Hair Loss Education

Hair Overview

Hair loss will affect the majority of people at some point in their lives. It not only becomes more common with age (40% of 40 year olds, 50% at 50), but makes us look older than we are, no matter what our age is. If you are fortunate you won’t be affected, but someone close to you will be.

It has always been a problem and a concern. The first record of a physician writing a prescription to a patient was for a remedy to grow hair, 2000 years ago (it didn’t work and is no longer on the market). Today, there are still “lotions and potions”, but also new treatments that are proven to work. To understand how we can solve the problem, we will start by explaining the cause and nature of hair loss. With knowledge comes the power to solve the problem.

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Hair Facts & Fiction

How does the body grow hair?

All hair is non-living fiber made of keratin proteins. Each hair is produced by one follicle.

What is a follicle?

It’s the structure in the skin that produces the hair. We have follicles all over our bodies, but it is those of the scalp that we are talking when we think of hair loss.

What is the hair follicle growth cycle?

There are three phases: anagen, the active growth phase that lasts 2-8 years, catagen, when the hair growth slows over a few weeks, and telogen, lasting a few months, when the follicle goes dormant and the hair does not grow. Follicles are all at different stages in the cycle on any given day.

Is it normal to lose hair every day?

Yes, every day 50-100 telogen follicles holding a resting hair will switch into anagen. A new hair starts from deep in the follicle, replacing the old hair and pushing it out. This means that even someone without noticeable hair loss will have a normal, daily “turnover” of hair.

What causes hair loss that is more than normal?

The usual cause is inherited (genetic). There are many uncommon causes, including medication side effects, serious illness, general anesthesia, high fever, autoimmune conditions and others.

What is inherited hair loss?

Both male and female pattern hair loss are known medically as androgenetic alopecia (AGA). Simply, “alopecia” means hair loss, “genetic” means we inherit the condition and “andro” refers to the androgen hormones testosterone and dihydrotestosterone (DHT) which stops the affected follicles from growing a visible hair.

You get the genes from your mother, right?

You can get the genes from either your mother or father, or both.

Wearing a cap makes it worse, right?

This is a myth. AGA is an inherited, genetic condition. Avoiding caps will not save us!

What if I use “special” shampoo?

Nope. If it were shampoo-related, we would lose the hair on the sides of our heads as well.

Is it caused by stress?

No. Although physical and emotional stress can accelerate the loss, the cause is hard-wired into the genes.

Is this due to a circulation problem to the top of my scalp?

The problem is not the scalp, but rather the genetics of the follicles. The circulation is the same as was when you were a kid.

Why is this also called male pattern baldness?

Hair loss in men does follow two typical patterns, although every individual will have their own unique nuances. The most common male pattern starts with recession of the frontal hairline in the corners (fronto-temporal recession) or with thinning in the crown (top back of the scalp), with the two areas expanding towards each other. 90% of affected men will have a variation of this pattern and the other 10% will have general thinning on top with preserved hairline location. The cause is the same: AGA.

Why the “horseshoe” pattern in men?

This is just the pattern that nature chose. DHT is found throughout the body, but it is those follicles on the top of the scalp, which are genetically vulnerable to DHT. Those at the sides and back are genetically resistant.

What are the different parts of the scalp affected by AGA?

The top, crown and temples. Think of the top of the scalp in terms of three areas. The forelock is the front 1/3 of the scalp, the mid-scalp is everything behind that as far back as you can see in the mirror, and the crown is the back part of the scalp that someone standing behind you sees. The temples are the sides of the scalp and may also recede.

Does the follicle disappear when the hair falls out?

The hair and follicle never truly disappear. The loss of hair in AGA is “progressive miniaturization”. As the AGA affects the follicles, the hair produced is smaller in diameter, grows slower in length, and has less pigment and shine. The hair gets finer and finer, and eventually invisible. It is a loss of hair fiber size, not loss of actual numbers. This is important in understanding how medical treatments work.

When can it start?

AGA can begin anytime after puberty, when the hormonal changes increase DHT and cause the vulnerable follicles to wither away. The “bad” genes were always there, but DHT is the culprit.

How do you know you are starting to lose hair?

For most men, seeing a change in the mirror in the “corners” of the hairline is the first concern. Some notice more difficulty styling the hair, which can mean a loss of hair volume behind the hairline. In the crown, it may be the first time you get sunburn, indicating lighter coverage of your scalp, or someone noticing a thin spot when your hair is wet.

