A Quick Guide On Hair Loss & How To Beat It
Hair loss in men and women comes with different characteristics and may stem from a variety of causes. Here’s how hair loss looks like in men and women.
HAIR LOSS IN MEN
When we speak of male pattern baldness (MPB) or androgenetic alopecia, this refers to a genetic condition that is also widely common in Asian men, whereas hair loss per se can be caused by several factors. MPB is characterized by progressive thinning of the hair on the head which eventually leads to baldness. It starts at the temples with the hairline gradually receding following a pattern. In some cases, the hairs at the crown area also starts to get thinner.
We have DHT or dihydrotestosterone to blame for male pattern baldness. The enzyme 5-alpha reductase transforms testosterone into DHT, which is a more potent form. DHT is not inherently a villain as it courses through the body because it functions to help the body grow and regulate itself. But, on the flip side, it also inhibits and reduces the proper growth of hair in a process called miniaturisation. It causes the hair follicles to shrink until it eventually stops growing.
There is also no age divide with hair loss. What is often associated with old age actually does not spare younger men – even as young as those in their teens. Being affected by this condition at a younger age, makes the psychological impact in those affected more profound.
HAIR LOSS IN WOMEN
Some women also suffer from pattern baldness. It is the same as male pattern baldness, except that it takes on a different pattern. The first signs may be a widening center part or a feeling that the hair does not feel as thick as usual. Shedding is also characteristically diffused instead of taking on a clear cut pattern. Hair loss, in this case, rarely progresses to total or near total baldness.
Hormonal shifts, medications, autoimmune diseases, or hairstyling (traction alopecia) are all causes of female hair loss. However, genetics is the identified culprit behind female pattern baldness.
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The treatment of hair loss is unlikely to be effective if the real underlying cause isn’t addressed. Zeroing in on the main culprit is only possible through diagnostic exams. Here are the following tests for hair loss:
In this test, the doctor lightly pulls a small amount of hair (around 100 strands) to determine if there is excessive loss. If more than three hairs come off, the patient is likely suffering from excessive hair loss. The normal range is one to three hairs for every pull. The hair pull test will show positive results where hair is thinning, and negative in areas away from the thinning.
A complete blood count can help uncover medical conditions related to hair loss.
This involves the removal of a small section of scalp, usually 4mm in diameter. It is examined under a microscope to determine the cause of hair loss.
Using a special instrument, the hairs trimmed from the bases are examined. Light microscopy helps uncover the possible disorders of the hair shaft.
A densitometer is a handheld magnification device that can check if hair shafts are shrinking.
This test checks for hormonal shifts or imbalance that could contribute to hair loss. It checks for DHEA, Testosterone, Androstendione, Follicular Stimulating Hormone, Prolactin, and Leutinizing Hormone.
Severe and prolonged hyperthyroidism and hypothyroidism can contribute to hair loss. Thyroid tests can determine which among the two you could be suffering from.
Serum Iron Tests
Hair loss could stem from iron deficiency and this can be corrected if it is proven. To measure your iron levels, the doctor will most likely order a ferritin level blood test. Ferritin is a protein that helps store iron.
The Venereal Disease Research Laboratory (VDRL) Test is a screening test for syphilis. This could detect if your hair loss is a symptom of syphilitic alopecia.
Hair Loss Treatments
LIFESTYLE CHANGES AND HOME REMEDIES
Positive lifestyle changes can foster improved hair growth. These are the easiest first steps to initiate because you can do it at home. Here are some of the things that you can do.
Besides keeping your lifestyle in check, supplements can also help boost your efforts to restore hair or minimise the blow of hair loss. There are certain nutrients that are key to making this happen, and companies invested in various formulas to support hair growth.
Among the hair restoration options available today, hair loss medications are the most popular. It is the option that is the most accessible and easily available. Two distinguished names in the market are Minoxidil and Finasteride. They come in different forms with different strengths and weak points which will be detailed below.
- An over-the-counter medication that is approved for men and women.
- Minoxidil dilates the blood vessels surrounding the hair follicles, increasing nutrient supply and encouraging hair growth.
- It comes in the form of a solution or a foam that is applied topically on the scalp.
- There are two formulations available, 2% and 5%.
- At least 6 months of use is needed to prevent further hair loss and to start the hair regeneration process.
- Long-term use of Minoxidil is recommended to maintain the results. The effects regress with drug discontinuation.
- Possible side effects include, unwanted hair growth on adjacent skin of the face or hands, scalp irritation, isolated itching, allergic contact dermatitis, scaly changes of the scalp, and a rapid heart rate.
- Contraindicated in patients with a history of hypersensitivity to the drug or its components, pregnant and breastfeeding women.
- An oral prescription medication for men who have male pattern hair loss ( androgenetic alopecia).
- It blocks the enzyme, 5-alpha reductase which causes the conversion of testosterone to DHT.
- Finasteride is proven to promote scalp hair growth and further hair loss.
