What is Causing Hair Loss? Your Guide to Alopecia

Signs of aging are seldom ever positively received by those experiencing them except for some men who embrace a bit of salt and pepper in their hair. A sign of aging that is sure to add a bit of white to any man or woman’s hair is hair loss. Today, Greenberg Cosmetic Surgery would like to present a simple guide that explains some of the many factors that are behind persistent hair loss and what can be done about it. Let’s dive in!

How Do I know I’m Losing Hair?

Hair loss is a catch all term for many different things that can contribute to the lessening of terminal hair density on the scalp. But before you start worrying and seeking out solutions, it can help to find out first if you are in fact losing hair at an abnormal rate.

Signs You Are Going Bald

There are a few tell-tale signs you are losing hair at a less than normal pace. Look for these signs in your day to day and treat them as warning signs. In many hair loss cases, the earlier you catch it, the better your outcomes can be for just about every treatment.

  • There are excess hairs on your pillow in the morning
  • You see more than a normal amount of hair shedding in the shower
  • You test positively on the pull test—choosing about a bundle of 40 hairs in different sections of your head and gently tugging. If more than 6 come out, you test positively.
  • The scalp is becoming highly visible on parts of your head—typically the crown or hairline.

These are many of the common signs that active hair loss is occurring. It is normal to lose about 50-100 strands of hair per day, that may seem like a lot, but throughout the day it is not much compared to the average hair density of about 100,000 hairs on a person’s head.

How the Hair Cycle Affects Hair Loss

Hair loss is like everything else in life, it goes in cycles, and for many people their hair health and condition is a sign of their life and vitality. This is why hair loss can be so devastating.

There are 3 (technically 4) stages of the hair loss cycle.

The Anagen Phase

The anagen phase is the growth phase of your hair cycle. The anagen phase lasts anywhere from 2-7 years, and reportedly this phase is longer in populations of Asian descent (coming in at around 7 years), which means that such people can potentially achieve longer terminal hair length since the growth phase is longer. On average, this phase is 3-5 years for most people and shortens with age.

On a healthy scalp that is not experiencing hair loss, approximately 80-90% of hairs are in the anagen phase at any given time.

The Catagen Phase

The catagen phase is a transitional phase that marks the end of the anagen phase and sends the hair follicle into a resting phase in which it is detached from the blood supply. This hair is called a club hair and will remain in this phase for about 2-3 weeks.

The Telogen Phase

This is the phase that breaks hearts and is the source of a multi-billion dollar hair loss industry. The telogen phase is the “final” stage which begins with the club hair resting in its root. This phase lasts approximately 3 months and after this period, the hair falls out and is replaced by the hair that was growing underneath it. The exodus stage is technically a 4th stage, in which the hair falls out.

What is Alopecia?

Alopecia has been used as a catch-all term to reference what is also known as MPB—male pattern baldness, or androgenic alopecia. Despite the name androgenic alopecia can effect women too, dubbed female pattern baldness.

Before we cover that, it is important to distinguish androgenic alopecia, from alopecia areata.

What is Alopecia Areata?

Alopecia areata is an auto-immune condition in which the immune system attacks the otherwise healthy hair follicles on a person’s head or body. This attack causes the hair in the follicle to fall out. As such, alopecia areata can come on hard and fast and be incredibly distressing to those experiencing it.

Sudden onset hair loss is very stressful and can raise significant health concerns. This is because those who possess one auto-immune condition, are at risk for developing or already possessing another. Thyroid issues are a common autoimmune condition in the form of Hashimoto’s thyroiditis.

As such, those experiencing hair loss are typically also screened for auto-immune conditions as well as for hyper/hypothyroidism, which on their own also contribute to hair loss regardless of whether alopecia areata is occurring or not.

Alopecia areata cannot be cured, but hair loss that is a result of alopecia areata typically grows back in full. The main issue is that such hair loss can be persistent or chronic and come in episodes.

For many people, AA leaves tell-tale signs such as circular bald spots or other shapes, such as a straight band of hair loss with a strong line of demarcation. Occasionally, AA will manifest as widespread hair loss.

What is Male Pattern Baldness?

MPB is a condition that affects many men. Men with moderate to extensive hair loss increases with age. About 16% of men 18-29 experience moderate to extensive hair loss and 53% of men 40-49. This loss is typically in the form of thinning or a recession of the hair line. Regardless, year after year, more hair is lost than is regrown, and as such the density of the hair is less and less each year.

The exact cause and mechanism of MPB is actually unknown. The prevailing theory is that the male androgen, DHT—dihydrotestosterone, is responsible for hair loss because it links to hair receptors and causes follicular miniaturization in those susceptible. Susceptibility is genetic, meaning that you inherit your follicular sensitivity to DHT from your parents and/or grandparents. This distribution is currently unknown.

Follicular miniaturization is a big sign of MPB. While everyone loses hair, if you’re noticing that your hair not only gets thinner every year, but you are also losing the thickness of individual strands of hair, it means that those follicles are getting smaller and smaller. Eventually, the hair that grows from that follicle will be a thin baby hair that doesn’t achieve full length. Then, the follicle closes.

Why Does Balding Feel So Bad?

MPB is a normal part of aging for many men, but that has not stopped men from experiencing a tremendous amount of shame and anxiety around the situation. It’s only natural, while there are many men who can sport a bald look with manly distinction, some men are simply not suited for the look. That is not unusual, as not every haircut looks good on everyone and so and so forth.

