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Hair Loss Starter's Guide
Introduction

The average person has around 5 million hairs (100,000 - 150,000 are on the scalp). Blonds usually have more hair (about 140,000 hairs), brunettes have slightly higher than average hair (about 105,000 hairs), and redheads have a little less than average (about 90,000 hairs). Hair is composed of keratin, the same protein that nails and the outer layer of skin is made of. Hairs are produced by a small structure underneath the skin called the hair follicle.

Hair follicles are formed while we are still a fetus, and after we are born no new follicles are produced. Hair growth is often regulated by hormones within the body. At puberty, certain male hormones trigger the growth of pubic, underarm, and beard hairs. They can also trigger the start of genetic male pattern hair loss.

Each hair grows in a series of phases. In the growth phase, the hair is continually growing for up to five years. At the end of the growth cycle, there is a transitional phase where the hair does not grow and begins to change into the third phase. The third phase is the resting phase. During this phase, the follicle is no longer growing, and at the end the old hair is pushed out, then the cycle starts over and a new growth phase starts. This happens repeatedly throughout our lives, and is why even people unaffected with hair loss lose 50-100 hairs per day.

In people affected with genetic hair loss, there appears to be a higher number of hormone receptors in the areas of the scalp with hair loss. In most people affected by hair loss, male hormone levels are the same as in normal people, but because there are more receptors in the balding areas of the scalp they are affected as if their hormone levels were higher than normal. Researchers are still working on how the presence of a certain male hormone, Dihydrotestosterone (DHT), causes damage to follicles in people with genetic hair loss. As the follicles are damaged, the hairs grown are thinner and the growth cycles are shorter with each new growth cycle, until eventually no hair or a small, miniaturized hair is all that can be produced. As more and more hairs become smaller and more miniaturized, the person appears balder.

Genetic hair loss causes about 95% of all hair loss. Another main cause is an autoimmune condition known as Alopecia Areata (patchy hair loss), Alopecia Totalis (loss of all hair on the head), and Alopecia Universalis (loss of all hair on the body). Researchers are also working on a treatment for this condition. Other causes include hair loss due to side effects of medication, stress, or dietary deficiency.

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What Can I Do About Hair Loss?

There is something that should be said about hair loss -- there is no perfect treatment or cure at this time. There are options, and many do work, but they all have their own advantages, disadvantages, and costs. When considering what to do, consider which fits your lifestyle and personality best. There are several options:

Do Nothing / Styling Your Hair
In an ideal world, this is probably the best solution. It costs nothing or very little. The only downside is that if you do nothing, you will definitely continue to lose hair. Currently, short, buzzed haircuts are in style and many men find that they look good with this kind of hair cut and it minimizes the appearance of their hair loss. However keep in mind that fashions change and that this kind of hair cut may be out of style eventually. One thing that can be done to look better even if not treating your hair loss is the use of hair loss concealers. These are cosmetics that make your existing hair look like there is more (they require you to have some hair left and do not work on slick bald spots).

Propecia
Propecia is the only FDA approved oral treatment for hair loss. It is taken once per day and grows hair in about 66% of individuals after two years of treatment. Roughly 83% of individuals on the treatment maintain their existing hair after two years as well. Propecia works by blocking an enzyme used to create the male hormone DHT, the hormone which causes hair loss. Propecia is for men only. It can cause lessening of libido, less semen production, and softer erections in roughly 2% of individuals for each of the three listed side effects. The side effects go away in over 50% of individuals who continue the treatment and 100% of individuals who stop using the medication. Propecia Costs approximately $45-55 per month.

Rogaine Regular & Extra Strength
Rogaine (Minoxidil) was the first FDA approved treatment for hair loss. It is a topical liquid applied to the scalp twice a day and is approved in two strengths - Regular (2%) and Extra Strength (5%). Regular strength Rogaine claims to grow hair in 30-40% of individuals, while Extra Strength Rogaine claims to grow hair in 50-60% of individuals. Rogaine stimulates the hair follicle to grow, but may not prevent the eventual deterioration of the follicle since it does not block the male hormone causing hair loss, so results may deteriorate after 2-5 years unless it is used with a DHT blocker like Propecia. Rogaine costs $20-30 per month.

Click here for more information on Rogaine Extra Strength

Commercial Treatments & Custom Formulas
Many commercial treatments and custom formulas are available for hair loss. These range from treatments marketed as "cosmetics" to off-label prescription medications. While some of these treatments do work for some people, there are many products available that seem to offer little benefit to anybody. The cosmetic treatments are best used as an addition to the approved products if you can afford them, or as a last results if the approved products do not work for you. Some of the prescription custom formulas may be very beneficial. Most contain 5% Minoxidil (or higher), the active ingredient in Rogaine Extra Strength, as well as other medications that help with hair loss. These do not undergo the same rigorous testing as approved medications, so caution should still be used.

Hair Transplants
Hair transplants involve surgically moving hair from the back of the head, where it does not fall out due to baldness, to the top of the head to give you the appearance of having more hair on top. It is a minor surgical procedure but not with out it's advantages and disadvantages. The advantages of hair transplantation are that it moves your own, permanent hair. No continual treatment is needed to keep it there. The disadvantages are the high cost (multiple transplants are usually needed to get the desired look or amount of hair), risk of scarring, limited amounts of movable hair, and variable abilities of different doctors and clinics. A scar is left where the hair is removed from the back of the scalp, but this is covered by the hair around it. However, the hair has to be long enough to cover the scar so you can not buzz your hair to a short length and still cover the scar once you have had a procedure. If you like your hair extremely short you should not have a transplant. (Costs can vary tremendously. An estimate would be $2,500-10,000 per session, $10,000 - 40,000 total)

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Click here to request transplant materials from doctors in your area

Non-Surgical Hair Replacement
Non-surgical hair replacement (often called a hair system or hair piece), involves attaching a fine mesh to the scalp with hairs matched to your hair color attached. The hair piece is either taped, glued, or clipped onto the scalp to keep it in place and is styled to match your hair style. A technique called hair weaving is no longer performed by reputable companies and should be avoided, because it has been found to cause 'traction alopecia' (hair loss due to constant strain on the hairs). The advantage of non-surgical hair replacement is that it is the only option that can always make you look like you have a full head of hair no matter who you are. Also, there are no side effects as with medicinal treatments and it is not permanent like transplantation. The disadvantages are a continual high cost per year, extra time for maintenance required to keep the hair looking good, lack of comfort for some people, and paranoia regarding discovery for some. Costs vary widely, but typically range between $1,000 and $3,000 per year. Several companies are now marketing programs to teach you how to create and maintain your own hair system as well as how to purchase the unit directly at a much lower cost. By purchasing and creating the hair piece yourself, your cost per year should easily be in the $500 or less range, however you will have to perform a lot more maintenance on your own and it can be very difficult to create a natural hair piece on your own with little training.