Hair Loss: Causes, Treatments, and Prevention

Hair loss affects millions of people worldwide, being a concern that goes beyond aesthetics and can significantly impact quality of life. Androgenic alopecia, also known as male or female pattern baldness, represents approximately 95% of hair loss cases in men and at least half of the cases in women. Understanding the causes, patterns, and available treatment options is fundamental to making informed decisions about hair care.

Why does hair loss occur?

Androgenic alopecia results from a combination of genetic susceptibility and hormonal exposure. The process begins when genetically susceptible hair follicles are exposed to dihydrotestosterone (DHT), a hormone derived from testosterone.

Biological mechanism:

• DHT has a binding affinity 20 times greater than testosterone for androgen receptors
• This binding causes a hair follicle miniaturization process
• Hair becomes progressively thinner and shorter
• Eventually, the follicle stops producing visible hair

Factors that influence hair loss:

• Genetics: Hereditary susceptibility is the most important factor
• Hormones: Elevated DHT levels accelerate the process in susceptible people
• Age: Most cases manifest before age 40
• Medications: Some testosterone treatments can accelerate hair loss

It's important to note that the genetic sensitivity of the follicle to DHT seems to be more determining than the absolute levels of this hormone in the body.

Differences between men and women

Hair loss patterns vary significantly between genders, requiring different treatment approaches.

Hair loss in men:

• Affects 30-50% of men by age 50
• Begins in the temporal regions and crown
• Follows a predictable pattern with established classification scales
• Almost all cases manifest before age 40

Hair loss in women:

• Affects 20-50% of women during their lifetime
• More diffuse and subtle pattern
• Begins with widening of the central part
• May include some frontal hairline recession
• May begin as late as age 60

Special considerations for women: Women require more exhaustive evaluation because other factors can contribute to hair loss, including nutritional deficiencies, hormonal changes from pregnancy and menopause, and certain autoimmune conditions.

Available treatments for alopecia

There's a wide range of therapeutic options, from topical treatments to advanced surgical procedures.

Pharmacological treatments:

• Minoxidil: Topical application that improves blood flow to the follicle
• Finasteride: 5-alpha reductase inhibitor that reduces DHT levels
• Dutasteride: More potent 5-alpha reductase inhibitor
• Spironolactone: Androgen blocker, mainly for women
• Ketoconazole: Medicated shampoo with antiandrogenic properties

Non-pharmacological therapies:

• Low-intensity laser therapy: Stimulates follicle cellular activity
• PRP injections: Platelet-rich plasma for hair regeneration
• Micropigmentation: Cosmetic technique to simulate hair density

Surgical treatments:

• Follicular unit transplantation (FUT): Extraction of a strip of scalp
• Follicular unit extraction (FUE): Individual follicle extraction
• Each method has specific advantages and disadvantages that must be evaluated

When to seek professional help

Early detection and timely treatment offer the best chances of success. It's advisable to consult with specialists when you observe:

Early warning signs:

• Increased hair on pillow or in drain
• Visible thinning in the crown or temples
• Changes in hair texture or thickness
• Frontal hairline recession

Risk factors to consider:

• Family history of hair loss
• Use of medications that may affect hair
• Significant hormonal changes
• Intense physical or emotional stress

Professional evaluation: Multidisciplinary hair centers offer the most complete evaluation, as they can rule out other causes of hair loss such as nutritional deficiencies, autoimmune conditions, or medication side effects.

Hair loss doesn't have to be inevitable. With adequate knowledge about the causes and available treatment options, you can make informed decisions about your hair care. The key lies in early detection, professional evaluation, and implementation of a personalized treatment plan that adapts to your specific needs and hair loss patterns.