Hair Loss – Treatment, Causes, Stages & Prevention

Overview | Hair loss treatments | Expected treatment outcomes | Symptoms and stages | Causes and diagnosis | Questions for your doctor

Did you know that the average adult head has about 100,000 to 150,000 hairs and loses up to 100 of them every day? While this is normal and not a cause for alarm, if you notice yourself losing more hair than this, it may be a sign of alopecia. This is severe hair loss that can affect men, women, and even children.

Hair fall may occur gradually or suddenly and may affect your whole body or simply your scalp. Some hair loss types are permanent, while others are temporary. However, as I reassure all my patients, it is never too late to seek professional medical treatment once you notice an onset of this condition.

In this article, I will answer some frequently asked questions on scalp hair loss and tell you how to effectively treat this condition to restore your strong, beautiful hair.

Let’s start by looking at hair loss treatments.

Treatments available for hair loss and growth

If you find hair fall and hair growth treatments too technical or confusing, let me help give you a clear understanding of each of them:

1. Prescription drugs – Propecia (finasteride) is a good prescription medicine option that inhibits the conversion of testosterone into 5 alpha-dihydrotestosterone (DHT). This is a hormone that contributes significantly to hair fall in men. Oral finasteride leads to increased hair growth and a decreased hair loss of the hair on the head. Hair growth on other parts of the body is not affected. Oral finasteride is not recommended for women and children. For women, a good medication option is spironolactone.
   PCOD (polycystic ovary disease) can cause hair loss in women and needs to be treated – after few essential blood tests – with prescribed hormonal contraceptives and male hormone blockers like Aldactone and Finasteride. For patients with high prolactin, an oral dopamine medication called Cabergoline helps to reduce prolactin production. For patients affected by thyroid health issues, it is important to visit an endocrinologist as hyperthyroidism and hypothyroidism are both known to cause hair loss.
   Alternatively, Minoxidil can be applied topically for female pattern hair loss and male pattern hair loss. It can also be used for hair loss due to hormones and age. It works better in women or men with a general case of hair thinning. If topical Minoxidil does not work, you can try oral Minoxidil to stimulate hair growth with increased blood flow to the roots. Do note that you should not consume oral Minoxidil if you are pregnant, trying to conceive, or have heart problems.
2. Supplements  – All the cells in your body require Vitamin A for growth. So does your hair. So, I recommend taking Vitamin A supplements for better hair growth. Other essential nutrients for hair growth include biotin, Vitamin C, Vitamin D, Vitamin E, iron, and zinc. Protein supplements are essential for people with deficiencies in their daily protein requirement. The newer, vegetarian sources of protein supplements like PEA Protein are gaining popularity. Collagen powder offers powerful antioxidants and helps to fight free radicals and prevent damage to the hair. It also prevents hair thinning and frizziness.
   Hair Fact Kits are very popular which are based on a patented cyclical hair nutrition approach. These hair fact kits contain all the essential nutrition for the hair and are designed to avoid over dosage, proper absorption, nutrition balance and more.
   Omega 3 and omega 6 supplements provide essential nutrients and amino acids to the hair as well. They improve blood circulation and prevent hair follicle inflammation, thereby helping reduce hair fall. Ensure that the supplements you opt for include these essential nutrients. I truly believe that eating right can solve a lot of our health problems at the start. So, while treating hair loss, I always make it a point to inquire with my patients about their dietary habits.
3. Intravenous Nutrition Hair Growth – One of the most effective hair growth treatments, this procedure involves providing nutrition intravenously for maximum efficacy. I have personally formulated a special hair nutrition IV therapy treatment that I administer to my patients at The Bombay Skin Clinic. The treatment involves delivering essential amino acids, trace elements, and critical vitamins intravenously for immediate absorption into the body. This method of treatment not only reduces damage to your hair but also encourages healthy hair growth. I really trust that the best way to heal is from within and this is exactly what this method of treatment focuses on.
4. Laser Treatment LLLT – Low-level laser therapy (LLLT) is also known as cold-laser therapy or red-light therapy. It works by irradiating photons into the scalp tissue. These photons get absorbed by the cells to promote better hair growth in patients impacted by hair loss.  Low-level lasers do not hurt, get hot, or burn tissue. There are also no side effects or medications required post treatment. Laser treatments for hair loss are non-invasive and tolerable treatment options that increase hair strength with no side effects. According to a study by the National Center for Biotechnology Information, laser is a safe treatment option that works effectively in both men and women. I personally do recommend laser treatments for hair fall as a first line of treatment as opposed to more invasive methods.
