Frequently Asked Questions About Hair Loss

Hair restoration surgeon, Dr. Ken Williams at Orange County Hair Restoration, evaluates and treats many men and women suffering with hair loss. During his evaluations he finds that many patients have been given misinformation about hair loss and how to treat it. These are some frequently asked questions by patients:

That causes hair loss?

There is much debate on this topic. While the link between certain forms of hair loss and the immune system is well-accepted, there is also evidence for a connection between the immune system and pattern loss (androgenic or androgenetic alopecia). In line with this, it appears that male hormones–especially DHT–trigger an autoimmune response in pattern loss, initiating an attack on the hair follicle that can be observed microscopically. This results in destructive inflammation that gradually destroys the follicle’s ability to produce terminal hair. The reason for this could be that androgens somehow alter the follicle, causing it to be labeled as a foreign body. A possibly related factor is that elevated androgens also trigger increased sebum (oil) production, which can favor an excessive microbial and parasitic population, also leading to inflammation. In any case, hair progressively miniaturizes under the withering autoimmune attack, so that with each successive growth cycle it gets shorter and thinner until it finally turns into tiny non-pigmented vellus hair (peach fuzz).

How does hair loss appear?

In men, balding typically follows the classic horseshoe pattern known as male pattern baldness or MPB, though diffuse thinning can also occur. It has been noted that both the number of androgen receptors and the level of 5-alpha reductase, which converts testosterone to DHT, are higher in susceptible areas than in the rest of the scalp. Women’s hair loss tends to be diffuse but is also primarily hormonally driven. The story of balding is, however, not the story of androgens alone. Rather male pattern hair loss appears to have multiple causes. For instance, damage to blood vessel linings can inhibit a growth factor they ordinarily produce: endothelium-derived relaxing factor or nitric oxide. Minoxidil probably works in part by mimicking this growth factor. Similarly it has been noted that severe baldness is strongly correlated with heart disease and even diabetes, so there appears to be some common etiology outside of the strictly androgen paradigm for male pattern hair loss. There are likely other factors as well.

Will Rogaine stop the hair loss in the frontal hairline?

All treatments that work on the crown also work to some degree in the front–just not as well. Treatments are generally more effective the further back you go. Confusion arises because of the way some studies were conducted. With Rogaine (minoxidil), for instance, studies only measured vertex balding; i.e., the traditional bald spot. Accordingly, the only hair growth results that the manufacturer is allowed to claim by the FDA is to say it will grow hair in the crown. However this does not mean that you should not use it on all areas of your hair loss as it most likely will have a positive result regardless of where its applied.

Will Rogaine or Propecia make my hair grow back?

Possibly, it depends on if you have started treatment soon enough. If the hair follicles are in the telogen phase, which means the follicles are alive but not growing hair, then yes the follicle will begin to grow hair again. However, if you have prolong the treatment of hair loss and the follicles are no longer alive there is no treatment available to regenerate dead follicles to begin growing hair again. These products are truly designed to keep your hairline and density where it’s at the day you start it. You will notice a decrease in shedding, and not necessarily new hair growth.

What is the average number of hairs lost per day?

On average a person loses approximately 100 to 150 hairs every day. Most of this hair regrows because the follicle remain healthy and intact. To put this in perspective, a typical adult head of hair consists of about 150,000 hair follicles.

What is the average age to consider hair restoration surgery?

Patients range in age from the early twenties to the early sixties. Only an honest and realistic evaluation can help you decide when hair restoration surgery is appropriate for you.

Does insurance cover hair restoration surgery?

Unless your hair loss was caused by an accident or a disease, health plans do not pay for transplantation surgery. However, if you are employed in certain occupational categories, such as acting or modeling, in which you can demonstrate that the procedure was important in enabling you to earn your livelihood, you could possibly claim the surgeon’s fees as an income tax deduction. You should ask your personal accountant to research this issue for you.

How long does it take to see results from any hair loss treatment?

At least 2-3 months, though usually significantly longer. Many do not notice any apparent improvements until well after a year. Best results are often seen after the two-year mark. This is because hair follicles undergo a relatively long dormancy period in between hair growth cycles (usually about 3 months). In addition, hair only grows about 1/2 inch per month in non-thinning areas and usually considerably slower in thinning areas. Since it generally takes several cycles of growth/fallout/regrowth, with the hair getting thicker and longer each time, it can take a great deal of time to see noticeable improvement. Note that best regrowth results are seen with hair that was lost within the last five years and in areas of the scalp in which there is still some fine hair.

Can shampoo make a difference in treating hair loss?

Sometimes, as a percentage of the active ingredients gets absorbed into the scalp and left behind after rinsing. For instance, seborrheic dermatitis (“seb derm,” a bad case of dandruff) is now thought to play a minor role in pattern loss. In the Propecia trials, researchers had test subjects use T/Gel shampoo (one of the many treatments for seb derm) as a means of leveling the field and cutting out this factor as a variable in determining results. Also, 2% prescription strength Nizoral shampoo used 2 – 4 times weekly was shown in one study to produce hair growth results comparable to 2% minoxidil used once daily in a small group of group of test subjects. It was also shown in a larger group to increase the number of hairs in the anagen (growth) phase and to increase average hair shaft diameter. There are almost certainly other shampoos that can positively influence hair growth, as medication can reach the hair follicle fairly easily when the scalp is in a well-hydrated state. Water is a superb penetration enhancer that is, in fact, added liberally to many medicated penetrating creams.

Can stress cause hair loss?

Sometimes stress can play a role in diffuse loss. Stress-induced loss ordinarily regrows within a year of eliminating the cause.

Is there a problem if my wife gets pregnant while I’m taking Propecia (Finasteride)?
No. Originally Merck decided to err on the side of caution and warned against the possible problem of finasteride transfer in semen. This warning has since been removed. At issue is the theoretical danger that there could be genital birth defects in the male fetus. However, women who are or could get pregnant should avoid finasteride ingestion and the handling of broken finasteride tablets.

For more information on the treatment of hair loss, a medical consultation for hair loss prevention is the best patient decision. Our hair restoration physician, Dr. Ken Williams at Orange County Hair Restoration, is available for a personal evaluation and discussion on the standard of care to prevent balding and hair loss in men and women. Our office number is (949) 333-2999.