Science is rapidly advancing our understanding of the causes of hair loss. The successful treatment of hair loss is being rapidly advanced by physician hair restoration specialists who use scientific knowledge to create innovative approaches to hair restoration.
As scientific knowledge advances, it becomes clear that the causes of hair loss are complex and may vary in multiple ways from person to person. The physician must establish a proper diagnosis for the cause of each patient's hair loss. This step is critical to the development of an individualized hair restoration treatment plan.
Physician hair restoration specialists understand that hair restoration must be as individualized to the patient on the basis of (1) cause, pattern, rapidity and extent of hair loss, and (2) the wishes of the patient regarding desired result, cost, investment of time, and potential complications and side effects.
Hair Loss in the Individual Patient
Over the past two decades a great deal has been learned about (1) what causes scalp hair to grow, an (2) what causes scalp hair to be lost. The causes of scalp hair growth are more universal to all humans, while the causes of scalp hair loss have many individual variations ranging from trauma to disease to genetically inherited male and female pattern hair loss.
Pattern hair loss is the most common cause of permanent hair loss in both men and women. See About Hair Loss for more detailed discussion of the causes of hair loss. Although much has been learned-and continues to be learned-about the underlying causes of male and female pattern hair loss, our understanding is not complete.
Thus, the scientific acumen and clinical skills of a physician hair restoration specialist are essential to interpret the results of diagnostic examination, establish a most probable cause of hair loss in any individual patient, and determine what treatment is likely to be most effective.
Interpreting Examination Results in Men
Genetic predisposition is known to be the underlying cause of male pattern hair loss. A gene (or genes) inherited from parents predispose a man to produce the testosterone byproduct associated with hair loss. See About Hair Loss for full explanation of the link between testosterone and hair loss.
However, the genetic predisposition is not clearly understood:
- No "baldness gene" has been identified with certainty.
- It seems likely that two or more genes acting in concert are involved in male pattern hair loss.
- Although male pattern hair loss is most common in men whose fathers and other close male relatives also had male pattern hair loss, one of the key genes believed involved in male pattern hair loss is inherited from the female line of the family (that is, it is located on a X or "female" chromosome rather than the Y or "male" chromosome).
- Although family history frequently reveals a genetic history of male pattern hair loss in close male relatives, 20% of men with male pattern hair loss have no family history of the disorder.
It is not entirely clear that genetic predisposition is the only factor involved in all cases of male pattern hair loss. In men over the age of 50 years, for example, it appears possible that age-related factors may be involved in addition to genetic predisposition.
Genetic predisposition appears to present differently in different ethnic groups. The pattern and extent of male pattern hair loss may differ in men of Caucasian, Asian, African and Native American descent.
Clinical findings and their evaluation require the skill and experience of a physician hair restoration specialist. While male pattern hair loss may appear to be the most likely cause of hair thinning, other possible causes must be excluded. In an athlete, for example, the possibility of hair loss accelerated by steroid use may be a consideration. Hypothyroidism can mimic male pattern hair loss or cause additional hair loss within a male pattern of hair thinning. Iron deficiency due to an iron-deficient diet may be a consideration in an otherwise unexplained instance of hair loss.
Evidence from standard tests such as the "hair pull" provides important information regarding the onset, duration and pattern of hair loss as well as indications that disorders other than male pattern hair loss may be involved. Information from standard tests is essential for the physician hair restoration specialist's eventual recommendation for treatment. For example, if hair thinning is not primarily due to male pattern hair loss, medical hair restoration therapy using finasteride (Propecia®) that selectively treats male pattern hair loss would be ineffective.
Clinical examination provides essential information regarding the current and probable future supply of a patient's donor hair-hair in the areas at the back and sides of the head that used to supply grafts for hair transplantation. See The Donor Site: Savings & Loan of Hair for Transplantation for more information. Correct interpretation of donor supply in context with a patient's type, duration, rapidity and probable future hair loss is critical for planning hair transplantation that will yield long-term successful results.
Interpreting Examination Results in Women
Pattern hair loss is seen in women as well as in men, but the "pattern" is significantly different, a family history of hair loss is often lacking, and causes other than pattern hair loss can be significantly involved.
The role of androgenic ("male") hormones in female pattern hair loss is not as clear-cut as it is in men. However, disorders of androgenic hormone production that contribute to hair loss may be due to underlying disease involving the ovaries or adrenal glands. Screening tests for androgenic hormone levels, thyroid hormone levels, and iron deficiency are commonly recommended by physician hair restoration specialists to rule out underlying chemical and metabolic disorders in women with hair loss. If underlying disorder is detected, the physician hair restoration specialist may recommend referral to an appropriate medical specialist such as an endocrinologist.
Scalp biopsy may be performed in a male or female patient when the physician hair restoration specialist believes it is necessary. The physician's recommendation for scalp biopsy is explained to the patient and is not done until all of the patient's questions are answered. The biopsy procedure itself involves taking a very small sample of scalp skin for examination under a microscope.
Scalp biopsy may be recommended to confirm or rule out a cause of hair loss, to examine the health and vitality of hair follicles, to obtain an accurate count of hairs in various phases of hair growth, or for other reasons as needed.
The Patient as Individual
The person who consults a physician hair restoration specialist regarding hair loss should never lose his or her identity as a "case". Hair loss has deep personal impact on a person, and it is important to that person that hair restoration be undertaken with appropriate concern for its deeply personal meaning.
The individuality of hair loss in all of its complexities needs to be established in order to undertake individualized hair restoration.