Dealing with hair loss is complicated

Hair loss is a complex and emotionally charged issue.

This is a vast topic, and cannot be completely covered in one column.

The causes of hair loss differ for men and women.

The exception to normal hair loss is sudden, total hair loss, a condition called alopecia totalis. This is a fairly rare autoimmune disease in which the body attacks its own hair follicles, and hair is lost without warning — scalp hair, facial hair, eyebrows and even eyelashes.

Other forms of the disease can result in spotty hair loss and sometimes total body hair loss.

Otherwise, men traditionally lose hair in what is called male pattern baldness: thinning on top, or crown, then loss of the frontal hairline, and in many cases, total baldness except for a halo of hair from ear to ear.

Whether or not one will exhibit male pattern baldness is genetically determined and susceptible to hormone levels.

You have a 50-50 chance of inheriting the trait from your mother, but the odds get worse if your father carries the baldness gene as well.

But in general, this is not what we are discussing.

Weakening of hair follicles and loss of hair are also related to circulating dihydrotestosterone (DHT).

Many scenarios have been postulated regarding testosterone, hair loss and virility.

None of these hold water. Still, testosterone antagonist drugs like finasteride (Propecia, Proscar), which is taken orally, slow the process of hair loss.

A popular topical agent, Minoxidil (Rogaine) also slows hair loss, though not as effectively as finasteride.

In both cases, when treatment stops, hair loss resumes.

There seem to be as many miracle baldness cures as there are bald men.

None, including hormone injections into the scalp, regrow hair.

The drugs mentioned above slow hair loss and may thicken hair, but they do not regrow hair in follicles that have atrophied.

As we all know, hair transplants have been around for a long time.

For two decades, they resulted in permanent little clumps of hair that looked like trees in a desert.

That has all changed, of course. Micrografts are now routinely performed, and the results are natural, and often undetectable.

This is an interesting topic in itself, and we will devote a column to information from some of the hair transplant experts.

Thinning hair and hair loss are far more common among women than one might expect.

Thinning usually occurs in the 50s and 60s, and is probably hormone related.

Minoxidil is now available for women, and seems to thicken hair.

Finasteride is also effective, but should not be used by women in their child-bearing years.

Micro-needling with platelet rich plasma (PRP), a relatively non-invasive therapy, has become very popular and widely reported to thicken women’s hair after several treatments. Scientific evidence to support this remains slim.

Many women with significant hair loss seek hair transplants, primarily along the frontal hairline, usually with excellent results.