What causes hair loss?
Alopecia is the general medical term for hair loss, and it has many different causes. Normal human hairs can be classified according to their phases of growth. Anagen is the growing stage of hair, while telogen is the sleeping stage of hair. About 80 percent of the hairs in the human scalp are growing hairs and about 20 percent of them are sleeping hairs. It has been estimated that the scalp normally contains about 100,000 hairs. Therefore, the average number of hairs that can be lost in a day is about 100. Contrary to popular belief, neither shaving nor hormonal changes, such as menstruation, has any effect upon hair growth.

Hair loss can be broken down into several different types, including alopecia areata (temporary hair loss in a coin-shaped patch), telogen effluvium (temporary hair loss secondary to a stressor on the system), and androgenetic alopecia (male-pattern hair loss). For the purposes of our discussion, we will focus on male-pattern hair loss. It generally shows itself in the 20s or early 30s by gradual loss of hair, chiefly on the top of the head and in the angles at the frontal hairline. There are several different patterns to this hair loss, but male-pattern hair loss is the most frequently encountered type. The exact mechanisms are still unknown. We have no doubt, however, that inherited factors and the effect of androgens (male hormones) on the hair are most responsible.

Is stress a factor in hair loss?
Stress does not cause hair loss—it simply makes a bad situation worse. Telogen effluvium, for example, occurs after an insult to the system. The most common cause is pregnancy. This can result in extensive and worrisome hair loss in women in the first few months after the birth of a baby. It is, however, temporary and returns completely.

What is DHT and how is it involved in hair loss?
DHT stands for dihydrotestosterone. This is the active form of the male hormone testosterone. It has been suggested that high DHT levels in genetically predisposed hair follicles initiate baldness. It is this chemical conversion from testosterone to dihydrotestosterone that is blocked by hair restoration products, such as finasteride, which is a prescription medicine and the active ingredient in Propecia, another prescription medication to treat hair loss. Finasteride blocks the formation of active testosterone and allows those hairs predisposed to inactivity to become active again and make new hairs.

What is the relationship between genetics and hair loss?
Although not the primary cause of male-pattern hair loss, genetics does have a significant role in male-pattern hair loss. It is, however, polygenic, in that there is more than one factor at work. It is unclear whether having an affected mother or an affected father predisposes descendants to greater risks.

Can hair loss occur in young adults?
Male-pattern hair loss can occur as early as 15, although it typically begins anywhere from the 20s and early 30s. Familial history may help determine if this is going to occur, as parents with a history of early-onset male-pattern hair loss may increase the risk for this to occur in descendants. Alopecia areata and telogen effluvium, two other forms of temporary hair loss, can occur in children as young as one year of age. Other precipitating factors may also be involved.

What can be the cause of a sudden loss of a large mass of hair?
Stressors to your system, such as illness, high fever, pregnancy, extreme weight loss or gain, and drug use, can cause temporary hair loss. This occurs when the ratio of growing to resting hairs is upset and more of the growing hair shifts into a resting phase. A greater quantity of normally sleeping hairs falls out, prompting a visit to the dermatologist. This type of hair loss is temporary and full regrowth should be expected.

Do shampoos and other hair products cause hair loss?
An allergic reaction to any constituent in shampoo or hair products can cause hair loss. Shampoos are designed to be as safe as possible, although there is always someone who will react to them. Caustic hair dyes, straighteners, and other products can certainly cause inflammation of the scalp and result in hair loss.

Can my hairstyle cause my hair to fall out?
Certain hairstyles can contribute to hair loss, most notably styles involving tight braids or pull-backs. This form of hair loss is called traction alopecia. This occurs when the hair is pulled tightly back and fastened at the base of the skull, or braided into tight braids or rows. Exposure to this type of hairstyle over long periods can result in a scarring alopecia, with no potential for regrowth.

How does minoxidil work?
Minoxidil(Rogaine) is a slightly oily solution that is rubbed into the scalp twice a day, or as recommended by your dermatologist. In its oral or intravenous form, it is a potent anti-hypertensive medicine, used in emergencies to lower critical blood pressures. It was during this use that hair growth was noted in patients with hair loss. Its exact mechanism of action is unknown; most experts feel that it causes dilation of the blood vessels in the scalp and increased exposure of the hair follicle to this flow. It has been shown to work best on the top of the head and less well at the angles. Its predominant effect is to decrease loss and maintain existing growth.

Are high-strength minoxidil formulas better than lower-strength ones?
There are two forms of topical minoxidil available over the counter today: two percent and five percent. It is generally felt that the five percent solution is more effective in preserving existing hair and stimulating new growth. The five percent solution is not recommended for use in women because of possible increased hair growth on the sides of the face. This growth is temporary, however, and some practitioners do use it after explaining the full range of possible side effects and complications to the individual. The five percent solution is definitely better at maintaining and promoting new hair growth.

Is it true that saw palmetto is better at treating hair loss than finasteride?
Saw palmetto is a small palm tree native to the eastern part of the United States. The berries contain a biologically active component similar in action to finasteride. The fat-soluble part of these berries has been shown to inhibit the conversion of testosterone into the active form, much like finasteride. Although there are several double-blind studies comparing saw palmetto to finasteride in the treatment of benign prostatic hypertrophy (enlarged prostate), there are no studies looking at its use in hair loss.

How effective is finasteride?
Finasteride (Propecia and Proscar) has been shown effective in the treatment of mild to moderate male-pattern hair loss. These results were based on two 24-month studies of men ages 18 to 41. About 80 percent of the men in the study maintained their base hair count (versus 28 percent on placebo), while 66 percent had visible regrowth as rated by independent observers (versus seven percent with placebo). Most of the men in the study reported an increase in the amount of hair, a decrease in their hair loss, and an improvement in their appearance.

What's the difference between Propecia and Proscar?
Propecia and Proscar are two forms of the same medicine, finasteride, but in two different dosages. They both block the conversion of testosterone into its active form, allowing hair growth.

How long does it take to see results from any treatment program?
It is recommended with both minoxidil formulas and Propecia that a person uses them for 12-month course before any decisions on efficacy are made. When considering the other temporary forms of hair loss, each individual is treated according to their needs.

When should I consider surgery to treat hair loss?
The consideration of when to undergo hair transplant surgery is a personal decision. Its success is based on many factors, including the amount of donor hair available as well as the amount of area that needs to be covered. An evaluation for hair transplant surgery with a qualified hair transplant surgeon is most important in determining when surgery should be considered. As a rule, hair transplant surgery is more successful when there is still existing hair that can be used to camouflage the surgical area. The goal of a successful session is to allow the patient to continue to recede in a natural and expected manner, rather than with unchecked hair loss. If you have enough hair with which to cover the thinning area, all the better.

How effective is hair transplantation?
Hair transplantation is a surgical office procedure for the treatment of hair loss. This is accomplished by actually transferring grafts or small sections of hair bearing skin from the back of his scalp to bold areas on the top of the head. Micro grafts, containing one hair, and mini grafts, containing two to seven hairs, are usually used. This technique is very effective in most types of hair loss, including male and female pattern loss. It is also effective when concealing scar injury and complications from disease. It is especially effective in concealing the scars from facial plastic surgical procedures (face lifts, brow lifts, etc.). Even eyebrows can be reconstructed with excellent cosmetic appearance. Women in particular are excellent candidates, as their hair loss tends to be diffuse and can afford them full coverage of the area while undergoing healing. Best of all, your results are permanent.