts and olive oil is especially effective.
  • Stop smoking
  • Reduce weight.
  • Hair consists of Keratin, which builds up to a large extent from protein thus additional protein can help prevent hair loss.
  • Include protein-containing foods in your diet. Vegetable protein (from potatoes, cereals, soya) is biologically more valuable than animal protein (from meat, eggs, cheese).
  • Vitamin A (spinach, butter, carrots, broccoli) can promote hair growth.

Active ingredients such as Baicapil can also promote hair growth.

Food supplements

  • In general, it can’t hurt in the fight against hair loss to take multivitamin supplements. These supplement the vitamin balance with many vitamins such as A, B1, B12, C and D3, as well as trace elements and minerals.
  • A lack of vitamin D can interrupt the hair cycle and promote hair loss. If one cannot produce enough vitamin D from exposure to sunlight, they should use appropriate dietary supplements. In a 2018 study, vitamin D was found to be associated with androgenetic alopecia. The treatment of deficiencies can help with hair regrowth. Talk to your doctor about taking 800 to 1000 I. U. daily.
  • Biotin, also known as vitamin B7 or vitamin H, is important for metabolism and strengthens both hair and nails. Dietary supplements provide hair and nails with all the important nutrients such as zinc, which make it fuller and stronger. And give the hair a healthy shine.
  • Zinc keeps the scalp healthy and inhibits the conversion of the male sexual hormone testosterone into dihydrotestosterone. It acts as a natural DHT blocker, the substance that causes the hair follicles to atrophy in hereditary hair loss.
  • The success of preparations made from the fruit of the saw palmetto is comparable to that of the drug Finasteride 5mg. Saw palmetto extract seems to be able to lower the DHT level, which increases the testosterone level. In addition, and to enhance the effect of the saw palmetto extract, broccoli and pumpkin seed oil can be added to the diet.
  • Ginseng is considered a rejuvenating treatment and a nutrient for the hair. Applied externally, the nutrients reach from the scalp via the hair root to the tips of the hair. When taken as a dietary supplement, it has the same effect. Caffeine has also been known to help enhance the effects of ginseng.
Summary

In the fight against hair loss, the effect of dietary supplements has not been scientifically proven so far. Whether these preparations actually help is therefore questionable. Nevertheless, it cannot harm the body and the immune system to take additional supplements.

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Hair Care

  • There are shampoos specially designed for hair loss, such as Alpecin, but gentle baby shampoos can also have a helpful effect. If you have oily hair, you should try to wash your hair less often. Regular washing should therefore be done gently. In general, after washing, you should make sure that you only dab your hair dry with a towel and avoid rubbing it heavily.
  • Many styling products are also responsible for hair loss. For example, color products, bleaching, hair spray and hair extensions or the regular use of straightening iron and hair dryer can promote hair loss. If you decide to continue hair styling with heated appliances such as straightening irons or curling irons, you should make sure that the temperature is kept low and the hair is completely dry.
  • Natural oils like coconut oil or olive oil have a stimulating effect on the follicles and can be massaged into the scalp for this purpose. The oils should be left in to work overnight and wash them out gently the next morning. According to a 2018 review of studies, researchers believe that coconut oil can help prevent hair damage caused by improper grooming and UV light (UV) exposure. Head massages in general are also beneficial and promote blood circulation to the scalp. A 2016 study showed  positive results from participants with only four minutes of massage a day for 24 weeks.
  • Alfatradiol hair lotions can help decrease the anagen hair rate. The active ingredient alfatradiol protects the hair roots and can be applied to wet or dry hair.
Summary

Pure hair care is not enough to prevent hair loss. These methods protect and care for the hair but they only have a limited influence on hair growth. If the hair loss is hereditary, the only treatments that will be effective are medical.

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Hiding or Embracing Hair Loss

Some individuals choose to attempt to hide their hair loss with the use of a wig, toupee, extensions, or a comb-over. These methods are only successful for a short time and as hair loss increases these become less effective. Celebrities like Donald Trump and Nicholas Cage style their hair with a comb-over to hide their hair loss.

Another alternative is to embrace the hair loss, this is often done by shaving one’s head. This method is more popular amongst men as hair is often seen as a symbol of feminism. Celebrities like Michael Jordan, Dwayne Johnson, and Ben Kingsley have all shaved their heads as a way of embracing their hair loss.

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Medical treatments

  • Gentle laser therapy can help to improve hair density in people with genetic hair loss or patients undergoing chemotherapy. This method is also called red light therapy and promotes the stimulation of stem cells. The use of home laser equipment can take several treatments to show results.
  • The over-the-counter drug Minoxidil, also known as Regaine, is effective in about two-thirds of subjects, according to the Mayo Clinic. The liquid or foam should be applied to your scalp daily. The more common side effects include scalp irritation and acne, which can manifest themselves in the application area. Rarely occurring side effects are an irregular heartbeat and blurred vision.
  • Prescription finasteride, also known as Propecia, can slow down hair loss and even promote new hair growth. According to the Mayo Clinic, it works best in men under 60 years of age. Women who are or may be pregnant should avoid taking this medication or coming into contact with it.

How do minoxidil and finasteride work?

  • Micro needling is a facial treatment that has become increasingly popular. The skin reacts to the so called ”micro injuries” caused by the fine needles.The process works relatively similar with hair loss therapy: the body’s healing reaction is activated and hair production is stimulated by rolling needles over the scalp. In this way, micro-needling stimulates the production of proteins in the skin cells, which are responsible for the development of a new hair follicle. After about four to six treatments, the hair grows back again.
  • The injection of platelet-rich plasma (PRP) into the scalp promotes growth in areas already affected by hair loss. Blood is passed through a centrifuge to separate the platelets and then injected into the scalp. In a 2017 study, 11 participants experienced 30 percent more growth in thinning areas after four sessions. Each session costs between $500 and $1000, according to the Cleveland Clinic, and is not covered by insurance.
  • Mesotherapy can be used for all types of hair loss regardless of the cause. This form of treatment can help hair regrow when the respective hair roots have not yet died. The solution consists of natural active ingredients and is usually well tolerated. However, caution is advised for people with severe allergies.
  • As a measure against progressive hair loss, the intake of so-called antiandrogens or estrogens can be useful. As with all hormone therapies, the side effects of antiandrogens can also be considerable, so consultation with the doctor is necessary.
  • Hair transplantation describes the transfer of hair to bald areas of your scalp. This works well for people with genetic hair loss. With hair transplantation a lasting result can be achieved without side effects. The costs for a hair transplantation are between 2.000 USD and 15.000 USD, depending on the clinic and the degree of hair loss. One of the most popular countries for a hair transplant is turkey because of the low prices.

Number of hair transplants worldwide

Summary

The medical treatments for hair loss are the most effective in preventing further loss or for regrowing hair in balding areas. They can be very helpful, but are also associated with high costs and sometimes side effects. The most effective and scientifically most accepted hair loss treatments are minoxidil, finasteride and hair transplants.

Frequently Asked Questions

Can you stop male pattern baldness?

What is the most effective remedy for hair loss?

What helps with female hair loss?

What causes male baldness?

What is the cause of hair loss in women?

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