5. Dermapen – A breakthrough in microneedling technology, the Dermapen 4 utilizes an advanced needle cartridge to pierce the skin vertically and induce hair growth by activating stems cells in the hair bulge region. At The Bombay Skin Clinic, the Dermapen 4 is passed over the scalp to create thousands of fine micro channels, followed by the application of peptides. This deeply penetrates the skin for renewed hair growth. The Dermapen 4 treatment is painless with no side effects and zero downtime. I advise my patients to follow up the treatment with a second session after 15 days for the best results in hair growth.
6. PRP/stem cell treatment – Platelet-rich plasma (PRP) refers to a process wherein an injection that is prepared with the patient’s blood platelets is administered to the affected scalp area to increase hair growth and prevent miniaturization of hair follicles. This allows for greater stimulation of hair follicles and boosts the hair growth factor. Often, PRP is used with hair transplant surgery to improve recovery and results. With this treatment, hair grows back thicker and the visibility of scarring on the scalp is also reduced.
7. Regenera Activa – A non-invasive and one-time treatment, Regenera Activa prevents hair loss by stimulating hair growth through regeneration therapy of the capillary vessels. After a thorough examination of the scalp and hair, a small skin tissue is taken from the lower back of the scalp, which is then processed and filtered by the US Food and Drug Administration-approved regenericons. Post this, the renewed tissue is then injected over the affected areas using mesotherapy.
   The present Regenera Activa is based on the principle of regenerative medicine, a newer generation breakthrough technology. Many of my patients swear by this treatment as it improves existing hair density, is natural and safe, and causes no side effects. While the results are indeed amazing, I would like to bring to your notice that it takes around three to four months for hair growth to show.
8. Micropigmentation – Non-surgical, painless, and with zero downtime, Scalp Micropigmentation (SMP) works similar to the traditional tattooing process. A non-allergic pigment is deposited into the epidermis with highly specialized equipment in thousands of tiny spots. This replicates the natural appearance of real hair follicles, giving a dense and fuller look. Ensure that the hair specialist you select is trained in this procedure. Scalp micropigmentation may be repeated two to three times every 20 days for best results that may last up to four years. Additionally, I only perform this treatment for patients who have: Chronic hair loss with visible bare patches; Alopecia areata with localized patches; or Male- and female-pattern baldnes.
9. Hair transplant – An invasive hair treatment procedure, hair transplant involves taking healthy hair follicles from one part of your scalp and transferring these to an area where you are impacted by hair loss. Two popular hair transplant methods employed are Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). Each may take several hours to complete, depending on the amount of work performed by the surgeon and on the severity of your condition. At The Bombay Skin Clinic, I recommend Follicular Unit Extraction (FUE) as the scarring in this process is relatively less and healing is faster. There is the minor discomfort that is usually associated with any type of surgery. I take personal care to advise each patient on the best aftercare methods for quick recovery.
10. Steroids for alopecia areata – A very common method of treating alopecia areata, this treatment involves injecting corticosteroids into bare patches of the scalp every four to six weeks. While this causes temporary discomfort from needle pricks, no pain lingers after leaving the dermatologist’s office. Corticosteroid injections promote new hair growth and results can be seen within four weeks of the last session. Do note that this treatment does not prevent new hair loss from developing.
11. Scalp reduction surgery – Also known as scalp lifting, scalp reduction involves stretching parts of the healthy scalp that has hair and repositioning these to cover bald areas. Some side-effects include swelling and numbness until the skin softens. Post surgery, you also need to take medicines prescribed by your doctor and avoid any form of strenuous activity. If a patient suffers from uncontrolled diabetes, chronic skin or liver disease, or autoimmune disorders, I generally do not recommend this surgery. Similarly, I only perform this surgery when there is not enough donor hair available for the FUE transplant procedure.

Now that we have explored the various hair loss treatment options available, I would like to answer some frequently asked questions regarding hair loss that my patients often put across to me.

What can you expect after hair loss treatments?

All of the treatment options that I have covered so far can reverse hair loss or slow further thinning. I do like to remind my patients that results differ on a case by case basis. Their efficacy also depend on the skill, knowledge, and proficiency of the hair specialist executing them. For safe hair loss treatments that bear good results, you should only seek the help of a certified medical professional.

