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Hair Loss in Men

The overwhelming majority of men with hair loss have male pattern baldness.  Doctors call this hereditary androgenic alopecia.  The gene that causes male pattern baldness is autosomal. That means that you can inherit the gene from either parent.  The gene has variable penetrance.  This means that there are other modifying genes that affect how much baldness the individual with the gene will actually develop.  In male pattern baldness, a metabolite of testosterone known as dihydrotestosterone (DHDT) will cause some genetically susceptible hair follicles to miniaturize eventually to a degree where they are no longer visible.  Hair loss typically starts after puberty but may continue to advance much later in life.

Psychological effects of hair loss varies greatly.  Some men are highly motivated to treat the problem; others become very accepting of their developing baldness.

Treatment options include a topical liquid (minoxidil) and an oral medication in the form of a pill (finasteride).  These medications provide benefit for some men but need to be continued lifelong to continue to be effective.  There is a variety of camouflage products including powders and creams that may be applied to thinning areas of scalp to make the hair loss less apparent.  Hair pieces may be used to cover areas of balding.  They may be held into place with adhesives, clips, or woven onto the remaining hair.  Hair transplants offer a surgical approach to provide a permanent and natural appearing result.  Since the development of follicular unit transplantation, other methods including scalp reduction (excising bald areas of scalp) and scalp flaps (transferring a flap of scalp from the side and back of the head to the top or front of the scalp) have become much less popular.

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Hair Loss in Women

Significant hair loss in women is less common than in men but can be particularly devastating psychologically.  The hair loss usually does not involve a receding hair line though in some cases it can.  Typically, there is diffuse thinning over the top of the head and in some cases, the entire scalp can be involved.  Most women with hair loss have female pattern baldness which is genetic.  There are less common causes of hair loss which may occur including thyroid disease, iron deficiency, malnutrition, hormonal changes with childbirth, lupus, and lichen planopilaris.  Women with female pattern baldness typically lose their hair very gradually although the rate may accelerate with pregnancy and at menopause.  The hair loss can be cyclical with temporary periods of improvement.

Women with a mild degree of thinning may be able to camouflage the hair loss with hair styling techniques.  Topical products such as spray on powders may help disguise the thinning.  The only FDA approved medical treatment for women is topical minoxidil which may provide some benefit.  Hair pieces and wigs may be used to cover areas of thinning.  Hair transplantation is a surgical approach that can help many women with hair loss.  Most women with hair loss still have thicker hair in the back of the head which can then be transplanted to other areas of hair loss.  Uncommonly, a woman may develop extensive hair loss at the back of the head in which case the benefit of hair transplantation would be severely limited.

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