Women are not the only one’s who feel pressure to meet beauty standards in society. Balding has a stigma around it and it unquestionably can add years to a man’s appearance or make him look older than he is.

The point is this: if it’s not a choice, then it feels worse. Going bald is not a choice for most men, and the experience is fraught with denial and typically occurs at a time where many men are transitioning from their youth to adulthood or middle age. Balding thus, feels like a forced transition from a man’s youthful days of fun to being an old man.

At Greenberg Cosmetic Surgery, we understand one thing very well: one of the keys to happiness and being comfortable in your appearance relies on being able to choose for yourself what your style and appearance should be.

Are You Experiencing Alopecia or Male Pattern Baldness?

Any hair loss is concerning but knowing the cause of it is crucial to knowing what can be done. Discerning whether you are experiencing alopecia areata or male pattern baldness is fairly simple.

Alopecia areata:

  • Typically has circular bald patches
  • Comes on suddenly or hair falls out fast
  • Can affect other parts of your body such as eyebrows and body hair
  • Is not limited to the top of your head, with loss occurring on any part of the head.
  • Growth most often reoccurs

Male Pattern Baldness:

  • Is genetic
  • Can be slow to progress or notice initially
  • Can be treated, but is not “curable”
  • Loss occurs occurs on the top of the head with sides remaining unaffected
  • Hairline is receding
  • Crown is thinning into a bald spot
  • Regrowth is thinner in diameter and increasing prevalence of baby hairs

Those are some of the basic differences.

What About Women? Do Women Get Pattern Baldness?

Women do in fact experience female pattern baldness, though the patterning is different. For women, female pattern baldness exhibits itself through a widening and loss of hair at the natural part of the hair. From thereon if it progresses then diffuse hair loss is observable with age. Because women are more susceptible to thyroid disorders than men, it is especially recommended to check for any endocrine issues with women experiencing hair loss.

Treatments for Balding: Medication or Surgery?

At Greenberg Cosmetic Surgery, hair restoration is one of our most popular treatment categories for men. Many men simply want to wear the hairstyle they’ve always worn and enjoy the wind tousling their hair on a leisurely drive. Sadly, those predisposed to balding are forced to lose the style options that hair gives everyone. Your hair can say a lot about you and in older men, is a sign of youth and desirability in the eyes of society.

We don’t back that sentiment up at Greenberg Cosmetic Surgery, but we understand that it is a feeling that many have and is reinforced through popular media.

Thankfully, this is not the 1820’s where the only available “cure’ was a charming snake oil salesman and his traveling caravan offering you a concoction to cure balding.

There are medicinal treatments as well as surgical treatments such as getting hair transplant surgery, but which one is better for you?

Should I Take Medications for Balding?

Medicinal treatments for hair loss are divided in two categories. Topical and oral.

Topical treatments are medications such as topical minoxidil (Rogaine) which can provide some regrowth in those beginning to show signs of balding. Those further along in their balding journey will not benefit nearly as much as those who have yet to lose most of their hair.

The second, and increasingly common one is finasteride (Propecia). Propecia was originally developed for handling issues with prostate enlargement, but a curious side effect of hair regrowth was observed. This is because finasteride blocks the conversion of DHT from testosterone through inhibiting the action of an enzyme called 5-alpha-reductase. This effectively stops thinning and encourages regrowth in active follicles that are no longer being besieged by DHT.

The issue? Propecia (finasteride) has been developing as of late, numerous personal injury lawsuits by many men who claim that finasteride has caused undue harm to reproductive ability, damaged their libido, or given them permanent difficulties with maintaining an erection or ED. While most men who take finasteride do not experience side effects, side effects are well-known and typically subside within a couple weeks or months.

Barring side effects, finasteride is effective, but the growing concerns around its long-term effects on some men make many men reluctant to take it.

Hair Transplants vs Finasteride

Finasteride is a pill you will have to take for the rest of your life to achieve your hair regrowth goals. Furthermore, much is still unknown about the long-term effects of this prostate medication. Even if the medication is mostly safe to use, many men are intent on limiting prescription medication usage and are in favor of more permanent solutions.

For these men, hair transplant surgery is a highly effective method of dealing with MPB. Dr. Greenberg of Greenberg Cosmetic Surgery is an expert at performing surgical hair restoration techniques.

The benefit of hair transplant surgery is that you don’t have to take a pill and fear side-effects regarding your libido or sexual performance.

Neograft is an FDA approved procedure that uses an instant follicular unit extraction technique which offers natural looking results and was designed with patient comfort in mind. Follicles are taken from one spot and placed in another to “spread the wealth”, as balding men have no shortage of healthy and functioning hair follicles on the sides and backs of the head.

Hair Transplant Surgery Long Island

Greenberg Cosmetic Surgery understands the importance many men place on having a full head of hair, whether it is for aesthetic reasons or simply personal reasons. Heck, maybe you’re just tired of your head being cold when winter rolls around.

No matter your reason, if it is important to you, we are here to offer our professional services backed by decades of experience in cosmetic surgery.

Contact Greenberg Cosmetic Surgery today if you are interested in hair transplant surgery in Long Island, or wish to consult about your various options for hair restoration.

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