The medical term for abnormal hair loss is alopecia. The usual place to lose hair is on the scalp. It is typically caused by your genetic makeup, often triggered by the environment including chemical exposure (including medicines), lack of proper nutrition, stress or illness.
There are three major forms of alopecia:
- Androgenetic Alopecia
This comprises both male pattern baldness and female pattern baldness. In men, this type of hair loss starts in a receding hairline and then start thinning the hair on the top of the head. In women, hair loss occurs more generally over the entire scalp. Most hair loss results from the miniaturization of genetically predisposed follicles.
- Alopecia Areata
This is an autoimmune skin disease where hair loss can occur anywhere on the body. It usually starts with a round area on the scale and can progress to total scalp hair loss (alopecia totalis) or total body hair loss (alopecia universalis).
- Aicatricial Alopecia
This is hair loss caused by the destruction of hair follicles due to inflammation or other causes.
To understand hair loss, we need to learn how your hair grows because hair loss results from a disruption in the hair growth cycle.
How Your Hair Grows
You start out with around 150,000 hair follicles. Each hair follicle keeps going through three phases in its repetitive growth cycle. These phases are:
- Anagen or Growing Phase
This typically last from 2 to 7 years and determines the maximum length of your hair. Full, thick, strong hair is called “terminal hair.” The hair follicle stem cells are actively helping grow the hair. Proper nutrition helps support your hair’s strength and prevents breakage. The length of this growth phase decreases as we age.
- Catagen or Transition Phase
This phase lasts about 10 days and during it the hair follicle decreases in size and detaches from the dermal papilla (which nourishes the growing hair and contains mesenchymal fibroblasts–stem cells). [Stem cells when they divide can become whatever cell type is needed–in this case the cell types that form a hair.]
- Telogen or Resting Phase
This phase lasts about 3 months during which the old hair is resting and a the stem cells begin forming and growing a new hair. This resting phase includes the exogen or shedding phase in which the old hair (club hair) is pushed upward and “falls out.” Somewhere between 50 and 150 hairs “fall out” every day.
Each hair follicle on your head is in one of these stages. You can expect to normally lose about 50 to 150 hairs a day as old hairs are pushed up and fall out. But, interference with this hair growth cycle will cause abnormal hair loss that results in both male pattern baldness and female pattern baldness.
Androgens Interfere With Hair Growth
Androgens help regulate hair growth, especially at puberty. During puberty androgens enlarge the follicles in the male beard and chest, and reshape the scalp hairline in men and women.
Testosterone is converted by 5a-reductase into dihydrotestosterone (DHT). This DHT binds to the androgen receptors where the hormone-receptor complex activates genes responsible for transforming large terminal follicles to “miniaturized follicles.” These miniaturized follicles have a shorter growing phases produce shorter and produce finer hairs that don’t cover the scalp as well. Eventually these finer hair follicles die.
These finer hairs are one detectable indicator that you have androgenetic alopecia.
How DHT (Dihydrotestosterone) Causes Miniaturized Follicles and Hair Loss
Watch this short video that explains how both male pattern baldness and female pattern baldness takes place.
Hair Loss Therapy
The goal of hair loss therapy is to increase the number of hairs on the scalp, increase their thickness, and preventing further losses. These approaches to hair loss therapy must be used before the hair follicle dies. After hair follicles die the solutions are limited to hair transplants or a toupee or wig.
There are several basic approaches to hair loss therapy for living hair follicles.
Prescription Drugs for Hair Loss Therapy
Two prescription pharmaceutical drugs are currently in use in the United States. Both drugs are helpful in increasing coverage of the scalp, but only for those with thinning hair and miniaturized follicles. Neither drug can help those who are bald with no visible hair.
Treatment for 6 to 12 months is needed for improved scalp coverage. And, once these drugs are stopped, thinning begins and is noticeable again in 6 to 12 months.
This drug can be taken orally (usually 1 mg per day) or applied topically on the scalp (in a % or 5% solution). This drug is an inhibitor of 5a-reductase and so inhibits the conversion of testosterone to dihydrotestosterone (DHT). It can lower DHT levels by 60%. This drug is effective because it has been found that men with a congenital deficiency of 5a-reductase do not get androgenetic alopecia, and men with androgenetic alopecia have increased 5a-reductase and elevated HDT. Some side effects of finasteride include impotence, decreased sexual desire or ability, swelling or tenderness in feet and breasts, weakness, dizziness, headaches, skin rashes, and a runny nose. The sexual side effects may continue after you stop taking finasteride.
- MinoxidilThis drug increases the length of the growing (anagen) period and enlarges miniaturized follicles. The exact reason for this improvement is not known. The drug was initially prescribed for hypertension and its action as a potassium channel opener and dilator of blood vessels is well documented. Side effects of minoxidil include irritation, burning or redness in the area of application, chest pain, irregular heartbeat, difficulty breathing, tiredness, dizziness, fainting, swelling of the hands and feet, and weight gain.
Remember that is your physician prescribes one of these drugs, he or she believes that the benefits to you of restoring hair outweighs the potential side effects.
Non-Prescription Supplements for Hair Loss Therapy
To keep your body (including hair follicles) functioning at its full capacity you need nutrients. These include the basic macro-nutrients of protein, carbohydrates and fats. But, micro-nutrients (often called supplements) are also needed. These include vitamins, minerals and herbs.
These supplements should provide both nutritional support and include DHT blockers and 5-α-Reductase blockers.