How fast does it happen?

This is different for everyone. In some, there is a slow, steady progression, in others, hair loss happens in “fits and spurts”. The only constant from person to person is that it gets worse over time.

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When Does It Stop

Once you get past 40, you are safe, right?

Wrong. AGA may not start until the 40s or even later. It becomes progressively more common the older one gets. Half of 50 year-old men will have AGA to some degree.

How do I know if I am going to lose more?

If your loss is stopped and has been unchanged for more than 5 years, you may be “stable”. On the other hand, it may start up again. Your family history will provide clues, but there is no “crystal ball”.

Does everyone with AGA end up totally bald on top?

No, most men and women with hair loss will stop short of losing the entire front and top. However, the earlier you start losing, the more likely you will lose a lot over time.

Won’t it just stop on its own?

Everyone has an end-point programmed into his or her genes. The trouble is, it is impossible to know for certain where this is and it is probably balder than you want to be. AGA is relentlessly progressive over time unless treated. In practical terms, it is rare for people over 60 to lose a lot more hair due to AGA, but until then future hair loss = current hair loss + more hair loss. It will not stop unless you take control with effective treatment!

Maybe I just have normal daily turnover?

You know if your hair is different than it used to be. Hair has function. We see it and style it. If you are worried, get your hair checked by a specialist physician who knows how to spot early loss and is interested in treating it. Every day you wait costs you hair. It will not stop on its own.

How can I tell how bald I am going to get?

Family history is helpful, but not a guarantee. Get your hair examined by an expert. To an experienced hair loss physician specialist, areas of impending loss can be seen and felt with the fingertips as a “wispy” texture. This can help estimate where it is headed.

Is there a cure?

If you have an infection and you eliminate it with an antibiotic, you are “cured”. Because AGA is a genetic condition it can be blocked, but not cured. It will progress until it reaches the end-point, or until stopped by treatment.

If I already have these genes and can’t get rid of them, what’s the point in worrying?

The point is choosing to stop the loss. You don’t have to go bald, but wishing and hoping won’t do anything. The earlier you start treatment, the more hair you will save.

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Why Does It Bother Me?

Why does hair loss make us look older than we are?

The front and temple hairlines (sides of the head above the ears) “frame” the face. Recession alters the proportions with the other facial features, like the nose, eyes and mouth, and adds years to our appearance. That’s why you look younger when you put on a hat and the recession disappears. Women who thin and lose volume and body from the hair on top will notice a similar change, plus the extra “shine” of the scalp showing through.

If this is so common, why should I let it bother me?

Hair loss causes a negative change in our appearance, and it just gets worse. It’s normal to dislike it. It’s normal to be bothered by it. If you were alone on a desert island, and saw your vanishing hairline reflected of in a pool of water, you wouldn’t like it. If you got your front teeth knocked out, you would have them replaced, wouldn’t you? Why should losing your hair be any different?

What can I do?

You don’t have to do anything. Fact: the loss will get worse. Fact: you can stop it, but you have to get the tools to do the job. Allowing more hair loss to happen is the only choice where you don’t have to do anything. It’s less work to go bald, but it’s not easier, is it?

If this is so common, why is it under-treated?

Unfortunately, most men with hair loss suffer in silence. Hair loss is not a medical risk like high cholesterol, so you won’t get screened for it. Often, many of us won’t ask our Doctor about hair loss because we feel shy, and your Doctor may not bring the issue up for the same reasons. Maybe it’s thought to be just part of getting older. Finally, many patients and physicians are not aware of the effectiveness of medical and surgical treatment. More years go by and more hair is lost. If you want treatment, you have to go after it.

Is it expensive to treat my hair loss?

It often isn’t, but of course, that depends on your goals and degree of loss. Finasteride costs $10-50 per month, depending on dose and format. Minoxidil is as little as $12 per bottle.

What about the cost of Doctors appointments?

Hair loss is a medical condition, so appointments to see a doctor are insured by Alberta Health. There is no additional cost to you

Maybe I shouldn’t worry about my hair.

Sometimes, we feel like we should be able to just accept the change in our appearance and that it shouldn’t matter. Wrong. It is NORMAL to be bothered by hair loss. Do something about it. Find out why it is happening and do what you can to stop it. Act. You’ll feel better.

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See An Expert

Is proper diagnosis important?

If you see a bald guy, you can make the diagnosis from across the street. However, specialized knowledge and experience are needed for diagnosis in the early stages. This is important because early treatment is so valuable.

