What Is Hair Loss?

Overview

Although losing your hair is typically not a sign of illness, and it is not a point of concern, it can be upsetting. However, there are medications that can promote hair growth or stop future baldness.

Alopecia, also called hair loss, can affect the scalp or the entire body. The condition can be either short- or long-lasting. It could be inherited, associated with hormonal changes, a consequence of medical issues, or a normal aspect of ageing. Anyone can lose hair on their head, but it is more prevalent amongst people assigned male at birth (AMAB).

People with AMAB and people assigned female at birth (AFAB) can face significant gradual hair loss. Androgenic alopecia is the term used to describe the most typical kind of hair loss. ''Male pattern hair loss'' and ''Female pattern hair loss'' are different types of hair loss. 

Baldness is characterised by significant hair loss from the scalp. Commonly, baldness is inherited and shows with age. Some people would rather let their hair loss go naturally without any treatment, while others may conceal it. Others decide to use one of the treatments on offer to stop their hair from thinning further or to encourage new growth.

Consult your doctor about the cause of your hair loss and your treatment options before beginning any hair loss treatments. In this post, we'll talk about the many forms of hair loss, its causes, and the practical and emotional solutions to this condition.

Types of hair loss

Alopecia comes in a variety of forms and patterns. Each type will have various causes, prevalence, and management strategies. The following lists more prevalent alopecia types below:¹

• Male pattern baldness
• Female pattern baldness
• Alopecia areata
• Telogen effluvium
• Anagen effluvium 
• Alopecia related to skin conditions
  • Seborrhoeic dermatitis
  • Lichen planus
  • Tinea capitis

Causes of hair loss

Androgenic alopecia (male pattern baldness)

This is a typical pattern of baldness in people AMAB, which becomes more prevalent with age.² The surviving hair may have a distinctive horseshoe shape due to bitemporal recession and/or a central recession. This type of balding pattern can start in the teenage years and affects approximately half of the people AMAB by the age of 50.

This condition is associated with androgen dependence of the follicle roots that give rise to hair. Cells in the skin convert testosterone (an androgen dominant in people AMAB) to dihydrotestosterone. The sensitive follicles react to dihydrotestosterone and this leads to the follicles shrinking. Terminal hairs become thinner and less pigmented and eventually are not able to reach the skin’s surface.¹

Female pattern baldness

People AFAB  who are genetically susceptible to hair loss may suffer from this balding pattern.² Compared to people with AMAB, this is a more widespread hair loss that primarily affects the top of the scalp.

Terminal hairs are gradually replaced by smaller hairs that are less pigmented, with fewer hairs being in the growth phase. This type of hair loss usually increases after menopause. The rate of progression is variable, but affected individuals rarely go completely bald.¹

Alopecia areata

Hair follicles, and occasionally nails, are affected by the chronic inflammatory illness known as alopecia areata.² The most common clinical manifestation is the scalp or the lower face being covered by well-defined bald patches. The skin has no scars or scaling. Exclamation mark hairs, which are short, broken hairs that taper towards the proximal end, are sometimes found at the edges.

The exact cause of this condition is not known. It is suggested that there is a genetic component to it since around 20% have a positive family history. The statistics for alopecia areata are that around 0.15% of the population has it. Peak incidence is recorded between the ages of 15-29 years, with around 60% of the affected individuals having their first patch of baldness before the age of 21.¹

Telogen effluvium

This is a condition in which numerous hairs enter a phase of stasis as a result of physiological or hormonal stress.² Up to six months can pass after the initial insult before new hairs emerge in the growth phase. People with this condition may remark that they are losing more hair than usual, and they frequently have handfuls of hair in their plughole after a shower, on their hair brush, or on their pillow.¹

Anagen effluvium

Hair production is suddenly terminated during the growth phase in people living with this condition.² This can occur after the use of radiotherapy, immunotherapy, or chemotherapy for cancer treatment. Hair normally grows back within a few months of stopping chemotherapy. For those who are already at a psychological disadvantage, losing hair may negatively impact a person’s mental health. 

