According to the International Society of Hair Restoration Surgery (ISHRS), 84% of surgical hair transplants were performed on men and 16% on women. Nonsurgical hair restoration procedures also reflected a male dominance, with 60% of procedures performed on men versus 40% on women. The age of patients was surprisingly young, with over half falling between 30-49 years old. Male patients tended to be slightly younger than female patients, which isn't surprising given male pattern baldness often begins in a man's late 20s or early 30s. The trend also shows that the average age of patients seeking their first hair restoration procedure is getting younger. These trends are fueled by the desire of the aging population to look and feel younger, as evidenced by the fact that last year, hair product sales grew 4.7% and skin care products grew 3.2% in the US. Hair restoration methods/treatments have improved over the last decade, are more versatile and within the financial reach of more patients. Causes of Hair Loss
First, there are many factors that may cause hair loss. In women, hair loss can be the result of medical conditions such as diabetes, acne or breast cancer. Hair loss may be the result of using birth control pills, implants or skin patches because they produce an increased level of androgens that may result in hair loss.
Hair loss may occur while using birth control or several weeks or months after ceasing its use. In women with darker skin tones, there's a condition known as central centrifugal cicatricial alopecia (CCCA). CCCA is the most common type of hair loss for black women, affecting 15%. It can cause permanent scarring of the scalp by damaging the hair follicles. Early detection is very important, as CCCA is frequently linked to breast cancer, high cholesterol, diabetes and hypertension. Treatment is possible with antibiotics, topical steroids and corticosteroid injections.
Another type of hair loss affecting millions of women of all skin tones is female pattern hair loss, which is genetic or hereditary. With female pattern hair loss, the hair on top of the scalp thins, most often beginning with significant widening of the part in the hair. It is influenced by an increase in hormones and may present with acne. Treatment for female pattern hair loss is hair transplantation. In men, androgenetic alopecia or male pattern baldness is the most common type of hair loss. It is genetic in nature and caused by the effects of the male hormone * dihydrotestosterone (DHT) on genetically susceptible scalp hair follicles. DHT causes male hair loss by reducing the growth, or "anagen," phase of the hair cycle. The follicles produce progressively shorter, finer hairs until eventually the susceptible follicles disappear, leaving a bald scalp.
Several things can result in hair loss in either men or women. These include: Drug-induced hair loss, which is a side effect of medication. For example, blood-thinning medications, oral contraceptives, drugs for depression, anti-inflammatories and beta and calcium channel blockers can all lead to thinning hair or baldness. Excess vitamin A and vitamin A-based retinoids can also cause hair loss, as well as some chemotherapy drugs used to treat cancer. In addition, taking dietary supplements such as selenium may also cause hair loss. Alopecia Areata is an autoimmune condition in which your immune system attacks and destroys your hair follicles, inhibiting the growth of new hair. Fortunately, Baricitinib, a drug approved for rheumatoid arthritis, was approved by the FDA in 2022 for treatment of alopecia areata. Telogen Effluvium is hair loss caused by trauma. With telogen effluvium, severe physical stress can disrupt the hair growth cycle, resulting in hair thinning and loss; it may even come out in clumps. Possible causes include severe stress, childbirth, rapid weight loss, thyroid problems, a severe accident, surgery, burns or serious illness, which can shock the hair follicles. Trauma may result in up to 50-75% of your hair falling out, sometimes months after the fact. The good news is that this type of catastrophic hair event may resolve within six to eight months. Anagen Effluvium is the rapid loss of large amounts of hair during growth phase of hair cycle. It may affect not only scalp, but also eyebrows, eyelashes and other parts of the body. Anagen Effluvium may be caused by chemotherapy, radiation, fungal infections or an autoimmune disease. The treatments vary, but often include topical minoxidil. Stress, not just your day to day stress, but an intense amount of physical or mental stress, such as an illness or undergoing surgery or other