Men's Health

Men's Health Conditions

Hair Loss

Facts about normal hair growth:

About 90 percent of hair on the scalp grows continually. The other 10 percent of scalp hair is in a resting phase that lasts two to three months. At the end of the resting stage, this hair is shed.

Shedding 50 to 100 hairs a day is normal. When a hair is shed, it is replaced by a new hair from the same follicle and the growing cycle starts again. Scalp hair grows about one-half inch a month.

As people age, the rate of hair growth slows.

What causes excessive hair loss?

Most hair shedding is due to the normal growth-rest cycle, and losing 50 to 100 hairs a day is no cause for alarm. When concerned about excessive loss of hair or dramatic thinning, consult a dermatologist. Excess loss of hair may be due to many different causes, including:

a high fever, severe infection
thyroid disease
inadequate protein in diet
certain medications
cancer treatments
low serum iron
major surgery/chronic illness
alopecia areata
hereditary thinning or balding
a fungus infection (i.e., ringworm) of the scalp
improper hair cosmetic use/improper hair care

Can hair loss be prevented?

Hair loss from some causes will regrow naturally. Other causes may be treated successfully by a dermatologist. There are several causes of hair loss for which there is no successful treatment at present.

Non-surgical hair replacement with medication:

Finasteride (Propecia)

Finasteride, produced by Merck and Company under the name Propecia, was approved by the FDA in December 1997, as a treatment for male pattern baldness. It is the first drug available in pill form for the treatment of baldness.

In men with mild to moderate hair loss, clinical trials showed that 83 percent of the male patients had kept their hair or grown more after one year of treatment. Propecia (finasteride) works by blocking an enzyme called 5-alpha reductase, which is responsible for the formation of dihydro-testosterone in a man's body. The enzyme converts testosterone to DHT (dihydrotestosterone). It is believed that DHT is a key factor in male pattern hair loss, and finasteride decreases the concentration of DHT in a man's scalp by about two-thirds.

Finasteride is available by prescription only.

minoxidil (Rogaine)

Minoxidil, a drug produced by Upjohn under the name of Rogaine, has been available since 1988 for the treatment of hair loss. It is currently available as an over-the-counter drug.
Minoxidil is topical solution that must be applied by applicator or fingers to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness within 3 to 6 weeks. It can take 4 to 12 months to see results.

According to the Food and Drug Administration (FDA), clinical studies show that 26 percent of men between 18 and 49 reported moderate to dense hair regrowth after four months of Rogaine treatment. An additional 33 percent had minimal hair regrowth. Almost 20 percent of women between 18 and 45 had moderate regrowth, while an additional 40 percent showed minimal regrowth.

Surgical hair replacement:

When experiencing thinning hair or baldness, men (and some women) consider hair transplantation, a permanent form of hair replacement. Anyone who has permanent hair loss may be a candidate for hair transplantation, including:

men with male pattern baldness
some women with thinning hair
persons who have lost hair as a result of burns or other scarring injuries to the scalp, eyebrows, or eyelashes

Types of hair replacement surgery:

There are a number of techniques used in hair replacement surgery. Sometimes two or more techniques are used to achieve the best results.

punch grafts - usually contain about 10-15 hairs
mini-grafts - contain about 2 to 4 hairs
micro-grafts - contain 1 to 2 hairs
slit grafts - contain about 4 to10 hairs each
strip grafts - contain 30-40 hairs

Complications of hair replacement surgery:

Individuals vary greatly in their physical reactions and healing abilities, and outcome is never completely predictable. Complications may include:

infection
excessive bleeding
wide scars, called stretch-back scars
some of the grafts may not take
bumps that form at the transplant sites
unnatural, patchy look may result
additional surgery may be required

Surgical hair replacement procedures:

Treatment may be performed in a surgeon's office, an outpatient surgery center, or, rarely, a hospital as an outpatient or an inpatient.

Hair replacement surgery is usually performed using a local anesthesia along with sedation to make the patient relaxed, although general anesthesia may be used for more complex cases involving tissue expansion or flaps.

hair transplantation
Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to two years before seeing the final result with a full transplant series.

The number of large plugs transplanted in the first session may vary, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session.

tissue expansion
A balloon-like device, called a tissue expander, is inserted beneath the hair-bearing scalp next to a bald area. The device is gradually inflated with saline over a period of weeks, causing the skin to expand and grow new skin cells. When the skin beneath the hair has stretched enough -- usually after about two months -- another procedure is performed to move the expanded skin over to cover the bald area.

flap surgery
A section of bald scalp is removed. A flap of hair-bearing skin, still attached at one end, is lifted off the surface and moved into its new position where the bald scalp was removed. It is sewn into place, but remains tethered to its original blood supply.

scalp-reduction
This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or advanced to fill in a bald crown. Scalp reduction is designed for coverage of bald areas at the top and back of the head. It is not beneficial for coverage of the frontal hairline.

Resuming normal routines depends on the length, complexity, and type of surgery.

Follow-up procedures for surgical hair replacement:

A surgical touch-up procedure may be needed to create more natural-looking results after the incisions have healed. This may involve blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts.

If a small bump, called a dog ear, remains visible on the scalp, it can be surgically removed after complete healing has occurred.

This page was last updated on: February 1, 2008.

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