Androgenetic alopeciaHair that begins to thin above both temples and a hairline that has receded into an M-shape are all signs of genetic male pattern hair loss (MPHL) or androgenetic alopecia, as its also known.
“The hair miniaturisation and eventual loss is due to the action of the hormone dihydrotestosterone (DHT) acting on those hairs that have receptors for DHT,” explains Etre Vous Expert and Hair Transplant Surgeon, Dr Greg Williams.
It’s a form of hair loss that is prevalent in men, and according to the NHS, 67 per cent of men with hair loss issues have the condition. But it's also found in 24 per cent of women who experience hair loss.
Androgens are typically thought of as male hormones, but women produce them too. For men, “the most effective treatment is to block the production of DHT which is converted from testosterone by an enzyme called 5-alpha reductase. Oral finasteride is licensed for the treatment of MPHL and works by blocking Type 2 5-alpha reductase,” shares Williams.
While for women, androgenetic alopecia can be treated with anti-androgens. These can block androgen receptors, reduce adrenal androgen production, ovarian androgen production, prolactin production, insulin resistance and inhibit that troublesome 5-alpha reductase. But Williams warns, “this should be (taken) under the supervision of a dermatologist with an interest in hair loss as the first step is to ensure the diagnosis is correct.”
Alongside prescription meds to stop or slow this form of alopecia, topical minoxidil, that shortens the resting phase of the hair – so that the hair enters its growth phase – can work well in some people. However, it is unlikely to grow back all the hair you’ve lost, and that’s where hair transplant surgery comes in. This surgery replaces hair where it has been lost, by either taking hair from one part of the body and transferring it to the scalp, or using synthetic fibres.
Telogen effluviumConsidered the second most common form of hair loss, Telogen Effluvium (TE) is characterised by large numbers of hair follicles entering telogen, aka the resting phase - all at the same time and then not entering anagen – the growth phase. This results in hair loss in all areas of the scalp.
The condition according to Williams, “can be acute or chronic and is thought to be due to a physical, psychological, or emotional stress. But the hair shedding might only start several months after the causative event.”
It’s not a well understood hair loss condition but acute TE will usually resolve spontaneously so specific treatment is not necessary. “However, recovery might take many months to commence, and because hair grows at about a centimetre a month, it can take a long time for hair volume to recover fully,” explains Williams.
When it comes to chronic TE treatment, this often requires a holistic approach. “Investigation into a patient’s lifestyle including diet and epigenetic factors is key. Ruling out dietary deficiencies such as protein, iron, zinc and vitamin D is important as well ensuring the patient does not have any thyroid disease. Epigenetics is not well understood but stress, smoking and excessive alcohol intake should be avoided, while sleep should be maintained,” adds Williams.
Diet wise, the consensus from doctors and trichologists alike is to ensure that it’s balanced, and protein levels are adequate. Your body uses proteins to build tissue cells — including the cells of your hair, skin and nails. 80 to 85 percent of your hair is composed of a protein called keratin, and dietary proteins are composed of amino acids, which are your hair’s building blocks.
"Without sufficient available protein, your hair can become brittle and fall out,” shares Trichologist Anabel Kingsley. Meaning consuming protein is important for hair health, so to work out how much you need per day, make sure for every kilo you weigh you consume 0.8 grams of protein.
Traction alopeciaTraction alopecia occurs from hairstyles that cause continual tension, think tight ponytails, braids and extensions (especially if used alongside chemical straighteners). “It is common in women with Afro-textured hair, but also occurs in ballerinas who wear tight buns and Sikh men from a combination of tight hairstyles and wearing turbans,” shares Williams.
Treatment can be simple: “if the causative habit is stopped early enough then there can be significant regrowth. But once a terminal stage in the hair deterioration is reached, only hair transplant surgery will restore hair coverage,” explains Williams.
And how do you create an environment for hair to grow back? Ditch, or at the very least limit chemical treatments, especially relaxer – as generally these leave hair weak, brittle and prone to breakage. In fact, in the case of relaxers specifically, repeated use can negatively impact the scalp and scar the follicle leading to permanent hair loss.
PRP, where ones' own plasma is injected, in this case into the scalp, is also a popular treatment for traction alopecia as it can help promote growth, thanks to the platelet rich plasma's ability to prolong the growth phase of a hairs life cycle.
Greg Williams, Hair Transplant Surgeon
I am a Plastic Surgeon with a full time practice in Hair Restoration Surgery. I spent just under a decade as an NHS...Book with Greg Williams