major stressors may trigger hair loss. Nutrient Deficiencies may result in a vans of hair issues, especially a diet that is inadequate in protein, biotin, zinc and iron. Vitamin or mineral deficiencies may disrupt the hair growth cycle and lead to hair loss. Malnutrition, low protein levels and vitamin/mineral deficiencies all put hair at risk. Examples of a dietary deficiency may include brittle hair, dull appearing hair, skin and scalp dryness and sparse, light-colored hair in children. Weight loss can affect hair loss, recently the clinic has been inundated by men and women who want to shed weight, but NOT HAIR! Unfortunately, ANY weight loss program can deprive hair follicles of the nutrients and fuel they need, resulting in a telogen effluvium. GLP-1 agonists can be quite effective for diabetes and weight loss, just like restrictive diets or even bariatric surgery. Treatments include TED (Transepidemal Delivery of growth factors and peptides) for the shedding, PRP (>10billion platelets), laser therapy. oral minoxidil, exosomes, etc. What many people don't realize is that just like COVID hair loss, postpartum hair loss and other severe shedding instances, this situation can "reveal" another underlying comorbid alopecia, like hereditary hair loss. Heavy Metal Poisoning results in many health issues, hair loss being one of them. Ingestion of excessive amount of certain heavy metals such as arsenic, thallium, mercury or lithium are likely to result in thinning hair or baldness. Extreme Hair Care can cause significant hair damage and even loss. Common culprits include over styling with heated tools such as blow-dryers; excessive shampooing; traction alopecia -- pulling hair into tight hairstyles such as a too-tight ponytail, braids, bun, cornrows or hair extensions; rubbing the scalp too vigorously and damaging hair follicles; and lastly, the chemicals that are applied as perms, relaxers and hair dyes may lead to damage-induced hair loss.
Now that we've listed some of the more common causes of hair loss, let's take a look at various treatment options. Hair Restoration Treatment Options Medication: In many cases, hair loss can be effectively treated using medication and/or non-surgical means. The most effective medications are oral or topical finasteride (Propecia), topical minoxidil (Rogaine) and low dose oral minoxidil. Let's take a more in-depth look at each of these. Finasteride (brand name Propodid, eudoes as to of DHT in the scalp. DHT is the androgen that shrinks the hair follicles causing shorter, thinner hairs. One of the downsides is that finasteride may not be effective in females, and it shouldn't be taken by pregnant women or women looking to become pregnant, It is, however, often prescribed to both men and women between puberty and menopause who did not show improvement using minoxidil. Finasteride has some possible side effects, which include erectile dysfunction, decreased libido and gynecomastia (growth of breast tissue). Both oral and topical versions of finasteride are available. Topical Minoxidil (brand name Rogaine), is the leading OTC hair loss treatment. It is an antihypertensive (treats high blood pressure) drug whose side effects include increased hair growth. Topical minoxidil does have some downsides. It can cause irritation or allergic reactions, as well as excessive hair growth on the face or other areas of the body. Additionally, the regrown hair texture may be of poor quality, and it may take 6 to 12 months to grow. It is inconvenient to use topical minoxidil and minoxidil is not effective in all patients, as some lack the SULTA1 enzyme that activates the medication Lastly, it must be used continually. If patient stops using minoxidil, hair loss will recur. Low Dose Oral Minoxidil is becoming a popular treatment option due to its convenience factor. While topical minoxidil has been approved by the FDA for hair loss treatment, oral minoxidil is gaining popularity as an off-label treatment for hair loss. Studies in 2021 & 2022 show low dose oral minoxidil ( 25 to .5 mg per day) to be a well-tolerated and effective therapy, but it doesn't work for everyone. About 30-40% of women and 50% of men see improvement. The patient must have an adequate amount of the enzyme SULT1A1 in their hair follicles to successfully regrow hair with minoxidil. Patience is also required, as it can take 6-9 months of LDOM treatment before results show. Spironolactone is an oral treatment for women. with pattern hair loss. Approved by the FDA as an antihypertensive drug, one of its side effects is hair growth. It is a less potent inhibitor of androgen activity than finasteride.