Hair loss is a routine part of aging. Losing around 50 to 100 scalp hairs daily is normal–it can even go up to 250 hairs on shampoo days. Most people don’t count the exact number of hairs that fall off, so hair loss or alopecia is recognized by symptoms that signal something is wrong with the body:
- Handfuls of loose hair after combing or slight tugging
- A receding hairline
- Hair thinning
- Growing bald spots
- Itchy and inflamed scalp
Alopecia Types and Causes
Androgenic alopecia: the most common type of hair loss, also known as male-pattern baldness or female-pattern hair loss. It is characterized by a receding frontal hairline in men and diffuse hair thinning in women. An estimated 80% of men will experience androgenetic alopecia by 80 years. As an autosomal dominant condition, the major cause behind it is genetics. Genetic factors modify the intensity of the hair follicle response to circulating sex hormones. Hair loss typically occurs on the temples, vertex, and frontal scalp. At the temples, hair loss starts at the front hairline and moves towards the back. Hair loss at the vertex begins at the center and spreads outward around the scalp. In front, hair follicle miniaturization causes an ‘M’ shaped pattern of hair loss.
Alopecia areata: an autoimmune disorder that causes hair loss in patches on the scalp or other body regions. The hair loss can be temporary or permanent. Alopecia areata affects up to 2% of the general population, most commonly teenagers and young adults. The immune system attacks the hair follicles, causing them to shrink and slow down hair production. Alopecia areata can cause hair loss in small, round patches on the scalp, or it can lead to more extensive hair loss, including complete loss of scalp hair, alopecia totalis, or complete hair loss on the scalp and body, alopecia universalis.
Telogen effluvium: hair loss that occurs when more hair follicles than normal enter the resting (telogen) phase of hair growth. This can lead to increased hair shedding, often months after a triggering event. Telogen effluvium is a common cause of hair loss that can affect men and women of any age. The triggering events include:
- Physical or emotional stress
- Hormonal changes
- Medications
- Nutritional deficiencies
- Rapid weight loss or extreme dieting
The hair loss in telogen effluvium is diffuse and not localized to one specific scalp area. Hair may appear thinner overall but without bald spots or patches. Hair growth usually returns to normal once the underlying trigger is resolved.
Thyroid disorders: Thyroid disorders disrupt the normal hair growth cycle resulting in diffuse or patchy hair loss. In hyperthyroidism, the thyroid gland produces too much thyroid hormone, which speeds up the hair growth cycle causing excessive shedding. In hypothyroidism, the thyroid gland does not produce enough thyroid hormone, which slows down hair growth leading to thinning and brittle hair. Lupus: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that can cause scalp discoid lupus erythematosus (DLE) in 30%–50% of lupus patients. There is gradual or sudden hair loss, which may occur in patches, or diffuse hair thinning. The scalp is red, scaly, and thickened, with visible scarring or skin lesions.
Iron deficiency anemia: Iron is an essential mineral for the growth and maintenance of healthy hair and without it, hair follicles may not receive enough oxygen and nutrients. This can lead to hair loss, thinning, and dryness. Alopecia due to iron deficiency anemia is typically gradual and diffuse; hair may become brittle and break easily, and the scalp might be itchy or tender.
Scalp infections: Scalp infections can cause hair loss by damaging the hair follicles or disrupting their growth cycle. Fungal infections such as ringworm are a common cause of hair loss. Scalp ringworm (tinea capitis) can cause hair loss in circular patches on the scalp. The scalp may also be itchy, red, or scaly. Hair may regrow once the infection is treated.
Trichotillomania: a psychological disorder characterized by the urge to pull out one’s hair, which can lead to hair loss. Trichotillomania is related to obsessive-compulsive disorder and can occur in people of all ages. It most commonly affects the scalp, eyebrows, and eyelashes. Hair loss ranges from mild to severe and may be patchy or diffuse.
Cancer: Chemotherapy and radiation therapy to treat cancer can cause hair loss.
Medical Treatment for Hair Loss
Minoxidil
Topical minoxidil is a Health Canada-approved treatment for male pattern hair loss. It is applied directly to the scalp to enhance hair growth and reduce hair loss. The drug helps hair grow by increasing blood flow to the hair follicles. It may also make the active hair growth phase, anagen, last longer.
According to clinical trial reviews, 62% of patients using 5% topical minoxidil twice daily showed a significant decrease in the affected scalp area, with 84.3% reporting hair regrowth.
