Hair loss: causes, treatments and transplants

Hair loss (alopecia) is thought to affect 10 million men and women in the UK. What can you do to maintain your 'crowning glory' and do any of the 'wonder drugs' work?

This article is written by Sarah Dawson, a freelance journalist who writes for national and international newspapers, magazines and websites.

Since time, immemorial hair is seen as a reflection of a person's overall attractiveness and vitality and in today's celebrity-driven look-good culture there's no wonder that losing it causes a great deal of distress. Alopecia is the term used to describe all forms of hair loss and baldness, of which there are several different types. Most hair loss is down to the ageing process and/or hormonal changes, and is not a disease.

Alopecia can be genetically inherited, or caused by a number of lifestyle factors such as diet, hormonal imbalances (increased production of male hormones, thyroid disorders) or stress. However, according to the Institute of Trichologists, hair loss could also be the first sign of an otherwise undiagnosed or undetected underlying illness so it's worth visiting your GP to get checked out.

The most common form of hair loss, predominantly affecting men but also common in women, is Androgenetic Alopecia. Known as Male Pattern Balding or Male Pattern Alopecia it occurs as men age.  The hairline recedes at the front and thins on top with a bald patch gradually developing in the middle of the scalp with the receding front and top bald patch eventually merging together.

A rim of hair might remain around the back and sides of the scalp, which can also thin out leaving a completely bald scalp and near-baldness by the time a man reaches his sixties. For some men, balding begins in their twenties and is down to the luck of the (gene) draw. In women, Androgenetic Alopecia is related to hormone levels in the body and a large genetic predisposition. A woman's hair begins to thin all over the head, with loss predominantly over the top and sides of the head, rarely resulting in full baldness.

Alopecia Areata is an autoimmune disease and, because the only symptoms are patches of hair falling out, your friends, family, or your hairdresser may notice the condition before you do. It can be inherited and is caused by hair follicles being attacked by white blood cells, making the follicles very small and slowing down hair production, resulting in no visible hair growth for a long period of time. The hair follicles are not permanently damaged so steroid injections or creams can help encourage the hair to grow back but many hair experts believe that in most cases alopecia areata resolves itself, after about a year without need for treatment.

Alopecia Totalis means a total loss of scalp hair and Alopecia Universalis is when hairs across the whole body have been shed including eyebrows/lashes.

With Telogen Effluvium hairs start shedding around the scalp, as well as over the body as a result of extreme stress, or as a side effect to medication. This condition can affect both men and women, and is often seen in middle aged women. It causes more of a 'thinning out' of hair, rather than a specific bald patch and can get better on its own provided the stress or trigger which started it is dealt with. It is thought to be caused by a deficiency in nutrients like iron (anaemia), hormones (menstruation, giving birth, breast-feeding), certain medication or a psychological shock such as a death or accident. Hair loss can also be caused by fungal infections, thyroid problems as well as chemotherapy (treatment for cancer) but treating the infection/condition may prevent further hair loss and in some cases - including after cancer treatment - the hair may start to grow again.

Treatments

There are many companies, products and treatments claiming to cure hair loss, but be wary of miracle cures and remedies with high claims - and high prices. Treatments which work well for one person may not for another but medications recommended by the NHS can help hair re-growth. Minoxidil is a treatment for high blood pressure and is available over the counter at the Chemists for men and women.

If the lotion is rubbed onto the scalp every day, reports show that that the balding process will slow in about half of users, about fifteen per cent will experience hair re-growth, but one third of users won't see any changes. Finasteride is a drug for treating prostrate cancer, available only by prescription for men from their GP. It works by preventing the hormone testosterone being converted to the hormone dihydrotestosterone (DHT). DHT causes the hair follicles to shrink so blocking its production allows the hair follicles to regain their normal size and is known to be effective. Finasteride isn't suitable for women. Both medications require around four months of use before any benefits are seen, otherwise the balding process will resume and there's the risk that any new hair which re-grows could fall out if treatment is stopped.

Hair transplant surgery

New technologies in cosmetic hair transplantation and scalp reduction procedures mean that you often can't tell when someone has had treatment. In a Hair Transplantation operation, the surgeon will take tiny punch-holes of skin containing a few follicles of hair from a well covered part of the body (quite often the back of the head) and implant these into the thinning areas. It takes place under local anesthetic and it's common to have a series of treatments. There are three types of scalp surgery - in a scalp reduction procedure devices are inserted under the skin to stretch areas of scalp that still have hair then the redundant bald areas are removed. Scalp flap surgery involves moving a hair-covered section of the scalp to a bald area of the scalp and stitching it back together and scalp extension means stretching and loosening an area of the scalp by placing a gradually expanding device underneath it for a few weeks, and then performing scalp reduction surgery. Ensure your surgeon has the appropriate skills and experience, check with the British Association of Hair Restoration Surgeons and that the clinic is registered with the Healthcare Commission.

Experts also believe that eating a balanced diet helps maintain healthy hair, while a diet full of fat, fried and refined food won't. If you choose to wear a wig, visit a specialist centre for a good quality one.