How Does the Body Grow Hair?
All hair is a non-living fiber made of keratin proteins. Each hair is produced by one follicle.
What Is a Follicle?
It’s the structure in the skin that produces the hair. We have follicles all over our bodies, but it is those of the scalp that we are talking about when we think of hair loss.
What Is the Hair Follicle Growth Cycle?
There are three phases: anagen, the active growth phase that lasts 2-8 years, catagen, when the hair growth slows over a few weeks, and telogen, lasting a few months when the follicle goes dormant and the hair does not grow. Follicles are all at different stages in the cycle on any given day.
Is It Normal to Lose Hair Every Day?
Yes, every day 50-100 telogen follicles holding a resting hair will switch into anagen. A new hair starts from deep in the follicle, replacing the old hair and pushing it out. This means that even someone without noticeable hair loss will have a normal, daily “turnover” of hair.
What Causes Hair Loss That Is More Than Normal?
The usual cause is inherited (genetic). There are many uncommon causes, including medication side effects, serious illness, general anesthesia, high fever, autoimmune conditions, and others.
What Has Inherited Hair Loss?
Both male and female pattern hair loss is known medically as androgenetic alopecia (AGA). Simply, “alopecia” means hair loss, “genetic” means we inherit the condition and “andro” refers to the androgen hormones testosterone and dihydrotestosterone (DHT) which stops the affected follicles from growing a visible hair.
You Get the Genes From Your Mother, Right?
You can get the genes from either your mother or father or both.
Wearing a Cap Makes It Worse, Right?
This is a myth. AGA is an inherited, genetic condition. Avoiding caps will not save us!
What if I Use “special” Shampoo?
Nope. If it were shampoo-related, we would lose the hair on the sides of our heads as well.
Is It Caused by Stress?
No. Although physical and emotional stress can accelerate the loss, the cause is hard-wired into the genes.
Is This Due to a Circulation Problem to the Top of My Scalp?
The problem is not the scalp, but rather the genetics of the follicles. The circulation is the same as was when you were a kid.
Why Is This Also Called Male Pattern Baldness?
Hair loss in men does follow two typical patterns, although every individual will have their own unique nuances. The most common male pattern starts with a recession of the frontal hairline in the corners (fronto-temporal recession) or with thinning in the crown (top back of the scalp), with the two areas expanding towards each other. 90% of affected men will have a variation of this pattern and the other 10% will have general thinning on top with the preserved hairline location. The cause is the same: AGA.
Why the “horseshoe” Pattern in Men?
This is just the pattern that nature chose. DHT is found throughout the body, but it is those follicles on the top of the scalp, which are genetically vulnerable to DHT. Those at the sides and back are genetically resistant.
What Are the Different Parts of the Scalp Affected by AGA?
The top, crown, and temples. Think of the top of the scalp in terms of three areas. The forelock is the front 1/3 of the scalp, the mid-scalp is everything behind that as far back as you can see in the mirror, and the crown is the back part of the scalp that someone standing behind you sees. The temples are the sides of the scalp and may also recede.
Does the Follicle Disappear When the Hair Falls Out?
The hair and follicle never truly disappear. The loss of hair in AGA is “progressive miniaturization”. As the AGA affects the follicles, the hair produced is smaller in diameter, grows slower in length, and has less pigment and shine. The hair gets finer and finer, and eventually invisible. It is a loss of hair fiber size, not loss of actual numbers. This is important in understanding how medical treatments work.
When Can It Start?
AGA can begin anytime after puberty when the hormonal changes increase DHT and cause the vulnerable follicles to wither away. The “bad” genes were always there, but DHT is the culprit.
How Do You Know You Are Starting to Lose Hair?
For most men, seeing a change in the mirror in the “corners” of the hairline is the first concern. Some notice more difficulty styling the hair, which can mean a loss of hair volume behind the hairline. In the crown, it may be the first time you get a sunburn, indicating lighter coverage of your scalp, or someone noticing a thin spot when your hair is wet.
How Fast Does It Happen?
This is different for everyone. In some, there is a slow, steady progression, in others, hair loss happens in “fits and spurts”. The only constant from person to person is that it gets worse over time.