On average there are 100,000 – 150,000 follicles/hairs on the scalp. If there are fewer than 90,000 hairs on the scalp, the hair density is considered low. Individuals with blonde hair have the highest number of follicles. Those with red hair have the fewest, although their hair is coarser. Male and female hair loss is more common today than ever. With androgenic alopecia or genetic hair loss affecting over 50% of men and women at some point in life. Although there are many forms and causes of hair loss. As a result diagnosing the condition is important.
Male Pattern Baldness
Male hair loss is most commonly passed down genetically. It can be inherited from either maternal or paternal sides. Male baldness affects 25% of men in their 20’s. Two-thirds of men will suffer hair loss by the age of 60. Hair loss can occur at any time. For example, signs of hair loss can be seen in the late teenage years.
Genetic hair loss is progressive. Often following the hair loss pattern of other male family members. Male Pattern Baldness can progress to advanced hair loss. As a result only a thin band of hair around the sides and back remains. A “horseshoe”. Male hair loss is a result of an enzyme and testosterone.
The male hormone is converted into DHT. Or dihydrotestosterone. 5 Alpha Reductase is a natural enzyme in the body. When combined with testosterone DHT is formed. DHT has no useful to the body. But can cause hair loss and enlarged prostate in men. The DHT triggers the male pattern baldness gene attached to the hair follicle. The hair loss gene only affects the hair follicles over the top of the head. The extent of hair loss is largely due to inherited factors. That said, it is possible to have the tendency despite the the parents having full heads of hair. This is due to spontaneous mutation. Whereby the genetic information changes at conception.
Hair loss stages are categorised in a useful guide to help diagnose the extent of the hair loss. The Norwood Scale is a classification of MPB for men. The scale covers from remedial thinning to progressive hair loss. As a result, this makes it easier to understand the grouping and determine the potential future loss. The Scale starts at 1 at its most minor up to 7 as the most aggressive form of hair loss. With the staging of loss between hairline and crown. This is a useful guide even if not totally depicting your hair loss stage. As there are so many causes of hair loss, some systemic, traumatic, chemical it is important before any treatment is administered a proper assessment is required.
Female Pattern Baldness
Genetic female hair loss is called female pattern baldness. Or FPB. It can start as early as puberty. Up to 50% of women having some degree of hair loss. Due to genetic factors. There are many reasons a woman can suffer hair loss. For example, post-pregnancy, stress, diet, and hormonal imbalances. Also, illness, and medical operations such as chemotherapy and anticancer drugs. Female hair loss holds more complexities. Compared to male hair loss. A blood test is often recommended.
Doctors´ may vary the blood test requirement. In general, the test will include a full spectrum blood count. This will include iron (Se Ferritin), thyroid stimulating hormone (TSH), blood sugar level (BSL), estradiol (E2) and erythrocyte sedimentation rate (ESR) which is a non-specific screening for various diseases.
Female pattern hair loss is normally diffused. Over the top of the head. Hair loss can be isolated to small areas. For example, along the central parting. The Ludwig scale classifies the variety of thinning patterns. From minor to advanced thinning patterns. Stage I describes thinning hair over the central scalp. Then, Stage II more progressive thinning. Stage III finally a more advanced hair loss. From, front to mid-scalp. Although the hairline may remain intact. The hairline hair density is often reduced. As well as the hair density further back. That said, it is rare though to see advanced hair loss in women.
Alternative Hair Loss Conditions
Traction alopecia is a common form of hair loss. The hair is subjected to excessive tension. As a result of hairstyles such as tight braids or a ponytail. Over time the hair becomes weaker. Finer in calibre and texture. Hair growth will slow and eventually stop. If treated early the process can be reversed. But, often can lead to permanent damage.
Trichotillomania is a form of traction alopecia. But when the hair is systematically pulled out. For example constant tugging or making tight curling motions. Often caused subconsciously.
Cicatricial Alopecia is scarring alopecia. A condition caused by a variety of skin disorders. As a consequence hair growth can reduce. As a result scarring becomes visible.
Telogen effluvium is a common hair loss condition. The hair sheds prematurely. As a result the hair follicle goes into the resting state. Telogen effluvium can be acute. Consequently as many as 70% of the scalp hairs are shed. The condition can last for a few months.
Autoimmune hair loss
Alopecia areata (AA), and the more aggressive alopecia totalis are autoimmune hair loss conditions. Lupus is another related and common hair loss cause. AA can affect any area of the body. Initially in small patches. Over time the spots can overlap. To form larger patches of hair loss. Autoimmune is a breach in the immune system. As a result, it turns on the hair follicles and shuts down the growth phase.
Diffuse Unpatterned Alopecia or “DUPA“. This hair loss condition affects around 2-6 % of men. Individuals with DUPA develop hair thinning throughout their entire head of hair. The top, back, and sides are all affected. In men with DUPA, the majority of hairs on the scalp are undergoing miniaturisation. As a result, the hairs reduce in calibre or diameter. This often coincides with the hairs becoming stunted or shorter in length.
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