What can I do?

Many patients who come to see Dr. Elliott are happy to know there is finally something they can do. If you are worried about hair loss, but haven’t been able to get help, don’t give up. See a hair loss treatment specialist and start getting solutions.

What is a hair loss treatment specialist?

These are physicians who by choice, training, and experience specialize in the medical and surgical treatment of hair loss. They have much more experience in the use of medical therapy and can more fully explain your options including hair restoration surgery. Many have experienced hair loss and its treatment themselves and can understand your concerns. Dr. Elliott has had 2 hair transplants and has used Finasteride and Minoxidil for many years with great results. He has seen thousands of patients for their hair loss. This is what he does.

Is it worth the trouble?

We are talking about your HAIR! This can be as simple as stopping the loss by seeing a doctor and taking a pill. Isn’t that worth it? Dr. Elliott doesn’t want to go bald either and he has maintained his hair for the last 10 years thanks to these same treatments. Meet Dr. Elliott and some of his patients. See what you think. It’s less work to go bald, but it’s not easier, is it?

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Hair Loss in Women

This is mostly a male problem, right?

Wrong. Hair loss is much more common in women than anyone realizes. The common cause is still inherited AGA, with some exceptions. The pattern tends to be different than in men and it tends to be even more under-diagnosed and treated than AGA in men, but the relentless worsening over time is the same.

What is female pattern hair loss?

This is the typical pattern of loss in a woman with AGA. The hairline may thin, but doesn’t recede much and there is general thinning through the top and crown. This will show itself in a widening of the part and more scalp showing through the hair. There is also loss of hair volume on top. Most affected areas will thin, but do not become totally bare. Approximately 90% of women with AGA will have this pattern, with the other 10% having fronto-temporal recession of the hairline.

What are the early clues in women?

Styling difficulty may develop because of less hair volume on top. A woman with longer hair may notice less thickness in her ponytail. Widening of the part or seeing more of the scalp will happen with more loss.

Does it happen in all age groups of women?

It can start as early as the late teen years and is a problem in all age groups. The longer diagnosis and treatment are delayed, the worse the loss gets.

If this is so common, why is it under-treated?

Unfortunately, most women with hair loss suffer without knowing there is help. It does not pose a risk to your physical health like high blood pressure or cholesterol. With all the physical health concerns your Family Doctor has to monitor, it is not surprising that hair loss is of lower priority for treatment. Often it is never diagnosed, or thought to be just part of getting older. Many patients and physicians are not aware of the effectiveness of medical and surgical treatment. Often, many of us won’t ask our Doctor about hair loss because we feel embarrassed or shy. Then more years go by and more hair is lost.

Is proper diagnosis important?

Hair loss in women can take many different forms and can be subtle. Specialized knowledge and experience are needed for diagnosis in the early stages. Many women with concerns will have their loss unrecognized by their general physician for this reason.

What can I do?

You don’t have to do anything. Fact: the loss will get worse. Fact: you can stop it, but you have to get the help to do it. Allowing more hair loss to happen is the only choice where you don’t have to do anything. It’s less work to go bald, but it’s not easier, is it?

Who can help?

Many female patients who come to see Dr. Elliott are reassured to know there is finally something they can do. If you are worried about hair loss, but haven’t been able to get help, don’t give up. See a hair loss treatment specialist and start getting solutions.

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Cost

Is it expensive to treat my hair loss?

It often isn’t, but of course, that depends on your goals and degree of loss. Minoxidil is no longer expensive. One bottle which 10 years ago cost around $65 can be as little as $15 today. This will last about a month. Non-surgical options, like wigs can be much more expensive than that.

If I want hair transplant surgery, how much does that cost?

Hair transplant costs are explained here.

What about the cost of Doctors appointments?

Hair loss is a medical condition, so appointments to see a doctor for consultation and medical treatment are insured by Alberta Health. There is no additional cost to you.

Maybe I shouldn’t worry about my hair.

It is normal to be bothered by hair loss. Find out why it is happening and what you can do about it. Act. Do something. You’ll feel better.

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How Do I Select a Hair Treatment Specialist?

How do I choose a hair loss treatment physician?

Simple. The same way you would choose any other professional. Experience, skill, integrity, honesty. Someone who understands your problem and takes it seriously. Find a doctor who will work as hard to save your hair as you would if you were a doctor. Someone you can trust with your hair. You’ll know when you’ve found the right one.

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Dr. Vance Elliot