Key vitamins vital to hair health include:
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
- Vitamin B Complex
- Coenzyme Q10
Key minerals required for hair health include:
Herbs that are useful in blocking DHT or inhibiting 5α-reductase include:
- Pygeum africanum (the African cherry)
- Seneroa repens (Saw palmetto)
- Urtica dioica (common nettle or stinging nettle)
- Camellia sinensis (evergreen shrub providing a Chinese tea)
- Panax ginseng (Asian ginseng, Chinese ginseng, or Korean ginseng)
Platelet-Rich Plasma (PRP) Injections Hair Loss Therapy
This treatment involves drawing some blood and putting it in a centrifuge to concentrate the platelets. This platelet enhanced plasma is then injected into areas of thinning hair (with miniaturized follicles). The growth factors in the PHP help stimulate the stem cells to keep producing thick hair and reverse the miniaturization of the hair follicles.
PRP Hair Loss Treatment on The Doctors
Watch this short video to see that actual procedure.
Low‐Level Laser (light) Therapy (LLLT) Hair Loss Therapy
In recent years technology has advanced to the point that low level lasers have become available to the general public. Numerous clinical trials have been conducted to examine the effect of laser light on hair follicles.
You may know that laser light at higher intensities can penetrate the skin to damage and kill hair follicles. Thus providing us with laser hair removal industry.
But, lower power lasers seem to have the effect of stimulating the stem cells adjacent to the hair follicle so that increased the hair count, and produced thinker and longer hairs. These low intensity laser devices are safe to use at home and are available to the general public.
One device type has undergone randomized, placebo (sham) controlled, double-blind trials with significant results. This is the HairMax LaserComb. It comes in three variations with 7, 9, or 12 lasers.
The 7 and 9 laser models emit a laser beam at a wavelength of 655 nm (±5 %). The 12 laser model has 6 beams at a wavelength of 655 nm and 6 beams at a wavelength of 635 nm.
These devices (along with identical looking sham devices that emitted white light) were tested by patients at several institutions and private practices. The devices were provided in sealed, numbered opaque packages so participants did not know which device they were using.
A total of 128 males and 141 females participated in these trials. They were randomly selected to receive either a sham device or a laser comb (7, 9, or 12 beams). They were to treat the entire scalp three times a week for the full 26 week duration of the study.
The main objective of the study was to compare the density of terminal hairs (full, rich, healthy hairs) at the start of the study, after 16 weeks, and finally at the end of 26 weeks. The hypothesis was that the laser combs would increase the density of termain hairs.
A target site about 1 inch square (25mm x 25mm) was selected for each participant. This site was then marked with a semi-permanent tattoo and photographed at the start, at 16 weeks and at 26 weeks.
Neither the physicians who worked with the participants nor the participants themselves knew whether the device being used was a sham or a real laser comb. The person evaluating the results (a hair transplant surgeon who had 20 years of experience evaluating hair counts) was also blinded as to which group any participant belonged.
The participants were instructed to use the 7-beam device for 15 minutes, the 9-beam model for 11 minutes, and the 12-beam model for 8 minutes three times a week. They were told to use it over their entire scalp. Each subject kept a diary of their use to help ensure compliance.
Overall, 122 females and 103 males completed the entire course of 26 weeks. The results after 26 weeks showed significantly increased numbers of healthy, terminal hairs for those using the hair comb over those using the sham. The hair comb groups increased their density of hair by 20.2, 20,6, 20,9 and 25.7 hairs per square centimeter. The sham group saw increases of 2.9, 3.0, 1.6, and 9.4 hairs per square centimeter.
The differences were all statistically significant and were not dependent on the age or sex of the participant. Participants using the hair comb all reported improvement in the hair loss condition in terms of thickness and fullness of their hair.
You can see examples of the before and after images below.
HairMax LaserComb on FOX News with hair restoration surgeon Dr. Carlos Puig
Houston hair restoration surgeon, Dr. Carlos Puig on Fox News Houston. Dr. Puig explains how the HairMax LaserComb works to treat hair loss and stimulate hair growth with laser light energy. One of Dr. Puig’s patients is also interviewed and talks about the benefits of using the HairMax LaserComb after his hair transplant surgery.
Conclusions You Can Use
Hair loss is primarily genetic. Once triggered the primary mechanism for hair loss is the conversion of testosterone by 5a-reductase into dihydrotestosterone (DHT).
DHT basically chokes the hair follicle resulting in finer hairs and eventually follicle death.
To prevent further loss and restore as much healthy hair as possible, you need to use a hair loss therapy early, before hair follicles die.
Basic hair loss therapies include prescription drugs, supplements, platelet-rich plasma injections, and low level laser light.
If you are concerned about preventing hair loss you should follow one of the hair loss therapies as soon as possible.
A good choice is obtaining a laser comb for a one-time charge and using it at least three days per week.
- ALOPECIA: HERBAL REMEDIES
- How Hair Grows – Stages
- TREATMENT OF HAIR LOSS from The New England Journal of Medicine
- Low‐level laser (light) therapy (LLLT) for treatment of hair loss from the journal Lasers in Surgery and Medicine
- The current role of laser/light sources in the treatment of male and female pattern hair loss from the Journal of Cosmetic and Laser Therapy
- Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study from the American Journal of Clinical Dermatology
- Aging, alopecia, and stem cells as it appeared in Science Magazine