About Hair Loss
The most common cause of hair loss is genetic or familial. Circulating androgen hormones cause a progressive decrease in hair length and caliber, a process termed miniaturization, and eventual hair loss. In such cases, the principle treatment is hair restoration surgery, although this can be complemented by medical treatment. Certain medical conditions, such as iron deficiency, are associated with hair loss. For patients with a medical condition, treating the underlying condition and considering medical therapy is an appropriate first step. If hair loss persists, then hair restoration surgery can be considered as a second step.
Female Patterns: In contrast to men, women tend to thin more diffusely but rarely become totally bald.
Male Patterns: Baldness progresses over time, but even severely bald men have a rim of permanent hair that can be used for hair transplantation.
Causes of Hair Loss:
Hair loss is most commonly driven by genetic factors and can affect both men and women across a wide range of ages. In individuals with a hereditary predisposition, circulating androgen hormones trigger a process known as miniaturization, where hair strands gradually become shorter, finer, and less pigmented. Over time, these miniaturized hairs may become virtually invisible.
Certain medical conditions—such as iron deficiency, thyroid disorders, and significant psychological stress—can accelerate the pace of hair loss. Medications, particularly testosterone replacement therapy (TRT), are another increasingly common contributor. TRT is frequently prescribed to older adults with non-specific symptoms such as fatigue, reduced libido, decreased bone density, and loss of muscle mass—many of which reflect normal aging. Despite its widespread use, numerous studies have shown that TRT often does not meaningfully improve these symptoms. However, it is well established that TRT can accelerate hair loss by raising androgen levels, which drive the miniaturization process.
Less commonly, hair loss results from inflammatory or scarring conditions such as lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and related disorders. These conditions may present with signs of scalp inflammation, including redness, flaking, or irritation.
Finally, while many patients worry that hair care practices are causing their hair loss, this is rarely the case. Exceptions include the frequent use of harsh chemical dyes, bleaching agents, or high-heat styling tools, which can damage the hair shaft and follicles. Similarly, hairstyles that place constant tension on the scalp—such as tight ponytails, braids, or buns—can lead to traction alopecia, a form of hair loss caused by chronic pulling. This condition can become permanent, especially along the temples and frontal hairline.