How many treatments or visits do you require?

The answer to this question varies from patient to patient. In my experience, patients who face milder cases of hair loss may not need more than one or two treatment sessions. Similarly, a patient with a more severe case of hair loss may need multiple sessions before the treatment bears desired results. Do remember that hair fall treatments can be effective only if followed through on a regular basis per your dermatologist’s recommendations.

How can you avoid hair loss in the future?

I advise all my patients to avoid hair loss by:

• Eating a protein-rich diet
• Consuming Vitamin A, B, and E supplements
• Avoiding tight hairstyles
• Quitting smoking
• Rubbing green tea onto your hair once a week
• Avoiding alcoholic beverages
• Keeping your head sweat-free
• Avoiding constant heating and drying of hair
• Limiting chemical exposure to the hair through hair color and similar products
• Taking scalp massages with essential oils
• Staying hydrated through the day
• Reducing stress and restoring hormonal balance with meditation and yoga

What are the symptoms of hair loss?

It is advised to consult with a trichologist as soon as you notice any symptoms. The hair specialist will help you to understand all the various treatments for hair loss. Hair fall can occur with different symptoms like

• Androgenetic alopecia (male pattern hair loss) – gradual and diffuse hair loss; can start from early twenties; hairline starts receding like letter ‘M’; hair loss is along frontal hairline, temples and on the crown gradually; left with hair only around  ears, back and sides; sometimes complete baldness results.
• Female pattern hair loss – for some women, may start after menopause, but general and diffuse thinning can start early; hair thinning in central scalp, frontal forehead areas or broadening at where hair is parted.

• Alopecia areata – hair loss is sudden; circular, smooth bald patches appear; about 2.5 centimeters diameter size; affects scalp only initially but can extend to eyebrows, lashes and beard areas.  Prior to hair-fall, tingling and itchiness may be present.  Finger nails look pitted or ribbed.
• Alopecia totalis – hair loss is complete, all over scalp.
• Alopecia universalis – complete hair loss on body and scalp.
• Telogen effluvium – sudden and rapid hair shedding after a physical stress or mental trauma incidence; diffuse hair loss pattern occurring only in women. Handfuls of hair fall out when brushing, washing, or combing.
• Chronic telogen effluvium – alarmingly excessive hair loss of scalp upto 400-500 hairs can be lost per day ,persisting for more than 6 months and has a fluctuant course for upto 6-7 years,but without apparent cause.This severe thinning is seen in women in the fourth and fifth decade of life and results in prominent bitemporal recession.
• Anagen effluvium – when chemotherapy causes sudden and rapid hair loss; can be all over the body and scalp; reversible after stopping chemo.

• Cicatricial alopecia – caused by another medical condition; sometimes itchy rash develops with inflammation; hair follicles are completely permanently destroyed with scar tissue formation.

What are the stages of hair loss?

According to the Hamilton-Norwood Scale, the seven stages of male-pattern baldness begin with a slightly receded hairline in Stage 1 and inward balding near the temples in Stage 2. In Stage 3, the hair on top of the head becomes noticeably thinner, while in Stage 4 hair on the crown thins out and large patches of hair in the back and front of the head begin to shed. Stages 5 and 6 see a horseshoe-shaped hairline and minimal coverage on the scalp. Finally, Stage 7 presents severe baldness where the top of the head is completely bald with minimal hair on the sides and back of the head.

As per the Ludwig Scale, the three stages of female-pattern baldness start with evenly distributed thinning of hair on the scalp that is barely noticeable. In Stage 2, however, the hair fall becomes more visible as the midline parts wider than before. In Stage 3, there is extensive hair loss across the scalp. 

What are the causes of hair fall?

Causes to each kind of hair-loss can be different and varied.

• Male (AGA) and female pattern baldness is due to – Heredity, aging and/or hormonal changes.
• Alopecia areata – due to an autoimmune response to hair follicles.
• TE & CTE – caused by diverse physical or mentally stressful events.
• Anagen effluvium – from treatments like chemotherapy.
• Scarring alopecia – medical conditions like lichen planus, bacterial/fungal infections, and scleroderma etc.
• Untreated ringworm (tinea capitis)  most common cause of hair loss in children.

Scarring alopecia

• Cicatricial alopecia – due to infection caused by bacteria/fungal growth, lichen planus, cutaneous discoid lupus, and scleroderma and traumatic injuries like mechanical, themal, chemical, electrical burns, traction, trichotillomania injuries etc.

