Hair Loss and Treatments

FEMALE HAIR LOSS

Female hair loss is a different kind of problem compared to males.  The hair loss is more often diffuse and results more in thinning of hair volume and density, than clear bald areas.  A thorough assessment of underlying condition is essential and in most cases hormonal and medical treatments can be quite effective.  Hair transplantation also has a definite role to play in some cases, especially if the patients desire lowering of the hairline.  Your surgeon will discuss this in details after a thorough assessment.  The technique and after care, is pretty much the same as for male hair transplantation. 

HAIR LOSS IN YOUNGER PATIENTS

Hair loss may a cause of concern in younger patients, sometimes in late teens and early twenties.  In most cases, until the patient has lost at least 50% of hairs, there may not be any obvious loss of density.  Family history of baldness is important in making some sort of prediction about the final extent and pattern of hair loss and hence in designing a realistic surgical plan.  As male pattern baldness is genetically determined, autosomal recessive, hair loss patterns of males, both from father and mother’s side are important.  In most patients, hair loss stabilizes by the age of 40 to 45, the hair transplant surgeon will be careful not to place the hairline too low in patients with a strong family history.  Possibility of further hair loss will always be in the surgeons mind while determining a strategy for management. 

OTHER CAUSES OF HAIR LOSS

Cicatrical alopecia
Traction alopecia in women
Injuries or burns
Following surgical excision of lesions
Trichotillomania or intentional self pulling of hair
Inflammation or infection of scalp
Malignancies of scalp

It is important to diagnose the cause of hair loss and treat the underlying pathology, before considering hair transplantation in such cases.  The list of medical conditions causing hair loss is quite extensive and hair transplant surgeon will do a thorough assessment of your medical history and scalp examination to rule out these conditions before recommending the hair transplantation procedure. 

MEDICAL THERAPIES

Hair transplantation is suitable and desirable for areas of scalp that have become completely bald but there are several hairs, which still have a living, though weakened hair root.  These hairs can be ‘revived’ by various forms of medical therapies.  For males, the most established and proven remedies include Minoxidil 5%, which is available as a solution and more recently as foam, which is more user friendly. Minoxidil acts by improving blood circulation to hair roots.  Another effective remedy in males is Finasteride 1 mg, also known by its brand name Propecia.  It acts by blocking the action of an enzyme (5 alpha reductase) and hence stop breakdown of testosterone to dihydrotestosterone or DHT.  DHT selectively acts on hair follicles and causes its to shrink causing the hair to thin out and eventually fall.  By blocking the conversion of Testosterone to DHT, even the miniaturized hair roots can be revived and hence the density of hair can be increased.   Zinc and iron supplements are also frequently prescribed, though their role is not well established. 

Stress and too much sun are sometimes blamed, however, they may have no more than an aggravating effect, rather than being the actual cause.   

In case of females, it is important to rule out underlying hormonal or metabolic causes before starting any treatment.  Minoxidil, in strength of 2% may be used but Finasteride is contraindicated.  Vitamins and iron supplements may be helpful. 

Self-medication can be harmful and all medical therapies must be started and closely monitored by a fully qualified medical practitioner.