Brand name: Rogaine
Forms: Topical gel 5%, Foam, Topical solution
Results within: 3 to 6 months
Side effects: facial or body hair changes (usually temporary), headache, allergic dermatitis, itching
Finasteride
Finasteride is another prescription pill recommended by Health Canada to treat hair loss. The drug blocks an enzyme in the body that turns testosterone into dihydrotestosterone (DHT), the hormone that mainly causes male pattern baldness. DHT harms hair follicles, making them smaller and eventually causing them to die.
By reducing DHT levels in the blood and scalp, finasteride slows down hair loss, stops further hair thinning, and sometimes even promotes hair regrowth.
Topical finasteride is believed to increase hair thickness and reduce hair loss by lowering DHT levels around the hair follicle, which could help slow down the shrinking of the follicles that leads to this type of hair loss.
Topical finasteride reduces scalp DHT by 68% to 75% over one week of treatment, while oral finasteride reduces it by 62% to 72% for men with androgenetic alopecia.
Brand name: Propecia
Forms: Oral tablet 1 mg, Topical gel 2.5%
Results within: 3 to 9 months
Side effects: libido and erectile issues, depression, skin irritation
Minoxidil with Finasteride
The DHT-blocking effects of finasteride combined with the hair regrowth properties of minoxidil create a powerful combination to treat alopecia. Research confirms that minoxidil in combination with finasteride shows higher therapeutic benefits. Finasteride comes in an easy once-a-day pill or pre-blended with minoxidil in a custom gel designed to enhance the delivery of both active ingredients.
Dutasteride
Dutasteride is a medication recommended by Health Canada to treat prostatic hyperplasia (enlarged prostate), but since it is also clinically effective at reducing hair loss it can be prescribed off-label in cases where alopecia does not respond to finasteride. Dutasteride works similarly to finasteride by blocking the conversion of testosterone to DHT. However, dutasteride stops both types of 5-alpha-reductase enzymes, while finasteride only stops one, which could make dutasteride better at reducing DHT levels in the body.
Brand name: Avodart
Forms: Oral tablet 0.5 mg
Results within: 3 to 6 months
Side effects: erectile dysfunction, low libido, breast enlargement
Hair Loss Coverage and Replacement Options
Hair replacement systems
Hair replacement system is becoming popular as an umbrella term for hair prostheses–hairpieces, wigs, and toupees–different cosmetic methods to cover hair thinning and loss. Toupees, hairpieces worn by men to conceal bald spots or patches, are crafted from real or synthetic hair and should be fitted by a professional to blend in seamlessly with the rest of the hair.
Research has shown that wearing hair prostheses can positively impact self-perception. Wearing wigs for around 4 weeks boosted self-esteem in people with severe alopecia, according to a 2018 study. In another study of alopecia patients in the United Kingdom, 46% said that wearing a wig improved their lives significantly.
Hair transplants
A hair transplant is a surgical procedure for alopecia where scalp hair is taken from an area of the head with dense hair growth, such as the back or sides of the head, and transplanted to the region where hair loss has occurred. The procedure can be performed in the clinic within 4 hours using a local anesthetic. It has a success rate of between 78% and 90%.
There are two main types of hair transplant surgery: follicular unit transplantation (FUT) and follicular unit extraction (FUE). FUT involves removing a strip of scalp from the donor area and dividing it into individual follicular units, which are then transplanted into the recipient area. In FUE individual follicular units are removed from the donor area and transplanted directly into the recipient area.
Laser treatment
Low-level laser therapy (LLLT) is a non-invasive treatment option for hair loss that involves using low-energy laser light to stimulate hair growth. The laser light is applied directly to the scalp using a specialized device, such as a laser comb or helmet. Laser light penetrates the scalp and stimulates the hair follicles, promoting increased blood flow and nutrient delivery to the hair follicles. This may prolong the anagen phase of the hair growth cycle and promote hair growth. LLLT is typically administered in a clinic setting, although some devices are available for home use.
Platelet-rich plasma therapy
Platelet-rich plasma (PRP) therapy is a non-surgical treatment option for hair loss that involves using a patient’s blood to stimulate hair growth. During the procedure, a small amount of blood is drawn from the patient and processed in a centrifuge to concentrate the platelets. The resulting platelet-rich plasma is then injected into the scalp, particularly in areas where hair loss has occurred. The platelets in the PRP contain growth factors that may help to stimulate hair growth by promoting the growth and survival of hair follicles. It works by increasing blood flow to the scalp and promoting the production of new hair cells.
Disclaimer:
The opinions shared in this article belong to the author and, like all content on Gambit’s Health Hub, should not be considered a replacement for professional medical advice, diagnosis, or treatment. If you have any health-related inquiries, consult with your preferred healthcare professional or visit a licensed, Canadian physician through Get Gambit for a supported condition.
This article has been medically reviewed and co authored:
Dr. Taneer Ahmed, MBBS, MS
