Hair growth occurs in a cyclical fashion with 4 major phases. The longest of these phases is the Anagen phase in which the hair follicle growth occurs. Disruption in this phase causes hair loss - this is known as anagen effluvium. The following shorter phases are the categan transitional phase and the telogen phase in which the hair follicle rests. The final phase where the hair falls out is known as the exogen phase. On average 40 hairs fall out in women and up to double that in men per day during the exogen phase. If more than 100 hairs fall out, clinical hair loss (telogen effluvium) is said to occur. Following this exogen phase the cycle of growth resumes. The tests for women fall under the heading of the Ludwig Scale and the Savin Scale. Male pattern baldness is diagnosed and assessed through the Hamilton–Norwood scale.
The diagnosis of hair loss is through 5 tests: the pull test, the pluck test (3 areas), and scalp biopsy. The pluck test hair is gently pulled from 3 different areas of the scalp. If more than 10 hairs come out in each area the pull test is considered to be positive and hair loss is occurring. The pluck test pulls hair from the root and examines it under a microscope to determine the phase of growth and any abnormalities in the growth cycle. Scalp biopsy involves taking hair from areas near the border of the balding patch on the scalp. Daily hair counts count the level of hair loss. This is done first thing in the morning after combing or washing the hair. Trichoscopy (a method of hair and scalp examination) involves the use of a dermoscope or a video dermoscope.
In almost all cases of thinning, and especially in cases of severe hair loss, it is recommended to seek advice from a doctor or dermatologist. Many types of thinning have an underlying genetic or health-related cause, which a qualified professional will be able to diagnose.
WHAT TO EXPECT
Female baldness medications are considerably more limited, the main types being related to hormonal modulators such as the contraceptive pill. 3 main medications - finasteride, dutasteride and minoxidil are used. They delay rather than “cure” hair loss.
Minoxidil (Rogaine) is an over-the-counter medication. It can be a liquid or foam, applied twice a day. It does not always work and hair regrowth can take 1 to 6 months to even begin and ceases if the product is not used. Irritation may develop. Care should be taken in using this medication as hair may grow on the shoulders and neck if misapplied.
Finasteride (Propecia) is for use only in male-pattern hair loss. It is a hormone that is also used in male to female transgender programmes. It causes increased hair retention, lustre and possible regrowth. This occurs in a relatively short period of about 6 weeks. It is only effective when being used. The side effects that occur in a low percentage of men include decreased sex drive, erectile dysfunction, and ejaculatory dysfunction.
Alopecia aerate (spot baldness) is treated with monthly corticosteroid injections into the scalp. Results may be seen within a month.
Surgery through hair transplant therapy discussed under the section on hair transplants is another option.
Reduced hair loss and possible hair growth.
Use of medication carries risks and possible side effects, as discussed above.