Before one can decide if they might need medical treatment or a hair transplant, a proper diagnosis of their hair loss condition should be made by a dermatologist or hair loss specialist. Hair loss may be pattern hair loss (male or female) or non-pattern hair loss.
Most hair loss is male or female pattern hair loss, which is characterized by the gradual miniaturization of hairs – usually in a specific pattern – for a few to several years until finally falling out due to a sensitivity to dihydrotestosterone in the case of males.
Norwood: Male Pattern Hair Loss Scale
Ludwig: Female Pattern Hair Loss Scale
The great majority of all hair loss is male or female pattern alopecia.
Hair loss (or alopecia) that is not in a genetic male or female pattern is divided into:
Sometimes generalized hair thinning is caused by hair shedding. More than 100 hairs per day is significant – this usually is a telogen effluvium (hairs which have entered the resting or telogen phase of the growth cycle – and are thus falling out). When hair follicles enter the telogen phase, the hairs held firmly in those follicles become loose and fall out. Certain severe toxins, radiation or chemo can cause anagen effluvium – where hairs are shed during the anagen (growth) phase of the cycle – as the follicles are destroyed. A telogen effluvium usually occurs about three months after the precipitating event, whereas anagen effluvium occurs closer to the toxic event.
Hair transplant surgeons often find unusual cases where the normal patterns of male-pattern baldness or female-pattern baldness are not present. Usually these are unusual and irregular patterns of hair loss on the scalp, frequently accompanied by loss of pores and hair in the area in question, and often a smooth, glassy appearance on the scalp.
When these are present, it is necessary to do a biopsy to determine the process that is active. Generally, loss of pores and smooth shiny scalp indicate a scarring alopecia.
Pattern Baldness Versus Generalized Diffuse Hair Loss
Note that male and female pattern baldness are just that, hair loss in a pattern, generally on the top, sides, and back of the head, but sparing a thick donor area. Other types of systemic problems such as low thyroid, iron deficiency, collagen disorder, growth or sex hormone deficiency, secondary syphilis all may cause diffuse hair thinning. If you have generalized hair thinning, you need a complete medical workup for the various causes. Also note that some people have both a pattern hair loss as well as a diffuse or generalized decrease in density. These people may well have both conditions simultaneously, but still require a complete medical workup, normally with lab tests and biopsy.
You can download in PDF format and email at another time. The form includes a medical history as well as asks you for photos of your head. Please follow the instructions for taking the photos – the better and more clear that they are, the better we can determine your needs.
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