Age

• As people age, hair loss is common with thinning hair.

Hereditary hair loss

• Androgenetic alopecia (AGA) (male pattern hair loss) – Some people are susceptible to hair loss due to inherited tendency from paternal, maternal genes. This makes them more sensitive to hormones called androgens which cause shrinking and weakening of hair follicles that result in hair loss.
• Female pattern hair loss – somewhat similar to AGA; but occurs after menopause but sometimes even earlier; due to hormonal changes.

Autoimmune related

• Alopecia areata; Alopecia totalis – due to immune system malfunction resulting in hair growth cycle disruption.

Medical condition related

Hair loss can happen due to diseases like Thyroid disease, Anemia, Lupus, Syphilis, & Untreated ringworm of scalp.

Traction alopecia

Hair loss can happen due to wrong type of hair-care like

• Bleaching/dyeing frequently and improperly.
• Frequent use of hair-care devices like flat irons, blow-driers etc.
• Banding hair tightly with clips, bands, pulling back tightly.

Other causes

• Anagen effluvium – due to chemotherapy.
• Diet deficient in iron, protein and vitamin C & K ,zinc, etc can cause hair loss.
• Due to hair shaft defect-hair fracture,hair nodes,hair narrowing, hair bands,unruly hair.

As per Johns Hopkins Medicine, untreated ringworm of the scalp and rapid weight loss can also cause loss of hair.

How is hair loss different for men and women?

As men age, they tend to lose the hair on top of their head in a pattern that leaves a ring of hair around the sides and patch of bare scalp on the crown. This is known as male-pattern baldness. 

In a case of female-pattern baldness, the hair in the front remains intact while the hair thins throughout the top of the scalp. According to Harvard Health Publishing, “About one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair thinning or bald spots.”

How is hair loss diagnosed?

I begin diagnosing with a physical examination of the scalp. I also inquire into the patient’s family history of hair loss and medical history. Depending on the extent of hair fall, I may perform a few tests. I always make it a point to ensure that my patients are comfortable while discussing their hair loss concerns. 

What information should you share with your doctor?

It is likely that you may share your initial hair loss concerns with your family doctor, who in turn will refer you to a dermatologist or hair specialist. It is important to be open and honest regarding personal information to help with an accurate diagnosis. You must share details of lifestyle habits and your medical history. Also, bring to their notice all the vitamins, medications, and supplements that you are taking. 

During a consultation, I personally ask in-depth questions regarding the patient’s medical history and only then recommend the right course of hair loss treatment.

Hair loss history

To know what caused the hair loss, and before suggesting an effective hair fall treatment plan your doctor will ask questions about hair loss like

• What are the characteristics?
  • Thinning hair, gradual diffuse hair loss, no noticeable amount of hair loss?
  • Sudden and rapid hair loss, like hair shedding – lots of hair falling out?
  • Any discernible pattern like receding hairline, frontal/central bald patches, thinning in specific areas or throughout the scalp?
  • Is the scalp showing?
  • Have you done any hair loss treatments before?
  • Did u find the patch of hair loss or your hair dresser?
  • How do the nearby hairs look?
  • How long since hair loss started?
  • Did you recently do any hair fall treatment?
  • Any symptoms like scalp redness, itching, flaking etc.
  • Any recent illness, injury, burn, or high fever?
  • Started on any new medication?
  • Do you dye, bleach, perm or color your hair?
  • Use devices like blow-drier, curling irons etc for hair styling?
  • What are the hair-care products you use?

Which questions should you ask your doctor during a consultation?

I like to give my patients all information about the condition because I strongly believe that the more they know about it, the better they can manage it. You can ask your hair specialist the following questions:

• What is causing my hair loss?
• Is my hair fall permanent?
• Will my hair grow back? If yes, how long will it take?
• Are there any dietary restrictions I should follow?
• How can I prevent further hair loss in the future?
• Are there any immediate lifestyle changes I should make?
• What should I do if my symptoms worsen?
• Is there anything I should avoid during treatment?

Closing thoughts

To sum up, let me reassure you that hair loss is not as severe a problem as it may sound or seem. Do not let this condition cause you to shy away from social engagements. There is hope on the horizon. With the right hair specialist and precise treatment plan, you can restore hair growth and go back to flaunting your long, lustrous hair in no time.

References:

• Harvard Health Publishing: https://www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss
• National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3944668/
• Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hair-loss