The use of wigs, hairpieces, and scarves is possible. Wigs are provided free of charge by the NHS to cancer patients undergoing chemotherapy. It could be quite painful to wear a wig if the treatment involves hormonal manipulation that could cause hot flushes. Alopecia can be managed with minoxidil. Additionally, localised scalp cooling may be beneficial.¹

Signs and symptoms of hair loss

The signs and symptoms of hair loss are listed below:^1,3

In people AMAB:

• Symptoms appear post-pubertally, with onset typically occurring before 30 years of age
• Bitemporal thinning of the frontal scalp
• Hair thing at the top, the middle portion of the scalp

In people AFAB:

• Occurs 1 to 6 months after a stressor
• Thinning of hair between the frontal and vertex of the scalp without affecting the frontal hairline

Diagnosis

Your doctor will examine your scalp and ask you questions. Hair loss is a clinical diagnosis and does not require many tests to diagnose, especially if there is a positive family history of androgenetic-type hair loss.

If your doctor suspects other causes for hair loss, they may ask questions about other signs and symptoms, about past medical history, and about your current medication. For example, a doctor may also perform thyroid tests or a CBC screening for iron deficiency.^1,3

Management and treatment for hair loss

When you, or someone you might know, seems to be distraught about their hair loss, it is advised to reach out to a doctor. A healthcare professional will be able to help you get an understanding of what might be causing your hair loss and will also recommend treatment. 

Treatment for hair loss usually consists of taking finasteride and minoxidil. Keep in mind that the cost of hair loss treatment is usually not covered by national health schemes in many countries.

Medication 

Both finasteride and minoxidil can be used as topical (surface application) agents. The former can also be used as a tablet. Both of them need to be used for at least 4 - 6 months before noticeable changes are observed. They then must be used indefinitely. Finasteride is prescribed as a 1mg dose for daily consumption and requires a prescription, whereas minoxidil has different concentrations (going up to 5%, which is the strongest and most effective) and can be bought over the counter.

Finasteride is not advised for people who are pregnant due to its ability to affect the foetus adversely. Another drug, called spironolactone, can be used instead. Minoxidil can safely be given to pregnant individuals as well. 

Hair transplant

Hair transplants can often help a person who has been affected by alopecia to feel confident about their appearance. Patients must, however, have a sufficient donor area that can be used to fill the bald spot. Hair transplants now look more cosmetically appealing and natural thanks to new procedures.

Microneedling

Microneedling is the process of rolling a device that is embedded with fine needles along the scalp to cause micro punctures on the skin as it is rolled. The procedure can stimulate new blood vessel formation, which in turn supports hair growth from follicles. Although it has not been found to be effective when used alone, microneedling alongside topical therapies (minoxidil or topical steroids) has been found to increase hair count.

Low level laser therapy 

This method, also known as red light therapy, involves using a device that emits a low-energy laser. This is thought to exert a stimulatory effect on tissue, promoting anti-inflammatory effects. Studies suggest that the effect of the laser therapy can support hair growth.

Platelet rich plasma (PRP)

This process involves using a small volume of plasma, which has been separated from the patient's own blood, to be injected into the scalp. It is thought that PRP contains platelet-derived growth factors (PDGFs), fibroblast growth factors, endothelial growth factors and insulin-like growth factors. All of these help prolong the growth phase of hair follicles.⁴ 

FAQs

How can I prevent hair loss?

Male pattern baldness (that has a genetic association) is not preventable. For the types that are preventable, following these tips can help avoid balding:

• Avoid being rough with your hair and use a wide-toothed hair brush
• Take supplements, like multivitamins
• Stop smoking
• For people going through chemotherapy, ask for a cooling cap

How common is hair loss?

Hair loss is more common in people with AMAB than in people with AFAB. In people, AMAB it usually presents after puberty and starts taking hold by the age of 30. In people with AFAB, hair loss more commonly occurs after menopause.¹

Who is at risk of hair loss?

There are a few risk factors that can increase your chances of hair loss:

• A family history of hair loss
• Age
• Significant weight loss
• Medical conditions like diabetes and lupus
• Stress
• Poor nutrition

When should I see a doctor?

You should see your doctor if you are concerned by the amount of hair loss that you are experiencing or if you feel that hair loss has negatively affected the way you look. You should also see your doctor if you notice sudden or patchy hair loss. This could signify a medical condition that needs urgent attention.

Summary

Alopecia is a condition that causes affected people to lose their hair. It is quite common due to it being a multifactorial condition that has many risk factors. There are different types of alopecia, with the most common being androgenic types (male and female pattern baldness). These are not preventable, but treatment is available. Other types of hair loss that are treatable usually require medication or removal of the stressor that is causing the hair loss. If you, or anyone you know, is experiencing hair loss, seeing a doctor is essential as they will be able to help you manage your hair loss and refer you towards the necessary psychological support.