- The full effects in both preventing hair loss and in re-growing hair may take up to three months or longer, granted that it is taken regularly
- It is not advised for women who are of childbearing age because it may result in fetal deformities. However, this may not be a problem for post-hysterectomy patients or menopausal women.
- Women need to undergo a thorough evaluation to see if this treatment will be in their best interest.
- A major issue about Finasteride is the side effects. In some cases, it may cause breast changes (lumps, breast pain or tenderness) and sexual side effects.
If your hair loss is caused by an underlying condition, treatment for that disease is necessary. This may require medications to reduce inflammation or suppress your immune system. However, if a drug is causing your hair loss, your doctor may advise you to stop taking it.
Low Level Laser Therapy
Lasers have been used for several cosmetic purposes. It is also used to treat hair loss and as complementary treatment for hair transplant. Here are some of the facts you need to know.
- Low Level Laser Therapy is also referred to as red light therapy, soft laser, cold laser, biostimulation and photobiomodulation.
- It is intended for men and women with hair thinning or genetic pattern baldness.
- Lasers increase vascularization to the scalp which improves the distribution of nutrients and oxygen to the roots of the hair.
- It can also prevent DHT buildup.
- You can get laser treatments at a salon or a clinic, or own a portable device you can use at home (Lasercombs). However, if you wish to get professional care alongside other complementary treatments, it is recommended that you approach an aesthetician or dermatologist trained in laser hair treatments.
- It is a painless procedure that requires minimal time commitment.
- Regular use over a long duration is important for low level laser to be fully effective.
- Scalp treatment and massages that promote blood circulation can be used additionally with Laser treatments.
- It should not be used together with medications or products that are photosensitizing (those that can make your skin sensitive to light). Otherwise, it could lead to adverse effects or injuries.
Hair Transplant Surgery
Hair transplant surgery is hailed as the last resort when it comes to hair restoration. It is an invasive procedure which involves several risks and potential complications. Therefore, it requires proper patient selection and preparation. Its complexity also means that it can be a costly treatment, but a promising one too. Here’s a run-down on the two different surgical techniques.
FUT (FOLLICULAR UNIT TRANSPLANTATION)
- It is also known as the “strip method” because it involves the excision of a strip of scalp from the back of the head from which the donor grafts are taken.
- Follicular units are made up of naturally occurring groups of one to four hairs, oil glands, nerves, and some fine vellus hairs.
- FUT uses microscopic dissection to separate the follicular units for transplantation and implant them in a fashion that closely resembles naturally occurring hair.
- The entire head needs to be shaved for this kind of procedure.
- The follicular units are placed in thinning or balding areas following natural hair growth patterns.
- It allows thousands of grafts to be transplanted in a single session.
- A study showed that FUT is an effective method for treating cicatricial alopecia (hair loss caused by burns, trauma, and plastic surgery).
- The major drawback about FUT is the scarring, which may be visible for men who prefer to wear their hair short.
- The total cost will depend on the amount of hair that will be needed. This will be determined after a thorough assessment is done during your consultation.
FUE (FOLLICULAR UNIT EXTRACTION)
- This is more recent and less invasive technique in hair transplantation. It no longer requires incisions and sutures because it only uses a punch-like tool to remove individual grafts.
- It uses sharp punches and blunt punches. A sharp punch is used in a two-step technique to minimize the amount of twisting needed to cut into the skin. A blunt punch is used in a three-step technique to decrease the follicular transection rate.
It is indicated for the following patients:
✅ Those who want to wear their hair short.
✅ Individuals with limited hair loss or those who require small sessions.
✅ Those who specifically request FUE and have enough grafts available to meet the desired results.
✅ Those who need treatment of widened scars due to traditional strip excisions.
✅ Individuals with an inordinate fear of pain or scars.
✅ Those who have scarring caused by dermatologic conditions, trauma, or neurosurgical procedures.
✅ Those with inadequate scalp laxity for a strip excision.
A FOX test can help determine if a patient is a good candidate for FUE. It is done by taking out a few (about 100) grafts from the donor area and then evaluating how many complete/incomplete follicular units are extracted. If the extraction is easy and complete units are extracted, the surgeon can go ahead with FUE; otherwise, a strip technique may be needed.
It takes less time to heal than FUT and you don’t need to visit the surgeon for stitch removal.
- It has an average recovery time of less than 7 days.
- This procedure can be a tedious process and it takes longer to finish than FUT.
- It can have a higher transection rate.
- There is a long learning curve in FUE, therefore it is better that you find a surgeon who is experienced in this technique.
Where are you in your journey? Whether you are still testing out other treatments or decided on hair transplant surgery, have professional guidance along the way. Book your appointment for a personalised plan of action towards fuller hair.
About Dr Tyng Tan
Dr. Tan Tyng Yuan, MBBS is one of the few doctors approved by the Singapore Medical Council to carry out both FUE and FUT hair transplant (which includes non-shaved FUE where donor hair length is preserved and reduction in downtime after surgery is possible to achieve). Her special interest is in hair loss and hair transplantation and she is recognized as a graduate fellow of the ISHRS after completing a lengthy fellowship at an ISHRS approved institution.